PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources,...

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Report to the New York Department of Financial Services New York State Medical Indemnity Fund 3 rd Quarter 2017 Actuarial Analysis As of September 30, 2017 Feb r ua ry 2018 PINN A CLE ACTUARIAL RESOURCES, INC. 3109 Cornelius Drive Bl oomington, IL 61704 309.807 .2300 pinnacleactuaries.com Commitment Beyond Numbers

Transcript of PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources,...

Page 1: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

Report to the New York Department of Financial Services

New York State Medical Indemnity Fund

3rd Quarter 2017 Actuarial Analysis

As of September 30 2017

February 2018

~ PINN ACLE ACTUARIAL RESOURCES INC

3109 Cornelius Drive

Bloomington IL 61704

309807 2300 pinnacleactuariescom

Commitment Beyond Numbers

TABLE OF CONTENTS

Section

Purpose amp Scope 1

Executive Summary 2

Background 4

Data Methods amp Assumptions 5

Discussion and Analysis 7

Number of Qualifying Participants 7

Mortality ExperienceLife Expectancy 8

Actuarial Ca lculation of Estimated Fund Liabilities 9

Amount of Benefits Paid 11

Patterns of Utilization 11

Benefit Payments and Injury Type 13

Inflationary Patterns of Types of Services 16

Administrative Expenses 17

Impact of Available Health Insurance 17

Investment Earnings 17

Distribution amp Use 18

Reliances amp Limitations 19

EXHIBITS

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund 3rd Quarter 2017 Actuarial Analysis

As of September 30 2017

Purpose amp Scope

Pinnacle Actuarial Resources Inc (Pinnacle) had been retained by the New York State Department of

Financial Services (NYS DFS or the Department) to provide quarterly actuaria l reports regard ing the

experience of the New York State Medical Indemnity Fund (MIF or the Fund) This analysis eva luates

data for the Fund as of September 30 2017

sect69-1019 of the New York State Department of Health Regulation states that the quarterly reports

should include a review of the various elements contributing to the amount of benefits paid by the

Fund and to the expenses of administration of the Fund including

bull The number of qualifying plaintiffs

bull The mortality experience of the qualified plaintiffs

bull The amount of benefits paid by the Fund

bull The patterns of utilization of types of services provided

bull Inflationary patterns by types of services provided

bull The expenses of administration of the Fund

bull The impact of avai lable health insurance on benefits paid by the Fund and

bull Investment earnings of the Fund

sect69-1020 of the New York State Department of Health Regulation also requires an actuaria l

calcu lation of the estimated liabi lities of the Fund for the coming year resu lting from the qualified

plaintiffs enrolled in the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 2 February 21 2018

Executive Summary

Based on our review of available information regarding the New York State Medical Indemnity Fund as

of September 30 2017 Pinnacle has arrived at a number of key conclusions

bull As of September 30 2017 the Fund had accepted 505 participants (500 living) with expected

future benefit payments of approximately $7271 mi ll ion and future administrative expenses of

$1240 million assuming a discount rate of 25 With a Fund balance as of September 30

2017 of approximately $2445 mi ll ion this results in an unfunded liability for the Fund of

approximately $6067 million

o Tota l future lifetime benefits for the 500 living Fund participants without discounting is

estimated to be $1756 bil lion

o The current present va lue of future benefit payments of $7271 million does not

consider any additional enrollees that may be admitted to the Fund in the future

o Prior to the passing of recent legislation each new participant admitted to the Fund

after June 30 2017 would increase the Funds future benefits payment liabilities by

$335 mi llion on a nominal basis or a present value of $132 million increasing at

approximately the medical inflation rate annually from March 31 2017

o Earlier this year new legislation was passed expanding eligibi lity for the Fund to nonshy

hospital births and significantly raising reimbursement rates for the period from July 1

2017 through December 31 2019 For new participants admitted during this period a

priori estimates of future lifetime benefits payment liabilities increased to $362 million

on a nominal basis or a present va lue of $152 million These liabilities vary depending

on the amount of an individual participants benefits that are paid during the period of

higher reimbursement rates

bull Prior to the beginning of the fisca l year the Fund was expected to have almost

one hundred three (10292) additional participants accepted between March 31

2017 and March 31 2018 These new participants were expected to add future

discounted benefits liabi lities of about $1550 million

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 3 February 21 2018

bull There were seventeen (17) new participants to the Fund in the second quarter of

fisca l year 2017-18 approximately nine (9) less than expected for this period

Quarterly new participant counts have varied between fifteen (15) and thirty-five

(35 ) in the last two years

bull The number of eligible participants is expected to continue increasing for at least

thirty years as more eligible participants are admitted to the Fund each year

bull Note that the Fund ba lance increased from approximately $1989 million at June

30 2017 to $2445 million at September 30 2017 due to the application of the

2016-17 year budget allocation of $52 m illion between the two dates

bull Actual benefit payments in the second quarter of the 2017-18 fiscal year (7 1 17-9 30 17) as of

930 17 were $603 million for a total of $13729 million paid so far in the 2017-18 fiscal year

There were no claims payments processed in September Expected benefit payments in the

remainder of the 2017-18 fiscal year are $38448 million Estimated tota l benefit payments for

the 2017-18 fisca l year (4 117- 331 18) are therefore $52177 million It is important to

recognize that these amounts can vary significantly each quarter

bull As of September 1 2017 the Funds claims handling is now performed by Public Consulting

Group (PCG) instead of Alicare The impact of this change on the administrative expenses of

the Fund has not been provided to us but we expect future administrative costs to be

somewhat lower based on this change Based on the prior Alicare costs and expected number

of participants we estimated that the Fund would incur approximately $497 million in

administrative expenses during the 2017-18 fiscal year

bull Exhibit 1 summarizes Fund payments by benefit type since 4th quarter of 2012

Compared to Virginia the Fund is having a substantial ly higher percentage of overa ll costs in

medical and hospital costs medical equipment and prescription drug costs and corresponding

lower percentages in nursing and long term care costs

bull As of September 30 2017 the number of participants that have received more than $1 million

in benefits payments is fourteen (14) Based on current annual severities by individual

member we expect six (6) more members to cross this threshold in the next twelve months

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

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10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

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Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

traderu

m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

mm s~=~

l 9 ll2 25 350

210266

39312 2S 350

2102

l9JU 25 350

110266

40418 26064

21618

40418

2606 216183

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2606 216 183

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2064 216183

1893

27015 224069

41 393

27015 224 069

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27015 224 069

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m = illtrade nm m-

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166 796 6171S9 69513

114 S37

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

170462 634S26

71469 111160

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71 469 117 NO

11680 6576n

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116680 657671

74076 1210SS

176680 6S76n

74016 1220SS

17668() 657 672 7076

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1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

121301

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194 936 72S626 81730 134~

19036 72S 626 81 uo

13667 201CU 2lt)1)(14

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m ~ ~m

187 OU 431316

111 OU 43136

1870W bulll 736

192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

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248 810~ 2015Ql 20150

27

~~

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wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

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nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

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57136 102634 ~10S

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57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

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S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 2: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

TABLE OF CONTENTS

Section

Purpose amp Scope 1

Executive Summary 2

Background 4

Data Methods amp Assumptions 5

Discussion and Analysis 7

Number of Qualifying Participants 7

Mortality ExperienceLife Expectancy 8

Actuarial Ca lculation of Estimated Fund Liabilities 9

Amount of Benefits Paid 11

Patterns of Utilization 11

Benefit Payments and Injury Type 13

Inflationary Patterns of Types of Services 16

Administrative Expenses 17

Impact of Available Health Insurance 17

Investment Earnings 17

Distribution amp Use 18

Reliances amp Limitations 19

EXHIBITS

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund 3rd Quarter 2017 Actuarial Analysis

As of September 30 2017

Purpose amp Scope

Pinnacle Actuarial Resources Inc (Pinnacle) had been retained by the New York State Department of

Financial Services (NYS DFS or the Department) to provide quarterly actuaria l reports regard ing the

experience of the New York State Medical Indemnity Fund (MIF or the Fund) This analysis eva luates

data for the Fund as of September 30 2017

sect69-1019 of the New York State Department of Health Regulation states that the quarterly reports

should include a review of the various elements contributing to the amount of benefits paid by the

Fund and to the expenses of administration of the Fund including

bull The number of qualifying plaintiffs

bull The mortality experience of the qualified plaintiffs

bull The amount of benefits paid by the Fund

bull The patterns of utilization of types of services provided

bull Inflationary patterns by types of services provided

bull The expenses of administration of the Fund

bull The impact of avai lable health insurance on benefits paid by the Fund and

bull Investment earnings of the Fund

sect69-1020 of the New York State Department of Health Regulation also requires an actuaria l

calcu lation of the estimated liabi lities of the Fund for the coming year resu lting from the qualified

plaintiffs enrolled in the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 2 February 21 2018

Executive Summary

Based on our review of available information regarding the New York State Medical Indemnity Fund as

of September 30 2017 Pinnacle has arrived at a number of key conclusions

bull As of September 30 2017 the Fund had accepted 505 participants (500 living) with expected

future benefit payments of approximately $7271 mi ll ion and future administrative expenses of

$1240 million assuming a discount rate of 25 With a Fund balance as of September 30

2017 of approximately $2445 mi ll ion this results in an unfunded liability for the Fund of

approximately $6067 million

o Tota l future lifetime benefits for the 500 living Fund participants without discounting is

estimated to be $1756 bil lion

o The current present va lue of future benefit payments of $7271 million does not

consider any additional enrollees that may be admitted to the Fund in the future

o Prior to the passing of recent legislation each new participant admitted to the Fund

after June 30 2017 would increase the Funds future benefits payment liabilities by

$335 mi llion on a nominal basis or a present value of $132 million increasing at

approximately the medical inflation rate annually from March 31 2017

o Earlier this year new legislation was passed expanding eligibi lity for the Fund to nonshy

hospital births and significantly raising reimbursement rates for the period from July 1

2017 through December 31 2019 For new participants admitted during this period a

priori estimates of future lifetime benefits payment liabilities increased to $362 million

on a nominal basis or a present va lue of $152 million These liabilities vary depending

on the amount of an individual participants benefits that are paid during the period of

higher reimbursement rates

bull Prior to the beginning of the fisca l year the Fund was expected to have almost

one hundred three (10292) additional participants accepted between March 31

2017 and March 31 2018 These new participants were expected to add future

discounted benefits liabi lities of about $1550 million

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 3 February 21 2018

bull There were seventeen (17) new participants to the Fund in the second quarter of

fisca l year 2017-18 approximately nine (9) less than expected for this period

Quarterly new participant counts have varied between fifteen (15) and thirty-five

(35 ) in the last two years

bull The number of eligible participants is expected to continue increasing for at least

thirty years as more eligible participants are admitted to the Fund each year

bull Note that the Fund ba lance increased from approximately $1989 million at June

30 2017 to $2445 million at September 30 2017 due to the application of the

2016-17 year budget allocation of $52 m illion between the two dates

bull Actual benefit payments in the second quarter of the 2017-18 fiscal year (7 1 17-9 30 17) as of

930 17 were $603 million for a total of $13729 million paid so far in the 2017-18 fiscal year

There were no claims payments processed in September Expected benefit payments in the

remainder of the 2017-18 fiscal year are $38448 million Estimated tota l benefit payments for

the 2017-18 fisca l year (4 117- 331 18) are therefore $52177 million It is important to

recognize that these amounts can vary significantly each quarter

bull As of September 1 2017 the Funds claims handling is now performed by Public Consulting

Group (PCG) instead of Alicare The impact of this change on the administrative expenses of

the Fund has not been provided to us but we expect future administrative costs to be

somewhat lower based on this change Based on the prior Alicare costs and expected number

of participants we estimated that the Fund would incur approximately $497 million in

administrative expenses during the 2017-18 fiscal year

bull Exhibit 1 summarizes Fund payments by benefit type since 4th quarter of 2012

Compared to Virginia the Fund is having a substantial ly higher percentage of overa ll costs in

medical and hospital costs medical equipment and prescription drug costs and corresponding

lower percentages in nursing and long term care costs

bull As of September 30 2017 the number of participants that have received more than $1 million

in benefits payments is fourteen (14) Based on current annual severities by individual

member we expect six (6) more members to cross this threshold in the next twelve months

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

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17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

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2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

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~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 3: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund 3rd Quarter 2017 Actuarial Analysis

As of September 30 2017

Purpose amp Scope

Pinnacle Actuarial Resources Inc (Pinnacle) had been retained by the New York State Department of

Financial Services (NYS DFS or the Department) to provide quarterly actuaria l reports regard ing the

experience of the New York State Medical Indemnity Fund (MIF or the Fund) This analysis eva luates

data for the Fund as of September 30 2017

sect69-1019 of the New York State Department of Health Regulation states that the quarterly reports

should include a review of the various elements contributing to the amount of benefits paid by the

Fund and to the expenses of administration of the Fund including

bull The number of qualifying plaintiffs

bull The mortality experience of the qualified plaintiffs

bull The amount of benefits paid by the Fund

bull The patterns of utilization of types of services provided

bull Inflationary patterns by types of services provided

bull The expenses of administration of the Fund

bull The impact of avai lable health insurance on benefits paid by the Fund and

bull Investment earnings of the Fund

sect69-1020 of the New York State Department of Health Regulation also requires an actuaria l

calcu lation of the estimated liabi lities of the Fund for the coming year resu lting from the qualified

plaintiffs enrolled in the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 2 February 21 2018

Executive Summary

Based on our review of available information regarding the New York State Medical Indemnity Fund as

of September 30 2017 Pinnacle has arrived at a number of key conclusions

bull As of September 30 2017 the Fund had accepted 505 participants (500 living) with expected

future benefit payments of approximately $7271 mi ll ion and future administrative expenses of

$1240 million assuming a discount rate of 25 With a Fund balance as of September 30

2017 of approximately $2445 mi ll ion this results in an unfunded liability for the Fund of

approximately $6067 million

o Tota l future lifetime benefits for the 500 living Fund participants without discounting is

estimated to be $1756 bil lion

o The current present va lue of future benefit payments of $7271 million does not

consider any additional enrollees that may be admitted to the Fund in the future

o Prior to the passing of recent legislation each new participant admitted to the Fund

after June 30 2017 would increase the Funds future benefits payment liabilities by

$335 mi llion on a nominal basis or a present value of $132 million increasing at

approximately the medical inflation rate annually from March 31 2017

o Earlier this year new legislation was passed expanding eligibi lity for the Fund to nonshy

hospital births and significantly raising reimbursement rates for the period from July 1

2017 through December 31 2019 For new participants admitted during this period a

priori estimates of future lifetime benefits payment liabilities increased to $362 million

on a nominal basis or a present va lue of $152 million These liabilities vary depending

on the amount of an individual participants benefits that are paid during the period of

higher reimbursement rates

bull Prior to the beginning of the fisca l year the Fund was expected to have almost

one hundred three (10292) additional participants accepted between March 31

2017 and March 31 2018 These new participants were expected to add future

discounted benefits liabi lities of about $1550 million

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 3 February 21 2018

bull There were seventeen (17) new participants to the Fund in the second quarter of

fisca l year 2017-18 approximately nine (9) less than expected for this period

Quarterly new participant counts have varied between fifteen (15) and thirty-five

(35 ) in the last two years

bull The number of eligible participants is expected to continue increasing for at least

thirty years as more eligible participants are admitted to the Fund each year

bull Note that the Fund ba lance increased from approximately $1989 million at June

30 2017 to $2445 million at September 30 2017 due to the application of the

2016-17 year budget allocation of $52 m illion between the two dates

bull Actual benefit payments in the second quarter of the 2017-18 fiscal year (7 1 17-9 30 17) as of

930 17 were $603 million for a total of $13729 million paid so far in the 2017-18 fiscal year

There were no claims payments processed in September Expected benefit payments in the

remainder of the 2017-18 fiscal year are $38448 million Estimated tota l benefit payments for

the 2017-18 fisca l year (4 117- 331 18) are therefore $52177 million It is important to

recognize that these amounts can vary significantly each quarter

bull As of September 1 2017 the Funds claims handling is now performed by Public Consulting

Group (PCG) instead of Alicare The impact of this change on the administrative expenses of

the Fund has not been provided to us but we expect future administrative costs to be

somewhat lower based on this change Based on the prior Alicare costs and expected number

of participants we estimated that the Fund would incur approximately $497 million in

administrative expenses during the 2017-18 fiscal year

bull Exhibit 1 summarizes Fund payments by benefit type since 4th quarter of 2012

Compared to Virginia the Fund is having a substantial ly higher percentage of overa ll costs in

medical and hospital costs medical equipment and prescription drug costs and corresponding

lower percentages in nursing and long term care costs

bull As of September 30 2017 the number of participants that have received more than $1 million

in benefits payments is fourteen (14) Based on current annual severities by individual

member we expect six (6) more members to cross this threshold in the next twelve months

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 4: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 2 February 21 2018

Executive Summary

Based on our review of available information regarding the New York State Medical Indemnity Fund as

of September 30 2017 Pinnacle has arrived at a number of key conclusions

bull As of September 30 2017 the Fund had accepted 505 participants (500 living) with expected

future benefit payments of approximately $7271 mi ll ion and future administrative expenses of

$1240 million assuming a discount rate of 25 With a Fund balance as of September 30

2017 of approximately $2445 mi ll ion this results in an unfunded liability for the Fund of

approximately $6067 million

o Tota l future lifetime benefits for the 500 living Fund participants without discounting is

estimated to be $1756 bil lion

o The current present va lue of future benefit payments of $7271 million does not

consider any additional enrollees that may be admitted to the Fund in the future

o Prior to the passing of recent legislation each new participant admitted to the Fund

after June 30 2017 would increase the Funds future benefits payment liabilities by

$335 mi llion on a nominal basis or a present value of $132 million increasing at

approximately the medical inflation rate annually from March 31 2017

o Earlier this year new legislation was passed expanding eligibi lity for the Fund to nonshy

hospital births and significantly raising reimbursement rates for the period from July 1

2017 through December 31 2019 For new participants admitted during this period a

priori estimates of future lifetime benefits payment liabilities increased to $362 million

on a nominal basis or a present va lue of $152 million These liabilities vary depending

on the amount of an individual participants benefits that are paid during the period of

higher reimbursement rates

bull Prior to the beginning of the fisca l year the Fund was expected to have almost

one hundred three (10292) additional participants accepted between March 31

2017 and March 31 2018 These new participants were expected to add future

discounted benefits liabi lities of about $1550 million

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 3 February 21 2018

bull There were seventeen (17) new participants to the Fund in the second quarter of

fisca l year 2017-18 approximately nine (9) less than expected for this period

Quarterly new participant counts have varied between fifteen (15) and thirty-five

(35 ) in the last two years

bull The number of eligible participants is expected to continue increasing for at least

thirty years as more eligible participants are admitted to the Fund each year

bull Note that the Fund ba lance increased from approximately $1989 million at June

30 2017 to $2445 million at September 30 2017 due to the application of the

2016-17 year budget allocation of $52 m illion between the two dates

bull Actual benefit payments in the second quarter of the 2017-18 fiscal year (7 1 17-9 30 17) as of

930 17 were $603 million for a total of $13729 million paid so far in the 2017-18 fiscal year

There were no claims payments processed in September Expected benefit payments in the

remainder of the 2017-18 fiscal year are $38448 million Estimated tota l benefit payments for

the 2017-18 fisca l year (4 117- 331 18) are therefore $52177 million It is important to

recognize that these amounts can vary significantly each quarter

bull As of September 1 2017 the Funds claims handling is now performed by Public Consulting

Group (PCG) instead of Alicare The impact of this change on the administrative expenses of

the Fund has not been provided to us but we expect future administrative costs to be

somewhat lower based on this change Based on the prior Alicare costs and expected number

of participants we estimated that the Fund would incur approximately $497 million in

administrative expenses during the 2017-18 fiscal year

bull Exhibit 1 summarizes Fund payments by benefit type since 4th quarter of 2012

Compared to Virginia the Fund is having a substantial ly higher percentage of overa ll costs in

medical and hospital costs medical equipment and prescription drug costs and corresponding

lower percentages in nursing and long term care costs

bull As of September 30 2017 the number of participants that have received more than $1 million

in benefits payments is fourteen (14) Based on current annual severities by individual

member we expect six (6) more members to cross this threshold in the next twelve months

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

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Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

1

162 ss 18167S 431269 bull2 227

372 bullu 2496 25ltU

212 728

91 6

4SOSO )60amp35

bull13929 1 165671

1l2023 116 207 361 amp86

41 285

127482 272 353 177 991

~ 29173 65 141

l 18800 136890 115 157 966bull26

68386

404028 317022

ll ll ll 91 2827 S4SU 47626 21564

33607 38S7 227Ul 17639 gt10S77 2S4C97 28190 369 7J8 3494S8 26762S

1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

SU396 462 2SO 462 250 4S07Jt 4S0738 6834

9 190CM

3S5bull1c 226106

1 35451t

1907S 21S624

644 200 121980C

2s1n

462 2SO 40583lt

9 108661 47SS5

322 911 256 2oa

1174 22)

110923

979919 633404 644 200

1219804 2SHl4 622SO

9 9 S148l 800

31812 9

321808 301643 90654

8119S1 782 976

91219 91219 61amp758 618758

1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

811951 7amp2 976 941 219 608390

618158 1171 631

10620 12856 111 l7l

919 S0087

8119S1 712 976 941219 60890 6187i8 ll4 7S2

70620 126856 111 tl

Ill ssm

6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

SI

24A S11 402980 6-S8086 642289 619368 137 S04 139847 2pound4803 S864

Ul0343 88101

9 9

531311 2 171 l8S

2laquoS71 244S71 402980 402980 153880 1S3 880 642289 619 168 176961 212727 2U717 1375deg 137 S04 09847 ll9S47 264803 1008 88101 88 101

2lt16Ql s 10 141 71 367 2016Ql 22 16Q4 1S 11Ql 7C2993 742 993

496bull56 S9002S 72 993

066sooa 53914 673 S94

674 066 S39U 673 59-C

674066 67C 066 6069U 606 913 bullS0084 4S0084 406246 534914 48162C 131607 6n 594 673 S94 1732amp2 171282

606913 11578lt U7607 171282

tn404 11S7amp4

137607 173282

166 SS6 166 SS6 Ut212 1112U 132173 U217 166439 16609

166 556 111 212 12113 166 439

166S56 111212 112 171 166439

U17S3 81973

1045S4 131 660

131 7S3 87973

10amp SS4 131660

Ul7U 1l1 75l 87971 amp79tl U)4 SS4

131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

traderu

m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

mm s~=~

l 9 ll2 25 350

210266

39312 2S 350

2102

l9JU 25 350

110266

40418 26064

21618

40418

2606 216183

40418

2606 216 183

40418

2064 216183

1893

27015 224069

41 393

27015 224 069

4 1893 2701S

22bull 069

41893

27015 224 069

44037

28197 lliS35

44037

2897 215 S35

44011

28397 235535

laquo on 28397

23SS3S

46221 29806

27221

46221 2bull 7121

20UQ1 2012(14 201lQl 201l(U

2S lO

ru~ ru~ m~ m~ ~~ 2mm2mm2mm2rnm2mffl

bull~ trade~ -trade trade~ nw wm ~m ww wm m-

~~

~lli

n w m-

m~~trade nw m~

m = illtrade nm m-

~~

m~

~m ~m

166 796 6171S9 69513

114 S37

16S 196 617 1S9 69SU

UA Sl7

165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

170462 634S26

71469 111160

170462 6WS26

71 469 117 NO

11680 6576n

74076 lll OSS

116680 657671

74076 1210SS

176680 6S76n

74016 1220SS

17668() 657 672 7076

122oss

1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

121301

18S 721 691326 77867

uuo

194 936 72S626 81730 134~

19036 72S 626 81 uo

13667 201CU 2lt)1)(14

27 ~m trade~

~m laquo~

mlli laquo ~

mm laquo rn

mm ~-

mm bullm

mm am

mm bullm

m ~ ~m

187 OU 431316

111 OU 43136

1870W bulll 736

192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

2881ll 160821

248 810~ 2015Ql 20150

27

~~

~~

~~

~~

~~~= ~~ ~~

wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

134 7Sl

57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 5: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 3 February 21 2018

bull There were seventeen (17) new participants to the Fund in the second quarter of

fisca l year 2017-18 approximately nine (9) less than expected for this period

Quarterly new participant counts have varied between fifteen (15) and thirty-five

(35 ) in the last two years

bull The number of eligible participants is expected to continue increasing for at least

thirty years as more eligible participants are admitted to the Fund each year

bull Note that the Fund ba lance increased from approximately $1989 million at June

30 2017 to $2445 million at September 30 2017 due to the application of the

2016-17 year budget allocation of $52 m illion between the two dates

bull Actual benefit payments in the second quarter of the 2017-18 fiscal year (7 1 17-9 30 17) as of

930 17 were $603 million for a total of $13729 million paid so far in the 2017-18 fiscal year

There were no claims payments processed in September Expected benefit payments in the

remainder of the 2017-18 fiscal year are $38448 million Estimated tota l benefit payments for

the 2017-18 fisca l year (4 117- 331 18) are therefore $52177 million It is important to

recognize that these amounts can vary significantly each quarter

bull As of September 1 2017 the Funds claims handling is now performed by Public Consulting

Group (PCG) instead of Alicare The impact of this change on the administrative expenses of

the Fund has not been provided to us but we expect future administrative costs to be

somewhat lower based on this change Based on the prior Alicare costs and expected number

of participants we estimated that the Fund would incur approximately $497 million in

administrative expenses during the 2017-18 fiscal year

bull Exhibit 1 summarizes Fund payments by benefit type since 4th quarter of 2012

Compared to Virginia the Fund is having a substantial ly higher percentage of overa ll costs in

medical and hospital costs medical equipment and prescription drug costs and corresponding

lower percentages in nursing and long term care costs

bull As of September 30 2017 the number of participants that have received more than $1 million

in benefits payments is fourteen (14) Based on current annual severities by individual

member we expect six (6) more members to cross this threshold in the next twelve months

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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9226

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26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

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57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 6: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 4 February 21 2018

Background

The Medical Indemnity Fund was established in 2011 to provide a funding source for future health

care costs associated w ith birth-related neurological injuries Enrollees of the Fund are plaintiffs in

medical malpractice actions who have received either court-approved settlements or judgments

deeming the plaintiffs neurological impairments to be birth-related1 More specifically a birthshy

related neurological injury is an inj ury to the brain or spinal cord that occurred in the course of

labor delivery or resuscitation or by the provision or non-provision of other medical services during

the delivery admission 2 These injuries must result in a physical impairment a developmental

disability or both

Benefits provided by the Fund include

bull Medical Denta l Surgical and Hospital Care

bull Nursing and Custodia l Care

bull Prescription and Non-Prescription Drugs

bull Rehabilitation Services

bull Durable Medical Equipment and Assistive Technology

bull Certain Home and Vehicle Modifications

bull Other Health Care Costs for Medical Services and Supplies for Participants

The New York State Department of Financial Services (NYS DFS) serves as the administrator of the

Fund For the first year of the MlFs operations Sedgwick CMS served as the Funds third party

administrators (TPA) For the second year of operations they were replaced by Alicare As of

September 1 2017 claims are now handled by Public Consulting Group (PCG) while Alicare continues

to work with Fund enrollment and case management Pinnacle serves as the actuarial advisors to the

Fund as well as the on ly other two state-run birth injury funds in the US the Virginia Birth Related

Neurological Injury Compensation Fund and the Florida Neurologica l Injury Compensation Association

1 Provided by NY DFS 2 http wwwdfsnygovinsurancemif mif _faqshtm

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

OAl 111 ltQgt 22 1S t S)ZS() deglS736 2011Ql 19 122431 14US4 9506 1Slc22

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 7: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 5 February 21 2018

The Fund currently is financed through a budget allocation from the state of New York Any party to a

medical professiona l liability claim can request for the j udgment to reflect eligibi lity for participation in

the Fund Upon this judgment the participant is eligible to receive covered benefits from the Fund

Data Methods amp Assumptions

Given that the Fund has been in operation for on ly six years a number of sources of information are

still in the formative stages Pinnacle has worked with Alicare and wi ll be working with Public

Consu lting Group to ensure that their claims databases are sufficient to support these ongoing

quarterly reports and to enhance the ongoing management of the Fund As a result we have

introduced more analysis by benefit category (ie nursing medical hospital prescription drugs etc)

and inj ury type

Early in the Funds operations some health care benefits that should have been paid by the Fund were

erroneously paid by New York Medicaid Pinnacle has been provided detailed benefits payment

information on these costs by the New York Department of Health (DOH) and they are reflected in the

exhibits

Some of the long term forecasts and industry benchmarks used in the ana lysis are based on data for

the birth injury funds in Virginia and Florida as wel l as medical professional liability insurers in the

state of New York These have been significantly modified based on data from the Fund as it becomes

more credible

One significant area of ongoing review of assumptions relates to the expected number of claims per

10000 live births Initia lly 110 participants per 10000 births were assumed based on data from

Virginia and Florida After the first year the frequency rate was increased to 290 participants per

10000 births In the first quarter 2014 report the expected number of eligible Fund participants was

increased from 290 per 10000 live births to 348 to be more consistent with the first two fu ll fiscal

years of experience and present more rea listic financial projections for the next five years In late

2016 we increased the assumption to 450 participants per 10000 births to better reflect ongoing

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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2881ll 160821

248 810~ 2015Ql 20150

27

~~

~~

~~

~~

~~~= ~~ ~~

wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

134 7Sl

57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 8: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 6 February 21 2018

frequency data It should be recognized that this is over four times the number of participants per

10000 live births experienced by the birth funds in Florida and Virginia

As we are accumulating more credible amounts of benefit payments data several differences are

emerging For example the annual benefit payments during 2016 to Fund participants that were

admitted to the program prior to 2016 (ie participants that have a full year of benefit payments

during 2016) are shown in the following graph and compared to data from Virginia Additional severity

information is conta ined in Exhibit 1 Page 2 and Exhibit 6

600

500

400

300

200o

100

I I I I 1 I 100 11 bullbull -bull VA Data bull NY Data

There are at least three key issues

1) The Fund has significantly more participants with $0 of benefit payments Will these

participants have benefit payments at some point

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

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3DSS

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1604

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4323

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6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

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2012Q2

11

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286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

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21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

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228S70

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81060

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295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

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110595

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115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

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6252

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15265

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69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

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203563

52078

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275891

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152339 344850 324486

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degmiddotdeg 11287

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140 125 104 169

190383

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201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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209 S22 48 992

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2U617 1367

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2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

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10t0Cl9 130974

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110836 139571

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116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

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153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

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386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

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110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

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103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

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1028()5

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lOS900

171875

39942

105248_170817

104600

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103956

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108604

176263

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107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

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110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

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5079S 90682

79125

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78638

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77673

47920 74646

47625 85022

7186

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74874

47771 85283

7441bull

1n 84758

73956

47 185

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73500

48605 86772

75713

48306 75247

8008 85707

74784

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88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

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79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 9: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 7 February 21 2018

2) The Fund has substantially more participants with less than $25000 in annual benefit

payments Is there something about the Fund s enabling legislation that is causing this or will

their costs increase over time

3) The Fund had five participants with annual benefits costs over $400000 Virginia has no

participants that breached this threshold Admittedly there are sample size issues but will this

phenomenon persist

We are continuing to monitor these phenomenon

In response to this information changes to the assumptions regarding the expected frequency and

severity of claims were made to the 4th quarter 2014 analysis and again in the second quarter of 2016

The assumptions will be detai led later in this report

Discussion and Analysis

Number of Qualifying Participants

Based on the loss runs provided by Sedgwick CMS Alicare and OOH valued as of September 30 2017

there are five hundred five (505) participants that have qualified for the Program as of this date five

hundred (500) were still living as of September 30 2017 This information is summarized in Exhibit 2

There were seventeen (17) new participants to the Fund in the second quarter of fiscal 2017

approximately nine (9) fewer than expected for that portion of the quarter

The number of Fund participants and the distribution of participants by age warrants continued

monitoring The average age of a Fund participant at the time of admission is about 87 which is

approximately four years older than the age of a Virginia Birth Fund participant at admission

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

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4983 3532

4330 2506

1604

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4323

4680

732

2614

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3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

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228S70

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n3so 37502

81060

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295227

-38987

317058

89190 40293

338117

93743

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361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

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689 3045

1899

lS6

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7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

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15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

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5764S

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246076

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129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

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bull 19

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7389 14764 38728

degmiddotdeg 11287

16178 23975

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128891

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140 125 104 169

190383

142782

lS0554 116624

207451

162620

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201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

1

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41 285

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l 18800 136890 115 157 966bull26

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404028 317022

ll ll ll 91 2827 S4SU 47626 21564

33607 38S7 227Ul 17639 gt10S77 2S4C97 28190 369 7J8 3494S8 26762S

1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

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321808 301643 90654

8119S1 782 976

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1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

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618158 1171 631

10620 12856 111 l7l

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6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

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066sooa 53914 673 S94

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166 SS6 166 SS6 Ut212 1112U 132173 U217 166439 16609

166 556 111 212 12113 166 439

166S56 111212 112 171 166439

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131 7S3 87973

10amp SS4 131660

Ul7U 1l1 75l 87971 amp79tl U)4 SS4

131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

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m~ tim

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m~ m~ wm ~mumtrade

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mm mm ~ m ~trade mootrade~

mm Mm m~

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l 9 ll2 25 350

210266

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2102

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110266

40418 26064

21618

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2606 216183

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2064 216183

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27015 224069

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166 796 6171S9 69513

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

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71 469 117 NO

11680 6576n

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

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m~ mm

m~ mm

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m~ m m

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2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

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217 S72 140 S5

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22S S09 14S 766

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139117 263 422

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1432SO 280711

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18 2SO 280 11bull

l SS 836 295 078

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sssn 998lS 87641

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139 669

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139 669

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146 816

62 251

111821 9817bull

146816

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16816

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146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

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bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 10: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 8 February 21 2018

Average Entry Age

120

110

100

90

80

70

60

ml

50

40

Mortality ExperienceLife Expectancy

It is reasonable to expect that average life expectancies for Fund participants w ill average in the high

twenties as a group unless the different admission standards materially changes life expectancies

relative to the Virginia and Florida birth funds The current life expectancies of the Virginia birth fund

are 284 years from birth and 292 years for participants that reach the age of three (3) As of the

current analysis the Fund has experienced the death of only five of its participants The following

graph compares the age of current participants with the expected age distribution based on the

Virginia Birth Fund data

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

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35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

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12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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2017Q1 19 6- 14278 2017Q2 29 328 S618

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Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

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066sooa 53914 673 S94

674 066 S39U 673 59-C

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so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

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m~ tim

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l 9 ll2 25 350

210266

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110266

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21618

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165 796 6171S9 69SU

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11680 6576n

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185 721 691 326

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

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mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

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237 049 1S 2lS

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248 810~ 2015Ql 20150

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mw mw

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U9U7 263 4ll

139117 263 422

09117 263422

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141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

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155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

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u= mm~trade rn~

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sssn 998lS 87641

13106S

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sssn 9982S 87641 lll 065

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134 753

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59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

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146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 11: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 9

February 21 2018

Participant Distribution by Age 80

70

60

C 50 -

f -0 40

0

E 30 z

20

10

-

- - - I- - -

- - - - - - -

- t- - - - - - - -

lJ T IT T

I I I I I bull 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Current Age

bull Actual II of Participants bull Expected If of Participants

Actuarial Ca lculation of Estimated Fund Liabilities

We have been asked to project expected fund liabilities for the next ten fiscal years of the M IF To do

this we have estimated the ultimate benefit payments for the participants admitted to the Fund each

quarter on both a nominal and discounted basis Three methods were used to estimate ult imate

benefit payments by the year in which a participant was accepted to the fund A loss development

method was used in which actua l benefit payments to date were divided by the expected percentage

of ultimate benefits as of each participant-quarters maturity These percentages were developed

based on information for the Virginia Birth Fund and modified to reflect the older average age of the

Fund participants upon admittance An expected loss method was also used in which expected

ult imate benefit payments by quarter were also estimated using a weighted average of expected

average ultimate benefit payments per Fund participant overall and by quarter of eligibility Finally a

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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New York Department ofFinancial Services Exhibits

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Exhibits

Page 2

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New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

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New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

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2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

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117755 431812

1607-48 623934

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300micro5 1180508

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286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

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9394 15787

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431269 42227

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340 303320

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642035 149203

638084 148284

634157 147372

630254 146465

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2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 12: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 10 February 21 2018

Bornhuetter-Ferguson (B-F) technique estimates ultimate losses using a combination of expected

losses and loss development techniques

These ultimate benefits amounts are then allocated to future payment quarter based on the benefits

payment patterns described previously To state future payments on a discounted basis a discount

rate of 25 was used This is based on discount rates for other medical professiona l liability insurance

programs in New York Prior to the recent legislative change average lifetime benefit payments were

estimated to average $335 million per participant on a nominal basis and $132 million on a

discounted basis using a 25 discount rate This amount increases annually to account for medical

inflation For new participants admitted subsequent to the law change an a priori estimate of future

lifetime benefits payment liabilities increases to an average of $362 million on a nominal basis or a

present va lue of $152 million These liabi lities will vary depending on the amount of an individual

participants benefits that are paid during the period of higher reimbursement rates The timing of the

payments used in our severity estimates also reflect the amount of time a participant is expected to

live so that these severities take participant mortality into account

Based on this approach and the new law we estimate that the 505 admitted Fund participants wi ll

ultimately receive benefits on the order of $1824 billion Adjusting for the time value of money at a

25 discount rate resu lts in a present value for these benefits of $7923 million

Actual benefit payments in the second quarter of the 2017-18 fiscal year were $603 million Based on

updated severity and payment timing estimates the expected 5165 additiona l participants increased

payments in the third quarter to account for the lack of September payments and the impacts of the

recent legislation estimated benefit payments for the 2017-18 fiscal year will be $52177 million It is

important to recognize that these amounts can vary significantly each quarter We will continue to

monitor this estimation methodology closely as they are quite sensitive to several key assumptions

The number of eligible participants is expected to continue increasing for at least 30 years as more

eligible participants are admitted to the Fund each year

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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9226

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17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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13416

8855

3648

27333

21962

5052

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2soo 5397

54635

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111n 104071

15273

126623

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63067

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81060

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-38987

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338117

93743

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361616

98814

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104246

59470

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110595

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2012Ql 2012Q4

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2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

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106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 13: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 11 February 21 2018

Amount of Benefits Paid

As shown in Exhibit 1 $603 mil lion has been paid to Fund participants during the second quarter of

the 2017-18 fisca l year (7117-930 17) based on the payment data provided by Alicare Due to the

transition of claims handling to PCG no claims were paid during the 91 17-930 17 period We

therefore expect to see proportionally higher payments in the third quarter of the 2017-18 fiscal year

as claim payments resume In addition we are continuing to investigate to see if there are materia l

differences in the types of inj uries experienced by participants in the New York Fund versus those in

Virginia and Florida that may explain some of the differences we are seeing between actual and

expected payments

Patterns of Utilization

It is too early in the life of the Fund to provide any credible conclusions regarding patterns of

utilization However Pinnacle is working with Alicare and wi ll continue to work with PCG to develop

the data capabi lities to provide this type of ana lysis in the future Specifically we are developing

detai led benefit payment information by participant Fund fiscal year and benefit type The benefit

types being captured are intended to reflect the benefits provided by the Funds legislation and follow

form with existing databases in Florida and Virginia

Exhibit 1 shows Alicare payment detail (provided through 930 17) grouped into the following

categories

bull Medical Treatment

bull Hospita l Based Care

bull Surgical Care

bull Nursing Care

bull Denta l Care

bull Rehabilitation Care

bull Custodial Care

bull Durable Medical Equipment

bull Home Modifications

Vehicle Modificationsbull Prescription and Non-Prescriptive Drugs bull

bull Other Health Care Costs

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

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10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

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2017Q1 19 6- 14278 2017Q2 29 328 S618

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Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

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m~ tim

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m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

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l 9 ll2 25 350

210266

39312 2S 350

2102

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110266

40418 26064

21618

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2606 216183

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2064 216183

1893

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27015 224 069

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27015 224 069

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166 796 6171S9 69513

114 S37

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

170462 634S26

71469 111160

170462 6WS26

71 469 117 NO

11680 6576n

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116680 657671

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176680 6S76n

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17668() 657 672 7076

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1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

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194 936 72S626 81730 134~

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187 OU 431316

111 OU 43136

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192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

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248 810~ 2015Ql 20150

27

~~

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wm mw

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mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

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u= mm~trade rn~

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sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

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57136 102634 ~10S

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57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

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S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 14: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 12 February 21 2018

bull Assistive Technology bull Other Payments

Our analysis suggests benefits patterns that are showing some differences from the Virginia data To

date t he Fund is having a substantia lly higher percentage of overall costs in medical and hospita l costs

medical equipment and prescription drug costs and correspondi ng lower percentages in nursing and

long-term care costs The prescription drug costs merit continued monitoring and potentially a more

detailed investigation Th is data is summarized in Exhibit 1 and shown graphically below Exhibit 1 also

compares New York data to benefit payments in Virgin ia Nursing costs are t he majority of total

payments in both states

Benefits Payments 1012 - 9 17

bull Medical Treatment 529

bull Hospital Based Care 1151

bull Surgical Care 068

bull Nursing care 5123

bull Dental Care 023

bull Rehabi lit ation Care 521

bull Custodial Care 371

Durable Med Equip 517

bull Hom e M odif ications 504

Vehicle Modifications 121

bull Rx and Non-Rx Drugs 1028

bull Other Health Care Costs 024

Assistive Technology 000

Other Paym ent s 019

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

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9226

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26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

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338117

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2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

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ll ll ll 91 2827 S4SU 47626 21564

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1219804 2573M

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so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

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m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

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2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

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U9U7 263 4ll

139117 263 422

09117 263422

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1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

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2015Q1 2015(14 2015Ql 20160

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sssn 998lS 87641

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62 2Sl 111 amp21 9811bull

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146816

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6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

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m~ m-mm

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bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 15: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 13 February 21 2018

Another key aspect of the database needed to evaluate patterns of utilization is differences in the

medical and mental condition of the Funds participants To facilitate this dimension of our future

ana lysis Pinnacle worked w ith Alicare to add a number of characteristics for each Fund participant

including

bull Current Age

bull Gender

bull Injury Description

bull Other Insurance (ie whether participant holds other insurance)

bull Ambulatory Status

bull Use of a gastric feeding tube (G-Tube)

bull Abi lity to lift head from the prone position

bull Use of a ventilator

bull Use of a tracheostomy tube (trach tube)

In Virginia several of these characteristics have been shown to influence life expectancies and average

annual benefit payments We expect they will serve equally va luable to the Fund as more benefit

payment data becomes available

Benefit Payments and Injury Type

For nearly all Fund participants the nature of the injury and primary diagnosis permitting entrance into

the Fund has been provided to Pinnacle as part of the quarterly Alicare payment data Although strict

standardization of participant injury types is not provided sufficiently detailed descriptions of the

nature of the injury have allowed us to judgmentally categorize participants into standardized injury

type groups As with the benefit type categorization injury type categorization can aid in identifying

differences in injury types that are relevant to the management of the Fund

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

OAl 111 ltQgt 22 1S t S)ZS() deglS736 2011Ql 19 122431 14US4 9506 1Slc22

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 16: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 14 February 21 2018

We have categorized the primary diagnosis for each Fund participant into one of the following injury

types

Brachia Plexus bull bull Cerebra l Palsy

Developmenta l Delays bull bull Encephalopathy

bull Erbs Palsy

bull Hemiplegia

Mental Retardation bull bull Neurological Disabi lities

bull Quadriplegia

bull Spastic Diplegia

Spastic Paraplegia bull bull Spastic Quadriplegia

bull Other

bull Not Ava ilable

The following is a graph of the distribution of participants by injury type group above Spastic

quadriplegia cerebra l palsy and encephalopathy combine to make up over 73 of total benefit

payments

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 17: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 15 February 21 2018

Benefit Payments 1012 - 917

2448

bull Brachia Plexus 008

bull Erbs Palsy 0 20

bull Spast ic Diplegia 036

bull Hemiplegia 040

bull Mental Retardation 220

bull Developmental Delays 691

Neurological Disabilities 796

bull Spastic Paraplegia 024

bull Cerebral Palsy 2922

Encephalopathy 2448

bull Spast ic Quadriplegia 1950

bull Other 560

Quadriplegia 151

Not Available 134

It is clear from t he graph that the Funds participant composition by injury type is varied but also

concentrated in a handful of categories The followi ng graph illustrates the number of participants and

average payment by injury type through the current quarter

_ Pinnacle Act uarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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New York Department ofFinancial Services Exhibits

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

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New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 18: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 16 February 21 2018

Average To Date Payments per Participant

S-0000000 160

45000000

110

40000000

100)St00000

l 300()(X)00 80c

i ~ 15000000 ~ G 60i 20000000

i 15000000

40

10000000

20

lt000000 I - bull - Nurrbe of Parnc1panrs Avenge Pcltbeioot Seenty

Participants with injury types of Cerebral Palsy Encephalopathy or Spastic Quadriplegia comprise

approximately 52 of the tota l participants but account for approximately 73 of total payments

resulting in relatively large average payments Conversely participants with injury types of Brachia I

Plexus Erbs Palsy Spastic Diplegia Hemiplegia Mental Retardation Developmental Delays or

Neurological Disabilities have relatively low average payments and comprise approximately 40 of the

total participants but account for roughly only 18 of tota l payments The large number of

participants in the Developmental Delays and Neurological Disabi lities categories with relatively low

benefit payments are also noteworthy

Inflationary Patterns of Types of Services

It is far too early in the life of the Fund to provide any credible conclusions regarding inflationary

patterns However based on our experience in Virginia we are confident that the detailed claims

benefits payment database being constructed will prove invaluable once more benefits experience has

been accumulated

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

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11

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286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

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228S70

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33179

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81060

38234

295227

-38987

317058

89190 40293

338117

93743

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361616

98814

49917

389135

104246

59470

laquogt9870

110595

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115352

2012Ql 2012Q4

2013Ql

2013Q2

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689 3045

1899

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7823 5557 2327

3637

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15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

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74188

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298-075

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2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

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New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 19: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 17 February 21 2018

Administrative Expenses

Pinnacle was provided information in early 2017 on administrative expenses for the Fund Prior to the

change in claims administration at 9 1 17 Alicare was charging the Fund $809 per Fund participant per

month Based on this information we estimated that the Fund would incur approximately $497

million in administrative expenses during the 2017-18 fiscal year or 80 of total fund expenditures

This is comparable to the administrative expenses in Virginia However this percentage is affected by

the significantly higher benefits payments expected due to recent legislation Once the legislation

expires administrative expenses as related to benefit payments were expected to return to previous

levels more on the order of 20 of the Funds tota l expenditures However the new contract with

PCG is expected to result in somewhat lower administrative expenses that will lower this percentage

Impact of Available Health Insurance

It is also far too early in the life of the Fund to provide any credible conclusions regarding the impact of

available health insurance However the detailed benefits payment database described earlier and

summarized in Exhibit 1 wi ll prove invaluable once more benefits experience has been accumulated

One early item of note is the number of participants with Medicaid has been consistently tracking at

more than half of the Funds participants In the current 2017 fiscal year over 70 of the Funds

admitted participants rely on Medicaid

Investment Earnings

We have not had the opportunity to review sign ificant information regarding the Funds investment

returns on the Funds invested assets at th is time We expect that more information will be provided

in upcoming quarterly reports Building up investment income on the Funds balance will be essentia l

to the Funds ongoing financial strength as participants continue to enter the Fund and calendar year

benefit payments continue to grow as the Fund moves toward a steady state over the next twenty or

more years

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

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17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

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13416

8855

3648

27333

21962

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54635

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63067

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-38987

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338117

93743

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104246

59470

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2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

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Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

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219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 20: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 18 February 21 2018

Distribution amp Use

This Report has been prepared for the use of the NY DFS and for the internal use of the NY DFS only

Permission is granted to share this Report with representatives of M IF under the Departments

standard guidelines for such review Any other distribution of this report is not authorized without the

prior written consent of Pinnacle Th ird parties reviewing the report shou ld recognize that the

furnishing of this report is not a substitute for their own due di ligence and should place no reliance on

this report or the data contained herein that would result in the creation of any duty or liability by

Pinnacle to the third party

Pinnacle consents to reference by the Department to Pinnacles reports opinions advice and firm

name in documents released by or at the direction of the Department concerning such financia l

examination findings In any instances other than the Departments fina l examination report regarding

the review of reserves and solvency analysis of the Fund in which Pinnacle is identified as the source of

a paraphrase quotation or partial quotation the Department shall notify Pinnacle prior to such

publication so that Pinnacle may review said reference(s) Further distribution or use of this Report is

expressly prohibited without the prior written consent of Pinnacle The nature of the materia l

contained in the Report is such that this limitation on distribution shou ld apply to requests made under

any Freedom of Information Act

The exhibits attached in support of our findings are an integral part of this Report These sections have

been prepared so that our actuarial assumptions and j udgments are documented Judgments about

the conclusions drawn in this Report should be made only after considering the Report in its entirety

We remain avai lable to answer any questions that may arise regarding this Report We assume that

the user of this Report will seek such explanation on any matter in question

Our conclusions are predicated on a number of assumptions as to future conditions and events Those

assumptions which are documented in subsequent sections of this report must be understood in

order to place our conclusions in their appropriate context In addition our work is subject to inherent

limitations which are also discussed in this Report

_ Pinnacle Actuarial Resources Inc

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

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4983 3532

4330 2506

1604

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4323

4680

732

2614

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3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

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228S70

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n3so 37502

81060

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295227

-38987

317058

89190 40293

338117

93743

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361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

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689 3045

1899

lS6

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7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

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15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

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5764S

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246076

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129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

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bull 19

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7389 14764 38728

degmiddotdeg 11287

16178 23975

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128891

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140 125 104 169

190383

142782

lS0554 116624

207451

162620

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201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

1

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41 285

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l 18800 136890 115 157 966bull26

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404028 317022

ll ll ll 91 2827 S4SU 47626 21564

33607 38S7 227Ul 17639 gt10S77 2S4C97 28190 369 7J8 3494S8 26762S

1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

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321808 301643 90654

8119S1 782 976

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1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

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618158 1171 631

10620 12856 111 l7l

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6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

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066sooa 53914 673 S94

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166 SS6 166 SS6 Ut212 1112U 132173 U217 166439 16609

166 556 111 212 12113 166 439

166S56 111212 112 171 166439

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131 7S3 87973

10amp SS4 131660

Ul7U 1l1 75l 87971 amp79tl U)4 SS4

131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

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m~ tim

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m~ m~ wm ~mumtrade

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mm mm ~ m ~trade mootrade~

mm Mm m~

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l 9 ll2 25 350

210266

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2102

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110266

40418 26064

21618

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2606 216183

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2064 216183

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27015 224069

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166 796 6171S9 69513

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

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71 469 117 NO

11680 6576n

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

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m~ mm

m~ mm

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m~ m m

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2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

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217 S72 140 S5

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22S S09 14S 766

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139117 263 422

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1432SO 280711

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18 2SO 280 11bull

l SS 836 295 078

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sssn 998lS 87641

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139 669

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139 669

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146 816

62 251

111821 9817bull

146816

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16816

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146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

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bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 21: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York State Medical Indemnity Fund Report - 3rd Quarter 2017 Page 19 February 21 2018

Reliances amp Limitations

We have prepared this Report in conformity with its intended use by persons technically competent in

the areas addressed and for the stated purposes only

Throughout our analysis we have without audit or verification relied on historical data and qualitative

information provided by NYS DFS related agencies and MlFs services providers The accuracy of our

results is dependent upon the accuracy and completeness of this underlying data Therefore any

material discrepancies discovered in this data or other information provided by NYS DFS its related

agencies or MlFs other service providers should be reported to us and this Report amended

accordingly

There is a limitation upon the accuracy of these estimates in that there is inherent uncertainty in any

estimate of unpaid claims obligations and benefits This is due to the fact that the ultimate liability for

claims is subject to the outcome of events yet to occur eg future program participant life

expectancies medical cost inflationary trends etc We have employed generally accepted actuarial

techniques and assumptions that we believe are reasonable and appropriate Further the conclusions

presented herein are reasonable and appropriate and supported by our analysis given the information

currently available However it should be recognized that future loss emergence wil l likely deviate

perhaps materially from our estimates

Additiona l uncertainty arises from lack of historical data and use of industry benchmarks Our

projections of future loss emergence and benefit payments are based primari ly on aggregate insurance

industry loss development patterns It is possible that these patterns may not be indicative of future

loss development for MIF

_ Pinnacle Actuarial Resources Inc

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

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New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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New York Department ofFinancial Services Exhibits

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

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Page 2

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New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 22: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

INDEX OF EXHIBITS

Exhibit Description

1 Fund Payments by Benefits and Injury Categories

2 Projected Balance Sheets and Income Statements

3 Actual vs Revised Expected Participant Counts

4 Payments by Admittance Quarter

5 Projected Payments by Admittance Quarter - Nominal and Discounted

6 Estimated Ultimate Benefits Payments by Admittance Year

7 Participant Profile

_ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

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New Yorilt Department of FIMnelal SMllces amptlibit 4

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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New York Department ofFinancial Services Exhibits

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2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 23: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 1

As of September 30 2017

Fund Payments by Benefits Category

Virampinia Birth Fund Percent

Benefit category lliZQ1 lliZfil FY 1617 FY 1516 FY1415 FY 1314 FY 1213 Total Percent of Total Benefit category ofTotal

Medical Treatment 337504 397605 1111413 868110 573589 263209 35184 3586614 529 Hospital Based Care 754869 1050283 1885043 2092358 1673039 300325 42922 7798840 1151 HospitalPhysician 140

Surgical care 33609 42722 113032 146685 101149 18896 2190 458283 068 Nursing care 2760908 3831353 10627012 8153130 6438280 2345151 552120 34707955 5123 Nursing 6511

Dental Care 16005 14592 43620 43956 28510 8619 586 155887 023 Rehabilitation care 266786 380875 1135719 995410 630482 62821 60191 3532284 521 Physical Therapy 264

Custodial care 428888 391187 1131480 485434 69581 9248 2515817 371 Durable Med Equip 321774 364773 945751 880138 533009 416785 42169 3504399 517 Medical Equipment 187

Home Modifications 271455 263254 1208614 674666 700673 292218 6110 3416990 504 Housing 1242 Vehicle Modifications 56139 145296 249284 153585 180606 37247 822157 121 Vans 523

Prescription and Non-Prescriptive Drugs 751443 784704 2537792 1669450 872352 281662 65176 6962579 1028 Prescription Drugs 099 other Health care Costs 12551 10598 46590 38122 43311 12976 360 164509 024 All Other 1033

Assistive Technology 500 1244 1744 000 Other Payments 14308 25740 64014 14022 7404 (4) 8 125492 019

Total 6026240 7702981 21099865 16216310 11851988 4049151 807015 67753550 10000Ai

Note FY 1213 includes only 4th quarter 2012 and 1st quarter 2013 FY 1213 does not include payments when Sedgwick was TPA

Claim Database thru 2017Q3 11272017~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

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2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

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348379 SS080

366278

37953 407151 152406

431269 42227

361886

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366426 311761 120264

270692 105891

340 303320

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816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 24: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Exhibit 1

Quarterly Analysis of New York Medical Indemnity Fund Page 2

As of Septembelt 30 2017

Fund Payments by Injury Category Total Percent Totallnjury Number of Injury category

Total Percent of Numberof of Total category Participant Annualized Injury Category 201703 201702 FY 1617 FY 1516 FY 1415 FY 1314 FY 1213 Payments Total P~ments Participants Panicipants Severity Quarters Severity

Brachial Plexus 9826 6482 10549 11927 8466 2687 49936 008 20 396 249682 203 984 Erbs Palsy 14961 15115 32885 34007 25640 3617 126225 020 36 713 3506 384 1315

Spastic Oiplegia 20418 26137 58214 65865 53702 224336 036 7 139 32048 96 9347 Hemiplegia 10786 21900 86939 18250 52271 53464 4331 247940 040 15 297 16529 197 5034

Mental Retardation 105499 102187 433236 514888 176580 32714 14964 1380069 220 16 317 86254 193 28602 Developmental Delays 323496 393448 1251998 1265010 949237 152790 389 4336368 691 60 1188 72273 729 23794

Neurological Disabilities 611079 699593 1788924 1130909 571830 169875 17260 4989469 796 50 990 99789 603 33098 Spastic Paraplegia 21115 9689 21081 39287 57729 148901 024 040 74450 17 35035

Cerebral Palsy 1533446 2277089 5909418 4116581 3052208 1227845 212024 18328611 2922 116 2297 158005 1422 51557 Encephalopathy 1285153 1662867 4109928 3785684 3244944 1055853 209787 15354217 2448 87 1723 176485 1141 53827

Spastic Quadriplegia 1114592 1460176 3839667 2999106 2096547 675214 45764 12231067 1950 59 1168 207306 602 81270

Other 202861 344133 892244 640451 707892 492737 233864 3514182 560 27 535 130155 301 46700 Quadriplegia 139325 80959 327236 272060 127694 947274 151 040 473637 19 199426 Not Available 62436 31096 351832 128354 149457 46031 68632 837839 134 8 158 104730 151 22194

Total 5454994 7130872 19114151 15022378 11274197 3912827 807015 62716433 505 10000 124191 6058 41411

Note FY 12 13 includes only 4th quarter 2012 and 1st quaner 2013 Medeare invokes for prescriptions also excluded Total Injury category Severity =-Total Payments Number of Participant Total Injury category Atmualized Severity = T oral Payments Number of Participant Quarters x 4

Claim Database thru 201703 ~ Pinnacle Actuarial Resources Inc 11272017

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

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New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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209 S22 48 992

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201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

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2U617 1367

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211 s12 140 63S

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2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

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10t0Cl9 130974

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186 561

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106935 134 659 191 810

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10693S U4659

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110836 139571

198808

110amp16 139 571

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U0836 l39S71 198808

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116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 25: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Exhibit 2

Quarterly Analysis of New York Medical Indemnity Fund Page 1 Future Fund Balances by Fiscal Year (000s) as of September 30 2017

With 250 Discount

8AlANCESHEpoundT

Projections as of flseal Year At93017 2017-18 ~ ~ ~ ~ ~ ~ ~ 2025middot2 2026-27

Assets

Fund Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

fls Future Benefits for Curent Participants 7270749 7776107 8701866 9628327 11045616 12514740 14042103 15628342 17270280 18962709 20705773

Future Administrative Expenses 1240415 1351661 1617269 1891731 2176462 2471990 2779418 3098796 3429556 3770645 4122039

Surplusf(Unfunded Llabillty [6066503) [6516953) [7994234 (9452416) [10972287) (12603560) (14356457) (16235247) (18241587) (2037493S) (22637737)

INCOME STATEMENT

Projectionbull at of Flsal Year Endlnc At 9(30(17 2017-18 2018-19 2019-20 2020-21 2021middot22 2022-23 2023-24 2024-25 2025middot2 2026-27

lnltial Fund 8alan~ 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419

Annual FuOOing 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000 Investment Income 25()91( 55994 54515 47809 46882 50777 53435 54777 54693 53045 49734

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511

AdmtntSuattve Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final FuM Balance 2444660 2610815 2324901 2067641 2249791 2383170 2465064 2491891 2458249 2358419 2190076

Change In Fund Balance 166154 (285914) (257260) 182150 133379 81894 26827 (33642) (99830) (168343)

Benefit Payments as 6 of lnltlal Fund Balance 157 307 325 146 152 160 172 188 211 240

Number of Participants Initial 500 545 640 734 827 919 1010 1100 1189 1276

Expected N= 52 104 104 104 104 105 105 105 105 105 Expeltted Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 545 640 734 827 919 1010 1100 1189 1276 1362

New York Medical Indemnity Fund as of9-3017 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

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Exhibit4

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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170462 634S26

71469 111160

170462 6WS26

71 469 117 NO

11680 6576n

74076 lll OSS

116680 657671

74076 1210SS

176680 6S76n

74016 1220SS

17668() 657 672 7076

122oss

1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

121301

18S 721 691326 77867

uuo

194 936 72S626 81730 134~

19036 72S 626 81 uo

13667 201CU 2lt)1)(14

27 ~m trade~

~m laquo~

mlli laquo ~

mm laquo rn

mm ~-

mm bullm

mm am

mm bullm

m ~ ~m

187 OU 431316

111 OU 43136

1870W bulll 736

192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

2881ll 160821

248 810~ 2015Ql 20150

27

~~

~~

~~

~~

~~~= ~~ ~~

wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

134 7Sl

57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 26: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Exhibit2 Quarterly Analysis of New York Medical Indemnity Fund Page 2 Future Fund Balances by Fiscal Year (OOOs) as ofSeptember 30 2017 Undiscounted

BALANCE SHEET

Projections as of Fiscal Year

At93017 l2lZl ~ ~ ~ ~ ~ ~ ~ ~ ~ Assets Fund Balance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 1668414

~ Future 6enefltS for CUrrent Participants 17556013 19368982 22973511 26805393 31414756 36360290 41675939 47381118 53487339 60000133 66935413 Future Administrative Expenses 3347735 3647976 4455702 5320571 6248968 7245491 8316807 9466749 10697728 12010853 13409277

SUrplus(Unfunded Liability (18459088) (20462137) (25214820) (30216641) (35619132) (41478588) (47837094) (S4n0165) (62145700) (70124495) (786762763)

INCOME STATEMENT

Projections as of Fiscel Year Ending

At 93017 2017-18 2018-19 2019-20 202~21 2021-22 2022-23 2023-24 202~25 2025-26 2026-27 Initial Fund Bance 2444660 2554821 2214393 1909324 2044591 2127193 2155652 2127702 2039367 1886491 Annual Funding 520000 520000 520000 520000 520000 520000 520000 520000 520000 520000

Benefit Payments 384481 801902 754810 302130 341797 382240 424209 469401 517999 566511 Administrative Expenses 25358 58526 70259 82602 95601 109301 123741 138934 154876 171567

Final fund Balance 2444660 2554821 2214393 1909324 2044591 2U7193 2155652 2127702 2039367 1886491 1668414

Change in Fund Balance 110161 (340429) (305069) 135268 82602 28459 (27950) (88335) (152876) (218078)

Benefit Payments as of Initial Fund Balance 157 314 341 158 167 180 197 221 254 300oo

Number of Participants Initial S00 54S 640 734 827 919 1010 1100 1189 1276

Expected New 52 104 104 104 104 10S 105 105 105 105 Expected Deceased 7 8 10 11 12 14 15 16 18 19

Final 500 54S 640 734 827 919 1010 1100 1189 1276 1362

New Yorilt Medical Indemnity Fund as of9-30-17v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

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2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 27: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Exhibit 3

Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017

Actual vs Revised Expected

Fiscal New Participants Total Participants Period Actual Expected Difference Actual Expected Difference

(1) (2a) (2b) (2c) (3a) (3b) (3c)

Fiscal 2011-12 Total 2200 2200 2200 2200 Fiscal 2012-13 Total 8600 8600 10800 10800 Fiscal 2013-14 Total 8400 8400 19200 19200 Fiscal 2014-15 Total 9100 9100 28300 28300 Fiscal 2015-16 Total 8500 8500 36800 36800 Fiscal 2016-17 Total 9100 9680 580 45900 46480 580

2nd Qtr 2017 2900 2544 (356) 48800 49024 224 3rd Qtr 2017 1700 2583 883 50500 51607 1107 4th Qtr 2017 1st Qtr 2018

Fiscal 2017-18 Total to Date 4600 5127 527 51607

Fiscal 2018-19Total 10366 61973 Fiscal 2019-20 Total 10360 72333 Fiscal 2020-21 Total 10386 82719 Fiscal 2021-22 Total 10417 93136 Fiscal 2022-23 Total 10473 103610 Fiscal 2023-24 Total 10518 114128 Fiscal 2024-25 Total 10540 124668 Fiscal 2025-26 Total 10529 135196 Fiscal 2026-27 Total 10500 145696

New York Medical Indemnity Fund as of 9-30-1~ Pinnacle Actuarial Resources Inc 2162018

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

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2014Ql

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bull 19

2S 20

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1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

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23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

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41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

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84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

OAl 111 ltQgt 22 1S t S)ZS() deglS736 2011Ql 19 122431 14US4 9506 1Slc22

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

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ll ll ll 91 2827 S4SU 47626 21564

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131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

traderu

m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

mm s~=~

l 9 ll2 25 350

210266

39312 2S 350

2102

l9JU 25 350

110266

40418 26064

21618

40418

2606 216183

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2606 216 183

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2064 216183

1893

27015 224069

41 393

27015 224 069

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27015 224 069

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m = illtrade nm m-

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166 796 6171S9 69513

114 S37

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

170462 634S26

71469 111160

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71 469 117 NO

11680 6576n

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116680 657671

74076 1210SS

176680 6S76n

74016 1220SS

17668() 657 672 7076

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1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

121301

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194 936 72S626 81730 134~

19036 72S 626 81 uo

13667 201CU 2lt)1)(14

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m ~ ~m

187 OU 431316

111 OU 43136

1870W bulll 736

192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

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248 810~ 2015Ql 20150

27

~~

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wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

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nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

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57136 102634 ~10S

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57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

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S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 28: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New Yorilt Department of Financial Services Quarterty AnaiSls of New Yortc Medical Indemnity Fund

Incremental Average Payments per Participant by Admittance Quarter AsofSeptember 30 2017

_ ll1 ll1 11 ~ m Qi

2011Q4 11 286 8569 ll107 2539 3833 -2012Ql -11 1003 1565 _ 346 843 2012Q2 16 45 13371 13917 1350lt 13797 13713 2012Ql 25 689 2356 4779 4710 600 5920 2012Q4 40 3658 1079S 1S598 13022 2013Ql s 156 2171 7343 718 11m 2013Q2 30 1380 2257 2615 3646 5367 2013Ql 27 348 3321 6536 12903 13566 2013Q4 8 1973 2805 6501 6885 4744 2014Ql 19 32 20SO s2n 8789 7551 14 193 2014Q2 25 U38 5308 8218 9212 13432 8895 201403 20 ~223 5283 32222 19624 14143 15262 201AQ4 19 85 3861 S473 9093 10454 8379 201SQ1 27 145 S076 7236 8544 2015Q2 3 1 4421 12991 14039 U 387 13234 16886 middot-2015Ql 16 UBS 6469 S03S 4362 S735 2015Q4 20 91 5104 4559 8601 16067 10SSS 201SQl 18 12 931 10298 9142 9815 12341 2016Q2 35 290 2039 4599 7550 S772 105amp6

2016Ql 22 4303 9321 8150 4995

2016Q4 15 10A83 10491 15156

2017Q1 19 6A44 7834

201702 29 32 5290

201703 17

Totgt sos

Note 3td ctv 2017 diagonal data only indudes thtou9h83117

Exhibit4

Pagel

lncmnertt111 Severity per Patlklpant~ P~Qllter

llZ Ill JlI mil lW lW lW WA ~ la IUZ llll IW lUll Im IIU ~ lilt 2065 2267

9226

2670

6332

4095

2610

5922

2621

3DSS

4983 3532

4330 2506

1604

443S

1na 9878

4323

4680

732

2614

m 4516

~306

4SS3

3692

5070

5932 5433 9553

6349

12620

4757

17778 17945 22SS2 2~096 19All 17781 20549 23109 22213 20186 24258 21amp31 21060 23A99 27519 20735 8449 12018 17357 11480 13978 10705 12099 9180 9068 10248 12872 12306 9536 12574 13285

26132 29513 29142 28720 30473 22362 24457 23196 33863 29356 22663 25950 44484 32893

35542 32511 26AOS 27378 23804 23499 17S29 24984 29815 22185 26411 31833 29499

7258 6056 3874 4505 6573 8547 5567 9125 7187 6376 9517 7092 15087 15973 13A03 13571 11547 10026 12611 11234 10430 12065 4663 19051 S278 S161 8548 15033 13236 S734 9_212 124SS 8496

14873 19602 U 973 21265 17A63 19181 191SS 28948 17068

14015 11214 10894 13081 10187 10614 18633 7843 14838 12484 18900 13223 17583 21358 14709

10208 13406 13903 17699 18m 15724 10670 7879 13139 12557 7022

12lll 21351 19941 13632 4299 ll939 10004

12617 8350 13265

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

448ln

200()39

201JQJ

201JQA

2014Ql

201402 201Q3

27

bull 19

2S 20

32

1238 1223

348

1981

2112 _ 6S06

3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

SBill

23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

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New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

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New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

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122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 29: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New Yorilt Department of Financial Services poundxhibit4

Quarterty AnaiSls of New Yortc Medical Indemnity Fund Page 2

cumulative Average Payments per Partldpant by Admittance Quarter AsofSeptember 30 2017

_- - OIMulatM 5oeyenttlly by FundhrticlpatlolI Quatter

JU ~ 111 Qi Qi lll llZ lll Ill ~ iw Wl lW llli IIIi Qli Q1Z WI lUl ~ QA Im w lllS

2011Q4 2012Ql

2012Q2

11

11

16 4S

286 1083

13416

8855

3648

27333

21962

5052

40837

2soo 5397

54635

28334

6240

68347

30399 8508

86126

39625

111n 104071

15273

126623

8628

21195

147720

5 1248

242Sl

167131

56231

27783 184912

60561 205461

63067

31Sl

228S70

67SOl

33179

ZS0783

n3so 37502

81060

38234

295227

-38987

317058

89190 40293

338117

93743

4398s

361616

98814

49917

389135

104246

59470

laquogt9870

110595

nltgt90

115352

2012Ql 2012Q4

2013Ql

2013Q2

2S

bullbull s 30

689 3045

1899

lS6

1380

7823 5557 2327

3637

U S34 16353 9670

6252

18964 31951

17088

9897

24884 44973

3436S

15265

33333 71106

69907

22523

45351 100618

102417

28579

62708 129760

128822

32452

74188

158480 156200

36957

SS166 1SB953 4lS31

98871 lll316

203563

52078

110970

235nz 221092

5764S

U0150 258969

246076

66no

129218 292)131

275891

73957

ll9M6 322 187

298-075

80334

152339 344850 324486

89851

164644 70800

lSo319 174180 41S284

385819

186754

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200()39

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bull 19

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348

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3669 4786

7389 14764 38728

degmiddotdeg 11287

16178 23975

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23107 18173

2ln9

37407 72496

36673

22917

37922 46303

87758

Sl760

41967 S279S

60317 102596

67 733

47 246 72397

71531 U S080

81136

S2A06

84370 82425

133980

94708

609SS

105634

95506

147207

10625-4

75983

123097

10S693 164791

116280

89224

1A2279

116307 186149

128891

94958 161434

134940 200BSB

140 125 104 169

190383

142782

lS0554 116624

207451

162620

US121

167283

201AQ4 19 BS 9418 18SU 28965 37 47552 60958 74861 92560 111281 U700S

2015Ql 27 14S 45Sl 9627 16446 23682 32226 42896 S077S 6391 76470 amp3493 2015Q2 31 4421 17412 31452 42839 56073 72953 15272 106623 126SM 140196

2015Ql 16 1-5 8354 133S9 17751 23486 27785 41724 Sl727

2015QA 20 191 S296 9855 lll4S6 34523 45078 57695 66045

2016Ql 18 12 942 11240 203S2 30198 42SlS SS80lt 2016Q2 3S 290 2329 6928 144n 20249 30835 2016Ql 22 4303 13624 21n4 26769

2016Q4 15 10micro3 20974 36130

2017Q1 19 6- 14278 2017Q2 29 328 S618

2017Cl3 17

Totgt sos

Note ltd ctv 2017 diagonal data only indudes thtolcenth83117

New York Medical Indemnity Fund as of9-3~17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

OAl 111 ltQgt 22 1S t S)ZS() deglS736 2011Ql 19 122431 14US4 9506 1Slc22

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2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

1

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41 285

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l 18800 136890 115 157 966bull26

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404028 317022

ll ll ll 91 2827 S4SU 47626 21564

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1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

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31812 9

321808 301643 90654

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1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

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618158 1171 631

10620 12856 111 l7l

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6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

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2lt16Ql s 10 141 71 367 2016Ql 22 16Q4 1S 11Ql 7C2993 742 993

496bull56 S9002S 72 993

066sooa 53914 673 S94

674 066 S39U 673 59-C

674066 67C 066 6069U 606 913 bullS0084 4S0084 406246 534914 48162C 131607 6n 594 673 S94 1732amp2 171282

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166 SS6 166 SS6 Ut212 1112U 132173 U217 166439 16609

166 556 111 212 12113 166 439

166S56 111212 112 171 166439

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131 7S3 87973

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131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

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mm Mm m~

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l 9 ll2 25 350

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40418 26064

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166 796 6171S9 69513

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11680 6576n

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187 OU 431316

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

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mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

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217 S72 140 S5

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22S S09 14$ 766

22S S09 14S 766

225S09 145 766

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237 049 1S 2lS

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237049 15J22S

2881ll 160821

248 810~ 2015Ql 20150

27

~~

~~

~~

~~

~~~= ~~ ~~

wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

134 7Sl

57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 30: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New Yorilt Department of FIMnelal SMllces amptlibit 4

Quarterty Analysis of New York Medical Indemnity Fund Incremental 8eneftts Payments by Admittance Quarter AsofSe~30 2017 _- _ 9l 9l 91IQlt

2012Q1 11 u gtQl 111 20939 ms 2012Q3 U9

2012Qlt n t46Ul 20UQl 108$7 20UQJ 27 deg 201lQ( lS7a7 22 442 bull2014 19 deg 1002sa 2014 2S 1n10 205442 2014()3 20 2460 10565) 2014Qt 19 19 nJs1 201SQl 3902 111911 13108 U 1049 40272 435224 20 9 1 lll201lt()gt 1amp 210 167$4 t8S361

OAl 111 ltQgt 22 1S t S)ZS() deglS736 2011Ql 19 122431 14US4 9506 1Slc22

I 1441n 21oc U71SS 431112111 71441

112 $201()

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21940 1480U 161013

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Note ltd(ltr 2011di~11ld11ta onlvindJditsthroti amp3117

2162018~ Pinnacle Actuarial Resources Inc

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

I 9 9 l 20UQlt 11 241S9 - -2012Q1 11 11909 ltOUbull 2012Q2 16 216S6 43331 2012Ql 25 11222 1111 313341 20UQlt 1S958 nm

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19 1789 JSt712deglOlS(U 27 121amp2 2S910 2012 UOd t 31995 13 tllampn 212)()0 10591amp J69 117 deg 194 20m deg JS 10141 2011Q) 22 deg )9029

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2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

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166 556 111 212 12113 166 439

166S56 111212 112 171 166439

U17S3 81973

1045S4 131 660

131 7S3 87973

10amp SS4 131660

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131660 131660 2017Ql 1~330 1 058 330 1osa130 1 0S8330 959 477 9S9bulln 9S9477 274 136 24682fi 246126 26826 246126 237071 237078 137 078 23707t 1815~ 17S39 187 S39 lt7S39 17Ql 17 578133 607807 607 807 607907 f1)1801 SSl 015 ss1 oas 157 4l8 1S7 431 11s 141 7S4 14115 14175-4 1316156 136 1S6 1316156 U6 1S6 10770S 1077()6 107705 107 70S

so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

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m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

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l 9 ll2 25 350

210266

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2102

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110266

40418 26064

21618

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2606 216183

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2606 216 183

40418

2064 216183

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27015 224069

41 393

27015 224 069

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166 796 6171S9 69513

114 S37

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

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71 469 117 NO

11680 6576n

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17668() 657 672 7076

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1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

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194 936 72S626 81730 134~

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187 OU 431316

111 OU 43136

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192 307 44 967

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192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

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248 810~ 2015Ql 20150

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~~

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wm mw

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mm mw

mw mw

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U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

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u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

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57136 102634 ~10S

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57 U6 10263 90 108

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134 753

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139 669

59220 106178 93S

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59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

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146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 31: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New Yorilt Department of FIMnelal SMllces Quarterly Analysis of New York Medical Indemnity Fund Cumulative Benefits Payments by Admittance Quarte r AsofSeptenINr 30 2017 _

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Note ltd(ltr 201 diqoNld11ta oni-cbdifsthro4h 8lll

2162018 ~ Pinnacle Actuarial Resources Inc

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

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ll ll ll 91 2827 S4SU 47626 21564

33607 38S7 227Ul 17639 gt10S77 2S4C97 28190 369 7J8 3494S8 26762S

1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

SU396 462 2SO 462 250 4S07Jt 4S0738 6834

9 190CM

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1 35451t

1907S 21S624

644 200 121980C

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1219804 2SHl4 622SO

9 9 S148l 800

31812 9

321808 301643 90654

8119S1 782 976

91219 91219 61amp758 618758

1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

811951 7amp2 976 941 219 608390

618158 1171 631

10620 12856 111 l7l

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8119S1 712 976 941219 60890 6187i8 ll4 7S2

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6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

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24A S11 402980 6-S8086 642289 619368 137 S04 139847 2pound4803 S864

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2lt16Ql s 10 141 71 367 2016Ql 22 16Q4 1S 11Ql 7C2993 742 993

496bull56 S9002S 72 993

066sooa 53914 673 S94

674 066 S39U 673 59-C

674066 67C 066 6069U 606 913 bullS0084 4S0084 406246 534914 48162C 131607 6n 594 673 S94 1732amp2 171282

606913 11578lt U7607 171282

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166 SS6 166 SS6 Ut212 1112U 132173 U217 166439 16609

166 556 111 212 12113 166 439

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131 7S3 87973

10amp SS4 131660

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so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

traderu

m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

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l 9 ll2 25 350

210266

39312 2S 350

2102

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110266

40418 26064

21618

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2606 216183

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2606 216 183

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2064 216183

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41 393

27015 224 069

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27015 224 069

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166 796 6171S9 69513

114 S37

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165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

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71469 111160

170462 6WS26

71 469 117 NO

11680 6576n

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116680 657671

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176680 6S76n

74016 1220SS

17668() 657 672 7076

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1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

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194 936 72S626 81730 134~

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187 OU 431316

111 OU 43136

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192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

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248 810~ 2015Ql 20150

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~~

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wm mw

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mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

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u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

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57136 102634 ~10S

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57 U6 10263 90 108

U 4 7Sl

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134 753

S9 220 1deg)78 93ffl

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139 669

59220 106178 93S

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59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 32: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department ofFinancial Services Exhibits

QuanOly Analygtis of NewYork Medlcal Indemnity fund 1

Projlaquoted lncremental Nominal Paymtnts per Participant by Admittanot Quarter As Of ~embef 30 2017 -- - ~ al lifflefitshldly-FundPatldpatlonOwarte

91 9l 91 9 9 9 11Q4 11 l 146 94260 14173 27926 42167 2012Ql 11 11909 2a-21s 1S444 92S 2012Ql m 213 939 222 67S 216063 221gt760 219402 2012Ql 2S 17222 S889S 119-68 117 7S5 160748 lASOU OUQ4 40 l7l JAampUl C31312 6l3934 208amp9 lOUQl 780 10851 361U 7090 86 20UQl 41 406 678 784Al 1)9369 161013 OUQl 27 9394 176462 366 278 20UQ4 60 l787 2242 52010 S080 201Ql lJ 602 1-00258 166996 10474 296S9 2010 2S l094S l ll 707 20S42 230289 lJS796 2223amp3 tOlAQl 20 105657 9 392438 232 863 30$247 201Q4 1609 73351 103 1n1u 198 623 1S9203 2015Ql 27 118 971 -137043 18lt125 19S 370 2015Ql 0709 -02 726 43522C 3S2 996 4102S7 SU4S1 2015Ql 16 30164 so 69794 91758 2015Q4 20 3829 102 081 91131 112019 321337 16Ql 18 210 16154 UISl61 164 559

gz 22720 2C92

284 456

211213 1045 294

1708 21776 401 St 1S2 406

2amp2 S92 350374 296N3 193 955 288099

91 llll 433 287128

1

162 ss 18167S 431269 bull2 227

372 bullu 2496 25ltU

212 728

91 6

4SOSO )60amp35

bull13929 1 165671

1l2023 116 207 361 amp86

41 285

127482 272 353 177 991

~ 29173 65 141

l 18800 136890 115 157 966bull26

68386

404028 317022

ll ll ll 91 2827 S4SU 47626 21564

33607 38S7 227Ul 17639 gt10S77 2S4C97 28190 369 7J8 3494S8 26762S

1218933 97820 927 SJ 119313 117497 114918 197 202 2S6 410 16702l 273 7bull3 JU 761 270692 303320 120 264 10S891 31801 25466S

1219804 2573M

SU396 462 2SO 462 250 4S07Jt 4S0738 6834

9 190CM

3S5bull1c 226106

1 35451t

1907S 21S624

644 200 121980C

2s1n

462 2SO 40583lt

9 108661 47SS5

322 911 256 2oa

1174 22)

110923

979919 633404 644 200

1219804 2SHl4 622SO

9 9 S148l 800

31812 9

321808 301643 90654

8119S1 782 976

91219 91219 61amp758 618758

1171631 1 171631 241171 27171 1268S6 111373 111973

9ll 49618

811951 7amp2 976 941 219 608390

618158 1171 631

10620 12856 111 l7l

919 S0087

8119S1 712 976 941219 60890 6187i8 ll4 7S2

70620 126856 111 tl

Ill ssm

6S8086 1S3880 62289 619368 744 S4S 31 263 13987 264803 100343 83101

SI

24A S11 402980 6-S8086 642289 619368 137 S04 139847 2pound4803 S864

Ul0343 88101

9 9

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496bull56 S9002S 72 993

066sooa 53914 673 S94

674 066 S39U 673 59-C

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so

Sources Nt MIF forJunddbullaakulatrd ciagonabbased on btibit6 Selected UltimateScYerity

flaquoJte31-d Qu 2017 diapal data only IIKiuda lttougfl 83117

New Yort Mtdieal lfldetMityfilndti of9--3~172 216201B ~ Pinnacle Actuarial Resources Inc

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

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l 9 ll2 25 350

210266

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110266

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21618

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170-461 63-02

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11680 6576n

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185 721 691 326

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187 OU 431316

111 OU 43136

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192 307 44 967

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44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

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248 810~ 2015Ql 20150

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wm mw

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mm mw

mw mw

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U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

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141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

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u= mm~trade rn~

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sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

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134 753

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139 669

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59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

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146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

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m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 33: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Departmentof Financial Services QuanbullrfyAnalysis of New York Medical Indemnity F1md Projected lnaemental Nominal Payments per Participant by Admittance Quarter As ofSeptembet 30 2017

Exhibits

Page 2

llllClelMIUI lendltshid byieud ~ QIMlrter

91 9ll ll ll1 ll 911 9 9 91 9 91 112 1011(14 lOUQl 10120

11 11 16

m~ ~m

tradem

m~ tim

traderu

m~ m~ wm ~mumtrade

tradern mm~~

mm mm ~ m ~trade mootrade~

mm Mm m~

mm s~=~

l 9 ll2 25 350

210266

39312 2S 350

2102

l9JU 25 350

110266

40418 26064

21618

40418

2606 216183

40418

2606 216 183

40418

2064 216183

1893

27015 224069

41 393

27015 224 069

4 1893 2701S

22bull 069

41893

27015 224 069

44037

28197 lliS35

44037

2897 215 S35

44011

28397 235535

laquo on 28397

23SS3S

46221 29806

27221

46221 2bull 7121

20UQ1 2012(14 201lQl 201l(U

2S lO

ru~ ru~ m~ m~ ~~ 2mm2mm2mm2rnm2mffl

bull~ trade~ -trade trade~ nw wm ~m ww wm m-

~~

~lli

n w m-

m~~trade nw m~

m = illtrade nm m-

~~

m~

~m ~m

166 796 6171S9 69513

114 S37

16S 196 617 1S9 69SU

UA Sl7

165 796 6171S9 69SU

114 531

170-461 63-02

11469 117760

17046gt 634 526 71469

117 760

170462 634S26

71469 111160

170462 6WS26

71 469 117 NO

11680 6576n

74076 lll OSS

116680 657671

74076 1210SS

176680 6S76n

74016 1220SS

17668() 657 672 7076

122oss

1SS721 691 326 n861

12a301

185 721 691 326

11861 128101

1asn1 91326

121301

18S 721 691326 77867

uuo

194 936 72S626 81730 134~

19036 72S 626 81 uo

13667 201CU 2lt)1)(14

27 ~m trade~

~m laquo~

mlli laquo ~

mm laquo rn

mm ~-

mm bullm

mm am

mm bullm

m ~ ~m

187 OU 431316

111 OU 43136

1870W bulll 736

192 307 44 967

192 )07

44967 192307 44967

192 307 44967

199 321 6fi01

199 322 46601

199322 46607

199 321 bull6 607

209 S22 48 992

1522 209 522 209S22 219917 51423

219 917 S14middotU

201AQ1 19 mm mm mm wm mm mm mm mm wtrade 181 ss 1amp2 SS4 182 S5 181691 181691 l87691 181691 194 537 194 537 1ssn 19bull S37 20 492 2042 204492 20U91 214 638 2U6l 2014Ql 2S m~ m~ m~ m~ m~ w~ w= m= o~~ 1760l9 l76Q39 17609 180 993 180993 180 991 180993 Ul7 595 187 S9S Uffl 181 S95 197195 197 1~ 19719S 197 19 2ltl6978 206 978 101cu 2014(l4

20 19

ru~ mm

m~ mm

m~ mm

m~ mm

m~ mm

m~ m m

m~ mm

mw mm

mm mm

2U617 1367

211617 13678

t u 11 11678

211 s12 140 63S

117Sn 140635

217 S72 140 S5

217572 140635

22S S09 14$ 766

22S S09 14S 766

225S09 145 766

us S09 lAS 766

237 049 1S 2lS

17049 153225

270t 153225

237049 15J22S

2881ll 160821

248 810~ 2015Ql 20150

27

~~

~~

~~

~~

~~~= ~~ ~~

wm mw

mm m w

mm mw

mw mw

mm ~m

U9U7 263 4ll

139117 263 422

09117 263422

tO0)2 270834

143032

27004 143032 270amp3A

141032 270834

1432SO 280711

14amp2SO 280714

182SO 28071bull

18 2SO 280 11bull

l SS 836 295 078

155836 29S07t

15S 836 29S078

155836 295071

16568 16l 568 309119

2015Q1 2015(14 2015Ql 20160

16

20 18 lS

~m ~~

u~ m ~

~= ~~

u~ rn~

frac12=~mum ~~ ~ffl tradetrade bull~ u~ ~~

m= w ~ m~

um wrn ~~

rn~

nm mtrade ~w mm

u= mm~trade rn~

~rn ~m v~ m~

sssn 998lS 87641

13106S

sss12 99 amp2S 176tl

131 065

sssn 9982S 87641 lll 065

s11u 102 6l4 9010amp

134 7Sl

57136 102634 ~10S

t34 7Sl

57 U6 10263 90 108

U 4 7Sl

57 ll6 102amp14 90 108

134 753

S9 220 1deg)78 93ffl

U9669

S9 220 106311 93 39S

139 669

59220 106178 93S

139669

59120 106 378 93395

139 669

62 2Sl 111 amp21 9811bull

146 816

62 251

111821 9817bull

146816

6l2St 111821 9817bull

16816

622Si l U821 98nbull

146 816

6339 111369

154 100 6Sl39

111369 103045 1 lOO

2016Q1 22 um um um um~~~~ ~m ~~ vm 87S1A 11S14- 875 14 89971 899 89 m 89 917 93 259 93 259 93259 93259 98031 98031 98031 9801 102 895 102 89 1016(14 2017Ql 20170

1S 19 29

tradem w~ wm

trademlli mm

~m m~ mm

~mm~ w~ rn~ mm mm

m~ m-mm

bull~ m~ mm

bull~ ~~ rn- ~m mm~trade

10t0Cl9 130974

186561

10 009 130974

186 561

104009 ll097bull 186 S61

106935 134 659 191 810

106935 134659 191810

10693S U4659

191810

106935 1W6S9

191810

110836 139571

198808

110amp16 139 571

198808

U0836 l39S71 198808

110836 ll9 571 198808

116508 146 713 208981

116508 146713 208981

116 S08 IA6n9 208981

116508 14713 122288

153992

219 349

122 288 1S3992 219349

2017Q1 107126 107826 107826 107826 110802 110802 110802 110802 107 143 107143 101143 107 143 1101S8 110 158 110 158 110 158 114 1n 114 177 nun 1u 1n 120019 20019 120019 120019 12597bull 125974

Sourus rft MIF fOIfund du~diqoalsbtsed onbhibit6 Select~ UltimateSeverity

Note3rd0v2017diagonaldta entv irctudes thro1gh 3)117

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 34: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial ServicH Ellthibit S

Qvarter1y Analysis of New Yorilt Medical Indemnity Fund Cel ProjKted~mental Nominal Payments per Participant by Admittance Quarter As of 5-tembet30 1017

IMftfflul lenefits PHIbyFund h rtkiP11doft~ - 9 ga 9a I 9ll I 9 9H 9 91 9 98 9Q 9 AfterQampl 2011Q4 11 4221 6221 49923 49928 49928 49918 3581 4aS81 1S9S1125 198788Jl 11 -- 2012Ql 11 291J06 l2196 22 196 32196 32196 31327 91127 l1U7 91 327 l1S90 31S90 )1590 l l 590 10286037 12an1M 2012()2 16 247121 147 221 267deg8 167048 7048 2S9841 2S98A1 259841 1S9841 262 017 262017 261017 262 017 ampSl1US7 106SOS7n 2012Ql 1~936 194936 110569 210S69 210 569 210S69 204SS1 104ampamp1 206 602 6602 gt06601 1062 1112136 83965184 l012Q4 72S 626 725626 183821 713121 783 821 71lamp21 M267 762 67 762667 1 70S4 769054 25041S248 3124390n 013Ql 11 7l0 81130 81285 SSlSS SS902 SS902 85902 amp6621 86621 86621 28 20S 159 3S2l082 2013-Ql lO 13 667 4661 145 47 145467 145467 145 467 lAl 541 141 541 141 S41 141 S41 142 726 142 726 142 726 141726 46 4131(1 saooo1n 20UQl 219 917 119917 ll7 SS4 237 SS4 237 SS4 231 SS4 231 143 231 143 231 143 2l114J 23J 079 2U079 233019 233079 15893856 ~845996 20134 51 423 51421 55541 S5S47 55 S47 5SSO 54048 54501 S4501 54501 1174 182 212010n 2014Ql 19 Ubullamp38 114638 23U52 231852 231U2 231 SS2 22SS9a 225594 225S94 12S~ 227484 121484 2274114 74072001 9-2 841143 1014Ql 206 978 6911 22351amp 213S71 123 S78 123 sa 21754t 217 544 217 S44 2175-U 219366 219 366 219366 119 366 71418689 89669S44

2014Q3 10 148 810 248810 268 764 268 764 163164 2631lt4 MtSlt 261S11 261511 261511 2lt)100 23700 26) 700 263100 IS 164 762 107966457 1014Q4 19 160127 160817 111725 173 72S mns 11372S 1f80316 169016 169036 1 170452 170S2 170452 1104S1 SS SOl 661 69893980 201SQ1 21 lampl S68 l63S61 176 686 116686 1166S6 17 686 171917 171 917 171 917 171917 17) 157 17357 173 3S7 1733S7 56 447 S85 112Sl 124 2015lt12 309 719 l09119 33458 3l4 SS8 1MSS8 lWSS8 32S 529 l2S S29 31SS29 32SS19 3282SS 3282SS 282SS 3281SS 1deg884S99 13SS10N3 101SQl 16 65139 6Sl9 10519 6t67S 6867 61675 69SO 69250 69250 692SO 21S48720 28607822 101SQ4 20 117 )69 117 369 126712 116711 1261amp2 126182 123361 123361 113361 121361 124 394 124 394 124394 114 394 40504 371 51418831 2016Ql 1S tOJ 045 111 309 U19 111309 111309 10UOS 108tOS ous 10SOS 109 211 109U 109212 109 212 3SSfi09S3 45206872 2016Q2 100 154 100 166459 1664S9 166459 16 4S9 161967 161 967 161967 161967 163lU 163 32l 16332) 163)23 Sl 180U9 67492649 l016Ql 102 89S 1l29lt 111 147 111 147 111147 111147 108iA8 108148 108148 109 053 w 10905) 109053 JS S09 l90 451412ltraquo

201604 1S 1222-H U2188 U1096 132096 131096 l ll 096 128531 128531 ll8SU U8U1 119 607 129601 129 607 119607 42 202 0a9 SJ737113 011Ql 19 l SJ 991 151992 166343 166343 166 34J 166 343 1618Sl 161853 161SS3 1611S) 163 209 163 209 163209 1632()9 SJ 143 161 67S3131l 2017Ql 119 149 2369-tl 236941 236941 2lOS46 1 2l05 1305 232 477 n2n 132 477 2324n 75697911 96 2904lS 2011Ql 11 12S974 12S97t U6077 u6on u6on 1)6017 132404 112 604 U2404 lllSU 1USU U3S13 133513 43 411863 S5 391266deg Toal Total t lwu 1017Q3 1823 841196

deg HY MIF fot fund amplrta alouteddi~onals based on amphlbit6 Sellaquotcd Ultimate Sewr~ ~ 3rd(ttr 1017dlJonaldataonlyindudu~hlll17

New Yort Mtdieal lfldetMityfilndti of9--3~ 172 216201B ~ Pinnacle Act uarial Resources Inc

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

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386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

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110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

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103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

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1028()5

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lOS900

171875

39942

105248_170817

104600

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103956

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108604

176263

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107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

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110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

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5079S 90682

79125

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78638

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77673

47920 74646

47625 85022

7186

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74874

47771 85283

7441bull

1n 84758

73956

47 185

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73500

48605 86772

75713

48306 75247

8008 85707

74784

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88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

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79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 35: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Finandal Services pounddllbltS

Quarmly Analysls of New Y0lt1lt Medical Indemnity Fund Page4

Projected lncnmental Discounted Payments plaquo Partldpant by Admittance Quarter As ofSeptember 30 2017 -- - Incremental 8eneflts aid by fund Patti~Quarter

Jl1 lU Ill lit ~ gj l2Z ga Q2 lllll 1W lllZ lUl llli 1W Jl1i lllZ lUl Im ~ Jw lllZ Im 1W 20UQ4 11 3146 94260 144173 27926 2167 2V20 10181 69656 29373 28827 54812 bull7626 27564 482 1-1 51481 28752 C9678 50()67 SS77S 59762

2012Ql 11 11909 2-821S 15444 3802 9275 24942 29365 45050 6S147 33607 38857 22710 17639 1900l 47SSS 8QSO 82-87 40610 2012Ql 16 m 213939 222675 216()153 220760 219402 284456 287128 36083S 337540 310Sn 284497 318790 369738 35541 322971 388125 349296 2012Q3 2012Q4

2S 17222

371 5889lt 75588

119468

146331

117755 431812

1607-48 623934

18012

520889

211218 1045294

300micro5 1180508

433929 1165671

286997 1148800

349458 1218931

267625 894490

302 978263

229506 9278S7

226706

135451 256203

1174221 311JI08 906524

307643 1038009

572628 2118425

2013Q1 780 10857 36713 37090 86384 1n1oa 162554 132023 136890 119318 117497 87645 121918 19075 110923 240083 237137 2013Q2 30 41406 67708 78micro1 109369 161013 217746 181675 116207 135157 197202 256410 167023 273743 393151 388328 2013Q3 201JQlt

27 60

9394 15787

89664 22micro2

176462

52010

348379 SS080

366278

37953 407151 152406

431269 42227

361886

bull t285

366426 311761 120264

270692 105891

340 303320

73694

816657 -us783

642035 149203

638084 148284

634157 147372

630254 146465

201AQ1 19 602 39529 100258 166996 143474- 269659 282S92 372432 227482 404028 331801 36447 797053 792147 787272 618934 61S12S 611339 61)1577 2014Q2 2S 30945 132707 205442 230289 335796 222383 350374 280346 272lSJ 327022 25466S 768609 763879 759178 754506 593174 589523 585895 166368

2014Q3 20 24460 10S657 9 392A88 282863 305247 296763 249677 1n991 MASS4 918263 912611 906995 901413 708-669 704308 199992 198762 2014(14 19 1609 73351 10398 172768 198623 159203 19395S 25-4713 264161 336275 617955 589898 586268 582660 579074 455254 129272 128476 127686

201SQ1 27 3902 118971 137048 184125 195370 230680 288099 212na 632379 628437 624620 S96260 592590 588943 585319 -1314s 130666 129862 129063 201SQ2 31 137049 401726 435224 3S2996 410257 S2l4S1 38171 1197422 1190053 1182729 117SA51 1122081 1115175 1108312 314712 247419 245896 244383 242879

201SQ3 16 30164 103507 80558 91758 280563 251057 2(9~512 247977 246ASl lli261 233813 66393 6Sl84 51875 51556 51239 50923 201SQ_4 20 3829 102088 9 11amp1 172019 211Ugt6 500874 448200 445442 U2701 439976 420000 119261 118527 117798 92610 92040 9147 90911

2016Ql 18 210 1675 164559 U2467 439744 437038 mon 388671 386279 383901 104706 104062 103421 102785 80807 80310 7981S 79324 2016Ql 2016Q)

3S 22

10141 71367 661697

439107 65762S_ 653578

433719 649556

431050

581246 385719

S77Ei69 383345

57411 108853

163023 108-183

155621

103271

154663 102636

153712 102004

152766 101376

120101 79700

119361 79209

118627 78722

117897

78237 2016Q4 1S 579199 575635 518656 515464 512292 509139 45SS96 129369 128573 127782 121980 121229 120483 119742 94138 93559 92983 92AU 2017Ql 19 729360 124871 720410 649101 645106 641136 637191 162909 161906 160910 159920 152659 151719 150786 J49858 J17SLt 117089 116369 115653 2017Q2 29 1032517 1026163 1019848 918899 913244 907624 257725 230622 229202 227792 226390 216111 214181 211459 212146 166784 165757 164737 161723 2017Q3 17 567525 589333 585706 582102 524W 5212SS 148013 147103 131633 130823 130017 129217 123~50 122591 121837 121087 95196 94610 94028 93449

Total sos

Sou NYMlF fOf Fund daucalculated diagonals ba$NI on Exhibit6 lldcet~ Uftimat~ Stverity andbull diSCIOutll factor of25

Note ltdQ_tr2017 diagonal data o~ includes lhrough 83117

New York Medkal Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 36: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New Yorilt DepartmentofFinancial Services EllthibttS

Quarterly Analyls of New York Medical Indemnity Fund Pa_geS Projected Incremental Discounted Paymtftts per Partldpant by Admittance Quart1t Asof September 30 1017

-- ~al8enefltshid byFund hrtkfpadotlltblarter-Im llli Im lUI ~ lllll lll1 llD 1111 llit lU1 IU2 QM SID ~ 1W Qi1 Q1 lHi llS1 Jljj w a ~ ~ 2011Q4 11 137617 136770 13S928 135092 137967 137117 13627bull 135435 130157 36959 36731 36505 37302 37072 3684- 36617 37719 3787 37256 37027 38682 38201 37973 39611 39368

2012Q2 2012Q2

2012Ql

11 16

2S

88196

727029

5697-40

8 7653

722SSS

566234

8 711 718108

562749

86577

713689

559286

88420

728-875 571187

87876 87335 724~390 719932

567672 16119A

86797

204429

160202

23llll

196462

153959

23686

19S2Sl

1S3D11

23540

194051

15~069

23395 191857

151134

U906 197o64

154430

23759

195851

1SlA80

23612 152515

23467

193448

151596

24174

199271

156160

2A02S 19Slt)44

155199

2lsn 196826

St243

23730 19561

153294

24791

204359

160147

U638 203101

159161

middot201851

158182

2A3l6

2009

157208

25386 2092fi6

163993

25230 207978

162983-2012Q4 40 210770 209t772 2Dampl880 2069068 21U096 600026 596334 592664 S69566 566lt)61 562578 559115 57U11 S67795 564301 560amp28 577709 S7C154 S70621 567109 S92micro0 588814 585190 581589 606687

201IQI 215942 23A-90 233046 231612 67SH 67167 6675 663A3 63757 63365 62975 62588 63953 63559 63 168 ~719 64669 64271 63875 6l482 66120 65912 66506 65103 67913 67495 2013Ql

2013Ql 201lQ4

lO

27

386370

627077 145726

lampl992

623218 uo

381629

176966 1us

10866

175877

40872

110672

179620 417tl

109991

178-514 41lt85

109314

177416 41230

108641

176324 40976

104407

169452

l939

103764

168A09 39137

103126

167373

33896

102-491

1663

38656

104721

169971

39500

1deg082

168925

39257

103442

167886 39015

1028()5

166852 38775

lOS900

171875

39942

105248_170817

104600

169766

39s2

103956

168721

39209

108604

176263

40962

107935

175179

40710

107271

11100 40459

106611

173029 40210

111212

180496

4 1MS

110527

179385

41687

2014Ql 19 172718 1716SS 170599 169549 173157 172091 171032 169980 1633SS 162350 161351 1603S8 163856 162847 161845 160849 16S691 164671 163658 162650 169921 16887S 167836 166803 174002 172931

2014Q2

2014QJ

25 165530

197759

161511

196s42

163499

195333

162-492

194131

165950

19S262

161929

1970U

163914

195829

162905

194624

156556

187039

155593

185888

15635

lM744

15368t

183607

157036

187612 156069 186457

155109

185310

154154

184169

158795

189713

157817

18854S

156846

187lampS

155881

186232

162849 194557

161M7

193359

160851

192170

159861

190987

166760

199229

16S733

198003 2014Q4 19 127042 126260 12SW 124711 12736S Ult581 125802 12S02B 12015S 119416 118681 117950 120523 119781 119044 118312 121873 121123 1203n 119637 12498S 12421S 1234S1 122691 127986 127198

201SQ1 27 128412 127622 126836 126056 128738 127946 U71S8 126376 121451 120703 119961 119222 121823 121073 120328 119587 123187 122429 121676 120927 126332 1BSSS 124782 124014 129366 128570 201SQ2 l1 241654 240167 238689 237220 242268 240777 239295 237amp23 228SM 227148 225750 224360 229254 227MJ 226441 225048 231822 23039S 228-977 227S68 2377U 236278 23A824 23337amp 2434SO 241952

201SQ)

2015QltI

2016Ql

16

20

18

50666

904S2 _ S03SS 89896 78amp38

S004S 89342

n956

49737

889l

77476

5079S 90682

79125

50482

90124

78638

50111 89560

781Samp

49863

89018

77673

47920 74646

47625 85022

7186

47332

84499

73730

47041

83979

73276

48lt)67 85811

74874

47771 85283

7441bull

1n 84758

73956

47 185

84236

73500

48605 86772

75713

48306 75247

8008 85707

74784

47713

8S180

74324

49M6

88987

77646

49539

88440 n168

49234

87895

76693

48931 87lSS

76221

Sl041 9 1124

79511

50729

90564 79021

2016Q2 lS 117302 116580 11S863 11S150 117600 116sn 1161S7 115442 110943 110261 109582 108908 111283 110598 109918 109241 112530 111837 111149 11046S 11S403 114693 11397 113285 118174 1174-t7

2016Q)

2016Q4

22

15

n so 9194S

n364

91379

76887

90817

76414

90258

78040

92178

nsGO 91611

n08l 91047

76606

90487

73623 73170

86lt25

72719

8S89l

72272

8S36S

7l88

81221

73394

86690

72942

86156

72493

8S626

74675

88204

74216

87661

73759

87121

7l305

66585

76582

90456

76111 7S642

89346

7S177

88796

78421

92628

n9a 92058

2017QI

2017U 19 115(169

162898

114361

16189S

113657

160899

112958

159909

115362

163312

114652

162307

113946

161308

113AS

16031S

108831

154067

106162

1S3119

107496

is21n

106slS

151240

10916S

154539

10849

1S3588

107825

152643

107162

151703

110387

156270

109708

lSS308 109033

1543S2

108362

lSl402

113206

16021i0

112509

1S9274

111817

158293

111129

157319

11S924

164106

11S211

16098 2017Ql 17 92978 92405 91837 91272 93214 9U40 92070 9 1503 87937 87396 86858 86324 88207 87664 87124 86588 8919S 88646 88100 87558 91472 90909 90350 8979lt 93669 93002

Total sos

SOutlte NYMlf tot Fund data telcw~ dlaeonillS based on Egttitiit 6 lndkated lHtlmate severity end a d~unt factorof2S

Not~ 3tdQtt 2017 diagonal dbta only indudes thrOICh 8ll17

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 37: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

-- -New Yorilt Department of Financial Services Exhibits

Quarterly Analysis of New Yorlc Medical Indemnity Fund Page6

Projecffll lncmental Discounted PavMnts per Participant by Admittance Quarter Asof~r30r 2017

lnctementtl Bendu aidby fund hrtldpfflon Qulrtel

w JIIZ JIU Ila w ~ JIil ga 1W lllill 1111 ~ w Slit lalal 2011Q4

2011Q1 12Q2

11

11 3912S

25075

206698

24_920

205426

41745

26 753 220536

41488

26589 219179

41232

26425 217830

40979

26-262 216489

39627

25396 209350

39383

25240- 39141

25085 2067amp1

3amp900

24930

205509

24984

20595-

387(5

24amp31

204687

3amp5(]6

24678

203427

38269

2s26 202175

5303607

3398968 28018886

8989649

snou1 781016

12Q) 25 161980 160983 172824 171760 170703 169651 161058- 163049 162045 161()48 161397 160404 159417 158-06 2 1957161 37505493

2012Q4

2013Q1

40 599243

67)79

595SSS 639359

71S70

635425

71130

63151(

70692

627628

70257

606931

67940

603196

67522

59948

67106

595794 S97086

66838

593412

66427

589760

66018

586130

65612

81230084 9()92927

138834856

15601870

20130Z JO 109347 109-171 U7201 116479 115761 115050 111256 110S72 109891 109llS 109ampS2 11l6m 108 109 107laquol 14890253 25533692

2013Ql 2013Q4

14Qt

27 178281

41431

171867

1n184 41176

170809

190216

204

183372

189046 43932

182244

187882

43662

181122

186726 43391

180007

180569 41962

174072

179457

4 1704

173microl(l

178353 171936

1n2ss

41192

170877

177640

middot ~282 171248

176546

1028

17019

175460

40ns 169147

174380

40524

168-106

24166839

5616130

23297288

41622038

9713769

40493056 2014Q2 25 164713 163700 175740 176S9 173SM J72516 166827 165800 164780 163766 164121 163111 162107 161109 223l76SO 38993992

2014Ql

2014Q4 20 19678amp

126416

195573

125638

209958

13l87amp

206666

134048

207382

133223

206105

32A04 199309 128037

198082 127249

196863

126466

195652

125688

196076

125961

125185

193670

124415

192478

123649

26674994

17136195

amp6SU878

30211689

2015QI 27 127719 126992 136333 13Sffl 134660 133831 129418 128622 127830 12703 127ll9 126535 125757 124983 17320993 l0735056 201SQgt

2015Q3 201SQ4

2016Q1

l1

240463

S0417 78535

233983

S0106

amp9452

780S2

256560

53792 96032

13792

254982

Sl461 83277

153412

53132

94853

82764

251853

S2BOS 94270

8225S

243S-48

S1063 91161

79543

242049

5079

90600

79053

240559

50437 90042

78567

239079

50126

89488

239597

so235

89682

782S2

238123

49926 89130

77771

236657

49619

88582

77292

235201

49313

88017

76816

32595196

613-4195

12200747

10645767

58502708

12300447

220H819

19293312

16Q2

2016Q3

2016Q4

17Ql

2017Q2

22

15

116724

nAS9 91491

114502

162095

116006 90928

113797

161097

124538

82644

97616

122167

172946

121n-2

82136

97016

121416

171882

121()10

81630

96A18

120668

170824

122253

81121

9S82S J19926

169771

118221 78amp53

92665 115971

16174

117494 77970

92095

115257

163164

116nt

77490

9 2S28 114548

162160

116052

nou 9096S

113843

161162

116304

n 1ao

91 162

11090 161511

115588

76705

90601

113388

160517

114877

76233 112690

1S9S29

114170

JS764

89489 111996

15822461

10A99892

12402068

15521264

21972660

2859272S

19068322

22632090

28212326

40073784 2017Q) 17 92519 91950 98713 98105 97502 96902 93706 middot~130 92SS6 91987 92186 91619 9 105S 9049S 12S4400 22984578

Total sos Totalthru 20170l 792303696

Sou NYM lf fo Fund data alcutattd dlagonals based on Exhibit 6 Indicated UCtimat~Soewirky~nd a diSltOIHltfacto of 2S

Note 3tdQtr2017 diagonal data orly includes thro~ 83117

New York Medk al Indemnity Fund as of 9middot30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 38: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Expected Fund Payments by Admittance Year

Exhibit 6

Cumulative Expected Expected Development B-F Indicated Selected Indicated Fiscal Admitted Benefit Benefit of Benefits of Current Benefit Ultimate Ultimate Year Live Births Participants Payments Payments Paid Payments Payments Payments Severity (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

2011 239608 22 2275964 30959025 716 31797104 31019013 31258380 1420835 2012 238237 86 31711496 520547963 633 501321266 519331763 513733664 5973647 2013 235956 84 12345530 256598845 537 230086088 255176273 255176273 3037813 2014 237491 91 12199946 322397099 429 284455841 320769848 320769848 3524943

2015 236335 85 7437433 245042955 312 238115493 244826579 244826579 2880313 2016 235084 91 2432448 220057476 183 132594952 218452980 219255228 2409398 2017 233832 46 159384 142277072 053 29985699 141680207 141978639 3086492

Total 1656542 sos 68562200 1737880436 1448356442 1731256661 1726998611 3419799

Sources (2) Vital Statistics of New York State adjusted to MIF fiscal year (3) Provided by MIF includes participants admitted through 093017 (4) Provided by MIF includes 79 load for prescription drugs

(5) (6) Pinnacle estimate of expected payments and payment distributions based on admittance year (7) Col (4) Col (6) (8) Col (4) + Col (5) x [lbullCol (6)1 (9) Judgmentally selected from (5) (7) and (8) - these selections do not reflect the impact of recent legislation see Exhibit 5 page 3 (10) Col (9) Col (3)

New York Medical Indemnity Fund as of 9-30-17 v2 2162018~ Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 39: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 1

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

2523 119772 119772 1662 57197 35221 92418

13828 302916 302916 276786 1631 278416

102634 316517 316517 15056 133083 133083

280 280 85916 2275921 2275921

1S0 2091 8946 11038 326 14194 14194

4437 76014 7885 83899 1417 1417 8557 11723 20280

219S 133929 133929 50 13237 1853 15090

4811 72845 10875 83719 8036 85843 85843 6171 59722 59722

3S910 1426397 1426397 20670 268793 268793

221780 25289 247068 719 8025 8744

1553 19333 10565 29898 3888 103804 103804

6530 6530 60011 132901 132901

9660 9660 88799 1710384 3057 1713441

49609 49609 11 174 11174

814 22290 22290 147 147

503 53611 9231 62842 4773 319672 319672 1692 37614 37614 1322 7418 7418

14806 487365 65793 553158 18723 78293 78293 8430 98318 98318

38904 38904 1559 13250 13250 1754 32064 32064

113154 113154 582 582

2158 63444 4130 67574 61 5650 5650

12598 156133 156 133 310 76807 76807

165902 165902 14097 287143 287143 15639 323906 50146 374052

594 7631 7631 3203 62624 62624

11007 432159 22702 454861

827 26304 26304 77829 552292 38552 590844

309 309 291 291

88296 1117737 1117737

47300 1260165 1260165 44253 623022 623022

218 5299 5299 7065 99889 99889

23317 53368 53368 2240 18165 18165

322022 322022 63866 399658 399658 58227 978827 978827

46545 775017 775017 41681 1139951 1139951 1242 21591 21591

32904 242180 242180 42 325 993016 993016

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 40: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 2

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in MLF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

15543 15543 8415 135327 135327

2623 2623 613 28399 28399

80189 998391 998391 7095 168232 168232

59078 590672 590672 25140 243674 243674 27755 271617 271617

201277 3351366 3351 366 184283 371450 371450 84927 1673356 1673356

186 4845 4845 483 23520 23520 897 10041 10041 739 150459 150459

5235 5235 3782 3782

1812 77382 77382 87598 1202844 1202844

193 40791 40791 1014 35005 35005 1014 34776 34776 2243 148535 148535

9497 9497 88 4148 4148

38683 344764 344764 469 20553 20553

57751 802244 802244 1835 1835

31788 640324 640324 29445 280380 280380 14531 59643 59643

37475 37475 1620 15807 15807

44915 525247 525247 1276 8460 8460

40 2074 2074 5732 50340 50340 7290 23227 23227

3098 3098 336 996 996

19189 310505 310505

6736 6736 2633 2633

388 388

636 8691 8691 18410 98075 98075 1047 181540 181540

52252 710625 710625

7135 7135 376 1504 1504

2852 7522 7522 1201 12690 12690

1435 1435 31925 472141 472141

3484 203901 203901

640 92121 92121 6551 150083 150083

971 3356 3356 6005 79543 79543

384 6584 6584 82 82

47786 47786 7836 51037 51037 2375 26178 26178

37 37 40 15980 15980

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 41: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 3

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

10822 176032 176032

488 6502 6502 1510 1510

12972 478360 478360 1629 16147 16147

1636 17584 17584 23622 255471 255471 3842 71453 71453 5447 2127253 2127253

26714 512735 512735 474 474

7S9 19472 19472 244 9499 9499

1003 17574 17574 162 162

29348 366576 366576 125 12154 12154

4161 4161 766 17199 17199

306S7 482290 482290 7854 7854 1104 1104

633 34033 34033 3S790 746612 746612

54735 54735 38190 634588 634588

4154 41S4 307 1580 1580

28641 352090 352090

22667 119611 119611 10719 10719

1485 24478 24478

132804 1152132 1152132 5833 23632 23632 1499 54437 54437 8201 145414 145414 5180 33076 33076

12474 27740S 277405 48S 3597 3597

20029 134 176 134176

1875 12253 12253 39409 861316 861316

105 105

4230 4230

836 3349 3349 8292 92759 92759 6763 20375 20375 6562 207769 207769

8193 B193 185036 185036

2292 31604 31604 3233 82000 82000

20211 48963S 489635 8141 155527 155527

2111S 148901 148901 387 102615 102615

1663 1663 29575 394634 394634 8759 364380 364380

8088 B088 37544 255392 255392

232 13793 13793 BS809 846036 846036 5020 34776 34776

9942 9942 1040 1040 631S 631S

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 42: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page4

State Paid Benefits

I Affiliate Number

Current Age Gender

Effective Date Primary Diagnosis Injury

Years in M IF

Date of Death (if applicable)

Current Quarter

Cumulative To Date Medicaid

Incurred to Date

768 36513 36513 35 554S 5545

567 23774 23774 2216 62652 62652

S0S3 S053 6748 6748

14863 14863

1762 40904 40904 3117 113360 113360

129228 2225651 2225651

7308 7308

38S8 59371 59371 105016 516S05 516505

6740 199377 199377 14829 298407 298407 24794 38676 38676

1748 1748 82188 82188

295 295 477 S204 5204

69487 497547 497547 14878 141975 141975 16474 224867 224867

6410 6410 1670 4300 4300

12220 135236 135236

1146S 14841S 148415 7S0 27713 27713

16012 273256 273256

16396 93592 93S92 6000 6000

297 15306 15306 2018 2018

1111 1111 1350 2914 2914 S7S5 66937 66937

788 4830 4830 895 10104 10104

33287 363836 363836 15661 276895 276895 10354 78174 78174 8896 82839 82839 5888 109783 109783

10862 237706 237706 13665 147573 147573

525 2282 2282 9607 60566 60566 9173 61486 61486

283 283 45084 382025 382025

17413 17413

1259 1259 7846 7846

1881 19251 19251 934 1440 1440

105093 807831 807831 225 2500 2500

10094 84924 84924 2433 2433

128S09 1649866 1649866 11205 326394 326394

394 12610 12610 1120 29272 29272 2297 166658 166658

New York Medical Indemnity Fund as of930-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 43: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 5

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

24737

Cumulative To Date

165719 204

Medicaid Incurred to Date

165719 204

122 122

150 3532 3532

1502 567

757 21335 6960 1231

757 21335

6960 1231

48753

710 860

1312

274581 11365 13424

57798 53344

3167

274581 11365 13424 57798 53344

3167

6855 78446 2361 1029

5939

44683

88144 194712

69579 2134 1923

13502

49579 178

196065

88144 194712 69579

2134 1923

13502 49579

178 196065

2689 2145

400 2844

14432 368

2455 14812

207

17999

32027 1104

68101 96939 11093

20536 55358

562 2105

181 30

17999

32027 1104

68101 96939 11093 20536 55358

562 2105

181

30

16670 265

1081 37019 1510 1301

55650

25650 815

187752 776

2176 230789 12446 41635

449635

82239 3498

187752 776

2176 230789 12446 41635

449635

82239 3498

271 12593

25420 26726

300 13048 46893 1065

77769 255194

300 13048

46893 1065

77769 255194

10968 12739 10958 3500

78948 3770 3784

77248 67163 54468 18120

3190 147374

58090 13256

77248 67163 54468 18120

3190 147374

58090 13256

9291 96

11017 614

11017 614

527 2195

1523 7941

147

1523 7941

147

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 44: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 6

I Affiliate Number

Current Age Gender

State Effective

Date Primary Oiaenosis Injury Years in

M IF Date of Death (if applicable)

Paid Benefits Current Quarter

18S3 325 528

4 2810

Cumulative To Date

4436 5193 1665

4 9565

Medicaid Incurred to Date

4436 5193 1665

4 9565

252 65 174 1067

15177 53516

14444 315

1532 89426 31446 19487

101238 35724 2855

89464 315

1532 89426 31446 19487

101238 35724

2855 89464

315

26641 11242 45510 12730 2008

8497

54766 78873

176127 16686

4795 2125

25011

54766 78873

176127

16686 4795 2125

25011

55052

6138

198532 3007 7562

198532 3007 7562

1758 2082

20

3723 16500

20

3723 16500

601 4398

3825 34659

3825 34659

298 572 30 68

84475

1333 275

1036 593

89 118

445395

1333 275

1036 593 89

118 445395

332 4550

301

332 26241

301

332 26241

301

77451 1242

30041 23258 1002

38783

217581 3284

106840 65169 1002

39189

217581 3284

106840 65169

1002 39189

169 1860

17462 5581

1669 1860

18420 20481

1669 1860

18420 20481

4868 4068

11071 23123 3460

636 6123 3884

7817 6904

13928 79693

3460 636

8211 3942

7817 6904

13928 79693

3460 636

8211 3942

1401 42416

1401 56572

1401 56572

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
Page 45: PINNACLE - New York State Department of Health · 2019. 10. 17. · Pinnacle Actuarial Resources, Inc. ("Pinnacle") had been retained by the New York State Department of Financial

New York Department of Financial Services Quarterly Analysis of New York Medical Indemnity Fund As of September 30 2017 Participant Profile

Exhibit 7

Page 7

State Paid Benefits Affiliate Current Effective Years in Date of Death Current Cumulative Incurred

I Number Age Gender Date Primary Diagnosis Injury M IF (if applicable) Quarter To Date Medicaid to Date

1080 1080 1080 8658 11642 11642 1550 2824 2824

190 190 23426 56589 56589 2348 2348 2348

5567 5567 5567

138 152 152

57548 57548 57548

2375 2375 2375

17369 17369 17369

54603 63390 63390

2163 2163 2163

4079 4079 4079

453 453 453

1S0 150 150

571246 5037116 5037116

25232 25232

Total 6026240 68267130 322301 68589431

New York Medical Indemnity Fund as of9-30-17 v2 2162018-- Pinnacle Actuarial Resources Inc

  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • Appendix A MIF Claims Requirements for 1500 Professional Form claims received with missing required elements will be rejected
  • 10 01 19 MIF Privacy Notice pdf
    • New York State Medical Indemnity Fund (MIF)
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES
    • NEW YORK STATE MEDICAL INDEMNITY FUND (MIF) NOTICE OF PRIVACY PRACTICES