Common use of Medical Loss Ratio Clause in Contracts

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted Contract arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- eighty-five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.EXHIBIT 1.E

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise HIP line of business. For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) for the Hoosier Healthwise HIP line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-sub- capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) for the Hoosier Healthwise HIP line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8438.8 and CMS guidance. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.  • For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  • Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date dates of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  • Under Subsub-Capitated capitated or Subsub-Contracted contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five ninety percent (8590%) for its the Hoosier Healthwise Care Connect line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five ninety percent (8590%) for the Hoosier Healthwise Care Connect line of business.. EXHIBIT 1 SCOPE OF WORK

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- eighty-five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- eighty-five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- eighty-five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted Contract arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year years 2015, 2016, and 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), ) based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.72.9). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. The Contractor shall maintain, at minimum, a MLR of eighty-seven percent (87%) for the Hoosier Care Connect line of business for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. FSSA shall recoup excess capitation paid to the Contractor in the EXHIBIT 1.M SCOPE OF WORK event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.  • For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  • Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  • Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its the Hoosier Healthwise Care Connect line of businessbusiness for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted Contract arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year years 2015, 2016, and 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), ) based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.72.9). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. The Contractor shall maintain, at minimum, a MLR of eighty-seven percent (87%) for the Hoosier Care Connect line of business for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.  • For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  • Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  • Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its the Hoosier Healthwise Care Connect line of businessbusiness for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), ) based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:   The MLR calculation shall be performed separately for each MLR reporting year.   The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.72.9). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. The Contractor shall maintain, at minimum, a MLR of eighty-seven percent (87%) for the Hoosier Care Connect line of business for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:   The MLR calculation shall be performed separately for each MLR reporting year.   The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.   For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.   Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).   Under Sub-Capitated or Sub-Contracted Contract arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its the Hoosier Healthwise Care Connect line of businessbusiness for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise HIP line of business. For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) for the Hoosier Healthwise HIP line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) for the Hoosier Healthwise HIP line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise HIP line of business. For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty -seven percent (8587%) for the Hoosier Healthwise HIP line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  EXHIBIT 2.I SCOPE OF WORK – HEALTHY INDIANA PLAN ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) for the Hoosier Healthwise HIP line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8438.8 and CMS guidance. In addition, the State provides the following clarifications:  • The MLR calculation shall be performed separately for each MLR reporting year.  • The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.  • For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  • Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date dates of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  • Under Subsub-Capitated capitated or Subsub-Contracted contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five ninety percent (8590%) for its the Hoosier Healthwise Care Connect line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five ninety percent (8590%) for the Hoosier Healthwise Care Connect line of business.. EXHIBIT 1.A. SCOPE OF WORK

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise HIP line of business. For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) for the Hoosier Healthwise HIP line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-sub- capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) for the Hoosier Healthwise HIP line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8438.8 and CMS guidance. In addition, the State provides the following clarifications:   The MLR calculation shall be performed separately for each MLR reporting year.   The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.   For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.   Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date dates of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).   Under Subsub-Capitated capitated or Subsub-Contracted contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five ninety percent (8590%) for its the Hoosier Healthwise Care Connect line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five ninety percent (8590%) for the Hoosier Healthwise Care Connect line of business.. EXHIBIT 1 SCOPE OF WORK

Medical Loss Ratio. In calendar year years 2015, 2016, and 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), ) based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:   The MLR calculation shall be performed separately for each MLR reporting year.   The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.72.9). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. The Contractor shall maintain, at minimum, a MLR of eighty-seven percent (87%) for the Hoosier Care Connect line of business for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty-seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:   The MLR calculation shall be performed separately for each MLR reporting year.   The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise Care Connect program shall be calculated separately from other managed care programs.   For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.   Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).   Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its the Hoosier Healthwise Care Connect line of businessbusiness for the first year of the Contract, eighty-eight percent (88%) for the second year of the Contract and ninety percent (90%) for the third year and beyond of the Contract. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseCare Connect. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) in year one (1), eighty-eight percent (88%) in year two (2) or ninety percent (90%) in year three (3) and beyond for the Hoosier Healthwise Care Connect line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: -five The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted Contract payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise HIP line of business. For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five eighty -seven percent (8587%) for the Hoosier Healthwise HIP line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise HIP program shall be calculated separately from other managed care programs.  ▪ For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  EXHIBIT 2.I SCOPE OF WORK – HEALHTY INDIANA PLAN ▪ Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  ▪ Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five seven percent (8587%) for its Hoosier Healthwise HIP line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier HealthwiseHIP. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five seven percent (8587%) for the Hoosier Healthwise HIP line of business.

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:  ▪ The MLR calculation shall be performed separately for each MLR reporting year.  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs.  For each MLR reporting year, a preliminary calculation will be performed with six months of incurred claims run-out, and a final calculation will be performed with 18 months of incurred claims run-out.  Incurred claims reported in the MLR should relate only to members who were enrolled with the MCE on the date of service, based on data and information available on the reporting date. (Claims for members who were retroactively disenrolled should be recouped from providers and excluded from MLR reporting).  Under Sub-Capitated or Sub-Contracted arrangements, the MCE may only include amounts actually paid to providers for covered services and supplies as incurred claims. The non-benefit portion of sub-capitated and sub-contracted payments should be excluded from incurred claims. The MCE should ensure all subcontracts provide for sufficient transparency to allow for this required reporting. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR is less than eighty-five percent (85%) for the Hoosier Healthwise line of business.