Our records indicate that you are licensed to transact the business of health insurance in Alaska. AS 21.56.075 requires all health care insurers to report total premiums earned in the preceding calendar year and other information that the director requires regarding health care insurance plans delivered or issued for delivery to small employers in Alaska. The information for calendar year 1998 should be submitted to the director on the attached Alaska Small Employer Health Insurance Activity Report no later than March 15, 1999.

This report will be used to determine each company's share of the assessment base for Alaska’s Small Employer Health Reinsurance Association. It also will be used by the association to report to the Alaska Legislature and to the director on the effectiveness of Alaska's small employer health insurance reforms and to compare the effectiveness of Alaska's small employer reforms with other states and regions of the country.

Please complete the attached activity report and return it to the division at the address indicated on the form.

DATED: February 23, 1999.

Marianne K. Burke Director of Insurance

ALASKA
SMALL EMPLOYER HEALTH INSURANCE
ACTIVITY REPORT
CALENDAR YEAR 1998

Director
Division of Insurance
Department of Commerce & Economic Development
State of Alaska
P.O. Box 110805
Juneau, AK 99811-0805

1. Administrative: _______________________________________________________

a. Carrier name: ___________________________________________________

b. Carrier contact name: _____________________________________________

Title: __________________________________________________

Address:_______________________________________________

Phone: ________________________________________________

2. Total Accident & Health Insurance Premiums Written in Alaska: $_____________

3. In Force:

a. Number of policies active as of 12/31/98: _______________

b. Monthly-earned premium based on 12/98 billing: $ _______________

c. 1998 calendar year earned premium: $ _______________

d. Number of insured employees, based on 12/98 billing: _______________

e. Number of insured lives (including dependents) based on 12/98 billing: _________

4. New Business:

a. Number of policies that became effective in 1998: _______________

b. Monthly-earned premium based on 12/98 billing for policies that went into effect in 1998: $______________

c. 1998 calendar year earned premium for policies that went into effect in 1998: $_______________

d. Number of insured employees based on 12/98 billing for policies that went into effect in 1998: _______________

e. Number of insured lives (including dependents) based on 12/98 billing for policies that went into effect in 1998: _______________

5. Cancellations:

a. Number of policies for which coverage was canceled in 1998: _______________

b. Monthly-earned premium based on 1/98 billing for policies for which coverage was canceled in 1998: $ _______________

c.1998 calendar year earned premium for policies for which coverage was canceled in 1998:  _______________

d. Number of insured employees, based on 1/98 billing for policies for which coverage was  canceled in 1998: ______________

e. Number of insured lives (including dependents) based on 1/98 billing of policies for which  coverage was canceled in 1998: _______________

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Revised 08/09/99