UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the Quarterly Period Ended March 31,June 30, 2022
OR
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                     to                     
Commission file number: 001-16751
ANTHEM,elv-20220630_g1.jpg
ELEVANCE HEALTH, INC.
(Exact name of registrant as specified in its charter)
Indiana 35-2145715
(State or other jurisdiction of
incorporation or organization)
 (I.R.S. Employer
Identification Number)
220 Virginia Avenue
Indianapolis, Indiana 46204
(Address of principal executive offices) (Zip Code)
Registrant’s telephone number, including area code: (800) 331-1476
Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading symbol(s)Name of each exchange on which registered
Common Stock, $0.01 par valueANTMELVNew York Stock Exchange
Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes ☒ No  ☐
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    Yes  ☒    No  ☐
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer”, “accelerated filer”, “smaller reporting company”, and “emerging growth company” in Rule 12b-2 of the Exchange Act:
Large accelerated filer  Accelerated filer
Non-accelerated filer  Smaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ☐    No  ☒
As of AprilJuly 13, 2022, 241,084,780240,000,694 shares of the Registrant’s Common Stock were outstanding.



Anthem,Elevance Health, Inc.
Quarterly Report on Form 10-Q
For the Period Ended March 31,June 30, 2022
Table of Contents
 
  Page
PART I. FINANCIAL INFORMATION
ITEM 1.
ITEM 2.
ITEM 3.
ITEM 4.
PART II. OTHER INFORMATION
ITEM 1.
ITEM 1A.
ITEM 2.
ITEM 3.
ITEM 4.
ITEM 5.
ITEM 6.
-1-


PART I. FINANCIAL INFORMATION
ITEM 1.    FINANCIAL STATEMENTS
Anthem,Elevance Health, Inc.
Consolidated Balance Sheets
March 31,
2022
December 31,
2021
June 30,
2022
December 31,
2021
(In millions, except share data)(In millions, except share data)(Unaudited) (In millions, except share data)(Unaudited) 
AssetsAssetsAssets
Current assets:Current assets:Current assets:
Cash and cash equivalentsCash and cash equivalents$6,161 $4,880 Cash and cash equivalents$6,456 $4,880 
Fixed maturity securities (amortized cost of $26,971 and $25,641; allowance for credit losses of $13 and $6)26,219 26,267 
Fixed maturity securities (amortized cost of $27,715 and $25,641; allowance for credit losses of $8 and $6)Fixed maturity securities (amortized cost of $27,715 and $25,641; allowance for credit losses of $8 and $6)25,765 26,267 
Equity securitiesEquity securities1,662 1,881 Equity securities1,572 1,881 
Premium receivablesPremium receivables7,349 5,681 Premium receivables6,757 5,681 
Self-funded receivablesSelf-funded receivables3,979 4,010 Self-funded receivables3,844 4,010 
Other receivablesOther receivables3,334 3,749 Other receivables3,600 3,749 
Other current assetsOther current assets5,193 4,654 Other current assets5,661 4,654 
Total current assetsTotal current assets53,897 51,122 Total current assets53,655 51,122 
Long-term investments:Long-term investments:Long-term investments:
Fixed maturity securities (amortized cost of $612 and $616; allowance for credit losses of $0 and $0)596 632 
Fixed maturity securities (amortized cost of $629 and $616; allowance for credit losses of $0 and $0)Fixed maturity securities (amortized cost of $629 and $616; allowance for credit losses of $0 and $0)603 632 
Other invested assetsOther invested assets5,365 5,225 Other invested assets5,398 5,225 
Property and equipment, netProperty and equipment, net3,986 3,919 Property and equipment, net4,090 3,919 
GoodwillGoodwill24,251 24,228 Goodwill24,367 24,228 
Other intangible assetsOther intangible assets10,588 10,615 Other intangible assets10,762 10,615 
Other noncurrent assetsOther noncurrent assets1,803 1,719 Other noncurrent assets2,002 1,719 
Total assetsTotal assets$100,486 $97,460 Total assets$100,877 $97,460 
Liabilities and equityLiabilities and equityLiabilities and equity
LiabilitiesLiabilitiesLiabilities
Current liabilities:Current liabilities:Current liabilities:
Medical claims payableMedical claims payable$14,713 $13,518 Medical claims payable$15,127 $13,518 
Other policyholder liabilitiesOther policyholder liabilities5,396 5,521 Other policyholder liabilities5,577 5,521 
Unearned incomeUnearned income1,210 1,153 Unearned income971 1,153 
Accounts payable and accrued expensesAccounts payable and accrued expenses5,493 4,970 Accounts payable and accrued expenses5,850 4,970 
Short-term borrowingsShort-term borrowings275 275 Short-term borrowings175 275 
Current portion of long-term debtCurrent portion of long-term debt3,097 1,599 Current portion of long-term debt2,248 1,599 
Other current liabilitiesOther current liabilities9,549 7,849 Other current liabilities9,360 7,849 
Total current liabilitiesTotal current liabilities39,733 34,885 Total current liabilities39,308 34,885 
Long-term debt, less current portionLong-term debt, less current portion19,883 21,157 Long-term debt, less current portion21,165 21,157 
Reserves for future policy benefitsReserves for future policy benefits811 802 Reserves for future policy benefits822 802 
Deferred tax liabilities, netDeferred tax liabilities, net2,349 2,805 Deferred tax liabilities, net2,021 2,805 
Other noncurrent liabilitiesOther noncurrent liabilities1,679 1,683 Other noncurrent liabilities1,694 1,683 
Total liabilitiesTotal liabilities64,455 61,332 Total liabilities65,010 61,332 
Commitments and contingencies – Note 11Commitments and contingencies – Note 1100Commitments and contingencies – Note 1100
Shareholders’ equityShareholders’ equityShareholders’ equity
Preferred stock, without par value, shares authorized – 100,000,000; shares issued and outstanding – nonePreferred stock, without par value, shares authorized – 100,000,000; shares issued and outstanding – none— — Preferred stock, without par value, shares authorized – 100,000,000; shares issued and outstanding – none— — 
Common stock, par value $0.01, shares authorized – 900,000,000; shares issued and outstanding –
241,140,929 and 241,770,746
Common stock, par value $0.01, shares authorized – 900,000,000; shares issued and outstanding –
240,051,897 and 241,770,746
Common stock, par value $0.01, shares authorized – 900,000,000; shares issued and outstanding –
240,051,897 and 241,770,746
Additional paid-in capitalAdditional paid-in capital9,151 9,148 Additional paid-in capital9,134 9,148 
Retained earningsRetained earnings28,058 27,088 Retained earnings28,825 27,088 
Accumulated other comprehensive lossAccumulated other comprehensive loss(1,236)(178)Accumulated other comprehensive loss(2,149)(178)
Total shareholders’ equityTotal shareholders’ equity35,975 36,060 Total shareholders’ equity35,812 36,060 
Noncontrolling interestsNoncontrolling interests56 68 Noncontrolling interests55 68 
Total equityTotal equity36,031 36,128 Total equity35,867 36,128 
Total liabilities and equityTotal liabilities and equity$100,486 $97,460 Total liabilities and equity$100,877 $97,460 


See accompanying notes.
-2-


Anthem,Elevance Health, Inc.
Consolidated Statements of Income
(Unaudited) 
 Three Months Ended 
 March 31
(In millions, except per share data)20222021
Revenues
Premiums$32,785 $27,676 
Product revenue3,301 2,737 
Administrative fees and other revenue1,800 1,685 
Total operating revenue37,886 32,098 
Net investment income360 291 
Net losses on financial instruments(151)(4)
Total revenues38,095 32,385 
Expenses
Benefit expense28,215 23,699 
Cost of products sold2,883 2,313 
Selling, general and administrative expense4,341 3,925 
Interest expense201 192 
Amortization of other intangible assets129 80 
Total expenses35,769 30,209 
Income before income tax expense2,326 2,176 
Income tax expense531 509 
Net income1,795 1,667 
Net loss (income) attributable to noncontrolling interests10 (2)
Shareholders’ net income$1,805 $1,665 
Shareholders’ net income per share
Basic$7.48 $6.80 
Diluted$7.39 $6.71 
Dividends per share$1.28 $1.13 

 Three Months Ended 
 June 30
Six Months Ended 
 June 30
(In millions, except per share data)2022202120222021
Revenues
Premiums$33,076 $28,533 $65,861 $56,209 
Product revenue3,568 3,042 6,869 5,779 
Administrative fees and other revenue1,838 1,704 3,638 3,389 
Total operating revenue38,482 33,279 76,368 65,377 
Net investment income381 400 741 691 
Net (losses) gains on financial instruments(231)172 (382)168 
Total revenues38,632 33,851 76,727 66,236 
Expenses
Benefit expense28,777 24,763 56,992 48,462 
Cost of products sold3,069 2,614 5,952 4,927 
Selling, general and administrative expense4,269 3,821 8,610 7,746 
Interest expense208 205 409 397 
Amortization of other intangible assets166 90 295 170 
Loss on extinguishment of debt— — 
Total expenses36,489 31,498 72,258 61,707 
Income before income tax expense2,143 2,353 4,469 4,529 
Income tax expense493 552 1,024 1,061 
Net income1,650 1,801 3,445 3,468 
Net loss (income) attributable to noncontrolling interests(8)13 (10)
Shareholders’ net income$1,653 $1,793 $3,458 $3,458 
Shareholders’ net income per share
Basic$6.87 $7.33 $14.35 $14.13 
Diluted$6.79 $7.25 $14.18 $13.95 
Dividends per share$1.28 $1.13 $2.56 $1.13 
















See accompanying notes.
-3-


Anthem,Elevance Health, Inc.
Consolidated Statements of Comprehensive Income
(Unaudited) 
 Three Months Ended 
 March 31
(In millions)20222021
Net income$1,795 $1,667 
Other comprehensive (loss) income, net of tax:
Change in net unrealized losses/gains on investments(1,069)(362)
Change in non-credit component of impairment losses on investments(1)
Change in net unrealized gains/losses on cash flow hedges
Change in net periodic pension and postretirement costs10 
Foreign currency translation adjustments(3)— 
Other comprehensive loss(1,063)(347)
Net loss (income) attributable to noncontrolling interests10 (2)
Other comprehensive loss attributable to noncontrolling interests
Total shareholders’ comprehensive income$747 $1,320 


 Three Months Ended 
 June 30
Six Months Ended 
 June 30
(In millions)2022202120222021
Net income$1,650 $1,801 $3,445 $3,468 
Other comprehensive (loss) income, net of tax:
Change in net unrealized losses/gains on investments(922)175 (1,991)(187)
Change in non-credit component of impairment losses on investments(1)(2)
Change in net unrealized gains/losses on cash flow hedges
Change in net periodic pension and postretirement costs16 18 
Foreign currency translation adjustments(5)(6)(8)(6)
Other comprehensive (loss) income(916)180 (1,979)(167)
Net loss (income) attributable to noncontrolling interests(8)13 (10)
Other comprehensive loss (income) attributable to noncontrolling interests(2)— 
Total shareholders’ comprehensive income$740 $1,971 $1,487 $3,291 































See accompanying notes.
-4-


Anthem,Elevance Health, Inc.
Consolidated Statements of Cash Flows
(Unaudited)
Three Months Ended 
 March 31
Six Months Ended 
 June 30
(In millions)(In millions)20222021(In millions)20222021
Operating activitiesOperating activitiesOperating activities
Net incomeNet income$1,795 $1,667 Net income$3,445 $3,468 
Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:
Net losses on financial instruments151 
Net losses (gains) on financial instrumentsNet losses (gains) on financial instruments382 (168)
Equity in net earnings of other invested assetsEquity in net earnings of other invested assets(153)(108)Equity in net earnings of other invested assets(258)(309)
Depreciation and amortizationDepreciation and amortization358 282 Depreciation and amortization751 591 
Deferred income taxesDeferred income taxes(92)31 Deferred income taxes(172)(8)
Share-based compensationShare-based compensation50 64 Share-based compensation122 133 
Changes in operating assets and liabilities:Changes in operating assets and liabilities:Changes in operating assets and liabilities:
Receivables, netReceivables, net(1,348)(1,258)Receivables, net(662)(1,632)
Other invested assetsOther invested assets(20)Other invested assets32 (44)
Other assetsOther assets(353)(288)Other assets(419)(247)
Policy liabilitiesPolicy liabilities1,075 1,455 Policy liabilities1,514 1,912 
Unearned incomeUnearned income57 (119)Unearned income(182)(180)
Accounts payable and other liabilitiesAccounts payable and other liabilities428 358 Accounts payable and other liabilities632 560 
Income taxesIncome taxes568 438 Income taxes(159)106 
Other, netOther, net(2)(1)Other, net(33)
Net cash provided by operating activitiesNet cash provided by operating activities2,541 2,505 Net cash provided by operating activities4,993 4,188 
Investing activitiesInvesting activitiesInvesting activities
Purchases of investmentsPurchases of investments(5,050)(6,978)Purchases of investments(13,253)(11,221)
Proceeds from sale of investmentsProceeds from sale of investments3,047 4,650 Proceeds from sale of investments7,140 6,345 
Maturities, calls and redemptions from investmentsMaturities, calls and redemptions from investments1,209 998 Maturities, calls and redemptions from investments4,347 2,246 
Changes in securities lending collateralChanges in securities lending collateral(441)(731)Changes in securities lending collateral(620)(642)
Purchases of subsidiaries, net of cash acquiredPurchases of subsidiaries, net of cash acquired(61)(27)Purchases of subsidiaries, net of cash acquired(609)(3,442)
Purchases of property and equipmentPurchases of property and equipment(254)(204)Purchases of property and equipment(549)(489)
Other, netOther, net(28)(15)Other, net(58)(29)
Net cash used in investing activitiesNet cash used in investing activities(1,578)(2,307)Net cash used in investing activities(3,602)(7,232)
Financing activitiesFinancing activitiesFinancing activities
Net proceeds from (repayments of) commercial paper borrowings225 (250)
Net proceeds from commercial paper borrowingsNet proceeds from commercial paper borrowings250 300 
Proceeds from long-term borrowingsProceeds from long-term borrowings— 3,462 Proceeds from long-term borrowings1,300 3,462 
Repayments of long-term borrowingsRepayments of long-term borrowings(14)— Repayments of long-term borrowings(943)(952)
Proceeds from short-term borrowingsProceeds from short-term borrowings1,275 175 
Repayments of short-term borrowingsRepayments of short-term borrowings(1,375)— 
Changes in securities lending payableChanges in securities lending payable441 731 Changes in securities lending payable620 642 
Changes in bank overdraftsChanges in bank overdrafts817 364 
Repurchase and retirement of common stockRepurchase and retirement of common stock(545)(447)Repurchase and retirement of common stock(1,169)(927)
Cash dividendsCash dividends(309)(277)Cash dividends(618)(555)
Proceeds from issuance of common stock under employee stock plansProceeds from issuance of common stock under employee stock plans76 89 Proceeds from issuance of common stock under employee stock plans116 141 
Taxes paid through withholding of common stock under employee stock plansTaxes paid through withholding of common stock under employee stock plans(86)(91)Taxes paid through withholding of common stock under employee stock plans(88)(93)
Other, netOther, net534 171 Other, net10 11 
Net cash provided by financing activitiesNet cash provided by financing activities322 3,388 Net cash provided by financing activities195 2,568 
Effect of foreign exchange rates on cash and cash equivalentsEffect of foreign exchange rates on cash and cash equivalents(4)(1)Effect of foreign exchange rates on cash and cash equivalents(10)(7)
Change in cash and cash equivalentsChange in cash and cash equivalents1,281 3,585 Change in cash and cash equivalents1,576 (483)
Cash and cash equivalents at beginning of periodCash and cash equivalents at beginning of period4,880 5,741 Cash and cash equivalents at beginning of period4,880 5,741 
Cash and cash equivalents at end of periodCash and cash equivalents at end of period$6,161 $9,326 Cash and cash equivalents at end of period$6,456 $5,258 








See accompanying notes.
-5-


Elevance Health, Inc.
Consolidated Statements of Changes in Equity
(Unaudited)
Total Shareholders' Equity
 Common StockAdditional
Paid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Loss
Noncontrolling
Interests
Total
Equity
(In millions)Number of
Shares
Par
Value
December 31, 2021 (audited)241.8 $$9,148 $27,088 $(178)$68 $36,128 
Adoption of Accounting Standards Update 2020-06 (Note 2)— — — (23)— — (23)
January 1, 2022241.8 9,148 27,065 (178)68 36,105 
Net income— — — 1,805 — (10)1,795 
Other comprehensive loss— — — — (1,058)(5)(1,063)
Noncontrolling interests adjustment— — — — — 
Repurchase and retirement of common stock(1.2)— (45)(500)— — (545)
Dividends and dividend equivalents— — — (312)— — (312)
Issuance of common stock under employee stock plans, net of related tax benefits0.5 — 39 — — — 39 
Convertible debenture repurchases, conversions and tax adjustments— — — — — 
March 31, 2022241.1 9,151 28,058 (1,236)56 36,031 
Net income— — — 1,653 — (3)1,650 
Other comprehensive loss— — — — (913)(3)(916)
Noncontrolling interests adjustment— — — — — 
Repurchase and retirement of common stock(1.3)— (48)(576)— — (624)
Dividends and dividend equivalents— — — (310)— — (310)
Issuance of common stock under employee stock plans, net of related tax benefits0.2 — 111 — — — 111 
Convertible debenture repurchases and conversions— — (80)— — — (80)
June 30, 2022240.0 $$9,134 $28,825 $(2,149)$55 $35,867 








See accompanying notes.
-6-


Elevance Health, Inc.
Consolidated Statements of Changes in Equity (continued)
(Unaudited)
Total Shareholders' Equity
 Common StockAdditional
Paid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Income (Loss)
Noncontrolling
Interests
Total
Equity
(In millions)Number of
Shares
Par
Value
January 1, 2021245.4 $$9,244 $23,802 $150 $— $33,199 
Net income— — — 1,665 — 1,667 
Other comprehensive loss— — — — (345)(2)(347)
Accumulated noncontrolling interests— — — — — 65 65 
Repurchase and retirement of common stock(1.4)(1)(53)(393)— — (447)
Dividends and dividend equivalents— — — (281)— — (281)
Issuance of common stock under employee stock plans, net of related tax benefits0.9 — 62 — — — 62 
March 31, 2021244.9 9,253 24,793 (195)65 33,918 
Net income— — — 1,793 — 1,801 
Other comprehensive income— — — — 178 180 
Noncontrolling interests adjustment— — — — — 
Repurchase and retirement of common stock(1.3)— (47)(433)— — (480)
Dividends and dividend equivalents— — — (279)— — (279)
Issuance of common stock under employee stock plans, net of related tax benefits0.3 — 119 — — — 119 
Convertible debenture repurchases and conversions— — (216)— — — (216)
June 30, 2021243.9 $$9,109 $25,874 $(17)$78 $35,046 
















See accompanying notes.
-5--7-


Anthem, Inc.
Consolidated Statements of Shareholders’ Equity
(Unaudited)
 Common StockAdditional
Paid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
(Loss) Income
Noncontrolling
Interests
Total
Equity
(In millions)Number of
Shares
Par
Value
December 31, 2021 (audited)241.8 $$9,148 $27,088 $(178)$68 $36,128 
Adoption of Accounting Standards Update 2020-06 (Note 2)— — — (23)— — (23)
January 1, 2022241.8 9,148 27,065 (178)68 36,105 
Net income— — — 1,805 — (10)1,795 
Other comprehensive loss— — — — (1,058)(5)(1,063)
Noncontrolling interests adjustment— — — — — 
Repurchase and retirement of common stock(1.2)— (45)(500)— — (545)
Dividends and dividend equivalents— — — (312)— — (312)
Issuance of common stock under employee stock plans, net of related tax benefits0.5 — 39 — — — 39 
Convertible debenture repurchases, conversions and tax adjustments— — — — — 
March 31, 2022241.1 $$9,151 $28,058 $(1,236)$56 $36,031 
January 1, 2021245.4 $$9,244 $23,802 $150 $— $33,199 
Net income— — — 1,665 — 1,667 
Other comprehensive loss— — — — (345)(2)(347)
Accumulated noncontrolling interest— — — — — 65 65 
Repurchase and retirement of common stock(1.4)(1)(53)(393)— — (447)
Dividends and dividend equivalents— — — (281)— — (281)
Issuance of common stock under employee stock plans, net of related tax benefits0.9 — 62 — — ��� 62 
March 31, 2021244.9 $$9,253 $24,793 $(195)$65 $33,918 









See accompanying notes.
-6-


Anthem,Elevance Health, Inc.
Notes to Consolidated Financial Statements
(Unaudited)
March 31,June 30, 2022
(In Millions, Except Per Share Data or As Otherwise Stated Herein)
 
1.     Organization
On May 18, 2022, our shareholders approved a proposal to amend our amended and restated articles of incorporation to change our name from Anthem, Inc. to Elevance Health, Inc., which amendment and name change went into effect on June 27, 2022. We began operating as Elevance Health, Inc. and trading under our new ticker symbol “ELV” on June 28, 2022. References to the terms “we,” “our,” “us” or “Anthem”“Elevance Health” used throughout these Notes to Consolidated Financial Statements refer to Anthem,Elevance Health, Inc., an Indiana corporation, and unless the context otherwise requires, its direct and indirect subsidiaries. References to the “states” include the District of Columbia and Puerto Rico, unless the context otherwise requires. On March 10, 2022, we announced our intent to change our name to better reflect our business and our journey from a traditional health benefits organization to a lifetime, trusted health partner. At our annual meeting of shareholders on May 18, 2022, our shareholders will vote on a proposed amendment to our amended and restated articles of incorporation to change our name to
Elevance Health Inc. Shareholdersis a health company with the purpose of record on March 17, 2022 are entitled to vote. If approved by our shareholders, we expectimproving the name change to occur in the second quarterhealth of 2022.
humanity. We are one of the largest health benefits companiesinsurer in the United States in terms of medical membership, serving nearlyover 47 million medical members through our affiliated health plans as of March 31,June 30, 2022. We offer a broad spectrum of network-based managed care risk-based plans to Individual, Group, Medicaid and Medicare markets. In addition, we provide a broad array of managed care services to fee-based customers, including claims processing, stop loss insurance, provider network access, medical management, care management and wellness programs, actuarial services and other administrative services. We also provide services to the federal government in connection with our Federal Health Products & Services business, which administers the Federal Employees Health Benefits (“FEHB”) Program. We provide an array of specialty services both to our subsidiary health plans and also unaffiliated health plans, including pharmacy benefits management (“PBM”) services and dental, vision, life, disability and supplemental health insurance benefits, as well as integrated health services.
We are an independent licensee of the Blue Cross and Blue Shield Association (“BCBSA”), an association of independent health benefit plans. We serve our members as the Blue Cross licensee for California and as the Blue Cross and Blue Shield (“BCBS”) licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (in the New York City metropolitan area and upstate New York), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.) and Wisconsin. In a majority of these service areas, we do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Empire Blue Cross Blue Shield or Empire Blue Cross. In addition, we conduct business through arrangements with other BCBS licensees as well as other strategic partners. Through our subsidiaries, we also serve customers in numerous states as AIM Specialty Health, Amerigroup, Aspire Health, Beacon, CareMore, Freedom Health, HealthLink, HealthSun, Integra Managed Care, MMM, Optimum HealthCare, Simply Healthcare, and/or UniCare. We offer PBM services through our IngenioRx, Inc. (“IngenioRx”) subsidiary. We are licensed to conduct insurance operations in all 50 states, the District of Columbia and Puerto Rico through our subsidiaries.
As part of our name change to Elevance Health, on June 15, 2022 we announced that over the next several years we will organize our brand portfolio into the following core go-to-market brands:
Anthem Blue Cross/Anthem Blue Cross and Blue Shield — represents our existing Anthem-branded and affiliated Blue Cross and/or Blue Shield licensed plans;
Wellpoint — we intend to unite select non-BCBSA licensed Medicare, Medicaid and Commercial plans under the Wellpoint name; and
Carelon — this brand will bring together our healthcare brands and capabilities, including our Diversified Business Group and IngenioRx business under a single brand name. We now refer to our Diversified Business Group as Carelon. In January 2023, IngenioRx will become CarelonRx.
There are currently no segment changes associated with this branding strategy.
-8-


2.     Basis of Presentation and Significant Accounting Policies
Basis of Presentation: The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) for interim financial reporting. Accordingly, they do not include all of the information and footnotes required by GAAP for annual financial statements. We have omitted certain footnote disclosures that would substantially duplicate the disclosures in our 2021 Annual Report on Form 10-K, unless the information contained in those disclosures materially changed or is required by GAAP. In the opinion of management, all adjustments, including normal recurring adjustments, necessary for a fair statement of the consolidated financial statements as of and for the three and six months ended March 31,June 30, 2022 and 2021 have been recorded. The results of operations for the three and six months ended March 31,June 30, 2022 are not necessarily indicative of the results that may be expected for the full year ending December 31, 2022, or any other period. These unaudited consolidated financial statements should be read in conjunction with our audited consolidated financial statements as of and for the year ended December 31, 2021 included in our 2021 Annual Report on Form 10-K.
Certain of our subsidiaries operate outside of the United States and have functional currencies other than the U.S. dollar (“USD”). We translate the assets and liabilities of those subsidiaries to USD using the exchange rate in effect at the end of the
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period. We translate the revenues and expenses of those subsidiaries to USD using the average exchange rates in effect during the period. The net effect of these translation adjustments is included in “Foreign currency translation adjustments” in our consolidated statements of comprehensive income.
Cash and Cash Equivalents: We control a number of bank accounts that are used exclusively to hold customer funds for the administration of customer benefits and we have cash and cash equivalents on deposit to meet certain regulatory requirements. These amounts totaled $162$306 and $173 at March 31,June 30, 2022 and December 31, 2021, respectively, and are included in the cash and cash equivalents line on our consolidated balance sheets.
Investments: We classify fixed maturity securities in our investment portfolio as “available-for-sale” and report those securities at fair value. Certain fixed maturity securities are available to support current operations and, accordingly, we classify such investments as current assets without regard to their contractual maturity. Investments used to satisfy contractual, regulatory or other requirements are classified as long-term, without regard to contractual maturity.
If a fixed maturity security is in an unrealized loss position and we have the intent to sell the fixed maturity security, or it is more likely than not that we will have to sell the fixed maturity security before recovery of its amortized cost basis, we write down the fixed maturity security’s cost basis to fair value and record an impairment loss in our consolidated statements of income. For impaired fixed maturity securities that we do not intend to sell or if it is more likely than not that we will not have to sell such securities, but we expect that we will not fully recover the amortized cost basis, we recognize the credit component of the impairment as an allowance for credit loss in our consolidated balance sheets and record an impairment loss in our consolidated statements of income. The non-credit component of the impairment is recognized in accumulated other comprehensive loss. Furthermore, unrealized losses entirely caused by non-credit-related factors related to fixed maturity securities for which we expect to fully recover the amortized cost basis continue to be recognized in accumulated other comprehensive loss.
The credit component of an impairment is determined primarily by comparing the net present value of projected future cash flows with the amortized cost basis of the fixed maturity security. The net present value is calculated by discounting our best estimate of projected future cash flows at the effective interest rate implicit in the fixed maturity security at the date of purchase. For mortgage-backed and asset-backed securities, cash flow estimates are based on assumptions regarding the underlying collateral, including prepayment speeds, vintage, type of underlying asset, geographic concentrations, default rates, recoveries and changes in value. For all other securities, cash flow estimates are driven by assumptions regarding probability of default, including changes in credit ratings and estimates regarding timing and amount of recoveries associated with a default.
For asset-backed securities included in fixed maturity securities, we recognize income using an effective yield based on anticipated prepayments and the estimated economic life of the securities. When estimates of prepayments change, the effective yield is recalculated to reflect actual payments to date and anticipated future payments. The net investment in the securities is adjusted to the amount that would have existed had the new effective yield been applied since the purchase date of the securities. Such adjustments are reported within net investment income.
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The changes in fair value of our marketable equity securities are recognized in our results of operations within net gains and losses on financial instruments. Certain marketable equity securities are held to satisfy contractual obligations, and are reported under the caption “Other invested assets” in our consolidated balance sheets.
We have corporate-owned life insurance policies on certain participants in our deferred compensation plans and other members of management. The cash surrender value of the corporate-owned life insurance policies is reported under the caption “Other invested assets” in our consolidated balance sheets.
We use the equity method of accounting for investments in companies in which our ownership interest may enable us to influence the operating or financial decisions of the investee company. Our proportionate share of equity in net income of these unconsolidated affiliates is reported within net investment income. The equity method investments are reported under the caption “Other invested assets” in our consolidated balance sheets.
Investment income is recorded when earned. All securities sold resulting in investment gains and losses are recorded on the trade date. Realized gains and losses are determined on the basis of the cost or amortized cost of the specific securities sold.
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We participate in securities lending programs whereby marketable securities in our investment portfolio are transferred to independent brokers or dealers in exchange for cash and securities collateral. We recognize the collateral as an asset, which is reported under the caption “Other current assets” in our consolidated balance sheets, and we record a corresponding liability for the obligation to return the collateral to the borrower, which is reported under the caption “Other current liabilities” in our consolidated balance sheets. The securities on loan are reported in the applicable investment category on our consolidated balance sheets. Unrealized gains or losses on securities lending collateral are included in accumulated other comprehensive loss as a separate component of shareholders’ equity. The market value of loaned securities and that of the collateral pledged can fluctuate in non-synchronized fashions. To the extent the loaned securities’ value appreciates faster or depreciates slower than the value of the collateral pledged, we are exposed to the risk of the shortfall. As a primary mitigating mechanism, the loaned securities and collateral pledged are marked to market on a daily basis and the shortfall, if any, is collected accordingly. Secondarily, the collateral level is set at 102% of the value of the loaned securities, which provides a cushion before any shortfall arises. The investment of the cash collateral is subject to market risk, which is managed by limiting the investments to higher quality and shorter duration instruments.
Receivables: Receivables are reported net of amounts for expected credit losses. The allowance for doubtful accounts is based on historical collection trends, future forecasts and our judgment regarding the ability to collect specific accounts.
Premium receivables include the uncollected amounts from insuredrisk-based groups, individuals and government programs.programs for insurance services. Premium receivables are reported net of an allowance for doubtful accounts of $140$137 and $142 at March 31,June 30, 2022 and December 31, 2021, respectively.
Self-funded receivables include administrative fees, claims and other amounts due from self-funded customers.fee-based customers for administrative services. Self-funded receivables are reported net of an allowance for doubtful accounts of $53$86 and $50 at March 31,June 30, 2022 and December 31, 2021, respectively.
Other receivables include pharmacy rebates, provider advances, claims recoveries, reinsurance receivables, proceeds due from brokers on investment trades, accrued investment income, and other miscellaneous amounts due to us. These receivables are reported net of an allowance for doubtful accounts of $698$699 and $648 at March 31,June 30, 2022 and December 31, 2021, respectively.
Revenue Recognition: For our non-risk-based contracts, we had no material contract assets, contract liabilities or deferred contract costs recorded on our consolidated balance sheet at March 31,June 30, 2022. For the three and six months ended March 31,June 30, 2022 and 2021, revenue recognized from performance obligations related to prior periods, such as due to changes in transaction price, was not material. For contracts that have an original expected duration of greater than one year, revenue expected to be recognized in future periods related to unfulfilled contractual performance obligations and contracts with variable consideration related to undelivered performance obligations is not material.
Recently Adopted Accounting Guidance: In January 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update No. 2021-01, Reference Rate Reform (Topic 848) (“ASU 2021-01”). The amendments in ASU
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2021-01 provide optional expedients and exceptions for applying GAAP to contract modifications and hedging relationships, subject to meeting certain criteria, that reference the London Interbank Offered Rate (“LIBOR”) or another reference rate expected to be discontinued because of the reference rate reform. The provisions must be applied at a Topic, Subtopic, or Industry Subtopic level for all transactions other than derivatives, which may be applied at a hedging relationship level. We adopted ASU 2021-01 on January 7, 2021, and the adoption did not have an impact on our consolidated financial position, results of operations or cash flows.
In October 2020, the FASB issued Accounting Standards Update No. 2020-08, Codification Improvements to Subtopic 310-20, Receivables—Nonrefundable Fees and Other Costs (“ASU 2020-08”). The amendments in ASU 2020-08 clarify when an entity should assess whether a callable debt security is within the scope of accounting guidance, which impacts the amortization period for nonrefundable fees and other costs. ASU 2020-08 became effective for interim and annual reporting periods beginning after December 15, 2020. The amendments were to be applied on a prospective basis as of the beginning of the period of adoption for existing or newly purchased callable debt securities. We adopted ASU 2020-08 on January 1, 2021, and the adoption did not have an impact on our consolidated financial position, results of operations or cash flows.
In August 2020, the FASB issued Accounting Standards Update No. 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting
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for Convertible Instruments and Contracts in an Entity’s Own Equity (“ASU 2020-06”). The amendments eliminate two of the three accounting models that require separate accounting for convertible features of debt securities, simplify the contract settlement assessment for equity classification, require the use of the if-converted method for all convertible instruments in the diluted earnings per share calculation and expand disclosure requirements. The amendments became effective for our annual and interim reporting periods beginning after December 15, 2021. We adopted ASU 2020-06 on January 1, 2022 using the modified retrospective transition method, which resulted in an increase to our reported debt outstanding of $31, a decrease to our deferred tax liabilities of $8, and a corresponding cumulative-effect reduction to our opening retained earnings of $23; thethese amounts are not material to our overall consolidated financial position. The adoption of ASU 2020-06 did not have an impact on our results of operations or our consolidated cash flows. Use of the if-converted method did not have an impact on our overall earnings per share calculation.
In December 2019, the FASB issued Accounting Standards Update No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”). The amendments in ASU 2019-12 remove certain exceptions to the general principles in Accounting Standards Codification Topic 740. The amendments also clarify and amend existing guidance to improve consistent application. The amendments became effective for our annual reporting periods beginning after December 15, 2020. The transition method (retrospective, modified retrospective, or prospective basis) related to the amendments depends on the applicable guidance, and all amendments for which there is no transition guidance specified are to be applied on a prospective basis. We adopted ASU 2019-12 on January 1, 2021, and the adoption did not have an impact on our consolidated financial position, results of operations or cash flows.
Recent Accounting Guidance Not Yet Adopted: In November 2020, the FASB issued Accounting Standards Update No. 2020-11, Financial Services—Insurance (Topic 944): Effective Date and Early Application (“ASU 2020-11”). The amendments in ASU 2020-11 make changes to the effective date and early application of Accounting Standards Update No. 2018-12, Financial Services—Insurance (Topic 944): Targeted Improvements to the Accounting for Long-Duration Contracts (“ASU 2018-12”), which was issued in November 2018. The amendments in ASU 2020-11 have extended the original effective date by one year, and now the amendments are required for our interim and annual reporting periods beginning after December 15, 2022. The amendments in ASU 2018-12 make changes to a variety of areas to simplify or improve the existing recognition, measurement, presentation and disclosure requirements for long-duration contracts issued by an insurance entity. The amendments require insurers to annually review the assumptions they make about their policyholders and update the liabilities for future policy benefits if the assumptions change. The amendments also simplify the amortization of deferred contract acquisition costs and add new disclosure requirements about the assumptions insurers use to measure their liabilities and how they may affect future cash flows. The amendments related to the liability for future policy benefits for traditional and limited-payment contracts and deferred acquisition costs are to be applied to contracts in force as of the beginning of the earliest period presented, with an option to apply such amendments retrospectively with a cumulative-effect adjustment to the opening balance of retained earnings as of the earliest period presented. The amendments for market risk benefits are to be applied retrospectively. We are currently evaluating the effects the adoption of ASU 2020-11 and ASU 2018-12 will have on our consolidated financial position, results of operations, cash flows, and related disclosures.
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There were no other new accounting pronouncements that were issued or became effective since the issuance of our 2021 Annual Report on Form 10-K that had, or are expected to have, a material impact on our consolidated financial position, results of operations or cash flows.
3.    Business Acquisitions
Pending Acquisition
On November 10, 2021, we announced our entrance into an agreement with Personal Touch Holding Corporation to acquire Integra Managed Care (“Integra”). Integra is a managed long-term care plan that serves New York state Medicaid members, enabling adults with long-term care needs and disabilities to live safely and independently in their own home. The acquisition is expected to close by the end of the second quarter of 2022 and is subject to standard closing conditions and customary approvals.
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Completed Acquisitions
On May 5, 2022, we completed our acquisition of Integra Managed Care (“Integra”) from Personal Touch Holding Corporation. Integra is a managed long-term care plan that serves New York state Medicaid members, enabling adults with long-term care needs and disabilities to live safely and independently in their own homes. The purchase price was allocated to the tangible and intangible net assets acquired based on management’s initial estimates of their fair values, of which $89 has been allocated to finite-lived intangible assets, $250 to indefinite-lived intangible assets, and $110 to goodwill. The majority of goodwill is deductible for income tax purposes.
Acquisitions completed during the year ended December 31, 2021, for which the initial accounting was not finalized as of March 31,June 30, 2022, included myNEXUS, Inc. (“myNEXUS”), a comprehensive home-based nursing management company for payors, and MMM Holdings, LLC (“MMM”), including its Medicare Advantage plan, Medicaid plan and other affiliated companies. As of March 31,June 30, 2022, the purchase price of each transaction was allocated to the tangible and intangible net assets acquired based on management’s final estimates of their fair values, of which $1,577 has been allocated to finite-lived intangible assets, $20 to indefinite-lived intangible assets, and $2,525$2,531 to goodwill. The majority of goodwill is not deductible for income tax purposes. Adjustments to goodwill arising from contractual purchase price adjustments and subsequent adjustments made to the assets acquired or liabilities assumed during the quarter ended March 31,June 30, 2022 were $4.$6.
4.    Business Optimization Initiatives
Provided below is a summary of the activity, by reportable segment, related to the liability for employee termination costs previously incurred in connection with our enterprise-wide business optimization initiatives introduced in 2020.
Commercial & Specialty BusinessGovernment BusinessIngenioRxOtherTotalCommercial & Specialty BusinessGovernment BusinessIngenioRxOtherTotal
2020 Business Optimization Initiatives2020 Business Optimization Initiatives2020 Business Optimization Initiatives
Employee termination costs:Employee termination costs:Employee termination costs:
Liability for employee termination costs at January 1, 2022Liability for employee termination costs at January 1, 2022$61 $57 $$$122 Liability for employee termination costs at January 1, 2022$61 $57 $$$122 
PaymentsPayments(5)(5)— — (10)Payments(10)(10)— — (20)
Liability for employee termination costs at March 31, 2022$56 $52 $$$112 
Liability for employee termination costs at June 30, 2022Liability for employee termination costs at June 30, 2022$51 $47 $$$102 
5.     Investments
Fixed Maturity Securities
We evaluate our available-for-sale fixed maturity securities for declines based on qualitative and quantitative factors. We have established an allowance for credit loss and recorded credit loss expense as a reflection of our expected impairment losses. We continue to review our investment portfolios under our impairment review policy. Given the inherent uncertainty of changes in market conditions and the significant judgments involved, there is a continuing risk that declines in fair value may occur and additional material impairment losses on investments may be recorded in future periods.
Although not material to our consolidated results of operations, during the threesix months ended March 31,June 30, 2022, we recorded a combination of credit losses, losses on sale of fixed maturity securities and impairments related to our exposure resulting from investments in Russia and Ukraine. These items are reflected in the tables presented below. At March 31,June 30, 2022, our remaining holdings of Russia and Ukraine fixed maturity securities were not material.

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A summary of current and long-term fixed maturity securities, available-for-sale, at March 31,June 30, 2022 and December 31, 2021 is as follows:
Cost or Amortized CostGross
Unrealized
Gains
Gross
Unrealized
Losses
Allowance
For Credit
Losses
Estimated
Fair Value
Cost or Amortized CostGross
Unrealized
Gains
Gross
Unrealized
Losses
Allowance
For Credit
Losses
Estimated
Fair Value
Cost or Amortized CostGross
Unrealized
Gains
Gross
Unrealized
Losses
Allowance
For Credit
Losses
Estimated
Fair Value
March 31, 2022
June 30, 2022June 30, 2022
Fixed maturity securities:Fixed maturity securities:Fixed maturity securities:
United States Government securitiesUnited States Government securities$2,145 $— $(78)$— $2,067 United States Government securities$1,479 $$(75)$— $1,405 
Government sponsored securitiesGovernment sponsored securities54 (2)— 54 Government sponsored securities70 (3)— 69 
Foreign government securitiesForeign government securities343 (25)(3)317 Foreign government securities323 — (60)(1)262 
States, municipalities and political subdivisionsStates, municipalities and political subdivisions5,369 84 (126)— 5,327 States, municipalities and political subdivisions4,954 30 (214)— 4,770 
Corporate securitiesCorporate securities12,361 104 (491)(8)11,966 Corporate securities13,135 15 (1,179)(5)11,966 
Residential mortgage-backed securitiesResidential mortgage-backed securities4,262 18 (174)(2)4,104 Residential mortgage-backed securities4,630 (322)(2)4,315 
Commercial mortgage-backed securitiesCommercial mortgage-backed securities82 (4)— 79 Commercial mortgage-backed securities79 — (5)— 74 
Other securitiesOther securities2,967 13 (79)— 2,901 Other securities3,674 (175)— 3,507 
Total fixed maturity securitiesTotal fixed maturity securities$27,583 $224 $(979)$(13)$26,815 Total fixed maturity securities$28,344 $65 $(2,033)$(8)$26,368 
December 31, 2021December 31, 2021December 31, 2021
Fixed maturity securities:Fixed maturity securities:Fixed maturity securities:
United States Government securitiesUnited States Government securities$1,443 $$(18)$— $1,432 United States Government securities$1,443 $$(18)$— $1,432 
Government sponsored securitiesGovernment sponsored securities65 (1)— 68 Government sponsored securities65 (1)— 68 
Foreign government securitiesForeign government securities353 (13)— 347 Foreign government securities353 (13)— 347 
States, municipalities and political subdivisionsStates, municipalities and political subdivisions5,321 310 (10)— 5,621 States, municipalities and political subdivisions5,321 310 (10)— 5,621 
Corporate securitiesCorporate securities12,044 401 (78)(4)12,363 Corporate securities12,044 401 (78)(4)12,363 
Residential mortgage-backed securitiesResidential mortgage-backed securities4,059 75 (35)(2)4,097 Residential mortgage-backed securities4,059 75 (35)(2)4,097 
Commercial mortgage-backed securitiesCommercial mortgage-backed securities65 (3)— 64 Commercial mortgage-backed securities65 (3)— 64 
Other securitiesOther securities2,907 24 (24)— 2,907 Other securities2,907 24 (24)— 2,907 
Total fixed maturity securitiesTotal fixed maturity securities$26,257 $830 $(182)$(6)$26,899 Total fixed maturity securities$26,257 $830 $(182)$(6)$26,899 

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For fixed maturity securities in an unrealized loss position at March 31,June 30, 2022 and December 31, 2021, the following table summarizes the aggregate fair values and gross unrealized losses by length of time those securities have continuously been in an unrealized loss position: 
Less than 12 Months12 Months or Greater Less than 12 Months12 Months or Greater
(Securities are whole amounts)(Securities are whole amounts)Number of
Securities
Estimated
Fair Value
Gross
Unrealized
Loss
Number of
Securities
Estimated
Fair Value
Gross
Unrealized
Loss
(Securities are whole amounts)Number of
Securities
Estimated
Fair Value
Gross
Unrealized
Loss
Number of
Securities
Estimated
Fair Value
Gross
Unrealized
Loss
March 31, 2022
June 30, 2022June 30, 2022
Fixed maturity securities:Fixed maturity securities:Fixed maturity securities:
United States Government securitiesUnited States Government securities86 $1,801 $(66)20 $149 $(12)United States Government securities77 $1,144 $(60)18 $139 $(15)
Government sponsored securitiesGovernment sponsored securities25 21 (1)(1)Government sponsored securities39 41 (2)(1)
Foreign government securitiesForeign government securities233 205 (15)95 54 (10)Foreign government securities259 207 (40)100 50 (20)
States, municipalities and political subdivisionsStates, municipalities and political subdivisions1,140 2,088 (123)23 25 (3)States, municipalities and political subdivisions1,557 2,887 (209)26 30 (5)
Corporate securitiesCorporate securities3,616 7,520 (423)532 620 (68)Corporate securities4,500 10,502 (1,048)593 629 (131)
Residential mortgage-backed securitiesResidential mortgage-backed securities1,547 3,142 (137)184 419 (37)Residential mortgage-backed securities1,979 3,630 (266)214 444 (56)
Commercial mortgage-backed securitiesCommercial mortgage-backed securities21 51 (1)(3)Commercial mortgage-backed securities30 54 (2)14 (3)
Other securitiesOther securities746 2,240 (70)84 183 (9)Other securities925 2,748 (154)109 220 (21)
Total fixed maturity securitiesTotal fixed maturity securities7,414 $17,068 $(836)944 $1,460 $(143)Total fixed maturity securities9,366 $21,213 $(1,781)1,068 $1,527 $(252)
December 31, 2021December 31, 2021December 31, 2021
Fixed maturity securities:Fixed maturity securities:Fixed maturity securities:
United States Government securitiesUnited States Government securities51 $990 $(11)27 $176 $(7)United States Government securities51 $990 $(11)27 $176 $(7)
Government sponsored securitiesGovernment sponsored securities— — — (1)Government sponsored securities— — — (1)
Foreign government securitiesForeign government securities188 143 (8)68 41 (5)Foreign government securities188 143 (8)68 41 (5)
States, municipalities and political subdivisionsStates, municipalities and political subdivisions281 634 (9)16 (1)States, municipalities and political subdivisions281 634 (9)16 (1)
Corporate securitiesCorporate securities1,846 3,310 (57)403 485 (21)Corporate securities1,846 3,310 (57)403 485 (21)
Residential mortgage-backed securitiesResidential mortgage-backed securities692 1,967 (26)125 173 (9)Residential mortgage-backed securities692 1,967 (26)125 173 (9)
Commercial mortgage-backed securitiesCommercial mortgage-backed securities(1)(2)Commercial mortgage-backed securities(1)(2)
Other securitiesOther securities511 1,707 (19)50 85 (5)Other securities511 1,707 (19)50 85 (5)
Total fixed maturity securitiesTotal fixed maturity securities3,571 $8,755 $(131)686 $985 $(51)Total fixed maturity securities3,571 $8,755 $(131)686 $985 $(51)
Below are discussions by security type for unrealized losses and credit losses as of March 31,June 30, 2022:
Foreign government securities: An allowance for credit loss was established on certain foreign government securities related to Russia and the Ukraine. The ongoing Russian/Ukrainian conflict and the uncertainties around future ability to collect payment, as well as a significant decline in fair value, were factors indicating a credit loss. No other foreign government securities had material unrealized losses or qualitative factors to indicate a credit loss.
Corporate securities: An allowance for credit losses on consumer-driven and financial sector fixed maturity corporate securities has been determined based on qualitative and quantitative factors including credit rating, decline in fair value and industry condition along with other available market data. With multiple risk factors present, these securities were reviewed for expected future cash flow to determine the portion of unrealized losses that were credit related and to record an allowance for credit losses. Unrealized losses on our other corporate securities were largely due to market conditions relating to increasing interest rates and the COVID-19 pandemic and increasing interest rates;pandemic; however, qualitative factors did not indicate a credit loss as of March 31,June 30, 2022. We do not intend to sell these investments and it is likely we will not have to sell these investments prior to maturity or recovery of amortized cost.
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Residential mortgage-backed securities: An allowance for credit loss was established on certain residential mortgage-backed securities. Notification of maturity and coupon default, as well as a significant and sustained decline in fair value, were factors to indicate a credit loss. Unrealized losses on our other residential mortgage-backed securities were largely due to market conditions and rising interest rates; however, qualitative factors did not indicate a credit loss. We do not intend to sell these investments and it is likely we will not be required to sell these investments prior to maturity or recovery of amortized cost.
As for the remaining securities shown in the table above, unrealized losses on these securities have not been recognized into income because we do not intend to sell these investments and it is likely that we will not be required to sell these investments prior to their anticipated recovery. The decline in fair value is largely due to changes in interest rates and other market conditions. We have evaluated these securities for any change in credit rating and have determined that no allowance is necessary. The fair value is expected to recover as the securities approach maturity.
The table below presents a roll-forward by major security type of the allowance for credit losses on fixed maturity securities available-for-sale held at period end for the three and six months March 31,ended months June 30, 2022 and 2021:
Three Months Ended March 31, 2022Three Months Ended June 30, 2022Six Months Ended June 30, 2022
Foreign government securitiesCorporate securitiesResidential mortgage-backed securitiesTotalForeign government securitiesCorporate securitiesResidential mortgage-backed securitiesTotalForeign government securitiesCorporate SecuritiesResidential mortgage-backed securitiesTotal
Allowance for credit losses:Allowance for credit losses:Allowance for credit losses:
Beginning balanceBeginning balance$— $$$Beginning balance$$$$13 $— $$$
Additions for securities for which no previous expected credit losses were recognizedAdditions for securities for which no previous expected credit losses were recognized— Additions for securities for which no previous expected credit losses were recognized— — — — — 
Securities sold during the periodSecurities sold during the period(2)(2)— (4)(2)(2)— (4)
Decreases to the allowance for credit losses on securitiesDecreases to the allowance for credit losses on securities— (1)— (1)— (1)— (1)
Total allowance for credit losses, ending balanceTotal allowance for credit losses, ending balance$$$$13 Total allowance for credit losses, ending balance$$$$$$$$
Three Months Ended March 31, 2021Three Months Ended June 30, 2021Six Months Ended June 30, 2021
Corporate securitiesResidential mortgage-backed securitiesTotalCorporate securitiesResidential mortgage-backed securitiesTotalCorporate SecuritiesResidential mortgage-backed securitiesTotal
Allowance for credit losses:Allowance for credit losses:Allowance for credit losses:
Beginning balanceBeginning balance$$— $Beginning balance$$$$$— $
Additions for securities for which no previous expected credit losses were recognizedAdditions for securities for which no previous expected credit losses were recognized— Additions for securities for which no previous expected credit losses were recognized— — — — 
Securities sold during the periodSecurities sold during the period(2)— (2)(2)— (2)
(Decreases) increases to the allowance for credit losses on securities(Decreases) increases to the allowance for credit losses on securities(2)— (Decreases) increases to the allowance for credit losses on securities— — — (2)— 
Total allowance for credit losses, ending balanceTotal allowance for credit losses, ending balance$$$Total allowance for credit losses, ending balance$$$$$$
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The amortized cost and fair value of fixed maturity securities at March 31,June 30, 2022, by contractual maturity, are shown below. Expected maturities may differ from contractual maturities because the issuers of the securities may have the right to prepay obligations.
Amortized
Cost
Estimated
Fair Value
Due in one year or less$1,257 $1,254 
Due after one year through five years6,686 6,569 
Due after five years through ten years9,225 8,905 
Due after ten years6,071 5,904 
Mortgage-backed securities4,344 4,183 
Total fixed maturity securities$27,583 $26,815 
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Amortized
Cost
Estimated
Fair Value
Due in one year or less$897 $892 
Due after one year through five years6,893 6,566 
Due after five years through ten years9,520 8,727 
Due after ten years6,325 5,794 
Mortgage-backed securities4,709 4,389 
Total fixed maturity securities$28,344 $26,368 
During the three and six months ended March 31,June 30, 2022, we received total proceeds from sales, maturities, calls or redemptions of fixed maturity securities of $7,026 and $10,672, respectively. During the three and six months ended June 30, 2021, we received total proceeds from sales, maturities, calls or redemptions of fixed maturity securities of $3,646$627 and $5,323,$5,950, respectively.
In the ordinary course of business, we may sell securities at a loss for a number of reasons, including, but not limited to: (i) changes in the investment environment; (ii) expectation that the fair value could deteriorate further; (iii) desire to reduce exposure to an issuer or an industry; (iv) changes in credit quality; or (v) changes in expected cash flow.
All securities sold resulting in investment gains and losses are recorded on the trade date. Realized gains and losses are determined on the basis of the cost or amortized cost of the specific securities sold.
Equity Securities
A summary of marketable equity securities at March 31,June 30, 2022 and December 31, 2021 is as follows:
March 31, 2022December 31, 2021 June 30, 2022December 31, 2021
Equity securities:Equity securities:Equity securities:
Exchange traded fundsExchange traded funds$1,539 $1,750 Exchange traded funds$1,460 $1,750 
Common equity securitiesCommon equity securities24 42 Common equity securities18 42 
Private equity securitiesPrivate equity securities99 89 Private equity securities94 89 
TotalTotal$1,662 $1,881 Total$1,572 $1,881 
Other Invested Assets
Other invested assets include primarily our investments in limited partnerships, joint ventures and other non-controlled corporations, mortgage loans and the cash surrender value of corporate-owned life insurance policies. Investments in limited partnerships, joint ventures and other non-controlled corporations are carried at our share in the entities’ undistributed earnings, which approximates fair value. Financial information for certain of these investments are reported on a one or three month lag due to the timing of when we receive financial information from the companies.
-16-


Investment Gains and Losses
Net investment (losses) gains (losses) for the three and six months ended March 31,June 30, 2022 and 2021 are as follows:
Three Months Ended March 31
20222021
Net (losses) gains:
Fixed maturity securities:
Gross realized gains from sales$20 $56 
Gross realized losses from sales(78)(12)
Impairment losses recognized in income(20)(1)
Net realized (losses) gains from sales of fixed maturity securities(78)43 
Equity securities:
Unrealized losses recognized on equity securities still held at the end of the period(71)(40)
Net realized losses recognized on equity securities sold during the period(14)(26)
Net losses on equity securities(85)(66)
Other investments:
Gross gains23 
Gross losses(30)— 
Impairment losses recognized in income(4)(8)
Net losses on other investments(11)(3)
Net losses on investments$(174)$(26)
-15-


Three Months Ended
June 30
Six Months Ended
June 30
2022202120222021
Net (losses) gains:
Fixed maturity securities:
Gross realized gains from sales$16 $47 $36 $103 
Gross realized losses from sales(176)(12)(254)(24)
Impairment (losses) recoveries recognized in income(1)(21)
Net realized (losses) gains from sales of fixed maturity securities(161)37 (239)80 
Equity securities:
Unrealized (losses) gains recognized on equity securities still held at the end of the period(83)17 (154)
Net realized (losses) gains recognized on equity securities sold during the period(5)(19)(56)
Net (losses) gains on equity securities(88)18 (173)(48)
Other investments:
Gross gains10 90 33 95 
Gross losses(15)— (44)— 
Impairment (losses) recoveries recognized in income(1)(5)(6)
Net losses on other investments(6)92 (16)89 
Net (losses) gains on investments$(255)$147 $(428)$121 
Accrued Investment Income
At March 31,June 30, 2022 and December 31, 2021, accrued investment income totaled $185$212 and $205, respectively. We recognize accrued investment income under the caption “Other receivables” on our consolidated balance sheets.
Securities Lending Programs
We participate in securities lending programs whereby marketable securities in our investment portfolio are transferred to independent brokers or dealers in exchange for cash and securities collateral. The fair value of the collateral received at the time of the transactions amounted to $2,596$2,775 and $2,155 at March 31,June 30, 2022 and December 31, 2021, respectively. The value of the collateral represented 102% of the market value of the securities on loan at each of March 31,June 30, 2022 and December 31, 2021. We recognize the collateral as an asset under the caption “Other current assets” in our consolidated balance sheets, and we recognize a corresponding liability for the obligation to return the collateral to the borrower under the caption “Other current liabilities.” The securities on loan are reported in the applicable investment category on our consolidated balance sheets.
At March 31,June 30, 2022 and December 31, 2021, the remaining contractual maturity of our securities lending agreements included overnight and continuous transactions of cash for $2,408$2,527 and $1,874, respectively, of United States Government securities for $184$241 and $281, respectively, and of Other securities for $4$7 and $0, respectively.
6.    Derivative Financial Instruments
We primarily invest in the following types of derivative financial instruments: interest rate swaps, futures, forward contracts, put and call options, swaptions, embedded derivatives and warrants. We also enter into master netting agreements, which reduce credit risk by permitting net settlement of transactions.
We have entered into various interest rate swap contracts to convert a portion of our interest rate exposure on our long-term debt from fixed rates to floating rates. The floating rates payable on all of our fair value hedges are benchmarked to
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LIBOR or the Secured Overnight Financing Rate (“SOFR”). Any amounts recognized for changes in fair value of these derivatives are included in the captions “Other current assets,” or “Other noncurrent assets,” or “Other current liabilities” or “Other noncurrent liabilities” in our consolidated balance sheets.
The unrecognized loss for all expired and terminated cash flow hedges included in accumulated other comprehensive loss, net of tax, was $236$233 and $239 at March 31,June 30, 2022 and December 31, 2021, respectively.
During the three and six months ended March 31,June 30, 2022, we recognized net gains on non-hedging derivatives of $24 and $46, respectively. During the three and six months ended June 30, 2021, we recognized net gains on non-hedging derivatives of $23$25 and $22,$47, respectively.
For additional information relating to the fair value of our derivative assets and liabilities, see Note 7, “Fair Value,” of this Form 10-Q.
7.    Fair Value
Assets and liabilities recorded at fair value in our consolidated balance sheets are categorized based upon the level of judgment associated with the inputs used to measure their fair value. Level inputs, as defined by FASB guidance for fair value measurements and disclosures, are as follows:
Level InputInput Definition
Level IInputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date.
Level IIInputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date.
Level IIIUnobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date.
-16-


The following methods, assumptions and inputs were used to determine the fair value of each class of the following assets and liabilities recorded at fair value in our consolidated balance sheets:
Cash equivalents: Cash equivalents primarily consist of highly rated money market funds with maturities of three months or less and are purchased daily at par value with specified yield rates. Due to the high ratings and short-term nature of the funds, we designate all cash equivalents as Level I.
Fixed maturity securities, available-for-sale: Fair values of available-for-sale fixed maturity securities are based on quoted market prices, where available. These fair values are obtained primarily from third-party pricing services, which generally use Level I or Level II inputs for the determination of fair value to facilitate fair value measurements and disclosures. Level II securities primarily include corporate securities, securities from states, municipalities and political subdivisions, mortgage-backed securities, United States government securities, foreign government securities, and certain other asset-backed securities. For securities not actively traded, the pricing services may use quoted market prices of comparable instruments or discounted cash flow analyses, incorporating inputs that are currently observable in the markets for similar securities. We have controls in place to review the pricing services’ qualifications and procedures used to determine fair values. In addition, we periodically review the pricing services’ pricing methodologies, data sources and pricing inputs to ensure the fair values obtained are reasonable. Inputs that are often used in the valuation methodologies include, but are not limited to, broker quotes, benchmark yields, credit spreads, default rates and prepayment speeds. We also have certain fixed maturity securities, primarily corporate debt securities, which are designated Level III securities. For these securities, the valuation methodologies may incorporate broker quotes or discounted cash flow analyses using assumptions for inputs such as expected cash flows, benchmark yields, credit spreads, default rates and prepayment speeds that are not observable in the markets.
Equity securities: Fair values of equity securities are generally designated as Level I and are based on quoted market prices. For certain equity securities, quoted market prices for the identical security are not always available, and the fair value is estimated by reference to similar securities for which quoted prices are available. These securities are designated Level II. We also have certain equity securities, including private equity securities, for which the fair value is estimated based on each security’s current condition and future cash flow projections. Such securities are designated Level III. The fair values of these private equity securities are generally based on either broker quotes or discounted cash flow projections using assumptions
-18-


for inputs such as the weighted-average cost of capital, long-term revenue growth rates and earnings before interest, taxes, depreciation and amortization, and/or revenue multiples that are not observable in the markets.
Securities lending collateral: Fair values of securities lending collateral are based on quoted market prices, where available. These fair values are obtained primarily from third-party pricing services, which generally use Level I or Level II inputs for the determination of fair value, to facilitate fair value measurements and disclosures.
Derivatives: Fair values are based on the quoted market prices by the financial institution that is the counterparty to the derivative transaction. We independently verify prices provided by the counterparties using valuation models that incorporate observable market inputs for similar derivative transactions. Derivatives are designated as Level II securities. Derivatives presented within the fair value hierarchy table below are presented on a gross basis and not on a master netting basis by counterparty.

-17--19-


A summary of fair value measurements by level for assets and liabilities measured at fair value on a recurring basis at March 31,June 30, 2022 and December 31, 2021 is as follows:
Level ILevel IILevel IIITotalLevel ILevel IILevel IIITotal
March 31, 2022
June 30, 2022June 30, 2022
Assets:Assets:Assets:
Cash equivalentsCash equivalents$2,831 $— $— $2,831 Cash equivalents$3,036 $— $— $3,036 
Fixed maturity securities, available-for-sale:Fixed maturity securities, available-for-sale:Fixed maturity securities, available-for-sale:
United States Government securitiesUnited States Government securities— 2,067 — 2,067 United States Government securities— 1,405 — 1,405 
Government sponsored securitiesGovernment sponsored securities— 54 — 54 Government sponsored securities— 69 — 69 
Foreign government securitiesForeign government securities— 317 — 317 Foreign government securities— 262 — 262 
States, municipalities and political subdivisions, tax-exemptStates, municipalities and political subdivisions, tax-exempt— 5,327 — 5,327 States, municipalities and political subdivisions, tax-exempt— 4,770 — 4,770 
Corporate securitiesCorporate securities— 11,625 341 11,966 Corporate securities— 11,811 155 11,966 
Residential mortgage-backed securitiesResidential mortgage-backed securities— 4,100 4,104 Residential mortgage-backed securities— 4,315 — 4,315 
Commercial mortgage-backed securitiesCommercial mortgage-backed securities— 79 — 79 Commercial mortgage-backed securities— 74 — 74 
Other securitiesOther securities— 2,864 37 2,901 Other securities— 3,289 218 3,507 
Total fixed maturity securities, available-for-saleTotal fixed maturity securities, available-for-sale— 26,433 382 26,815 Total fixed maturity securities, available-for-sale— 25,995 373 26,368 
Equity securities:Equity securities:Equity securities:
Exchange traded fundsExchange traded funds1,539 — — 1,539 Exchange traded funds1,460 — — 1,460 
Common equity securitiesCommon equity securities16 — 24 Common equity securities10 — 18 
Private equity securitiesPrivate equity securities— — 99 99 Private equity securities— — 94 94 
Total equity securitiesTotal equity securities1,547 16 99 1,662 Total equity securities1,468 10 94 1,572 
Other invested assets - common equity securitiesOther invested assets - common equity securities126 — — 126 Other invested assets - common equity securities127 — — 127 
Securities lending collateralSecurities lending collateral— 2,596 — 2,596 Securities lending collateral— 2,775 — 2,775 
Derivatives - other assetsDerivatives - other assets— — Derivatives - other assets— — 
Total assetsTotal assets$4,504 $29,054 $481 $34,039 Total assets$4,631 $28,787 $467 $33,885 
Liabilities:Liabilities:Liabilities:
Derivatives - other liabilitiesDerivatives - other liabilities$— $(19)$— $(19)Derivatives - other liabilities$— $(36)$— $(36)
Total liabilitiesTotal liabilities$— $(19)$— $(19)Total liabilities$— $(36)$— $(36)
December 31, 2021December 31, 2021December 31, 2021
Assets:Assets:Assets:
Cash equivalentsCash equivalents$2,415 $— $— $2,415 Cash equivalents$2,415 $— $— $2,415 
Fixed maturity securities, available-for-sale:Fixed maturity securities, available-for-sale:Fixed maturity securities, available-for-sale:
United States Government securitiesUnited States Government securities— 1,432 — 1,432 United States Government securities— 1,432 — 1,432 
Government sponsored securitiesGovernment sponsored securities— 68 — 68 Government sponsored securities— 68 — 68 
Foreign government securitiesForeign government securities— 347 — 347 Foreign government securities— 347 — 347 
States, municipalities and political subdivisions, tax-exemptStates, municipalities and political subdivisions, tax-exempt— 5,621 — 5,621 States, municipalities and political subdivisions, tax-exempt— 5,621 — 5,621 
Corporate securitiesCorporate securities— 12,027 336 12,363 Corporate securities— 12,027 336 12,363 
Residential mortgage-backed securitiesResidential mortgage-backed securities— 4,092 4,097 Residential mortgage-backed securities— 4,092 4,097 
Commercial mortgage-backed securitiesCommercial mortgage-backed securities— 64 — 64 Commercial mortgage-backed securities— 64 — 64 
Other securitiesOther securities— 2,888 19 2,907 Other securities— 2,888 19 2,907 
Total fixed maturity securities, available-for-saleTotal fixed maturity securities, available-for-sale— 26,539 360 26,899 Total fixed maturity securities, available-for-sale— 26,539 360 26,899 
Equity securities:Equity securities:Equity securities:
Exchange traded fundsExchange traded funds1,750 — — 1,750 Exchange traded funds1,750 — — 1,750 
Common equity securitiesCommon equity securities34 — 42 Common equity securities34 — 42 
Private equity securitiesPrivate equity securities— — 89 89 Private equity securities— — 89 89 
Total equity securitiesTotal equity securities1,758 34 89 1,881 Total equity securities1,758 34 89 1,881 
Other invested assets - common equity securitiesOther invested assets - common equity securities138 — — 138 Other invested assets - common equity securities138 — — 138 
Securities lending collateralSecurities lending collateral— 2,155 — 2,155 Securities lending collateral— 2,155 — 2,155 
Derivatives - other assetsDerivatives - other assets— 19 — 19 Derivatives - other assets— 19 — 19 
Total assetsTotal assets$4,311 $28,747 $449 $33,507 Total assets$4,311 $28,747 $449 $33,507 
Liabilities:Liabilities:Liabilities:
Derivatives - other liabilitiesDerivatives - other liabilities$— $(1)$— $(1)Derivatives - other liabilities$— $(1)$— $(1)
Total liabilitiesTotal liabilities$— $(1)$— $(1)Total liabilities$— $(1)$— $(1)
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A reconciliation of the beginning and ending balances of assets measured at fair value on a recurring basis using Level III inputs for the three months ended March 31,June 30, 2022 and 2021 is as follows:
Corporate
Securities
Residential
Mortgage-
backed
Securities
Other 
Securities
Equity
Securities
Total
Three Months Ended March 31, 2022
Beginning balance at January 1, 2022$336 $$19 $89 $449 
Total gains (losses):
Recognized in net income— — 
Recognized in accumulated other comprehensive (loss) income(2)(1)— (2)
Purchases46 — 17 71 
Sales(7)— — (1)(8)
Settlements(33)— — — (33)
Ending balance at March 31, 2022$341 $$37 $99 $481 
Change in unrealized gains (losses) included in net income related to assets still held at March 31, 2022$— $— $— $$
Three Months Ended March 31, 2021
Beginning balance at January 1, 2021$325 $$$60 $392 
Total gains:
Recognized in net income— — — 
Recognized in accumulated other comprehensive (loss) income— — — 
Purchases39 — — — 39 
Sales(2)— — (3)(5)
Settlements(41)— — — (41)
Ending balance at March 31, 2021$324 $$$65 $396 
Change in unrealized gains (losses) included in net income related to assets still held at March 31, 2021$— $— $— $$
Corporate
Securities
Residential
Mortgage-
backed
Securities
Other 
Securities
Equity
Securities
Total
Three Months Ended June 30, 2022
Beginning balance at April 1, 2022$341 $$37 $99 $481 
Total losses:
Recognized in net income(5)— — (2)(7)
Purchases11 — 190 11 212 
Sales(188)— — (14)(202)
Settlements(5)— — — (5)
Transfers into Level III14 — — — 14 
Transfers out of Level III(13)(4)(9)— (26)
Ending balance at June 30, 2022$155 $— $218 $94 $467 
Change in unrealized losses included in net income related to assets still held at June 30, 2022$— $— $— $(3)$(3)
Three Months Ended June 30, 2021
Beginning balance at April 1, 2021$324 $$$65 $396 
Total gains:
Recognized in net income— — — 
Recognized in accumulated other comprehensive loss— — — 
Purchases65 — 75 
Sales(9)— — (1)(10)
Settlements(32)— — — (32)
Ending balance at June 30, 2021$351 $$$77 $437 
Change in unrealized gains included in net income related to assets still held at June 30, 2021$— $— $— $$
















-21-


A reconciliation of the beginning and ending balances of assets measured at fair value on a recurring basis using Level III inputs for the six months ended June 30, 2022 and 2021 is as follows:
Corporate
Securities
Residential
Mortgage-
backed
Securities
Other 
Securities
Equity
Securities
Total
Six Months Ended June 30, 2022
Beginning balance at January 1, 2022$336 $$19 $89 $449 
Total losses:
Recognized in net income(4)— — (3)
Recognized in accumulated other comprehensive loss(2)— — — (2)
Purchases35 — 205 20 260 
Sales(175)— — (16)(191)
Settlements(39)— — — (39)
Transfers into Level III14 — — — 14 
Transfers out of Level III(10)(5)(6)— (21)
Ending balance at June 30, 2022$155 $— $218 $94 $467 
Change in unrealized gains included in net income related to assets still held at June 30, 2022$— $— $— $$
Six Months Ended June 30, 2021
Beginning balance at January 1, 2021$325 $$$60 $392 
Total gains:
Recognized in net income— — — 13 13 
Recognized in accumulated other comprehensive loss— — — 
Purchases104 — 114 
Sales(11)— — (4)(15)
Settlements(73)— — — (73)
Ending balance at June 30, 2021$351 $$$77 $437 
Change in unrealized gains included in net income related to assets still held at June 30, 2021$— $— $— $13 $13 
There were no individually material transfers into or out of Level III during the three and six months ended March 31,June 30, 2022 or 2021.
Certain assets and liabilities are measured at fair value on a nonrecurring basis; that is, the instruments are not measured at fair value on an ongoing basis but are subject to fair value adjustments only in certain circumstances. As disclosed in Note 3, “Business Acquisitions,” we completed our acquisition of Integra in the second quarter of 2022 and the acquisitions of myNEXUS and MMM during the second quarter of 2021. The net assets acquired in our acquisitions of Integra, myNEXUS and MMM and resulting goodwill and other intangible assets were recorded at fair value primarily using Level III inputs. The majority of assets acquired and liabilities assumed were recorded at their carrying values as of the respective date of acquisition, as their carrying values approximated their fair values due to their short-term nature. The fair values of goodwill and other intangible assets acquired in our acquisitions of Integra, myNEXUS and MMM were internally estimated based on the income approach. The income approach estimates fair value based on the present value of the cash flows that the assets could be expected to generate in the future. We developed internal estimates for the expected cash flows and discount rate in the present value calculation. Other than the assets acquired and liabilities assumed in our acquisitions of Integra, myNEXUS and MMM described above, there were no material assets or liabilities measured at fair value on a nonrecurring basis during the three and six months ended March 31,June 30, 2022 or 2021.
-22-


Our valuation policy is determined by members of our treasury and accounting departments. Whenever possible, our policy is to obtain quoted market prices in active markets to estimate fair values for recognition and disclosure purposes. Where quoted market prices in active markets are not available, fair values are estimated using discounted cash flow analyses, broker quotes, unobservable inputs or other valuation techniques. These techniques are significantly affected by our assumptions, including discount rates and estimates of future cash flows. The use of assumptions for unobservable inputs for the determination of fair value involves a level of judgment and uncertainty. Changes in assumptions that reasonably could have been different at the reporting date may result in a higher or lower determination of fair value. Changes in fair value measurements, if significant, may affect performance of cash flows.
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Potential taxes and other transaction costs are not considered in estimating fair values. Our valuation policy is generally to obtain quoted prices for each security from third-party pricing services, which are derived through recently reported trades for identical or similar securities making adjustments through the reporting date based upon available market observable information. As we are responsible for the determination of fair value, we perform analysis on the prices received from the pricing services to determine whether the prices are reasonable estimates of fair value. This analysis is performed by our internal treasury personnel who are familiar with our investment portfolios, the pricing services engaged and the valuation techniques and inputs used. Our analysis includes procedures such as a review of month-to-month price fluctuations and price comparisons to secondary pricing services. There were no adjustments to quoted market prices obtained from the pricing services during the three and six months ended March 31,June 30, 2022 or 2021.
In addition to the preceding disclosures on assets recorded at fair value in the consolidated balance sheets, FASB guidance also requires the disclosure of fair values for certain other financial instruments for which it is practicable to estimate fair value, whether or not such values are recognized in our consolidated balance sheets.
Non-financial instruments such as real estate, property and equipment, other current assets, deferred income taxes, intangible assets and certain financial instruments, such as policy liabilities, are excluded from the fair value disclosures. Therefore, the fair value amounts cannot be aggregated to determine our underlying economic value.
The carrying amounts reported in the consolidated balance sheets for cash, premium receivables, self-funded receivables, other receivables, unearned income, accounts payable and accrued expenses, and certain other current liabilities approximate fair value because of the short-term nature of these items. These assets and liabilities are not listed in the table below.
The following methods and assumptions were used to estimate the fair value of each class of financial instrument that is recorded at its carrying value in our consolidated balance sheets:
Other invested assets: Other invested assets include primarily our investments in limited partnerships, joint ventures and other non-controlled corporations and mortgage loans, as well as the cash surrender value of corporate-owned life insurance policies. Investments in limited partnerships, joint ventures and other non-controlled corporations are carried at our share in the entities’ undistributed earnings, which approximates fair value. Mortgage loans are carried at amortized cost, which approximates fair value. The carrying value of corporate-owned life insurance policies represents the cash surrender value as reported by the respective insurer, which approximates fair value.
Short-term borrowings: The fair value of our short-term borrowings is based on quoted market prices for the same or similar debt, or, if no quoted market prices were available, on the current market interest rates estimated to be available to us for debt of similar terms and remaining maturities.
Long-term debt—commercial paper: The carrying amount for commercial paper approximates fair value, as the underlying instruments have variable interest rates at market value.
Long-term debt—senior unsecured notes and surplus notes: The fair values of our notes are based on quoted market prices in active markets for the same or similar debt, or, if no quoted market prices are available, on the current market observable rates estimated to be available to us for debt of similar terms and remaining maturities.
Long-term debt—convertible debentures: The fair value of our convertible debentures is based on the quoted market price in the active private market in which the convertible debentures trade.
-20--23-


A summary of the estimated fair values by level of each class of financial instrument that is recorded at its carrying value on our consolidated balance sheets at March 31,June 30, 2022 and December 31, 2021 is as follows:
Carrying
Value
Estimated Fair Value Carrying
Value
Estimated Fair Value
Level ILevel IILevel IIITotal Level ILevel IILevel IIITotal
March 31, 2022
June 30, 2022June 30, 2022
Assets:Assets:Assets:
Other invested assetsOther invested assets$5,239 $— $— $5,239 $5,239 Other invested assets$5,271 $— $— $5,271 $5,271 
Liabilities:Liabilities:Liabilities:
Debt:Debt:Debt:
Short-term borrowingsShort-term borrowings275 — 275 — 275 Short-term borrowings175 — 175 — 175 
Commercial paperCommercial paper525 — 525 — 525 Commercial paper550 — 550 — 550 
NotesNotes22,354 — 23,030 — 23,030 Notes22,774 — 21,596 — 21,596 
Convertible debenturesConvertible debentures102 — 730 — 730 Convertible debentures89 — 718 — 718 
December 31, 2021December 31, 2021December 31, 2021
Assets:Assets:Assets:
Other invested assetsOther invested assets$5,087 $— $— $5,087 $5,087 Other invested assets$5,087 $— $— $5,087 $5,087 
Liabilities:Liabilities:Liabilities:
Debt:Debt:Debt:
Short-term borrowingsShort-term borrowings275 — 275 — 275 Short-term borrowings275 — 275 — 275 
Commercial paperCommercial paper300 — 300 — 300 Commercial paper300 — 300 — 300 
NotesNotes22,384 — 25,150 — 25,150 Notes22,384 — 25,150 — 25,150 
Convertible debenturesConvertible debentures72 — 687 — 687 Convertible debentures72 — 687 — 687 
8.     Income Taxes
During the three months ended March 31,June 30, 2022 and 2021, we recognized income tax expense of $531$493 and $509,$552, respectively, which represent effective income tax rates of 22.8%23.0% and 23.5%, respectively. The decrease in our effective tax rate from the three months ended June 30, 2021 is primarily related to the tax impact of expected geographic changes in our mix of 2022 earnings.
During thesix months ended June 30, 2022 and 2021, we recognized income tax expense of $1,024 and $1,061, respectively, which represent effective income tax rates of 22.9% and 23.4%, respectively. The decrease in our effective tax rate from the threesix months ended March 31,June 30, 2021 was is primarily related to the tax impact of expected geographic changes in our mix of 2022 earnings.
Income taxes payable totaled $395 at March 31, 2022. Income taxes receivable totaled $332 and $173 at June 30, 2022 and December 31, 2021.2021, respectively. We recognized the income tax payable as a liability under the caption “Other current liabilities” and the income taxtaxes receivable as an asset under the caption “Other current assets” in our consolidated balance sheets.
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9. Medical Claims Payable
A reconciliation of the beginning and ending balances for medical claims payable, by segment (see Note 15, “Segment Information”), for the threesix months ended March 31,June 30, 2022 is as follows:
Commercial
& Specialty
Business
Government
Business
OtherTotalCommercial
& Specialty
Business
Government
Business
OtherTotal
Gross medical claims payable, beginning of periodGross medical claims payable, beginning of period$3,847 $9,157 $278 $13,282 Gross medical claims payable, beginning of period$3,847 $9,157 $278 $13,282 
Ceded medical claims payable, beginning of periodCeded medical claims payable, beginning of period(13)(8)— (21)Ceded medical claims payable, beginning of period(13)(8)— (21)
Net medical claims payable, beginning of periodNet medical claims payable, beginning of period3,834 9,149 278 13,261 Net medical claims payable, beginning of period3,834 9,149 278 13,261 
Business combinations and purchase adjustmentsBusiness combinations and purchase adjustments— — Business combinations and purchase adjustments130 — 133 
Net incurred medical claims:Net incurred medical claims:Net incurred medical claims:
Current periodCurrent period7,070 20,586 408 28,064 Current period14,541 40,439 757 55,737 
Prior periods redundanciesPrior periods redundancies(236)(643)(54)(933)Prior periods redundancies(185)(708)(79)(972)
Total net incurred medical claimsTotal net incurred medical claims6,834 19,943 354 27,131 Total net incurred medical claims14,356 39,731 678 54,765 
Net payments attributable to:Net payments attributable to:Net payments attributable to:
Current period medical claimsCurrent period medical claims4,571 12,331 214 17,116 Current period medical claims11,251 31,094 537 42,882 
Prior periods medical claimsPrior periods medical claims2,232 6,457 137 8,826 Prior periods medical claims2,874 7,350 177 10,401 
Total net paymentsTotal net payments6,803 18,788 351 25,942 Total net payments14,125 38,444 714 53,283 
Net medical claims payable, end of periodNet medical claims payable, end of period3,868 10,304 281 14,453 Net medical claims payable, end of period4,068 10,566 242 14,876 
Ceded medical claims payable, end of periodCeded medical claims payable, end of period— 17 Ceded medical claims payable, end of period10 — 13 
Gross medical claims payable, end of periodGross medical claims payable, end of period$3,877 $10,312 $281 $14,470 Gross medical claims payable, end of period$4,078 $10,569 $242 $14,889 
At March 31,June 30, 2022, the total of net incurred but not reported liabilities plus expected development on reported claims for the Commercial & Specialty Business was $148, $1,217$101, $673 and $2,503$3,294 for the claim years 2020 and prior, 2021 and 2022, respectively.
At March 31,June 30, 2022, the total of net incurred but not reported liabilities plus expected development on reported claims for the Government Business was $270, $1,779$223, $869 and $8,255$9,474 for the claim years 2020 and prior, 2021 and 2022, respectively.
At March 31,June 30, 2022, the total of net incurred but not reported liabilities plus expected development on reported claims for Other was $3, $84$1, $21 and $194$220 for the claim years 2020 and prior, 2021 and 2022, respectively.
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A reconciliation of the beginning and ending balances for medical claims payable, by segment (see Note 15, “Segment Information”), for the threesix months ended March 31,June 30, 2021 is as follows:
Commercial
& Specialty
Business
Government
Business
OtherTotalCommercial
& Specialty
Business
Government
Business
OtherTotal
Gross medical claims payable, beginning of periodGross medical claims payable, beginning of period$3,294 $7,646 $195 $11,135 Gross medical claims payable, beginning of period$3,294 $7,646 $195 $11,135 
Ceded medical claims payable, beginning of periodCeded medical claims payable, beginning of period(13)(33)— (46)Ceded medical claims payable, beginning of period(13)(33)— (46)
Net medical claims payable, beginning of periodNet medical claims payable, beginning of period3,281 7,613 195 11,089 Net medical claims payable, beginning of period3,281 7,613 195 11,089 
Business combinations and purchase adjustmentsBusiness combinations and purchase adjustments— 375 45 420 
Net incurred medical claims:Net incurred medical claims:Net incurred medical claims:
Current periodCurrent period6,575 17,289 351 24,215 Current period13,360 34,232 751 48,343 
Prior periods redundanciesPrior periods redundancies(503)(970)(15)(1,488)Prior periods redundancies(570)(1,190)(12)(1,772)
Total net incurred medical claimsTotal net incurred medical claims6,072 16,319 336 22,727 Total net incurred medical claims12,790 33,042 739 46,571 
Net payments attributable to:Net payments attributable to:Net payments attributable to:
Current period medical claimsCurrent period medical claims4,164 10,650 217 15,031 Current period medical claims10,295 26,647 591 37,533 
Prior periods medical claimsPrior periods medical claims1,746 4,856 146 6,748 Prior periods medical claims2,154 5,455 158 7,767 
Total net paymentsTotal net payments5,910 15,506 363 21,779 Total net payments12,449 32,102 749 45,300 
Net medical claims payable, end of periodNet medical claims payable, end of period3,443 8,426 168 12,037 Net medical claims payable, end of period3,622 8,928 230 12,780 
Ceded medical claims payable, end of periodCeded medical claims payable, end of period30 — 39 Ceded medical claims payable, end of period11 30 — 41 
Gross medical claims payable, end of periodGross medical claims payable, end of period$3,452 $8,456 $168 $12,076 Gross medical claims payable, end of period$3,633 $8,958 $230 $12,821 
The favorable development recognized in the threesix months ended March 31,June 30, 2022 and 2021 resulted primarily from trend factors in late 2021 and late 2020, respectively, developing more favorably than originally expected. Favorable development in the completion factors resulting from the latter parts of 2020 developing faster than expected also contributed to the favorable development in the threesix months ended March 31,June 30, 2021. The impact from COVID-19 on healthcare utilization and medical claims submission patterns continues to provide increased estimation uncertainty on our incurred but not reported liability at March 31,June 30, 2022.
The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for periods in 2022 andis as follows:
Three Months EndedSix Months Ended June 30, 2022
March 31, 2022June 30, 2022
Net incurred medical claims:
Commercial & Specialty Business$6,834 $7,522 $14,356 
Government Business19,943 19,788 39,731 
Other354 324 678 
Total net incurred medical claims27,131 27,634 54,765 
Quality improvement and other claims expense1,084 1,143 2,227 
Benefit expense$28,215 $28,777 $56,992 
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The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for periods in 2021 is as follows:
Three Months Ended
March 31, 2022March 31, 2021
Net incurred medical claims:
Commercial & Specialty Business$6,834 $6,072 
Government Business19,943 16,319 
Other354 336 
Total net incurred medical claims27,131 22,727 
Quality improvement and other claims expense1,084 972 
Benefit expense$28,215 $23,699 

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Three Months EndedSix Months Ended June 30, 2021
March 31, 2021June 30, 2021
Net incurred medical claims:
Commercial & Specialty Business$6,072 $6,718 $12,790 
Government Business16,319 16,723 33,042 
Other336 403 739 
Total net incurred medical claims22,727 23,844 46,571 
Quality improvement and other claims expense972 919 1,891 
Benefit expense$23,699 $24,763 $48,462 
The reconciliation of the medical claims payable reflected in the tables above to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of March 31,June 30, 2022, is as follows:
Commercial
& Specialty
Business
Government
Business
OtherTotalCommercial
& Specialty
Business
Government
Business
OtherTotal
Net medical claims payable, end of periodNet medical claims payable, end of period$3,868 $10,304 $281 $14,453 Net medical claims payable, end of period$4,068 $10,566 $242 $14,876 
Ceded medical claims payable, end of periodCeded medical claims payable, end of period— 17 Ceded medical claims payable, end of period10 — 13 
Insurance lines other than short durationInsurance lines other than short duration— 243 — 243 Insurance lines other than short duration— 238 — 238 
Gross medical claims payable, end of periodGross medical claims payable, end of period$3,877 $10,555 $281 $14,713 Gross medical claims payable, end of period$4,078 $10,807 $242 $15,127 
10.     Debt
We generally issue senior unsecured notes for long-term borrowing purposes. At March 31,June 30, 2022 and December 31, 2021, we had $22,329$22,749 and $22,359, respectively, outstanding under these notes.
On May 16, 2022 we repaid, at maturity, the $850 outstanding balance of our 3.125% senior unsecured notes.
On April 29, 2022, we issued $600 aggregate principal amount of 4.100% Notes due 2032 (the “2032 Notes”) and $700 aggregate principal amount of 4.550% Notes due 2052 (the “2052 Notes”) under our shelf registration statement. Interest on the 2032 Notes and 2052 Notes is payable semi-annually in arrears on May 15 and November 15 of each year, commencing November 15, 2022. We used the net proceeds for working capital and general corporate purposes, such as the funding of acquisitions, repayment of short-term and long-term debt and the repurchase of our common stock pursuant to our share repurchase program.
We have an unsecured surplus note with an outstanding principal balance of $25 at both March 31,June 30, 2022 and December 31, 2021.
We have a senior revolving credit facility (the “5-Year Facility”) with a group of lenders for general corporate purposes. On April 18, 2022, we amended and restated the credit agreement for the 5-Year Facility to, among other things, extend the maturity date of the 5-Year Facility from June 2024 to April 2027 and increase the amount of credit available under the 5-Year Facility from $2,500 to $4,000. Also on April 18, 2022, concurrently with the amendment and restatement of the 5-Year Facility, we terminated our 364-day senior revolving credit facility that provided for credit in the amount of $1,000, which was scheduled to mature in June 2022 (the “2021 364-Day Facility” and together with the 5-Year Facility, the “Credit Facilities”). In June 2021, we terminated our 364-day senior revolving credit facility (the “prior 364-Day Facility”), which was scheduled to mature in June 2021, and entered into the 2021 364-Day Facility with a group of lenders for general corporate purposes. Our ability to borrow under the 5-Year Facility is subject to compliance with certain covenants, including covenants requiring us to maintain a defined debt-to-capital ratio of not more than 60%, subject to increase in certain circumstances set forth in the credit agreement for the 5-Year Facility. As of March 31,June 30, 2022, our debt-to-capital ratio, as defined and calculated under the Credit Facilities,5-Year Facility, was 39.2%39.7%. We do not believe the restrictions contained in our 5-Year Facility covenants materially affect our financial or operating flexibility. As of March 31,June 30, 2022, we were in compliance with all
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of our debt covenants under the Credit Facilities.5-Year Facility. There were no amounts outstanding under the 5-Year Facility, 2021 364-Day Facility or the prior 364-Day Facility at any time during the threesix months ended March 31,June 30, 2022 or the year ended December 31, 2021.

Through certain subsidiaries, we have entered into multiple 364-day lines of credit (the “Subsidiary Credit Facilities”) with separate lenders for general corporate purposes. The Subsidiary Credit Facilities provide combined credit of up to $200. At March 31,June 30, 2022 and December 31, 2021, there were no amounts outstanding under our Subsidiary Credit Facilities.
We have an authorized commercial paper program of up to $3,500,$4,000, the proceeds of which may be used for general corporate purposes. In July 2022, we increased the amount available under the commercial paper program from $3,500 to $4,000. At March 31,June 30, 2022 and December 31, 2021, we had $525$550 and $300, respectively, outstanding under this program.
We have outstanding senior unsecured convertible debentures due 2042 (the “Debentures”), which are governed by an indenture (the “indenture”) between us and The Bank of New York Mellon Trust Company, N.A., as trustee. We accounted for the Debentures in accordance with the FASB cash conversion guidance for debt with conversion and other options at the time of issue. As a result, the value of the embedded conversion option (net of deferred taxes and equity issuance costs) was bifurcated from its debt host and recorded as a component of additional paid-in capital in our consolidated balance sheets. We adopted ASU 2020-06 on January 1, 2022 using the modified retrospective transition method, which resulted in an increase to our reported debt outstanding of $31, a decrease of our deferred tax liabilities of $8 and a corresponding cumulative-effect reduction to our opening retained earnings of $23, eliminating the bifurcation of the embedded conversion option. During the three and six months ended March 31,June 30, 2022, $2$13 and $15 of aggregate principal amount of the Debentures was surrendered for conversion by certain holders in accordance with the terms and provisions of the indenture. We elected to settle the excess of the principal amount of the conversions with cash for total payments during the three and six months ended March 31,June 30, 2022 of $14.$93 and $107, respectively.

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The following table summarizes at March 31,June 30, 2022 the related balances, conversion rate and conversion price of the Debentures:
Outstanding principal amount$10289 
Net debt carrying amount$10289 
Conversion rate (shares of common stock per $1,000 of principal amount)14.239014.2674 
Effective conversion price (per $1,000 of principal amount)$70.229770.0899 
We are a member, through certain subsidiaries, of the Federal Home Loan Bank of Indianapolis, the Federal Home Loan Bank of Cincinnati, the Federal Home Loan Bank of Atlanta and the Federal Home Loan Bank of New York (collectively, the “FHLBs”). As a member, we have the ability to obtain short-term cash advances, subject to certain minimum collateral requirements. We had $175 and $275 of outstanding short-term borrowings from the FHLBs at each of March 31,June 30, 2022 and December 31, 2021.2021, respectively.
All debt is a direct obligation of Anthem,Elevance Health, Inc., except for the surplus note, the FHLB borrowings, and the Subsidiary Credit Facilities.
11.     Commitments and Contingencies
Litigation and Regulatory Proceedings
In the ordinary course of business, we are defendants in, or parties to, a number of pending or threatened legal actions or proceedings. To the extent a plaintiff or plaintiffs in the following cases have specified in their complaint or in other court filings the amount of damages being sought, we have noted those alleged damages in the descriptions below. With respect to the cases described below, we contest liability and/or the amount of damages in each matter and believe we have meritorious defenses.
Where available information indicates that it is probable that a loss has been incurred as of the date of the consolidated financial statements and we can reasonably estimate the amount of that loss, we accrue the estimated loss by a charge to income. In many proceedings, however, it is difficult to determine whether any loss is probable or reasonably possible. In
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addition, even where loss is possible or an exposure to loss exists in excess of the liability already accrued with respect to a previously identified loss contingency, it is not always possible to reasonably estimate the amount of the possible loss or range of loss.
With respect to many of the proceedings to which we are a party, we cannot provide an estimate of the possible losses, or the range of possible losses in excess of the amount, if any, accrued, for various reasons, including but not limited to some or all of the following: (i) there are novel or unsettled legal issues presented, (ii) the proceedings are in early stages, (iii) there is uncertainty as to the likelihood of a class being certified or decertified or the ultimate size and scope of the class, (iv) there is uncertainty as to the outcome of pending appeals or motions, (v) there are significant factual issues to be resolved, and/or (vi) in many cases, the plaintiffs have not specified damages in their complaint or in court filings. For those legal proceedings where a loss is probable, or reasonably possible, and for which it is possible to reasonably estimate the amount of the possible loss or range of losses, we currently believe that the range of possible losses, in excess of established reserves is, in the aggregate, from $0 to approximately $250$325 at March 31,June 30, 2022. This estimated aggregate range of reasonably possible losses is based upon currently available information taking into account our best estimate of such losses for which such an estimate can be made.
Blue Cross Blue Shield Antitrust Litigation
We are a defendant in multiple lawsuits that were initially filed in 2012 against the BCBSA and Blue Cross and/or Blue Shield licensees (the “Blue plans”) across the country. Cases filed in twenty-eight states were consolidated into a single, multi-district proceeding captioned In re Blue Cross Blue Shield Antitrust Litigation that is pending in the U.S. District Court for the Northern District of Alabama (the “Court”). Generally, the suits allege that the BCBSA and the Blue plans have conspired to horizontally allocate geographic markets through license agreements, best efforts rules that limit the percentage of non-Blue revenue of each plan, restrictions on acquisitions, rules governing the BlueCard® and National Accounts
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programs and other arrangements in violation of the Sherman Antitrust Act (“Sherman Act”Act���) and related state laws. The cases were brought by two putative nationwide classes of plaintiffs, health plan subscribers and providers.

In April 2018, the Court issued an order on the parties’ cross motions for partial summary judgment, determining that the defendants’ aggregation of geographic market allocations and output restrictions are to be analyzed under a per se standard of review, and the BlueCard® program and other alleged Section 1 Sherman Act violations are to be analyzed under the rule of reason standard of review. The Court also found that there remain genuine issues of material fact as to whether the defendants operate as a single entity with regard to the enforcement of the Blue Cross Blue Shield trademarks. In April 2019, the plaintiffs filed motions for class certification, which defendants opposed.
The BCBSA and Blue plans have approved a settlement agreement and release (the “Subscriber Settlement Agreement”) with the subscriber plaintiffs. If approved by the Court, the Subscriber Settlement Agreement will require the defendants to make a monetary settlement payment, our portion of which is estimated to be $594, and will contain certain terms imposing non-monetary obligations including (i) eliminating the “national best efforts” rule in the BCBSA license agreements (which rule limits the percentage of non-Blue revenue permitted for each Blue plan) and (ii) allowing for some large national employers with self-funded benefit plans to request a bid for insurance coverage from a second Blue plan in addition to the local Blue plan. As of March 31,June 30, 2022, the liability balance accrued for our estimated payment obligation was $507, net of payments made.
In November 2020, the Court issued an order preliminarily approving the Subscriber Settlement Agreement, following which members of the subscriber class were provided notice of the Subscriber Settlement Agreement and an opportunity to opt out of the class. All terms of the Subscriber Settlement Agreement are subject to final approval by the Court. The deadline for objections to the settlement as well as the deadline for those who wishwished to opt-out from the settlement was in July 2021 and a small number of subscribers submitted valid opt outsopt-outs by the deadline. The claims deadline was in November 2021 and in excess of 8000 claims were submitted. A final approval hearing was held in October 2021. The Court took the request for approval under advisement and requested supplemental briefing that was submitted. In February 2022, the Court ordered the issuance of a supplemental notice to self-funded account class members. The notice process was completed in March 2022. ObjectionsThe deadline for objections to the supplemental notice along with opt-outs must be submitted bywas in May 2, 2022, withand a motion certifying compliance with the supplemental notice due fromwas filed by class counsel byin May 10, 2022. If the Court grants approval of the Subscriber Settlement Agreement, and after all appellate rights have expired or have been exhausted in a
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manner that affirms the Court’s final order and judgment, the defendants’ payment and non-monetary obligations under the Subscriber Settlement Agreement will become effective.
In October 2020, after the Court lifted the stay as to the provider litigation, provider plaintiffs filed a renewed motion for class certification, which defendants opposed. In March 2021, the Court issued an order terminating the pending motion for class certification until the Court determines the standard of review applicable to providers’ claims. In May 2021, the defendants and provider plaintiffs filed renewed standard of review motions, which are now fully briefed.motions. In June 2021, the parties filed summary judgment motions not critically dependent on class certification. In February 2022, the Court issued (1) an order granting certain defendants’ motion for partial summary judgment against provider plaintiffs who had previously released claims against such defendants, and (2) an order granting provider plaintiffs’ motion for partial summary judgment, holding that Ohio v. American Express Co. does not affect the standard of review in this case. We intend to continue to vigorously defend the provider suit, which we believe is without merit; however, its ultimate outcome cannot be presently determined.
Blue Cross of California Taxation Litigation
In July 2013, our California affiliate Blue Cross of California (doing business as Anthem Blue Cross) (“BCC”) was named as a defendant in a California taxpayer action filed in Los Angeles County Superior Court (the “Superior Court”) captioned Michael D. Myers v. State Board of Equalization, et al. This action was brought under a California statute that permits an individual taxpayer to sue a governmental agency when the taxpayer believes the agency has failed to enforce governing law. Plaintiff contends that BCC, a licensed Health Care Service Plan, is an “insurer” for purposes of taxation despite acknowledging it is not an “insurer” under regulatory law. At the time, under California law, “insurers” were required to pay a gross premiums tax (“GPT”) calculated as 2.35% on gross premiums. As a licensed Health Care Service Plan, BCC has paid the California Corporate Franchise Tax (“CFT”), the tax paid by California businesses generally. Plaintiff contends that BCC must pay the GPT rather than the CFT, and seeks a writ of mandate directing the taxing
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agencies to collect the GPT and an order requiring BCC to pay GPT back taxes, interest, and penalties for the eight-year period prior to the filing of the complaint.
Because the GPT is constitutionally imposed in lieu of certain other taxes, BCC has filed protective tax refund claims with the City of Los Angeles, the California Department of Health Care Services and the Franchise Tax Board to protect its rights to recover certain taxes previously paid should BCC eventually be determined to be subject to the GPT for the tax periods at issue in the litigation.
In March 2018, the Superior Court denied BCC's motion for judgment on the pleadings and similar motions brought by other entities. BCC filed a motion for summary judgment with the Superior Court, which was heard in October 2020. In December 2020, the Superior Court granted BCC’s motion for summary judgment, dismissing the plaintiff's lawsuit. In November 2021, the plaintiff appealed the order granting ourBCC's motion for summary judgment. OurBCC's responding brief was filed in February 2022. We estimate that the appeal will be heard sometime in the fall of 2022. We intend to vigorously defend the appeal of this lawsuit.
Express Scripts, Inc. Pharmacy Benefit Management Litigation
In March 2016, we filed a lawsuit against Express Scripts, Inc. (“Express Scripts”), our vendor at the time for PBM services, captioned Anthem, Inc. v. Express Scripts, Inc., in the U.S. District Court for the Southern District of New York.York (the “District Court”). The lawsuit seeks to recover over $14,800 in damages for pharmacy pricing that is higher than competitive benchmark pricing under the agreement between the parties (the “ESI PBM Agreement”), over $158 in damages related to operational breaches, as well as various declarations under the ESI PBM Agreement, including that Express Scripts: (i) breached its obligation to negotiate in good faith and to agree in writing to new pricing terms; (ii) was required to provide competitive benchmark pricing to us through the term of the ESI PBM Agreement; (iii) has breached the ESI PBM Agreement; and (iv) is required under the ESI PBM Agreement to provide post-termination services, at competitive benchmark pricing, for one year following any termination.
Express Scripts has disputed our contractual claims and is seeking declaratory judgments: (i) regarding the timing of the periodic pricing review under the ESI PBM Agreement, and (ii) that it has no obligation to ensure that we receive any specific level of pricing, that we have no contractual right to any change in pricing under the ESI PBM Agreement and that its sole obligation is to negotiate proposed pricing terms in good faith. In the alternative, Express Scripts claims that we have been unjustly enriched by its payment of $4,675 at the time we entered into the ESI PBM Agreement. In March 2017, the
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District Court granted our motion to dismiss Express Scripts’ counterclaims for (i) breach of the implied covenant of good faith and fair dealing, and (ii) unjust enrichment with prejudice. After such action, the only remaining claims were for breach of contract and declaratory relief. In August 2021, Express Scripts filed a motion for summary judgment, which we opposed. In March 2022, the District Court granted in part and denied in part Express Scripts'Scripts’ motion for summary judgment. The District Court dismissed our declaratory judgment claim, our breach of contract claim for failure to prove damages and most of our operational breach claims. As a result of the summary judgment decision, the only remaining claims as of the filing of this Quarterly Report on Form 10-Q are (i) our operational breach claim based on Express Scripts'Scripts’ prior authorization processes and (ii) Express Scripts'Scripts’ counterclaim for breach of the market check provision of the ESI PBM Agreement. Express Scripts filed a second motion for summary judgment in June 2022, challenging our remaining operational breach claims, and we filed an opposition to Express Scripts’ motion in July 2022. We intend to appeal the earlier summary judgment decision at the appropriate time, vigorously pursue our claims and defend against counterclaims, which we believe are without merit; however, the ultimate outcome of this litigation cannot be presently determined.
In re Express Scripts/AnthemElevance Health ERISA Litigation
We are a defendant in a class action lawsuit that was initially filed in June 2016 against Elevance Health (fka Anthem, Inc.) and Express Scripts, which has been consolidated into a single multi-district lawsuit captioned In Re Express Scripts/Anthem ERISA Litigation, in the U.S. District Court for the Southern District of New York. The consolidated complaint was filed by plaintiffs against Express Scripts and us on behalf of all persons who are participants in or beneficiaries of any ERISA or non-ERISA healthcare plan from December 1, 2009 to December 31, 2019 in which we provided prescription drug benefits through the ESI PBM Agreement and paid a percentage based co-insurance payment in the course of using that prescription drug benefit. The plaintiffs allege that we breached our duties, either under ERISA or with respect to the implied covenant of good faith and fair dealing implied in the health plans, (i) by failing to adequately monitor Express Scripts’ pricing under the ESI PBM Agreement, (ii) by placing our own pecuniary interest above the best interests of our insureds by allegedly agreeing to higher pricing in the ESI PBM Agreement in exchange for the purchase price for our NextRx PBM business, and (iii) with
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respect to the non-ERISA members, by negotiating and entering into the ESI PBM Agreement that was allegedly detrimental to the interests of such non-ERISA members. Plaintiffs seek to hold us and Express Scripts jointly and severally liable and to recover all losses suffered by the proposed class, equitable relief, disgorgement of alleged ill-gotten gains, injunctive relief, attorney’s fees and costs and interest.
In April 2017, we filed a motion to dismiss the claims brought against us, and it was granted, without prejudice, in January 2018. Plaintiffs pursued an appeal with the United States Court of Appeals for the Second Circuit (the “Second Circuit”). In December 2020, the Second Circuit affirmed the trial court’s order dismissing the ERISA complaint. Plaintiffs filed a Petition for Rehearing and Rehearing En Banc, which was denied. Plaintiffs filed a writ of certiorari with the United States Supreme Court, which we opposed. In December 2021, the United States Supreme Court requested that the Solicitor General submit a brief “expressing the views of the United States” as to whether the court should grant plaintiffs’ writ. We intend to vigorously defend this suit, which we believe is without merit; however, its ultimate outcome cannot be presently determined.In May 2022, the Solicitor General recommended that the United States Supreme Court deny plaintiffs’ writ. In June 2022, the United States Supreme Court declined plaintiffs’ writ of certiorari.
Medicare Risk Adjustment Litigation
In March 2020, the U.S. Department of Justice (“DOJ”) filed a civil lawsuit against Elevance Health (fka Anthem, Inc.) in the U.S. District Court for the Southern District of New York in a case captioned United States v. Anthem, Inc. The DOJ’s suit alleges, among other things, that we falsely certified the accuracy of the diagnosis data we submitted to the Centers for Medicare and Medicaid Services (“CMS”) for risk-adjustment purposes under Medicare Part C and knowingly failed to delete inaccurate diagnosis codes. The DOJ further alleges that, as a result of these purported acts, we caused CMS to calculate the risk-adjustment payments based on inaccurate diagnosis information, which enabled us to obtain unspecified amounts of payments in Medicare funds in violation of the False Claims Act. The DOJ filed an amended complaint in July 2020, alleging the same causes of action but revising some of its allegations. In September 2020, we filed a motion to transfer the lawsuit to the Southern District of Ohio, a motion to dismiss part of the lawsuit, and a motion to strike certain allegations in the amended complaint. The motions are fully briefed and no decision has been rendered. We intend to continue to vigorously defend this suit, which we believe is without merit; however, the ultimate outcome cannot be presently determined.

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Investigations of CareMore and HealthSun
With the assistance of outside counsel, we are conducting investigations of risk-adjustment practices involving data submitted to CMS (unrelated to our retrospective chart review program) at CareMore Health Plans, Inc. (“CareMore”), one of our California subsidiaries, and HealthSun Health Plans, Inc. (“HealthSun”), one of our Florida subsidiaries. Our CareMore investigation has resulted in the termination of CareMore’s relationship with one contracted provider in California. Our HealthSun investigation has focused on risk adjustment practices initiated prior to our acquisition of HealthSun in December 2017 that continued after the acquisition. We have voluntarily self-disclosed the existence of both of our investigations to CMS and the Criminal and Civil Divisions of the DOJ. We are cooperating with the ongoing investigations of the Criminal and Civil Divisions of the DOJ related to these risk adjustment practices, and have entered into a tolling agreement with the Civil Division of the DOJ related to its investigation. We are analyzing the scope of potential data corrections to be submitted to CMS and have begun to submit data corrections to CMS. We have also asserted indemnity claims for escrowed funds under the HealthSun purchase agreement for, among other things, breach of healthcare and financial representation provisions, based on the conduct discovered during our investigation. While certain elements of the escrow claims were resolved in the fourth quarter of 2021, there remains litigation in the Delaware Court of Chancery related to the remaining indemnity claims for escrowed funds.
Other Contingencies
From time to time, we and certain of our subsidiaries are parties to various legal proceedings, many of which involve claims for coverage encountered in the ordinary course of business. We, like Health Maintenance Organizations (“HMOs”) and health insurers generally, exclude certain healthcare and other services from coverage under our HMO, Preferred Provider Organizations and other plans. We are, in the ordinary course of business, subject to the claims of our enrollees arising out of decisions to restrict or deny reimbursement for uncovered services. The loss of even one such claim, if it results in a significant punitive damage award, could have a material adverse effect on us. In addition, the risk of potential liability under punitive damage theories may increase significantly the difficulty of obtaining reasonable reimbursement of coverage claims.
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In addition to the lawsuits described above, we are also involved in other pending and threatened litigation of the character incidental to our business and are from time to time involved as a party in various governmental investigations, audits, reviews and administrative proceedings. These investigations, audits, reviews and administrative proceedings include routine and special inquiries by state insurance departments, state attorneys general, the U.S. Attorney General and subcommittees of the U.S. Congress. Such investigations, audits, reviews and administrative proceedings could result in the imposition of civil or criminal fines, penalties, other sanctions and additional rules, regulations or other restrictions on our business operations. Any liability that may result from any one of these actions, or in the aggregate, could have a material adverse effect on our consolidated financial position or results of operations.
Contractual Obligations and Commitments
In March 2020, we entered into an agreement with a vendor for information technology infrastructure and related management and support services through June 2025. The new agreement supersedes certain prior agreements for such services and includes provisions for additional services not provided under those agreements. Our remaining commitment under this agreement at March 31,June 30, 2022 is approximately $971.$902. We will have the ability to terminate the agreement upon the occurrence of certain events, subject to early termination fees.
In the second quarter of 2019, we began using our pharmacy benefits manager IngenioRx to market and offer PBM services to our affiliated health plan customers, as well as to external customers outside of the health plans we own. The comprehensive PBM services portfolio includes, but is not limited to, formulary management, pharmacy networks, prescription drug database, member services and mail order capabilities. IngenioRx delegates certain PBM administrative functions, such as claims processing and prescription fulfillment, to CaremarkPCS Health, L.L.C., which is a subsidiary of CVS Health Corporation, pursuant to a five-year agreement. With IngenioRx, we retain the responsibilities for clinical and formulary strategy and development, member and employer experiences, operations, sales, marketing, account management and retail network strategy.
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12.     Capital Stock
Use of Capital – Dividends and Stock Repurchase Program
We regularly review the appropriate use of capital, including acquisitions, common stock and debt security repurchases and dividends to shareholders. The declaration and payment of any dividends or repurchases of our common stock or debt is at the discretion of our Board of Directors and depends upon our financial condition, results of operations, future liquidity needs, regulatory and capital requirements and other factors deemed relevant by our Board of Directors.
A summary of our cash dividend activity for the threesix months ended March 31,June 30, 2022 and 2021 is as follows: 
Declaration DateDeclaration DateRecord DatePayment Date
Cash
Dividend
per Share
TotalDeclaration DateRecord DatePayment Date
Cash
Dividend
per Share
Total
Three Months Ended March 31, 2022
Six Months Ended June 30, 2022Six Months Ended June 30, 2022
January 25, 2022January 25, 2022March 10, 2022March 25, 2022$1.28$309 January 25, 2022March 10, 2022March 25, 2022$1.28$309 
April 19, 2022April 19, 2022June 10, 2022June 24, 2022$1.28$309 
Three Months Ended March 31, 2021
Six Months Ended June 30, 2021Six Months Ended June 30, 2021
January 26, 2021January 26, 2021March 10, 2021March 25, 2021$1.13$277 January 26, 2021March 10, 2021March 25, 2021$1.13$277 
April 20, 2021April 20, 2021June 10, 2021June 25, 2021$1.13$278 
On AprilJuly 19, 2022, our Audit Committee declared a secondthird quarter 2022 dividend to shareholders of $1.28 per share, payable on June 24,September 23, 2022 to shareholders of record at the close of business on June 10,September 9, 2022.
Under our Board of Directors’ authorization, we maintain a common stock repurchase program. On January 26, 2021, our Audit Committee, pursuant to authorization granted by the Board of Directors, authorized a $5,000 increase to the common stock repurchase program. Repurchases may be made from time to time at prevailing market prices, subject to certain restrictions on volume, pricing and timing. The repurchases are effected from time to time in the open market, through negotiated transactions, including accelerated share repurchase agreements, and through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended. Our stock repurchase program is discretionary, as we are under no obligation to repurchase shares. We repurchase shares under the program when we believe it is a prudent use of
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capital. The excess cost of the repurchased shares over par value is charged on a pro rata basis to additional paid-in capital and retained earnings.
A summary of common stock repurchases for the threesix months ended March 31,June 30, 2022 and 2021 is as follows:
Three Months Ended March 31Six Months Ended June 30
20222021 20222021
Shares repurchasedShares repurchased1.2 1.4 Shares repurchased2.5 2.7 
Average price per shareAverage price per share$453.32 $316.06 Average price per share$471.72 $346.47 
Aggregate costAggregate cost$545 $447 Aggregate cost$1,169 $927 
Authorization remaining at the end of the periodAuthorization remaining at the end of the period$3,647 $5,645 Authorization remaining at the end of the period$3,022 $5,165 
For additional information regarding the use of capital for debt security repurchases, see Note 10, “Debt,” included in this Form 10-Q and Note 13, “Debt,” to our audited consolidated financial statements as of and for the year ended December 31, 2021 included in our 2021 Annual Report on Form 10-K.
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Stock Incentive Plans
A summary of stock option activity for the threesix months ended March 31,June 30, 2022 is as follows:
Number of
Shares
Weighted-
Average
Option Price
per Share
Weighted-
Average
Remaining
Contractual
Life (Years)
Aggregate
Intrinsic
Value
Number of
Shares
Weighted-
Average
Option Price
per Share
Weighted-
Average
Remaining
Contractual
Life (Years)
Aggregate
Intrinsic
Value
Outstanding at January 1, 2022Outstanding at January 1, 20222.9 $255.50 Outstanding at January 1, 20222.9 $255.50 
GrantedGranted0.5 451.50 Granted0.5 452.14 
ExercisedExercised(0.2)249.89 Exercised(0.3)247.80 
Forfeited or expiredForfeited or expired— 306.80 Forfeited or expired(0.1)338.54 
Outstanding at March 31, 20223.2 288.98 7.06$643 
Exercisable at March 31, 20221.9 238.19 5.87$480 
Outstanding at June 30, 2022Outstanding at June 30, 20223.0 290.27 6.81$586 
Exercisable at June 30, 2022Exercisable at June 30, 20221.8 238.24 5.61$439 
A summary of the status of nonvested restricted stock activity, including restricted stock units and performance units, for the threesix months ended March 31,June 30, 2022 is as follows:
Restricted
Stock Shares
and Units
Weighted-
Average
Grant Date
Fair Value
per Share
Restricted
Stock Shares
and Units
Weighted-
Average
Grant Date
Fair Value
per Share
Nonvested at January 1, 2022Nonvested at January 1, 20221.3 $299.65 Nonvested at January 1, 20221.3 $299.65 
GrantedGranted0.5 451.42 Granted0.5 452.78 
VestedVested(0.5)301.42 Vested(0.5)301.26 
ForfeitedForfeited— 310.98 Forfeited(0.1)343.38 
Nonvested at March 31, 20221.3 353.20 
Nonvested at June 30, 2022Nonvested at June 30, 20221.2 355.01 
During the threesix months ended March 31,June 30, 2022, we granted approximately 0.2 restricted stock units that are contingent upon us achieving earnings targets over the three year period from 2022 to 2024. These grants have been included in the activity shown above, but will be subject to adjustment at the end of 2024 based on results in the three year period.
Fair Value
We use a binomial lattice valuation model to estimate the fair value of all stock options granted. For a more detailed discussion of our stock incentive plan fair value methodology, see Note 15, “Capital Stock,” to our audited consolidated financial statements as of and for the year ended December 31, 2021 included in our 2021 Annual Report on Form 10-K.
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The following weighted-average assumptions were used to estimate the fair values of options granted during the threesix months ended March 31,June 30, 2022 and 2021:
Three Months Ended March 31Six Months Ended June 30
2022202120222021
Risk-free interest rateRisk-free interest rate1.97 %1.44 %Risk-free interest rate1.97 %1.44 %
Volatility factorVolatility factor29.00 %30.00 %Volatility factor29.00 %30.00 %
Quarterly dividend yieldQuarterly dividend yield0.282 %0.360 %Quarterly dividend yield0.282 %0.360 %
Weighted-average expected life (years)Weighted-average expected life (years)5.105.50Weighted-average expected life (years)5.105.50
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The following weighted-average fair values per option or share were determined for the threesix months ended March 31,June 30, 2022 and 2021: 
Three Months Ended March 31Six Months Ended June 30
2022202120222021
Options granted during the periodOptions granted during the period$116.64 $79.03 Options granted during the period$116.80 $79.22 
Restricted stock awards granted during the periodRestricted stock awards granted during the period451.42 311.32 Restricted stock awards granted during the period452.78 312.50 

-31--35-


13.     Accumulated Other Comprehensive Loss
A reconciliation of the components of accumulated other comprehensive loss at March 31,June 30, 2022 and 2021 is as follows:
March 31
20222021
Net unrealized investment (losses) gains:
Beginning of period balance$494 $949 
Other comprehensive loss before reclassifications, net of tax benefit of $355 and $108, respectively(1,146)(333)
Amounts reclassified from accumulated other comprehensive loss, net of tax (expense) benefit of $(21) and $8, respectively77 (29)
Other comprehensive loss(1,069)(362)
Other comprehensive loss attributable to noncontrolling interests, net of tax benefit of $(2) and $(1), respectively
End of period balance(570)589 
Non-credit components of impairments on investments:
Beginning of period balance— (2)
Other comprehensive (loss) income, net of tax benefit (expense) of $1 and $(1), respectively(1)
End of period balance(1)(1)
Net cash flow hedges:
Beginning of period balance(239)(250)
Other comprehensive income, net of tax expense of $(1) and $(1), respectively
End of period balance(236)(246)
Pension and other postretirement benefits:
Beginning of period balance(429)(552)
Other comprehensive income, net of tax expense of $(2) and $(4), respectively10 
End of period balance(422)(542)
Foreign currency translation adjustments:
Beginning of period balance(4)
Other comprehensive loss, net of tax benefit of $1 and $0(3)— 
End of period balance(7)
Total:
Total beginning of period accumulated other comprehensive (loss) income(178)150 
Total other comprehensive loss, net of tax benefit of $333 and $110, respectively(1,063)(347)
Total other comprehensive loss attributable to noncontrolling interests, net of tax benefit of $(2) and $(1), respectively
Total end of period accumulated other comprehensive loss$(1,236)$(195)

Three Months Ended
June 30
Six Months Ended
June 30
2022202120222021
Net unrealized investment (losses) gains:
Beginning of period balance$(570)$589 $494 $949 
Other comprehensive (loss) income before reclassifications, net of tax benefit (expense) of $323, $(61), $677 and $46, respectively(1,050)201 (2,196)(125)
Amounts reclassified from accumulated other comprehensive loss, net of tax (expense) benefit of $(34), $7, $(55) and $16, respectively128 (26)205 (62)
Other comprehensive (loss) income(922)175 (1,991)(187)
Other comprehensive loss (income) attributable to noncontrolling interests, net of tax (benefit) expense of $(1), $1, $(3) and $1, respectively(2)— 
End of period balance(1,489)762 (1,489)762 
Non-credit components of impairments on investments:
Beginning of period balance(1)(1)— (2)
Other comprehensive (loss) income, net of tax benefit (expense) of $0, $0, $1 and $(1), respectively(1)(2)
End of period balance(2)— (2)— 
Net cash flow hedges:
Beginning of period balance(236)(246)(239)(250)
Other comprehensive income, net of tax expense of $(1), $(1), $(2) and $(2), respectively
End of period balance(233)(244)(233)(244)
Pension and other postretirement benefits:
Beginning of period balance(422)(542)(429)(552)
Other comprehensive income, net of tax expense of $(4), $(2), $(6) and $(6), respectively16 18 
End of period balance(413)(534)(413)(534)
Foreign currency translation adjustments:
Beginning of period balance(7)(4)
Other comprehensive loss, net of tax benefit of $1, $1, $2 and $1, respectively(5)(6)(8)(6)
End of period balance(12)(1)(12)(1)
Total:
Total beginning of period accumulated other comprehensive loss(1,236)(195)(178)150 
Total other comprehensive (loss) income, net of tax benefit (expense) of $285, $(56), $617 and $54, respectively(916)180 (1,979)(167)
Total other comprehensive loss (income) attributable to noncontrolling interests, net of tax (benefit) expense of $(1), $1, $(3) and $1, respectively(2)— 
Total end of period accumulated other comprehensive loss$(2,149)$(17)$(2,149)$(17)
-32--36-


14.     Earnings per Share
The denominator for basic and diluted earnings per share for the three and six months ended March 31,June 30, 2022 and 2021 is as follows:
Three Months Ended 
 March 31
Three Months Ended 
 June 30
Six Months Ended 
 June 30
20222021 2022202120222021
Denominator for basic earnings per share – weighted-average sharesDenominator for basic earnings per share – weighted-average shares241.4 245.0 Denominator for basic earnings per share – weighted-average shares240.7 244.5 241.0 244.8 
Effect of dilutive securities – employee stock options, nonvested restricted stock awards and convertible debenturesEffect of dilutive securities – employee stock options, nonvested restricted stock awards and convertible debentures3.0 3.2 Effect of dilutive securities – employee stock options, nonvested restricted stock awards and convertible debentures2.7 2.9 2.9 3.0 
Denominator for diluted earnings per shareDenominator for diluted earnings per share244.4 248.2 Denominator for diluted earnings per share243.4 247.4 243.9 247.8 
During the three months ended March 31,June 30, 2022 and 2021, weighted-average shares related to certain stock options of 0.20.5 and 0.4,0.3, respectively, were excluded from the denominator for diluted earnings per share because the stock options were anti-dilutive. During the six months ended June 30, 2022 and 2021, weighted-average shares related to certain stock options of 0.4 and 0.4, respectively, were excluded from each of the denominators for diluted earnings per share because the stock options were anti-dilutive.
During the three and six months ended March 31,June 30, 2022, we issued approximately 0.0 and 0.5 restricted stock units under our stock incentive plans, 0.0 and 0.2 of which vesting is contingent upon us meeting specified annual earnings targets for the three year period of 2022 through 2024. During the three and six months ended March 31,June 30, 2021, we issued approximately 0.0 and 0.9 restricted stock units under our stock incentive plans, 0.0 and 0.3 of which vesting is contingent upon us meeting specified annual earnings targets for the three year period of 2021 through 2023. The contingent restricted stock units have been excluded from the denominators for diluted earnings per share and will be included only if and when the contingency is met.
15.     Segment Information
As discussed in Note 1 “Organization”, we will be organizing our brand portfolio into three core go-to-market brands over the next several years. Currently, there are no changes to our segments associated with this branding strategy. The results of our operations arecontinue to be described through 4 reportable segments: Commercial & Specialty Business, Government Business, IngenioRx and Other.
Our Commercial & Specialty Business segment offers plans and services to our Individual, Group risk-based, Group fee-based and BlueCard® members. The Commercial & Specialty Business segment offers health products on a full-risk basis; provides a broad array of administrative managed care services to our fee-based customers; and provides a variety of specialty and other insurance products and services such as dental, vision, life, disability and supplemental health insurance benefits.
Our Government Business segment includes our Medicare and Medicaid businesses, National Government Services, and services provided to the federal government in connection with the FEHB program.
Our IngenioRx segment includes our PBM business. IngenioRx markets and offers PBM services to our affiliated health plan customers, as well as to external customers outside of the health plans we own. IngenioRx has a comprehensive PBM services portfolio, which includes services such as formulary management, pharmacy networks, prescription drug database, member services and mail order capabilities.
Our Other segment includes our Diversified Business Group, now known as Carelon, which is our health services business focused on lowering the cost and improving the quality of healthcare by enabling and creating new care delivery and payment models, with a special emphasis on serving those with complex and chronic conditions. This segment also includes certain eliminations and corporate expenses not allocated to our other reportable segments.
We define operating revenues to include premium income, product revenue and administrative fees and other revenues. Operating revenues are derived from premiumpremiums and fees received, primarily from the sale and administration of health
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benefits and pharmacy products and services. Operating gain is calculated as total operating revenue less benefit expense, cost of products sold and selling, general and administrative expense.
Affiliated revenues represent revenues or cost for services provided to our subsidiaries by IngenioRx and Carelon, formerly known as our Diversified Business Group, as well as certain back-office services provided by our international businesses, and are recorded at cost or management’s estimate of fair market value. These affiliated revenues are eliminated in consolidation.
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Financial data by reportable segment for the three and six months ended March 31,June 30, 2022 and 2021 is as follows:
Commercial
& Specialty
Business
Government
Business
IngenioRxOtherEliminationsTotalCommercial
& Specialty
Business
Government
Business
IngenioRxOtherEliminationsTotal
Three Months Ended March 31, 2022
Three Months Ended June 30, 2022Three Months Ended June 30, 2022
Operating revenue - unaffiliatedOperating revenue - unaffiliated$10,269 $23,758 $3,301 $558 $— $37,886 Operating revenue - unaffiliated$10,561 $23,835 $3,566 $520 $— $38,482 
Operating revenue - affiliatedOperating revenue - affiliated— — 3,382 2,663 (6,045)— Operating revenue - affiliated— — 3,505 2,778 (6,283)— 
Operating gainOperating gain1,082 789 398 178 — 2,447 Operating gain806 996 479 86 — 2,367 
Three Months Ended March 31, 2021
Three Months Ended June 30, 2021Three Months Ended June 30, 2021
Operating revenue - unaffiliatedOperating revenue - unaffiliated$9,491 $19,283 $2,738 $586 $— $32,098 Operating revenue - unaffiliated$9,550 $20,066 $3,042 $621 $— $33,279 
Operating revenue - affiliatedOperating revenue - affiliated— — 3,124 1,784 (4,908)— Operating revenue - affiliated— — 3,177 1,896 (5,073)— 
Operating gainOperating gain1,268 478 407 — 2,161 Operating gain791 868 405 17 — 2,081 
Six Months Ended June 30, 2022Six Months Ended June 30, 2022
Operating revenue - unaffiliatedOperating revenue - unaffiliated$20,830 $47,593 $6,867 $1,078 $— $76,368 
Operating revenue - affiliatedOperating revenue - affiliated— — 6,887 5,441 (12,328)— 
Operating gainOperating gain1,888 1,785 877 264 — 4,814 
Six Months Ended June 30, 2021Six Months Ended June 30, 2021
Operating revenue - unaffiliatedOperating revenue - unaffiliated$19,041 $39,349 $5,780 $1,207 $— $65,377 
Operating revenue - affiliatedOperating revenue - affiliated— — 6,301 3,680 (9,981)— 
Operating gainOperating gain2,059 1,346 812 25 — 4,242 
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The major product revenues for each of the reportable segments for the three and six months ended March 31,June 30, 2022 and 2021 are as follows:
Three Months Ended 
 March 31
Three Months Ended 
 June 30
Six Months Ended 
 June 30
202220212022202120222021
Commercial & Specialty BusinessCommercial & Specialty BusinessCommercial & Specialty Business
Managed care productsManaged care products$8,401 $7,689 Managed care products$8,621 $7,772 $17,023 $15,461 
Managed care servicesManaged care services1,476 1,386 Managed care services1,532 1,416 3,008 2,802 
Dental/Vision products and servicesDental/Vision products and services356 336 Dental/Vision products and services360 335 716 671 
OtherOther36 80 Other48 27 83 107 
Total Commercial & Specialty BusinessTotal Commercial & Specialty Business10,269 9,491 Total Commercial & Specialty Business10,561 9,550 20,830 19,041 
Government BusinessGovernment BusinessGovernment Business
Managed care productsManaged care products23,635 19,182 Managed care products23,733 19,965 47,368 39,147 
Managed care servicesManaged care services123 101 Managed care services102 101 225 202 
Total Government BusinessTotal Government Business23,758 19,283 Total Government Business23,835 20,066 47,593 39,349 
IngenioRxIngenioRxIngenioRx
Pharmacy products and servicesPharmacy products and services6,683 5,862 Pharmacy products and services7,071 6,219 13,754 12,081 
OtherOtherOther
Integrated health servicesIntegrated health services2,947 2,249 Integrated health services2,983 2,366 5,930 4,615 
OtherOther274 121 Other315 151 589 272 
Total Other BusinessTotal Other Business3,221 2,370 Total Other Business3,298 2,517 6,519 4,887 
EliminationsEliminationsEliminations
EliminationsEliminations(6,045)(4,908)Eliminations(6,283)(5,073)(12,328)(9,981)
Total product revenuesTotal product revenues$37,886 $32,098 Total product revenues$38,482 $33,279 $76,368 $65,377 
The classification between managed care products and managed care services in the above table primarily distinguishes between the levels of risk assumed. Managed care products represent insurance products where we bear the insurance risk, whereas managed care services represent product offerings where we provide claims adjudication and other administrative services to the customer, but the customer principally bears the insurance risk. 
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A reconciliation of reportable segments’ operating revenue to the amounts of total revenues included in our consolidated statements of income for the three and six months ended March 31,June 30, 2022 and 2021 is as follows:
Three Months Ended 
 March 31
Three Months Ended 
 June 30
Six Months Ended 
 June 30
20222021 2022202120222021
Reportable segments’ operating revenueReportable segments’ operating revenue$37,886 $32,098 Reportable segments’ operating revenue$38,482 $33,279 $76,368 $65,377 
Net investment incomeNet investment income360 291 Net investment income381 400 741 691 
Net losses on financial instruments(151)(4)
Net (losses) gains on financial instrumentsNet (losses) gains on financial instruments(231)172 (382)168 
Total revenuesTotal revenues$38,095 $32,385 Total revenues$38,632 $33,851 $76,727 $66,236 
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A reconciliation of income before income tax expense to reportable segments’ operating gain included in our consolidated statements of income for the three and six months ended March 31,June 30, 2022 and 2021 is as follows:
Three Months Ended 
 March 31
Three Months Ended 
 June 30
Six Months Ended 
 June 30
20222021 2022202120222021
Income before income tax expenseIncome before income tax expense$2,326 $2,176 Income before income tax expense$2,143 $2,353 $4,469 $4,529 
Net investment incomeNet investment income(360)(291)Net investment income(381)(400)(741)(691)
Net losses on financial instruments151 
Net losses (gains) on financial instrumentsNet losses (gains) on financial instruments231 (172)382 (168)
Interest expenseInterest expense201 192 Interest expense208 205 409 397 
Amortization of other intangible assetsAmortization of other intangible assets129 80 Amortization of other intangible assets166 90 295 170 
Loss on extinguishment of debtLoss on extinguishment of debt— — 
Reportable segments’ operating gainReportable segments’ operating gain$2,447 $2,161 Reportable segments’ operating gain$2,367 $2,081 $4,814 $4,242 
16.     Leases
We lease office space and certain computer and related equipment using noncancellable operating leases. Our leases have remaining lease terms of 1 year to 12 years.
The information related to our leases is as follows:
Balance Sheet LocationMarch 31, 2022December 31, 2021Balance Sheet LocationJune 30, 2022December 31, 2021
Operating LeasesOperating LeasesOperating Leases
Right-of-use assetsRight-of-use assetsOther noncurrent assets$599 $628 Right-of-use assetsOther noncurrent assets$601 $628 
Lease liabilities, currentLease liabilities, currentOther current liabilities128 133 Lease liabilities, currentOther current liabilities180 133 
Lease liabilities, noncurrentLease liabilities, noncurrentOther noncurrent liabilities807 864 Lease liabilities, noncurrentOther noncurrent liabilities738 864 
Three Months Ended 
 March 31
20222021
Lease Expense
Operating lease expense$28 $29 
Short-term lease expense12 12 
Sublease income(1)(1)
Total lease expense$39 $40 
Other information
 Operating cash paid for amounts included in the measurement of lease liabilities, operating leases$53 $52 
Right-of-use assets obtained in exchange for new lease liabilities, operating leases$— $14 
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Three Months Ended 
 June 30
Six Months Ended 
 June 30
2022202120222021
Lease Expense
Operating lease expense$33 $34 $65 $63 
Short-term lease expense11 12 24 24 
Sublease income(1)(1)(2)(2)
Total lease expense$43 $45 $87 $85 
Other information
 Operating cash paid for amounts included in the measurement of lease liabilities, operating leases$53 $36 $105 $88 
Right-of-use assets obtained in exchange for new lease liabilities, operating leases$29 $145 $37 $160 
As of March 31,June 30, 2022 and December 31, 2021, the weighted average remaining lease term of our operating leases was 7 years for each period. The lease liabilities reflect a weighted average discount rate of 2.68%2.75% at March 31,June 30, 2022 and 2.69% at December 31, 2021.
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Future lease payments for noncancellable operating leases with initial or remaining terms of one year or more are as follows:
2022 (excluding the three months ended March 31, 2022)$157 
2022 (excluding the six months ended June 30, 2022)2022 (excluding the six months ended June 30, 2022)$109 
20232023194 2023203 
20242024165 2024174 
20252025127 2025136 
2026202690 202699 
ThereafterThereafter307 Thereafter335 
Total future minimum paymentsTotal future minimum payments1,040 Total future minimum payments1,056 
Less imputed interestLess imputed interest(105)Less imputed interest(138)
Total lease liabilitiesTotal lease liabilities$935 Total lease liabilities$918 
As of March 31,June 30, 2022, we have additional operatingno new leases for building spaces that have not yet commenced,which will commence during the second half of 2022.
17. Goodwill and some building spaces are being constructed by the lessors and their agents. These leases have terms of up to 10 years and are expected to commence on various dates during 2022 when the construction is complete and we take possessionOther Intangible Assets
A summary of the buildings. The undiscounted lease payments for these leases, which are not includedchange in the tables above, aggregate to $41.carrying amount of goodwill for our segments (see Note 15, “Segment Information”) for 2022 and 2021 is as follows:
Commercial
and Specialty
Business
Government
Business
IngenioRxOtherTotal
Balance as of January 1, 2021$11,593 $8,331 $48 $1,719 $21,691 
Acquisitions and adjustments— 2,018 11 508 2,537 
Balance as of December 31, 202111,593 10,349 59 2,227 24,228 
Acquisitions and adjustments18 112 — 139 
Balance as of June 30, 2022$11,611 $10,461 $59 $2,236 $24,367 
Accumulated impairment as of June 30, 2022$— $— $— $— $— 
The components of other intangible assets as of June 30, 2022 and December 31, 2021 are as follows:
 June 30, 2022December 31, 2021
Gross
Carrying
Amount
Accumulated
Amortization
Net
Carrying
Amount
Gross
Carrying
Amount
Accumulated
Amortization
Net
Carrying
Amount
Intangible assets with finite lives:
Customer relationships$5,791 $(3,467)$2,324 $5,598 $(3,236)$2,362 
Provider and hospital relationships327 (138)189 324 (129)195 
Other920 (202)718 610 (141)469 
Total7,038 (3,807)3,231 6,532 (3,506)3,026 
Intangible assets with indefinite lives:
Blue Cross and Blue Shield and other trademarks5,991 — 5,991 6,299 — 6,299 
State Medicaid licenses1,540 — 1,540 1,290 — 1,290 
Total7,531 — 7,531 7,589 — 7,589 
Other intangible assets$14,569 $(3,807)$10,762 $14,121 $(3,506)$10,615 
-36--41-


During the three months ended June 30, 2022, we recorded intangible assets related to Integra and also reclassified $308 of trademarks with indefinite lives to intangible assets with finite lives - Other, which relates to our new branding strategy. In addition, the amortization period of certain intangible assets is being shortened to align with the anticipated dates the new branding will take place.
Intangible assets, along with the related accumulated amortization, are removed from the table above at the end of the fiscal year in which they become fully amortized.
As of June 30, 2022, the estimated amortization expense for the year ending December 31, 2022 and each of the five succeeding years is as follows: 2022, $745; 2023, $736; 2024, $370; 2025, $312; 2026, $259; and 2027, $219.
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ITEM 2.    MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
(In Millions, Except Per Share Data or as Otherwise Stated Herein)
This Management’sOn May 18, 2022, our shareholders approved a proposal to amend our amended and restated articles of incorporation to change our name from Anthem, Inc. to Elevance Health, Inc., which amendment and name change went into effect on June 27, 2022. We began operating as Elevance Health, Inc. and trading under our new ticker symbol “ELV” on June 28, 2022. References to the terms “we,” “our,” “us,” or “Elevance Health” used throughout this Management's Discussion and Analysis of Financial Condition and Results of Operations (“MD&A”) refer to Elevance Health, Inc., an Indiana corporation, and unless the context otherwise requires, its direct and indirect subsidiaries. References to the “states” include the District of Columbia and Puerto Rico, unless the context otherwise requires.
This MD&A should be read in conjunction with the accompanying consolidated financial statements and notes, our consolidated financial statements and notes as of and for the year ended December 31, 2021 and the MD&A included in our 2021 Annual Report on Form 10-K. References to the terms “we,” “our,” “us,” or “Anthem” used throughout this MD&A refer to Anthem, Inc., an Indiana corporation, and unless the context otherwise requires, its direct and indirect subsidiaries. References to the “states” include the District of Columbia and Puerto Rico, unless the context otherwise requires.
Results of operations, cost of care trends, investment yields and other measures for the three and six months ended March 31,June 30, 2022 are not necessarily indicative of the results and trends that may be expected for the full year ending December 31, 2022, or any other period.
Overview
Elevance Health is a health company with the purpose of improving the health of humanity. We are one of the largest health benefits companiesinsurer in the United States in terms of medical membership, serving nearlyover 47 million medical members through our affiliated health plans as of March 31,June 30, 2022. We are an independent licensee of the Blue Cross and Blue Shield Association (“BCBSA”), an association of independent health benefit plans. We serve our members as the Blue Cross licensee for California and as the Blue Cross and Blue Shield (“BCBS”) licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (in the New York City metropolitan area and upstate New York), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.) and Wisconsin. In a majority of these service areas, we do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Empire Blue Cross Blue Shield or Empire Blue Cross. In addition, we conduct business through arrangements with other BCBS licensees as well as other strategic partners. Through our subsidiaries, we also serve customers in numerous states as AIM Specialty Health, Amerigroup, Aspire Health, Beacon, CareMore, Freedom Health, HealthLink, HealthSun, Integra Managed Care, MMM, Optimum HealthCare, Simply Healthcare, and/or UniCare. We offer pharmacy benefits management (“PBM”) services through our IngenioRx, Inc. (“IngenioRx”) subsidiary. We are licensed to conduct insurance operations in all 50 states, the District of Columbia and Puerto Rico through our subsidiaries.
As part of our name change to Elevance Health, on June 15, 2022 we announced that over the next several years we will organize our brand portfolio into the following core go-to-market brands:
Anthem Blue Cross/Anthem Blue Cross and Blue Shield — represents our existing Anthem-branded and affiliated Blue Cross and/or Blue Shield licensed plans;
Wellpoint — we intend to unite select non-BCBSA licensed Medicare, Medicaid and Commercial plans under the Wellpoint name; and
Carelon — this brand will bring together our healthcare brands and capabilities, including our Diversified Business Group and IngenioRx business under a single brand name. We now refer to our Diversified Business Group as Carelon. In January 2023, IngenioRx will become CarelonRx.
There are currently no segment changes associated with this branding strategy.
For additional information about our organization, see Part I, Item 1, “Business” and Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” included in our 2021 Annual Report on Form 10-K. Additional information on our segments can be found in this MD&A and in Note 15, “Segment Information” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
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COVID-19
The COVID-19 pandemic continues to impact the global economy, cause market instability and uncertainty in the labor market and put pressure on the healthcare system, and it has impacted, and will likely continue to impact, our membership, benefit expense and members behavior, including how members access healthcare services. We continue to assist our customers, providers, members and communities in addressing the effects of the COVID-19 pandemic, including by providing expanded benefit coverage for COVID-19 diagnostic tests and vaccine administration and taking steps to increase vaccinations by enabling, educating, and encouraging vaccine acceptance among our members as well as in the communities in which we operate.
COVID-19 care, testing and vaccine administration, and the impact of new COVID-19 variants, have resulted in increased medical costs for us in the first quarter of 2022. In the first quarter of 2022, our Medicaid membership continued to grow as a result of the temporary suspension of eligibility recertification in response to the COVID-19 pandemic, which we expect will remain suspended at least until the third quarter of 2022. Once eligibility recertification resumes, which may not occur until 2023 in certain states, we expect a decline in our Medicaid membership. At the same time, we expect growth in our Commercial risk-based and fee-based plans, including through Individual on-exchange products through state- or federally-facilitated marketplaces (the “Public Exchange”), as members exiting Medicaid in our fourteen Commercial states seek coverage elsewhere. See “Business Trends - Medical Cost TrendsTrends” below for a discussion of the impact of COVID-19 on our healthcarepricing and medical costs.
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The COVID-19 pandemic continues to evolve and the full extent of its impact will depend on future developments, which are highly uncertain and cannot be predicted at this time. We will continue to monitor the COVID-19 pandemic as well as resulting legislative and regulatory changes to manage our response and assess and mitigate potential adverse impacts to our business. For additional discussion regarding our risks related to the COVID-19 pandemic and our other risk factors, see Part I, Item 1A, “Risk Factors” included in our 2021 Annual Report on Form 10-K.
Business Trends
We made the decision to modestly expand our participation in the Individual on-exchange products through state- or federally-facilitated marketplaces (the “Public Exchange”) for 2022 after also expanding in 2021. As a result, for 2022 we are offering Public Exchange products in 122 of the 143 rating regions in which we operate, in comparison to 103 of 143 rating regions in 2021. Our strategy has been, and will continue to be, to only participate in rating regions where we have an appropriate level of confidence that these markets are on a path toward sustainability, including, but not limited to, factors such as expected financial performance, regulatory environment and underlying market characteristics. Changes to our business environment are likely to continue as elected officials at the national and state levels continue to enact, and both elected officials and candidates for election continue to propose, significant modifications to existing laws and regulations, including changes to taxes and fees. In addition, the continuing growth in our government-sponsored business exposes us to increased regulatory oversight.
Our IngenioRx subsidiary markets and offers PBM services to our affiliated health plan customers throughout the country, as well as to customers outside of the health plans we own. Our comprehensive PBM services portfolio includes features such as formulary management, pharmacy networks, a prescription drug database, member services and mail order capabilities. IngenioRx delegates certain PBM administrative functions, such as claims processing and prescription fulfillment, to CaremarkPCS Health, L.L.C., which is a subsidiary of CVS Health Corporation, pursuant to a five-year agreement. With IngenioRx, we retain the responsibilities for clinical and formulary strategy and development, member and employer experiences, operations, sales, marketing, account management and retail network strategy.
Pricing Trends: We strive to price our health benefit products consistent with anticipated underlying medical cost trends. We continue to closely monitor the COVID-19 pandemic (including new COVID-19 variants, which may be more contagious or severe, or less responsive to treatment or vaccines) and the impacts it may have on our pricing, such as surges in COVID-19 related hospitalizations, infection rates, the cost of COVID-19 vaccines, testing and treatment and the return of non-COVID-19 healthcare utilization to our estimate of normal levels, based on historical utilization patterns. We frequently make adjustments to respond to legislative and regulatory changes as well as pricing and other actions taken by existing competitors and new market entrants. Product pricing in our Commercial & Specialty Business segment, including our Individual and small group lines of business, remains competitive. Revenues from the Medicare and Medicaid programs are dependent, in whole or in part, upon annual funding from the federal government and/or applicable state governments.
Medical Cost Trends: Our medical cost trends are primarily driven by increases in the utilization of services across all provider types and the unit cost increases of these services. We work to mitigate these trends through various medical management programs such as care and condition management, program integrity and specialty pharmacy management and utilization management, as well as benefit design changes. There are many drivers of medical cost trends that can cause variance from our estimates, such as changes in the level and mix of services utilized, regulatory changes, aging of the population, health status and other demographic characteristics of our members, epidemics, pandemics, advances in medical technology, new high-cost prescription drugs, contracting inflation and healthcare provider or member fraud.
At its onset, the COVID-19 pandemic caused a decrease in utilization of non-COVID-19 health services, which decreased our claim costs in 2020. As the pandemic continued through 2021, our non-COVID-19 healthcare utilization experience gradually increased and largely normalized. Our COVID-19 related healthcare expenses increased during 2021 as new variants (Delta and Omicron) emerged and vaccinations and boosters became available.
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The Omicron surge quickly declined during the first quarter of 2022, with COVID-19 inpatient authorizations, provider-based tests, visits and vaccinations all decreasing to lower levels by the end of the first quarter of 2022; concurrently, non-COVID-19 healthcare utilization throughout the second quarter of 2022 recovered from lower levels earlier in the quarter. Inyear. For the remainder of 2022, we anticipate additional claim costs for new pharmaceutical treatments for COVID-19 and compliance with governmental regulations on COVID-19 testing reimbursement. We expect claims costs related to COVID-19 testing, treatment and hospitalizations will continue throughout 2022 even during periods with lower COVID-19 infection and confirmed case activity. The ongoing cost and volume of
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covered services related to the COVID-19 pandemic may have a material adverse effect on our future claim costs. We continue to closely monitor the COVID-19 pandemic and its impacts on our business, financial condition, results of operations and medical cost trends.
For additional discussion regarding business trends, see Part I, Item 1, “Business” included in our 2021 Annual Report on Form 10-K.
Regulatory Trends and Uncertainties
Federal and state governments have enacted, and may continue to enact, legislation and regulations in response to the COVID-19 pandemic that have had, and we expect will continue to have, a significant impact on health benefits, consumer eligibility for public programs and our cash flows for all lines of business, and which have introduced increased uncertainty around our cost structure. These actions, which are or have been in effect for various durations, provide, among other things:
mandates to waive cost-sharing for COVID-19 testing (including over-the-counter testing in accordance with state and federal requirements), vaccines and related services;
reforms, including waiving Medicare originating site restrictions for qualified providers of telehealth services;
financial support to healthcare providers, including expansion of the Medicare accelerated payment program to all providers receiving Medicare payments;
mandated expansion of premium payment terms, including the time period for which claims can be denied for lack of payment; and
mandates related to prior authorizations and payment levels to providers, additional consumer enrollment windows and an increased ability to provide telehealth services.
At the end of the currently enacted public health emergency, which has been extended until October 2022, Medicaid eligibility recertification will resume. Recertifications could begin as early as November 2022, but may not occur until 2023 in certain states, and we expect a decline in our Medicaid membership once recertification resumes. At the same time, we expect growth in our Commercial risk-based and fee-based plans, including through the Public Exchange, as members exiting Medicaid in our fourteen Commercial states seek coverage elsewhere.
Beginning in July 2022, the health plan price transparency regulations issued in October 2020 by the U.S. Departments of Health and Human Services, Labor and Treasury (the “Health Plan Transparency Rule”) will require us to disclose, on a monthly basis, detailed pricing information regarding negotiated rates for all covered items and services between the plan or issuer and in-network providers and historical payments to, and billed charges from, out-of-network providers. Additionally, beginning in 2023, we will be required to make available to members personalized out-of-pocket cost information and the underlying negotiated rates for 500 covered healthcare items and services, including prescription drugs. In 2024, this requirement will expand to all items and services.
The Consolidated Appropriations Act of 2021, which was enacted in December 2020 (the “Appropriations Act”), has impacted and in the future may have a material effect upon our business, including procedures and coverage requirements related to surprise medical bills and new mandates for continuity of care for certain patients, price comparison tools, disclosure of broker compensation, mental health parity reporting, and reporting on pharmacy benefits and drug costs. The requirements of the Appropriations Act applicable to us have varying effective dates, some of which were effective in December 2021 and others that have been extended since the enactment of the Appropriations Act.
The American Rescue Plan Act of 2021, (the “Rescue Plan”), which was enacted in March 2021, contains several health-related provisions that have impacted our business, including expansion of premium tax credits for our Public Exchange business and full subsidization of the Consolidated Omnibus Budget Reconciliation Act (“COBRA”) continuation coverage for those who were involuntarily terminated or had their work hours reduced. The Rescue Plan’s premium tax credit
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provisions became effective in January 2021, while the COBRA premium subsidization was effective from April 2021 through September 2021. Expiration of the premium tax credit provisions on December 31, 2022, unless extended by Congress, may have an adverse effect upon our business.

Since its enactment in 2010, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the “ACA”), has introduced new risks, regulatory challenges and uncertainties, has impacted our business model and strategy and has required changes in the way our products are designed, underwritten, priced, distributed and administered. The ACA has evolved and various challenges since its enactment have introduced increased uncertainty to our business. In June 2021, the U.S. Supreme Court issued its opinion and dismissed the last legal challenge to the constitutionality of the ACA, leaving the law intact. We expect the ACA will continue to significantly impact our business and results of operations, including pricing, minimum medical loss ratios and the geographies in which our products are available, and as a result of future modifications of, and guidance by federal regulatory
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agencies related to, the ACA and our businesses more broadly. We will continue to evaluate the impact of the ACA as any further developments occur.
For additional discussion regarding regulatory trends and uncertainties and risk factors, see Part I, Item 1, “Business – Regulation”, Part I, Item 1A, “Risk Factors”, and the “Regulatory Trends and Uncertainties” section of Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our 2021 Annual Report on Form 10-K.
Other Significant Items
Business and Operational Matters
On March 10, 2022,As mentioned above, we announced our intent tobegan operating as Elevance Health on June 28, 2022. This change our nameis intended to better reflect our business and our journey from a traditional health benefits organization to a lifetime, trusted health partner. At our annual meeting of shareholders on May 18, 2022, our shareholders will vote on a proposed amendment to our amended and restated articles of incorporation to change our name to Elevance Health Inc. Shareholders of record on March 17, 2022 are entitled to vote. If approved by our shareholders, we expect the name change to occur in the second quarter of 2022.supports health at every stage, offering health plans and clinical, behavioral, pharmacy and complex-care solutions that promote whole health.
On November 10, 2021,May 5, 2022, we announcedcompleted our entrance into an agreement with Personal Touch Holding Corporation to acquireacquisition of Integra Managed Care (“Integra”). Integra is a managed long-term care plan that serves New York state Medicaid members, enabling adults with long-term care needs and disabilities to live safely and independently in their own homes. The acquisition is expected to close by the end of the second quarter of 2022 and is subject to standard closing conditions and customary approvals.
On June 29, 2021, we completed our acquisition of MMM Holdings, LLC (“MMM”) and its Medicare Advantage plan, Medicaid plan and other affiliated companies from InnovaCare Health, L.P.companies. MMM is a Puerto Rico-based integrated healthcare organization and seeks to provide its Medicare Advantage and Medicaid members with a whole health experience through its network of specialized clinics and wholly owned independent physician associations. This acquisition aligns with our vision to be an innovative, valuable and inclusive healthcare partner by providing care management programs that improve the lives of the people we serve.
On April 28, 2021, we completed our acquisition of myNEXUS, Inc. (“myNEXUS”) from WindRose Health Investors.. myNEXUS is a comprehensive home-based nursing management company for payors and, at the time of acquisition, delivered integrated clinical support services for Medicare Advantage members across twenty states. This acquisition aligns with our strategy to manage integrated, whole person multi-site care and support by providing national, large-scale expertise to manage nursing services in the home and facilitate transitions of care.
For additional information, see Note 3, “Business Acquisitions,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
In 2020, we introduced enterprise-wide initiatives to optimize our business and as a result, recorded a charge of $653 in selling, general and administrative expenses. We believe these initiatives largely represent the next step forward in our progression towards becoming a more agile organization, including process automation and a reduction in our office space footprint. In the fourth quarter of 2021, we identified additional office space reductions and related fixed asset impairments due to the continuing COVID-19 pandemic and recorded a charge of $202 in selling general and administrative expenses. For additional information, see Note 4, “Business Optimization Initiatives” and Note 16, “Leases,Initiatives,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q.
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Litigation Matters
In the consolidated multi-district proceeding in the United States District Court for the Northern District of Alabama (the “Court”) captioned In re Blue Cross Blue Shield Antitrust Litigation (“BCBSA Litigation”), the BCBSA and Blue Cross and/or Blue Shield licensees, including us (the “Blue plans”) have approved a settlement agreement and release (the “Subscriber Settlement Agreement”) with the plaintiffs representing a putative nationwide class of health plan subscribers. Generally, the lawsuits in the BCBSA Litigation challenge elements of the licensing agreements between the BCBSA and the independently owned and operated Blue plans. The cases were brought by two putative nationwide classes of plaintiffs, health plan
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subscribers and providers, and the Subscriber Settlement Agreement applies only to the putative subscriber class. No settlement agreement has been reached with the provider plaintiffs at this time, and the defendants continue to contest the consolidated cases brought by the provider plaintiffs.
If approved by the Court, the Subscriber Settlement Agreement will require the defendants to make a monetary settlement payment, our portion of which is estimated to be $594, and will include certain terms imposing non-monetary obligations on the defendants. As of March 31,June 30, 2022, the liability balance accrued for our estimated remaining payment obligation was $507, net of payments made. All terms of the Subscriber Settlement Agreement are subject to approval by the Court before they become effective. For additional information regarding the BCBSA Litigation, see Note 11, “Commitments and Contingencies – Litigation and Regulatory Proceedings – Blue Cross Blue Shield Antitrust Litigation,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q.
Selected Operating Performance
For the twelve months ended March 31,June 30, 2022, total medical membership increased by 3.32.7 million, or 7.5%6.1%. The Government Business segment increase was driven primarily by organic growth in our Medicaid business due to the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic, the acquisitions of MMM in the second quarter of 2021 and Ohiopandemic. In addition, Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract andmembership growth was impacted by the launch of our HealthyBlueHealthy Blue managed care alliance in North Carolina in the third quarter of 2021. Our2021, the acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022 and the acquisition of Integra in the second quarter of 2022, as well as organic growth in our Medicare Advantage membership also increased due to organic growth. Increases in ourbusiness. Our Commercial & Specialty Business segment were driven primarily by new sales exceeding lapsesexperienced organic growth in both our Group fee-based and our Group risk-based membership.membership as sales exceeded lapses. BlueCard membership increased due to favorable membership activity at other BCBSA plans whose members reside in or travel to our licensed areas. Individual membership increased due to our Public Exchange expansion in 2022.

Operating revenue for the three months ended March 31,June 30, 2022 was $37,886,$38,482, an increase of $5,788,$5,203, or 18.0%15.6%, from the three months ended March 31,June 30, 2021. This increase in operatingOperating revenue wasincreased primarily driven byas a result of higher premium revenue due mainly to organic membership growth in our Medicaid business, resulting primarilyincluding due to membership growth from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic. Other contributors to the operating revenue increase werepandemic, the acquisition of MMM in the second quarter of 2021, the acquisition of Ohio Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract in the first quarter of 2022, as well as from premium rate increases to cover medical cost trends and membership growth in our Medicare Advantage and Commercial & Specialty Business risk-based businesses. The increase in operating revenue was further attributable to increased pharmacy product revenue in our IngenioRx segment, the acquisition of Integra in the second quarter of 2022 and the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021.
Operating revenue for the six months ended June 30, 2022 was $76,368, an increase of $10,991, or 16.8%, from the six months ended June 30, 2021. This increase in operating revenue was primarily driven by higher premium revenue in our Medicaid business, including due to membership growth from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic, the acquisition of MMM in the second quarter of 2021 and the retroactive reinstatement of a MedicaidMedicare directed payment program. Membership increasesgrowth and premium rate increases designed to cover medical cost trends in our Medicare Advantage and Commercial & Specialty Business risk-based businesses also provided additionalcontributed to higher premium revenue. ProductThe increase in operating revenue was further attributable to increased due to growth in integrated pharmacy membersproduct revenue in our IngenioRx segment, which also contributed to the overall operating revenue increase.acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022, the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021 and the acquisition of Integra in the second quarter of 2022.
Net income for the three months ended March 31,June 30, 2022 was $1,795, an increase$1,650, a decrease of $128,$151, or 7.7%8.4%, from the three months ended March 31,June 30, 2021. This increaseThe decrease in net income was primarily due to losses on financial instruments in 2022, as compared
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to gains on financial instruments in 2021, as well as increased intangible amortization in 2022 related to recent acquisitions and the rebranding of our products, as we expect to retire certain trade names in the future. These decreases were partially offset by operating gain increases in each of our business units.
Net income for the six months ended June 30, 2022 was $3,445, a decrease of $23, or 0.7%, from the six months ended June 30, 2021. The decrease in net income was primarily due to losses on financial instruments in 2022, as compared to gains on financial instruments in 2021, as well as increased intangible amortization in 2022 related to recent acquisitions and the rebranding of our products, as we expect to retire certain trade names in the future. These decreases were partially offset by a net operating gain increase from our business units and increased net investment income, partially offset by increased losses on financial instruments, increased interest expense, increased amortization of intangibles and increased income tax expense due to higher income before income tax expense.units.
Our fully-diluted shareholders’ earnings per share (“EPS”) was $7.39$6.79 for the three months ended March 31,June 30, 2022, which represented a 10.1% increase6.3% decrease from EPS of $6.71$7.25 for the three months ended March 31,June 30, 2021. Our diluted shares for the three months ended March 31,June 30, 2022 were 244.4,243.4, a decrease of 3.8,4.0, or 1.5%1.6%, compared to the three months ended March 31,June 30, 2021. The decrease in EPS for the three months ended June 30, 2022 resulted primarily from reduced shareholders' net income, partially offset by the impact of fewer diluted shares outstanding.
Our fully-diluted shareholders’ EPS was $14.18 for the six months ended June 30, 2022, which represented a 1.6% increase from fully-diluted EPS of $13.95 for the six months ended June 30, 2021. Our diluted shares for the six months ended June 30, 2022 were 243.9, a decrease of 3.9, or 1.6%, compared to the six months ended June 30, 2021. The increase in EPS for the six months ended June 30, 2022 resulted primarily from the increase in net income, as well as from the lowerimpact of fewer diluted shares outstanding during the three months ended March 31, 2022.outstanding.
Operating cash flow for the threesix months ended March 31,June 30, 2022 and 2021 was $2,541$4,993 and $2,505,$4,188, respectively. The minor increase in operating cash flow was primarily due to higher net income in 2022, partially offset byexcluding the non-cash impact of losses/gains on investments, as we recognized realized losses during the first six months of 2022 compared to realized gains in the first six months of 2021. The increase was further attributable to the timing of working capital changes year over year.changes.
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Membership
The following table presents our medical membership by reportable segment and customer type as of March 31,June 30, 2022 and 2021. Also included below is other membership by product. The medical membership and other membership data presented are unaudited and in certain instances include estimates of the number of members represented by each contract at the end of the period. For a more detailed description of our medical membership, see the “Membership” section of Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our 2021 Annual Report on Form 10-K.
March 31  
June 30  
(In thousands)(In thousands)20222021Change% Change(In thousands)20222021Change% Change
Medical MembershipMedical MembershipMedical Membership
Commercial & Specialty Business:Commercial & Specialty Business:Commercial & Specialty Business:
IndividualIndividual818 731 8711.9 %Individual803 738 658.8 %
Group Risk-BasedGroup Risk-Based4,028 3,837 1915.0 %Group Risk-Based4,020 3,851 1694.4 %
Commercial Risk-BasedCommercial Risk-Based4,846 4,568 2786.1 %Commercial Risk-Based4,823 4,589 2345.1 %
BlueCard®
BlueCard®
6,370 6,166 2043.3 %
BlueCard®
6,445 6,235 2103.4 %
Group Fee-BasedGroup Fee-Based20,148 19,515 6333.2 %Group Fee-Based20,086 19,372 7143.7 %
Commercial Fee-BasedCommercial Fee-Based26,518 25,681 837 3.3 %Commercial Fee-Based26,531 25,607 924 3.6 %
Total Commercial & Specialty BusinessTotal Commercial & Specialty Business31,364 30,249 1,115 3.7 %Total Commercial & Specialty Business31,354 30,196 1,158 3.8 %
Government Business:Government Business:Government Business:
Medicare AdvantageMedicare Advantage1,921 1,538 38324.9 %Medicare Advantage1,946 1,824 1226.7 %
Medicare SupplementMedicare Supplement939 930 91.0 %Medicare Supplement942 936 60.6 %
Total MedicareTotal Medicare2,860 2,468 392 15.9 %Total Medicare2,888 2,760 128 4.6 %
MedicaidMedicaid10,919 9,172 1,74719.0 %Medicaid11,181 9,754 1,42714.6 %
Federal Employees Health BenefitsFederal Employees Health Benefits1,632 1,632 — %Federal Employees Health Benefits1,628 1,631 (3)(0.2)%
Total Government BusinessTotal Government Business15,411 13,272 2,13916.1 %Total Government Business15,697 14,145 1,55211.0 %
Total Medical MembershipTotal Medical Membership46,775 43,521 3,2547.5 %Total Medical Membership47,051 44,341 2,7106.1 %
Other MembershipOther MembershipOther Membership
Life and Disability MembersLife and Disability Members4,679 4,766 (87)(1.8)%Life and Disability Members4,779 4,732 47 1.0 %
Dental MembersDental Members6,649 6,599 50 0.8 %Dental Members6,620 6,606 14 0.2 %
Dental Administration MembersDental Administration Members1,588 1,488 100 6.7 %Dental Administration Members1,589 1,497 92 6.1 %
Vision MembersVision Members9,211 7,798 1,413 18.1 %Vision Members9,385 7,819 1,566 20.0 %
Medicare Part D Standalone MembersMedicare Part D Standalone Members279 450 (171)(38.0)%Medicare Part D Standalone Members276 433 (157)(36.3)%
Medical Membership
Total medicalMedical membership increased in both our Government Business and Commercial & Specialty Business and Government Business segments. The largest increase was in our Government Business segment,segments primarily due to organic Medicaid membershipgrowth. The Government Business segment organic growth resulting fromwas primarily driven by the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic,pandemic. In addition, Medicaid membership growth was impacted by the acquisitionslaunch of MMMour Healthy Blue managed care alliance in North Carolina in the secondthird quarter of 2021, andthe acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022 and the acquisition of Integra in the second quarter of 2022, as well as the launch of our HealthyBlue managed care allianceorganic membership growth in North Carolina in the third quarter of 2021.Medicare Advantage. Our Medicare Advantage membership also increased due to organic growth. Increases in our Commercial & Specialty Business segment were driven primarily by new sales exceeding lapsesexperienced organic growth in both our Group fee-based and Group risk-based membership.membership as sales exceeded lapses. BlueCard membership increases andincreased due to favorable membership activity at other BCBSA plans whose members reside in or travel to our licensed areas. Individual membership increasesincreased due to our Public Exchange expansion in 2022 also contributed to our overall membership increases.2022.
Other Membership
Our other membership can be impacted by changes in our medical membership, as our medical members often purchase our other products that are ancillary to our health business. Life and disability membership decreasedincreased primarily due to lapses and negative in-group change exceeding membership increases in our Group fee-based business. Dental membershipnew
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sales of disability products, partially offset by lapses and negative in-group change of life membership. Dental membership increased primarily due to sales exceeding lapses in our Group risk-based accounts and penetration increases in our Federal Employees Health Benefits (“FEHB”) program, partially offset by the loss of a significant Group fee-based account. Dental administration membership increased primarily due to increased sales to other BCBS plans associated with the FEHB program. Vision membership increased primarily due to the launch of a new entry level vision product in our Group markets, as well as the growth in our Medicare Advantage business. Medicare Part D Standalone membership declined as we discontinued certain legacy products.
Consolidated Results of Operations
Our consolidated summarized results of operations and other financial information for the three and six months ended March 31,June 30, 2022 and 2021 are as follows: 
Three Months Ended 
 June 30
Six Months Ended 
 June 30
Change
Six Months Ended 
 June 30
Three Months Ended 
 June 30
Six Months Ended 
 June 30
Three Months Ended 
 March 31
2022 vs. 20212022 vs. 2021
20222021Change% Change2022202120222021$%$%
Total operating revenueTotal operating revenue$37,886 $32,098 $5,788 18.0 %Total operating revenue$38,482$33,279$76,368$65,377$5,203 15.6 %$10,991 16.8 %
Net investment incomeNet investment income360 291 69 23.7 %Net investment income381400741691(19)(4.8)%50 7.2 %
Net losses on financial instruments(151)(4)(147)NM
Net (losses) gains on financial instrumentsNet (losses) gains on financial instruments(231)172(382)168(403)NM(550)NM
Total revenuesTotal revenues38,095 32,385 5,710 17.6 %Total revenues38,63233,85176,72766,2364,781 14.1 %10,491 15.8 %
Benefit expenseBenefit expense28,215 23,699 4,516 19.1 %Benefit expense28,77724,76356,99248,4624,014 16.2 %8,530 17.6 %
Cost of products soldCost of products sold2,883 2,313 570 24.6 %Cost of products sold3,0692,6145,9524,927455 17.4 %1,025 20.8 %
Selling, general and administrative expenseSelling, general and administrative expense4,341 3,925 416 10.6 %Selling, general and administrative expense4,2693,8218,6107,746448 11.7 %864 11.2 %
Other expense1
Other expense1
330 272 58 21.3 %
Other expense1
37430070457274 24.7 %132 23.1 %
Total expensesTotal expenses35,769 30,209 5,560 18.4 %Total expenses36,48931,49872,25861,7074,991 15.8 %10,551 17.1 %
Income before income tax expenseIncome before income tax expense2,326 2,176 150 6.9 %Income before income tax expense2,1432,3534,4694,529(210)(8.9)%(60)(1.3)%
Income tax expenseIncome tax expense531 509 22 4.3 %Income tax expense4935521,0241,061(59)(10.7)%(37)(3.5)%
Net incomeNet income$1,795 $1,667 $128 7.7 %Net income$1,650$1,801$3,445$3,468$(151)(8.4)%$(23)(0.7)%
Net loss (income) attributable to noncontrolling interestsNet loss (income) attributable to noncontrolling interests10 (2)12 NMNet loss (income) attributable to noncontrolling interests3(8)13(10)11 NM23 NM
Shareholders’ net incomeShareholders’ net income$1,805 $1,665 $140 8.4 %Shareholders’ net income$1,653$1,793$3,458$3,458$(140)(7.8)%$— — %
Average diluted shares outstandingAverage diluted shares outstanding244.4 248.2 (3.8)(1.5)%Average diluted shares outstanding243.4247.4243.9247.8(4.0)(1.6)%(3.9)(1.6)%
Diluted shareholders’ net income per shareDiluted shareholders’ net income per share$7.39 $6.71 $0.68 10.1 %Diluted shareholders’ net income per share$6.79$7.25$14.18$13.95$(0.46)(6.3)%$0.23 1.6 %
Effective tax rateEffective tax rate22.8 %23.4 %
(60) bp3
Effective tax rate23.0 %23.5 %22.9 %23.4 %
(50) bp3
(50) bp3
Benefit expense ratio2
Benefit expense ratio2
86.1 %85.6 %
50 bp3
Benefit expense ratio2
87.0 %86.8 %86.5 %86.2 %
20 bp3
30 bp3
Selling, general and administrative expense ratio4
Selling, general and administrative expense ratio4
11.5 %12.2 %
(70) bp3
Selling, general and administrative expense ratio4
11.1 %11.5 %11.3 %11.8 %
(40) bp3
(50) bp3
Income before income tax expense as a percentage of total revenuesIncome before income tax expense as a percentage of total revenues6.1 %6.7 %
(60) bp3
Income before income tax expense as a percentage of total revenues5.5 %7.0 %5.8 %6.8 %
(150) bp3
(100) bp3
Shareholders’ net income as a percentage of total revenuesShareholders’ net income as a percentage of total revenues4.7 %5.1 %
(40) bp3
Shareholders’ net income as a percentage of total revenues4.3 %5.3 %4.5 %5.2 %
(100) bp3
(70) bp3
Certain of the following definitions are also applicable to all other results of operations tables in this discussion:
NM    Not meaningful.
1    Includes interest expense, and amortization of other intangible assets.assets and loss on extinguishment of debt..
2    Benefit expense ratio represents benefit expense as a percentage of premium revenue. Premiums for the three months ended March 31,June 30, 2022 and 2021 were $32,785$33,076 and $27,676,$28,533, respectively. Premiums for the six months ended June 30, 2022 and 2021 were $65,861 and $56,209, respectively.
3    bp = basis point; one hundred basis points = 1%.
4    Selling, general and administrative expense ratio represents selling, general and administrative expense as a percentage of total operating revenue.
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Three Months Ended March 31,June 30, 2022 Compared to the Three Months Ended March 31,June 30, 2021
Total operating revenue increased primarily as a result of higher premium revenue due mainly to organic membership growth in our Medicaid business, resulting primarilyincluding due to membership growth from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic. Other contributors to the operating revenue increase werepandemic, the acquisition of MMM in the second quarter of 2021, the acquisition of Ohio Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract andin the retroactive reinstatementfirst quarter of a Medicaid directed payment program. Membership increases and2022, as well as from premium rate increases designed to cover medical cost trends and membership growth in our Medicare Advantage and Commercial & Specialty Business risk-based businesses also
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provided additional premium revenue. Productbusinesses. The increase in operating revenue was further attributable to increased due to growth in integrated pharmacy membersproduct revenue in our IngenioRx segment, which also contributed to the overall operating revenue increase.acquisition of Integra in the second quarter of 2022 and the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021.
Net investment income increased primarily due to increases inWe had net income from our alternative investments and higher income from fixed maturity securities.
Net losses on financial instruments increased primarilyin the second quarter of 2022 as compared to net gains in the second quarter of 2021, as a result of increased losses on fixed maturity securities, mark-to-market losses on equity securities still held and fewerreduced gains on sales of equity securities. Losses related to our Russia and Ukraine fixed maturity securities were not material. At March 31, 2022, our remaining holdings of Russia and Ukraine fixed maturity securities were not material.
Benefit expense increased primarily due to healthcare costs associated with organic membership growth in our Medicaid and Medicare businesses, the acquisition of MMM in the second quarter of 2021 and the acquisition of Ohio Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract. Membership growth in our Commercial risk-based business also contributed to the increased benefit expense. The increase in benefit expense was also attributable to the acquisition of Integra in the second quarter of 2022 and the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021.
Our benefit expense ratio increased primarily due to the impact of continued membership increases in our Government Business segment, which has a higher benefit expense ratio than our Commercial & Specialty Business segment.
Cost of products sold reflects the cost of pharmaceuticals dispensed by IngenioRx for our unaffiliated PBM customers. Cost of products sold increased as the corresponding pharmacy product revenues increased.
Selling, general and administrative expense increased primarily due to increased costs to support membership growth and related to our acquisitions.
Our selling, general and administrative expense ratio decreased primarily due to the operating revenue growth in 2022, partially offset by increased costs to support membership growth.
Other expense increased primarily due to additional amortization of intangible assets related to recent acquisitions and the rebranding of our products. The amortization period of certain intangible assets is being shortened to align with anticipated dates the new branding will take place. In addition, certain indefinite-lived intangible assets have been reclassified as definite-lived, and therefore, are now being amortized. For additional information regarding intangible asset amortization, see Note 17, “Goodwill and Other Intangible Assets,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q.
Our shareholders’ net income as a percentage of total revenues decreased in 2022 as compared to 2021 as a result of all factors discussed above.
Six Months Ended June 30, 2022Compared to theSix Months Ended June 30, 2021
Total operating revenue increased primarily as a result of higher premium revenue in our Medicaid business, including due to membership growth from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic, the acquisition of MMM in the second quarter of 2021 and the retroactive reinstatement of a Medicaid directed payment program. Membership growth and premium rate increases to cover medical cost trends in our Medicare Advantage and Commercial & Specialty Business risk-based businesses also contributed to higher premium revenue. The increase in operating revenue was further attributable to increased pharmacy product revenue in our IngenioRx segment, the acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022, the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021 and the acquisition of Integra in the second quarter of 2022.
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Net investment income increased primarily due to higher income from fixed maturity securities, partially offset by reduced investment income from alternative investments.
We had net losses on financial instruments in the first six months of 2022 as compared to net gains in the first six months of 2021, as a result of increased losses on fixed maturity securities, mark-to-market losses on equity securities still held and reduced gains on sales of equity securities.
Benefit expense increased primarily due to healthcare costs associated with organic membership growth in our Medicaid and Medicare businesses, the acquisition of MMM in the second quarter of 2021 and the retroactive reinstatement of a Medicaid directed payment program. Membership growth and higher healthcare costs in our Commercial risk-based business also contributed to the higher benefit expense. The increase in benefit expense was also attributable to the acquisition of Ohio Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract, the launch of our Healthy Blue managed care alliance in North Carolina in the first quarter of 2021 and the retroactive reinstatementacquisition of a Medicaid directed payment program. Higher healthcare costsIntegra in our Commercial risk-based business also contributed to the increased benefit expense.second quarter of 2022.
Our benefit expense ratio increased primarily due to the impact of continued membership increases in our Government Business segment, membership, which has a higher benefit expense ratio than our Commercial & Specialty Business segment membership.segment. Higher healthcare costs in our Commercial risk-based businesses also contributed to the benefit expense ratio increase.
Cost of products sold reflects the cost of pharmaceuticals dispensed by IngenioRx for our unaffiliated PBM customers. Cost of products sold increased as the corresponding pharmacy product revenues increased.
Selling, general and administrative expense increased primarily due to the increased costs to support growth.membership growth and related to our acquisitions.
Our selling, general and administrative expense ratio decreased primarily due to the operating revenue growth in 2022, partially offset by increased costs to support membership growth.
Other expense increased primarily due to additional amortization of intangible assets related to recent acquisitions and the rebranding of our products. The amortization period of certain intangible assets is being shortened to align with anticipated dates the new branding will take place. In addition, certain indefinite-lived intangible assets have been reclassified as definite-lived, and therefore, are now being amortized. For additional information regarding intangible asset amortization, see Note 17, “Goodwill and Other Intangible Assets,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q.
Our shareholders’ net income as a percentage of total revenues decreased in 2022 as compared to 2021 as a result of all factors discussed above.
Reportable Segments Results of Operations
Our results of operations discussed throughout this MD&A are determined in accordance with U.S. generally accepted accounting principles (“GAAP”). We also calculate operating gain and operating margin to further aid investors in understanding and analyzing our core operating results and comparing them among periods. We define operating revenue as premium income, product revenue and administrative fees and other revenue. Operating gain is calculated as total operating revenue less benefit expense, cost of products sold and selling, general and administrative expense. It does not include net investment income, net (losses) gains (losses) on financial instruments, interest expense, amortization of other intangible assets, loss on extinguishment of debt or income taxes, as these items are managed in our corporate shared service environment and are not the responsibility of operating segment management. Operating margin is calculated as operating gain divided by operating revenue. We use these measures as a basis for evaluating segment performance, allocating resources, forecasting future operating periods and setting incentive compensation targets. This information is not intended to be considered in isolation or as a substitute for income before income tax expense, shareholders’ net income or EPS prepared in accordance with GAAP, and may not be comparable to similarly titled measures reported by other companies. For a reconciliation of reportable segments’ operating revenue to the amounts of total revenue included in the consolidated statements of income and a reconciliation of income before income tax expense to reportable segments’ operating gain, see Note 15, “Segment Information,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
Results
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As previously discussed, we will be organizing our brand portfolio into three core go-to-market brands over the next several years. There are currently no changes to our segments associated with this branding strategy. The results of our operations arecontinue to be described through four reportable segments: Commercial & Specialty Business, Government Business, IngenioRx and Other. For additional information, see Note 15, “Segment Information,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
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The following table presents a summary of the reportable segment financial information for the three and six months ended March 31,June 30, 2022 and 2021:
 Three Months Ended 
 March 31
 Three Months Ended 
 June 30
Six Months Ended 
 June 30
Change
 Three Months Ended 
 June 30
Three Months Ended 
 June 30
Six Months Ended 
 June 30
 2022 vs. 20212022 vs. 2021
 20222021Change% Change 2022202120222021$%$%
Operating RevenueOperating RevenueOperating Revenue
Commercial & Specialty BusinessCommercial & Specialty Business$10,269$9,491 $778 8.2 %Commercial & Specialty Business$10,561$9,550$20,830$19,041$1,011 10.6 %$1,789 9.4 %
Government BusinessGovernment Business23,75819,283 4,475 23.2 %Government Business23,83520,06647,59339,3493,769 18.8 %8,244 21.0 %
IngenioRxIngenioRx6,6835,862 821 14.0 %IngenioRx7,0716,21913,75412,081852 13.7 %1,673 13.8 %
OtherOther3,2212,370 851 35.9 %Other3,2982,5176,5194,887781 31.0 %1,632 33.4 %
EliminationsEliminations(6,045)(4,908)(1,137)NMEliminations(6,283)(5,073)(12,328)(9,981)(1,210)NM(2,347)NM
Total operating revenueTotal operating revenue$37,886$32,098 $5,788 18.0 %Total operating revenue$38,482$33,279$76,368$65,377$5,203 15.6 %$10,991 16.8 %
Operating GainOperating GainOperating Gain
Commercial & Specialty BusinessCommercial & Specialty Business$1,082 $1,268 $(186)(14.7)%Commercial & Specialty Business$806$791$1,888$2,059$15 1.9 %$(171)(8.3)%
Government BusinessGovernment Business789 478 311 65.1 %Government Business9968681,7851,346128 14.7 %439 32.6 %
IngenioRxIngenioRx398 407 (9)(2.2)%IngenioRx47940587781274 18.3 %65 8.0 %
OtherOther178 170 NMOther86172642569 NM239 NM
Operating MarginOperating MarginOperating Margin
Commercial & Specialty BusinessCommercial & Specialty Business10.5 %13.4 %(290) bpCommercial & Specialty Business7.6 %8.3 %9.1 %10.8 %(70) bp(170) bp
Government BusinessGovernment Business3.3 %2.5 %80 bpGovernment Business4.2 %4.3 %3.8 %3.4 %(10) bp40 bp
IngenioRxIngenioRx6.0 %6.9 %(90) bpIngenioRx6.8 %6.5 %6.4 %6.7 %30 bp(30) bp
Three Months Ended March 31,June 30, 2022 Compared to the Three Months Ended March 31,June 30, 2021
Commercial & Specialty Business
Operating revenue increased primarily due to higher premiums in our Commercial risk-based businessesbusiness due to increased membership growth, premium rate increases in our Commercial risk-based businessesbusiness designed to cover medical cost trends and increased administrative fees in our Commercial fee-based businesses.
Operating gain increased primarily due to the positive contribution from increased risk-based and fee-based membership, partially offset by the net unfavorable effect of COVID-19.
Government Business
Operating revenue increased primarily as a result of higher premium revenue associated with organic Medicaid membership growth resulting from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic, the acquisition of MMM at the end of the second quarter of 2021 and the acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022. Membership growth and premium rate increases to cover medical cost trends in our Medicare Advantage business also increased premium revenue, as did the acquisition of Integra during the second quarter of 2022 and the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021.
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The increase in operating gain was primarily driven by premium rates in Medicare that better reflect the acuity of our members and organic membership growth in our Medicaid membership resulting from the continued temporary suspension of eligibility recertification during the COVID-19 pandemic.
IngenioRx
Operating revenue increased primarily due to higher prescription volume driven by growth in integrated medical and pharmacy members in 2022 and to a lesser extent, a favorable out of period adjustment related to the first quarter of 2022.
The increase in operating gain was primarily driven by a favorable out of period adjustment related to the first quarter of 2022, as well as the impact of higher prescription volume associated with growth in integrated medical and pharmacy members in 2022.
Other
Operating revenue increased primarily due to higher revenue for expanded services performed by Carelon, formerly known as our Diversified Business Group, for our Commercial & Specialty Business segment in 2022. In addition, results in 2022 include revenue from myNEXUS, which was acquired in the second quarter of 2021. These increases were partially offset by the reduction of external revenue due to the loss of a behavioral health contract.
Operating gain increased primarily due to improved performance in Carelon.
Six Months Ended June 30, 2022Compared to theSix Months Ended June 30, 2021
Commercial & Specialty Business
Operating revenue increased primarily due to higher premiums in our Commercial risk-based business due to membership growth, premium rate increases in our Commercial risk-based business to cover medical cost trends and increased administrative fees in our Commercial fee-based businesses.
Operating gain decreased primarily due to the net unfavorable effect of COVID-19 and increased selling, general and administrative costsspend to support growth and innovation.growth. These impacts were partially offset by positive contribution from the growth in our risk-based and fee-based membership.
Government Business
Operating revenue increased primarily as a result of higher premium revenue due mainly toassociated with organic Medicaid membership growth in our Medicaid business primarily resulting from the continued temporary suspension of Medicaid eligibility recertification during the COVID-19 pandemic. Other contributors to the operating revenue increase werepandemic, the acquisition of MMM inat the end of the second quarter of 2021 the acquisition of Ohio Medicaid members in the first quarter of 2022 through the purchase of a Medicaid contract and the retroactive reinstatement of a Medicaid directed payment program. Membership increasesgrowth and premium rate increases designed to cover medical cost trends in our Medicare Advantage business also increased premium revenue.revenue, as did the acquisition of Ohio Medicaid members through the purchase of a Medicaid contract in the first quarter of 2022, the launch of our Healthy Blue managed care alliance in North Carolina in the third quarter of 2021 and the acquisition of Integra during the second quarter of 2022.
The increase in operating gain was primarily driven by premium rates in Medicare that better reflect the acquisitionacuity of MMM in the second quarter of 2021,our members, organic membership growth in our Medicaid businessmembership resulting from the continued temporary suspension of eligibility recertification during the COVID-19 pandemic improved risk revenueand the acquisition of MMM in Medicare and favorable outthe second quarter of period adjustments in our Medicaid businesses.2022. These increases were partially offset by increased selling, general and administrative costsadditional spend to support growth.
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IngenioRx
Operating revenue increased as a result of higher prescription volume, driven by growth in integrated medical and pharmacy members in 2022.
The decreaseincrease in operating gain was primarily a result of higher prescription volume, driven by growth in integrated medical and pharmacy members in 2022, partially offset by the non-recurrence of a favorable out of period adjustment recorded in the first quarter of 2021 partially offset by the impact of higher prescription volume resulting from growth in integrated medical and pharmacy members.related to 2020.
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Other
Operating revenue increased primarily due to higher revenue for expanded services performed by our Diversified Business GroupCarelon for our Commercial & Specialty Business segment in 2022. In addition, results in 2022 includeincluded revenue from myNEXUS, which was acquired in the second quarter of 2021. These increases were partially offset by the reduction of external revenue due to the loss of a behavioral health contract.
Operating gain increased primarily due to improved performance in our Diversified Business Group’s affiliated and unaffiliated earningsCarelon and the acquisition of myNEXUS. The increasemyNEXUS in operating gain was further driven by lower unallocated corporate expenses in 2022.2021.
Critical Accounting Policies and Estimates
We prepare our consolidated financial statements in conformity with GAAP. Application of GAAP requires management to make estimates and assumptions that affect the amounts reported in our consolidated financial statements and accompanying notes and within this MD&A. We consider our most important accounting policies that require significant estimates and management judgment to be those policies with respect to liabilities for medical claims payable, income taxes, goodwill and other intangible assets, investments and retirement benefits. Our accounting policies related to these items are discussed in our 2021 Annual Report on Form 10-K in Note 2, “Basis of Presentation and Significant Accounting Policies,” to our audited consolidated financial statements as of and for the year ended December 31, 2021, as well as in the “Critical Accounting Policies and Estimates” section of Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.” As of March 31,June 30, 2022, our critical accounting policies and estimates have not changed from those described in our 2021 Annual Report on Form 10-K.
Medical Claims Payable
The most subjective accounting estimate in our consolidated financial statements is our liability for medical claims payable. Our accounting policies related to medical claims payable are discussed in the references cited above. As of March 31,June 30, 2022, our critical accounting policies and estimates related to medical claims payable have not changed from those described in our 2021 Annual Report on Form 10-K. For a reconciliation of the beginning and ending balance for medical claims payable for the threesix months ended March 31,June 30, 2022 and 2021, see Note 9, “Medical Claims Payable,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
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The following table provides a summary of the two key assumptions having the most significant impact on our incurred but not paid liability estimates for the threesix months ended March 31,June 30, 2022 and 2021, which are the trend and completion factors. These two key assumptions can be influenced by utilization levels, unit costs, mix of business, benefit plan designs, provider reimbursement levels, processing system conversions and changes, claim inventory levels, claim processing patterns, claim submission patterns and operational changes resulting from business combinations. The impact from COVID-19 on healthcare utilization and medical claims submission patterns continues to provide increased estimation uncertainty on our incurred but not reported liability at March 31,June 30, 2022.
Favorable Developments by 
Changes in Key Assumptions
Favorable Developments by 
Changes in Key Assumptions
Three Months Ended 
 March 31
Six Months Ended 
 June 30
2022202120222021
Assumed trend factorsAssumed trend factors$880 $998 Assumed trend factors$967 $1,402 
Assumed completion factorsAssumed completion factors53 490 Assumed completion factors370 
TotalTotal$933 $1,488 Total$972 $1,772 
The favorable development recognized in the threesix months ended March 31,June 30, 2022 and 2021 resulted primarily from trend factors in late 2021 and late 2020, respectively, developing more favorably than originally expected. Favorable development in the completion factors resulting from the latter part of 2020 developing faster than expected also contributed to the favorable development for the threesix months ended March 31,June 30, 2021.
The ratio of current year medical claims paid as a percent of current year net medical claims incurred was 61.0%76.9% and 62.1%77.6% for the threesix months ended March 31,June 30, 2022 and 2021, respectively. This ratio serves as an indicator of claims processing
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speed whereby claims payments slowed down slightly during the threesix months ended March 31,June 30, 2022 as compared to the threesix months ended March 31,June 30, 2021. This was driven by the strengthening of incurred but not reported claims, within our medical claims payable, to account for an increase in overall payment cycle time.
We calculate the percentage of prior year redundancies in the current period as a percent of prior year net medical claims payable less prior year redundancies in the current period in order to demonstrate the development of prior year reserves. For the threesix months ended March 31,June 30, 2022, this metric was 7.6%7.9%, largely driven by favorable trend factor development at the end of 2021. For the threesix months ended March 31,June 30, 2021, this metric was 15.5%19.0%, largely driven by favorable trend factor development at the end of 2020 as well as favorable completion factor development from 2020.
We calculate the percentage of prior year redundancies in the current period as a percent of prior year net incurred medical claims to indicate the percentage of redundancy included in the preceding year calculation of current year net incurred medical claims. We believe this calculation supports the reasonableness of our prior year estimate of incurred medical claims and the consistency in our methodology. For the threesix months ended March 31,June 30, 2022, this metric was 0.9%1.0%, which was calculated using the redundancy of $933.$972. For the threesix months ended March 31,June 30, 2021, the comparable metric was 1.8%2.1%, which was calculated using the redundancy of $1,488.$1,772. We believe these metrics demonstrate an appropriate level of reserve conservatism.
New Accounting Pronouncements
For information regarding new accounting pronouncements that were adopted and new accounting pronouncements that were issued during the threesix months ended March 31,June 30, 2022, see the “Recently Adopted Accounting Guidance” and “Recent Accounting Guidance Not Yet Adopted” sections of Note 2, “Basis of Presentation and Significant Accounting Policies,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
Liquidity and Capital Resources
Sources and Uses of Capital
Our cash receipts result primarily from premiums, product revenue, administrative fees and other revenue, investment income, proceeds from the sale or maturity of our investment securities, proceeds from borrowings, and proceeds from the
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issuance of common stock under our employee stock plans. Cash disbursements result mainly from claims payments, administrative expenses, taxes, purchases of investment securities, interest expense, payments on borrowings, acquisitions, capital expenditures, repurchases of our debt securities and common stock and the payment of cash dividends. Cash outflows fluctuate with the amount and timing of settlement of these transactions. Any future decline in our profitability would likely have an unfavorable impact on our liquidity.
For a more detailed overview of our liquidity and capital resources management, see the “Introduction” section included in the “Liquidity and Capital Resources” section of Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our 2021 Annual Report on Form 10-K.
For additional information regarding our sources and uses of capital during the three and six months ended March 31,June 30, 2022, see Note 6, “Derivative Financial Instruments,” Note 10, “Debt,” and Note 12, “Capital Stock – Use of Capital – Dividends and Stock Repurchase Program,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
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Liquidity
A summary of our major sources and uses of cash and cash equivalents for the threesix months ended March 31,June 30, 2022 and 2021 is as follows:
Three Months Ended 
 March 31
2022 vs. 2021 Six Months Ended 
 June 30
2022 vs. 2021
20222021Change 20222021Change
Sources of Cash:Sources of Cash:Sources of Cash:
Net cash provided by operating activitiesNet cash provided by operating activities$2,541 $2,505 $36 Net cash provided by operating activities$4,993 $4,188 $805 
Issuances of commercial paper and short- and long-term debt, net of repaymentsIssuances of commercial paper and short- and long-term debt, net of repayments211 3,212 (3,001)Issuances of commercial paper and short- and long-term debt, net of repayments507 2,985 (2,478)
Proceeds from issuance of common stock under employee stock plansProceeds from issuance of common stock under employee stock plans76 89 (13)Proceeds from issuance of common stock under employee stock plans116 141 (25)
Other sources of cash, netOther sources of cash, net420 65 355 Other sources of cash, net681 253 428 
Total sources of cashTotal sources of cash3,248 5,871 (2,623)Total sources of cash6,297 7,567 (1,270)
Uses of Cash:Uses of Cash:Uses of Cash:
Purchases of investments, net of proceeds from sales, maturities, calls and redemptionsPurchases of investments, net of proceeds from sales, maturities, calls and redemptions(794)(1,330)536 Purchases of investments, net of proceeds from sales, maturities, calls and redemptions(1,766)(2,630)864 
Purchases of subsidiaries, net of cash acquiredPurchases of subsidiaries, net of cash acquired(61)(27)(34)Purchases of subsidiaries, net of cash acquired(609)(3,442)2,833 
Repurchase and retirement of common stockRepurchase and retirement of common stock(545)(447)(98)Repurchase and retirement of common stock(1,169)(927)(242)
Purchases of property and equipmentPurchases of property and equipment(254)(204)(50)Purchases of property and equipment(549)(489)(60)
Cash dividendsCash dividends(309)(277)(32)Cash dividends(618)(555)(63)
Total uses of cashTotal uses of cash(1,963)(2,285)322 Total uses of cash(4,711)(8,043)3,332 
Effect of foreign exchange rates on cash and cash equivalentsEffect of foreign exchange rates on cash and cash equivalents(4)(1)(3)Effect of foreign exchange rates on cash and cash equivalents(10)(7)(3)
Net increase in cash and cash equivalents$1,281 $3,585 $(2,304)
Net increase (decrease) in cash and cash equivalentsNet increase (decrease) in cash and cash equivalents$1,576 $(483)$2,059 
The increase in net cash provided by operating activities was primarily driven bydue to higher net income in 2022, partially offset byexcluding the non-cash impact of losses/gains on investments, as we recognized realized losses during the first six months of 2022 compared to realized gains in the first six months of 2021. The increase was further attributable to the timing of working capital changes, year-over-year.changes.
Other significant changes in sources or uses of cash year-over-year included reduced proceeds from commercial paper and short- and long-term debt,lower amounts for purchases of subsidiaries, net of repayments, partially offset bycash acquired and reduced purchases of investments, net of proceeds from sales, maturities, calls and redemptions and increased other sources of cash, net.net, partially offset by reduced proceeds from commercial paper and short- and long-term debt, net of repayments.
Financial Condition
We maintained a strong financial condition and liquidity position, with consolidated cash, cash equivalents and investments in fixed maturity and equity securities of $34,638$34,396 at March 31,June 30, 2022. Since December 31, 2021, total cash, cash equivalents and investments in fixed maturity and equity securities increased by $978,$736, primarily due to cash generated from operations and net proceeds from the issuance of commercial paper. Theoperations. This increase was partially offset by cash used for common stock repurchases, dividends paid to shareholders, acquisitions and purchases of property and equipment and cash used for acquisitions.
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equipment.
Many of our subsidiaries are subject to various government regulations that restrict the timing and amount of dividends and other distributions that may be paid to their respective parent companies. Certain accounting practices prescribed by insurance regulatory authorities, or statutory accounting practices, differ from GAAP. Changes that occur in statutory accounting practices, if any, could impact our subsidiaries’ future dividend capacity. In addition, we have agreed to certain undertakings to regulatory authorities, including the requirement to maintain certain capital levels in certain of our subsidiaries.
At March 31,June 30, 2022, we held $1,424$948 of cash, cash equivalents and investments at the parent company, which are available for general corporate use, including investment in our businesses, acquisitions, potential future common stock repurchases and dividends to shareholders, repurchases of debt securities and debt and interest payments.
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Periodically, we access capital markets and issue debt (“Notes”) for long-term borrowing purposes, for example, to refinance debt, to finance acquisitions or for share repurchases. Certain of these Notes may have a call feature that allows us to redeem the Notes at any time at our option and/or a put feature that allows a Note holder to redeem the Notes upon the occurrence of both a change in control event and a downgrade of the Notes below an investment grade rating. For more information on our debt, including redemptions and issuances, see Note 10, “Debt,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
We calculate our consolidated debt-to-capital ratio, a non-GAAP measure, from the amounts presented on our consolidated balance sheets included in Part I, Item 1 of this Form 10-Q. Our debt-to-capital ratio is calculated as total debt divided by total debt plus total shareholders’ equity. Total debt is the sum of short-term borrowings, current portion of long-term debt and long-term debt, less current portion. We believe our debt-to-capital ratio assists investors and rating agencies in measuring our overall leverage and additional borrowing capacity. In addition, our bank covenants include a maximum debt-to-capital ratio that we cannot and did not exceed. Our debt-to-capital ratio may not be comparable to similarly titled measures reported by other companies. Our consolidated debt-to-capital ratio was 39.2%39.7% and 38.9% as of March 31,June 30, 2022 and December 31, 2021, respectively.
Our senior debt is rated “A” by S&P Global Ratings, “BBB” by Fitch Ratings, Inc., “Baa2” by Moody’s Investor Service, Inc. and “bbb+” by AM Best Company, Inc. We intend to maintain our senior debt investment grade ratings. If our credit ratings are downgraded, our business, liquidity, financial condition and results of operations could be adversely impacted by limitations on future borrowings and a potential increase in our borrowing costs.
Capital Resources
We have a shelf registration statement on file with the U.S. Securities and Exchange Commission to register an unlimited amount of any combination of debt or equity securities in one or more offerings. Specific information regarding terms and securities being offered will be provided at the time of an offering. Proceeds from future offerings are expected to be used for general corporate purposes, including, but not limited to, the repayment of debt, investments in or extensions of credit to our subsidiaries, the financing of possible acquisitions or business expansions.
We have a senior revolving credit facility (the “5-Year Facility”) with a group of lenders for general corporate purposes. In April 2022, we amended and restated the credit agreement for the 5-Year Facility to, among other things, extend the maturity date of the 5-Year Facility from June 2024 to April 2027 and increase the amount of credit available under the 5-Year Facility from $2,500 to $4,000. Also in April 2022, concurrently with the amendment and restatement of the 5-Year Facility, we terminated our 364-day senior revolving credit facility that provided for credit in the amount of $1,000, which was scheduled to mature in June 2022 (the “2021 364-Day Facility” and together with the 5-Year Facility, the “Credit Facilities”). In June 2021, we terminated our 364-day senior revolving credit facility (the “prior 364-Day Facility”), which was scheduled to mature in June 2021, and entered into the 2021 364-Day Facility with a group of lenders for general corporate purposes. Our ability to borrow under the 5-Year Facility is subject to compliance with certain covenants, including covenants requiring us to maintain a defined debt-to-capital ratio of not more than 60%, subject to increase in certain circumstances set forth in the credit agreement for the 5-Year Facility. We do not believe the restrictions contained in our 5-Year Credit Facility covenants materially affect our financial or operating flexibility. As of March 31,June 30, 2022, we were in compliance with all of the debt covenants under the Credit Facilities.
Through certain subsidiaries, we have entered into multiple 364-day lines of credit (the “Subsidiary Credit Facilities”) with separate lenders for general corporate purposes. The Subsidiary Credit Facilities provide combined credit up to $200.
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Our ability to borrow under the Subsidiary Credit Facilities is subject to compliance with certain covenants. At March 31,June 30, 2022 and December 31, 2021, we had no outstanding borrowings under the Subsidiary Credit Facilities.
We have a $3,500an authorized commercial paper program of up to $4,000, the proceeds of which may be used for general corporate purposes. In July 2022, we increased the amount available under the commercial paper program from $3,500 to $4,000. Should commercial paper issuance become unavailable, we have the ability to use a combination of cash on hand and/or our 5-Year Facility, which provides for credit in the amount of $4,000, to redeem any outstanding commercial paper upon maturity.
We are a member, through certain subsidiaries, of the Federal Home Loan Bank of Indianapolis, the Federal Home Loan Bank of Cincinnati, the Federal Home Loan Bank of Atlanta and the Federal Home Loan Bank of New York, collectively (the “FHLBs”). As a member, we have the ability to obtain short-term cash advances, subject to certain minimum collateral
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requirements. We had $175 and $275 of outstanding short-term borrowings from the FHLBs at March 31,June 30, 2022 and December 31, 2021.2021, respectively.
While there is no assurance in the current economic environment, we believe the lenders participating in our credit facilities, if market conditions allow, would be willing to provide financing in accordance with their legal obligations. At March 31,June 30, 2022, we had $525$550 outstanding under our commercial paper program.
We regularly review the appropriate use of capital, including acquisitions, common stock and debt security repurchases and dividends to shareholders. The declaration and payment of any dividends or repurchases of our common stock or debt is at the discretion of our Board of Directors and depends upon our financial condition, results of operations, future liquidity needs, regulatory and capital requirements and other factors deemed relevant by our Board of Directors.
For additional information regarding our sources and uses of capital at March 31,June 30, 2022, see Note 5, “Investments,” Note 6, “Derivative Financial Instruments,” Note 10, “Debt,” and Note 12, “Capital Stock Use of Capital – Dividends and Stock Repurchase Program,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
In addition to regulations regarding the timing and amount of dividends, our regulated subsidiaries’ states of domicile have statutory risk-based capital (“RBC”) requirements for health and other insurance companies and health maintenance organizations largely based on the National Association of Insurance Commissioners (“NAIC”) Risk-Based Capital (RBC) for Health Organizations Model Act (the “RBC Model Act”). These RBC requirements are intended to measure capital adequacy, taking into account the risk characteristics of an insurer’s investments and products. The NAIC sets forth the formula for calculating the RBC requirements, which are designed to take into account asset risks, insurance risks, interest rate risks and other relevant risks with respect to an individual insurance company’s business. In general, under the RBC Model Act, an insurance company must submit a report of its RBC level to the state insurance department or insurance commissioner, as appropriate, at the end of each calendar year. Our regulated subsidiaries’ respective RBC levels as of December 31, 2021, which was the most recent date for which reporting was required, were in excess of all applicable mandatory RBC requirements. In addition to exceeding these RBC requirements, we are in compliance with the liquidity and capital requirements for a licensee of the BCBSA and with the tangible net worth requirements applicable to certain of our California subsidiaries. For additional information, see Note 22, “Statutory Information,” in our audited consolidated financial statements as of and for the year ended December 31, 2021 included in our 2021 Annual Report on Form 10-K.
Future Sources and Uses of Liquidity
We believe that funds from cash on hand, future operating cash receipts, investments and funds available under our commercial paper program, our 5-Year Facility, our Subsidiary Credit Facilities and the FHLBs will be adequate to fund our expected cash disbursements over the next twelve months.
There have been no material changes to our long-term liquidity requirements as disclosed in our 2021 Annual Report on Form 10-K. For additional updates regarding our estimated long-term liquidity requirements, see Note 6, “Derivative Financial Instruments,” Note 10, “Debt,” and the “Other Contingencies” and “Contractual Obligations and Commitments” sections of Note 11 “Commitments and Contingencies,” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q. We believe that funds from future operating cash flows, cash and investments and funds available under our 5-Year Facility and/or from public or private financing sources will be sufficient for future operations and commitments, and for capital acquisitions and other strategic transactions.
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FORWARD-LOOKING STATEMENTS
This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent otherwise required by federal securities laws, we do not undertake any obligation to republish revised forward-looking statements to reflect events or circumstances after the date hereof. These risks and uncertainties include, but are not limited to: the impact of large scale medical emergencies, such as public health epidemics and pandemics, including COVID-19, and catastrophes; trends in healthcare costs and utilization rates; our ability to secure sufficient premium rates, including regulatory approval for and implementation of such rates; the impact of federal, state and international law and regulation, including ongoing changes in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; our ability to contract with providers on cost-effective and competitive terms; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; reduced enrollment; the impact of a cyber-attack or other cyber security breach resulting in unauthorized disclosure of member or employee sensitive or confidential information, including the impact and outcome of any investigations, inquiries, claims and litigation related thereto; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; risks and uncertainties related to our pharmacy benefit management (“PBM”) business, including non-compliance by any party with the PBM services agreement between us and CaremarkPCS Health, L.L.C.; medical malpractice or professional liability claims or other risks related to healthcare and PBM services provided by our subsidiaries; general risks associated with mergers, acquisitions, joint ventures and strategic alliances; changes in tax laws; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness; a downgrade in our financial strength ratings; the effects of any negative publicity related to the health benefits industry in general or us in particular; failure to effectively maintain and modernize our information systems; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.
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ITEM 3.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
For a discussion of our market risks, refer to Item 7A, “Quantitative and Qualitative Disclosures about Market Risk,” included in our 2021 Annual Report on Form 10-K. There have been no material changes to any of these risks since December 31, 2021.

ITEM 4.    CONTROLS AND PROCEDURES
We carried out an evaluation as of March 31,June 30, 2022, under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as defined in Rule 13a-15(e) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). Based upon that evaluation, the Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective in timely alerting them to material information relating to us (including our consolidated subsidiaries) required to be disclosed in our reports under the Exchange Act. In addition, based on that evaluation, the Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective in ensuring that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is accumulated and communicated to our management, including the Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions regarding required disclosures.
There have been no changes in our internal control over financial reporting that occurred during the three months ended March 31,June 30, 2022 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

PART II. OTHER INFORMATION

ITEM 1.    LEGAL PROCEEDINGS
For information regarding legal proceedings at March 31,June 30, 2022, see the “Litigation and Regulatory Proceedings,” and “Other Contingencies” sections of Note 11, “Commitments and Contingencies” of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q, which information is incorporated herein by reference.

ITEM 1A.    RISK FACTORS
There have been no material changes to the risk factors disclosed in our 2021 Annual Report on Form 10-K.
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ITEM 2.    UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS
Issuer Purchases of Equity Securities
The following table presents information related to our repurchases of common stock for the periods indicated:
Period
Total Number
of Shares
Purchased1 
Average
Price Paid
per Share
Total Number
of Shares
Purchased
as Part
of Publicly
Announced
Programs2
Approximate
Dollar Value
of Shares
that May Yet
Be Purchased
Under the
Programs
(in millions, except share and per share data)    
January 1, 2022 to January 31, 2022469,833 $446.37 467,595 $3,983 
February 1, 2022 to February 28, 2022351,000 447.83 349,528 3,827 
March 1, 2022 to March 31, 2022570,779 462.60 386,216 3,647 
1,391,612 1,203,339 
Period
Total Number
of Shares
Purchased1 
Average
Price Paid
per Share
Total Number
of Shares
Purchased
as Part
of Publicly
Announced
Programs2
Approximate
Dollar Value
of Shares
that May Yet
Be Purchased
Under the
Programs
(in millions, except share and per share data)    
April 1, 2022 to April 30, 2022334,332 $508.42 333,668 $3,477 
May 1, 2022 to May 31, 2022417,759 493.11 416,662 3,272 
June 1, 2022 to June 30, 2022528,268 473.67 526,428 3,022 
1,280,359 1,276,758 
1    Total number of shares purchased includes 188,2733,601 shares delivered to or withheld by us in connection with employee payroll tax withholding upon the exercise or vesting of stock awards. Stock grants to employees and directors and stock issued for stock option plans and stock purchase plans in the consolidated statements of shareholders’ equity are shown net of these shares purchased.
2    Represents the number of shares repurchased through the common stock repurchase program authorized by our Board of Directors, which the Board of Directors evaluates periodically. During the three months ended March 31,June 30, 2022, we repurchased 1,203,3391,276,758 shares at a total cost of $545$624 under the program, including the cost of options to purchase shares. The Board of Directors has authorized our common stock repurchase program since 2003. The most recent authorized increase to the program was $5,000 on January 26, 2021 by our Audit Committee, pursuant to authorization granted by the Board of Directors. No duration has been placed on our common stock repurchase program, and we reserve the right to discontinue the program at any time.

ITEM 3.    DEFAULTS UPON SENIOR SECURITIES
None.

ITEM 4.    MINE SAFETY DISCLOSURES
None.

ITEM 5.    OTHER INFORMATION
None.

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ITEM 6.    EXHIBITS
Exhibit
Number
 Exhibit
3.1 
3.2 
4.6 (p)
(q)
4.7 Upon the request of the U.S. Securities and Exchange Commission, the Company will furnish copies of any other instruments defining the rights of holders of long-term debt of the Company or its subsidiaries.
10.2*
*(l)
*(m)
*(n)
10.3*
10.4*
10.5*
10.6*
10.7*
10.8*
31.1 
31.2 
32.1 
32.2 
101 The following material from Anthem,Elevance Health, Inc.’s Quarterly Report on Form 10-Q for the quarter ended March 31,June 30, 2022, formatted in Inline XBRL (Inline Extensible Business Reporting Language): (i) the Consolidated Balance Sheets; (ii) the Consolidated Statements of Income; (iii) the Consolidated Statements of Comprehensive Income; (iv) the Consolidated Statements of Cash Flows; (v) the Consolidated Statements of Shareholders’Changes in Equity; and (vi) Notes to Consolidated Financial Statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
104 Cover Page Interactive Data File formatted in Inline XBRL and contained in Exhibit 101.

*Indicates management contracts or compensatory plans or arrangements
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
 
ANTHEM,ELEVANCE HEALTH, INC.
Registrant
AprilJuly 20, 2022By: 
/S/  JOHN E. GALLINA
 John E. Gallina
Executive Vice President and Chief Financial Officer
(Duly Authorized Officer and Principal Financial Officer)
AprilJuly 20, 2022By: 
/S/  RONALD W. PENCZEK
 Ronald W. Penczek
Chief Accounting Officer and Controller
(Principal Accounting Officer)
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