| Humana Inc. | | | | | | | Page 2 of 9 |
| Dollars in thousands, except per share results | | | | | | |
| | | | -----------------Three months ended---------------------- |
| | | | | | | | |
| | | | | Adjusted | | |
| | | | March 31, | Restructuring | March 31, | | March 31, |
Consolidated Statement of Income | | | 2003 | Charge | 2003 | | 2002 |
Revenues: | | | | | | | |
Premiums | | | $ 2,842,949 | $ - | $ 2,842,949 | | $ 2,641,812 |
Administrative services fees | | | 61,136 | - | 61,136 | | 65,013 |
Investment income | | | 25,817 | - | 25,817 | | 24,308 |
Other income | | | 1,814 | - | 1,814 | | 1,449 |
| Total revenues | | | 2,931,716 | - | 2,931,716 | | 2,732,582 |
Operating Expenses: | | | | | | | |
Medical | | | 2,371,434 | - | 2,371,434 | | 2,194,539 |
Selling, general and administrative | | | 447,045 | - | 447,045 | | 435,064 |
Depreciation | | | 27,209 | - | 27,209 | | 25,865 |
Other intangible amortization | | | 3,931 | - | 3,931 | | 3,931 |
Restructuring charge | | | 30,760 | (30,760) | - | | - |
| Total operating expenses | | | 2,880,379 | (30,760) | 2,849,619 | | 2,659,399 |
Income from operations | | | 51,337 | 30,760 | 82,097 | | 73,183 |
Interest expense | | | 3,935 | - | 3,935 | | 4,404 |
Income before income taxes | | | 47,402 | 30,760 | 78,162 | | 68,779 |
Provision for income taxes | | | 16,172 | 11,966 | 28,138 | | 22,009 |
Net Income | | | $ 31,230 | $ 18,794 | $ 50,024 | | $ 46,770 |
| | | | | | | | |
| | | | | | | | |
Basic earnings per common share | | $ 0.20 | $ 0.12 | $ 0.32 | | $ 0.28 |
Diluted earnings per common share | | $ 0.19 | $ 0.12 | $ 0.31 | | $ 0.28 |
| | | | | | | | |
Shares used in basic earnings per common share computation (000) | | 157,739 | 157,739 | 157,739 | | 164,255 |
Shares used in diluted earnings per common share computation (000) | | 161,406 | 161,406 | 161,406 | | 167,704 |
| | | | | | | | |
Key Ratios | | | | | | | |
Medical expense ratio | | | | | | | |
Commercial | | | 81.3% | - | 81.3% | | 81.9% |
Government | | | 86.2% | - | 86.2% | | 84.5% |
| Total | | | 83.4% | - | 83.4% | | 83.1% |
| | | | | | | | |
Selling, general, and administrative expense ratio | | | | | |
Commercial | | | 16.8% | - | 16.8% | | 17.6% |
Government | | | 13.6% | - | 13.6% | | 14.3% |
| Total | | | 15.4% | - | 15.4% | | 16.1% |
Humana Inc. | | | | | | | Page 3 of 9 |
Dollars in thousands, except per share results | | | | | |
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| | | | | ----------------Three months ended---------------- |
| | | | | | | | | |
| | | | | | | Adjusted | | |
| | | | | March 31, | Restructuring | March 31, | | March 31, |
Operating Results by Segment | | | 2003 | Charge | 2003 | | 2002 |
Commercial: | | | | | | | |
| Income before income taxes | | | $ 37,239 | $ 17,852 | $ 55,091 | | $ 26,095 |
| Interest expense | | | 3,063 | - | 3,063 | | 3,059 |
| Depreciation and amortization | | | 19,228 | - | 19,228 | | 17,167 |
| | Commercial EBITDA* | | | 59,530 | 17,852 | 77,382 | | 46,321 |
Government: | | | | | | | |
| Income before income taxes | | | 10,163 | 12,908 | 23,071 | | 42,684 |
| Interest expense | | | 872 | - | 872 | | 1,345 |
| Depreciation and amortization | | | 11,912 | - | 11,912 | | 12,629 |
| | Government EBITDA* | | | 22,947 | 12,908 | 35,855 | | 56,658 |
Consolidated: | | | | | | | |
| Income before income taxes | | | 47,402 | 30,760 | 78,162 | | 68,779 |
| Interest expense | | | 3,935 | - | 3,935 | | 4,404 |
| Depreciation and amortization | | | 31,140 | - | 31,140 | | 29,796 |
| | Consolidated EBITDA* | | | $ 82,477 | $ 30,760 | $ 113,237 | | $ 102,979 |
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| | | | | | | | | |
* | EBITDA represents earnings (including investment and other income) before interest expense, income taxes, depreciation and amortization. EBITDA is not a measure under accounting principles generally accepted in the United States and may not be similar to EBITDA measures of other companies. EBITDA also is a measure commonly used by analysts, investors and other interested parties in the health care industry. We believe EBITDA is an important indicator of the cash content of the Company's operating income, and as such the quality of net income. |
Humana Inc. | | | | Page 4 of 9 |
Dollars in thousands, except per share results |
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| | | | |
| | March 31, | | December 31, |
Consolidated Balance Sheets | | 2003 | | 2002 |
Assets | |
Current assets: |
| Cash and cash equivalents | | $ 532,652 | | $ 721,357 |
| Investment securities | 1,411,356 | | 1,405,833 |
| Receivables, net: | | | |
| | Premiums | 472,972 | | 348,562 |
| | Administrative services fees | 55,726 | | 68,316 |
| Other | 258,481 | | 250,857 |
| | Total current assets | 2,731,187 | | 2,794,925 |
| | | | | |
Property and equipment, net | 423,465 | | 459,842 |
| | | | | |
Other assets: | | | | |
| Long-term investment securities | 312,517 | | 288,724 |
| Goodwill | 776,874 | | 776,874 |
| Other | 185,144 | | 279,665 |
| | Total other assets | 1,274,535 | | 1,345,263 |
| Total assets | $ 4,429,187 | | $ 4,600,030 |
Liabilities and Stockholders' Equity | | | |
Current liabilities: | | | |
| Medical and other expenses payable | $ 1,226,043 | | $ 1,142,131 |
| Trade accounts payable and accrued expenses | | 512,723 | | 552,689 |
| Book overdraft | | 84,579 | | 94,882 |
| Unearned premium revenues | | 117,604 | | 335,757 |
| Short-term debt | | 265,000 | | 265,000 |
| | Total current liabilities | | 2,205,949 | | 2,390,459 |
| Long-term debt | | 334,328 | | 339,913 |
| Other long-term liabilities | | | 268,131 | | 263,184 |
| | Total liabilities | | 2,808,408 | | 2,993,556 |
Commitments and contingencies | | | | |
Stockholders' equity: | | | | |
| Preferred stock, $1 par; 10,000,000 shares authorized; none issued | | | | - | | - |
| Common stock, $0.16 2/3 par; 300,000,000 shares authorized; | | | | | | |
| | 171,371,759 shares issued at March 31, 2003 and 171,334,893shares issued at December 31, 2002 | | | | 28,562 | | 28,556 |
| Capital in excess of par value | | | | 931,460 | | 931,089 |
| Retained earnings | | | 752,107 | | 720,877 |
| Accumulated other comprehensive income | | 23,257 | | 22,455 |
| Unearned restricted stock compensation | | (3,961) | | (6,516) |
| Treasury stock, at cost, 10,584,719 shares at March 31, 2003 and 8,362,537 shares at December 31, 2002 | | (110,646) | | (89,987) |
| | Total stockholders' equity | | | | | 1,620,779 | | 1,606,474 |
| Total liabilities and stockholders' equity | | | | $ 4,429,187 | | $ 4,600,030 |
| | | | | | | | | |
| | | | | | | | | |
Debt to total capitalization ratio | | | | | 27.0% | | 27.4% |
Humana Inc. | | | Page 5 of 9 |
Dollars in thousands | | | | |
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| | | | | | |
| | | | | Three months ended |
| | | | | March 31, |
Consolidated Statements of Cash Flows | | | 2003 | 2002 |
Cash flows from operating activities | | | | |
| Net income | | | $ 31,230 | $ 46,770 |
Adjustments to reconcile net income to net cash provided by operating activities: | | | | |
| | | |
| | Non-cash restructuring charge | | | 30,760 | - |
| | Depreciation and amortization | | | 31,140 | 29,796 |
| | Provision for deferred income taxes | | | 3,646 | 12,880 |
| | Changes in operating assets and liabilities excluding effects of acquisitions and divestitures: | | | | |
| | Receivables | | | (48,553) | (45,810) |
| | Other assets | | | 5,685 | (2,398) |
| | Medical and other expenses payable | | | 83,912 | 63,977 |
| | Other liabilities | | | (29,012) | (10,804) |
| | Unearned premium revenues | | | (218,153) | (237,758) |
| | Other | | | 1,115 | 3,210 |
| | Net cash used in operating activities | | | (108,230) | (140,137) |
| | Timing of Medicare+Choice premium payment from CMS | | | 205,755 | 216,628 |
| | Normalized net cash provided by operating activities | | | 97,525 | 76,491 |
| | | | | | |
Cash flows from investing activities | | | | |
| | Purchases of property and equipment, net | | | (21,634) | (31,256) |
| | Purchases of marketable securities | | | (1,545,241) | (425,135) |
| | Proceeds from maturities of marketable securities | | | 196,923 | 115,954 |
| | Proceeds from sales of marketable securities | | | 1,320,246 | 303,896 |
| | Net cash used in investing activities | | | (49,706) | (36,541) |
| | | | | | |
Cash flows from financing activities | | | | |
| | Debt issue costs | | | (153) | (559) |
| | Change in book overdraft | | | (10,303) | 10,673 |
| | Common stock repurchases | | | (20,817) | - |
| | Other | | | 504 | 1,026 |
| | Net cash (used in) provided by financing activities | | | (30,769) | 11,140 |
| | | | | | |
| | Decrease in cash and cash equivalents | | | (188,705) | (165,538) |
| | Cash and cash equivalents at beginning of period | | | 721,357 | 651,420 |
| | Cash and cash equivalents at end of period | | | $ 532,652 | $ 485,882 |
Humana Inc. | | | | | | | | | | | | | Page 6 of 9 |
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Percentage of Ending Membership Under Capitation Arrangements | | | | | | |
| | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | |
| | | | Commercial Segment | | Government Segment | | | | Consol. | |
| | | | Fully | | Total | | Medicare+ | | TRICARE | Total | | Total | |
| | | | Insured | ASO | Segment | Choice | Medicaid | TRICARE | ASO | Segment | | Medical | |
March 31, 2003 | | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| Capitated HMO hospital system basedA | 6.3% | - | 4.9% | | 12.9% | 2.5% | - | - | 1.5% | | 3.0% | |
| | | | | | | | | | | | | |
| Capitated HMO physician group basedA | 3.2% | - | 2.5% | | 2.0% | 56.2% | - | - | 7.8% | | 5.4% | |
Risk-sharingB | | 3.1% | - | 2.4% | | 47.8% | 33.9% | - | - | 8.9% | | 6.0% | |
All other membership | 87.4% | 100.0% | 90.2% | | 37.3% | 7.4% | 100.0% | 100.0% | 81.8% | | 85.6% | |
| Total | | | 100.0% | 100.0% | 100.0% | | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | | 100.0% | |
| | | | | | | | | | | | | | | |
March 31, 2002 | | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| Capitated HMO hospital system basedA | 6.7% | - | 5.3% | | 13.3% | 2.2% | - | - | 1.6% | | 3.3% | |
| | | | | | | | | | | | | |
| Capitated HMO physician group basedA | 4.1% | - | 3.2% | | 4.1% | 57.6% | - | - | 8.1% | | 5.9% | |
Risk-sharingB | | 3.2% | - | 2.5% | | 45.7% | 34.3% | - | - | 9.2% | | 6.2% | |
All other membership | 86.0% | 100.0% | 89.0% | | 36.9% | 5.9% | 100.0% | 100.0% | 81.1% | | 84.6% | |
| Total | | | 100.0% | 100.0% | 100.0% | | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | | 100.0% | |
| | | | | | | | | | | | | | | |
A | In a limited number of circumstances, we contract with hospitals and physicians to accept financial risk for a defined set of HMO membership. In transferring this risk, we prepay these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their capitated HMO membership, including some health benefit administrative functions and claims processing. For these capitated HMO arrangements, we generally agree to reimbursement rates that target a medical expense ratio ranging from 82% to 89%. Providers participating in hospital-based capitated HMO arrangements generally receive a monthly payment for all of the services within their system for their HMO membership. Providers participating in physician-based capitated HMO arrangements generally have subcontracted directly with hospitals and specialist physicians, and are responsible for reimbursing such hospitals and physicians for services rendered to their HMO membership. |
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B | In some circumstances, we contract with physicians under risk-sharing arrangements whereby physicians have assumed some level of risk for all or a portion of the medical costs of their HMO membership. Although these arrangements do include capitation payments for services rendered, we process substantially all of the claims under these arrangements. |
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Humana Inc. | | | | | | | | Page 7 of 9 |
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Medical Claim Reserves - Details and Statistics | | | | | | |
| | | | | | | | | | | |
| Change in medical and other expenses payable: | | | | | |
| | | | | | | | | | | |
| The change in medical and other expenses payable is summarized as follows: | | | |
| | | | | | | | | | | |
| | | | | | For the Three | | For the Twelve | | | |
| | | | | | Months Ended | | Months Ended | | | |
| | | | | | March 31, 2003 | | December 31, 2002 | | | |
| Balances at January 1 | | | $ 1,142,131 | | $ 1,086,386 | | | |
| | | | | | | | | | | |
| Incurred related to: | | | | | | | | | |
| Current year | | | | 2,425,464 | | 9,125,915 | | | |
| Prior years - TRICARE | | (18,890) | | 25,685 | (1) | | |
| Prior years - non-TRICARE(2) | (35,140) | | (13,404) | | | |
| Total incurred | | | | 2,371,434 | | 9,138,196 | | | |
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| Paid related to: | | | | | | | | | |
| Current year | | | | (1,403,792) | | (8,002,610) | | | |
| Prior years | | | | (883,730) | | (1,079,841) | | | |
| Total paid | | | | | (2,287,522) | | (9,082,451) | | | |
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| Balances at end of period | | $ 1,226,043 | | $ 1,142,131 | | | |
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(1) | Changes in estimates of medical expenses payable for TRICARE may result from issues that entitle us to additional revenues derived from change orders or the bid price adjustment process, which was the case with substantially all of the unfavorable development for prior periods recognized during 2002. | |
(2) | Changes in estimates of non-TRICARE incurred claims for prior years recognized during 2003 and 2002 related primarily to our commercial lines of business. The impact of any reduction of "incurred related to prior years" claims may be offset as we re-establish the "incurred related to current year". Our reserving practice is to consistently recognize the actuarial best estimate of our ultimate liability for our claims within a level of confidence required to meet actuarial standards. Thus, only when the release of a prior year reserve is not offset with the same level of conservatism in estimating the current year reserve will the redundancy reduce medical expense. We believe we have consistently applied this methodology in determining our best estimate for unpaid claims liability in each period. | |
Humana Inc. | | | | | | | | | Page 8 of 9 |
Dollars in thousands | | | | | | | | |
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Medical Claim Reserves - Details and Statistics | | | | | | | |
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Medical and Other Expenses Payable Detail: | | | | | | | |
| | | | | | March 31, | | December 31, | | |
| | | | | | 2003 | | 2002 | | |
A | IBNR and other medical expenses payable | | $ 703,910 | | $ 650,606 | | |
B | TRICARE IBNR | | | | 232,249 | | 212,826 | | |
C | TRICARE other medical expenses payable | | 30,055 | | 37,793 | | |
D | Unprocessed claim inventories | | | 99,000 | | 92,300 | | |
E | Processed claim inventories | | | 118,300 | | 105,422 | | |
F | Payable to pharmacy benefit administrator | | 42,529 | | 43,184 | | |
| | Total medical and other expenses payable | $ 1,226,043 | | $ 1,142,131 | | |
| | | | | | | | | | |
A | IBNR represents an estimate of medical expenses payable for claims incurred but not reported (IBNR) at the balance sheet date. The level of IBNR is primarily impacted by membership levels, medical claim trends and the receipt cycle time which represents the length of time between when a claim is initially incurred and when the claim form is received (i.e. a shorter time span results in lower reserves for claims IBNR). |
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B | TRICARE IBNR has increased primarily due to an increase in claim inventories at our third party claim administrator for claims not submitted electronically. |
C | TRICARE other medical expense payable may include liabilities to subcontractors and/or risk share payables to the Department of Defense. The level of these balances may fluctuate from period to period due to the timing of payment (cutoff) and whether or not the balances are payables or receivables (receivables from the Department of Defense are classified as "receivables" in our balance sheet). |
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D | Unprocessed claim inventories represent the estimated valuation of claims received but not yet fully processed. TRICARE claim inventories are not included in this amount as an independent third party administrator processes all TRICARE medical claims on our behalf. Reserves for TRICARE claims inventory are included in TRICARE IBNR. |
E | Processed claim inventories represent the estimated valuation of processed claims that are in the post claim adjudication process, which consists of administrative functions such as audit and check batching and handling. |
F | The balance due to our pharmacy benefit administrator fluctuates due to bi-weekly payments and the month-end cutoff. |
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Receipt Cycle Time: | | | | | | | | |
| Due to increasing electronic connectivity and other efficiencies gained by our providers with regards to the claim submission process, the average length of time between when a claim was initially incurred and when the claim form was received has generally shortened over the past several years. Below is a summary: |
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| | | Average # of Days from Incurred Date to Receipt Date (1) | | | | |
| | | 2003 | 2002 | Change | % Change | | | | |
| 1st Quarter Average | 17.1 | 19.0 | (1.9) | -10.0% | | | | |
| 2nd Quarter Average | - | 18.1 | n/a | n/a | | | | |
| 3rd Quarter Average | - | 17.3 | n/a | n/a | | | | |
| 4th Quarter Average | - | 16.9 | n/a | n/a | | | | |
| Full Year Average | 17.1 | 17.8 | (0.7) | -3.9% | | | | |
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| (1) Receipt cycle time data for our 2 largest claim processing platforms representing approximately 90% of our claims volume. |
Humana Inc. | | | | | | | | | Page 9 of 9 |
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Medical Claim Reserves - Details and Statistics | | | | | | |
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Unprocessed Claim Inventories: | | | | | | | |
The estimated valuation and number of claims on hand that are yet to be processed are as follows: | |
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| | Estimated | | Number | | | | | |
| | Valuation | Claim Item | of Days | | | | | |
Date | | (000) | Counts | On Hand | | | | | |
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12/31/2001 | | $ 125,400 | 518,100 | 5.0 | | | | | |
03/31/2002 | | $ 121,000 | 559,600 | 5.2 | | | | | |
06/30/2002 | | $ 110,300 | 513,100 | 4.8 | | | | | |
09/30/2002 | | $ 108,800 | 496,200 | 4.8 | | | | | |
12/31/2002 | | $ 92,300 | 424,200 | 4.1 | | | | | |
03/31/2003 | | $ 99,000 | 421,700 | 4.0 | | | | | |
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Days in Claims Payable (Quarterly): | | | | | | | |
A common metric for monitoring medical claim reserve levels relative to the medical claim expenses is days in claims payable, or DCP, which represents the medical claim liabilities at the end of the period divided by average medical expenses per day in the quarterly period. Since we have some providers under capitation payment arrangements (which do not require a medical claim IBNR reserve), we have also summarized this metric excluding capitation expenses. |
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| | Days | | | DCP | | | | |
| | in Claims | Annual | | Excluding | Annual | | | |
Quarter Ended | | Payable (DCP) | Change | % Change | Capitation | Change | % Change | | |
12/31/2001 | | 47.4 | (3.9) | -7.6% | 57.1 | (4.4) | -7.2% | | |
03/31/2002 | | 47.2 | (2.3) | -4.6% | 56.2 | (3.4) | -5.7% | | |
06/30/2002 | | 46.8 | (3.1) | -6.2% | 55.3 | (4.7) | -7.8% | | |
09/30/2002 | | 46.6 | (2.5) | -5.1% | 55.3 | (3.9) | -6.6% | | |
12/31/2002 | | 45.2 | (2.2) | -4.6% | 53.3 | (3.8) | -6.7% | | |
03/31/2003 | | 46.5 | (0.7) | -1.5% | 54.7 | (1.5) | -2.7% | | |
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This metric fluctuates due to all of the issues reviewed above, including the change in the receipt cycle time, the change in medical claim inventories, the change in TRICARE liability balances, and the timing of our bi-weekly payment to our pharmacy benefits administrator. An annual recap follows: |
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| | | | | 2003 | 2002 | | | |
4th quarter-prior year | | | 45.2 | 47.4 | | | |
Impact of change in claim receipt cycle time | | 0.3 | (2.6) | | | |
Impact of change in unprocessed claim inventories | 0.3 | (1.3) | | | |
Impact of changing TRICARE reserve balances | | 0.7 | 0.3 | | | |
Impact of change in pharmacy payment cutoff | | - | 0.7 | | | |
All other | | | | | - | 0.7 | | | |
Year to date-current year | | | 46.5 | 45.2 | | | |
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