Exhibit 99.2
| | |
news release | | Humana Inc. |
| | 500 West Main Street |
| | P.O. Box 1438 |
| | Louisville, KY 40201-1438 |
| | http://www.humana.com |
FOR MORE INFORMATION CONTACT:
| | |
Regina Nethery | | ![LOGO](https://capedge.com/proxy/8-K/0001193125-13-189483/g531092g82p98.jpg) |
Humana Investor Relations | |
(502) 580-3644 e-mail:Rnethery@humana.com | |
| |
Tom Noland | | |
Humana Corporate Communications | | |
(502) 580-3674 e-mail:Tnoland@humana.com | | |
Humana Reports First Quarter 2013 Financial Results;
Raises Full Year EPS Guidance; Comments on 2014
| • | | 1Q13 EPS of $2.95 exceeds management’s expectations |
| • | | 2013 EPS guidance raised to range of $8.40 to $8.60 |
| • | | 2014 earnings growth uncertain |
| • | | Share repurchase authorization reset to $1 billion |
LOUISVILLE, KY (May 1, 2013)– Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended March 31, 2013 (1Q13) of $2.95, compared to $1.49 per share for the quarter ended March 31, 2012 (1Q12). Results for 1Q13 exceeded management’s previous expectations of $1.75 to $1.85 primarily due to outperformance across the company’s portfolio of businesses as well as the beneficial effect of certain discrete items and a lower-than-projected tax rate.
The company’s results for 1Q13 included the beneficial effect of settlement of contract claims with the Department of Defense (DoD) related to previously-disclosed litigation and a delay in the implementation of sequestration for the company’s Medicare business – neither of which was anticipated in management’s previous financial guidance. The beneficial effect of these items upon 1Q13 results was approximately $66 million on a pretax basis, or $0.26 per diluted common share.
The company now anticipates EPS for the year ending December 31, 2013 (FY13) to be in the range of $8.40 to $8.60 versus management’s previous guidance of $7.60 to $7.80. This increase reflects the better-than-expected first quarter results partially offset by higher-than-previously projected investment spending for the company’s integrated care delivery model and health care exchanges during the latter half of 2013.
“Our better-than-expected earnings this quarter are a testament to the benefits of our focus on further developing our new member and chronic care clinical programs – key elements of our integrated care delivery model,” said Bruce D. Broussard, President and Chief Executive Officer of Humana. “We expect this model will allow us to maintain and improve the economic value proposition we provide, which we
believe will enable long-term earnings growth. On the immediate horizon, while the final 2014 Medicare rate notice remedied some aspects of the major reduction that was initially proposed, funding challenges continue, making 2014 earnings growth uncertain at this time.”
CONSOLIDATED HIGHLIGHTS
Consolidated revenues
1Q13 consolidated revenues were $10.49 billion, an increase of 2.6 percent from $10.22 billion in 1Q12, with total premiums and services revenue also up 2.6 percent compared to the prior year’s quarter. The year-over-year increase in premiums and services revenue was primarily driven by higher Retail and Employer Group segment revenues resulting from higher average individual and group Medicare membership, partially offset by the company’s new South Region TRICARE contract being accounted for as self-funded versus fully-insured for the previous contract. The new contract became effective on April 1, 2012.
Consolidated benefits expense
The 1Q13 consolidated benefit ratio (benefits expense as a percent of premiums) of 83.0 percent declined by 240 basis points from 85.4 percent for the prior year’s quarter due primarily to lower benefit ratios in both the Retail and Employer Group segments, both of which benefitted from favorable weekday seasonality and a higher level of favorable prior period development. The company experienced favorable prior-period development in its medical claims reserves of approximately $266 million in 1Q13 compared to $141 million in 1Q12.
Consolidated operating expenses
The consolidated operating cost ratio (operating costs as a percent of total revenues less investment income) of 13.9 percent for 1Q13 increased from 13.7 percent in 1Q12 primarily due to substantial reductions in this operating metric for the Retail and Employer Group Segments being more than offset by the impact of the accounting for the company’s new South Region TRICARE contract in the company’s Other Businesses.
Balance sheet
At March 31, 2013, the company had cash, cash equivalents, and investment securities of $11.36 billion, up $210 million from $11.15 billion at December 31, 2012 reflecting higher average invested balances associated with higher average medical membership.
Parent company cash and short-term investments of $202 million at March 31, 2013 decreased $144 million from $346 million at December 31, 2012, primarily reflecting share repurchases and cash dividends during 1Q13.
Days in claims payable of 49.0 at March 31, 2013 increased slightly from 48.5 days at December 31, 2012.
Debt-to-total capitalization at March 31, 2013 was 22.2 percent, down 60 basis points from 22.8 percent at December 31, 2012 primarily driven by higher capitalization associated with 1Q13 earnings.
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Cash flows from operations
Cash flows provided by operations for 1Q13 were $412 million compared to cash flows provided by operations of $2.35 billion in 1Q12. The company also evaluates operating cash flows on a non-GAAP basis:
| | | | | | | | |
Net cash from operating activities (in millions) | | 1Q13 Cash Flows | | | 1Q12 Cash Flows | |
GAAP | | $ | 412 | | | $ | 2,346 | |
Timing of premium payment from CMS (a) | | | — | | | | (2,015 | ) |
Non-GAAP (b) | | $ | 412 | | | $ | 331 | |
The year-over-year increase in the non-GAAP cash flows from operations is due primarily to higher net income partially offset by the effect on cash flows of changes in working capital accounts.
Share repurchases
During 1Q13, the company executed share repurchases of $81 million, or 1,205,600 of its outstanding shares, at an average price of $67.60 per share under a previously approved authorization. In April 2013, the Board of Directors replaced its previous share repurchase authorization (of which approximately $557 million remained unused) with a new $1 billion repurchase authorization with an expiration date of June 30, 2015.
Cash dividends
During 1Q13, the company paid cash dividends to its stockholders totaling approximately $42 million.
Business segment reclassifications
Beginning on January 1, 2013, the company reclassified its HumanaVitality, Lifesynch, Limited Income Newly Eligible Transition (LI-NET) and state-based Medicaid businesses to correspond with internal management reporting changes for the related operations. Additionally, the company renamed its Health and Well-Being Services segment as Healthcare Services. Segment results of prior periods were recast to conform to the current presentation. Those recast segment results are included in the statistical pages of this earnings press release.
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RETAIL SEGMENT
This segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, marketed directly to individuals including the company’s contract with CMS to administer the LI-NET program and contracts for state-based Medicaid members.
Retail Segment Highlights
Pretax results:
| • | | Retail Segment pretax income of $350 million in 1Q13 compares to $128 million in 1Q12, an increase of $222 million. This increase was primarily due to membership and premium growth and lower benefit and operating cost ratios. Retail Segment results for 1Q13 include the beneficial effect of $193 million in favorable prior-period medical claims reserve development compared to $116 million in 1Q12. |
Enrollment:
| • | | Individual Medicare Advantage membership was 2,012,100 as of March 31, 2013, an increase of 128,300 members, or 6.8 percent from 1,883,800 at March 31, 2012 and up 84,500, or 4.4 percent from 1,927,600 at December 31, 2012, primarily due to a successful enrollment season associated with the 2013 plan year. |
| • | | Individual Medicare Advantage net membership growth during 1Q13 included the divestiture of 12,600 members acquired with the March 2012 Arcadian Management Services, Inc. transaction, in accordance with the company’s previously disclosed agreement with the United States Department of Justice. |
| • | | Membership in the company’s stand-alone Prescription Drug Plans (PDPs) was 3,202,300 at March 31, 2013, up 261,700, or 8.9 percent compared to 2,940,600 at March 31, 2012 and up 149,600, or 4.9 percent from 3,052,700 at December 31, 2012. These increases resulted primarily from growth in the company’s innovative Humana-Walmart plan offering. |
| • | | HumanaOne® medical membership increased to 460,800 at March 31, 2013, an increase of 18,800, or 4.3 percent, from 442,000 at March 31, 2012 and up 16,800, or 3.8 percent from 444,000 at December 31, 2012. |
| • | | Medical membership in state-based Medicaid plans increased to 73,300 at March 31, 2013, an increase of 27,200, or 59.0 percent, from 46,100 at March 31, 2012 and up 21,200, or 40.7 percent, from 52,100 at December 31, 2012, primarily driven by the addition of the company’s recently awarded Kentucky Medicaid contract on January 1, 2013. |
| • | | Membership in individual specialty products(c) of 959,600 at March 31, 2013 increased 111,700, or 13.2 percent, from 847,900 at March 31, 2012 and increased 10,900, or 1.1 percent, from 948,700 at December 31, 2012, primarily driven by increased membership in dental and vision offerings. |
Premiums and services revenue:
| • | | 1Q13 premiums and services revenue for the Retail Segment was $6.91 billion, an increase of 12.2 percent from $6.15 billion in 1Q12. The increase was primarily the result of 9.4 percent higher average individual Medicare Advantage membership year over year together with a 2.9 percent average increase in the per member premium for Medicare Advantage. |
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Benefits expense:
| • | | The 1Q13 benefit ratio for the Retail Segment was 85.9 percent, a decrease of 160 basis points from 87.5 percent in 1Q12. The year-over-year decrease was primarily due to a decline in the benefit ratio associated with the company’s Medicare Advantage and stand-alone PDP businesses primarily driven by an increase in favorable prior-period medical claims reserve development and favorable weekday seasonality in 1Q13 versus 1Q12. |
Operating costs:
| • | | The Retail Segment’s operating cost ratio of 8.9 percent in 1Q13 decreased 150 basis points from 10.4 percent in 1Q12. The decrease was primarily the result of cost efficiencies resulting from higher average membership as well as the company’s continued focus on operating cost efficiencies. |
EMPLOYER GROUP SEGMENT
This segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, as well as administrative services only (ASO) products and health and productivity solutions businesses primarily marketed to employer groups.
Employer Group Segment Highlights
Pretax results:
| • | | Employer Group Segment pretax income of $205 million in 1Q13 compares to pretax income of $129 million in 1Q12, and reflects improved benefit and operating cost ratios for this segment. Employer Group Segment results for 1Q13 include the beneficial effect of $76 million in favorable prior-period medical claims reserve development compared to $15 million in 1Q12. |
Enrollment:
| • | | Fully-insured group Medicare Advantage membership was 412,800 at March 31, 2013, an increase of 55,100 members, or 15.4 percent, from 357,700 at March 31, 2012 and up 42,000, or 11.3 percent, from 370,800 at December 31, 2012, reflecting on-going success in demonstrating the company’s value proposition for retirees to employers. On January 1, 2013, the company lost its sole ASO group Medicare Advantage account which had 28,100 members at March 31, 2012 and 27,700 members at December 31, 2012. |
| • | | Group fully-insured commercial medical membership increased to 1,197,800 at March 31, 2013, an increase of 15,000, or 1.3 percent, from 1,182,800 at March 31, 2012 and down 14,000, or 1.2 percent, from 1,211,800 at December 31, 2012, as increases in small group business membership were generally offset by lower membership in large group accounts. Approximately 60 percent of group fully-insured commercial medical membership was in small group accounts at March 31, 2013 versus 57 percent at March 31, 2012 and 59 percent at December 31, 2012. |
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| • | | Group ASO commercial medical membership declined to 1,200,800 at March 31, 2013, a decrease of 35,800, or 2.9 percent, from 1,236,600 at March 31, 2012 and down 36,900, or 3.0 percent, from 1,237,700 at December 31, 2012. This decline reflected a continuation of discipline in pricing services for self-funded accounts amid a highly competitive environment. |
| • | | Membership in Employer Group specialty products(c) increased to 7,274,000 at March 31, 2013, an increase of 424,700, or 6.2 percent, from 6,849,300 at March 31, 2012 and was up 137,800, or 1.9 percent, from 7,136,200 at December 31, 2012. This increase primarily resulted from increased cross-sales of the company’s specialty products to its medical membership and growth in stand-alone specialty product sales. |
Premiums and services revenue:
| • | | 1Q13 premiums and services revenue for the Employer Group Segment were $2.83 billion, up 7.8 percent from $2.63 billion in 1Q12, primarily reflecting the impacts of higher average group Medicare Advantage and commercial fully-insured membership. |
Benefits expense:
| • | | The 1Q13 benefit ratio for the Employer Group Segment was 79.6 percent, a decrease of 160 basis points from 81.2 percent for 1Q12. The year-over-year decrease in the benefit ratio primarily reflected an increase in favorable prior-period medical claims reserve development and more favorable weekday seasonality in 1Q13 than in 1Q12. |
Operating costs:
| • | | The Employer Group Segment’s operating cost ratio was 15.5 percent in 1Q13, a decline of 110 basis points from 16.6 percent in 1Q12, primarily reflecting a higher percentage of members in group Medicare Advantage plans (which carry a lower operating cost ratio than commercial fully-insured group accounts) as well as cost savings associated with operating cost reduction initiatives. |
HEALTHCARE SERVICES SEGMENT (formerly Health and Well-Being Services Segment)
This segment includes services offered to the company’s health plan members as well as to third parties including provider services, pharmacy solutions and mail-order pharmacy, integrated behavioral health services, and home care services.
Healthcare Services Segment Highlights
Pretax results:
| • | | Healthcare Services Segment pretax income of $125 million in 1Q13 was essentially flat to 1Q12, as revenue growth and the profit contribution from the Metropolitan Health Networks, Inc. (Metropolitan) acquisition were generally offset by costs incurred in expanding our integrated care delivery model. |
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Revenues:
| • | | Revenues of $3.72 billion in 1Q13 for the Healthcare Services Segment increased $434 million, or 13.2 percent from $3.28 billion in 1Q12, primarily due to the company’s acquisitions of Metropolitan and other provider businesses as well as growth in the company’s pharmacy solutions business. |
Operating costs:
| • | | The Healthcare Services Segment’s operating cost ratio of 95.7 percent in 1Q13 was relatively unchanged from 95.6 percent in 1Q12. |
OTHER BUSINESSES
The Other Businesses category consists of the company’s military services, Puerto Rico Medicaid, and closed-block long-term care businesses. The military services business consists primarily of the company’s TRICARE South Region contract.
Other Businesses Highlights
Pretax results:
| • | | Other Businesses reported pretax income of $58 million in 1Q13 versus pretax income of $5 million in 1Q12, primarily due to the beneficial effect of the $48 million favorable settlement discussed above. |
| • | | On April 1, 2012, the company’s new South Region TRICARE contract became effective with the DoD. The company’s new contract is structured similar to self-funded products versus a fully-insured structure for the company’s previous South Region TRICARE contract with the DoD. This change resulted in significant volatility in year-over-year comparisons for the company’s Other Businesses. |
Footnotes
(a) | Generally, when the first day of a month falls on a weekend or holiday, with the exception of January 1 (New Year’s Day), the company receives this payment on the last business day of the previous month. Consequently, 1Q12 cash flows included four monthly Medicare payments compared to three monthly Medicare payments during 1Q13. |
(b) | The company has included certain financial measures that are not in accordance with Generally Accepted Accounting Principles (GAAP) in its summary of financial results within this earnings press release. The company believes that these non-GAAP measures, when presented in conjunction with comparable GAAP measures, are useful to both management and its investors in analyzing the company’s ongoing business and operating performance. Internally, management uses these non-GAAP financial measures as indicators of business performance, as well as for operational planning and decision making purposes. Non-GAAP financial measures should be considered in addition to, but not as a substitute for, or superior to, financial measures prepared in accordance with GAAP. |
(c) | The company provides a full range of insured specialty products including dental, vision and other supplemental health and financial protection products. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products. Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies. |
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Conference Call & Virtual Slide Presentation
Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings. A live virtual presentation (audio with slides) may be accessed via Humana’s Investor Relations page at www.humana.com. The company suggests web participants sign on at least 15 minutes in advance of the call. The company also suggests web participants visit the site well in advance of the call to run a system test and to download any free software needed to view the presentation.
All parties interested in the audio-only portion of the conference call are invited to dial 888-625-7430. No password is required. The company suggests participants dial in at least ten minutes in advance of the call. For those unable to participate in the live event, the virtual presentation archive may be accessed via the Historical Webcasts & Presentations section of the Investor Relations page at www.humana.com.
Cautionary Statement
This news release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:
| • | | If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of health care services delivered to its members, if the company is unable to implement clinical initiatives to provide a better health care experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. These estimates, however, involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in payment patterns and medical cost trends. |
| • | | If Humana fails to effectively implement its operational and strategic initiatives, particularly its Medicare initiatives (given the concentration of the company’s revenues in the Medicare business), the company’s business may be materially adversely affected. |
| • | | If Humana fails to properly maintain the integrity of its data, to strategically implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks, the company’s business may be materially adversely affected. |
| • | | Humana’s business may be materially adversely impacted by CMS’s adoption of a new coding set for diagnoses (commonly known as ICD-10). |
| • | | Humana is involved in various legal actions and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages. Increased litigation and negative publicity could also increase the company’s cost of doing business. |
| • | | As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government health care programs including, among other things, loss of material government contracts, governmental audits and investigations, potential inadequacy of government-determined payment rates or other changes in the governmental programs in which Humana participates. |
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| • | | Recently enacted health insurance reform, including The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010, could have a material adverse effect on Humana’s results of operations, including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products (and particularly how the ratio may apply to Medicare plans, including aggregation, credibility thresholds, and its possible application to prescription drug plans), lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible federal premium tax and other assessments; financial position, including the company’s ability to maintain the value of its goodwill; and cash flows. In addition, if the new non-deductible federal premium tax and other assessments, including a three-year commercial reinsurance fee, were imposed as enacted, and if Humana is unable to adjust its business model to address these new taxes and assessments, such as through the reduction of the company’s operating costs, there can be no assurance that the non-deductible federal premium tax and other assessments would not have a material adverse effect on the company’s results of operations, financial position, and cash flows. |
| • | | Humana’s business activities are subject to substantial government regulation. New laws or regulations, or changes in existing laws or regulations or their manner of application could increase the company’s cost of doing business and may adversely affect the company’s business, profitability and cash flows. |
| • | | Any failure to manage operating costs could hamper Humana’s profitability. |
| • | | Any failure by Humana to manage acquisitions and other significant transactions successfully may have a material adverse effect on its results of operations, financial position, and cash flows. |
| • | | If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected. |
| • | | Humana’s pharmacy business is highly competitive and subjects it to regulations in addition to those the company faces with its core health benefits businesses. |
| • | | Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance. |
| • | | If Humana does not continue to earn and retain purchase discounts and volume rebates from pharmaceutical manufacturers at current levels, Humana’s gross margins may decline. |
| • | | Humana’s ability to obtain funds from its subsidiaries is restricted by state insurance regulations. |
| • | | Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition. |
| • | | Changes in economic conditions could adversely affect Humana’s business and results of operations. |
| • | | The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business. |
| • | | Given the current economic climate, Humana’s stock and the stock of other companies in the insurance industry may be increasingly subject to stock price and trading volume volatility. |
In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.
Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:
| • | | Form 10-K for the year ended December 31, 2012; |
| • | | Form 8-Ks filed during 2013. |
About Humana
Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
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More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:
| • | | Annual reports to stockholders; |
| • | | Securities and Exchange Commission filings; |
| • | | Most recent investor conference presentations; |
| • | | Quarterly earnings news releases; |
| • | | Replays of most recent earnings release conference calls; |
| • | | Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors); |
| • | | Corporate Governance information. |
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Humana Inc. – Earnings Guidance Points as of May 1, 2013
| | | | |
(in accordance with Generally Accepted Accounting Principles) | | For the year ending December 31, 2013 | | Comments |
| | |
Diluted earnings per common share (EPS) | | | | |
Full Year | | $8.40 to $8.60 | | |
Second Quarter | | $2.40 to $2.50 | | |
| | |
Revenues | | | | |
Consolidated | | $41.0 billion to $41.5 billion | | Includes expected investment income in the range of $365 million to $385 million |
Retail Segment | | $26.75 billion to $27.25 billion | |
Employer Group Segment Healthcare Services Segment Other Businesses | | $11.0 billion to $11.5 billion $15.0 billion to $15.5 billion $1.3 billion to $1.5 billion | | Segment-level revenue estimates reflect the business segment reclassifications discussed in this press release. Additionally, segment-level revenues include intersegment amounts that eliminate in consolidation. |
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| |
| | |
Ending medical membership versus prior year end | | | | |
Retail Segment | | | | |
Medicare Advantage | | Up 120,000 to 130,000 | | Includes the January 1, 2013 disposition of 12,600 Medicare Advantage members acquired in the March 2012 Arcadian transaction in accordance with the company’s previously disclosed agreement with the United States Department of Justice. |
Medicare stand-alone PDPs (excl. LI-NET) | | Up 170,000 to 190,000 | | |
HumanaOne | | Down 10,000 to 20,000 | | |
Medicare Supplement | | Up 15,000 to 25,000 | | |
Employer Group Segment | | | | |
Medicare Advantage fully-insured | | Up 50,000 to 60,000 | | |
Medicare Advantage ASO | | Down 28,000 | | |
Commercial fully-insured | | Relatively unchanged | | |
Commercial ASO | | Down 60,000 to 70,000 | | |
| | |
Benefit ratios Retail Segment Employer Group Segment | | 84.5% to 85.0% 84.5% to 85.0% | | Benefits expense as a percent of premiums. Ratio estimates reflect the business segment reclassifications discussed in this press release. |
| | |
Operating cost ratios Consolidated Healthcare Services Segment | | 14.75% to 15.25% 95.5% to 96.0% | | Operating costs as a percent of total revenues excluding investment income |
| | |
Consolidated depreciation and amortization (D&A) Income statement Cash flows statement | | $330 million to $350 million $415 million to $435 million | | Certain D&A is included in benefits expense on the income statement but shown as a non-cash item on the cash flows statement |
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Humana Inc. – Earnings Guidance Points as of May 1, 2013
| | | | |
(in accordance with Generally Accepted Accounting Principles) | | For the year ending December 31, 2013 | | Comments |
| | |
Consolidated interest expense | | $140 million to $145 million | | |
| | |
Pretax results | | | | Segment-level pretax results and margins include the impact of net investment income |
Retail Segment | | $1.3 billion to $1.4 billion; Approximately 5% pretax margin | | |
| | |
Employer Group Segment | | $190 million to $210 million; Approximately 2% pretax margin | | |
| | |
Healthcare Services Segment | | $525 million to $550 million; Approximately 3.5% pretax margin | | |
| | |
Effective Tax Rate | | Approximately 36% | | |
| | |
Diluted shares | | Approximately 161 million | | Projections exclude the impact of future share repurchases |
| | |
Cash flows from operations | | $1.9 billion to $2.1 billion | | |
| | |
Capital expenditures | | $425 million to $450 million | | |
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Humana Inc.
Statistical Schedules
And
Supplementary Information
1Q13 Earnings Release
S-1
Humana Inc.
Statistical Schedules and Supplementary Information
1Q13 Earnings Release
Contents
| | |
Page | | Description |
| |
S-3 | | Consolidated Statements of Income |
S-4-5 | | Quarterly Segment Financial Information |
S-6-8 | | Quarterly Segment Financial Information (Recast) |
S-9 | | FY12 Segment Financial Information (Recast) |
S-10 | | Consolidated Balance Sheets |
S-11 | | Consolidated Statements of Cash Flows |
S-12 | | Key Income Statement Ratios and Segment Operating Results |
S-13-14 | | Healthcare Services Segment Metrics |
S-15 | | Membership Detail |
S-16 | | Premiums and Services Revenue Detail |
S-17 | | Medicare Summary |
S-18 | | Investments |
S-19-21 | | Benefits Payable Detail and Statistics |
S-22 | | Footnotes |
S-2
Humana Inc.
Consolidated Statements of Income
Dollars in millions, except per common share results
| | | | | | | | | | | | | | | | |
| | Three Months Ended March 31, | | | Dollar | | | Percentage | |
| | 2013 | | | 2012 | | | Change | | | Change | |
Revenues: | | | | | | | | | | | | | | | | |
Premiums | | $ | 9,868 | | | $ | 9,775 | | | $ | 93 | | | | 1.0 | % |
Services | | | 525 | | | | 350 | | | | 175 | | | | 50.0 | % |
Investment income | | | 93 | | | | 94 | | | | (1 | ) | | | -1.1 | % |
| | | | | | | | | | | | | | | | |
Total revenues | | | 10,486 | | | | 10,219 | | | | 267 | | | | 2.6 | % |
| | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | |
Benefits | | | 8,195 | | | | 8,350 | | | | (155 | ) | | | -1.9 | % |
Operating costs | | | 1,446 | | | | 1,383 | | | | 63 | | | | 4.6 | % |
Depreciation and amortization | | | 80 | | | | 70 | | | | 10 | | | | 14.3 | % |
| | | | | | | | | | | | | | | | |
Total operating expenses | | | 9,721 | | | | 9,803 | | | | (82 | ) | | | -0.8 | % |
| | | | | | | | | | | | | | | | |
Income from operations | | | 765 | | | | 416 | | | | 349 | | | | 83.9 | % |
Interest expense | | | 35 | | | | 26 | | | | 9 | | | | 34.6 | % |
| | | | | | | | | | | | | | | | |
Income before income taxes | | | 730 | | | | 390 | | | | 340 | | | | 87.2 | % |
Provision for income taxes | | | 257 | | | | 142 | | | | 115 | | | | 81.0 | % |
| | | | | | | | | | | | | | | | |
Net income | | $ | 473 | | | $ | 248 | | | $ | 225 | | | | 90.7 | % |
| | | | | | | | | | | | | | | | |
Basic earnings per common share | | $ | 2.97 | | | $ | 1.51 | | | $ | 1.46 | | | | 96.7 | % |
Diluted earnings per common share | | $ | 2.95 | | | $ | 1.49 | | | $ | 1.46 | | | | 98.0 | % |
Shares used in computing basic earnings per common share (000’s) | | | 158,917 | | | | 163,717 | | | | | | | | | |
Shares used in computing diluted earnings per common share (000’s) | | | 160,403 | | | | 166,088 | | | | | | | | | |
S-3
Humana Inc.
1Q13 Segment Financial Information
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,736 | | | $ | 1,190 | | | $ | — | | | $ | — | | | $ | — | | | $ | 6,926 | |
Medicare stand-alone PDP | | | 761 | | | | 2 | | | | — | | | | — | | | | — | | | | 763 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 6,497 | | | | 1,192 | | | | — | | | | — | | | | — | | | | 7,689 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 279 | | | | 1,268 | | | | — | | | | — | | | | — | | | | 1,547 | |
Specialty | | | 49 | | | | 275 | | | | — | | | | — | | | | — | | | | 324 | |
Military services | | | — | | | | — | | | | — | | | | 11 | | | | — | | | | 11 | |
Medicaid and other (A) | | | 79 | | | | — | | | | — | | | | 218 | | | | — | | | | 297 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 6,904 | | | | 2,735 | | | | — | | | | 229 | | | | — | | | | 9,868 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 4 | | | | 306 | | | | — | | | | — | | | | 310 | |
ASO and other (B) | | | 2 | | | | 84 | | | | — | | | | 120 | | | | — | | | | 206 | |
Pharmacy | | | — | | | | — | | | | 9 | | | | — | | | | — | | | | 9 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 2 | | | | 88 | | | | 315 | | | | 120 | | | | — | | | | 525 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 6,906 | | | | 2,823 | | | | 315 | | | | 349 | | | | — | | | | 10,393 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | — | | | | 11 | | | | 2,749 | | | | — | | | | (2,760 | ) | | | — | |
Products | | | — | | | | — | | | | 654 | | | | — | | | | (654 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | — | | | | 11 | | | | 3,403 | | | | — | | | | (3,414 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 18 | | | | 11 | | | | — | | | | 15 | | | | 49 | | | | 93 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 6,924 | | | | 2,845 | | | | 3,718 | | | | 364 | | | | (3,365 | ) | | | 10,486 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 5,929 | | | | 2,177 | | | | — | | | | 187 | | | | (98 | ) | | | 8,195 | |
Operating costs | | | 613 | | | | 440 | | | | 3,557 | | | | 115 | | | | (3,279 | ) | | | 1,446 | |
Depreciation and amortization | | | 32 | | | | 23 | | | | 36 | | | | 4 | | | | (15 | ) | | | 80 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 6,574 | | | | 2,640 | | | | 3,593 | | | | 306 | | | | (3,392 | ) | | | 9,721 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income from operations | | | 350 | | | | 205 | | | | 125 | | | | 58 | | | | 27 | | | | 765 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 35 | | | | 35 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) before income taxes | | $ | 350 | | | $ | 205 | | | $ | 125 | | | $ | 58 | | | $ | (8 | ) | | $ | 730 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 85.9 | % | | | 79.6 | % | | | | | | | 81.7 | % | | | | | | | 83.0 | % |
Operating cost ratio | | | 8.9 | % | | | 15.5 | % | | | 95.7 | % | | | 33.0 | % | | | | | | | 13.9 | % |
S-4
Humana Inc.
1Q12 Segment Financial Information (Recast) (C)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,093 | | | $ | 1,025 | | | $ | — | | | $ | — | | | $ | — | | | $ | 6,118 | |
Medicare stand-alone PDP | | | 726 | | | | 2 | | | | — | | | | — | | | | — | | | | 728 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 5,819 | | | | 1,027 | | | | — | | | | — | | | | — | | | | 6,846 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 244 | | | | 1,242 | | | | — | | | | — | | | | — | | | | 1,486 | |
Specialty | | | 38 | | | | 260 | | | | — | | | | — | | | | — | | | | 298 | |
Military services | | | — | | | | — | | | | — | | | | 893 | | | | — | | | | 893 | |
Medicaid and other (A) | | | 46 | | | | — | | | | — | | | | 206 | | | | — | | | | 252 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 6,147 | | | | 2,529 | | | | — | | | | 1,099 | | | | — | | | | 9,775 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 2 | | | | 231 | | | | — | | | | — | | | | 233 | |
ASO and other (B) | | | 6 | | | | 89 | | | | — | | | | 18 | | | | — | | | | 113 | |
Pharmacy | | | — | | | | — | | | | 4 | | | | — | | | | — | | | | 4 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 6 | | | | 91 | | | | 235 | | | | 18 | | | | — | | | | 350 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 6,153 | | | | 2,620 | | | | 235 | | | | 1,117 | | | | — | | | | 10,125 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | — | | | | 10 | | | | 2,465 | | | | — | | | | (2,475 | ) | | | — | |
Products | | | — | | | | — | | | | 584 | | | | — | | | | (584 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | — | | | | 10 | | | | 3,049 | | | | — | | | | (3,059 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 19 | | | | 10 | | | | — | | | | 14 | | | | 51 | | | | 94 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 6,172 | | | | 2,640 | | | | 3,284 | | | | 1,131 | | | | (3,008 | ) | | | 10,219 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 5,377 | | | | 2,053 | | | | — | | | | 1,016 | | | | (96 | ) | | | 8,350 | |
Operating costs | | | 637 | | | | 436 | | | | 3,140 | | | | 106 | | | | (2,936 | ) | | | 1,383 | |
Depreciation and amortization | | | 30 | | | | 22 | | | | 19 | | | | 4 | | | | (5 | ) | | | 70 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 6,044 | | | | 2,511 | | | | 3,159 | | | | 1,126 | | | | (3,037 | ) | | | 9,803 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income from operations | | | 128 | | | | 129 | | | | 125 | | | | 5 | | | | 29 | | | | 416 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 26 | | | | 26 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income before income taxes | | $ | 128 | | | $ | 129 | | | $ | 125 | | | $ | 5 | | | $ | 3 | | | $ | 390 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 87.5 | % | | | 81.2 | % | | | | | | | 92.4 | % | | | | | | | 85.4 | % |
Operating cost ratio | | | 10.4 | % | | | 16.6 | % | | | 95.6 | % | | | 9.5 | % | | | | | | | 13.7 | % |
S-5
Humana Inc.
2Q12 Segment Financial Information (Recast) (C)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,308 | | | $ | 1,011 | | | $ | — | | | $ | — | | | $ | — | | | $ | 6,319 | |
Medicare stand-alone PDP | | | 745 | | | | 2 | | | | — | | | | — | | | | — | | | | 747 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 6,053 | | | | 1,013 | | | | — | | | | — | | | | — | | | | 7,066 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 250 | | | | 1,247 | | | | — | | | | — | | | | — | | | | 1,497 | |
Specialty | | | 42 | | | | 262 | | | | — | | | | — | | | | — | | | | 304 | |
Military services | | | — | | | | — | | | | — | | | | 44 | | | | — | | | | 44 | |
Medicaid and other (A) | | | 45 | | | | — | | | | — | | | | 210 | | | | — | | | | 255 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 6,390 | | | | 2,522 | | | | — | | | | 254 | | | | — | | | | 9,166 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 2 | | | | 243 | | | | — | | | | — | | | | 245 | |
ASO and other (B) | | | 5 | | | | 89 | | | | — | | | | 91 | | | | — | | | | 185 | |
Pharmacy | | | — | | | | — | | | | 4 | | | | — | | | | — | | | | 4 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 5 | | | | 91 | | | | 247 | | | | 91 | | | | — | | | | 434 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 6,395 | | | | 2,613 | | | | 247 | | | | 345 | | | | — | | | | 9,600 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | 1 | | | | 7 | | | | 2,359 | | | | — | | | | (2,367 | ) | | | — | |
Products | | | — | | | | — | | | | 591 | | | | — | | | | (591 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | 1 | | | | 7 | | | | 2,950 | | | | — | | | | (2,958 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 20 | | | | 10 | | | | — | | | | 15 | | | | 54 | | | | 99 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 6,416 | | | | 2,630 | | | | 3,197 | | | | 360 | | | | (2,904 | ) | | | 9,699 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 5,378 | | | | 2,063 | | | | — | | | | 301 | | | | (90 | ) | | | 7,652 | |
Operating costs | | | 638 | | | | 428 | | | | 3,049 | | | | 111 | | | | (2,842 | ) | | | 1,384 | |
Depreciation and amortization | | | 33 | | | | 22 | | | | 20 | | | | 4 | | | | (6 | ) | | | 73 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 6,049 | | | | 2,513 | | | | 3,069 | | | | 416 | | | | (2,938 | ) | | | 9,109 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) from operations | | | 367 | | | | 117 | | | | 128 | | | | (56 | ) | | | 34 | | | | 590 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 26 | | | | 26 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) before income taxes | | $ | 367 | | | $ | 117 | | | $ | 128 | | | $ | (56 | ) | | $ | 8 | | | $ | 564 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 84.2 | % | | | 81.8 | % | | | | | | | 118.5 | % | | | | | | | 83.5 | % |
Operating cost ratio | | | 10.0 | % | | | 16.3 | % | | | 95.4 | % | | | 32.2 | % | | | | | | | 14.4 | % |
S-6
Humana Inc.
3Q12 Segment Financial Information (Recast) (C)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,203 | | | $ | 1,023 | | | $ | — | | | $ | — | | | $ | — | | | $ | 6,226 | |
Medicare stand-alone PDP | | | 699 | | | | 2 | | | | — | | | | — | | | | — | | | | 701 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 5,902 | | | | 1,025 | | | | — | | | | — | | | | — | | | | 6,927 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 255 | | | | 1,256 | | | | — | | | | — | | | | — | | | | 1,511 | |
Specialty | | | 45 | | | | 271 | | | | — | | | | — | | | | — | | | | 316 | |
Military services | | | — | | | | — | | | | — | | | | 69 | | | | — | | | | 69 | |
Medicaid and other (A) | | | 47 | | | | — | | | | — | | | | 218 | | | | — | | | | 265 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 6,249 | | | | 2,552 | | | | — | | | | 287 | | | | — | | | | 9,088 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 3 | | | | 268 | | | | — | | | | — | | | | 271 | |
ASO and other (B) | | | 6 | | | | 88 | | | | — | | | | 99 | | | | — | | | | 193 | |
Pharmacy | | | — | | | | — | | | | 3 | | | | — | | | | — | | | | 3 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 6 | | | | 91 | | | | 271 | | | | 99 | | | | — | | | | 467 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 6,255 | | | | 2,643 | | | | 271 | | | | 386 | | | | — | | | | 9,555 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | 1 | | | | 5 | | | | 2,306 | | | | — | | | | (2,312 | ) | | | — | |
Products | | | — | | | | — | | | | 602 | | | | — | | | | (602 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | 1 | | | | 5 | | | | 2,908 | | | | — | | | | (2,914 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 19 | | | | 11 | | | | — | | | | 14 | | | | 52 | | | | 96 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 6,275 | | | | 2,659 | | | | 3,179 | | | | 400 | | | | (2,862 | ) | | | 9,651 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 5,150 | | | | 2,168 | | | | — | | | | 232 | | | | (83 | ) | | | 7,467 | |
Operating costs | | | 675 | | | | 421 | | | | 3,013 | | | | 108 | | | | (2,809 | ) | | | 1,408 | |
Depreciation and amortization | | | 32 | | | | 23 | | | | 22 | | | | 4 | | | | (6 | ) | | | 75 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 5,857 | | | | 2,612 | | | | 3,035 | | | | 344 | | | | (2,898 | ) | | | 8,950 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income from operations | | | 418 | | | | 47 | | | | 144 | | | | 56 | | | | 36 | | | | 701 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 26 | | | | 26 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income before income taxes | | $ | 418 | | | $ | 47 | | | $ | 144 | | | $ | 56 | | | $ | 10 | | | $ | 675 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 82.4 | % | | | 85.0 | % | | | | | | | 80.8 | % | | | | | | | 82.2 | % |
Operating cost ratio | | | 10.8 | % | | | 15.9 | % | | | 94.8 | % | | | 28.0 | % | | | | | | | 14.7 | % |
S-7
Humana Inc.
4Q12 Segment Financial Information (Recast) (C)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,184 | | | $ | 1,005 | | | $ | — | | | $ | — | | | $ | — | | | $ | 6,189 | |
Medicare stand-alone PDP | | | 683 | | | | 2 | | | | — | | | | — | | | | — | | | | 685 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 5,867 | | | | 1,007 | | | | — | | | | — | | | | — | | | | 6,874 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 255 | | | | 1,251 | | | | — | | | | — | | | | — | | | | 1,506 | |
Specialty | | | 46 | | | | 277 | | | | — | | | | — | | | | — | | | | 323 | |
Military services | | | — | | | | — | | | | — | | | | 11 | | | | — | | | | 11 | |
Medicaid and other (A) | | | 47 | | | | — | | | | — | | | | 219 | | | | — | | | | 266 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 6,215 | | | | 2,535 | | | | — | | | | 230 | | | | — | | | | 8,980 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 5 | | | | 266 | | | | — | | | | — | | | | 271 | |
ASO and other (B) | | | 7 | | | | 92 | | | | — | | | | 100 | | | | — | | | | 199 | |
Pharmacy | | | — | | | | — | | | | 5 | | | | — | | | | — | | | | 5 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 7 | | | | 97 | | | | 271 | | | | 100 | | | | — | | | | 475 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 6,222 | | | | 2,632 | | | | 271 | | | | 330 | | | | — | | | | 9,455 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | — | | | | 9 | | | | 2,394 | | | | — | | | | (2,403 | ) | | | — | |
Products | | | — | | | | — | | | | 565 | | | | — | | | | (565 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | — | | | | 9 | | | | 2,959 | | | | — | | | | (2,968 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 21 | | | | 11 | | | | — | | | | 15 | | | | 55 | | | | 102 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 6,243 | | | | 2,652 | | | | 3,230 | | | | 345 | | | | (2,913 | ) | | | 9,557 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 5,143 | | | | 2,187 | | | | — | | | | 253 | | | | (67 | ) | | | 7,516 | |
Operating costs | | | 817 | | | | 459 | | | | 3,138 | | | | 111 | | | | (2,870 | ) | | | 1,655 | |
Depreciation and amortization | | | 35 | | | | 22 | | | | 26 | | | | 4 | | | | (10 | ) | | | 77 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 5,995 | | | | 2,668 | | | | 3,164 | | | | 368 | | | | (2,947 | ) | | | 9,248 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) from operations | | | 248 | | | | (16 | ) | | | 66 | | | | (23 | ) | | | 34 | | | | 309 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 27 | | | | 27 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) before income taxes | | $ | 248 | | | $ | (16 | ) | | $ | 66 | | | $ | (23 | ) | | $ | 7 | | | $ | 282 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 82.8 | % | | | 86.3 | % | | | | | | | 110.0 | % | | | | | | | 83.7 | % |
Operating cost ratio | | | 13.1 | % | | | 17.4 | % | | | 97.2 | % | | | 33.6 | % | | | | | | | 17.5 | % |
S-8
Humana Inc.
FY 2012 Segment Financial Information (Recast) (C)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Employer | | | Healthcare | | | Other | | | Eliminations/ | | | | |
| | Retail | | | Group | | | Services | | | Businesses | | | Corporate | | | Consolidated | |
Revenues—external customers | | | | | | | | | | | | | | | | | | | | | | | | |
Premiums: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 20,788 | | | $ | 4,064 | | | $ | — | | | $ | — | | | $ | — | | | $ | 24,852 | |
Medicare stand-alone PDP | | | 2,853 | | | | 8 | | | | — | | | | — | | | | — | | | | 2,861 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | | 23,641 | | | | 4,072 | | | | — | | | | — | | | | — | | | | 27,713 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Fully-insured | | | 1,004 | | | | 4,996 | | | | — | | | | — | | | | — | | | | 6,000 | |
Specialty | | | 171 | | | | 1,070 | | | | — | | | | — | | | | — | | | | 1,241 | |
Military services | | | — | | | | — | | | | — | | | | 1,017 | | | | — | | | | 1,017 | |
Medicaid and other (A) | | | 185 | | | | — | | | | — | | | | 853 | | | | — | | | | 1,038 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total premiums | | | 25,001 | | | | 10,138 | | | | — | | | | 1,870 | | | | — | | | | 37,009 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Services revenue: | | | | | | | | | | | | | | | | | | | | | | | | |
Provider | | | — | | | | 12 | | | | 1,008 | | | | — | | | | — | | | | 1,020 | |
ASO and other (B) | | | 24 | | | | 358 | | | | — | | | | 308 | | | | — | | | | 690 | |
Pharmacy | | | — | | | | — | | | | 16 | | | | — | | | | — | | | | 16 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total services revenue | | | 24 | | | | 370 | | | | 1,024 | | | | 308 | | | | — | | | | 1,726 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues—external customers | | | 25,025 | | | | 10,508 | | | | 1,024 | | | | 2,178 | | | | — | | | | 38,735 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Intersegment revenues | | | | | | | | | | | | | | | | | | | | | | | | |
Services | | | 2 | | | | 31 | | | | 9,524 | | | | — | | | | (9,557 | ) | | | — | |
Products | | | — | | | | — | | | | 2,342 | | | | — | | | | (2,342 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total intersegment revenues | | | 2 | | | | 31 | | | | 11,866 | | | | — | | | | (11,899 | ) | | | — | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Investment income | | | 79 | | | | 42 | | | | — | | | | 58 | | | | 212 | | | | 391 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total revenues | | | 25,106 | | | | 10,581 | | | | 12,890 | | | | 2,236 | | | | (11,687 | ) | | | 39,126 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Operating expenses: | | | | | | | | | | | | | | | | | | | | | | | | |
Benefits | | | 21,048 | | | | 8,471 | | | | — | | | | 1,802 | | | | (336 | ) | | | 30,985 | |
Operating costs | | | 2,767 | | | | 1,744 | | | | 12,340 | | | | 436 | | | | (11,457 | ) | | | 5,830 | |
Depreciation and amortization | | | 130 | | | | 89 | | | | 87 | | | | 16 | | | | (27 | ) | | | 295 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total operating expenses | | | 23,945 | | | | 10,304 | | | | 12,427 | | | | 2,254 | | | | (11,820 | ) | | | 37,110 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) from operations | | | 1,161 | | | | 277 | | | | 463 | | | | (18 | ) | | | 133 | | | | 2,016 | |
Interest expense | | | — | | | | — | | | | — | | | | — | | | | 105 | | | | 105 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Income (loss) before income taxes | | $ | 1,161 | | | $ | 277 | | | $ | 463 | | | $ | (18 | ) | | $ | 28 | | | $ | 1,911 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Benefit ratio | | | 84.2 | % | | | 83.6 | % | | | | | | | 96.4 | % | | | | | | | 83.7 | % |
Operating cost ratio | | | 11.1 | % | | | 16.5 | % | | | 95.7 | % | | | 20.0 | % | | | | | | | 15.1 | % |
S-9
Humana Inc.
Consolidated Balance Sheets
Dollars in millions, except share amounts
| | | | | | | | | | | | | | | | |
| | March 31, | | | December 31, | | | Sequential Change | |
| | 2013 | | | 2012 | | | Dollar | | | Percent | |
Assets | | | | | | | | | | | | | | | | |
Current assets: | | | | | | | | | | | | | | | | |
Cash and cash equivalents | | $ | 1,398 | | | $ | 1,306 | | | | | | | | | |
Investment securities | | | 8,141 | | | | 8,001 | | | | | | | | | |
Receivables, net | | | 1,321 | | | | 733 | | | | | | | | | |
Other | | | 1,818 | | | | 1,670 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Total current assets | | | 12,678 | | | | 11,710 | | | $ | 968 | | | | 8.3 | % |
Property and equipment, net | | | 1,119 | | | | 1,098 | | | | | | | | | |
Long-term investment securities | | | 1,824 | | | | 1,846 | | | | | | | | | |
Goodwill | | | 3,641 | | | | 3,640 | | | | | | | | | |
Other | | | 1,712 | | | | 1,685 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Total assets | | | 20,974 | | | | 19,979 | | | $ | 995 | | | | 5.0 | % |
| | | | | | | | | | | | | | | | |
Liabilities and Stockholders’ Equity | | | | | | | | | | | | | | | | |
Current liabilities: | | | | | | | | | | | | | | | | |
Benefits payable | | | 4,090 | | | | 3,779 | | | | | | | | | |
Trade accounts payable and accrued expenses | | | 2,321 | | | | 2,042 | | | | | | | | | |
Book overdraft | | | 290 | | | | 324 | | | | | | | | | |
Unearned revenues | | | 243 | | | | 230 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Total current liabilities | | | 6,944 | | | | 6,375 | | | $ | 569 | | | | 8.9 | % |
Long-term debt | | | 2,608 | | | | 2,611 | | | | | | | | | |
Future policy benefits payable | | | 1,924 | | | | 1,858 | | | | | | | | | |
Other long-term liabilities | | | 334 | | | | 288 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Total liabilities | | | 11,810 | | | | 11,132 | | | $ | 678 | | | | 6.1 | % |
| | | | | | | | | | | | | | | | |
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; 195,022,433 issued at March 31, 2013 | | | 32 | | | | 32 | | | | | | | | | |
Capital in excess of par value | | | 2,140 | | | | 2,101 | | | | | | | | | |
Retained earnings | | | 8,311 | | | | 7,881 | | | | | | | | | |
Accumulated other comprehensive income | | | 328 | | | | 386 | | | | | | | | | |
Treasury stock, at cost, 37,520,682 shares at March 31, 2013 | | | (1,647 | ) | | | (1,553 | ) | | | | | | | | |
| | | | | | | | | | | | | | | | |
Total stockholders’ equity | | | 9,164 | | | | 8,847 | | | $ | 317 | | | | 3.6 | % |
| | | | | | | | | | | | | | | | |
Total liabilities and stockholders’ equity | | $ | 20,974 | | | $ | 19,979 | | | $ | 995 | | | | 5.0 | % |
| | | | | | | | | | | | | | | | |
Debt-to-total capitalization ratio | | | 22.2 | % | | | 22.8 | % | | | | | | | | |
Return on Invested Capital (ROIC)—trailing 12 months | | | 13.4 | % | | | 11.5 | % | | | | | | | | |
S-10
Humana Inc.
Consolidated Statements of Cash Flows
Dollars in millions
| | | | | | | | | | | | | | | | |
| | Three Months Ended March 31, | | | Dollar | | | Percentage | |
| | 2013 | | | 2012 | | | Change | | | Change | |
Cash flows from operating activities | | | | | | | | | | | | | | | | |
Net income | | $ | 473 | | | $ | 248 | | | | | | | | | |
Adjustments to reconcile net income to net cash provided by operating activities: | | | | | | | | | | | | | | | | |
Depreciation and amortization | | | 102 | | | | 78 | | | | | | | | | |
Net realized capital gains | | | (5 | ) | | | (4 | ) | | | | | | | | |
Stock-based compensation | | | 32 | | | | 40 | | | | | | | | | |
Benefit from deferred income taxes | | | — | | | | (9 | ) | | | | | | | | |
Changes in operating assets and liabilities excluding the effects of acquisitions: | | | | | | | | | | | | | | | | |
Receivables | | | (588 | ) | | | (255 | ) | | | | | | | | |
Other assets | | | (130 | ) | | | (138 | ) | | | | | | | | |
Benefits payable | | | 311 | | | | 284 | | | | | | | | | |
Other liabilities | | | 190 | | | | 52 | | | | | | | | | |
Unearned revenues | | | 13 | | | | 2,034 | | | | | | | | | |
Other | | | 14 | | | | 16 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Net cash provided by operating activities | | | 412 | | | | 2,346 | | | ($ | 1,934 | ) | | | -82.4 | % |
| | | | | | | | | | | | | | | | |
Cash flows from investing activities | | | | | | | | | | | | | | | | |
Acquisitions, net of cash acquired | | | (5 | ) | | | (56 | ) | | | | | | | | |
Purchases of property and equipment | | | (90 | ) | | | (86 | ) | | | | | | | | |
Purchases of investment securities | | | (783 | ) | | | (714 | ) | | | | | | | | |
Proceeds from maturities of investment securities | | | 294 | | | | 424 | | | | | | | | | |
Proceeds from sales of investment securities | | | 192 | | | | 242 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Net cash used in investing activities | | | (392 | ) | | | (190 | ) | | ($ | 202 | ) | | | -106.3 | % |
| | | | | | | | | | | | | | | | |
Cash flows from financing activities | | | | | | | | | | | | | | | | |
Receipts from contract deposits, net | | | 236 | | | | 298 | | | | | | | | | |
Repayment of long-term debt | | | — | | | | (36 | ) | | | | | | | | |
Change in book overdraft | | | (34 | ) | | | (12 | ) | | | | | | | | |
Common stock repurchases | | | (94 | ) | | | (151 | ) | | | | | | | | |
Excess tax benefit from stock-based compensation | | | 1 | | | | 20 | | | | | | | | | |
Dividends paid | | | (42 | ) | | | (41 | ) | | | | | | | | |
Proceeds from stock option exercises and other | | | 5 | | | | 45 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Net cash provided by financing activities | | | 72 | | | | 123 | | | ($ | 51 | ) | | | -41.5 | % |
| | | | | | | | | | | | | | | | |
Increase in cash and cash equivalents | | | 92 | | | | 2,279 | | | | | | | | | |
Cash and cash equivalents at beginning of period | | | 1,306 | | | | 1,377 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
Cash and cash equivalents at end of period | | $ | 1,398 | | | $ | 3,656 | | | | | | | | | |
| | | | | | | | | | | | | | | | |
S-11
Humana Inc.
Key Income Statement Ratios and Segment Operating Results
Dollars in millions
| | | | | | | | | | | | | | | | |
| | Three Months Ended March 31, | | | | | | Percentage | |
| | 2013 | | | 2012 | | | Difference | | | Change | |
Benefit ratio | | | | | | | | | | | | | | | | |
Retail | | | 85.9 | % | | | 87.5 | % | | | -1.6 | % | | | | |
Employer Group | | | 79.6 | % | | | 81.2 | % | | | -1.6 | % | | | | |
Other Businesses | | | 81.7 | % | | | 92.4 | % | | | -10.7 | % | | | | |
Consolidated | | | 83.0 | % | | | 85.4 | % | | | -2.4 | % | | | | |
Operating cost ratio | | | | | | | | | | | | | | | | |
Retail | | | 8.9 | % | | | 10.4 | % | | | -1.5 | % | | | | |
Employer Group | | | 15.5 | % | | | 16.6 | % | | | -1.1 | % | | | | |
Healthcare Services | | | 95.7 | % | | | 95.6 | % | | | 0.1 | % | | | | |
Other Businesses | | | 33.0 | % | | | 9.5 | % | | | 23.5 | % | | | | |
Consolidated | | | 13.9 | % | | | 13.7 | % | | | 0.2 | % | | | | |
Detail of pretax income | | | | | | | | | | | | | | | | |
Retail | | $ | 350 | | | $ | 128 | | | $ | 222 | | | | 173.4 | % |
Employer Group | | $ | 205 | | | $ | 129 | | | $ | 76 | | | | 58.9 | % |
Healthcare Services | | $ | 125 | | | $ | 125 | | | $ | 0 | | | | 0.0 | % |
Other Businesses | | $ | 58 | | | $ | 5 | | | $ | 53 | | | | 1060.0 | % |
Consolidated | | $ | 730 | | | $ | 390 | | | $ | 340 | | | | 87.2 | % |
S-12
Humana Inc.
Healthcare Services Segment Metrics
| | | | | | | | | | | | | | | | |
| | Quarter Ended | | | Quarter Ended | | | | | | | |
| | March 31, 2013 | | | December 31, 2012 | | | Difference | | | | |
Primary Care Providers: | | | | | | | | | | | | | | | | |
Risk (D) | | | | | | | | | | | | | | | | |
Owned / JV | | | 4,100 | | | | 4,200 | | | | (100 | ) | | | -2.4 | % |
Contracted | | | 2,100 | | | | 1,200 | | | | 900 | | | | 75.0 | % |
Path-to-Risk (E) | | | 21,600 | | | | 18,200 | | | | 3,400 | | | | 18.7 | % |
Care Management Professionals: | | | | | | | | | | | | | | | | |
Employed | | | 3,400 | | | | 3,300 | | | | 100 | | | | 3.0 | % |
Contracted | | | 4,200 | | | | 3,400 | | | | 800 | | | | 23.5 | % |
| | | | | | | | | | | | | | | | |
Total | | | 7,600 | | | | 6,700 | | | | 900 | | | | 13.4 | % |
| | | | | | | | | | | | | | | | |
Care Management Statistics: | | | | | | | | | | | | | | | | |
Number of members with complex chronic conditions in Humana Chronic Care Program | | | 180,300 | | | | 151,100 | | | | 29,200 | | | | | |
Number of high-risk discharges managed by Humana Transitions Program | | | 2,100 | | | | 1,300 | | | | 800 | | | | | |
S-13
Humana Inc.
Healthcare Services Segment Metrics (Continued)
Script volume in thousands
| | | | | | | | | | | | | | | | |
| | Quarter Ended | | | Quarter ended | | | | | | | |
| | March 31, 2013 | | | December 31, 2012 | | | Difference | | | | |
Pharmacy: | | | | | | | | | | | | | | | | |
Generic Dispense Rate | | | | | | | | | | | | | | | | |
Retail | | | 86.2 | % | | | 85.9 | % | | | 0.3 | % | | | | |
Employer Group | | | 79.3 | % | | | 78.1 | % | | | 1.2 | % | | | | |
Total | | | 85.4 | % | | | 85.0 | % | | | 0.4 | % | | | | |
| | | | | | | | | | | | | | | | |
Mail-Order Penetration | | | | | | | | | | | | | | | | |
Retail | | | 22.9 | % | | | 22.2 | % | | | 0.7 | % | | | | |
Employer Group | | | 14.6 | % | | | 14.6 | % | | | 0.0 | % | | | | |
Total | | | 21.9 | % | | | 21.3 | % | | | 0.6 | % | | | | |
| | | | | | | | | | | | | | | | |
| | | | |
| | | | | | | | | | | Percentage | |
| | | | | | | | Difference | | | Change | |
Script volume | | | | | | | | | | | | | | | | |
Retail | | | 58,900 | | | | 54,100 | | | | 4,800 | | | | 8.9 | % |
Employer Group | | | 7,700 | | | | 7,200 | | | | 500 | | | | 6.9 | % |
| | | | | | | | | | | | | | | | |
Total | | | 66,600 | | | | 61,300 | | | | 5,300 | | | | 8.6 | % |
| | | | | | | | | | | | | | | | |
S-14
Humana Inc.
Membership Detail
In thousands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | Ending | | | Average | | | Ending | | | Year-over-year Change | | | Ending | | | Sequential Change | |
| | March 31, 2013 | | | 1Q13 | | | March 31, 2012 | | | Amount | | | Percent | | | December 31, 2012 | | | Amount | | | Percent | |
Medical Membership: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Retail | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | | 2,012.1 | | | | 2,010.9 | | | | 1,883.8 | | | | 128.3 | | | | 6.8 | % | | | 1,927.6 | | | | 84.5 | | | | 4.4 | % |
Medicare stand-alone PDPs | | | 3,202.3 | | | | 3,197.7 | | | | 2,940.6 | | | | 261.7 | | | | 8.9 | % | | | 3,052.7 | | | | 149.6 | | | | 4.9 | % |
Individual commercial | | | 460.8 | | | | 453.7 | | | | 442.0 | | | | 18.8 | | | | 4.3 | % | | | 444.0 | | | | 16.8 | | | | 3.8 | % |
State-based Medicaid | | | 73.3 | | | | 76.2 | | | | 46.1 | | | | 27.2 | | | | 59.0 | % | | | 52.1 | | | | 21.2 | | | | 40.7 | % |
Medicare Supplement | | | 87.6 | | | | 87.1 | | | | 67.3 | | | | 20.3 | | | | 30.2 | % | | | 77.4 | | | | 10.2 | | | | 13.2 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Retail | | | 5,836.1 | | | | 5,825.6 | | | | 5,379.8 | | | | 456.3 | | | | 8.5 | % | | | 5,553.8 | | | | 282.3 | | | | 5.1 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Employer Group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage fully-insured | | | 412.8 | | | | 411.6 | | | | 357.7 | | | | 55.1 | | | | 15.4 | % | | | 370.8 | | | | 42.0 | | | | 11.3 | % |
Medicare Advantage ASO | | | 0.0 | | | | 0.0 | | | | 28.1 | | | | (28.1 | ) | | | -100.0 | % | | | 27.7 | | | | (27.7 | ) | | | -100.0 | % |
Medicare stand-alone PDPs | | | 3.8 | | | | 3.9 | | | | 4.2 | | | | (0.4 | ) | | | -9.5 | % | | | 4.4 | | | | (0.6 | ) | | | -13.6 | % |
Fully-insured medical commercial | | | 1,197.8 | | | | 1,203.2 | | | | 1,182.8 | | | | 15.0 | | | | 1.3 | % | | | 1,211.8 | | | | (14.0 | ) | | | -1.2 | % |
ASO commercial | | | 1,200.8 | | | | 1,204.3 | | | | 1,236.6 | | | | (35.8 | ) | | | -2.9 | % | | | 1,237.7 | | | | (36.9 | ) | | | -3.0 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Employer Group | | | 2,815.2 | | | | 2,823.0 | | | | 2,809.4 | | | | 5.8 | | | | 0.2 | % | | | 2,852.4 | | | | (37.2 | ) | | | -1.3 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Other Businesses | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Military Services | | | 3,111.8 | | | | 3,110.7 | | | | 3,021.7 | | | | 90.1 | | | | 3.0 | % | | | 3,123.9 | | | | (12.1 | ) | | | -0.4 | % |
Puerto Rico Medicaid and other | | | 550.7 | | | | 554.1 | | | | 556.7 | | | | (6.0 | ) | | | -1.1 | % | | | 558.7 | | | | (8.0 | ) | | | -1.4 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Other Businesses | | | 3,662.5 | | | | 3,664.8 | | | | 3,578.4 | | | | 84.1 | | | | 2.4 | % | | | 3,682.6 | | | | (20.1 | ) | | | -0.5 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Medical Membership | | | 12,313.8 | | | | 12,313.4 | | | | 11,767.6 | | | | 546.2 | | | | 4.6 | % | | | 12,088.8 | | | | 225.0 | | | | 1.9 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Specialty Membership: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Retail | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Dental—fully-insured | | | 687.7 | | | | 672.2 | | | | 626.0 | | | | 61.7 | | | | 9.9 | % | | | 691.5 | | | | (3.8 | ) | | | -0.5 | % |
Vision | | | 131.2 | | | | 125.9 | | | | 90.2 | | | | 41.0 | | | | 45.5 | % | | | 118.7 | | | | 12.5 | | | | 10.5 | % |
Other supplemental benefits (F) | | | 140.7 | | | | 139.4 | | | | 131.7 | | | | 9.0 | | | | 6.8 | % | | | 138.5 | | | | 2.2 | | | | 1.6 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Retail | | | 959.6 | | | | 937.5 | | | | 847.9 | | | | 111.7 | | | | 13.2 | % | | | 948.7 | | | | 10.9 | | | | 1.1 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Employer Group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Dental—fully-insured | | | 2,503.9 | | | | 2,510.0 | | | | 2,386.2 | | | | 117.7 | | | | 4.9 | % | | | 2,446.4 | | | | 57.5 | | | | 2.4 | % |
Dental—ASO | | | 867.9 | | | | 871.2 | | | | 852.4 | | | | 15.5 | | | | 1.8 | % | | | 868.3 | | | | (0.4 | ) | | | 0.0 | % |
Vision | | | 2,543.6 | | | | 2,543.5 | | | | 2,418.3 | | | | 125.3 | | | | 5.2 | % | | | 2,525.0 | | | | 18.6 | | | | 0.7 | % |
Other supplemental benefits (F) | | | 1,358.6 | | | | 1,340.0 | | | | 1,192.4 | | | | 166.2 | | | | 13.9 | % | | | 1,296.5 | | | | 62.1 | | | | 4.8 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Employer Group | | | 7,274.0 | | | | 7,264.7 | | | | 6,849.3 | | | | 424.7 | | | | 6.2 | % | | | 7,136.2 | | | | 137.8 | | | | 1.9 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Total Specialty Membership | | | 8,233.6 | | | | 8,202.2 | | | | 7,697.2 | | | | 536.4 | | | | 7.0 | % | | | 8,084.9 | | | | 148.7 | | | | 1.8 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
S-15
Humana Inc.
Premiums and Services Revenue Detail
Dollars in millions, except per member per month
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | Per Member per Month (G) | |
| | Three Months Ended March 31, | | | Dollar | | | Percentage | | | Three Months Ended March 31, | |
| | 2013 | | | 2012 | | | Change | | | Change | | | 2013 | | | 2012 | |
Premiums and Services Revenue | | | | | | | | | | | | | | | | | | | | | | | | |
Retail: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 5,736 | | | $ | 5,093 | | | $ | 643 | | | | 12.6 | % | | $ | 951 | | | $ | 924 | |
Medicare stand-alone PDPs | | | 761 | | | | 726 | | | | 35 | | | | 4.8 | % | | | 79 | | | | 83 | |
Individual commercial | | | 236 | | | | 211 | | | | 25 | | | | 11.8 | % | | | 173 | | | | 161 | |
State-based Medicaid | | | 79 | | | | 46 | | | | 33 | | | | 71.7 | % | | | 346 | | | | 321 | |
Medicare Supplemental | | | 43 | | | | 33 | | | | 10 | | | | 30.3 | % | | | 165 | | | | 165 | |
Specialty | | | 49 | | | | 38 | | | | 11 | | | | 28.9 | % | | | 17 | | | | 15 | |
ASO & other services (B) | | | 2 | | | | 6 | | | | (4 | ) | | | -66.7 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Retail | | | 6,906 | | | | 6,153 | | | | 753 | | | | 12.2 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Employer Group: | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage fully-insured | | | 1,190 | | | | 1,025 | | | | 165 | | | | 16.1 | % | | | 964 | | | | 956 | |
Medicare stand-alone PDPs | | | 2 | | | | 2 | | | | — | | | | 0.0 | % | | | | | | | | |
Fully-insured medical commercial | | | 1,268 | | | | 1,242 | | | | 26 | | | | 2.1 | % | | | 351 | | | | 349 | |
Specialty | | | 275 | | | | 260 | | | | 15 | | | | 5.8 | % | | | 14 | | | | 14 | |
ASO & other services (B) | | | 99 | | | | 101 | | | | (2 | ) | | | -2.0 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Employer Group | | | 2,834 | | | | 2,630 | | | | 204 | | | | 7.8 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Healthcare Services: | | | | | | | | | | | | | | | | | | | | | | | | |
Pharmacy solutions | | | 3,094 | | | | 2,933 | | | | 161 | | | | 5.5 | % | | | | | | | | |
Provider services | | | 509 | | | | 281 | | | | 228 | | | | 81.1 | % | | | | | | | | |
Home care services | | | 83 | | | | 36 | | | | 47 | | | | 130.6 | % | | | | | | | | |
Integrated behavioral health | | | 32 | | | | 34 | | | | (2 | ) | | | -5.9 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Healthcare Services | | | 3,718 | | | | 3,284 | | | | 434 | | | | 13.2 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Other Businesses: | | | | | | | | | | | | | | | | | | | | | | | | |
Military services (H) | | | 110 | | | | 906 | | | | (796 | ) | | | -87.9 | % | | | | | | | | |
Puerto Rico Medicaid and other (I) | | | 239 | | | | 211 | | | | 28 | | | | 13.3 | % | | | 131 | | | | 124 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Other Businesses | | $ | 349 | | | $ | 1,117 | | | $ | (768 | ) | | | -68.8 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
S-16
Humana Inc.
Medicare Summary
Premiums in millions, except per member per month
Membership in thousands
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | Per Member per Month (G) | |
| | Three Months Ended March 31, | | | Year-over-year Change | | | Three Months Ended March 31, | |
| | 2013 | | | 2012 | | | Amount | | | Percent | | | 2013 | | | 2012 | |
Premiums | | | | | | | | | | | | | | | | | | | | | | | | |
Medicare Advantage | | $ | 6,926 | | | $ | 6,118 | | | $ | 808 | | | | 13.2 | % | | $ | 953 | | | $ | 929 | |
Medicare stand-alone PDPs | | | 763 | | | | 728 | | | | 35 | | | | 4.8 | % | | | 79 | | | | 83 | |
| | | | | | | | | | | | | | | | | | | | | | | | |
Total Medicare | | $ | 7,689 | | | $ | 6,846 | | | $ | 843 | | | | 12.3 | % | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | |
| | | |
| | Ending | | | Ending | | | Year-over-year Change | |
| | March 31, 2013 | | | March 31, 2012 | | | Amount | | | Percent | |
Fully-Insured Membership | | | | | | | | | | | | | | | | |
Medicare Advantage | | | 2,424.9 | | | | 2,241.5 | | | | 183.4 | | | | 8.2 | % |
Medicare stand-alone PDPs | | | 3,206.1 | | | | 2,944.8 | | | | 261.3 | | | | 8.9 | % |
| | | | | | | | | | | | | | | | |
Total Medicare | | | 5,631.0 | | | | 5,186.3 | | | | 444.7 | | | | 8.6 | % |
| | | | | | | | | | | | | | | | |
| | | |
| | | | | | | | Member Mix | |
| | Ending | | | Ending | | | March 31 | | | March 31 | |
| | March 31, 2013 | | | March 31, 2012 | | | 2013 | | | 2012 | |
Retail Segment Detail | | | | | | | | | | | | | | | | |
Medicare Advantage Membership | | | | | | | | | | | | | | | | |
HMO | | | 1,015.0 | | | | 910.8 | | | | 50.4 | % | | | 48.3 | % |
PPO | | | 997.1 | | | | 973.0 | | | | 49.6 | % | | | 51.7 | % |
| | | | | | | | | | | | | | | | |
Total Individual Medicare | | | 2,012.1 | | | | 1,883.8 | | | | 100.0 | % | | | 100.0 | % |
| | | | | | | | | | | | | | | | |
Medicare Advantage Membership | | | | | | | | | | | | | | | | |
Risk (D) | | | 530.3 | | | | 497.9 | | | | 26.3 | % | | | 26.4 | % |
Path-to-Risk (E) | | | 408.0 | | | | 303.0 | | | | 20.3 | % | | | 16.1 | % |
Other | | | 1,073.8 | | | | 1,082.9 | | | | 53.4 | % | | | 57.5 | % |
| | | | | | | | | | | | | | | | |
Total Individual Medicare | | | 2,012.1 | | | | 1,883.8 | | | | 100.0 | % | | | 100.0 | % |
| | | | | | | | | | | | | | | | |
S-17
Humana Inc.
Investments
Dollars in millions
| | | | | | | | | | | | |
| | Fair value | |
| | 3/31/2013 | | | 12/31/2012 | | | 3/31/2012 | |
Investment Portfolio: | | | | | | | | | | | | |
Cash & cash equivalents | | $ | 1,398 | | | $ | 1,306 | | | $ | 3,656 | |
Investment securities | | | 8,141 | | | | 8,001 | | | | 7,889 | |
Long-term investments | | | 1,824 | | | | 1,846 | | | | 1,704 | |
| | | | | | | | | | | | |
Total investment portfolio | | $ | 11,363 | | | $ | 11,153 | | | $ | 13,249 | |
| | | | | | | | | | | | |
Duration (J) | | | 4.21 | | | | 4.02 | | | | 3.33 | |
| | | | | | | | | | | | |
Average Credit Rating | | | AA- | | | | AA- | | | | AA- | |
| | | | | | | | | | | | |
Investment Portfolio Detail: | | | | | | | | | | | | |
Cash and cash equivalents | | $ | 1,398 | | | $ | 1,306 | | | $ | 3,656 | |
| | | | | | | | | | | | |
U.S. Government and agency obligations | | | | | | | | | | | | |
U.S. Treasury and agency obligations | | | 552 | | | | 618 | | | | 550 | |
U.S. Government residential mortgage-backed | | | 1,585 | | | | 1,569 | | | | 1,725 | |
U.S. Government commercial mortgage-backed | | | 33 | | | | 34 | | | | 33 | |
| | | | | | | | | | | | |
Total U.S. Government and agency obligations | | | 2,170 | | | | 2,221 | | | | 2,308 | |
| | | | | | | | | | | | |
Tax-exempt municipal securities | | | | | | | | | | | | |
Pre-refunded | | | 322 | | | | 311 | | | | 304 | |
Insured | | | 613 | | | | 627 | | | | 645 | |
Other | | | 2,235 | | | | 2,120 | | | | 1,928 | |
Auction rate securities | | | 13 | | | | 13 | | | | 15 | |
| | | | | | | | | | | | |
Total tax-exempt municipal securities | | | 3,183 | | | | 3,071 | | | | 2,892 | |
| | | | | | | | | | | | |
Residential mortgage-backed | | | | | | | | | | | | |
Prime residential mortgages | | | 29 | | | | 32 | | | | 38 | |
Alt-A residential mortgages | | | 1 | | | | 1 | | | | 2 | |
Sub-prime residential mortgages | | | 1 | | | | 1 | | | | 1 | |
| | | | | | | | | | | | |
Total residential mortgage-backed | | | 31 | | | | 34 | | | | 41 | |
| | | | | | | | | | | | |
Commercial mortgage-backed | | | 694 | | | | 659 | | | | 437 | |
| | | | | | | | | | | | |
Asset-backed securities | | | 85 | | | | 68 | | | | 74 | |
| | | | | | | | | | | | |
Corporate securities | | | | | | | | | | | | |
Financial services | | | 889 | | | | 864 | | | | 867 | |
Other | | | 2,913 | | | | 2,930 | | | | 2,974 | |
| | | | | | | | | | | | |
Total corporate securities | | | 3,802 | | | | 3,794 | | | | 3,841 | |
| | | | | | | | | | | | |
Total investment portfolio | | $ | 11,363 | | | $ | 11,153 | | | $ | 13,249 | |
| | | | | | | | | | | | |
S-18
Humana Inc.
Detail of Benefits Payable Balance and Year-to-Date Changes
Dollars in millions
| | | | | | | | | | | | |
| | March 31, | | | March 31, | | | December 31, | |
| | 2013 | | | 2012 | | | 2012 | |
Detail of benefits payable | | | | | | | | | | | | |
IBNR and other benefits payable (K) | | $ | 3,442 | | | $ | 2,918 | | | $ | 3,158 | |
Unprocessed claim inventories (L) | | | 327 | | | | 376 | | | | 302 | |
Processed claim inventories (M) | | | 150 | | | | 262 | | | | 230 | |
Payable to pharmacy benefit administrator (N) | | | 169 | | | | 199 | | | | 85 | |
| | | | | | | | | | | | |
Benefits payable, excluding military services | | | 4,088 | | | | 3,755 | | | | 3,775 | |
Military services benefits payable (O) | | | 2 | | | | 353 | | | | 4 | |
| | | | | | | | | | | | |
Total Benefits Payable | | $ | 4,090 | | | $ | 4,108 | | | $ | 3,779 | |
| | | | | | | | | | | | |
| | | |
| | Three Months Ended | | | Three Months Ended | | | Year Ended | |
| | March 31, 2013 | | | March 31, 2012 | | | December 31, 2012 | |
Year-to-date changes in benefits payable, excluding military services (P) | | | | | | | | | | | | |
Balances at January 1 | | $ | 3,775 | | | $ | 3,415 | | | $ | 3,415 | |
Acquisitions | | | — | | | | 70 | | | | 66 | |
Incurred related to: | | | | | | | | | | | | |
Current year | | | 8,476 | | | | 7,652 | | | | 30,198 | |
Prior years (Q) | | | (266 | ) | | | (141 | ) | | | (257 | ) |
| | | | | | | | | | | | |
Total incurred | | | 8,210 | | | | 7,511 | | | | 29,941 | |
| | | | | | | | | | | | |
Paid related to: | | | | | | | | | | | | |
Current year | | | (5,255 | ) | | | (4,795 | ) | | | (26,738 | ) |
Prior years | | | (2,642 | ) | | | (2,446 | ) | | | (2,909 | ) |
| | | | | | | | | | | | |
Total paid | | | (7,897 | ) | | | (7,241 | ) | | | (29,647 | ) |
| | | | | | | | | | | | |
Balances at end of period | | $ | 4,088 | | | $ | 3,755 | | | $ | 3,775 | |
| | | | | | | | | | | | |
| | | |
| | Three Months Ended | | | Three Months Ended | | | Year Ended | |
| | March 31, 2013 | | | March 31, 2012 | | | December 31, 2012 | |
Summary of Consolidated Benefit Expense: | | | | | | | | | | | | |
Total benefit expense incurred, per above | | $ | 8,210 | | | $ | 7,511 | | | $ | 29,941 | |
Military services benefit expense | | | (40 | ) | | | 813 | | | | 908 | |
Future policy benefit expense (R) | | | 25 | | | | 26 | | | | 136 | |
| | | | | | | | | | | | |
Consolidated Benefit Expense | | $ | 8,195 | | | $ | 8,350 | | | $ | 30,985 | |
| | | | | | | | | | | | |
S-19
Humana Inc.
Benefits Payable Statistics (S)
Receipt Cycle Time (T)
| | | | | | | | | | | | | | | | |
| | 2013 | | | 2012 | | | Change | | | Percentage Change | |
1st Quarter Average | | | 12.5 | | | | 13.0 | | | | (0.5 | ) | | | -3.8 | % |
2nd Quarter Average | | | | | | | 13.7 | | | | n/a | | | | n/a | |
3rd Quarter Average | | | | | | | 13.0 | | | | n/a | | | | n/a | |
4th Quarter Average | | | | | | | 12.8 | | | | n/a | | | | n/a | |
| | | | | | | | | | | | | | | | |
Full Year Average | | | 12.5 | | | | 13.1 | | | | (0.6 | ) | | | -4.6 | % |
| | | | | | | | | | | | | | | | |
Unprocessed Claims Inventories
| | | | | | | | | | | | |
Date | | Estimated Valuation (millions) | | | Claim Item Counts (000s) | | | Number of Days on Hand | |
3/31/2011 | | $ | 482 | | | | 1,197 | | | | 6.0 | |
6/30/2011 | | $ | 410 | | | | 1,093 | | | | 5.1 | |
9/30/2011 | | $ | 419 | | | | 1,272 | | | | 5.7 | |
12/31/2011 | | $ | 280 | | | | 599 | | | | 2.8 | |
3/31/2012 | | $ | 376 | | | | 1,028 | | | | 4.2 | |
6/30/2012 | | $ | 310 | | | | 1,077 | | | | 4.2 | |
9/30/2012 | | $ | 380 | | | | 1,440 | | | | 5.7 | |
12/31/2012 | | $ | 302 | | | | 1,061 | | | | 4.1 | |
| | | | | | | | | | | | |
3/31/2013 | | $ | 327 | | | | 1,247 | | | | 4.7 | |
| | | | | | | | | | | | |
S-20
Humana Inc.
Benefits Payable Statistics (Continued) (S)
Days in Claims Payable(U)
| | | | | | | | | | | | |
Quarter Ended | | Days in Claims Payable (DCP) | | | Change Last 4 Quarters | | | Percentage Change | |
3/31/2011 | | | 55.5 | | | | 1.3 | | | | 2.4 | % |
6/30/2011 | | | 56.0 | | | | (1.0 | ) | | | -1.8 | % |
9/30/2011 | | | 54.2 | | | | (3.6 | ) | | | -6.2 | % |
12/31/2011 | | | 52.5 | | | | (1.0 | ) | | | -1.9 | % |
3/31/2012 | | | 50.1 | | | | (5.4 | ) | | | -9.7 | % |
6/30/2012 | | | 51.0 | | | | (5.0 | ) | | | -8.9 | % |
9/30/2012 | | | 51.6 | | | | (2.6 | ) | | | -4.8 | % |
12/31/2012 | | | 48.5 | | | | (4.0 | ) | | | -7.6 | % |
| | | | | | | | | | | | |
3/31/2013 | | | 49.0 | | | | (1.1 | ) | | | -2.2 | % |
| | | | | | | | | | | | |
Year-to-Date Change in Days in Claims Payable(V)
| | | | | | | | |
| | 2013 | | | 2012 | |
DCP—beginning of period | | | 48.5 | | | | 52.5 | |
Components of change in DCP: | | | | | | | | |
Change in unprocessed claims inventories | | | 0.3 | | | | (0.1 | ) |
Change in processed claims inventories | | | 1.1 | | | | 0.3 | |
Change in pharmacy payment cutoff | | | — | | | | (0.1 | ) |
Change in capitation/provider settlements | | | (0.8 | ) | | | (4.3 | ) |
All other | | | (0.1 | ) | | | 0.2 | |
| | | | | | | | |
DCP—end of period | | | 49.0 | | | | 48.5 | |
| | | | | | | | |
S-21
Humana Inc.
Footnotes to Statistical Schedules and Supplementary Information
1Q13 Earnings Release
(A) | The Medicaid and other category includes the company’s Medicaid business as well as the closed block of long-term care. |
(B) | The ASO and other category is primarily comprised of ASO fees and other ancillary services fees. |
(C) | Beginning on January 1, 2013, the company reclassified certain businesses and renamed its Health and Well-Being Services segment as Healthcare Services. Prior periods were recast to conform to the current presentation. |
(D) | In certain circumstances, the company contracts with providers to accept financial risk for a defined set of Medicare Advantage membership. In transferring this risk, the company prepays these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their Medicare Advantage members assigned or attributed to their provider panel, including some health benefit administrative functions and claims processing. For these capitated arrangements, the company generally agrees to payment rates that target a benefit expense ratio. The result is a high level of engagement on the part of the provider and, we believe, better quality care for the member. |
(E) | A path-to-risk provider is one who has a high level of engagement and participates in one of Humana’s pay-for-performance programs (Model Practice or Medical Home) or has a risk contract in place with a trigger (future date or membership threshold) which has not yet been met. In addition to earning incentives, these providers may also have a shared savings component by which they can share in achieved surpluses when the actual cost of the medical services provided to patients assigned or attributed to their panel is less than the agreed upon medical expense target. |
(F) | Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies. |
(G) | Computed based on average membership for the period (i.e., monthly ending membership during the period divided by the number of months in the period). |
(H) | Military services revenues are generally not contracted on a per-member basis. |
(I) | Includes premiums associated with Puerto Rico Medicaid and the closed block of long-term care as well as services revenue. |
(J) | Duration is the time-weighted average of the present value of the fixed income portfolio cash flows. |
(K) | IBNR represents an estimate of benefits expense payable for claims incurred but not reported (IBNR) at the balance sheet date. The level of IBNR is primarily impacted by membership levels, benefit 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). Other benefits payable includes amounts payable to providers under capitation arrangements. |
(L) | Unprocessed claim inventories represent the estimated valuation of claims received but not yet fully processed. |
(M) | Processed claim inventories represent the estimated valuation of processed claims that are in the post-claim-adjudication process, which consists of operating functions such as audit and check batching and handling. |
(N) | The balance due to the company’s pharmacy benefit administrator fluctuates as a result of the number of business days in the last payment cycle of the month. Payment cycles are every 8 days (8th, 16th, and 24th of month) and the last day of the month. |
(O) | Military services benefits payable primarily consist of IBNR related to the company’s previous contract that expired on March 31, 2012. |
(P) | The table excludes activity associated with military services benefits payable related to the previous contract that expired March 31, 2012. |
(Q) | Amounts incurred related to prior years vary from previously estimated liabilities as the claims ultimately are settled. Negative amounts reported for incurred related to prior years result from claims being ultimately settled for amounts less than originally estimated (favorable development). There were no changes in the approach used to determine the company’s estimate of medical claim reserves during the quarter. |
(R) | Future policy benefit expense has a related liability classified as a long-term liability on the balance sheet. |
(S) | Benefits reserves statistics represents fully-insured medical claims data and excludes military services claims data and specialty benefits. |
(T) | The receipt cycle time measures the average length of time between when a claim was initially incurred and when the claim form was received. Receipt cycle time data for the company’s largest claim processing platforms represent approximately 93% of the company’s fully-insured medical claims volume. Pharmacy and specialty claims, including dental, vision and other supplemental benefits, are excluded from this measurement. |
(U) | A common metric for monitoring benefits payable levels relative to the benefit expense is days in claims payable, or DCP, which represents the benefits payable at the end of the period divided by average benefits expense per day in the quarterly period. |
(V) | DCP fluctuates due to a number of factors, the more significant of which are detailed in this roll forward. Growth in certain product lines can also impact DCP for the quarter since a provision for claims would not have been recorded for members that had not yet enrolled earlier in the quarter, yet those members would have a provision and corresponding medical claims reserve recorded upon enrollment later in the quarter. This analysis excludes the impact upon DCP of military services and Medicare stand-alone PDPs. |
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