Humana Reports Third Quarter 2015 Financial Results; Reaffirms 2015 Adjusted EPS Guidance
- 3Q 2015 Adjusted EPS of
$2.16 excludes the impact of$0.07 per share in Aetna transaction costs and is in line with management’s guidance of approximately$2.15 per share - Reaffirmed full-year 2015 Adjusted EPS guidance of approximately
$7.75 excluding$1.53 per share of gain on the company’s sale of Concentra and total expected Aetna transaction costs of$0.10 per share - Consolidated revenues up 13 percent year to date
- 3Q 2015 operating cash flow of
$1.03 billion
The company has included certain adjusted financial measures throughout this earnings press release. Adjusted pretax income and Adjusted EPS for 3Q 2015 and YTD 2015 were as follows (a):
| Consolidated pretax income (in millions) | 3Q 2015 | 3Q 2014 | YTD 2015 | YTD 2014 | |||||||||
| GAAP | |
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| Costs associated with proposed transaction with Aetna | 11 | - | 11 | - | |||||||||
| Gain related to sale of |
- | - | (267) | - | |||||||||
| Adjusted (non-GAAP) | |
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| Diluted earnings per common share | 3Q 2015 | 3Q 2014 | YTD 2015 | YTD 2014 | |||||||||
| GAAP | |
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| Costs associated with proposed transaction with Aetna | 0.07 | - | 0.07 | - | |||||||||
| Gain related to sale of Concentra | - | - | (1.53) | - | |||||||||
| Adjusted (non-GAAP) | |
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The higher year-over-year Adjusted pretax income for the quarter and year to date reflected higher operating results from the Group and Healthcare Services segments and higher investment income associated with repositioning of the investment portfolio, partially offset by lower operating results in the Retail segment. Further discussion of the drivers of the business segment operating results are discussed in the sections below highlighting each segment.
The higher year-over-year Adjusted EPS for the quarter reflected the same factors impacting Adjusted pretax income and the favorable impact of share repurchase activity in the first half of 2015, partially offset by a higher effective tax rate associated with the expected increase in the non-deductible health insurance industry fee. The lower year-over year Adjusted EPS year to date also reflected the same factors impacting Adjusted pretax income for the quarter and the favorable impact of share repurchase activity, but these favorable factors were more than offset by the higher effective tax rate on a year-to-date basis.
“Our third quarter results included operating performance for our
Earnings Guidance
The company reaffirms Adjusted EPS guidance for the year ending
| Diluted earnings per common share | FY 2015 | |||
| GAAP | |
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| Estimated costs associated with proposed transaction with Aetna | 0.10 | |||
| Gain related to sale of Concentra | (1.53) | |||
| Adjusted (non-GAAP) | |
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“As we look to 2016, we anticipate marked improvement in our
A listing of items expected to significantly impact the company’s 2016 earnings are discussed throughout this press release and on page S-24 of the statistical supplement included herein.
The company’s FY 2015 Adjusted EPS guidance includes the following changes from its previous expectations:
| Adjusted EPS | FY 2015 | |||
| Guidance – |
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0.10 | |||
| Healthcare Services segment operating performance | 0.38 | |||
| Administrative cost efficiencies, other discretionary cost reductions and investment income associated with investment portfolio rebalancing | 0.43 | |||
| Individual commercial medical underwriting performance | (0.91) | |||
| Guidance – |
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Proposed Transaction
As previously announced,
The transaction is subject to customary closing conditions, including the expiration of the Hart-Scott-Rodino anti-trust waiting period and approvals of certain state Departments of Insurance and other regulators. The company expects the transaction to close in the second half of 2016.
CONSOLIDATED HIGHLIGHTS
Consolidated revenues
Consolidated revenues (including investment income) for 3Q 2015 were
Consolidated revenues for YTD 2015 increased
Investment income for 3Q 2015 of
Consolidated benefits expense
The 3Q 2015 consolidated benefit ratio (benefits expense as a percent of premiums) of 83.9 percent increased by 60 basis points from 83.3 percent for the prior year’s quarter primarily reflecting higher ratios in both the
The YTD 2015 consolidated benefit ratio of 84.0 percent increased by 110 basis points from 82.9 percent in YTD 2014. The increase primarily reflects the same factors impacting the third quarter year-over-year comparison. Prior
As discussed in the Retail segment highlights below, the company’s consolidated Prior
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Consolidated operating expenses
The consolidated operating cost ratio (operating costs as a percent of total revenues less investment income) of 12.8 percent for 3Q 2015 decreased 280 basis points from 15.6 percent in 3Q 2014, primarily reflecting lower ratios in the
The YTD 2015 consolidated operating cost ratio of 13.4 percent decreased 200 basis points from 15.4 percent in YTD 2014, primarily reflecting the same factors impacting the year-over-year comparisons for the third quarter.
Consolidated operating expenses included amortization expense for intangible assets of approximately
For 2016, the company anticipates higher consolidated operating expenses as discretionary cost reductions implemented in 2015 are expected to return to normal levels in 2016.
Balance sheet
At
Cash and short-term investments held at the parent company of
At
| Net Amounts Accrued for the |
Balances Related | Balances Related to | Total Balances at | ||||||
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to 2014 plan year |
2015 plan year |
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| Net risk adjustment settlement | 10 | (59) | (49) | ||||||
| Net risk corridor settlement(c) | 241 | 205 | 446 | ||||||
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Reinsurance recoverables for the 2015 plan year are anticipated to be primarily collected in the third quarter of 2016. Net risk corridor receivables are now anticipated to be primarily collected in future years and thus the related amounts have been classified as long-term receivables as of
Days in claims payable of 43.4 at
Debt-to-total capitalization at
Cash flows from operations
Cash flows provided by operations for 3Q 2015 were
For YTD 2015, cash flows provided by operations totaled
Fourth quarter 2015 cash flows from operations are anticipated to be lower than previously expected primarily due to the delay in collection of risk corridor receivables associated with the
Share repurchases
In
As a result of the proposed transaction with Aetna, the company has suspended its share repurchase program. Consequently, the company did not repurchase shares during 3Q 2015. The company executed repurchases of 967,200 shares for approximately
Year to date through
In light of the suspension of the company’s share repurchase program discussed above, 2016 EPS is not expected to include any benefit from share repurchases versus an active share repurchase program in the first half of 2015.
Cash dividends
The company paid cash dividends to its stockholders of
The company’s ability and intent to continue its quarterly dividend policy is not impacted by the proposed transaction with Aetna, although the company has agreed with Aetna that its quarterly dividend will not exceed
RETAIL SEGMENT(d)
This segment consists of
Retail Segment Highlights
While operating performance for the company’s stand-alone PDP and group
The company’s
For 2016,
2016 individual
Individual commercial business
Operating results for the company’s individual commercial medical business continue to be challenged primarily due to the volatility related to the start of the healthcare exchange program created under the Affordable Care Act (ACA) as well as the morbidity of membership served under this relatively new program. The benefit ratio associated with many of the company’s individual products, in particular ACA-compliant offerings, continue to exceed prior expectations for FY 2015 driven primarily by product designs which attracted a higher-utilizing member base than was assumed when the 2015 plan offerings were priced, in part due to the on-going impact of the transitional policies associated with the program. The transitory nature of the population served has also contributed to use of emergency room services and non-participating providers above priced-for levels.
During 2015, the company has taken a number of actions that are anticipated to improve the profitability of the individual commercial business in 2016. However, the deterioration in claims experience for this business in 3Q 2015, if it continues, would reduce the likelihood of achieving the level of profitability the company had previously anticipated for this business in 2016. The company continues to evaluate its participation in this line of business for 2017.
Steps taken to address challenges in this business during 2015 include:
- Premium increases for 2016 including the impact of early 2015 claims experience and
June 2015 updated risk adjustment data from CMS. - Discontinuance of certain products as well as market exits for 2016, with approximately 100,000 current members expected to be impacted, though approximately 88 percent of those will have other
Humana options from which they can choose in addition to offerings in the open market. Product discontinuance for 2016 primarily focuses on off-exchange products as well as platinum metal-tier and broad-network products both on and off exchange. Offerings to be discontinued in 2016 account for a significant portion of the 2015 pretax losses for the individual commercial business. - Network improvements, enhancements to claims and clinical processes and administrative cost right-sizing.
State-based contracts business
In total, the company’s state-based contracts business continues to perform in line with management’s expectations. State-based business associated with the company’s dual eligible membership is outperforming expectations while its Medicaid Temporary Assistance for Needy Families (TANF) products are underperforming expectations.
For 2016, the company’s state-based contracts business is expected to benefit from the full-year effect of rate increases and operational improvements implemented in 2015.
Retail segment premiums and services revenue:
- The 3Q 2015 premiums and services revenues for the Retail segment was
$11.35 billion , an increase of 14 percent from$9.99 billion in 3Q 2014. The increase resulted primarily from an increase of 12 percent in averageMedicare Advantage membership year over year, along with membership growth in the company’s state-based contracts and stand-alone PDP offerings as well as a heavier percentage of individual commercial business in higher premium ACA-compliant plans. - YTD 2015 premium and services revenues for the Retail segment was
$34.49 billion , an increase of 17 percent from$29.45 billion in YTD 2014, primarily reflecting the same factors impacting the year-over-year comparison for the third quarter.
Retail segment enrollment:
- Individual
Medicare Advantage membership was 2,737,100 as ofSeptember 30, 2015 , an increase of 334,300, or 14 percent, from 2,402,800 atSeptember 30, 2014 , and up 309,200, or 13 percent from 2,427,900 as ofDecember 31, 2014 , primarily due to net membership additions associated with the 2015 plan year, particularly HMO offerings. - Group
Medicare Advantage membership was 481,300 as ofSeptember 30, 2015 , a decrease of 3,600, or 1 percent, from 484,900 atSeptember 30, 2014 and down 8,400, or 2 percent, from 489,700 atDecember 31, 2014 . The decline fromDecember 31, 2014 primarily reflects the loss of a large group account. - Membership in the company’s stand-alone PDP offerings was 4,509,600 as of
September 30, 2015 , an increase of 568,800 or 14 percent, from 3,940,800 atSeptember 30, 2014 , and up 515,600, or 13 percent from 3,994,000 as ofDecember 31, 2014 . These increases primarily resulted from growth in the company’s low-priced Humana-Walmart plan offering for the 2015 plan year. - Individual commercial membership decreased to 963,700 as of
September 30, 2015 , down 122,100, or 11 percent, from 1,085,800 atSeptember 30, 2014 , and down 52,500, or 5 percent from 1,016,200 atDecember 31, 2014 . These declines were primarily driven by the loss of approximately 150,000 members due to termination by CMS for lack of proper immigration documentation and/or income status. Individual commercial membership changes both year over year and year to date also reflect the loss of members who had subscribed to non-ACA-compliant plans, partially offset by growth in ACA-compliant plans, primarily off-exchange. Further, the membership change from 3Q 2014 to 3Q 2015 reflected the loss of membership in the fourth quarter 2014 associated with non-payment of premiums. - State-based
Medicaid membership was 368,400 as ofSeptember 30, 2015 (including 16,600 dual-eligible demonstration members), an increase of 72,100, or 24 percent, from 296,300 (including 15,100 dual-eligible demonstration members) atSeptember 30, 2014 , and up 51,600, or 16 percent, from 316,800 (including 18,300 dual-eligible demonstration members) atDecember 31, 2014 . These increases were primarily driven by the addition of membership from state-based contracts for the Florida Medicaid business. - Membership in individual specialty products(f) was 1,187,300 as of
September 30, 2015 , a decrease of 32,200, or 3 percent, from 1,219,500 atSeptember 30, 2014 , but up 21,500, or 2 percent, from 1,165,800 atDecember 31, 2014 . The year-over-year decrease in membership primarily reflects lower membership in supplemental health and financial protection product offerings.
Retail segment benefits expense:
- The 3Q 2015 benefit ratio for the Retail segment of 86.1 percent increased 120 basis points from 84.9 percent in 3Q 2014 primarily due to higher than expected medical costs as compared to the assumptions used in the company’s pricing for its individual commercial and
Medicare Advantage products for 2015. Additionally, the benefit ratio was increased by the impact of unfavorable year-over-year comparisons of PriorPeriod Development and higher benefit ratios associated with a greater number of members in state-based contracts. PriorPeriod Development decreased the 3Q 2015 Retail segment benefit ratio by 60 basis points versus 80 basis points for 3Q 2014. Excluding PriorPeriod Development , the Retail segment benefit ratios were 86.7 percent and 85.7 percent for 3Q 2015 and 3Q 2014, respectively. - The YTD 2015 benefit ratio for the Retail segment of 86.4 percent was 120 basis points higher than the YTD 2014 ratio of 85.2 percent, primarily reflecting the same factors impacting the year-over-year comparisons for the third quarter as well as the change in estimate for 2014 net
3Rs receivables. The YTD 2015 benefit ratio was also favorably impacted by the release of reserves for future policy benefits as individual commercial medical members transitioned to ACA-compliant plans. PriorPeriod Development lowered the YTD 2015 Retail segment benefit ratio by 70 basis points and by 140 basis points in YTD 2014. Excluding PriorPeriod Development , the Retail segment benefit ratios were 87.1 percent and 86.6 percent for YTD 2015 and YTD 2014, respectively. - The Retail segment Prior
Period Development declined approximately$18 million year over year for 3Q 2015 and$176 million year over year for YTD 2015 primarily reflecting the impact of lower financial claim recoveries due in part to the company’s implementation of a front-end review of certain claims, flu-associated claims from the fourth quarter of 2014, and continued volatility in claims associated with individual commercial medical products. Retail segment PriorPeriod Development was as follows:
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Retail segment operating costs:
- The Retail segment’s operating cost ratio of 10.9 percent in 3Q 2015 decreased 70 basis points from 11.6 percent in 3Q 2014. The decrease primarily resulted from administrative cost efficiencies associated with medical membership growth in the segment and other discretionary cost reductions, partially offset by an increase in the non-deductible health insurance industry fee mandated by health care reform. The non-deductible health insurance industry fee increased the Retail segment’s operating cost ratio by approximately 170 basis points in 3Q 2015 and 120 basis points in 3Q 2014. Excluding the industry fee, the Retail segment operating cost ratios were 9.2 percent and 10.4 percent for 3Q 2015 and 3Q 2014, respectively.
- The Retail segment’s YTD 2015 operating cost ratio of 10.8 percent decreased 20 basis points from 11.0 percent in YTD 2014. The non-deductible health insurance industry fee increased the Retail segment’s operating cost ratio by approximately 160 basis points in YTD 2015 and 120 basis points in YTD 2014. Excluding the industry fee, the Retail segment operating cost ratios were 9.2 percent and 9.8 percent for YTD 2015 and YTD 2014, respectively, reflecting scale efficiencies within the segment.
Retail segment pretax results:
- Retail segment pretax income of
$325 million in 3Q 2015 compared to$346 million in 3Q 2014, a decrease of$21 million , as a decline in the segment’s operating cost ratio, growth inMedicare Advantage membership, discretionary cost reductions and higher investment income were more than offset by an increase in the benefit ratio. - For YTD 2015, pretax income for the Retail Segment of
$960 million decreased by$155 million from YTD 2014 pretax earnings of$1.12 billion . The YTD 2015 decrease primarily reflected the same factors impacting the quarterly comparison.
GROUP SEGMENT(d)
This segment consists of employer group commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and voluntary insurance benefits, as well as Administrative Services Only (ASO) products. In addition, the Group segment includes health and wellness products (primarily marketed to employer groups) and military services business, primarily the
Group Segment Highlights
The Group segment’s operating performance is generally in line with company expectations as fully-insured medical operating results were substantially offset by performance in the company’s specialty, wellness and TRICARE operations.
Group segment premiums and services revenue:
- The 3Q 2015 premiums and services revenues for the Group segment was
$1.82 billion , up less than 1 percent from$1.81 billion in 3Q 2014, primarily reflecting an increase in fully-insured commercial medical per-member premiums, partially offset by declines in average fully-insured and ASO commercial group medical membership. - For YTD 2015 premium and services revenues for the Group segment was
$5.52 billion , an increase of 2 percent from$5.43 billion in YTD 2014, primarily reflecting the same factors impacting the year-over-year comparison for the third quarter.
Group segment enrollment:
- Group fully-insured commercial medical membership was 1,167,400 at
September 30, 2015 , a decrease of 44,900, or 4 percent, from 1,212,300 atSeptember 30, 2014 , and was down 68,100, or 6 percent, from 1,235,500 atDecember 31, 2014 reflecting lower membership in both large group and small group accounts for each comparative period. Approximately 65 percent of group fully-insured commercial medical membership was in small group accounts (2-100 sized employer groups) atSeptember 30, 2015 andDecember 31, 2014 versus 63 percent atSeptember 30, 2014 . - Group ASO commercial medical membership was 709,800 at
September 30, 2015 , a decline of 402,100, or 36 percent, from 1,111,900 atSeptember 30, 2014 , and down 394,500, or 36 percent from 1,104,300 atDecember 31, 2014 . This decline primarily reflects the loss of certain large group accounts due to continued discipline in pricing of services for self-funded accounts amid a highly competitive environment. - Military services membership was 3,082,700 at
September 30, 2015 , generally unchanged with a decrease of 2,900, or less than 1 percent, from 3,085,600 atSeptember 30, 2014 , and down 7,700, or less than 1 percent, from 3,090,400 atDecember 31, 2014 . - Membership in Group specialty products was 6,090,700 at
September 30, 2015 , a decline of 434,600, or 7 percent, from 6,525,300 atSeptember 30, 2014 , and down 412,000, or 6 percent, from 6,502,700 atDecember 31, 2014 . This decrease primarily resulted from the loss of certain fully-insured group medical accounts that also had specialty coverage. - Membership in HumanaVitality®, the company’s wellness and loyalty rewards program, was 3,901,100 at
September 30, 2015 , an increase of 62,300, or 2 percent, from 3,838,800 atSeptember 30, 2014 , and up 44,300, or 1 percent, from 3,856,800 atDecember 31, 2014 primarily due to individualMedicare Advantage growth as well as growth in stand-alone sales.
Group segment benefits expense:
- The 3Q 2015 benefit ratio for the Group segment was 82.4 percent, an increase of 40 basis points from 82.0 percent for 3Q 2014. The year-over-year increase in the benefit ratio primarily reflected lower Prior
Period Development year over year. PriorPeriod Development decreased the Group segment benefit ratio by 20 basis points in 3Q 2015 and 60 basis points 3Q 2014. Excluding PriorPeriod Development , the Group segment benefit ratio was 82.6 percent in both 3Q 2015 and 3Q 2014. - The YTD 2015 benefit ratio for the Group segment of 79.2 percent increased 140 basis points from the 77.8 percent ratio for YTD 2014, primarily reflecting the impact of higher specialty drug costs, net of rebates, as well as higher outpatient costs and lower prior period development, partially offset by an increase in the non-deductible health insurance industry fee included in the pricing of the company’s products. Prior
Period Development did not materially impact the Group segment benefit ratio in YTD 2015 and lowered the ratio by 50 basis points in YTD 2014. Excluding PriorPeriod Development , the Group segment benefit ratio was 78.3 for YTD 2014.
Group segment operating costs:
- The Group segment’s operating cost ratio was 23.4 percent in 3Q 2015, a decrease of 240 basis points from 25.8 percent in 3Q 2014, primarily reflecting the loss of certain large ASO accounts resulting in a lower percentage of ASO business (which carries a higher operating cost ratio than fully-insured commercial business) as well as operating cost efficiencies associated with the fully-insured business as a result of cost reduction initiatives. These decreases were partially offset by the increase of the non-deductible health insurance industry fee mandated by health care reform. The non-deductible health insurance industry fee impacted the Group segment’s operating cost ratio by approximately 140 basis points in 3Q 2015 and 100 basis points in 3Q 2014. Excluding the industry fee, the Group segment operating cost ratios were 22.0 percent and 24.8 percent for 3Q 2015 and 3Q 2014, respectively.
- The Group segment’s operating cost ratio of 24.0 percent for YTD 2015 was down 260 basis points compared to 26.6 percent for YTD 2014 primarily reflecting the same factors impacting the year-over-year comparison for the third quarter. The non-deductible health insurance industry fee also impacted the Group segment’s operating cost ratio by approximately 140 basis points in YTD 2015 and 100 basis points in YTD 2014. Excluding the industry fee, the Group segment operating cost ratios were 22.6 percent and 25.6 percent for YTD 2015 and YTD 2014, respectively.
Group segment pretax results:
- The 3Q 2015 Group segment pretax income of
$39 million increased from pretax income of$1 million in 3Q 2014, primarily reflecting the segment’s lower operating cost ratio, partially offset by an increase in the segment’s benefit ratio. - For YTD 2015, pretax income for the Group segment of
$236 million increased by$61 million versus YTD 2014 pretax earnings of$175 million . The YTD 2015 increase primarily reflects the same factors impacting the quarterly comparisons.
HEALTHCARE SERVICES SEGMENT(d)
This segment includes services offered to the company’s health plan members as well as to third parties, including pharmacy solutions, provider services, home based services, and clinical programs, as well as services and capabilities to advance population health.
Healthcare Services Segment Highlights
Operating performance for the Healthcare Services segment continues to exceed previous expectations, primarily driven by pharmacy related cost reduction initiatives as well as higher mail order and specialty pharmacy usage. Additionally, high levels of
For 2016, the company anticipates continued segment profit growth at a somewhat slower rate due primarily to an expectation for individual
Healthcare Services segment revenues:
- Revenue of
$5.97 billion in 3Q 2015 for the Healthcare Services segment increased$780 million , or 15 percent, from$5.19 billion in 3Q 2014, primarily due to growth in the company’sMedicare membership which resulted in higher utilization of the healthcare services businesses, partially offset by lower revenues due to the sale of the Concentra business inJune 2015 . - YTD 2015 revenue for the Healthcare Services segment was
$17.83 billion , an increase of$2.97 billion , or 20 percent from$14.86 billion in YTD 2014, primarily reflecting the same factors impacting the year-over-year comparison for the third quarter.
Healthcare Services segment operating costs:
- The Healthcare Services segment’s operating cost ratio of 94.7 percent in 3Q 2015 decreased 70 basis points from 95.4 percent in 3Q14 primarily due to increased profitability in the company’s pharmacy business. Improving operating performance in the pharmacy business was primarily driven by lower cost of goods associated with increased purchasing scale, lower cost to fill and improvements in technology leading to higher efficiencies year over year.
- The Healthcare Services segment’s operating cost ratio of 95.2 percent for YTD 2015 was relatively unchanged compared to 95.3 percent for YTD 2014.
Healthcare Services segment operating statistics:
- Primary care providers in value-based (shared risk and path to risk) relationships of 44,200 at
September 30, 2015 increased 15 percent from 38,500 atSeptember 30, 2014 , and increased 5 percent from 42,300 atDecember 31, 2014 . AtSeptember 30, 2015 , 59 percent of the company’s individualMedicare Advantage members were in value-based relationships, compared to 54 percent atDecember 31, 2014 , and 53 percent atSeptember 30, 2014 . -
Medicare Advantage membership in the Humana Chronic Care Program rose to 548,000 atSeptember 30, 2015 , up 44 percent from 379,900 atSeptember 30, 2014 , and up 30 percent from 420,700 atDecember 31, 2014 , reflecting enhanced predictive modeling capabilities and focus on proactive clinical outreach and member engagement. - Pharmacy script volumes of 100.6 million for the quarter ended
September 30, 2015 increased 20 percent compared to 83.5 million for the quarter endedSeptember 30, 2014 , driven primarily by higher average medical membership. - YTD 2015 pharmacy script volumes of 295.1 million increased 21 percent compared to 243.7 million for YTD 2015 primarily reflecting the same factor impacting the year-over-year comparison for the third quarter.
Healthcare Services segment pretax results:
- Healthcare Services segment pretax income of
$284 million in 3Q 2015 increased by$81 million from$203 million in 3Q 2014, primarily due to revenue growth from the pharmacy solutions and home based services businesses, as they serve the company’s growingMedicare membership. - YTD 2015 pretax income for the Healthcare Services segment of
$737 million increased by$143 million from YTD 2014 pretax earnings of$594 million , primarily reflecting the same factors impacting year-over-year comparisons.
Footnotes
| (a) | Adjusted pretax income and Adjusted EPS for 3Q 2015 excludes pretax transaction costs of |
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| The company has included these financial measures (which are not in accordance with Generally Accepted Accounting Principles (GAAP)) in its summary of financial results within this earnings press release as management believes that these measures, when presented in conjunction with the comparable GAAP measures, are useful to both management and its investors in analyzing the company’s ongoing business and operating performance. The excluded items described herein are not a recurring part of the company’s operating plan. Consequently, 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. | ||
| (b) | Under health care reform, premium stabilization programs, commonly referred to as the |
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| (c) | On |
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| (d) | On |
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| (e) | State-based contracts include the company’s operations and membership associated with |
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| (f) | The company provides a full range of insured specialty products including dental, vision, other supplemental health, financial protection, and voluntary insurance benefits. 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. | |
Conference Call
Given the proposed transaction with Aetna, the company is not hosting a conference call in conjunction with its 3Q 2015 earnings release and does not expect to do so for future quarters. Please direct any questions regarding this earnings press release to Humana Investor Relations or
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,
- Humana’s transaction with Aetna is subject to various closing conditions, including governmental and regulatory approvals as well as other uncertainties and there can be no assurances as to whether and when it may be completed.
- The merger agreement between
Humana and Aetna prohibitsHumana from pursuing alternative transactions to the proposed transaction with Aetna. - The number of shares of Aetna common stock that Humana’s stockholders will receive in the transaction is based on a fixed exchange ratio. Because the market price of Aetna’s common stock will fluctuate, Humana’s stockholders cannot be certain of the value of the portion of the transaction consideration to be paid in Aetna’s common stock.
- While the transaction with Aetna is pending,
Humana is subject to business uncertainties and contractual restrictions that could materially adversely affect Humana’s results of operations, financial position and cash flows or result in a loss of employees, customers, members or suppliers. - Failure to consummate the transaction with Aetna could negatively impact Humana’s results of operations, financial position and cash flows.
- If
Humana does not design and price its products properly and competitively, if the premiumsHumana 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 claim payment patterns and medical cost trends. - If
Humana fails to effectively implement its operational and strategic initiatives, particularly itsMedicare initiatives, state-based contract strategy, and its participation in the new health insurance exchanges, the company’s business may be materially adversely affected, which is of particular importance given the concentration of the company’s revenues in these products. - 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 the adoption of a new coding set for diagnoses (commonly known as ICD-10), the implementation of which became effective on
October 1, 2015 . -
Humana is involved in various legal actions, or disputes that could lead to legal actions (such as, among other things, provider contract disputes relating to rate adjustments resulting from the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, commonly referred to as “sequestration”; other provider contract disputes; and qui tam litigation brought by individuals on behalf of the government) and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages or changes in its business practices. 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, potential restrictions on profitability, including by comparison of profitability of the company’sMedicare Advantage business to non-Medicare Advantage business, or other changes in the governmental programs in whichHumana participates. - The Health Care Reform Law, 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, lowering the company’sMedicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee and other assessments; the company’s financial position, including the company's ability to maintain the value of its goodwill; and the company’s cash flows. - Humana’s participation in the new federal and state health care exchanges, which entail uncertainties associated with mix, volume of business, and the operation of premium stabilization programs, which are subject to federal administrative action, could adversely affect 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.
- 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 certain of its licensed 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.
- The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.
In making forward-looking statements,
- Form 10-K for the year ended
December 31, 2014 ; - Form 10-Q for the quarters ended
March 31, 2015 andJune 30, 2015 and - Form 8-Ks filed during 2015.
About
More information regarding
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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
- Corporate Governance information
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Statistical Schedules |
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And |
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Supplementary Information |
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3Q15 Earnings Release |
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S-1 |
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Statistical Schedules and Supplementary Information |
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3Q15 Earnings Release |
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Contents |
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Page |
Description |
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| S-3-4 | Consolidated Statements of Income | ||
| S-5-6 | Quarterly Segment Financial Information | ||
| S-7-8 | YTD Segment Financial Information | ||
| S-9 | Consolidated Balance Sheets | ||
| S-10-11 | Consolidated Statements of Cash Flows | ||
| S-12 | Key Income Statement Ratios and Segment Operating Results | ||
| S-13-15 | Healthcare Services Segment Metrics | ||
| S-16 | Ending Membership Detail | ||
| S-17-18 | Premiums and Services Revenue Detail | ||
| S-19 | Medicare Summary | ||
| S-20 | Investments | ||
| S-21-23 | Benefits Payable Detail and Statistics | ||
| S-24 | Items Expected to Significantly Impact 2016 |
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| S-25 | Footnotes | ||
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Consolidated Statements of Income |
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Dollars in millions, except per common share results |
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| Three Months Ended |
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| Dollar | Percentage | ||||||||||||||||||||
| 2015 | 2014 | Change | Change | ||||||||||||||||||
| Revenues: | |||||||||||||||||||||
| Premiums | $ | 12,987 | $ | 11,607 | $ | 1,380 | 11.9 | % | |||||||||||||
| Services | 246 | 536 | (290 | ) | -54.1 | % | |||||||||||||||
| Investment income | 130 | 95 | 35 | 36.8 | % | ||||||||||||||||
| Total revenues | 13,363 | 12,238 | 1,125 | 9.2 | % | ||||||||||||||||
| Operating expenses: | |||||||||||||||||||||
| Benefits | 10,896 | 9,666 | 1,230 | 12.7 | % | ||||||||||||||||
| Operating costs | 1,688 | 1,898 | (210 | ) | -11.1 | % | |||||||||||||||
| Depreciation and amortization | 84 | 85 | (1 | ) | -1.2 | % | |||||||||||||||
| Total operating expenses | 12,668 | 11,649 | 1,019 | 8.7 | % | ||||||||||||||||
| Income from operations | 695 | 589 | 106 | 18.0 | % | ||||||||||||||||
| Interest expense | 47 | 38 | 9 | 23.7 | % | ||||||||||||||||
| Income before income taxes | 648 | 551 | 97 | 17.6 | % | ||||||||||||||||
| Provision for income taxes | 334 | 261 | 73 | 28.0 | % | ||||||||||||||||
| Net income | $ | 314 | $ | 290 | $ | 24 | 8.3 | % | |||||||||||||
| Basic earnings per common share | $ | 2.11 | $ | 1.87 | $ | 0.24 | 12.8 | % | |||||||||||||
| Diluted earnings per common share | $ | 2.09 | $ | 1.85 | $ | 0.24 | 13.0 | % | |||||||||||||
| Shares used in computing basic earnings per common share (000's) | 148,889 | 154,502 | |||||||||||||||||||
| Shares used in computing diluted earnings per common share (000's) | 150,466 | 156,230 | |||||||||||||||||||
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S-3 |
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Consolidated Statements of Income |
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| Dollars in millions, except per common share results | |||||||||||||||||||||
| Nine months ended |
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| Dollar | Percentage | ||||||||||||||||||||
| 2015 | 2014 | Change | Change | ||||||||||||||||||
| Revenues: | |||||||||||||||||||||
| Premiums | $ | 39,447 | $ | 34,274 | $ | 5,173 | 15.1 | % | |||||||||||||
| Services | 1,143 | 1,620 | (477 | ) | -29.4 | % | |||||||||||||||
| Investment income | 338 | 278 | 60 | 21.6 | % | ||||||||||||||||
| Total revenues | 40,928 | 36,172 | 4,756 | 13.1 | % | ||||||||||||||||
| Operating expenses: | |||||||||||||||||||||
| Benefits | 33,153 | 28,417 | 4,736 | 16.7 | % | ||||||||||||||||
| Operating costs | 5,450 | 5,518 | (68 | ) | -1.2 | % | |||||||||||||||
| Depreciation and amortization | 267 | 246 | 21 | 8.5 | % | ||||||||||||||||
| Total operating expenses | 38,870 | 34,181 | 4,689 | 13.7 | % | ||||||||||||||||
| Income from operations | 2,058 | 1,991 | 67 | 3.4 | % | ||||||||||||||||
| Gain on sale of business | 267 | - | 267 | n/a | |||||||||||||||||
| Interest expense | 140 | 108 | 32 | 29.6 | % | ||||||||||||||||
| Income before income taxes | 2,185 | 1,883 | 302 | 16.0 | % | ||||||||||||||||
| Provision for income taxes | 1,010 | 881 | 129 | 14.6 | % | ||||||||||||||||
| Net income | $ | 1,175 | $ | 1,002 | $ | 173 | 17.3 | % | |||||||||||||
| Basic earnings per common share | $ | 7.85 | $ | 6.46 | $ | 1.39 | 21.5 | % | |||||||||||||
| Diluted earnings per common share | $ | 7.77 | $ | 6.39 | $ | 1.38 | 21.6 | % | |||||||||||||
| Shares used in computing basic earnings per common share (000's) | 149,617 | 155,006 | |||||||||||||||||||
| Shares used in computing diluted earnings per common share (000's) | 151,321 | 156,641 | |||||||||||||||||||
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S-4 |
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3Q15 Segment Financial Information |
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| In millions | ||||||||||||||||||||||||||||||
| Healthcare | Other | Eliminations/ | ||||||||||||||||||||||||||||
| Retail | Group | Services | Businesses | Corporate | Consolidated | |||||||||||||||||||||||||
| Revenues - external customers | ||||||||||||||||||||||||||||||
| Premiums: | ||||||||||||||||||||||||||||||
| Individual |
$ | 7,316 | $ | - | $ | - | $ | - | $ | - | $ | 7,316 | ||||||||||||||||||
| Group |
1,396 | - | - | - | - | 1,396 | ||||||||||||||||||||||||
| |
927 | - | - | - | - | 927 | ||||||||||||||||||||||||
| Total |
9,639 | - | - | - | - | 9,639 | ||||||||||||||||||||||||
| Fully-insured | 1,056 | 1,362 | - | - | - | 2,418 | ||||||||||||||||||||||||
| Specialty | 66 | 260 | - | - | - | 326 | ||||||||||||||||||||||||
| |
592 | 6 | - | 6 | - | 604 | ||||||||||||||||||||||||
| Total premiums | 11,353 | 1,628 | - | 6 | - | 12,987 | ||||||||||||||||||||||||
| Services revenue: | ||||||||||||||||||||||||||||||
| Provider | - | 9 | 61 | - | - | 70 | ||||||||||||||||||||||||
| ASO and other (B) | 1 | 162 | - | 5 | - | 168 | ||||||||||||||||||||||||
| Pharmacy | - | - | 8 | - | - | 8 | ||||||||||||||||||||||||
| Total services revenue | 1 | 171 | 69 | 5 | - | 246 | ||||||||||||||||||||||||
| Total revenues - external customers | 11,354 | 1,799 | 69 | 11 | - | 13,233 | ||||||||||||||||||||||||
| Intersegment revenues | ||||||||||||||||||||||||||||||
| Services | - | 24 | 4,633 | - | (4,657 | ) | - | |||||||||||||||||||||||
| Products | - | - | 1,271 | - | (1,271 | ) | - | |||||||||||||||||||||||
| Total intersegment revenues | - | 24 | 5,904 | - | (5,928 | ) | - | |||||||||||||||||||||||
| Investment income | 38 | 7 | - | 16 | 69 | 130 | ||||||||||||||||||||||||
| Total revenues | 11,392 | 1,830 | 5,973 | 27 | (5,859 | ) | 13,363 | |||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||||||
| Benefits | 9,777 | 1,341 | - | 22 | (244 | ) | 10,896 | |||||||||||||||||||||||
| Operating costs | 1,241 | 426 | 5,659 | 3 | (5,641 | ) | 1,688 | |||||||||||||||||||||||
| Depreciation and amortization | 49 | 24 | 30 | - | (19 | ) | 84 | |||||||||||||||||||||||
| Total operating expenses | 11,067 | 1,791 | 5,689 | 25 | (5,904 | ) | 12,668 | |||||||||||||||||||||||
| Income from operations | 325 | 39 | 284 | 2 | 45 | 695 | ||||||||||||||||||||||||
| Interest expense | - | - | - | - | 47 | 47 | ||||||||||||||||||||||||
| Income (loss) before income taxes | $ | 325 | $ | 39 | $ | 284 | $ | 2 | $ | (2 | ) | $ | 648 | |||||||||||||||||
| Benefit ratio | 86.1 | % | 82.4 | % | 83.9 | % | ||||||||||||||||||||||||
| Operating cost ratio | 10.9 | % | 23.4 | % | 94.7 | % | 12.8 | % | ||||||||||||||||||||||
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S-5 |
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3Q14 Segment Financial Information (Recast) (C) |
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| In millions | ||||||||||||||||||||||||||||||
| Healthcare | Other | Eliminations/ | ||||||||||||||||||||||||||||
| Retail | Group | Services | Businesses | Corporate | Consolidated | |||||||||||||||||||||||||
| Revenues - external customers | ||||||||||||||||||||||||||||||
| Premiums: | ||||||||||||||||||||||||||||||
| Individual |
$ | 6,448 | $ | - | $ | - | $ | - | $ | - | $ | 6,448 | ||||||||||||||||||
| Group |
1,381 | - | - | - | - | 1,381 | ||||||||||||||||||||||||
| |
806 | - | - | - | - | 806 | ||||||||||||||||||||||||
| Total |
8,635 | - | - | - | - | 8,635 | ||||||||||||||||||||||||
| Fully-insured | 926 | 1,335 | - | - | - | 2,261 | ||||||||||||||||||||||||
| Specialty | 67 | 274 | - | - | - | 341 | ||||||||||||||||||||||||
| |
352 | 5 | - | 13 | - | 370 | ||||||||||||||||||||||||
| Total premiums | 9,980 | 1,614 | - | 13 | - | 11,607 | ||||||||||||||||||||||||
| Services revenue: | ||||||||||||||||||||||||||||||
| Provider | - | 6 | 320 | - | - | 326 | ||||||||||||||||||||||||
| ASO and other (B) | 10 | 172 | - | 2 | - | 184 | ||||||||||||||||||||||||
| Pharmacy | - | - | 26 | - | - | 26 | ||||||||||||||||||||||||
| Total services revenue | 10 | 178 | 346 | 2 | - | 536 | ||||||||||||||||||||||||
| Total revenues - external customers | 9,990 | 1,792 | 346 | 15 | - | 12,143 | ||||||||||||||||||||||||
| Intersegment revenues | ||||||||||||||||||||||||||||||
| Services | - | 22 | 3,879 | - | (3,901 | ) | - | |||||||||||||||||||||||
| Products | - | - | 968 | - | (968 | ) | - | |||||||||||||||||||||||
| Total intersegment revenues | - | 22 | 4,847 | - | (4,869 | ) | - | |||||||||||||||||||||||
| Investment income | 24 | 6 | - | 15 | 50 | 95 | ||||||||||||||||||||||||
| Total revenues | 10,014 | 1,820 | 5,193 | 30 | (4,819 | ) | 12,238 | |||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||||||
| Benefits | 8,469 | 1,324 | - | 24 | (151 | ) | 9,666 | |||||||||||||||||||||||
| Operating costs | 1,156 | 468 | 4,953 | 5 | (4,684 | ) | 1,898 | |||||||||||||||||||||||
| Depreciation and amortization | 43 | 27 | 37 | - | (22 | ) | 85 | |||||||||||||||||||||||
| Total operating expenses | 9,668 | 1,819 | 4,990 | 29 | (4,857 | ) | 11,649 | |||||||||||||||||||||||
| Income from operations | 346 | 1 | 203 | 1 | 38 | 589 | ||||||||||||||||||||||||
| Interest expense | - | - | - | - | 38 | 38 | ||||||||||||||||||||||||
| Income before income taxes | $ | 346 | $ | 1 | $ | 203 | $ | 1 | $ | - | $ | 551 | ||||||||||||||||||
| Benefit ratio | 84.9 | % | 82.0 | % | 83.3 | % | ||||||||||||||||||||||||
| Operating cost ratio | 11.6 | % | 25.8 | % | 95.4 | % | 15.6 | % | ||||||||||||||||||||||
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S-6 |
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YTD 3Q15 Segment Financial Information |
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| In millions | ||||||||||||||||||||||||||||||
| Healthcare | Other | Eliminations/ | ||||||||||||||||||||||||||||
| Retail | Group | Services | Businesses | Corporate | Consolidated | |||||||||||||||||||||||||
| Revenues - external customers | ||||||||||||||||||||||||||||||
| Premiums: | ||||||||||||||||||||||||||||||
| Individual |
$ | 22,183 | $ | - | $ | - | $ | - | $ | - | $ | 22,183 | ||||||||||||||||||
| Group |
4,188 | - | - | - | - | 4,188 | ||||||||||||||||||||||||
| |
2,915 | - | - | - | - | 2,915 | ||||||||||||||||||||||||
| Total |
29,286 | - | - | - | - | 29,286 | ||||||||||||||||||||||||
| Fully-insured | 3,263 | 4,125 | - | - | - | 7,388 | ||||||||||||||||||||||||
| Specialty | 195 | 795 | - | - | - | 990 | ||||||||||||||||||||||||
| |
1,742 | 16 | - | 25 | - | 1,783 | ||||||||||||||||||||||||
| Total premiums | 34,486 | 4,936 | - | 25 | - | 39,447 | ||||||||||||||||||||||||
| Services revenue: | ||||||||||||||||||||||||||||||
| Provider | - | 29 | 590 | - | - | 619 | ||||||||||||||||||||||||
| ASO and other (B) | 7 | 485 | - | 10 | - | 502 | ||||||||||||||||||||||||
| Pharmacy | - | - | 22 | - | - | 22 | ||||||||||||||||||||||||
| Total services revenue | 7 | 514 | 612 | 10 | - | 1,143 | ||||||||||||||||||||||||
| Total revenues - external customers | 34,493 | 5,450 | 612 | 35 | - | 40,590 | ||||||||||||||||||||||||
| Intersegment revenues | ||||||||||||||||||||||||||||||
| Services | - | 68 | 13,561 | - | (13,629 | ) | - | |||||||||||||||||||||||
| Products | - | - | 3,654 | - | (3,654 | ) | - | |||||||||||||||||||||||
| Total intersegment revenues | - | 68 | 17,215 | - | (17,283 | ) | - | |||||||||||||||||||||||
| Investment income | 96 | 18 | - | 53 | 171 | 338 | ||||||||||||||||||||||||
| Total revenues | 34,589 | 5,536 | 17,827 | 88 | (17,112 | ) | 40,928 | |||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||||||
| Benefits | 29,781 | 3,908 | - | 66 | (602 | ) | 33,153 | |||||||||||||||||||||||
| Operating costs | 3,708 | 1,323 | 16,978 | 10 | (16,569 | ) | 5,450 | |||||||||||||||||||||||
| Depreciation and amortization | 140 | 69 | 112 | - | (54 | ) | 267 | |||||||||||||||||||||||
| Total operating expenses | 33,629 | 5,300 | 17,090 | 76 | (17,225 | ) | 38,870 | |||||||||||||||||||||||
| Income from operations | 960 | 236 | 737 | 12 | 113 | 2,058 | ||||||||||||||||||||||||
| Gain on sale of business | - | - | - | - | 267 | 267 | ||||||||||||||||||||||||
| Interest expense | - | - | - | - | 140 | 140 | ||||||||||||||||||||||||
| Income before income taxes | $ | 960 | $ | 236 | $ | 737 | $ | 12 | $ | 240 | $ | 2,185 | ||||||||||||||||||
| Benefit ratio | 86.4 | % | 79.2 | % | 84.0 | % | ||||||||||||||||||||||||
| Operating cost ratio | 10.8 | % | 24.0 | % | 95.2 | % | 13.4 | % | ||||||||||||||||||||||
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S-7 |
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YTD 3Q14 Segment Financial Information (C) |
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| In millions | ||||||||||||||||||||||||||||||
| Healthcare | Other | Eliminations/ | ||||||||||||||||||||||||||||
| Retail | Group | Services | Businesses | Corporate | Consolidated | |||||||||||||||||||||||||
| Revenues - external customers | ||||||||||||||||||||||||||||||
| Premiums: | ||||||||||||||||||||||||||||||
| Individual |
$ | 19,375 | $ | - | $ | - | $ | - | $ | - | $ | 19,375 | ||||||||||||||||||
| Group |
4,131 | - | - | - | - | 4,131 | ||||||||||||||||||||||||
| |
2,612 | - | - | - | - | 2,612 | ||||||||||||||||||||||||
| Total |
26,118 | - | - | - | - | 26,118 | ||||||||||||||||||||||||
| Fully-insured | 2,363 | 3,985 | - | - | - | 6,348 | ||||||||||||||||||||||||
| Specialty | 192 | 824 | - | - | - | 1,016 | ||||||||||||||||||||||||
| |
735 | 15 | - | 42 | - | 792 | ||||||||||||||||||||||||
| Total premiums | 29,408 | 4,824 | - | 42 | - | 34,274 | ||||||||||||||||||||||||
| Services revenue: | ||||||||||||||||||||||||||||||
| Provider | - | 17 | 951 | - | - | 968 | ||||||||||||||||||||||||
| ASO and other (B) | 37 | 535 | - | 8 | - | 580 | ||||||||||||||||||||||||
| Pharmacy | - | - | 72 | - | - | 72 | ||||||||||||||||||||||||
| Total services revenue | 37 | 552 | 1,023 | 8 | - | 1,620 | ||||||||||||||||||||||||
| Total revenues - external customers | 29,445 | 5,376 | 1,023 | 50 | - | 35,894 | ||||||||||||||||||||||||
| Intersegment revenues | ||||||||||||||||||||||||||||||
| Services | - | 57 | 11,084 | - | (11,141 | ) | - | |||||||||||||||||||||||
| Products | - | - | 2,752 | - | (2,752 | ) | - | |||||||||||||||||||||||
| Total intersegment revenues | - | 57 | 13,836 | - | (13,893 | ) | - | |||||||||||||||||||||||
| Investment income | 71 | 17 | - | 45 | 145 | 278 | ||||||||||||||||||||||||
| Total revenues | 29,516 | 5,450 | 14,859 | 95 | (13,748 | ) | 36,172 | |||||||||||||||||||||||
| Operating expenses: | ||||||||||||||||||||||||||||||
| Benefits | 25,044 | 3,753 | - | 73 | (453 | ) | 28,417 | |||||||||||||||||||||||
| Operating costs | 3,237 | 1,445 | 14,157 | 14 | (13,335 | ) | 5,518 | |||||||||||||||||||||||
| Depreciation and amortization | 120 | 77 | 108 | 2 | (61 | ) | 246 | |||||||||||||||||||||||
| Total operating expenses | 28,401 | 5,275 | 14,265 | 89 | (13,849 | ) | 34,181 | |||||||||||||||||||||||
| Income from operations | 1,115 | 175 | 594 | 6 | 101 | 1,991 | ||||||||||||||||||||||||
| Interest expense | - | - | - | - | 108 | 108 | ||||||||||||||||||||||||
| Income (loss) before income taxes | $ | 1,115 | $ | 175 | $ | 594 | $ | 6 | $ | (7 | ) | $ | 1,883 | |||||||||||||||||
| Benefit ratio | 85.2 | % | 77.8 | % | 82.9 | % | ||||||||||||||||||||||||
| Operating cost ratio | 11.0 | % | 26.6 | % | 95.3 | % | 15.4 | % | ||||||||||||||||||||||
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S-8 |
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Consolidated Balance Sheets |
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| Dollars in millions, except share amounts | ||||||||||||||||||||
| September 30, | December 31, | YTD Change | ||||||||||||||||||
| 2015 | 2014 | Dollar | Percent | |||||||||||||||||
| Assets | ||||||||||||||||||||
| Current assets: | ||||||||||||||||||||
| Cash and cash equivalents | $ | 1,597 | $ | 1,935 | ||||||||||||||||
| Investment securities | 7,423 | 7,598 | ||||||||||||||||||
| Receivables, net | 986 | 1,053 | ||||||||||||||||||
| Other current assets | 5,767 | 4,007 | ||||||||||||||||||
| Assets held-for-sale | - | 943 | ||||||||||||||||||
| Total current assets | 15,773 | 15,536 | $ | 237 | 1.5 | % | ||||||||||||||
| Property and equipment, net | 1,343 | 1,228 | ||||||||||||||||||
| Long-term investment securities | 1,879 | 1,949 | ||||||||||||||||||
| |
3,266 | 3,231 | ||||||||||||||||||
| Other long-term assets | 2,035 | 1,583 | ||||||||||||||||||
| Total assets | $ | 24,296 | $ | 23,527 | $ | 769 | 3.3 | % | ||||||||||||
| Liabilities and Stockholders' Equity | ||||||||||||||||||||
| Current liabilities: | ||||||||||||||||||||
| Benefits payable | $ | 4,922 | $ | 4,475 | ||||||||||||||||
| Trade accounts payable and accrued expenses | 2,216 | 2,095 | ||||||||||||||||||
| Book overdraft | 296 | 334 | ||||||||||||||||||
| Unearned revenues | 297 | 361 | ||||||||||||||||||
| Short-term borrowings | 11 | - | ||||||||||||||||||
| Liabilities held-for-sale | - | 206 | ||||||||||||||||||
| Total current liabilities | 7,742 | 7,471 | $ | 271 | 3.6 | % | ||||||||||||||
| Long-term debt | 3,822 | 3,825 | ||||||||||||||||||
| Future policy benefits payable | 2,154 | 2,349 | ||||||||||||||||||
| Other long-term liabilities | 225 | 236 | ||||||||||||||||||
| Total liabilities | 13,943 | 13,881 | $ | 62 | 0.4 | % | ||||||||||||||
| 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; | ||||||||||||||||||||
| 198,350,100 issued at September 30, 2015 | 33 | 33 | ||||||||||||||||||
| Capital in excess of par value | 2,515 | 2,330 | ||||||||||||||||||
| Retained earnings | 10,960 | 9,916 | ||||||||||||||||||
| Accumulated other comprehensive income | 137 | 223 | ||||||||||||||||||
| |
(3,292 | ) | (2,856 | ) | ||||||||||||||||
| Total stockholders' equity | 10,353 | 9,646 | $ | 707 | 7.3 | % | ||||||||||||||
| Total liabilities and stockholders' equity | $ | 24,296 | $ | 23,527 | $ | 769 | 3.3 | % | ||||||||||||
| Debt-to-total capitalization ratio | 27.0 | % | 28.4 | % | ||||||||||||||||
|
Return on Invested Capital (ROIC) based on Net Operating Profit After Tax (NOPAT) - trailing 12 months |
10.2 | % | 10.0 | % | ||||||||||||||||
|
S-9 |
||||||||||||||||||||
|
|
|||||||||||||||||||||
|
Consolidated Statements of Cash Flows |
|||||||||||||||||||||
| Dollars in millions | |||||||||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||
| Dollar | Percentage | ||||||||||||||||||||
| 2015 | 2014 | Change | Change | ||||||||||||||||||
| Cash flows from operating activities | |||||||||||||||||||||
| Net income | $ | 314 | $ | 290 | |||||||||||||||||
| Adjustments to reconcile net income to net cash provided by operating activities: | |||||||||||||||||||||
| Depreciation | 85 | 83 | |||||||||||||||||||
| Other intangible amortization | 22 | 29 | |||||||||||||||||||
| Net realized capital gains | (51 | ) | (6 | ) | |||||||||||||||||
| Stock-based compensation | 23 | 21 | |||||||||||||||||||
| Provision for deferred income taxes | 41 | 9 | |||||||||||||||||||
|
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: |
|||||||||||||||||||||
| Receivables | 1,143 | 1,069 | |||||||||||||||||||
| Other assets | 357 | (46 | ) | ||||||||||||||||||
| Benefits payable | 141 | (102 | ) | ||||||||||||||||||
| Other liabilities | (1,063 | ) | (403 | ) | |||||||||||||||||
| Unearned revenues | 6 | (2 | ) | ||||||||||||||||||
| Other, net | 14 | 12 | |||||||||||||||||||
| Net cash provided by operating activities | 1,032 | 954 | $ | 78 | 8.2 | % | |||||||||||||||
| Cash flows from investing activities | |||||||||||||||||||||
| Purchases of property and equipment | (125 | ) | (145 | ) | |||||||||||||||||
| Purchases of investment securities | (2,624 | ) | (981 | ) | |||||||||||||||||
| Maturities of investment securities | 266 | 190 | |||||||||||||||||||
| Proceeds from sales of investment securities | 1,878 | 164 | |||||||||||||||||||
| Net cash used in investing activities | (605 | ) | (772 | ) | $ | 167 | 21.6 | % | |||||||||||||
| Cash flows from financing activities | |||||||||||||||||||||
| Receipts (withdrawals) from contract deposits, net | (725 | ) | (616 | ) | |||||||||||||||||
| Proceeds from issuance of senior notes, net | - | 1,733 | |||||||||||||||||||
| Repayments from issuance of commercial paper, net | (290 | ) | - | ||||||||||||||||||
| Change in book overdraft | (13 | ) | (27 | ) | |||||||||||||||||
| Common stock repurchases | (9 | ) | (118 | ) | |||||||||||||||||
| Excess tax benefit from stock-based compensation | 1 | 1 | |||||||||||||||||||
| Dividends paid | (43 | ) | (43 | ) | |||||||||||||||||
| Proceeds from stock option exercises and other | (1 | ) | - | ||||||||||||||||||
| Net cash (used in) provided by financing activities | (1,080 | ) | 930 | ($2,010 | ) | -216.1 | % | ||||||||||||||
| (Decrease) increase in cash and cash equivalents | (653 | ) | 1,112 | ||||||||||||||||||
| Cash and cash equivalents at beginning of period | 2,250 | 1,593 | |||||||||||||||||||
| Cash and cash equivalents at end of period | $ | 1,597 | $ | 2,705 | |||||||||||||||||
|
S-10 |
|||||||||||||||||||||
|
|
|||||||||||||||||||||
|
Consolidated Statements of Cash Flows |
|||||||||||||||||||||
| Dollars in millions | |||||||||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||
| Dollar | Percentage | ||||||||||||||||||||
| 2015 | 2014 | Change | Change | ||||||||||||||||||
| Cash flows from operating activities | |||||||||||||||||||||
| Net income | $ | 1,175 | $ | 1,002 | |||||||||||||||||
|
Adjustments to reconcile net income to net cash provided by operating activities: |
|||||||||||||||||||||
| Gain on sale of business | (267 | ) | - | ||||||||||||||||||
| Depreciation | 263 | 240 | |||||||||||||||||||
| Other intangible amortization | 72 | 85 | |||||||||||||||||||
| Net realized capital gains | (88 | ) | (9 | ) | |||||||||||||||||
| Stock-based compensation | 92 | 76 | |||||||||||||||||||
| Provision (benefit) for deferred income taxes | 13 | (30 | ) | ||||||||||||||||||
|
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: |
|||||||||||||||||||||
| Receivables | 56 | (68 | ) | ||||||||||||||||||
| Other assets | (1,080 | ) | (960 | ) | |||||||||||||||||
| Benefits payable | 447 | 783 | |||||||||||||||||||
| Other liabilities | (140 | ) | 238 | ||||||||||||||||||
| Unearned revenues | (64 | ) | 40 | ||||||||||||||||||
| Other, net | 52 | 28 | |||||||||||||||||||
| Net cash provided by operating activities | 531 | 1,425 | ($894 | ) | -62.7 | % | |||||||||||||||
| Cash flows from investing activities | |||||||||||||||||||||
| Proceeds from sale of business | 1,055 | 72 | |||||||||||||||||||
| Acquisitions, net of cash acquired | (38 | ) | (3 | ) | |||||||||||||||||
| Purchases of property and equipment | (384 | ) | (361 | ) | |||||||||||||||||
| Purchases of investment securities | (4,345 | ) | (1,949 | ) | |||||||||||||||||
| Maturities of investment securities | 881 | 702 | |||||||||||||||||||
| Proceeds from sales of investment securities | 3,448 | 1,171 | |||||||||||||||||||
| Net cash provided by (used in) investing activities | 617 | (368 | ) | $ | 985 | 267.7 | % | ||||||||||||||
| Cash flows from financing activities | |||||||||||||||||||||
| Receipts (withdrawals) from contract deposits, net | (984 | ) | (743 | ) | |||||||||||||||||
| Proceeds from issuance of senior notes, net | - | 1,733 | |||||||||||||||||||
| Proceeds from issuance of commercial paper, net | 10 | - | |||||||||||||||||||
| Change in book overdraft | (38 | ) | (136 | ) | |||||||||||||||||
| Common stock repurchases | (380 | ) | (270 | ) | |||||||||||||||||
| Excess tax benefit from stock-based compensation | 15 | 10 | |||||||||||||||||||
| Dividends paid | (129 | ) | (129 | ) | |||||||||||||||||
| Proceeds from stock option exercises and other | 20 | 45 | |||||||||||||||||||
| Net cash (used in) provided by financing activities | (1,486 | ) | 510 | ($1,996 | ) | -391.4 | % | ||||||||||||||
| (Decrease) increase in cash and cash equivalents | (338 | ) | 1,567 | ||||||||||||||||||
| Cash and cash equivalents at beginning of period | 1,935 | 1,138 | |||||||||||||||||||
| Cash and cash equivalents at end of period | $ | 1,597 | $ | 2,705 | |||||||||||||||||
|
S-11 |
|||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||||
|
Key Income Statement Ratios and Segment Operating Results |
||||||||||||||||||||||||||||||||||||||||
| Dollars in millions | ||||||||||||||||||||||||||||||||||||||||
| Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||
| Percentage | Percentage | |||||||||||||||||||||||||||||||||||||||
| 2015 | 2014 | Difference | Change | 2015 | 2014 | Difference | Change | |||||||||||||||||||||||||||||||||
| Benefit ratio | ||||||||||||||||||||||||||||||||||||||||
| Retail | 86.1 | % | 84.9 | % | 1.2 | % | 86.4 | % | 85.2 | % | 1.2 | % | ||||||||||||||||||||||||||||
| Group | 82.4 | % | 82.0 | % | 0.4 | % | 79.2 | % | 77.8 | % | 1.4 | % | ||||||||||||||||||||||||||||
| Consolidated | 83.9 | % | 83.3 | % | 0.6 | % | 84.0 | % | 82.9 | % | 1.1 | % | ||||||||||||||||||||||||||||
| Operating cost ratio | ||||||||||||||||||||||||||||||||||||||||
| Retail | 10.9 | % | 11.6 | % | -0.7 | % | 10.8 | % | 11.0 | % | -0.2 | % | ||||||||||||||||||||||||||||
| Group | 23.4 | % | 25.8 | % | -2.4 | % | 24.0 | % | 26.6 | % | -2.6 | % | ||||||||||||||||||||||||||||
| Healthcare Services | 94.7 | % | 95.4 | % | -0.7 | % | 95.2 | % | 95.3 | % | -0.1 | % | ||||||||||||||||||||||||||||
| Consolidated | 12.8 | % | 15.6 | % | -2.8 | % | 13.4 | % | 15.4 | % | -2.0 | % | ||||||||||||||||||||||||||||
| Detail of pretax income | ||||||||||||||||||||||||||||||||||||||||
| Retail | $ | 325 | $ | 346 | ($21 | ) | -6.1 | % | $ | 960 | $ | 1,115 | ($155 | ) | -13.9 | % | ||||||||||||||||||||||||
| Group | $ | 39 | $ | 1 | $ | 38 | 3800.0 | % | $ | 236 | $ | 175 | $ | 61 | 34.9 | % | ||||||||||||||||||||||||
| Healthcare Services | $ | 284 | $ | 203 | $ | 81 | 39.9 | % | $ | 737 | $ | 594 | $ | 143 | 24.1 | % | ||||||||||||||||||||||||
| Consolidated | $ | 648 | $ | 551 | $ | 97 | 17.6 | % | $ | 2,185 | $ | 1,883 | $ | 302 | 16.0 | % | ||||||||||||||||||||||||
|
S-12 |
||||||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||
|
Healthcare Services Segment Metrics |
||||||||||||||||||||||||||
| Quarter Ended | Quarter Ended | Quarter Ended | ||||||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | Difference | June 30, 2015 | Difference | ||||||||||||||||||||||
| Primary Care Providers: | ||||||||||||||||||||||||||
| Shared Risk (D) | ||||||||||||||||||||||||||
| Owned / JV | 1,700 | 2,700 | (1,000 | ) | -37.0 | % | 1,600 | 100 | 6.3 | % | ||||||||||||||||
| Contracted | 15,300 | 10,600 | 4,700 | 44.3 | % | 15,100 | 200 | 1.3 | % | |||||||||||||||||
| Path to Risk (E) | 27,200 | 25,200 | 2,000 | 7.9 | % | 26,300 | 900 | 3.4 | % | |||||||||||||||||
| Total Value-based | 44,200 | 38,500 | 5,700 | 14.8 | % | 43,000 | 1,200 | 2.8 | % | |||||||||||||||||
| Medicare Care Management Professionals: | ||||||||||||||||||||||||||
| Employed (F) | 6,500 | 5,500 | 1,000 | 18.2 | % | 6,200 | 300 | 4.8 | % | |||||||||||||||||
| Contracted (G) | 12,500 | 12,200 | 300 | 2.5 | % | 11,900 | 600 | 5.0 | % | |||||||||||||||||
| Total | 19,000 | 17,700 | 1,300 | 7.3 | % | 18,100 | 900 | 5.0 | % | |||||||||||||||||
| Care Management Statistics: | ||||||||||||||||||||||||||
|
Number of |
548,000 | 379,900 | 168,100 | 44.2 | % | 512,000 | 36,000 | 7.0 | % | |||||||||||||||||
|
Number of high-risk discharges enrolled in Humana Transitions Program (H) |
55,900 | 39,700 | 16,200 | 40.8 | % | 55,900 | - | 0.0 | % | |||||||||||||||||
|
S-13 |
||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||
|
Healthcare Services Segment Metrics (Continued) |
||||||||||||||||||||||||
| Script volume in thousands | ||||||||||||||||||||||||
| Quarter Ended | Quarter Ended | Year-over-Year | Quarter Ended | Sequential | ||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | Difference | June 30, 2015 | Difference | ||||||||||||||||||||
| Pharmacy: | ||||||||||||||||||||||||
| Generic Dispense Rate | ||||||||||||||||||||||||
| Retail | 89.9% | 88.7% | 1.2% | 89.7% | 0.2% | |||||||||||||||||||
| Group | 83.0% | 81.3% | 1.7% | 83.0% | 0.0% | |||||||||||||||||||
| Total | 89.5% | 88.3% | 1.2% | 89.3% | 0.2% | |||||||||||||||||||
| Mail-Order Penetration | ||||||||||||||||||||||||
| Retail | 26.2% | 24.0% | 2.2% | 25.7% | 0.5% | |||||||||||||||||||
| Group | 8.8% | 9.3% | -0.5% | 8.6% | 0.2% | |||||||||||||||||||
| Total | 25.2% | 23.1% | 2.1% | 24.8% | 0.4% | |||||||||||||||||||
| Percentage | Percentage | |||||||||||||||||||||||
| Difference | Change | Difference | Change | |||||||||||||||||||||
| Script volume (I) | ||||||||||||||||||||||||
| Retail | 95,500 | 78,200 | 17,300 | 22.1% | 93,200 | 2,300 | 2.5% | |||||||||||||||||
| Group | 5,100 | 5,300 | (200) | -3.8% | 5,200 | (100) | -1.9% | |||||||||||||||||
| Total | 100,600 | 83,500 | 17,100 | 20.5% | 98,400 | 2,200 | 2.2% | |||||||||||||||||
|
S-14 |
||||||||||||||||||||||||
|
|
|||||||||||||||||||
|
Healthcare Services Segment Metrics (Continued) |
|||||||||||||||||||
|
Script volume in thousands |
|||||||||||||||||||
| Nine months ended | Nine months ended | Year-over-Year | |||||||||||||||||
| September 30, 2015 | September 30, 2014 | Difference | |||||||||||||||||
| Pharmacy: | |||||||||||||||||||
| Generic Dispense Rate | |||||||||||||||||||
| Retail | 89.7 | % | 88.5 | % | 1.2 | % | |||||||||||||
| Group | 83.0 | % | 81.0 | % | 2.0 | % | |||||||||||||
| Total | 89.4 | % | 88.0 | % | 1.4 | % | |||||||||||||
| Mail-Order Penetration | |||||||||||||||||||
| Retail | 25.9 | % | 24.1 | % | 1.8 | % | |||||||||||||
| Group | 8.6 | % | 9.3 | % | -0.7 | % | |||||||||||||
| Total | 24.9 | % | 23.1 | % | 1.8 | % | |||||||||||||
| Percentage | |||||||||||||||||||
| Difference | Change | ||||||||||||||||||
| Script volume (I) | |||||||||||||||||||
| Retail | 279,700 | 228,000 | 51,700 | 22.7 | % | ||||||||||||||
| Group | 15,400 | 15,700 | (300 | ) | -1.9 | % | |||||||||||||
| Total | 295,100 | 243,700 | 51,400 | 21.1 | % | ||||||||||||||
|
S-15 |
|||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||
|
Ending Membership Detail |
|||||||||||||||||||||||||||||||
| In thousands | |||||||||||||||||||||||||||||||
|
Average |
Year-over-Year Change | YTD Change | |||||||||||||||||||||||||||||
| September 30, 2015 |
3Q15 |
September 30, 2014 | Amount | Percent | December 31, 2014 | Amount | Percent | ||||||||||||||||||||||||
| Medical Membership: | |||||||||||||||||||||||||||||||
| Retail | |||||||||||||||||||||||||||||||
| Individual |
2,737.1 | 2,729.0 | 2,402.8 | 334.3 | 13.9 | % | 2,427.9 | 309.2 | 12.7 | % | |||||||||||||||||||||
| Group |
481.3 | 479.7 | 484.9 | (3.6 | ) | -0.7 | % | 489.7 | (8.4 | ) | -1.7 | % | |||||||||||||||||||
| |
4,509.6 | 4,488.1 | 3,940.8 | 568.8 | 14.4 | % | 3,994.0 | 515.6 | 12.9 | % | |||||||||||||||||||||
| Total |
7,728.0 | 7,696.8 | 6,828.5 | 899.5 | 13.2 | % | 6,911.6 | 816.4 | 11.8 | % | |||||||||||||||||||||
| Individual commercial | 963.7 | 978.6 | 1,085.8 | (122.1 | ) | -11.2 | % | 1,016.2 | (52.5 | ) | -5.2 | % | |||||||||||||||||||
| State-based |
368.4 | 365.8 | 296.3 | 72.1 | 24.3 | % | 316.8 | 51.6 | 16.3 | % | |||||||||||||||||||||
| Medicare Supplement | 157.1 | 156.4 | 129.2 | 27.9 | 21.6 | % | 131.9 | 25.2 | 19.1 | % | |||||||||||||||||||||
| Total Retail | 9,217.2 | 9,197.6 | 8,339.8 | 877.4 | 10.5 | % | 8,376.5 | 840.7 | 10.0 | % | |||||||||||||||||||||
| Group | |||||||||||||||||||||||||||||||
| Fully-insured medical commercial | 1,167.4 | 1,173.4 | 1,212.3 | (44.9 | ) | -3.7 | % | 1,235.5 | (68.1 | ) | -5.5 | % | |||||||||||||||||||
| ASO commercial | 709.8 | 728.4 | 1,111.9 | (402.1 | ) | -36.2 | % | 1,104.3 | (394.5 | ) | -35.7 | % | |||||||||||||||||||
| Military services | 3,082.7 | 3,076.9 | 3,085.6 | (2.9 | ) | -0.1 | % | 3,090.4 | (7.7 | ) | -0.2 | % | |||||||||||||||||||
| Total Group | 4,959.9 | 4,978.7 | 5,409.8 | (449.9 | ) | -8.3 | % | 5,430.2 | (470.3 | ) | -8.7 | % | |||||||||||||||||||
| Other Businesses | |||||||||||||||||||||||||||||||
| Long-term care and other | 33.0 | 33.2 | 36.0 | (3.0 | ) | -8.3 | % | 35.0 | (2.0 | ) | -5.7 | % | |||||||||||||||||||
| Total Other Businesses | 33.0 | 33.2 | 36.0 | (3.0 | ) | -8.3 | % | 35.0 | (2.0 | ) | -5.7 | % | |||||||||||||||||||
| Total Medical Membership | 14,210.1 | 14,209.5 | 13,785.6 | 424.5 | 3.1 | % | 13,841.7 | 368.4 | 2.7 | % | |||||||||||||||||||||
|
Detail of Individual commercial |
|||||||||||||||||||||||||||||||
| ACA compliant: | |||||||||||||||||||||||||||||||
| On-Exchange | 609.6 | 620.6 | 601.4 | 8.2 | 1.4 | % | 554.8 | 54.8 | 9.9 | % | |||||||||||||||||||||
| Off-Exchange | 204.8 | 206.0 | 126.4 | 78.4 | 62.0 | % | 131.5 | 73.3 | 55.7 | % | |||||||||||||||||||||
| Non-ACA compliant (legacy) | 149.3 | 152.0 | 358.0 | (208.7 | ) | -58.3 | % | 329.9 | (180.6 | ) | -54.7 | % | |||||||||||||||||||
| Total individual commercial | 963.7 | 978.6 | 1,085.8 | (122.1 | ) | -11.2 | % | 1,016.2 | (52.5 | ) | -5.2 | % | |||||||||||||||||||
| Specialty Membership: | |||||||||||||||||||||||||||||||
| Retail | |||||||||||||||||||||||||||||||
| Dental - fully-insured | 873.9 | 880.2 | 876.4 | (2.5 | ) | -0.3 | % | 828.5 | 45.4 | 5.5 | % | ||||||||||||||||||||
| Vision | 199.3 | 199.6 | 209.0 | (9.7 | ) | -4.6 | % | 208.4 | (9.1 | ) | -4.4 | % | |||||||||||||||||||
| Other supplemental benefits (K) | 114.1 | 116.0 | 134.1 | (20.0 | ) | -14.9 | % | 128.9 | (14.8 | ) | -11.5 | % | |||||||||||||||||||
| Total Retail | 1,187.3 | 1,195.8 | 1,219.5 | (32.2 | ) | -2.6 | % | 1,165.8 | 21.5 | 1.8 | % | ||||||||||||||||||||
| Group | |||||||||||||||||||||||||||||||
| Dental - fully-insured | 2,204.1 | 2,220.1 | 2,379.7 | (175.6 | ) | -7.4 | % | 2,370.5 | (166.4 | ) | -7.0 | % | |||||||||||||||||||
| Dental - ASO | 764.6 | 755.1 | 783.7 | (19.1 | ) | -2.4 | % | 772.4 | (7.8 | ) | -1.0 | % | |||||||||||||||||||
| Vision | 1,978.6 | 1,983.1 | 2,074.7 | (96.1 | ) | -4.6 | % | 2,103.3 | (124.7 | ) | -5.9 | % | |||||||||||||||||||
| Other supplemental benefits (K) | 1,143.4 | 1,151.4 | 1,287.2 | (143.8 | ) | -11.2 | % | 1,256.5 | (113.1 | ) | -9.0 | % | |||||||||||||||||||
| Total Group | 6,090.7 | 6,109.7 | 6,525.3 | (434.6 | ) | -6.7 | % | 6,502.7 | (412.0 | ) | -6.3 | % | |||||||||||||||||||
| Total Specialty Membership | 7,278.0 | 7,305.5 | 7,744.8 | (466.8 | ) | -6.0 | % | 7,668.5 | (390.5 | ) | -5.1 | % | |||||||||||||||||||
|
S-16 |
|||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||
|
Premiums and Services Revenue Detail |
|||||||||||||||||||||||||||||
| Dollars in millions, except per member per month | |||||||||||||||||||||||||||||
| Per Member per Month (L) | |||||||||||||||||||||||||||||
| Three Months Ended September 30, | Three Months Ended September 30, | ||||||||||||||||||||||||||||
| Dollar | Percentage | ||||||||||||||||||||||||||||
| 2015 | 2014 | Change | Change | 2015 | 2014 | ||||||||||||||||||||||||
| Premiums and Services Revenue | |||||||||||||||||||||||||||||
| Retail: | |||||||||||||||||||||||||||||
| Individual |
$ | 7,316 | $ | 6,448 | $ | 868 | 13.5 | % | $ | 894 | $ | 898 | |||||||||||||||||
| Group |
1,396 | 1,381 | 15 | 1.1 | % | 970 | 953 | ||||||||||||||||||||||
| |
927 | 806 | 121 | 15.0 | % | 69 | 68 | ||||||||||||||||||||||
| Individual commercial | 978 | 863 | 115 | 13.3 | % | 333 | 262 | ||||||||||||||||||||||
| State-based |
592 | 352 | 240 | 68.2 | % | 539 | 468 | ||||||||||||||||||||||
| Medicare Supplemental | 78 | 63 | 15 | 23.8 | % | 166 | 165 | ||||||||||||||||||||||
| Specialty | 66 | 67 | (1 | ) | -1.5 | % | 18 | 18 | |||||||||||||||||||||
| Other services | 1 | 10 | (9 | ) | -90.0 | % | |||||||||||||||||||||||
| Total Retail | 11,354 | 9,990 | 1,364 | 13.7 | % | ||||||||||||||||||||||||
| Group: | |||||||||||||||||||||||||||||
| Fully-insured medical commercial | 1,362 | 1,335 | 27 | 2.0 | % | 387 | 367 | ||||||||||||||||||||||
| Specialty | 260 | 274 | (14 | ) | -5.1 | % | 16 | 16 | |||||||||||||||||||||
| Commercial ASO & other services (B) | 104 | 114 | (10 | ) | -8.8 | % | |||||||||||||||||||||||
| Military services (M) | 97 | 91 | 6 | 6.6 | % | ||||||||||||||||||||||||
| Total Group | 1,823 | 1,814 | 9 | 0.5 | % | ||||||||||||||||||||||||
| Healthcare Services: | |||||||||||||||||||||||||||||
| Pharmacy solutions | 5,229 | 4,373 | 856 | 19.6 | % | ||||||||||||||||||||||||
| Provider services | 428 | 583 | (155 | ) | -26.6 | % | |||||||||||||||||||||||
| Home based services | 263 | 184 | 79 | 42.9 | % | ||||||||||||||||||||||||
| Clinical programs | 53 | 53 | - | 0.0 | % | ||||||||||||||||||||||||
| Total Healthcare Services | 5,973 | 5,193 | 780 | 15.0 | % | ||||||||||||||||||||||||
|
S-17 |
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|
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|
Premiums and Services Revenue Detail |
|||||||||||||||||||||||||||||
| Dollars in millions, except per member per month | |||||||||||||||||||||||||||||
| Per Member per Month (L) | |||||||||||||||||||||||||||||
| Nine Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||||||||
| Dollar | Percentage | ||||||||||||||||||||||||||||
| 2015 | 2014 | Change | Change | 2015 | 2014 | ||||||||||||||||||||||||
| Premiums and Services Revenue | |||||||||||||||||||||||||||||
| Retail: | |||||||||||||||||||||||||||||
| Individual |
$ | 22,183 | $ | 19,375 | $ | 2,808 | 14.5 | % | $ | 912 | $ | 914 | |||||||||||||||||
| Group |
4,188 | 4,131 | 57 | 1.4 | % | 982 | 958 | ||||||||||||||||||||||
| |
2,915 | 2,612 | 303 | 11.6 | % | 73 | 75 | ||||||||||||||||||||||
| Individual commercial | 3,038 | 2,183 | 855 | 39.2 | % | 332 | 262 | ||||||||||||||||||||||
| State-based |
1,742 | 735 | 1,007 |
137.0 |
% | 555 | 474 | ||||||||||||||||||||||
| Medicare Supplemental | 225 | 180 | 45 | 25.0 | % | 164 | 163 | ||||||||||||||||||||||
| Specialty | 195 | 192 | 3 | 1.6 | % | 18 | 18 | ||||||||||||||||||||||
| Other services | 7 | 37 | (30 | ) | -81.1 | % | |||||||||||||||||||||||
| Total Retail | 34,493 | 29,445 | 5,048 | 17.1 | % | ||||||||||||||||||||||||
| Group: | |||||||||||||||||||||||||||||
| Fully-insured medical commercial | 4,125 | 3,985 | 140 | 3.5 | % | 387 | 367 | ||||||||||||||||||||||
| Specialty | 795 | 824 | (29 | ) | -3.5 | % | 16 | 16 | |||||||||||||||||||||
| Commercial ASO & other services (B) | 302 | 327 | (25 | ) | -7.6 | % | |||||||||||||||||||||||
| Military services (M) | 296 | 297 | (1 | ) | -0.3 | % | |||||||||||||||||||||||
| Total Group | 5,518 | 5,433 | 85 | 1.6 | % | ||||||||||||||||||||||||
| Healthcare Services: | |||||||||||||||||||||||||||||
| Pharmacy solutions | 15,280 | 12,480 | 2,800 | 22.4 | % | ||||||||||||||||||||||||
| Provider services | 1,659 | 1,737 | (78 | ) | -4.5 | % | |||||||||||||||||||||||
| Home based services | 736 | 488 | 248 | 50.8 | % | ||||||||||||||||||||||||
| Clinical programs | 152 | 154 | (2 | ) | -1.3 | % | |||||||||||||||||||||||
| Total Healthcare Services | 17,827 | 14,859 | 2,968 | 20.0 | % | ||||||||||||||||||||||||
|
S-18 |
|||||||||||||||||||||||||||||
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|
|||||||||||||||||||||||||||||
|
Medicare Summary |
|||||||||||||||||||||||||||||
| Premiums in millions, except per member per month | |||||||||||||||||||||||||||||
| Membership in thousands | |||||||||||||||||||||||||||||
| Per Member per Month (L) | |||||||||||||||||||||||||||||
| Three Months Ended September 30, | Year-over-year Change | Three Months Ended September 30, | |||||||||||||||||||||||||||
| 2015 | 2014 | Amount | Percent |
2015 |
2014 |
||||||||||||||||||||||||
| Premiums | |||||||||||||||||||||||||||||
| |
$ | 8,712 | $ | 7,829 | $ | 883 | 11.3 | % | $ | 905 | $ | 907 | |||||||||||||||||
| |
927 | 806 | 121 | 15.0 | % | 69 | 68 | ||||||||||||||||||||||
| Total |
$ | 9,639 | $ | 8,635 | $ | 1,004 | 11.6 | % | |||||||||||||||||||||
| Per Member per Month (L) | |||||||||||||||||||||||||||||
| Nine Months Ended September 30, | Year-over-year Change | Nine Months Ended September 30, | |||||||||||||||||||||||||||
| 2015 | 2014 | Amount | Percent |
2015 |
2014 |
||||||||||||||||||||||||
| Premiums | |||||||||||||||||||||||||||||
| |
$ | 26,371 | $ | 23,506 | $ | 2,865 | 12.2 | % | $ | 922 | $ | 921 | |||||||||||||||||
| |
2,915 | 2,612 | 303 | 11.6 | % | 73 | 75 | ||||||||||||||||||||||
| Total |
$ | 29,286 | $ | 26,118 | $ | 3,168 | 12.1 | % | |||||||||||||||||||||
| Year-over-year Change | |||||||||||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | Amount | Percent | ||||||||||||||||||||||||||
| Fully-Insured Membership | |||||||||||||||||||||||||||||
| |
3,218.4 | 2,887.7 | 330.7 | 11.5 | % | ||||||||||||||||||||||||
| |
4,509.6 | 3,940.8 | 568.8 | 14.4 | % | ||||||||||||||||||||||||
| Total |
7,728.0 | 6,828.5 | 899.5 | 13.2 | % | ||||||||||||||||||||||||
| Member Mix | |||||||||||||||||||||||||||||
| September 30, | September 30, | ||||||||||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | 2015 | 2014 | ||||||||||||||||||||||||||
| Individual Medicare Advantage Membership | |||||||||||||||||||||||||||||
| HMO | 1,551.8 | 1,287.8 | 56.7 | % | 53.6 | % | |||||||||||||||||||||||
| PPO | 1,185.3 | 1,115.0 | 43.3 | % | 46.4 | % | |||||||||||||||||||||||
| Total Individual Medicare Advantage | 2,737.1 | 2,402.8 | 100.0 | % | 100.0 | % | |||||||||||||||||||||||
| Individual Medicare Advantage Membership | |||||||||||||||||||||||||||||
| Shared Risk (D) | 860.5 | 689.9 | 31.4 | % | 28.7 | % | |||||||||||||||||||||||
| Path to Risk (E) | 745.6 | 583.2 | 27.2 | % | 24.3 | % | |||||||||||||||||||||||
| Total Value-based | 1,606.1 | 1,273.1 | 58.6 | % | 53.0 | % | |||||||||||||||||||||||
| Other | 1,131.0 | 1,129.7 | 41.4 | % | 47.0 | % | |||||||||||||||||||||||
| Total Individual Medicare Advantage | 2,737.1 | 2,402.8 | 100.0 | % | 100.0 | % | |||||||||||||||||||||||
|
S-19 |
|||||||||||||||||||||||||||||
|
|
Fair value | |||||||||||||||
|
Investments |
||||||||||||||||
| Dollars in millions | ||||||||||||||||
| 9/30/2015 | 6/30/2015 | 12/31/2014 | ||||||||||||||
| Investment Portfolio: | ||||||||||||||||
| Cash & cash equivalents | $ | 1,597 | $ | 2,250 | $ | 1,935 | ||||||||||
| Investment securities | 7,423 | 7,041 | 7,598 | |||||||||||||
| Long-term investment securities | 1,879 | 1,839 | 1,949 | |||||||||||||
| Total investment portfolio | $ | 10,899 | $ | 11,130 | $ | 11,482 | ||||||||||
| Duration (N) | 4.27 | 4.19 | 4.14 | |||||||||||||
| Average Credit Rating | AA- | AA- | AA- | |||||||||||||
| Investment Portfolio Detail: | ||||||||||||||||
| Cash and cash equivalents | $ | 1,597 | $ | 2,250 | $ | 1,935 | ||||||||||
| |
||||||||||||||||
| U.S. |
328 | 337 | 374 | |||||||||||||
| |
1,550 | 1,344 | 1,477 | |||||||||||||
| |
17 | 18 | 21 | |||||||||||||
| Total |
1,895 | 1,699 | 1,872 | |||||||||||||
| Tax-exempt municipal securities | ||||||||||||||||
| Pre-refunded | 251 | 181 | 199 | |||||||||||||
| Insured | 250 | 453 | 484 | |||||||||||||
| Other | 2,245 | 2,002 | 2,376 | |||||||||||||
| Auction rate securities | 5 | 5 | 9 | |||||||||||||
| Total tax-exempt municipal securities | 2,751 | 2,641 | 3,068 | |||||||||||||
| Residential mortgage-backed | 13 | 14 | 17 | |||||||||||||
| Commercial mortgage-backed | 1,031 | 944 | 843 | |||||||||||||
| Asset-backed securities | 273 | 163 | 29 | |||||||||||||
| Corporate securities | ||||||||||||||||
| Financial services | 835 | 793 | 772 | |||||||||||||
| Other | 2,504 | 2,626 | 2,946 | |||||||||||||
| Total corporate securities | 3,339 | 3,419 | 3,718 | |||||||||||||
| Total investment portfolio | $ | 10,899 | $ | 11,130 | $ | 11,482 | ||||||||||
|
S-20 |
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|
|||||||||||||||||||||||||||||||||
|
Detail of Benefits Payable Balance and Year-to-Date Changes |
|||||||||||||||||||||||||||||||||
| Dollars in millions | |||||||||||||||||||||||||||||||||
| September 30, | June 30, | March 31, | December 31, | September 30, | June 30, | March 31, | |||||||||||||||||||||||||||
| 2015 | 2015 | 2015 | 2014 | 2014 | 2014 | 2014 | |||||||||||||||||||||||||||
| Detail of benefits payable | |||||||||||||||||||||||||||||||||
| IBNR (O) | $ | 3,667 | $ | 3,376 | $ | 3,398 | $ | 3,254 | $ | 3,412 | $ | 3,242 | $ | 2,940 | |||||||||||||||||||
| Reported Claims in Process (P) | 576 | 522 | 553 | 475 | 476 | 635 | 545 | ||||||||||||||||||||||||||
| Other Benefits Payable (Q) | 679 | 883 | 813 | 746 | 788 | 901 | 947 | ||||||||||||||||||||||||||
| Total Benefits Payable | $ | 4,922 | $ | 4,781 | $ | 4,764 | $ | 4,475 | $ | 4,676 | $ | 4,778 | $ | 4,432 | |||||||||||||||||||
| Nine Months Ended | Nine Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | December 31, 2014 | |||||||||||||||||||||||||||||||
|
Year-to-date changes in benefits payable, excluding military services (R) |
|||||||||||||||||||||||||||||||||
| Balances at January 1 | $ | 4,475 | $ | 3,893 | $ | 3,893 | |||||||||||||||||||||||||||
| Less: Reinsurance recoverables (S) | (78 | ) | - | - | |||||||||||||||||||||||||||||
| Balances at January 1, net | 4,397 | 3,893 | 3,893 | ||||||||||||||||||||||||||||||
| Incurred related to: | |||||||||||||||||||||||||||||||||
| Current year | 33,482 | 28,827 | 38,641 | ||||||||||||||||||||||||||||||
| Prior years (T) | (245 | ) | (440 | ) | (518 | ) | |||||||||||||||||||||||||||
| Total incurred | 33,237 | 28,387 | 38,123 | ||||||||||||||||||||||||||||||
| Paid related to: | |||||||||||||||||||||||||||||||||
| Current year | (28,828 | ) | (24,399 | ) | (34,357 | ) | |||||||||||||||||||||||||||
| Prior years | (3,982 | ) | (3,270 | ) | (3,262 | ) | |||||||||||||||||||||||||||
| Total paid | (32,810 | ) | (27,669 | ) | (37,619 | ) | |||||||||||||||||||||||||||
| Reinsurance recoverables (S) | 98 | 65 | 78 | ||||||||||||||||||||||||||||||
| Balances at end of period | $ | 4,922 | $ | 4,676 | $ | 4,475 | |||||||||||||||||||||||||||
| Nine Months Ended | Nine Months Ended | Year Ended | |||||||||||||||||||||||||||||||
| September 30, 2015 | September 30, 2014 | December 31, 2014 | |||||||||||||||||||||||||||||||
| Summary of Consolidated Benefit Expense: | |||||||||||||||||||||||||||||||||
| Total benefit expense incurred, per above | $ | 33,237 | $ | 28,387 | $ | 38,123 | |||||||||||||||||||||||||||
| Military services benefit expense | 9 | 7 | 11 | ||||||||||||||||||||||||||||||
| Future policy benefit expense (U) | (93 | ) | 23 | 32 | |||||||||||||||||||||||||||||
| Consolidated Benefit Expense | $ | 33,153 | $ | 28,417 | $ | 38,166 | |||||||||||||||||||||||||||
|
S-21 |
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|
|
|||||||||||||
|
Benefits Payable Statistics (V) |
|||||||||||||
| Receipt Cycle Time (W) | |||||||||||||
| 2015 | 2014 | Change |
Percentage Change |
||||||||||
| 1st Quarter Average | 13.9 | 13.6 | 0.3 | 2.2% | |||||||||
| 2nd Quarter Average | 14.0 | 13.5 | 0.5 | 3.7% | |||||||||
| 3rd Quarter Average | 13.8 | 13.4 | 0.4 | 3.0% | |||||||||
| 4th Quarter Average | n/a | 13.5 | n/a | n/a | |||||||||
| Full Year Average | 13.9 | 13.5 | 0.4 | 3.0% | |||||||||
| Unprocessed Claims Inventories (X) | |||||||||||||
| Date |
Estimated Valuation (millions) |
Number of Days on Hand |
|||||||||||
| 3/31/2014 | $688 | 6.9 | |||||||||||
| 6/30/2014 | $817 | 7.3 | |||||||||||
| 9/30/2014 | $823 | 7.1 | |||||||||||
| 12/31/2014 | $782 | 6.4 | |||||||||||
| 3/31/2015 | $862 | 6.7 | |||||||||||
| 6/30/2015 | $779 | 5.6 | |||||||||||
| 9/30/2015 | $920 | 6.8 | |||||||||||
|
S-22 |
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|
|
|||||||||||||||||||||||||||||||||
|
Benefits Payable Statistics (Continued) (V) |
|||||||||||||||||||||||||||||||||
|
Days in Claims Payable (Y) |
|||||||||||||||||||||||||||||||||
| Quarter Ended |
Days in Claims Payable (DCP) |
Change Last 4 Quarters |
Percentage Change |
||||||||||||||||||||||||||||||
| 9/30/2013 | 49.5 | (2.1 | ) | -4.1 | % | ||||||||||||||||||||||||||||
| 12/31/2013 | 47.8 | (0.7 | ) | -1.4 | % | ||||||||||||||||||||||||||||
| 3/31/2014 | 47.7 | (1.3 | ) | -2.7 | % | ||||||||||||||||||||||||||||
| 6/30/2014 | 48.7 | (2.0 | ) | -3.9 | % | ||||||||||||||||||||||||||||
| 9/30/2014 | 46.6 | (2.9 | ) | -5.9 | % | ||||||||||||||||||||||||||||
| 12/31/2014 | 43.5 | (4.3 | ) | -9.0 | % | ||||||||||||||||||||||||||||
| 3/31/2015 | 42.8 | (4.9 | ) | -10.3 | % | ||||||||||||||||||||||||||||
| 6/30/2015 | 41.1 | (7.6 | ) | -15.6 | % | ||||||||||||||||||||||||||||
| 9/30/2015 | 43.4 | (3.2 | ) | -6.9 | % | ||||||||||||||||||||||||||||
| Change in Days in Claims Payable (Z) | 1Q | 2Q | 3Q | YTD 3Q | YTD 3Q | FY | |||||||||||||||||||||||||||
| 2015 | 2015 | 2015 | 2015 | 2014 | 2014 | ||||||||||||||||||||||||||||
| DCP - beginning of period | 43.5 | 42.8 | 41.1 | 43.5 | 47.8 | 47.8 | |||||||||||||||||||||||||||
| Components of change in DCP: | |||||||||||||||||||||||||||||||||
| Change in unprocessed claims inventories | 0.7 | (0.7 | ) | 1.2 | 1.2 | 2.0 | 1.5 | ||||||||||||||||||||||||||
| Change in processed claims inventories | 0.2 | - | 0.4 | 0.6 | 0.7 | 0.4 | |||||||||||||||||||||||||||
| Change in pharmacy payment cutoff | 0.2 | (0.1 | ) | - | 0.1 | 0.1 | - | ||||||||||||||||||||||||||
| Change in capitation/provider settlements | (0.4 | ) | 0.9 | (1.0 | ) | (0.5 | ) | (3.2 | ) | (3.8 | ) | ||||||||||||||||||||||
| All other (AA) | (1.4 | ) | (1.8 | ) | 1.7 | (1.5 | ) | (0.8 | ) | (2.4 | ) | ||||||||||||||||||||||
| DCP - end of period | 42.8 | 41.1 | 43.4 | 43.4 | 46.6 | 43.5 | |||||||||||||||||||||||||||
|
S-23 |
|||||||||||||||||||||||||||||||||
|
Items Expected to Significantly Impact 2016 |
|||
|
Items Expected to Pressure Earnings Growth in 2016 |
Items Expected to Facilitate Earnings Growth in 2016 | ||
|
Individual commercial business:
The company continues to evaluate its participation in this line of business for 2017. |
|
||
| Healthcare Services segment:
|
Individual commercial business:
|
||
|
|
State-based contracts business:
|
||
| Operating expenses and investment income:
|
|||
| Share repurchase:
|
|||
|
S-24 |
|||
|
|
||
| (A) | The |
|
| (B) | The ASO and other category is primarily comprised of ASO fees and other ancillary services fees. | |
| (C) | On January 1, 2015, the company realigned certain of its businesses among its financial reporting segments to correspond with internal management reporting changes and renamed its Employer Group segment the Group segment. The company’s three reportable segments remain Retail, Group, and Healthcare Services. | |
| (D) | In certain circumstances, the company contracts with providers to accept financial risk for a defined set of |
|
| (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) | Based on full-time employee equivalent counts that include clinicians responsible for managing and coordinating member care. Excludes professionals that support the non-clinical aspects of care. | |
| (G) | Based on employee headcount figures that include clinicians responsible for managing and coordinating member care. Excludes professionals that support the non-clinical aspects of care. | |
| (H) | Includes the number of high-risk discharges enrolled in the |
|
| (I) | Script volume is presented on an adjusted 30-day equivalent basis. | |
| (J) | Includes Medicaid Temporary Assistance for Needy Families (TANF), which contracts are generally reinsured through partnering relationships, dual-eligible demonstration, and Long-Term Support Services (LTSS) from state-based contracts. | |
| (K) | Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies. | |
| (L) | 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). | |
| (M) | The majority of Military services revenues are generally not contracted on a per-member basis. | |
| (N) | Duration is the time-weighted average of the present value of the fixed income portfolio cash flows. | |
| (O) | 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, medical claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received (i.e. a shorter time span results in a lower IBNR). IBNR includes unprocessed claims inventories. | |
| (P) | Reported claims in process represents the estimated valuation of processed claims that are in the post-claim adjudication process, which consists of administrative functions such as audit and check batching and handling, as well as amounts owed to the company’s pharmacy benefit administrator, which fluctuate due to bi-weekly payments and the month-end cutoff. | |
| (Q) | Other benefits payable primarily include amounts owed to providers under capitated and risk sharing arrangements. | |
| (R) | The table excludes activity associated with military services benefits payable related to the previous contract that expired March 31, 2012. | |
| (S) | Represents reinsurance recoverables associated with the company’s state-based |
|
| (T) | 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. | |
| (U) | Future policy benefit expense has a related liability classified as a long-term liability on the balance sheet. | |
| (V) | Benefits payable statistics represents fully-insured medical claims data and exclude military services claims data and specialty benefits. | |
| (W) | 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 99% 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. | |
| (X) | Unprocessed claim inventories, included in IBNR, represent fully-insured medical claims which have not been adjudicated and completely processed. These claims can be received but not entered into the claims system, pended for further review prior to final processing, or held due to prepay edits. Number of days on hand represents the estimated unprocessed inventory value divided by the average processed dollars per day for the quarter. Prior period days on hand have been recast to calculate based on claim valuations in lieu of claim counts previously presented. | |
| (Y) | 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. This metric excludes military services, |
|
| (Z) | 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 metric excludes military services, |
|
|
(AA) |
|
The “All Other” component in the DCP rollforward primarily includes items related to claim payment processes, the impact of pharmacy costs, and other expenses that impact benefits expense differently than the liability. Changes in claim payment-processes would primarily include (1) gradual implementation during 2014 of inpatient authorization review prior to admission as opposed to post adjudication and (2) changes in certain components of claim payment cycle time. |
|
S-25 |
||
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