EX-99.2 3 d531092dex992.htm EX-99.2 EX-99.2

Exhibit 99.2

 

news release

     Humana Inc.
     500 West Main Street
     P.O. Box 1438
     Louisville, KY 40201-1438
     http://www.humana.com

FOR MORE INFORMATION CONTACT:

 

Regina Nethery

  LOGO

Humana Investor Relations

 

(502) 580-3644

e-mail: Rnethery@humana.com

 

Tom Noland

 

Humana Corporate Communications

 

(502) 580-3674

e-mail: Tnoland@humana.com

 

Humana Reports First Quarter 2013 Financial Results;

Raises Full Year EPS Guidance; Comments on 2014

 

   

1Q13 EPS of $2.95 exceeds management’s expectations

 

   

2013 EPS guidance raised to range of $8.40 to $8.60

 

   

2014 earnings growth uncertain

 

   

Share repurchase authorization reset to $1 billion

LOUISVILLE, KY (May 1, 2013) – Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended March 31, 2013 (1Q13) of $2.95, compared to $1.49 per share for the quarter ended March 31, 2012 (1Q12). Results for 1Q13 exceeded management’s previous expectations of $1.75 to $1.85 primarily due to outperformance across the company’s portfolio of businesses as well as the beneficial effect of certain discrete items and a lower-than-projected tax rate.

The company’s results for 1Q13 included the beneficial effect of settlement of contract claims with the Department of Defense (DoD) related to previously-disclosed litigation and a delay in the implementation of sequestration for the company’s Medicare business – neither of which was anticipated in management’s previous financial guidance. The beneficial effect of these items upon 1Q13 results was approximately $66 million on a pretax basis, or $0.26 per diluted common share.

The company now anticipates EPS for the year ending December 31, 2013 (FY13) to be in the range of $8.40 to $8.60 versus management’s previous guidance of $7.60 to $7.80. This increase reflects the better-than-expected first quarter results partially offset by higher-than-previously projected investment spending for the company’s integrated care delivery model and health care exchanges during the latter half of 2013.

“Our better-than-expected earnings this quarter are a testament to the benefits of our focus on further developing our new member and chronic care clinical programs – key elements of our integrated care delivery model,” said Bruce D. Broussard, President and Chief Executive Officer of Humana. “We expect this model will allow us to maintain and improve the economic value proposition we provide, which we


believe will enable long-term earnings growth. On the immediate horizon, while the final 2014 Medicare rate notice remedied some aspects of the major reduction that was initially proposed, funding challenges continue, making 2014 earnings growth uncertain at this time.”

CONSOLIDATED HIGHLIGHTS

Consolidated revenues

1Q13 consolidated revenues were $10.49 billion, an increase of 2.6 percent from $10.22 billion in 1Q12, with total premiums and services revenue also up 2.6 percent compared to the prior year’s quarter. The year-over-year increase in premiums and services revenue was primarily driven by higher Retail and Employer Group segment revenues resulting from higher average individual and group Medicare membership, partially offset by the company’s new South Region TRICARE contract being accounted for as self-funded versus fully-insured for the previous contract. The new contract became effective on April 1, 2012.

Consolidated benefits expense

The 1Q13 consolidated benefit ratio (benefits expense as a percent of premiums) of 83.0 percent declined by 240 basis points from 85.4 percent for the prior year’s quarter due primarily to lower benefit ratios in both the Retail and Employer Group segments, both of which benefitted from favorable weekday seasonality and a higher level of favorable prior period development. The company experienced favorable prior-period development in its medical claims reserves of approximately $266 million in 1Q13 compared to $141 million in 1Q12.

Consolidated operating expenses

The consolidated operating cost ratio (operating costs as a percent of total revenues less investment income) of 13.9 percent for 1Q13 increased from 13.7 percent in 1Q12 primarily due to substantial reductions in this operating metric for the Retail and Employer Group Segments being more than offset by the impact of the accounting for the company’s new South Region TRICARE contract in the company’s Other Businesses.

Balance sheet

At March 31, 2013, the company had cash, cash equivalents, and investment securities of $11.36 billion, up $210 million from $11.15 billion at December 31, 2012 reflecting higher average invested balances associated with higher average medical membership.

Parent company cash and short-term investments of $202 million at March 31, 2013 decreased $144 million from $346 million at December 31, 2012, primarily reflecting share repurchases and cash dividends during 1Q13.

Days in claims payable of 49.0 at March 31, 2013 increased slightly from 48.5 days at December 31, 2012.

Debt-to-total capitalization at March 31, 2013 was 22.2 percent, down 60 basis points from 22.8 percent at December 31, 2012 primarily driven by higher capitalization associated with 1Q13 earnings.

 

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Cash flows from operations

Cash flows provided by operations for 1Q13 were $412 million compared to cash flows provided by operations of $2.35 billion in 1Q12. The company also evaluates operating cash flows on a non-GAAP basis:

 

Net cash from operating activities

(in millions)

   1Q13
Cash Flows
     1Q12
Cash Flows
 

GAAP

   $ 412       $ 2,346   

Timing of premium payment from CMS (a)

     —           (2,015

Non-GAAP (b)

   $ 412       $ 331   

The year-over-year increase in the non-GAAP cash flows from operations is due primarily to higher net income partially offset by the effect on cash flows of changes in working capital accounts.

Share repurchases

During 1Q13, the company executed share repurchases of $81 million, or 1,205,600 of its outstanding shares, at an average price of $67.60 per share under a previously approved authorization. In April 2013, the Board of Directors replaced its previous share repurchase authorization (of which approximately $557 million remained unused) with a new $1 billion repurchase authorization with an expiration date of June 30, 2015.

Cash dividends

During 1Q13, the company paid cash dividends to its stockholders totaling approximately $42 million.

Business segment reclassifications

Beginning on January 1, 2013, the company reclassified its HumanaVitality, Lifesynch, Limited Income Newly Eligible Transition (LI-NET) and state-based Medicaid businesses to correspond with internal management reporting changes for the related operations. Additionally, the company renamed its Health and Well-Being Services segment as Healthcare Services. Segment results of prior periods were recast to conform to the current presentation. Those recast segment results are included in the statistical pages of this earnings press release.

 

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RETAIL SEGMENT

This segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, marketed directly to individuals including the company’s contract with CMS to administer the LI-NET program and contracts for state-based Medicaid members.

Retail Segment Highlights

Pretax results:

   

Retail Segment pretax income of $350 million in 1Q13 compares to $128 million in 1Q12, an increase of $222 million. This increase was primarily due to membership and premium growth and lower benefit and operating cost ratios. Retail Segment results for 1Q13 include the beneficial effect of $193 million in favorable prior-period medical claims reserve development compared to $116 million in 1Q12.

Enrollment:

 

   

Individual Medicare Advantage membership was 2,012,100 as of March 31, 2013, an increase of 128,300 members, or 6.8 percent from 1,883,800 at March 31, 2012 and up 84,500, or 4.4 percent from 1,927,600 at December 31, 2012, primarily due to a successful enrollment season associated with the 2013 plan year.

 

   

Individual Medicare Advantage net membership growth during 1Q13 included the divestiture of 12,600 members acquired with the March 2012 Arcadian Management Services, Inc. transaction, in accordance with the company’s previously disclosed agreement with the United States Department of Justice.

 

   

Membership in the company’s stand-alone Prescription Drug Plans (PDPs) was 3,202,300 at March 31, 2013, up 261,700, or 8.9 percent compared to 2,940,600 at March 31, 2012 and up 149,600, or 4.9 percent from 3,052,700 at December 31, 2012. These increases resulted primarily from growth in the company’s innovative Humana-Walmart plan offering.

 

   

HumanaOne® medical membership increased to 460,800 at March 31, 2013, an increase of 18,800, or 4.3 percent, from 442,000 at March 31, 2012 and up 16,800, or 3.8 percent from 444,000 at December 31, 2012.

 

   

Medical membership in state-based Medicaid plans increased to 73,300 at March 31, 2013, an increase of 27,200, or 59.0 percent, from 46,100 at March 31, 2012 and up 21,200, or 40.7 percent, from 52,100 at December 31, 2012, primarily driven by the addition of the company’s recently awarded Kentucky Medicaid contract on January 1, 2013.

 

   

Membership in individual specialty products(c) of 959,600 at March 31, 2013 increased 111,700, or 13.2 percent, from 847,900 at March 31, 2012 and increased 10,900, or 1.1 percent, from 948,700 at December 31, 2012, primarily driven by increased membership in dental and vision offerings.

Premiums and services revenue:

 

   

1Q13 premiums and services revenue for the Retail Segment was $6.91 billion, an increase of 12.2 percent from $6.15 billion in 1Q12. The increase was primarily the result of 9.4 percent higher average individual Medicare Advantage membership year over year together with a 2.9 percent average increase in the per member premium for Medicare Advantage.

 

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Benefits expense:

 

   

The 1Q13 benefit ratio for the Retail Segment was 85.9 percent, a decrease of 160 basis points from 87.5 percent in 1Q12. The year-over-year decrease was primarily due to a decline in the benefit ratio associated with the company’s Medicare Advantage and stand-alone PDP businesses primarily driven by an increase in favorable prior-period medical claims reserve development and favorable weekday seasonality in 1Q13 versus 1Q12.

Operating costs:

 

   

The Retail Segment’s operating cost ratio of 8.9 percent in 1Q13 decreased 150 basis points from 10.4 percent in 1Q12. The decrease was primarily the result of cost efficiencies resulting from higher average membership as well as the company’s continued focus on operating cost efficiencies.

EMPLOYER GROUP SEGMENT

This segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, as well as administrative services only (ASO) products and health and productivity solutions businesses primarily marketed to employer groups.

Employer Group Segment Highlights

Pretax results:

 

   

Employer Group Segment pretax income of $205 million in 1Q13 compares to pretax income of $129 million in 1Q12, and reflects improved benefit and operating cost ratios for this segment. Employer Group Segment results for 1Q13 include the beneficial effect of $76 million in favorable prior-period medical claims reserve development compared to $15 million in 1Q12.

Enrollment:

 

   

Fully-insured group Medicare Advantage membership was 412,800 at March 31, 2013, an increase of 55,100 members, or 15.4 percent, from 357,700 at March 31, 2012 and up 42,000, or 11.3 percent, from 370,800 at December 31, 2012, reflecting on-going success in demonstrating the company’s value proposition for retirees to employers. On January 1, 2013, the company lost its sole ASO group Medicare Advantage account which had 28,100 members at March 31, 2012 and 27,700 members at December 31, 2012.

 

   

Group fully-insured commercial medical membership increased to 1,197,800 at March 31, 2013, an increase of 15,000, or 1.3 percent, from 1,182,800 at March 31, 2012 and down 14,000, or 1.2 percent, from 1,211,800 at December 31, 2012, as increases in small group business membership were generally offset by lower membership in large group accounts. Approximately 60 percent of group fully-insured commercial medical membership was in small group accounts at March 31, 2013 versus 57 percent at March 31, 2012 and 59 percent at December 31, 2012.

 

5


   

Group ASO commercial medical membership declined to 1,200,800 at March 31, 2013, a decrease of 35,800, or 2.9 percent, from 1,236,600 at March 31, 2012 and down 36,900, or 3.0 percent, from 1,237,700 at December 31, 2012. This decline reflected a continuation of discipline in pricing services for self-funded accounts amid a highly competitive environment.

 

   

Membership in Employer Group specialty products(c) increased to 7,274,000 at March 31, 2013, an increase of 424,700, or 6.2 percent, from 6,849,300 at March 31, 2012 and was up 137,800, or 1.9 percent, from 7,136,200 at December 31, 2012. This increase primarily resulted from increased cross-sales of the company’s specialty products to its medical membership and growth in stand-alone specialty product sales.

Premiums and services revenue:

 

   

1Q13 premiums and services revenue for the Employer Group Segment were $2.83 billion, up 7.8 percent from $2.63 billion in 1Q12, primarily reflecting the impacts of higher average group Medicare Advantage and commercial fully-insured membership.

Benefits expense:

 

   

The 1Q13 benefit ratio for the Employer Group Segment was 79.6 percent, a decrease of 160 basis points from 81.2 percent for 1Q12. The year-over-year decrease in the benefit ratio primarily reflected an increase in favorable prior-period medical claims reserve development and more favorable weekday seasonality in 1Q13 than in 1Q12.

Operating costs:

 

   

The Employer Group Segment’s operating cost ratio was 15.5 percent in 1Q13, a decline of 110 basis points from 16.6 percent in 1Q12, primarily reflecting a higher percentage of members in group Medicare Advantage plans (which carry a lower operating cost ratio than commercial fully-insured group accounts) as well as cost savings associated with operating cost reduction initiatives.

HEALTHCARE SERVICES SEGMENT (formerly Health and Well-Being Services Segment)

This segment includes services offered to the company’s health plan members as well as to third parties including provider services, pharmacy solutions and mail-order pharmacy, integrated behavioral health services, and home care services.

Healthcare Services Segment Highlights

Pretax results:

 

   

Healthcare Services Segment pretax income of $125 million in 1Q13 was essentially flat to 1Q12, as revenue growth and the profit contribution from the Metropolitan Health Networks, Inc. (Metropolitan) acquisition were generally offset by costs incurred in expanding our integrated care delivery model.

 

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Revenues:

 

   

Revenues of $3.72 billion in 1Q13 for the Healthcare Services Segment increased $434 million, or 13.2 percent from $3.28 billion in 1Q12, primarily due to the company’s acquisitions of Metropolitan and other provider businesses as well as growth in the company’s pharmacy solutions business.

Operating costs:

 

   

The Healthcare Services Segment’s operating cost ratio of 95.7 percent in 1Q13 was relatively unchanged from 95.6 percent in 1Q12.

OTHER BUSINESSES

The Other Businesses category consists of the company’s military services, Puerto Rico Medicaid, and closed-block long-term care businesses. The military services business consists primarily of the company’s TRICARE South Region contract.

Other Businesses Highlights

Pretax results:

 

   

Other Businesses reported pretax income of $58 million in 1Q13 versus pretax income of $5 million in 1Q12, primarily due to the beneficial effect of the $48 million favorable settlement discussed above.

 

   

On April 1, 2012, the company’s new South Region TRICARE contract became effective with the DoD. The company’s new contract is structured similar to self-funded products versus a fully-insured structure for the company’s previous South Region TRICARE contract with the DoD. This change resulted in significant volatility in year-over-year comparisons for the company’s Other Businesses.

Footnotes

 

(a) Generally, when the first day of a month falls on a weekend or holiday, with the exception of January 1 (New Year’s Day), the company receives this payment on the last business day of the previous month. Consequently, 1Q12 cash flows included four monthly Medicare payments compared to three monthly Medicare payments during 1Q13.
(b) The company has included certain financial measures that are not in accordance with Generally Accepted Accounting Principles (GAAP) in its summary of financial results within this earnings press release. The company believes that these non-GAAP measures, when presented in conjunction with comparable GAAP measures, are useful to both management and its investors in analyzing the company’s ongoing business and operating performance. Internally, management uses these non-GAAP financial measures as indicators of business performance, as well as for operational planning and decision making purposes. Non-GAAP financial measures should be considered in addition to, but not as a substitute for, or superior to, financial measures prepared in accordance with GAAP.
(c) The company provides a full range of insured specialty products including dental, vision and other supplemental health and financial protection products. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products. Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies.

 

7


Conference Call & Virtual Slide Presentation

Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings. A live virtual presentation (audio with slides) may be accessed via Humana’s Investor Relations page at www.humana.com. The company suggests web participants sign on at least 15 minutes in advance of the call. The company also suggests web participants visit the site well in advance of the call to run a system test and to download any free software needed to view the presentation.

All parties interested in the audio-only portion of the conference call are invited to dial 888-625-7430. No password is required. The company suggests participants dial in at least ten minutes in advance of the call. For those unable to participate in the live event, the virtual presentation archive may be accessed via the Historical Webcasts & Presentations section of the Investor Relations page at www.humana.com.

Cautionary Statement

This news release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:

 

   

If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of health care services delivered to its members, if the company is unable to implement clinical initiatives to provide a better health care experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. These estimates, however, involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in payment patterns and medical cost trends.

 

   

If Humana fails to effectively implement its operational and strategic initiatives, particularly its Medicare initiatives (given the concentration of the company’s revenues in the Medicare business), the company’s business may be materially adversely affected.

 

   

If Humana fails to properly maintain the integrity of its data, to strategically implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks, the company’s business may be materially adversely affected.

 

   

Humana’s business may be materially adversely impacted by CMS’s adoption of a new coding set for diagnoses (commonly known as ICD-10).

 

   

Humana is involved in various legal actions and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages. Increased litigation and negative publicity could also increase the company’s cost of doing business.

 

   

As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government health care programs including, among other things, loss of material government contracts, governmental audits and investigations, potential inadequacy of government-determined payment rates or other changes in the governmental programs in which Humana participates.

 

8


   

Recently enacted health insurance reform, including The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010, could have a material adverse effect on Humana’s results of operations, including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products (and particularly how the ratio may apply to Medicare plans, including aggregation, credibility thresholds, and its possible application to prescription drug plans), lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible federal premium tax and other assessments; financial position, including the company’s ability to maintain the value of its goodwill; and cash flows. In addition, if the new non-deductible federal premium tax and other assessments, including a three-year commercial reinsurance fee, were imposed as enacted, and if Humana is unable to adjust its business model to address these new taxes and assessments, such as through the reduction of the company’s operating costs, there can be no assurance that the non-deductible federal premium tax and other assessments would not have a material adverse effect on the company’s results of operations, financial position, and cash flows.

 

   

Humana’s business activities are subject to substantial government regulation. New laws or regulations, or changes in existing laws or regulations or their manner of application could increase the company’s cost of doing business and may adversely affect the company’s business, profitability and cash flows.

 

   

Any failure to manage operating costs could hamper Humana’s profitability.

 

   

Any failure by Humana to manage acquisitions and other significant transactions successfully may have a material adverse effect on its results of operations, financial position, and cash flows.

 

   

If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected.

 

   

Humana’s pharmacy business is highly competitive and subjects it to regulations in addition to those the company faces with its core health benefits businesses.

 

   

Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance.

 

   

If Humana does not continue to earn and retain purchase discounts and volume rebates from pharmaceutical manufacturers at current levels, Humana’s gross margins may decline.

 

   

Humana’s ability to obtain funds from its subsidiaries is restricted by state insurance regulations.

 

   

Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition.

 

   

Changes in economic conditions could adversely affect Humana’s business and results of operations.

 

   

The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.

 

   

Given the current economic climate, Humana’s stock and the stock of other companies in the insurance industry may be increasingly subject to stock price and trading volume volatility.

In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.

Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:

 

   

Form 10-K for the year ended December 31, 2012;

 

   

Form 8-Ks filed during 2013.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

 

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More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

 

   

Annual reports to stockholders;

 

   

Securities and Exchange Commission filings;

 

   

Most recent investor conference presentations;

 

   

Quarterly earnings news releases;

 

   

Replays of most recent earnings release conference calls;

 

   

Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors);

 

   

Corporate Governance information.

 

10


Humana Inc. – Earnings Guidance Points as of May 1, 2013

 

(in accordance with Generally Accepted

Accounting Principles)

  

For the year ending December 31, 2013

  

Comments

Diluted earnings per common share (EPS)

     

    Full Year

   $8.40 to $8.60   

    Second Quarter

   $2.40 to $2.50   

Revenues

     

    Consolidated

   $41.0 billion to $41.5 billion   

Includes expected investment income in the range of $365 million to $385 million

    Retail Segment

   $26.75 billion to $27.25 billion   

    Employer Group Segment

    Healthcare Services Segment

    Other Businesses

  

$11.0 billion to $11.5 billion

$15.0 billion to $15.5 billion

$1.3 billion to $1.5 billion

  

Segment-level revenue estimates reflect the business segment reclassifications discussed in this press release. Additionally, segment-level revenues include intersegment amounts that eliminate in consolidation.

     
     

Ending medical membership versus prior year end

     

    Retail Segment

     

        Medicare Advantage

   Up 120,000 to 130,000   

Includes the January 1, 2013 disposition of 12,600 Medicare Advantage members acquired in the March 2012 Arcadian transaction in accordance with the company’s previously disclosed agreement with the United States Department of Justice.

        Medicare stand-alone PDPs (excl. LI-NET)

   Up 170,000 to 190,000   

        HumanaOne

   Down 10,000 to 20,000   

        Medicare Supplement

   Up 15,000 to 25,000   

    Employer Group Segment

     

        Medicare Advantage fully-insured

   Up 50,000 to 60,000   

        Medicare Advantage ASO

   Down 28,000   

        Commercial fully-insured

   Relatively unchanged   

        Commercial ASO

   Down 60,000 to 70,000   

Benefit ratios

    Retail Segment

    Employer Group Segment

  

 

84.5% to 85.0%

84.5% to 85.0%

  

Benefits expense as a percent of premiums. Ratio estimates reflect the business segment reclassifications discussed in this press release.

Operating cost ratios

    Consolidated

    Healthcare Services Segment

  

 

14.75% to 15.25%

95.5% to 96.0%

  

Operating costs as a percent of total revenues excluding investment income

Consolidated depreciation and amortization (D&A)

    Income statement

    Cash flows statement

  

 

$330 million to $350 million

$415 million to $435 million

  

Certain D&A is included in benefits expense on the income statement but shown as a non-cash item on the cash flows statement

 

11


Humana Inc. – Earnings Guidance Points as of May 1, 2013

 

(in accordance with Generally Accepted

Accounting Principles)

  

For the year ending December 31, 2013

  

Comments

Consolidated interest expense

   $140 million to $145 million   

Pretax results

     

Segment-level pretax results and margins include the impact of net investment income

    Retail Segment

  

$1.3 billion to $1.4 billion;

Approximately 5% pretax margin

  

    Employer Group Segment

  

$190 million to $210 million;

Approximately 2% pretax margin

  

    Healthcare Services Segment

  

$525 million to $550 million;

Approximately 3.5% pretax margin

  

Effective Tax Rate

   Approximately 36%   

Diluted shares

   Approximately 161 million   

Projections exclude the impact of future share repurchases

Cash flows from operations

   $1.9 billion to $2.1 billion   

Capital expenditures

   $425 million to $450 million   

 

12


Humana Inc.

Statistical Schedules

And

Supplementary Information

1Q13 Earnings Release

 

S-1


Humana Inc.

Statistical Schedules and Supplementary Information

1Q13 Earnings Release

Contents

 

Page

  

Description

S-3    Consolidated Statements of Income
S-4-5    Quarterly Segment Financial Information
S-6-8    Quarterly Segment Financial Information (Recast)
S-9    FY12 Segment Financial Information (Recast)
S-10    Consolidated Balance Sheets
S-11    Consolidated Statements of Cash Flows
S-12    Key Income Statement Ratios and Segment Operating Results
S-13-14    Healthcare Services Segment Metrics
S-15    Membership Detail
S-16    Premiums and Services Revenue Detail
S-17    Medicare Summary
S-18    Investments
S-19-21    Benefits Payable Detail and Statistics
S-22    Footnotes

 

S-2


Humana Inc.

Consolidated Statements of Income

Dollars in millions, except per common share results

 

     Three Months Ended March 31,      Dollar     Percentage  
     2013      2012      Change     Change  

Revenues:

          

Premiums

   $ 9,868       $ 9,775       $ 93        1.0

Services

     525         350         175        50.0

Investment income

     93         94         (1     -1.1
  

 

 

    

 

 

    

 

 

   

Total revenues

     10,486         10,219         267        2.6
  

 

 

    

 

 

    

 

 

   

Operating expenses:

          

Benefits

     8,195         8,350         (155     -1.9

Operating costs

     1,446         1,383         63        4.6

Depreciation and amortization

     80         70         10        14.3
  

 

 

    

 

 

    

 

 

   

Total operating expenses

     9,721         9,803         (82     -0.8
  

 

 

    

 

 

    

 

 

   

Income from operations

     765         416         349        83.9

Interest expense

     35         26         9        34.6
  

 

 

    

 

 

    

 

 

   

Income before income taxes

     730         390         340        87.2

Provision for income taxes

     257         142         115        81.0
  

 

 

    

 

 

    

 

 

   

Net income

   $ 473       $ 248       $ 225        90.7
  

 

 

    

 

 

    

 

 

   

Basic earnings per common share

   $ 2.97       $ 1.51       $ 1.46        96.7

Diluted earnings per common share

   $ 2.95       $ 1.49       $ 1.46        98.0

Shares used in computing basic earnings per common share (000’s)

     158,917         163,717        

Shares used in computing diluted earnings per common share (000’s)

     160,403         166,088        

 

S-3


Humana Inc.

1Q13 Segment Financial Information

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 5,736      $ 1,190      $ —        $ —        $ —        $ 6,926   

Medicare stand-alone PDP

     761        2        —          —          —          763   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     6,497        1,192        —          —          —          7,689   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     279        1,268        —          —          —          1,547   

Specialty

     49        275        —          —          —          324   

Military services

     —          —          —          11        —          11   

Medicaid and other (A)

     79        —          —          218        —          297   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,904        2,735        —          229        —          9,868   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —          4        306        —          —          310   

ASO and other (B)

     2        84        —          120        —          206   

Pharmacy

     —          —          9        —          —          9   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     2        88        315        120        —          525   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     6,906        2,823        315        349        —          10,393   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     —          11        2,749        —          (2,760     —     

Products

     —          —          654        —          (654     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     —          11        3,403        —          (3,414     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     18        11        —          15        49        93   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,924        2,845        3,718        364        (3,365     10,486   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,929        2,177        —          187        (98     8,195   

Operating costs

     613        440        3,557        115        (3,279     1,446   

Depreciation and amortization

     32        23        36        4        (15     80   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     6,574        2,640        3,593        306        (3,392     9,721   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     350        205        125        58        27        765   

Interest expense

     —          —          —          —          35        35   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 350      $ 205      $ 125      $ 58      $ (8   $ 730   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     85.9     79.6       81.7       83.0

Operating cost ratio

     8.9     15.5     95.7     33.0       13.9

 

S-4


Humana Inc.

1Q12 Segment Financial Information (Recast) (C)

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 5,093      $ 1,025      $ —         $ —         $ —         $ 6,118   

Medicare stand-alone PDP

     726        2        —           —           —           728   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     5,819        1,027        —           —           —           6,846   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     244        1,242        —           —           —           1,486   

Specialty

     38        260        —           —           —           298   

Military services

     —           —           —           893        —           893   

Medicaid and other (A)

     46        —           —           206        —           252   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,147        2,529        —           1,099        —           9,775   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —           2        231        —           —           233   

ASO and other (B)

     6        89        —           18        —           113   

Pharmacy

     —           —           4        —           —           4   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     6        91        235        18        —           350   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     6,153        2,620        235        1,117        —           10,125   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     —           10        2,465        —           (2,475     —      

Products

     —           —           584        —           (584     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     —           10        3,049        —           (3,059     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     19        10        —           14        51        94   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,172        2,640        3,284        1,131        (3,008     10,219   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,377        2,053        —           1,016        (96     8,350   

Operating costs

     637        436        3,140        106        (2,936     1,383   

Depreciation and amortization

     30        22        19        4        (5     70   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     6,044        2,511        3,159        1,126        (3,037     9,803   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     128        129        125        5        29        416   

Interest expense

     —           —           —           —           26        26   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

   $ 128      $ 129      $ 125      $ 5      $ 3      $ 390   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     87.5     81.2       92.4       85.4

Operating cost ratio

     10.4     16.6     95.6     9.5       13.7

 

S-5


Humana Inc.

2Q12 Segment Financial Information (Recast) (C)

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 5,308      $ 1,011      $ —         $ —         $ —         $ 6,319   

Medicare stand-alone PDP

     745        2        —           —           —           747   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     6,053        1,013        —           —           —           7,066   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     250        1,247        —           —           —           1,497   

Specialty

     42        262        —           —           —           304   

Military services

     —           —           —           44        —           44   

Medicaid and other (A)

     45        —           —           210        —           255   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,390        2,522        —           254        —           9,166   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —           2        243        —           —           245   

ASO and other (B)

     5        89        —           91        —           185   

Pharmacy

     —           —           4        —           —           4   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     5        91        247        91        —           434   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     6,395        2,613        247        345        —           9,600   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     1        7        2,359        —           (2,367     —      

Products

     —           —           591        —           (591     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     1        7        2,950        —           (2,958     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     20        10        —           15        54        99   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,416        2,630        3,197        360        (2,904     9,699   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,378        2,063        —           301        (90     7,652   

Operating costs

     638        428        3,049        111        (2,842     1,384   

Depreciation and amortization

     33        22        20        4        (6     73   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     6,049        2,513        3,069        416        (2,938     9,109   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     367        117        128        (56     34        590   

Interest expense

     —           —           —           —           26        26   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 367      $ 117      $ 128      $ (56   $ 8      $ 564   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     84.2     81.8       118.5       83.5

Operating cost ratio

     10.0     16.3     95.4     32.2       14.4

 

S-6


Humana Inc.

3Q12 Segment Financial Information (Recast) (C)

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 5,203      $ 1,023      $ —         $ —        $ —         $ 6,226   

Medicare stand-alone PDP

     699        2        —           —           —           701   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     5,902        1,025        —           —           —           6,927   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     255        1,256        —           —           —           1,511   

Specialty

     45        271        —           —           —           316   

Military services

     —           —           —           69        —           69   

Medicaid and other (A)

     47        —           —           218        —           265   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,249        2,552        —           287        —           9,088   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —           3        268        —           —           271   

ASO and other (B)

     6        88        —           99        —           193   

Pharmacy

     —           —           3        —           —           3   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     6        91        271        99        —           467   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     6,255        2,643        271        386        —           9,555   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     1        5        2,306        —           (2,312     —      

Products

     —           —           602        —           (602     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     1        5        2,908        —           (2,914     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     19        11        —           14        52        96   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,275        2,659        3,179        400        (2,862     9,651   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,150        2,168        —           232        (83     7,467   

Operating costs

     675        421        3,013        108        (2,809     1,408   

Depreciation and amortization

     32        23        22        4        (6     75   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     5,857        2,612        3,035        344        (2,898     8,950   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     418        47        144        56        36        701   

Interest expense

     —           —           —           —           26        26   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

   $ 418      $ 47      $ 144      $ 56      $ 10      $ 675   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     82.4     85.0       80.8       82.2

Operating cost ratio

     10.8     15.9     94.8     28.0       14.7

 

S-7


Humana Inc.

4Q12 Segment Financial Information (Recast) (C)

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 5,184      $ 1,005      $ —         $ —         $ —         $ 6,189   

Medicare stand-alone PDP

     683        2        —           —           —           685   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     5,867        1,007        —           —           —           6,874   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     255        1,251        —           —           —           1,506   

Specialty

     46        277        —           —           —           323   

Military services

     —           —           —           11        —           11   

Medicaid and other (A)

     47        —           —           219        —           266   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,215        2,535        —           230        —           8,980   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —           5        266        —           —           271   

ASO and other (B)

     7        92        —           100        —           199   

Pharmacy

     —           —           5        —           —           5   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     7        97        271        100        —           475   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     6,222        2,632        271        330        —           9,455   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     —           9        2,394        —           (2,403     —      

Products

     —           —           565        —           (565     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     —           9        2,959        —           (2,968     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     21        11        —           15        55        102   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,243        2,652        3,230        345        (2,913     9,557   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,143        2,187        —           253        (67     7,516   

Operating costs

     817        459        3,138        111        (2,870     1,655   

Depreciation and amortization

     35        22        26        4        (10     77   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     5,995        2,668        3,164        368        (2,947     9,248   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     248        (16     66        (23     34        309   

Interest expense

     —           —           —           —           27        27   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 248      $ (16   $ 66      $ (23   $ 7      $ 282   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     82.8     86.3       110.0       83.7

Operating cost ratio

     13.1     17.4     97.2     33.6       17.5

 

S-8


Humana Inc.

FY 2012 Segment Financial Information (Recast) (C)

In millions

 

           Employer     Healthcare     Other     Eliminations/        
     Retail     Group     Services     Businesses     Corporate     Consolidated  

Revenues—external customers

            

Premiums:

            

Medicare Advantage

   $ 20,788      $ 4,064      $ —         $ —         $ —         $ 24,852   

Medicare stand-alone PDP

     2,853        8        —           —           —           2,861   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     23,641        4,072        —           —           —           27,713   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     1,004        4,996        —           —           —           6,000   

Specialty

     171        1,070        —           —           —           1,241   

Military services

     —           —           —           1,017        —           1,017   

Medicaid and other (A)

     185        —           —           853        —           1,038   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     25,001        10,138        —           1,870        —           37,009   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —           12        1,008        —           —           1,020   

ASO and other (B)

     24        358        —           308        —           690   

Pharmacy

     —           —           16        —           —           16   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     24        370        1,024        308        —           1,726   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues—external customers

     25,025        10,508        1,024        2,178        —           38,735   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     2        31        9,524        —           (9,557     —      

Products

     —           —           2,342        —           (2,342     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     2        31        11,866        —           (11,899     —      
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     79        42        —           58        212        391   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     25,106        10,581        12,890        2,236        (11,687     39,126   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     21,048        8,471        —           1,802        (336     30,985   

Operating costs

     2,767        1,744        12,340        436        (11,457     5,830   

Depreciation and amortization

     130        89        87        16        (27     295   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     23,945        10,304        12,427        2,254        (11,820     37,110   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     1,161        277        463        (18     133        2,016   

Interest expense

     —           —           —           —           105        105   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 1,161      $ 277      $ 463      $ (18   $ 28      $ 1,911   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     84.2     83.6       96.4       83.7

Operating cost ratio

     11.1     16.5     95.7     20.0       15.1

 

S-9


Humana Inc.

Consolidated Balance Sheets

Dollars in millions, except share amounts

 

     March 31,     December 31,     Sequential Change  
     2013     2012     Dollar      Percent  

Assets

         

Current assets:

         

Cash and cash equivalents

   $ 1,398      $ 1,306        

Investment securities

     8,141        8,001        

Receivables, net

     1,321        733        

Other

     1,818        1,670        
  

 

 

   

 

 

      

Total current assets

     12,678        11,710      $ 968         8.3

Property and equipment, net

     1,119        1,098        

Long-term investment securities

     1,824        1,846        

Goodwill

     3,641        3,640        

Other

     1,712        1,685        
  

 

 

   

 

 

      

Total assets

     20,974        19,979      $ 995         5.0
  

 

 

   

 

 

      

Liabilities and Stockholders’ Equity

         

Current liabilities:

         

Benefits payable

     4,090        3,779        

Trade accounts payable and accrued expenses

     2,321        2,042        

Book overdraft

     290        324        

Unearned revenues

     243        230        
  

 

 

   

 

 

      

Total current liabilities

     6,944        6,375      $ 569         8.9

Long-term debt

     2,608        2,611        

Future policy benefits payable

     1,924        1,858        

Other long-term liabilities

     334        288        
  

 

 

   

 

 

      

Total liabilities

     11,810        11,132      $ 678         6.1
  

 

 

   

 

 

      

Commitments and contingencies

         

Stockholders’ equity:

         

Preferred stock, $1 par; 10,000,000 shares authorized, none issued

     —          —          

Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 195,022,433 issued at March 31, 2013

     32        32        

Capital in excess of par value

     2,140        2,101        

Retained earnings

     8,311        7,881        

Accumulated other comprehensive income

     328        386        

Treasury stock, at cost, 37,520,682 shares at March 31, 2013

     (1,647     (1,553     
  

 

 

   

 

 

      

Total stockholders’ equity

     9,164        8,847      $ 317         3.6
  

 

 

   

 

 

      

Total liabilities and stockholders’ equity

   $ 20,974      $ 19,979      $ 995         5.0
  

 

 

   

 

 

      

Debt-to-total capitalization ratio

     22.2     22.8     

Return on Invested Capital (ROIC)—trailing 12 months

     13.4     11.5     

 

S-10


Humana Inc.

Consolidated Statements of Cash Flows

Dollars in millions

 

     Three Months Ended March 31,     Dollar     Percentage  
     2013     2012     Change     Change  

Cash flows from operating activities

        

Net income

   $ 473      $ 248       

Adjustments to reconcile net income to net cash provided by operating activities:

        

Depreciation and amortization

     102        78       

Net realized capital gains

     (5     (4    

Stock-based compensation

     32        40       

Benefit from deferred income taxes

     —           (9    

Changes in operating assets and liabilities excluding the effects of acquisitions:

        

Receivables

     (588     (255    

Other assets

     (130     (138    

Benefits payable

     311        284       

Other liabilities

     190        52       

Unearned revenues

     13        2,034       

Other

     14        16       
  

 

 

   

 

 

     

Net cash provided by operating activities

     412        2,346      ($ 1,934     -82.4
  

 

 

   

 

 

     

Cash flows from investing activities

        

Acquisitions, net of cash acquired

     (5     (56    

Purchases of property and equipment

     (90     (86    

Purchases of investment securities

     (783     (714    

Proceeds from maturities of investment securities

     294        424       

Proceeds from sales of investment securities

     192        242       
  

 

 

   

 

 

     

Net cash used in investing activities

     (392     (190   ($ 202     -106.3
  

 

 

   

 

 

     

Cash flows from financing activities

        

Receipts from contract deposits, net

     236        298       

Repayment of long-term debt

     —           (36    

Change in book overdraft

     (34     (12    

Common stock repurchases

     (94     (151    

Excess tax benefit from stock-based compensation

     1        20       

Dividends paid

     (42     (41    

Proceeds from stock option exercises and other

     5        45       
  

 

 

   

 

 

     

Net cash provided by financing activities

     72        123      ($ 51     -41.5
  

 

 

   

 

 

     

Increase in cash and cash equivalents

     92        2,279       

Cash and cash equivalents at beginning of period

     1,306        1,377       
  

 

 

   

 

 

     

Cash and cash equivalents at end of period

   $ 1,398      $ 3,656       
  

 

 

   

 

 

     

 

S-11


Humana Inc.

Key Income Statement Ratios and Segment Operating Results

Dollars in millions

 

     Three Months Ended March 31,           Percentage  
     2013     2012     Difference     Change  

Benefit ratio

        

Retail

     85.9     87.5     -1.6  

Employer Group

     79.6     81.2     -1.6  

Other Businesses

     81.7     92.4     -10.7  

Consolidated

     83.0     85.4     -2.4  

Operating cost ratio

        

Retail

     8.9     10.4     -1.5  

Employer Group

     15.5     16.6     -1.1  

Healthcare Services

     95.7     95.6     0.1  

Other Businesses

     33.0     9.5     23.5  

Consolidated

     13.9     13.7     0.2  

Detail of pretax income

        

Retail

   $ 350      $ 128      $ 222        173.4

Employer Group

   $ 205      $ 129      $ 76        58.9

Healthcare Services

   $ 125      $ 125      $ 0        0.0

Other Businesses

   $ 58      $ 5      $ 53        1060.0

Consolidated

   $ 730      $ 390      $ 340        87.2

 

S-12


Humana Inc.

Healthcare Services Segment Metrics

 

     Quarter Ended      Quarter Ended               
     March 31, 2013      December 31, 2012      Difference        

Primary Care Providers:

          

Risk (D)

          

Owned / JV

     4,100         4,200         (100     -2.4

Contracted

     2,100         1,200         900        75.0

Path-to-Risk (E)

     21,600         18,200         3,400        18.7

Care Management Professionals:

          

Employed

     3,400         3,300         100        3.0

Contracted

     4,200         3,400         800        23.5
  

 

 

    

 

 

    

 

 

   

Total

     7,600         6,700         900        13.4
  

 

 

    

 

 

    

 

 

   

 

 

 

Care Management Statistics:

          

Number of members with complex chronic conditions in Humana Chronic Care Program

     180,300         151,100         29,200     

Number of high-risk discharges managed by Humana Transitions Program

     2,100         1,300         800     

 

S-13


Humana Inc.

Healthcare Services Segment Metrics (Continued)

Script volume in thousands

 

     Quarter Ended     Quarter ended              
     March 31, 2013     December 31, 2012     Difference        

Pharmacy:

        

Generic Dispense Rate

        

Retail

     86.2     85.9     0.3  

Employer Group

     79.3     78.1     1.2  

Total

     85.4     85.0     0.4  
  

 

 

   

 

 

   

 

 

   

Mail-Order Penetration

        

Retail

     22.9     22.2     0.7  

Employer Group

     14.6     14.6     0.0  

Total

     21.9     21.3     0.6  
  

 

 

   

 

 

   

 

 

   
                       Percentage  
                 Difference     Change  

Script volume

        

Retail

     58,900        54,100        4,800        8.9

Employer Group

     7,700        7,200        500        6.9
  

 

 

   

 

 

   

 

 

   

Total

     66,600        61,300        5,300        8.6
  

 

 

   

 

 

   

 

 

   

 

 

 

 

S-14


Humana Inc.

Membership Detail

In thousands

 

     Ending      Average      Ending      Year-over-year Change     Ending      Sequential Change  
     March 31, 2013      1Q13      March 31, 2012      Amount     Percent     December 31, 2012      Amount     Percent  

Medical Membership:

                    

Retail

                    

Medicare Advantage

     2,012.1         2,010.9         1,883.8         128.3        6.8     1,927.6         84.5        4.4

Medicare stand-alone PDPs

     3,202.3         3,197.7         2,940.6         261.7        8.9     3,052.7         149.6        4.9

Individual commercial

     460.8         453.7         442.0         18.8        4.3     444.0         16.8        3.8

State-based Medicaid

     73.3         76.2         46.1         27.2        59.0     52.1         21.2        40.7

Medicare Supplement

     87.6         87.1         67.3         20.3        30.2     77.4         10.2        13.2
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Retail

     5,836.1         5,825.6         5,379.8         456.3        8.5     5,553.8         282.3        5.1
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Employer Group

                    

Medicare Advantage fully-insured

     412.8         411.6         357.7         55.1        15.4     370.8         42.0        11.3

Medicare Advantage ASO

     0.0         0.0         28.1         (28.1     -100.0     27.7         (27.7     -100.0

Medicare stand-alone PDPs

     3.8         3.9         4.2         (0.4     -9.5     4.4         (0.6     -13.6

Fully-insured medical commercial

     1,197.8         1,203.2         1,182.8         15.0        1.3     1,211.8         (14.0     -1.2

ASO commercial

     1,200.8         1,204.3         1,236.6         (35.8     -2.9     1,237.7         (36.9     -3.0
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Employer Group

     2,815.2         2,823.0         2,809.4         5.8        0.2     2,852.4         (37.2     -1.3
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Other Businesses

                    

Military Services

     3,111.8         3,110.7         3,021.7         90.1        3.0     3,123.9         (12.1     -0.4

Puerto Rico Medicaid and other

     550.7         554.1         556.7         (6.0     -1.1     558.7         (8.0     -1.4
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Other Businesses

     3,662.5         3,664.8         3,578.4         84.1        2.4     3,682.6         (20.1     -0.5
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Medical Membership

     12,313.8         12,313.4         11,767.6         546.2        4.6     12,088.8         225.0        1.9
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Specialty Membership:

                    

Retail

                    

Dental—fully-insured

     687.7         672.2         626.0         61.7        9.9     691.5         (3.8     -0.5

Vision

     131.2         125.9         90.2         41.0        45.5     118.7         12.5        10.5

Other supplemental benefits (F)

     140.7         139.4         131.7         9.0        6.8     138.5         2.2        1.6
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Retail

     959.6         937.5         847.9         111.7        13.2     948.7         10.9        1.1
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Employer Group

                    

Dental—fully-insured

     2,503.9         2,510.0         2,386.2         117.7        4.9     2,446.4         57.5        2.4

Dental—ASO

     867.9         871.2         852.4         15.5        1.8     868.3         (0.4     0.0

Vision

     2,543.6         2,543.5         2,418.3         125.3        5.2     2,525.0         18.6        0.7

Other supplemental benefits (F)

     1,358.6         1,340.0         1,192.4         166.2        13.9     1,296.5         62.1        4.8
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Employer Group

     7,274.0         7,264.7         6,849.3         424.7        6.2     7,136.2         137.8        1.9
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Specialty Membership

     8,233.6         8,202.2         7,697.2         536.4        7.0     8,084.9         148.7        1.8
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

 

S-15


Humana Inc.

Premiums and Services Revenue Detail

Dollars in millions, except per member per month

 

                        Per Member per Month (G)  
     Three Months Ended March 31,      Dollar     Percentage     Three Months Ended March 31,  
     2013      2012      Change     Change     2013      2012  

Premiums and Services Revenue

               

Retail:

               

Medicare Advantage

   $ 5,736       $ 5,093       $ 643        12.6   $ 951       $ 924   

Medicare stand-alone PDPs

     761         726         35        4.8     79         83   

Individual commercial

     236         211         25        11.8     173         161   

State-based Medicaid

     79         46         33        71.7     346         321   

Medicare Supplemental

     43         33         10        30.3     165         165   

Specialty

     49         38         11        28.9     17         15   

ASO & other services (B)

     2         6         (4     -66.7     
  

 

 

    

 

 

    

 

 

        

Total Retail

     6,906         6,153         753        12.2     
  

 

 

    

 

 

    

 

 

        

Employer Group:

               

Medicare Advantage fully-insured

     1,190         1,025         165        16.1     964         956   

Medicare stand-alone PDPs

     2         2         —           0.0     

Fully-insured medical commercial

     1,268         1,242         26        2.1     351         349   

Specialty

     275         260         15        5.8     14         14   

ASO & other services (B)

     99         101         (2     -2.0     
  

 

 

    

 

 

    

 

 

        

Total Employer Group

     2,834         2,630         204        7.8     
  

 

 

    

 

 

    

 

 

        

Healthcare Services:

               

Pharmacy solutions

     3,094         2,933         161        5.5     

Provider services

     509         281         228        81.1     

Home care services

     83         36         47        130.6     

Integrated behavioral health

     32         34         (2     -5.9     
  

 

 

    

 

 

    

 

 

        

Total Healthcare Services

     3,718         3,284         434        13.2     
  

 

 

    

 

 

    

 

 

        

Other Businesses:

               

Military services (H)

     110         906         (796     -87.9     

Puerto Rico Medicaid and other (I)

     239         211         28        13.3     131         124   
  

 

 

    

 

 

    

 

 

        

Total Other Businesses

   $ 349       $ 1,117       $ (768     -68.8     
  

 

 

    

 

 

    

 

 

        

 

S-16


Humana Inc.

Medicare Summary

Premiums in millions, except per member per month

Membership in thousands

 

                                Per Member per Month (G)  
     Three Months Ended March 31,      Year-over-year Change     Three Months Ended March 31,  
     2013      2012      Amount      Percent     2013      2012  

Premiums

                

Medicare Advantage

   $ 6,926       $ 6,118       $ 808         13.2   $ 953       $ 929   

Medicare stand-alone PDPs

     763         728         35         4.8     79         83   
  

 

 

    

 

 

    

 

 

         

Total Medicare

   $ 7,689       $ 6,846       $ 843         12.3     
  

 

 

    

 

 

    

 

 

         

 

     Ending      Ending      Year-over-year Change  
     March 31, 2013      March 31, 2012      Amount     Percent  

Fully-Insured Membership

          

Medicare Advantage

     2,424.9         2,241.5         183.4        8.2

Medicare stand-alone PDPs

     3,206.1         2,944.8         261.3        8.9
  

 

 

    

 

 

    

 

 

   

Total Medicare

     5,631.0         5,186.3         444.7        8.6
  

 

 

    

 

 

    

 

 

   
                   Member Mix  
     Ending      Ending      March 31     March 31  
     March 31, 2013      March 31, 2012      2013     2012  

Retail Segment Detail

          

Medicare Advantage Membership

          

HMO

     1,015.0         910.8         50.4     48.3

PPO

     997.1         973.0         49.6     51.7
  

 

 

    

 

 

    

 

 

   

 

 

 

Total Individual Medicare

     2,012.1         1,883.8         100.0     100.0
  

 

 

    

 

 

    

 

 

   

 

 

 

Medicare Advantage Membership

          

Risk (D)

     530.3         497.9         26.3     26.4

Path-to-Risk (E)

     408.0         303.0         20.3     16.1

Other

     1,073.8         1,082.9         53.4     57.5
  

 

 

    

 

 

    

 

 

   

 

 

 

Total Individual Medicare

     2,012.1         1,883.8         100.0     100.0
  

 

 

    

 

 

    

 

 

   

 

 

 

 

S-17


Humana Inc.

Investments

Dollars in millions

 

 

     Fair value  
     3/31/2013      12/31/2012      3/31/2012  

Investment Portfolio:

        

Cash & cash equivalents

   $ 1,398       $ 1,306       $ 3,656   

Investment securities

     8,141         8,001         7,889   

Long-term investments

     1,824         1,846         1,704   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

   $ 11,363       $ 11,153       $ 13,249   
  

 

 

    

 

 

    

 

 

 

Duration (J)

     4.21         4.02         3.33   
  

 

 

    

 

 

    

 

 

 

Average Credit Rating

     AA-         AA-         AA-   
  

 

 

    

 

 

    

 

 

 

Investment Portfolio Detail:

        

Cash and cash equivalents

   $ 1,398       $ 1,306       $ 3,656   
  

 

 

    

 

 

    

 

 

 

U.S. Government and agency obligations

        

U.S. Treasury and agency obligations

     552         618         550   

U.S. Government residential mortgage-backed

     1,585         1,569         1,725   

U.S. Government commercial mortgage-backed

     33         34         33   
  

 

 

    

 

 

    

 

 

 

Total U.S. Government and agency obligations

     2,170         2,221         2,308   
  

 

 

    

 

 

    

 

 

 

Tax-exempt municipal securities

        

Pre-refunded

     322         311         304   

Insured

     613         627         645   

Other

     2,235         2,120         1,928   

Auction rate securities

     13         13         15   
  

 

 

    

 

 

    

 

 

 

Total tax-exempt municipal securities

     3,183         3,071         2,892   
  

 

 

    

 

 

    

 

 

 

Residential mortgage-backed

        

Prime residential mortgages

     29         32         38   

Alt-A residential mortgages

     1         1         2   

Sub-prime residential mortgages

     1         1         1   
  

 

 

    

 

 

    

 

 

 

Total residential mortgage-backed

     31         34         41   
  

 

 

    

 

 

    

 

 

 

Commercial mortgage-backed

     694         659         437   
  

 

 

    

 

 

    

 

 

 

Asset-backed securities

     85         68         74   
  

 

 

    

 

 

    

 

 

 

Corporate securities

        

Financial services

     889         864         867   

Other

     2,913         2,930         2,974   
  

 

 

    

 

 

    

 

 

 

Total corporate securities

     3,802         3,794         3,841   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

   $ 11,363       $ 11,153       $ 13,249   
  

 

 

    

 

 

    

 

 

 

 

S-18


Humana Inc.

Detail of Benefits Payable Balance and Year-to-Date Changes

Dollars in millions

 

     March 31,     March 31,     December 31,  
     2013     2012     2012  

Detail of benefits payable

      

IBNR and other benefits payable (K)

   $ 3,442      $ 2,918      $ 3,158   

Unprocessed claim inventories (L)

     327        376        302   

Processed claim inventories (M)

     150        262        230   

Payable to pharmacy benefit administrator (N)

     169        199        85   
  

 

 

   

 

 

   

 

 

 

Benefits payable, excluding military services

     4,088        3,755        3,775   

Military services benefits payable (O)

     2        353        4   
  

 

 

   

 

 

   

 

 

 

Total Benefits Payable

   $ 4,090      $ 4,108      $ 3,779   
  

 

 

   

 

 

   

 

 

 
     Three Months Ended     Three Months Ended     Year Ended  
     March 31, 2013     March 31, 2012     December 31, 2012  

Year-to-date changes in benefits payable, excluding military services (P)

      

Balances at January 1

   $ 3,775      $ 3,415      $ 3,415   

Acquisitions

     —          70        66   

Incurred related to:

      

Current year

     8,476        7,652        30,198   

Prior years (Q)

     (266     (141     (257
  

 

 

   

 

 

   

 

 

 

Total incurred

     8,210        7,511        29,941   
  

 

 

   

 

 

   

 

 

 

Paid related to:

      

Current year

     (5,255     (4,795     (26,738

Prior years

     (2,642     (2,446     (2,909
  

 

 

   

 

 

   

 

 

 

Total paid

     (7,897     (7,241     (29,647
  

 

 

   

 

 

   

 

 

 

Balances at end of period

   $ 4,088      $ 3,755      $ 3,775   
  

 

 

   

 

 

   

 

 

 
     Three Months Ended     Three Months Ended     Year Ended  
     March 31, 2013     March 31, 2012     December 31, 2012  

Summary of Consolidated Benefit Expense:

      

Total benefit expense incurred, per above

   $ 8,210      $ 7,511      $ 29,941   

Military services benefit expense

     (40     813        908   

Future policy benefit expense (R)

     25        26        136   
  

 

 

   

 

 

   

 

 

 

Consolidated Benefit Expense

   $ 8,195      $ 8,350      $ 30,985   
  

 

 

   

 

 

   

 

 

 

 

S-19


Humana Inc.

Benefits Payable Statistics (S)

Receipt Cycle Time (T)

 

     2013      2012      Change     Percentage
Change
 

1st Quarter Average

     12.5         13.0         (0.5     -3.8

2nd Quarter Average

        13.7         n/a        n/a   

3rd Quarter Average

        13.0         n/a        n/a   

4th Quarter Average

        12.8         n/a        n/a   
  

 

 

    

 

 

    

 

 

   

Full Year Average

     12.5         13.1         (0.6     -4.6
  

 

 

    

 

 

    

 

 

   

Unprocessed Claims Inventories

 

Date

   Estimated Valuation
(millions)
     Claim Item
Counts (000s)
     Number of Days
on Hand
 

3/31/2011

   $ 482         1,197         6.0   

6/30/2011

   $ 410         1,093         5.1   

9/30/2011

   $ 419         1,272         5.7   

12/31/2011

   $ 280         599         2.8   

3/31/2012

   $ 376         1,028         4.2   

6/30/2012

   $ 310         1,077         4.2   

9/30/2012

   $ 380         1,440         5.7   

12/31/2012

   $ 302         1,061         4.1   
  

 

 

    

 

 

    

 

 

 

3/31/2013

   $ 327         1,247         4.7   
  

 

 

    

 

 

    

 

 

 

 

S-20


Humana Inc.

Benefits Payable Statistics (Continued) (S)

Days in Claims Payable (U)

 

Quarter Ended

   Days in Claims
Payable (DCP)
     Change Last 4
Quarters
    Percentage
Change
 

3/31/2011

     55.5         1.3        2.4

6/30/2011

     56.0         (1.0     -1.8

9/30/2011

     54.2         (3.6     -6.2

12/31/2011

     52.5         (1.0     -1.9

3/31/2012

     50.1         (5.4     -9.7

6/30/2012

     51.0         (5.0     -8.9

9/30/2012

     51.6         (2.6     -4.8

12/31/2012

     48.5         (4.0     -7.6
  

 

 

    

 

 

   

 

 

 

3/31/2013

     49.0         (1.1     -2.2
  

 

 

    

 

 

   

 

 

 

Year-to-Date Change in Days in Claims Payable (V)

 

     2013     2012  

DCP—beginning of period

     48.5        52.5   

Components of change in DCP:

    

Change in unprocessed claims inventories

     0.3        (0.1

Change in processed claims inventories

     1.1        0.3   

Change in pharmacy payment cutoff

     —          (0.1

Change in capitation/provider settlements

     (0.8     (4.3

All other

     (0.1     0.2   
  

 

 

   

 

 

 

DCP—end of period

     49.0        48.5   
  

 

 

   

 

 

 

 

S-21


Humana Inc.

Footnotes to Statistical Schedules and Supplementary Information

1Q13 Earnings Release

 

(A) The Medicaid and other category includes the company’s Medicaid business as well as the closed block of long-term care.
(B) The ASO and other category is primarily comprised of ASO fees and other ancillary services fees.
(C) Beginning on January 1, 2013, the company reclassified certain businesses and renamed its Health and Well-Being Services segment as Healthcare Services. Prior periods were recast to conform to the current presentation.
(D) In certain circumstances, the company contracts with providers to accept financial risk for a defined set of Medicare Advantage membership. In transferring this risk, the company prepays these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their Medicare Advantage members assigned or attributed to their provider panel, including some health benefit administrative functions and claims processing. For these capitated arrangements, the company generally agrees to payment rates that target a benefit expense ratio. The result is a high level of engagement on the part of the provider and, we believe, better quality care for the member.
(E) A path-to-risk provider is one who has a high level of engagement and participates in one of Humana’s pay-for-performance programs (Model Practice or Medical Home) or has a risk contract in place with a trigger (future date or membership threshold) which has not yet been met. In addition to earning incentives, these providers may also have a shared savings component by which they can share in achieved surpluses when the actual cost of the medical services provided to patients assigned or attributed to their panel is less than the agreed upon medical expense target.
(F) Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies.
(G) Computed based on average membership for the period (i.e., monthly ending membership during the period divided by the number of months in the period).
(H) Military services revenues are generally not contracted on a per-member basis.
(I) Includes premiums associated with Puerto Rico Medicaid and the closed block of long-term care as well as services revenue.
(J) Duration is the time-weighted average of the present value of the fixed income portfolio cash flows.
(K) IBNR represents an estimate of benefits expense payable for claims incurred but not reported (IBNR) at the balance sheet date. The level of IBNR is primarily impacted by membership levels, benefit claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received (i.e. a shorter time span results in lower reserves for claims IBNR). Other benefits payable includes amounts payable to providers under capitation arrangements.
(L) Unprocessed claim inventories represent the estimated valuation of claims received but not yet fully processed.
(M) Processed claim inventories represent the estimated valuation of processed claims that are in the post-claim-adjudication process, which consists of operating functions such as audit and check batching and handling.
(N)

The balance due to the company’s pharmacy benefit administrator fluctuates as a result of the number of business days in the last payment cycle of the month. Payment cycles are every 8 days (8th, 16th, and 24th of month) and the last day of the month.

(O) Military services benefits payable primarily consist of IBNR related to the company’s previous contract that expired on March 31, 2012.
(P) The table excludes activity associated with military services benefits payable related to the previous contract that expired March 31, 2012.
(Q) Amounts incurred related to prior years vary from previously estimated liabilities as the claims ultimately are settled. Negative amounts reported for incurred related to prior years result from claims being ultimately settled for amounts less than originally estimated (favorable development). There were no changes in the approach used to determine the company’s estimate of medical claim reserves during the quarter.
(R) Future policy benefit expense has a related liability classified as a long-term liability on the balance sheet.
(S) Benefits reserves statistics represents fully-insured medical claims data and excludes military services claims data and specialty benefits.
(T) The receipt cycle time measures the average length of time between when a claim was initially incurred and when the claim form was received. Receipt cycle time data for the company’s largest claim processing platforms represent approximately 93% of the company’s fully-insured medical claims volume. Pharmacy and specialty claims, including dental, vision and other supplemental benefits, are excluded from this measurement.
(U) A common metric for monitoring benefits payable levels relative to the benefit expense is days in claims payable, or DCP, which represents the benefits payable at the end of the period divided by average benefits expense per day in the quarterly period.
(V) DCP fluctuates due to a number of factors, the more significant of which are detailed in this roll forward. Growth in certain product lines can also impact DCP for the quarter since a provision for claims would not have been recorded for members that had not yet enrolled earlier in the quarter, yet those members would have a provision and corresponding medical claims reserve recorded upon enrollment later in the quarter. This analysis excludes the impact upon DCP of military services and Medicare stand-alone PDPs.

 

S-22