26.04.2010 10:00:00
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Humana Reports First Quarter Financial Results
Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended March 31, 2010 (1Q10) of $1.52, ahead of management’s guidance of $1.10 to $1.20. EPS for 1Q10 included earnings of approximately $0.37 per share from higher-than-anticipated favorable prior-period development of medical claims reserves as well as $0.04 per share in higher-than-projected income tax expense due to recently enacted health reform legislation. Excluding these items, 1Q10 EPS was at the top end of the company’s previous guidance range. The 1Q10 results compared to EPS of $1.22 for the quarter ended March 31, 2009 (1Q09).
The company also announced that it had raised its EPS projection for the year ending December 31, 2010 (FY10) to a range of $5.55 to $5.65 versus its previous EPS estimate of $5.15 to $5.35 primarily to reflect the impact of the favorable prior-period reserve development impacting 1Q10 earnings noted above, partially offset by the higher effective tax rate now anticipated.
"Our first quarter results demonstrate solid execution in both of our business segments,” said Michael B. McCallister, Humana’s president and chief executive officer. "We believe strategic and tactical initiatives over the past several years, together with our continued focus on the consumer, position us well for the remainder of 2010 and for the challenges of the post-health-reform environment.”
Consolidated Highlights
Revenues – 1Q10 consolidated revenues rose 9.5 percent to $8.44 billion from $7.71 billion in 1Q09, with total premium and administrative services fees up 9.2 percent compared to the prior year’s quarter. The year-over-year increase in premiums and administrative services fees primarily reflects a 19 percent increase in average membership for the company’s Medicare Advantage plans and continued pricing discipline across all of the company’s lines of business, partially offset by lower average stand-alone Prescription Drug Plan (PDP) and commercial fully-insured medical membership.
Benefit expenses – The 1Q10 consolidated benefit ratio (benefit expenses as a percent of premium revenues) of 83.4 percent compares to 83.9 percent in 1Q09. This 50 basis point decrease was driven by declines in the benefit ratio in both of the company’s business segments.
Selling, general, & administrative (SG&A) expenses – The 1Q10 consolidated SG&A expense ratio (SG&A expenses as a percent of premiums, administrative services fees and other revenue) of 13.5 percent decreased 40 basis points compared to the 1Q09 ratio of 13.9 percent due primarily to efficiencies associated with higher average Medicare Advantage membership together with the company’s continued focus on administrative cost reductions.
Government Segment Results
Pretax results:
- Government segment pretax income increased to $279.2 million in 1Q10 from $166.1 million in 1Q09. The 1Q10 results included the benefit of $85.9 million in favorable prior-period reserve development and also reflected higher average Medicare Advantage membership year over year as well as improved operating metrics.
Enrollment:
- Medicare Advantage membership grew to 1,742,300 at March 31, 2010, an increase of 273,400 members, or 19 percent from March 31, 2009, and up 233,800, or 16 percent versus December 31, 2009.
- April 2010 membership in the company’s Medicare Advantage plans approximated 1,750,900, with 72 percent of fully-insured members in network-based products, up from 63 percent at December 31, 2009.
- Membership in the company’s stand-alone PDPs totaled 1,917,100 at March 31, 2010 compared to 2,078,900 at March 31, 2009 and 1,927,900 at December 31, 2009. The decline during 1Q10 primarily resulted from the company’s continued competitive positioning as it realigned stand-alone PDP premium and benefit designs to correspond with its pharmacy claims experience.
- Military services membership at March 31, 2010 of 3,031,400 was up approximately 1 percent from 2,990,600 at March 31, 2009 and essentially unchanged from 3,034,400 at December 31, 2009.
Premiums and administrative services fees:
- Medicare Advantage premiums and administrative service fees of $4.82 billion in 1Q10 increased 19 percent compared to $4.06 billion in 1Q09, primarily due to a 19 percent increase in average Medicare Advantage membership.
- Medicare stand-alone PDP premiums of $579.0 million in 1Q10 decreased 3 percent compared to $595.7 million in 1Q09, reflecting a 13 percent decline in average membership year over year, partially offset by an 11 percent increase in premiums per member per month.
- Military services premiums and administrative services fees during 1Q10 decreased $22.1 million to $867.3 million compared to $889.4 million in 1Q09.
Benefit Expenses:
- The Government Segment benefit ratio decreased 80 basis points to 86.0 percent in 1Q10 compared to 86.8 percent in the prior year’s quarter, primarily driven by a 130 basis point benefit from higher-than-anticipated favorable prior-period reserve development. The increase in the benefit ratio excluding this favorable reserve development is primarily due to growth in the company’s Medicare Advantage group business which generally carries a higher benefit ratio than the company’s individual Medicare Advantage business.
SG&A Expenses:
- The Government Segment’s SG&A expense ratio decreased 40 basis points to 10.1 percent in 1Q10 compared to 10.5 percent in the prior year’s quarter driven primarily by increased efficiencies from higher average medical membership in the company’s Medicare Advantage plans and the company’s continued focus on administrative cost reductions.
Commercial Segment Results
Pretax results:
- Commercial Segment pretax earnings increased to $137.8 million in 1Q10 compared to $127.7 million in 1Q09 primarily driven by the benefit of $14.1 million in higher-than-anticipated favorable prior-period reserve development during 1Q10, partially offset by the effect of an 8 percent decline in average fully-insured commercial medical membership from the prior year’s quarter.
Enrollment:
- Commercial Segment medical membership at March 31, 2010 of 3,331,500 was down 140,000 from March 31, 2009 and down 79,300 from December 31, 2009. The decline during 1Q10 primarily reflected the impact of the economy across various of the company’s fully-insured group medical lines of business.
- The company’s individual product line has continued to grow steadily, with membership of 370,500, up 10 percent at March 31, 2010 compared to March 31, 2009.
- Membership in Commercial Segment specialty products(a) of 7,237,900 at March 31, 2010 increased 11 percent from 6,535,100 at March 31, 2009 and up 2 percent from 7,109,900 at December 31, 2009.
Premiums and administrative services fees:
- Premiums and administrative services fees for the Commercial Segment decreased 2 percent to $1.85 billion in 1Q10 compared to $1.88 billion in the prior year’s quarter, reflecting lower average medical membership partially offset by continued pricing discipline.
- Commercial Segment medical premiums for fully-insured group accounts increased approximately 8 percent on a per-member basis during 1Q10 compared to 1Q09.
Benefit Expenses:
- The Commercial Segment benefit ratio for 1Q10 of 74.1 percent was 60 basis points lower than the 1Q09 benefit ratio of 74.7 percent, primarily due to an 80 basis point benefit from higher-than-expected favorable prior-period reserve development during 1Q10.
SG&A Expenses:
- The Commercial Segment SG&A expense ratio of 24.8 percent for 1Q10 compares to 24.1 percent in 1Q09, primarily driven by increases in the company’s specialty, ancillary and individual medical businesses that carry a higher administrative expense load as a percent of revenues, partially offset by the company’s continued focus on administrative cost reductions.
Balance Sheet
- At March 31, 2010, the company had cash, cash equivalents, and investment securities of $9.91 billion, up 9 percent from $9.11 billion at December 31, 2009 and up 33 percent from $7.43 billion at March 31, 2009.
- Parent company cash and investments of $729.8 million at March 31, 2010 increased $64.2 million from $665.6 million at December 31, 2009.
- Debt-to-total capitalization at March 31, 2010 was 21.6 percent, down 90 basis points from December 31, 2009 due primarily to the increase in capitalization associated with net income during 1Q10.
Cash Flows from Operations
Cash flows provided by operations for 1Q10 of $754.7 million compared to cash flows provided by operations of $45.5 million in 1Q09 with the year-over-year increase primarily due to higher medical claims reserve balances associated with higher average Medicare Advantage membership and increased claims inventories on hand together with other working capital changes during 1Q10 versus the prior year’s quarter.
Footnote
(a) |
The Commercial Segment provides a full range of insured specialty products including dental, vision and other supplemental 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. | |
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 approximately 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 approximately 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,” "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:
- Recently enacted health care 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 lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible federal premium tax; financial position, including goodwill recoverability; and cash flows. In addition, if the new non-deductible federal premium tax is imposed as enacted, and if Humana is unable to adjust its business model to address this new tax, there can be no assurance that the non-deductible federal premium tax would not have a material adverse effect on the company’s results of operations, financial position, and cash flows.
- If Humana does not design and price its products properly and competitively, if the premiums Humana charges are insufficient to cover the cost of health care services delivered to its members, or if its estimates of benefit expenses 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 that is extremely sensitive to payment patterns and medical cost trends.
- If Humana fails to effectively implement its operational and strategic initiatives, including its Medicare initiatives, the company’s business may be materially adversely affected, which is of particular importance given the concentration of the company’s revenues in the Medicare business.
- If Humana fails to properly maintain the integrity of its data, to strategically implement new information systems, or to protect Humana’s proprietary rights to its systems, the company’s business may be materially adversely affected.
- Humana is involved in various legal actions, which, if resolved unfavorably to Humana, could result in substantial monetary damages. Increased litigation and negative publicity could increase the company’s cost of doing business.
- 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 financial condition. In addition, as a government contractor, Humana is exposed to additional risks that may adversely affect the company’s business or the company’s willingness to participate in government health care programs.
- Any failure to manage administrative 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 mail order 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, 2009;
- Form 8-Ks filed during 2010.
About Humana
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.4 million medical members and 7.2 million specialty members. Humana is a full-service benefits solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals.
Over its 49-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.
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.
(in accordance with Accounting Principles) |
For the year ending December 31, 2010 |
Comments |
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Diluted earnings per |
Full year 2010: $5.55 to $5.65 |
FY2010 estimate includes $0.37 per share in higher-than- |
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Revenues | Consolidated revenues: $33.5 billion to $34.5 billion | |||||
Premiums and ASO fees: | ||||||
Medicare Advantage: $19.0 billion to $19.5 billion |
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Medicare stand-alone PDPs: $2.3 billion to $2.4 billion |
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Military services: $3.5 billion to $3.6 billion |
Assumes a 3/31/11 transition date for the South Region |
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Commercial Segment: $7.3 billion to $7.5 billion |
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Consolidated investment income: $325 million to $340 million |
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Consolidated other revenue: $320 million to $340 million |
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Ending medical membership | Medicare Advantage: up 250,000 to 260,000 from prior year |
Includes ASO and fully-insured group and individual |
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Medicare stand-alone PDPs: down approximately 220,000 from |
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Military services: no material change from prior year |
Fully-insured and ASO combined; assumes 3/31/11 |
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Medicaid: no material change from prior year |
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Commercial: | ||||||
Fully insured: down 170,000 to 180,000 from prior year |
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ASO: down 90,000 to 100,000 from prior year |
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Benefit ratios and benefit | Government Segment benefit ratio in the range of 85% to 86% | Medicare, Medicaid, and Military Services combined | ||||
expense trend |
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components |
Medicare benefit ratio in the range of 84% to 85% |
Medicare Advantage and Stand-Alone PDP combined | ||||
Commercial Segment benefit ratio in the range of 80% to 81% | Medical and Specialty combined | |||||
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Commercial group fully-insured secular benefit expense trend |
Commercial group fully-insured secular trends of |
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Selling, general & |
13% to 13.5% |
SG&A expenses as a percent of premiums, administrative |
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Depreciation & amortization | $250 million to $260 million | |||||
Interest expense | $105 million to $110 million | |||||
Government Segment |
Medicare pretax operating margin: approximately 5.5% |
Medicare Advantage & stand-alone PDP combined; |
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Military services: operating earnings of $25 million to $50 million |
Military Services earnings include the anticipated impact of |
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Commercial Segment pretax |
$150 million to $175 million |
Includes $14 million in pretax earnings from higher-than- |
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Cash flows from operations | $1.2 billion to $1.4 billion | |||||
Capital expenditures | Approximately $200 million | |||||
Effective tax rate | 37.0% to 37.5% |
Includes the impact of health reform provisions disallowing |
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Shares used in computing |
Approximately 171 million | Excludes impact of potential future share repurchases |
Humana Inc. |
Statistical Schedules |
And |
Supplementary Information |
1Q10 Earnings Release |
S-1 |
Humana Inc. | |||||
Statistical Schedules and Supplementary Information | |||||
1Q10 Earnings Release | |||||
Contents | |||||
Page |
Description |
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S-3 | Consolidated Statements of Income | ||||
S-4 | Consolidated Balance Sheets | ||||
S-5 | Consolidated Statements of Cash Flows | ||||
S-6 | Key Income Statement Ratios and Segment Operating Results | ||||
S-7 | Membership Detail | ||||
S-8 | Premiums and Administrative Services Fees Detail | ||||
S-9 | Percentage of Ending Membership under Capitation Arrangements | ||||
S-10 | Investments | ||||
S-11-13 | Benefits Payable | ||||
S-14 | Footnotes | ||||
S-2 |
Humana Inc. | |||||||||||||||||
Consolidated Statements of Income | |||||||||||||||||
In thousands, except per common share results | |||||||||||||||||
Three Months Ended March 31, | |||||||||||||||||
Dollar | Percentage | ||||||||||||||||
2010 | 2009 | Change | Change | ||||||||||||||
Revenues: | |||||||||||||||||
Premiums | $ | 8,161,863 | $ | 7,471,294 | $ | 690,569 | 9.2 | % | |||||||||
Administrative services fees | 125,882 | 115,882 | 10,000 | 8.6 | % | ||||||||||||
Investment income | 85,455 | 69,544 | 15,911 | 22.9 | % | ||||||||||||
Other revenue | 67,394 | 54,941 | 12,453 | 22.7 | % | ||||||||||||
Total revenues | 8,440,594 | 7,711,661 | 728,933 | 9.5 | % | ||||||||||||
Operating expenses: | |||||||||||||||||
Benefits | 6,807,555 | 6,269,310 | 538,245 | 8.6 | % | ||||||||||||
Selling, general and administrative | 1,127,043 | 1,063,803 | 63,240 | 5.9 | % | ||||||||||||
Depreciation | 53,189 | 48,676 | 4,513 | 9.3 | % | ||||||||||||
Other intangible amortization | 9,567 | 9,338 | 229 | 2.5 | % | ||||||||||||
Total operating expenses | 7,997,354 | 7,391,127 | 606,227 | 8.2 | % | ||||||||||||
Income from operations | 443,240 | 320,534 | 122,706 | 38.3 | % | ||||||||||||
Interest expense | 26,314 | 26,772 | (458 | ) | -1.7 | % | |||||||||||
Income before income taxes | 416,926 | 293,762 | 123,164 | 41.9 | % | ||||||||||||
Provision for income taxes | 158,158 | 88,045 | 70,113 | 79.6 | % | ||||||||||||
Net income | $ | 258,768 | $ | 205,717 | $ | 53,051 | 25.8 | % | |||||||||
Basic earnings per common share | $ | 1.54 | $ | 1.23 | $ | 0.31 | 25.2 | % | |||||||||
Diluted earnings per common share | $ | 1.52 | $ | 1.22 | $ | 0.30 | 24.6 | % | |||||||||
Shares used in computing basic earnings per common share | 168,200 | 167,043 | |||||||||||||||
Shares used in computing diluted earnings per common share | 170,080 | 168,658 | |||||||||||||||
S-3 |
Humana Inc. | ||||||||||||||||||
Consolidated Balance Sheets | ||||||||||||||||||
Dollars in thousands, except share amounts | ||||||||||||||||||
March 31, | December 31, | Sequential Change | ||||||||||||||||
2010 | 2009 | Dollar | Percent | |||||||||||||||
Assets | ||||||||||||||||||
Current assets: | ||||||||||||||||||
Cash and cash equivalents | $ | 1,813,993 | $ | 1,613,588 | ||||||||||||||
Investment securities | 6,764,833 | 6,190,062 | ||||||||||||||||
Receivables, net: | ||||||||||||||||||
Premiums | 1,091,372 | 811,800 | ||||||||||||||||
Administrative services fees | 13,226 | 11,820 | ||||||||||||||||
Securities lending invested collateral | 62,013 | 119,586 | ||||||||||||||||
Other | 514,549 | 505,960 | ||||||||||||||||
Total current assets | 10,259,986 | 9,252,816 | $ | 1,007,170 | 10.9 | % | ||||||||||||
Property and equipment, net | 665,909 | 679,142 | ||||||||||||||||
Long-term investment securities | 1,333,659 | 1,307,088 | ||||||||||||||||
Goodwill | 1,992,924 | 1,992,924 | ||||||||||||||||
Other | 956,658 | 921,524 | ||||||||||||||||
Total assets | $ | 15,209,136 | $ | 14,153,494 | $ | 1,055,642 | 7.5 | % | ||||||||||
Liabilities and Stockholders' Equity | ||||||||||||||||||
Current liabilities: | ||||||||||||||||||
Benefits payable | $ | 3,707,033 | $ | 3,222,574 | ||||||||||||||
Trade accounts payable and accrued expenses | 1,658,985 | 1,307,710 | ||||||||||||||||
Book overdraft | 236,038 | 374,464 | ||||||||||||||||
Securities lending payable | 68,221 | 126,427 | ||||||||||||||||
Unearned revenues | 235,584 | 228,817 | ||||||||||||||||
Total current liabilities | 5,905,861 | 5,259,992 | $ | 645,869 | 12.3 | % | ||||||||||||
Long-term debt | 1,675,880 | 1,678,166 | ||||||||||||||||
Future policy benefits payable | 1,213,179 | 1,193,047 | ||||||||||||||||
Other long-term liabilities | 328,979 | 246,286 | ||||||||||||||||
Total liabilities | 9,123,899 | 8,377,491 | $ | 746,408 | 8.9 | % | ||||||||||||
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; 189,981,964 issued at March 31, 2010 |
31,664 | 31,634 | ||||||||||||||||
Capital in excess of par value | 1,688,768 | 1,658,521 | ||||||||||||||||
Retained earnings | 4,688,379 | 4,429,611 | ||||||||||||||||
Accumulated other comprehensive income | 69,994 | 42,135 | ||||||||||||||||
Treasury stock, at cost, 19,784,653 shares at March 31, 2010 |
(393,568 | ) | (385,898 | ) | ||||||||||||||
Total stockholders' equity | 6,085,237 | 5,776,003 | $ | 309,234 | 5.4 | % | ||||||||||||
Total liabilities and stockholders' equity | $ | 15,209,136 | $ | 14,153,494 | $ | 1,055,642 | 7.5 | % | ||||||||||
Debt-to-total capitalization ratio | 21.6 | % | 22.5 | % | ||||||||||||||
S-4 |
Humana Inc. | |||||||||||||||||||
Consolidated Statements of Cash Flows | |||||||||||||||||||
Dollars in thousands | |||||||||||||||||||
Three Months Ended March 31, | |||||||||||||||||||
Dollar | Percentage | ||||||||||||||||||
2010 | 2009 | Change | Change | ||||||||||||||||
Cash flows from operating activities | |||||||||||||||||||
Net income | $ | 258,768 | $ | 205,717 | |||||||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | |||||||||||||||||||
Depreciation and amortization | 62,756 | 58,014 | |||||||||||||||||
Net realized capital gains | (8,694 | ) | (1,043 | ) | |||||||||||||||
Stock-based compensation | 27,339 | 15,676 | |||||||||||||||||
(Benefit) provision from deferred income taxes | (20,862 | ) | 19,687 | ||||||||||||||||
Changes in operating assets and liabilities excluding the effects of acquisitions: |
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Receivables | (280,978 | ) | (255,098 | ) | |||||||||||||||
Other assets | (29,177 | ) | (61,907 | ) | |||||||||||||||
Benefits payable | 484,459 | 32,920 | |||||||||||||||||
Other liabilities | 246,068 | 22,375 | |||||||||||||||||
Unearned revenues | 6,767 | 3,364 | |||||||||||||||||
Other | 8,205 | 5,815 | |||||||||||||||||
Net cash provided by operating activities | 754,651 | 45,520 | $ | 709,131 | 1557.8 | % | |||||||||||||
Cash flows from investing activities | |||||||||||||||||||
Acquisitions, net of cash acquired | - | (12,367 | ) | ||||||||||||||||
Purchases of property and equipment | (39,028 | ) | (39,047 | ) | |||||||||||||||
Purchases of investment securities | (1,525,349 | ) | (1,403,906 | ) | |||||||||||||||
Proceeds from maturities of investment securities | 433,788 | 404,951 | |||||||||||||||||
Proceeds from sales of investment securities | 545,166 | 722,288 | |||||||||||||||||
Change in securities lending collateral | 58,206 | 71,283 | |||||||||||||||||
Net cash used in investing activities | (527,217 | ) | (256,798 | ) | ($270,419 | ) | -105.3 | % | |||||||||||
Cash flows from financing activities | |||||||||||||||||||
Receipts from CMS contract deposits | 438,108 | 528,965 | |||||||||||||||||
Withdrawals from CMS contract deposits | (266,649 | ) | (334,528 | ) | |||||||||||||||
Change in book overdraft | (138,426 | ) | 33,520 | ||||||||||||||||
Change in securities lending payable | (58,206 | ) | (71,283 | ) | |||||||||||||||
Common stock repurchases | (7,670 | ) | (5,999 | ) | |||||||||||||||
Excess tax benefit from stock-based compensation | 734 | 148 | |||||||||||||||||
Proceeds from stock option exercises and other | 5,080 | 1,234 | |||||||||||||||||
Net cash (used in) provided by financing activities | (27,029 | ) | 152,057 | ($179,086 | ) | -117.8 | % | ||||||||||||
Increase (decrease) in cash and cash equivalents | 200,405 | (59,221 | ) | ||||||||||||||||
Cash and cash equivalents at beginning of period | 1,613,588 | 1,970,423 | |||||||||||||||||
Cash and cash equivalents at end of period | $ | 1,813,993 | $ | 1,911,202 | |||||||||||||||
S-5 |
Humana Inc. | |||||||||||||||||||
Key Income Statement Ratios and Segment Operating Results | |||||||||||||||||||
Dollars in thousands | |||||||||||||||||||
Three Months Ended March 31, | |||||||||||||||||||
Percentage | |||||||||||||||||||
2010 | 2009 | Difference | Change | ||||||||||||||||
Benefit ratio | |||||||||||||||||||
Government Segment | 86.0 | % | 86.8 | % | -0.8 | % | |||||||||||||
Commercial Segment | 74.1 | % | 74.7 | % | -0.6 | % | |||||||||||||
Consolidated | 83.4 | % | 83.9 | % | -0.5 | % | |||||||||||||
Selling, general, and administrative expense ratio (A) |
|||||||||||||||||||
Government Segment | 10.1 | % | 10.5 | % | -0.4 | % | |||||||||||||
Commercial Segment | 24.8 | % | 24.1 | % | 0.7 | % | |||||||||||||
Consolidated | 13.5 | % | 13.9 | % | -0.4 | % | |||||||||||||
Investment income | |||||||||||||||||||
Government Segment | $ | 56,169 | $ | 40,782 | $ | 15,387 | 37.7 | % | |||||||||||
Commercial Segment | 29,286 | 28,762 | 524 | 1.8 | % | ||||||||||||||
Consolidated | $ | 85,455 | $ | 69,544 | $ | 15,911 | 22.9 | % | |||||||||||
Interest expense | |||||||||||||||||||
Government Segment | $ | 19,781 | $ | 16,488 | $ | 3,293 | 20.0 | % | |||||||||||
Commercial Segment | 6,533 | 10,284 | (3,751 | ) | -36.5 | % | |||||||||||||
Consolidated | $ | 26,314 | $ | 26,772 | ($458 | ) | -1.7 | % | |||||||||||
Detail of pretax income | |||||||||||||||||||
Government Segment | $ | 279,173 | $ | 166,101 | $ | 113,072 | 68.1 | % | |||||||||||
Commercial Segment | 137,753 | 127,661 | 10,092 | 7.9 | % | ||||||||||||||
Consolidated | $ | 416,926 | $ | 293,762 | $ | 123,164 | 41.9 | % | |||||||||||
Detail of pretax margins | |||||||||||||||||||
Government Segment | 4.3 | % | 2.9 | % | 1.4 | % | |||||||||||||
Commercial Segment | 7.1 | % | 6.5 | % | 0.6 | % | |||||||||||||
Consolidated | 4.9 | % | 3.8 | % | 1.1 | % | |||||||||||||
S-6 |
Humana Inc. | ||||||||||||||||||||||||||||
Membership Detail | ||||||||||||||||||||||||||||
In thousands | ||||||||||||||||||||||||||||
Ending |
Average |
Ending | Year-over-year Change | Ending | Sequential Change | |||||||||||||||||||||||
March 31, 2010 |
1Q10 |
March 31, 2009 | Amount | Percent | December 31, 2009 | Amount | Percent | |||||||||||||||||||||
Medical Membership: | ||||||||||||||||||||||||||||
Government Segment: | ||||||||||||||||||||||||||||
Medicare Advantage - HMO | 629.8 | 627.5 | 578.6 | 51.2 | 8.8 | % | 591.9 | 37.9 | 6.4 | % | ||||||||||||||||||
Medicare Advantage - PPO | 602.6 | 594.5 | 313.2 | 289.4 | 92.4 | % | 352.4 | 250.2 | 71.0 | % | ||||||||||||||||||
Medicare Advantage - PFFS | 480.9 | 483.7 | 577.1 | (96.2 | ) | -16.7 | % | 564.2 | (83.3 | ) | -14.8 | % | ||||||||||||||||
Total MA fully-insured | 1,713.3 | 1,705.7 | 1,468.9 | 244.4 | 16.6 | % | 1,508.5 | 204.8 | 13.6 | % | ||||||||||||||||||
ASO | 29.0 | 29.3 | - | 29.0 | - | 29.0 | ||||||||||||||||||||||
Total Medicare Advantage | 1,742.3 | 1,735.0 | 1,468.9 | 273.4 | 18.6 | % | 1,508.5 | 233.8 | 15.5 | % | ||||||||||||||||||
Medicare stand-alone PDPs | 1,917.1 | 1,844.4 | 2,078.9 | (161.8 | ) | -7.8 | % | 1,927.9 | (10.8 | ) | -0.6 | % | ||||||||||||||||
Total Medicare | 3,659.4 | 3,579.4 | 3,547.8 | 111.6 | 3.1 | % | 3,436.4 | 223.0 | 6.5 | % | ||||||||||||||||||
Military services insured | 1,756.8 | 1,755.3 | 1,746.6 | 10.2 | 0.6 | % | 1,756.0 | 0.8 | 0.0 | % | ||||||||||||||||||
Military services ASO | 1,274.6 | 1,272.8 | 1,244.0 | 30.6 | 2.5 | % | 1,278.4 | (3.8 | ) | -0.3 | % | |||||||||||||||||
Total military services | 3,031.4 | 3,028.1 | 2,990.6 | 40.8 | 1.4 | % | 3,034.4 | (3.0 | ) | -0.1 | % | |||||||||||||||||
Medicaid | 398.6 | 397.3 | 385.2 | 13.4 | 3.5 | % | 401.7 | (3.1 | ) | -0.8 | % | |||||||||||||||||
Total Government Segment | 7,089.4 | 7,004.8 | 6,923.6 | 165.8 | 2.4 | % | 6,872.5 | 216.9 | 3.2 | % | ||||||||||||||||||
Commercial Segment: | ||||||||||||||||||||||||||||
Fully-insured medical: | ||||||||||||||||||||||||||||
Group | 1,338.8 | 1,357.7 | 1,534.8 | (196.0 | ) | -12.8 | % | 1,442.1 | (103.3 | ) | -7.2 | % | ||||||||||||||||
Individual | 370.5 | 368.9 | 336.1 | 34.4 | 10.2 | % | 367.4 | 3.1 | 0.8 | % | ||||||||||||||||||
Medicare supplement | 33.7 | 33.4 | 22.8 | 10.9 | 47.8 | % | 30.0 | 3.7 | 12.3 | % | ||||||||||||||||||
Total fully-insured medical | 1,743.0 | 1,760.0 | 1,893.7 | (150.7 | ) | -8.0 | % | 1,839.5 | (96.5 | ) | -5.2 | % | ||||||||||||||||
ASO | 1,588.5 | 1,589.9 | 1,577.8 | 10.7 | 0.7 | % | 1,571.3 | 17.2 | 1.1 | % | ||||||||||||||||||
Total Commercial Segment | 3,331.5 | 3,349.9 | 3,471.5 | (140.0 | ) | -4.0 | % | 3,410.8 | (79.3 | ) | -2.3 | % | ||||||||||||||||
Total medical membership | 10,420.9 | 10,354.7 | 10,395.1 | 25.8 | 0.2 | % | 10,283.3 | 137.6 | 1.3 | % | ||||||||||||||||||
Specialty Membership | ||||||||||||||||||||||||||||
Dental - fully-insured | 2,656.3 | 2,650.3 | 2,466.9 | 189.4 | 7.7 | % | 2,635.7 | 20.6 | 0.8 | % | ||||||||||||||||||
Dental - ASO | 1,213.9 | 1,214.2 | 982.3 | 231.6 | 23.6 | % | 1,197.2 | 16.7 | 1.4 | % | ||||||||||||||||||
Total dental | 3,870.2 | 3,864.5 | 3,449.2 | 421.0 | 12.2 | % | 3,832.9 | 37.3 | 1.0 | % | ||||||||||||||||||
Vision | 2,439.5 | 2,422.0 | 2,224.6 | 214.9 | 9.7 | % | 2,369.4 | 70.1 | 3.0 | % | ||||||||||||||||||
Other supplemental benefits (B) | 928.2 | 917.0 | 861.3 | 66.9 | 7.8 | % | 907.6 | 20.6 | 2.3 | % | ||||||||||||||||||
Total specialty membership | 7,237.9 | 7,203.5 | 6,535.1 | 702.8 | 10.8 | % | 7,109.9 | 128.0 | 1.8 | % | ||||||||||||||||||
S-7 |
Humana Inc. | |||||||||||||||||||||||||
Premiums and Administrative Services Fees Detail | |||||||||||||||||||||||||
Dollars in thousands, except per member per month | |||||||||||||||||||||||||
Per Member per Month (C) | |||||||||||||||||||||||||
Three Months Ended March 31, | Three Months Ended March 31, | ||||||||||||||||||||||||
Dollar | Percentage | ||||||||||||||||||||||||
2010 | 2009 | Change | Change | 2010 | 2009 | ||||||||||||||||||||
Premium revenues | |||||||||||||||||||||||||
Government Segment: | |||||||||||||||||||||||||
Medicare Advantage | $ | 4,816,980 | $ | 4,060,459 | $ | 756,521 | 18.6 | % | $ | 941 | $ | 930 | |||||||||||||
Medicare stand-alone PDPs | 579,025 | 595,683 | (16,658 | ) | -2.8 | % | $ | 105 | $ | 94 | |||||||||||||||
Total Medicare |
5,396,005 | 4,656,142 | 739,863 | 15.9 | % | ||||||||||||||||||||
Military services insured (D) | 844,994 | 871,171 | (26,177 | ) | -3.0 | % | $ | 160 | $ | 167 | |||||||||||||||
Medicaid insured | 164,703 | 156,660 | 8,043 | 5.1 | % | $ | 138 | $ | 136 | ||||||||||||||||
Total Government Segment premiums | 6,405,702 | 5,683,973 | 721,729 | 12.7 | % | ||||||||||||||||||||
Commercial Segment: | |||||||||||||||||||||||||
Fully-insured medical | 1,506,818 | 1,558,669 | (51,851 | ) | -3.3 | % | $ | 285 | $ | 273 | |||||||||||||||
Specialty | 249,343 | 228,652 | 20,691 | 9.0 | % | $ | 12 | $ | 12 | ||||||||||||||||
Total Commercial Segment premiums | 1,756,161 | 1,787,321 | (31,160 | ) | -1.7 | % | |||||||||||||||||||
Total premium revenues | $ | 8,161,863 | $ | 7,471,294 | $ | 690,569 | 9.2 | % | |||||||||||||||||
Administrative services fees | |||||||||||||||||||||||||
Military services ASO (D) | $ | 22,298 | $ | 18,196 | $ | 4,102 | 22.5 | % | $ | 6 | $ | 5 | |||||||||||||
Other government ASO (E) | 5,230 | 2,137 | 3,093 | 144.7 | % | n/a | n/a | ||||||||||||||||||
Commercial Segment | 98,354 | 95,549 | 2,805 | 2.9 | % | $ | 12 | $ | 12 | ||||||||||||||||
Total administrative services fees | $ | 125,882 | $ | 115,882 | $ | 10,000 | 8.6 | % | |||||||||||||||||
S-8 |
Humana Inc. | ||||||||||||||||||||||||||||||||||||
Percentage of Ending Membership under Capitation Arrangements | ||||||||||||||||||||||||||||||||||||
Government Segment | Commercial Segment | |||||||||||||||||||||||||||||||||||
March 31, 2010 |
Medicare Advantage |
Medicare stand-alone PDPs |
Military Services |
Medicaid |
Total Govt. Segment |
Fully-insured | ASO |
Total Comm. Segment |
Total Medical Membership |
|||||||||||||||||||||||||||
Capitated HMO hospital system based (F) | 0.8 | % | - | - | - | 0.2 | % | 1.3 | % | - | 0.7 | % | 0.3 | % | ||||||||||||||||||||||
Capitated HMO physician group based (F) | 2.5 | % | - | - | 28.9 | % | 2.3 | % | 1.6 | % | - | 0.8 | % | 1.8 | % | |||||||||||||||||||||
Risk-sharing (G) | 18.2 | % | - | - | 66.9 | % | 8.2 | % | 1.4 | % | - | 0.7 | % | 5.9 | % | |||||||||||||||||||||
All other membership | 78.5 | % | 100.0 | % | 100.0 | % | 4.2 | % | 89.3 | % | 95.7 | % | 100.0 | % | 97.8 | % | 92.0 | % | ||||||||||||||||||
Total medical membership | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | ||||||||||||||||||
March 31, 2009 |
||||||||||||||||||||||||||||||||||||
Capitated HMO hospital system based (F) | 1.9 | % | - | - | - | 0.4 | % | 1.2 | % | - | 0.7 | % | 0.5 | % | ||||||||||||||||||||||
Capitated HMO physician group based (F) | 3.3 | % | - | - | 37.1 | % | 2.8 | % | 1.4 | % | - | 0.8 | % | 2.1 | % | |||||||||||||||||||||
Risk-sharing (G) | 19.0 | % | - | - | 61.7 | % | 7.5 | % | 1.3 | % | - | 0.7 | % | 5.2 | % | |||||||||||||||||||||
All other membership | 75.8 | % | 100.0 | % | 100.0 | % | 1.2 | % | 89.3 | % | 96.1 | % | 100.0 | % | 97.8 | % | 92.2 | % | ||||||||||||||||||
Total medical membership | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | ||||||||||||||||||
S-9 |
Humana Inc. | Fair value | |||||||
Investments | ||||||||
Dollars in thousands |
03/31/2010 |
12/31/2009 |
||||||
Investment Portfolio: | ||||||||
Cash & cash equivalents | $ | 1,813,993 | $ | 1,613,588 | ||||
Investment securities | 6,764,833 | 6,190,062 | ||||||
Long-term investment securities | 1,333,659 | 1,307,088 | ||||||
Total investment portfolio | $ | 9,912,485 | $ | 9,110,738 | ||||
Duration (H) | 3.60 | 3.78 | ||||||
Average Credit Rating | AA | AA+ | ||||||
Securities Lending Invested Collateral Portfolio: | ||||||||
Cash & cash equivalents | $ | 28,823 | $ | 53,569 | ||||
Corporate floating rate | - | 32,375 | ||||||
Asset-backed securities | 33,190 | 33,642 | ||||||
$ | 62,013 | $ | 119,586 | |||||
Average Credit Rating | AAA | AAA- | ||||||
Investment Portfolio Detail: | ||||||||
Cash and cash equivalents | $ | 1,813,993 | $ | 1,613,588 | ||||
U.S. Government and agency obligations | ||||||||
U.S. Treasury and agency obligations | 968,631 | 1,009,352 | ||||||
U.S. Government residential mortgage-backed | 1,847,196 | 1,662,246 | ||||||
U.S. Government commercial mortgage-backed | 27,152 | 26,417 | ||||||
Total U.S. Government and agency obligations | 2,842,979 | 2,698,015 | ||||||
Tax-exempt municipal securities | ||||||||
Pre-refunded | 346,485 | 346,937 | ||||||
Insured | 581,215 | 587,203 | ||||||
Other | 1,150,634 | 1,221,087 | ||||||
Auction rate securities | 63,902 | 68,814 | ||||||
Total tax-exempt municipal securities | 2,142,236 | 2,224,041 | ||||||
Residential mortgage-backed | ||||||||
Prime residential mortgages | 72,338 | 89,956 | ||||||
Alt-A residential mortgages | 2,551 | 3,856 | ||||||
Sub-prime residential mortgages | 1,502 | 1,600 | ||||||
Total residential mortgage-backed | 76,391 | 95,412 | ||||||
Commercial mortgage-backed | 289,615 | 279,626 | ||||||
Asset-backed securities | 201,358 | 107,188 | ||||||
Corporate securities | ||||||||
Financial services | 811,713 | 775,990 | ||||||
Other | 1,732,200 | 1,303,578 | ||||||
Total corporate securities | 2,543,913 | 2,079,568 | ||||||
Redeemable preferred stocks | 2,000 | 13,300 | ||||||
Total investment portfolio | $ | 9,912,485 | $ | 9,110,738 | ||||
S-10 |
Humana Inc. | |||||||||||||||
Detail of Benefits Payable Balance and Year-to-Date Changes | |||||||||||||||
Dollars in thousands | |||||||||||||||
March 31, | March 31, | December 31, | |||||||||||||
2010 | 2009 | 2009 | |||||||||||||
Detail of benefits payable | |||||||||||||||
IBNR and other benefits payable (I) | $ | 2,755,876 | $ | 2,338,794 | $ | 2,377,324 | |||||||||
Unprocessed claim inventories (J) | 426,200 | 258,800 | 323,000 | ||||||||||||
Processed claim inventories (K) | 126,581 | 166,402 | 48,358 | ||||||||||||
Payable to pharmacy benefit administrator (L) | 136,688 | 162,663 | 194,697 | ||||||||||||
Benefits payable, excluding military services | 3,445,345 | 2,926,659 | 2,943,379 | ||||||||||||
Military services benefits payable (M) | 261,688 | 311,840 | 279,195 | ||||||||||||
Total Benefits Payable | $ | 3,707,033 | $ | 3,238,499 | $ | 3,222,574 | |||||||||
Three Months Ended | Three Months Ended | Year Ended | |||||||||||||
March 31, 2010 | March 31, 2009 | December 31, 2009 | |||||||||||||
Year-to-date changes in benefits payable, excluding military services (N) |
|||||||||||||||
Balances at January 1 | $ | 2,943,379 | $ | 2,898,782 | $ | 2,898,782 | |||||||||
Incurred related to: | |||||||||||||||
Current year | 6,344,639 | 5,645,070 | 21,934,973 | ||||||||||||
Prior years (O) | (307,855 | ) | (168,955 | ) | (252,756 | ) | |||||||||
Total incurred | 6,036,784 | 5,476,115 | 21,682,217 | ||||||||||||
Paid related to: | |||||||||||||||
Current year | (3,590,194 | ) | (3,545,040 | ) | (19,572,740 | ) | |||||||||
Prior years | (1,944,624 | ) | (1,903,198 | ) | (2,064,880 | ) | |||||||||
Total paid | (5,534,818 | ) | (5,448,238 | ) | (21,637,620 | ) | |||||||||
Balances at end of period | $ | 3,445,345 | $ | 2,926,659 | $ | 2,943,379 | |||||||||
Three Months Ended | Three Months Ended | Year Ended | |||||||||||||
March 31, 2010 | March 31, 2009 | December 31, 2009 | |||||||||||||
Summary of Consolidated Benefit Expense: | |||||||||||||||
Total benefit expense incurred, per above | $ | 6,036,784 | $ | 5,476,115 | $ | 21,682,217 | |||||||||
Military services benefit expense | 749,300 | 778,289 | 3,019,655 | ||||||||||||
Future policy benefit expense (P) | 21,471 | 14,906 | 73,130 | ||||||||||||
Consolidated Benefit Expense | $ | 6,807,555 | $ | 6,269,310 | $ | 24,775,002 | |||||||||
S-11 |
Humana Inc. | |||||||||||||||
Benefits Payable Statistics (Q) | |||||||||||||||
Receipt Cycle Time (R) | |||||||||||||||
2010 | 2009 | Change |
Percentage Change |
||||||||||||
1st Quarter Average | 13.8 | 14.8 | (1.0 | ) | -6.8 | % | |||||||||
2nd Quarter Average | - | 14.0 | n/a | n/a | |||||||||||
3rd Quarter Average | - | 13.7 | n/a | n/a | |||||||||||
4th Quarter Average | - | 13.6 | n/a | n/a | |||||||||||
Full Year Average | 13.8 | 14.0 | (0.2 | ) | -1.4 | % | |||||||||
Unprocessed Claims Inventories | |||||||||||||||
Date |
Estimated Valuation (000's) |
Claim Item Counts |
Number of Days on Hand |
||||||||||||
3/31/2008 | $ | 212,000 | 673,000 | 4.4 | |||||||||||
6/30/2008 | $ | 228,700 | 742,800 | 4.6 | |||||||||||
9/30/2008 | $ | 293,600 | 946,500 | 6.0 | |||||||||||
12/31/2008 | $ | 247,200 | 745,500 | 4.3 | |||||||||||
3/31/2009 | $ | 258,800 | 740,600 | 4.2 | |||||||||||
6/30/2009 | $ | 258,000 | 709,900 | 4.0 | |||||||||||
9/30/2009 | $ | 317,100 | 856,500 | 4.9 | |||||||||||
12/31/2009 | $ | 323,000 | 775,500 | 4.3 | |||||||||||
3/31/2010 | $ | 426,200 | 1,091,700 | 5.6 | |||||||||||
S-12 |
Humana Inc. | |||||||||||||||||||||||
Benefits Payable Statistics (Continued) (Q) | |||||||||||||||||||||||
Days in Claims Payable (S) |
|||||||||||||||||||||||
Quarter Ended |
Days in Claims Payable (DCP) |
Change Last 4 Quarters |
Percentage Change |
DCP Excluding Capitation |
Change Last 4 Quarters |
Percentage Change |
|||||||||||||||||
3/31/2008 | 56.9 | (2.4 | ) | -4.0 | % | 63.3 | (2.7 | ) | -4.1 | % | |||||||||||||
6/30/2008 | 57.2 | (2.8 | ) | -4.7 | % | 63.3 | (5.2 | ) | -7.6 | % | |||||||||||||
9/30/2008 | 58.1 | (3.7 | ) | -6.0 | % | 65.1 | (5.1 | ) | -7.3 | % | |||||||||||||
12/31/2008 | 59.4 | (0.8 | ) | -1.3 | % | 66.5 | (1.8 | ) | -2.6 | % | |||||||||||||
3/31/2009 | 54.6 | (2.3 | ) | -4.0 | % | 60.9 | (2.4 | ) | -3.8 | % | |||||||||||||
6/30/2009 | 56.1 | (1.1 | ) | -1.9 | % | 61.5 | (1.8 | ) | -2.8 | % | |||||||||||||
9/30/2009 | 56.2 | (1.9 | ) | -3.3 | % | 62.7 | (2.4 | ) | -3.7 | % | |||||||||||||
12/31/2009 | 55.4 | (4.0 | ) | -6.7 | % | 62.1 | (4.4 | ) | -6.6 | % | |||||||||||||
3/31/2010 | 57.0 | 2.4 | 4.4 | % | 64.3 | 3.4 | 5.6 | % | |||||||||||||||
Year-to-Date Change in Days in Claims Payable (T) | |||||||||||||||||||||||
2010 | 2009 | ||||||||||||||||||||||
DCP - beginning of period | 55.4 | 59.4 | |||||||||||||||||||||
Components of change in DCP: | |||||||||||||||||||||||
Change in unprocessed claims inventories | 1.7 | 0.6 | |||||||||||||||||||||
Change in processed claims inventories | 1.2 | (2.7 | ) | ||||||||||||||||||||
Change in pharmacy payment cutoff | (1.0 | ) | (1.1 | ) | |||||||||||||||||||
Impact of Cariten acquisition in 4Q08 | - | (0.9 | ) | ||||||||||||||||||||
All other | (0.3 | ) | 0.1 | ||||||||||||||||||||
DCP - end of period | 57.0 | 55.4 | |||||||||||||||||||||
S-13 |
Humana Inc.
Footnotes to Statistical Schedules and Supplementary Information 1Q10 Earnings Release |
||
(A) |
The selling, general and administrative (SG&A) expense ratio is defined as SG&A expenses as a percent of premiums, administrative services fees and other revenue. |
|
(B) |
Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies. |
|
(C) |
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). |
|
(D) |
Military services revenues are generally not contracted on a per-member basis. |
|
(E) |
Includes administrative services fees associated with Medicare and Medicaid, operations in the United Kingdom, and, for 2009, fees associated with Green Ribbon Health. |
|
(F) |
In a limited number of circumstances, the company contracts with hospitals and physicians to accept financial risk for a defined set of HMO 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 capitated HMO membership, including some health benefit administrative functions and claims processing. For these capitated HMO arrangements, the company generally agrees to reimbursement rates that target a benefit expense ratio. Providers participating in hospital-based capitated HMO arrangements generally receive a monthly payment for all of the services within their system for their HMO membership. Providers participating in physician-based capitated HMO arrangements generally have subcontracted specialist physicians and are responsible for reimbursing such physicians and hospitals for services rendered to their HMO membership. |
|
(G) |
In some circumstances, the company contracts with physicians under risk-sharing arrangements whereby physicians have assumed some level of risk for all or a portion of the benefit expenses of their HMO membership. Although these arrangements do include capitation payments for services rendered, the company processes substantially all of the claims under these arrangements. |
|
(H) |
Duration is the time-weighted average of the present value of the bond portfolio cash flows. |
|
(I) |
IBNR represents an estimate of benefit expenses 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. |
|
(J) |
Unprocessed claim inventories represent the estimated valuation of claims received but not yet fully processed. |
|
(K) |
Processed claim inventories represent the estimated valuation of processed claims that are in the post-claim-adjudication process, which consists of administrative functions such as audit and check batching and handling. |
|
(L) |
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 10 days (10th & 20th of month) and the last day of the month. |
|
(M) |
Military services benefits payable primarily consist of IBNR and to a lesser extent risk share payables to the Department of Defense and liabilities to subcontractors. |
|
(N) |
The table excludes activity associated with military services benefits payable, because the federal government bears a substantial portion of the risk associated with financing the cost of health benefits. More specifically, the risk-sharing provisions of the military services contracts with the federal government and with subcontractors effectively limit profits and losses when actual claim experience varies from the targeted claim amount negotiated annually. As a result of these contract provisions, the impact of changes in estimates for prior year military services benefits payable are substantially offset by the associated changes in estimates of revenue from health care services reimbursements. As such, any impact on the company's results of operations is reduced substantially, whether positive or negative. |
|
(O) |
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 claim reserves during the quarter. |
|
(P) |
Future policy benefit expense has a related liability classified as a long-term liability on the balance sheet. |
|
(Q) |
Benefits reserves statistics represents fully-insured medical claims data and excludes military services claims data and specialty benefits. |
|
(R) |
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 95% of the company's fully-insured claims volume. Pharmacy and specialty claims, including dental, vision and other supplemental benefits, are excluded from this measurement. |
|
(S) |
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 benefit expenses per day in the quarterly period. Since the company has some providers under capitation payment arrangements (which do not require a benefits payable IBNR reserve), the company has also summarized this metric excluding capitation expense. In addition, this calculation excludes the impact of the company's military services and stand-alone PDP business. |
|
(T) |
DCP fluctuates due to a number of issues, the more significant of which are detailed in this rollforward. 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 reserve recorded upon enrollment later in the quarter. This analysis excludes the impact of military services and Medicare stand-alone PDPs upon DCP. |
|
S-14 |
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Humana Inc. | 285,00 | 1,32% |
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