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Exhibit 99.2

 

n e w s   r e l e a s e    Humana Inc.
  

500 West Main Street

P.O. Box 1438

Louisville, KY 40201-1438

http://www.humana.com

FOR MORE INFORMATION CONTACT:

 

Regina Nethery

Humana Investor Relations

(502) 580-3644

e-mail: Rnethery@humana.com

   LOGO

Tom Noland

Humana Corporate Communications

(502) 580-3674

e-mail: Tnoland@humana.com

Humana Reports Second Quarter 2013 Financial Results;

Raises Full Year EPS Guidance

 

   

2Q13 EPS of $2.63 exceeds management’s expectations

 

   

Year-over-year second quarter pretax income up 14 percent in Retail Segment and up 9 percent in Employer Group Segment

 

   

2013 EPS guidance raised to range of $8.65 to $8.75

 

   

2013 cash flows from operations now projected to be at least $2 billion

LOUISVILLE, KY (July 31, 2013) – Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended June 30, 2013 (2Q13) of $2.63, compared to $2.16 per share for the quarter ended June 30, 2012 (2Q12). Results for 2Q13 exceeded management’s previous expectations of $2.40 to $2.50 per share primarily due to strong operating performance across the company’s business units and the favorable impact of the company’s reduced share count, partially offset by pretax expenses of $31 million ($0.12 per share) in connection with the company’s pending exit from its Puerto Rico Medicaid business.

For the six months ended June 30, 2013 (1H13) the company reported EPS of $5.58 compared to $3.65 in the six months ended June 30, 2012 (1H12). The 1H13 performance reflected the items discussed above for 2Q13 along with the first quarter 2013 beneficial effect of settlement of contract claims with the Department of Defense (DoD), as well as a benefit from a delay in the impact of sequestration for the company’s Medicare business.

The company now anticipates EPS for the year ending December 31, 2013 (FY13) to be in the range of $8.65 to $8.75 versus management’s previous guidance of $8.40 to $8.60. This increase reflects the better-than-expected second quarter results discussed above.

 

1


“Our second quarter’s solid operating performance reflects the continued focus and executional discipline involved in key initiatives like our chronic care program, including increased care management professional staffing and clinical assessments,” said Bruce D. Broussard, President and Chief Executive Officer of Humana. “The favorable outcomes seen from those programs year to date reinforce our commitment to the related planned investments in the second half of 2013. We believe maintaining momentum on those and other key capability-building initiatives, together with our focus on operating cost efficiencies, will effectively position Humana to face the reform-related challenges that accelerate in 2014.”

CONSOLIDATED HIGHLIGHTS

Consolidated revenues

2Q13 consolidated revenues were $10.32 billion, an increase of 6.4 percent from $9.70 billion in 2Q12, with total premiums and services revenue up 6.6 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 impact of sequestration.

1H13 consolidated revenues rose $889 million, or 4.5 percent, to $20.81 billion from $19.92 billion in 1H12 with total premiums and services revenue of $20.62 billion also up 4.5 percent, increasing $897 million from $19.73 billion in the prior year period. These revenue increases were driven primarily by higher average individual and group Medicare membership, partially offset by the impact of sequestration and a change in TRICARE contract accounting, which beginning on April 1, 2012 is accounted for as self-funded versus fully-insured for the previous contract.

Consolidated benefits expense

The 2Q13 consolidated benefit ratio (benefits expense as a percent of premiums) of 83.4 percent declined by 10 basis points from 83.5 percent for the prior year’s quarter. The company experienced favorable prior-year medical claims reserve development of approximately $100 million in 2Q13 compared to $40 million in 2Q12.

The 1H13 consolidated benefit ratio of 83.2 percent decreased by 130 basis points from 84.5 percent in 1H12 primarily due to favorable prior-year development and the beneficial effect in the 2013 period of the favorable settlement of contract claims with the DoD as discussed above.

Consolidated operating expenses

The consolidated operating cost ratio (operating costs as a percent of total revenues less investment income) of 14.3 percent for 2Q13 decreased from 14.4 percent in 2Q12 as improved operating leverage in the Retail and Employer Group Segments more than offset the 20 basis point impact of costs associated with the exit of the Puerto Rico Medicaid business described above.

 

2


The 1H13 consolidated operating cost ratio of 14.1 percent increased from 14.0 percent in 1H12, as the negative impact of the most recent TRICARE South Region contract being accounted for as an administrative services only (ASO) arrangement was partially offset by improved operating leverage in the Retail and Employer Group segments.

Balance sheet

At June 30, 2013, the company had cash, cash equivalents, and investment securities of $10.85 billion, down $518 million from $11.36 billion at March 31, 2013, reflecting normal cash management activities and lower net unrealized gains primarily due to an increase in market interest rates.

Parent company cash and short-term investments of $883 million at June 30, 2013 increased $681 million from $202 million at March 31, 2013, primarily due to approximately $970 million of dividends to the parent company from the operating subsidiaries, partially offset by share repurchases, capital expenditures, and payment of a cash dividend to shareholders during 2Q13.

Days in claims payable of 50.7 at June 30, 2013 increased 1.7 days from 49.0 days at March 31, 2013.

Debt-to-total capitalization at June 30, 2013 was 21.8 percent, down 40 basis points from 22.2 percent at March 31, 2013 primarily driven by higher capitalization associated with 2Q13 earnings.

Cash flows from operations

Cash flows provided by operations for 2Q13 were $173 million compared to cash flows provided by operations of $706 million in 2Q12. For 1H13, cash flows provided by operations totaled $585 million versus $3.05 billion in cash flows from operations during 1H12. The company also evaluates operating cash flows on a non-GAAP basis:

 

Net cash from operating activities

    (in millions)

   2Q13      2Q12     1H13      1H12  

GAAP

   $ 173       $ 706      $ 585       $ 3,052   

Timing of premium payment from CMS (a)

     —           (118     —           (2,133
  

 

 

    

 

 

   

 

 

    

 

 

 

Non-GAAP (b)

   $ 173       $ 588      $ 585       $ 919   

The year-over-year decrease in the non-GAAP cash flows from operations is due primarily to the effect on cash flows of changes in working capital accounts, including the timing of the mid-year Medicare Risk Adjustment payment that more than offset higher net income.

Share repurchases and cash dividends

During 2Q13, the company executed share repurchases of $130 million, or 1,623,400 of its outstanding shares, at an average price of $79.92 per share. 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. As of July 31, 2013, $871 million of the current repurchase authorization was remaining, with an expiration date of June 30, 2015.

During 2Q13, the company paid cash dividends to its stockholders totaling approximately $41 million.

 

3


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, and includes 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 $418 million in 2Q13 compared to $367 million in 2Q12, an increase of $51 million, reflecting the company’s improved operating performance over the prior year. This year-over-year increase was primarily due to membership growth and a lower operating cost ratio as favorable outcomes from clinical initiatives were generally offset by related investment spending.

 

   

For 1H13, pretax earnings for the Retail Segment of $768 million increased by $273 million from 1H12 pretax earnings of $495 million. The first-half increase reflects the same factors impacting the second quarter year-over-year comparison, in addition to the favorable impact of a lower year-to-date benefit ratio.

Enrollment:

 

   

Individual Medicare Advantage membership was 2,029,700 as of June 30, 2013, an increase of 133,900 members, or 7.1 percent from 1,895,800 at June 30, 2012 and up 102,100, or 5.3 percent from 1,927,600 at December 31, 2012, primarily due to a successful enrollment season associated with the 2013 plan year as well as age-in activity year to date.

 

   

Individual Medicare Advantage net membership growth during 2013 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 individual stand-alone Prescription Drug Plans (PDPs) was 3,220,600 at June 30, 2013, up 250,500, or 8.4 percent compared to 2,970,100 at June 30, 2012 and up 167,900, or 5.5 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 478,000 at June 30, 2013, an increase of 34,200, or 7.7 percent from 443,800 at June 30, 2012, while also increasing 34,000, or 7.7 percent from 444,000 at December 31, 2012. Membership growth reflects new sales in the first half of 2013 and favorable member retention.

 

   

Medical membership in state-based Medicaid plans increased to 70,600 at June 30, 2013, an increase of 24,100, or 51.8 percent, from 46,500 at June 30, 2012 and up 18,500, or 35.5 percent, from 52,100 at December 31, 2012, primarily driven by the addition of the company’s Kentucky Medicaid contract effective on January 1, 2013.

 

4


   

Membership in individual specialty products(c) of 1,011,700 at June 30, 2013 increased 105,500, or 11.6 percent, from 906,200 at June 30, 2012 and increased 63,000, or 6.6 percent, from 948,700 at December 31, 2012, primarily driven by increased membership in dental and vision offerings.

Premiums and services revenue:

 

   

2Q13 premiums and services revenue for the Retail Segment was $6.77 billion, an increase of 5.8 percent from $6.40 billion in 2Q12. The increase was primarily the result of a 7.0 percent increase in average individual Medicare Advantage membership year-over-year, partially offset by lower per-member premiums in the quarter which reflected the impact of sequestration beginning April 1, 2013.

Benefits expense:

 

   

The 2Q13 benefit ratio for the Retail Segment of 84.2 percent was flat year-over-year. Retail Segment benefits expense for 2Q13 included the beneficial effect of $72 million in favorable prior-year development compared to $24 million in 2Q12. Additionally, year-over-year timing differences primarily associated with clinical investment spending and weekday seasonality generally offset the impact of favorable outcomes associated with clinical programs and higher prior-year claims development.

Operating costs:

 

   

The Retail Segment’s operating cost ratio of 9.5 percent in 2Q13 decreased 50 basis points from 10.0 percent in 2Q12. The decrease was primarily the result of cost efficiencies associated with higher average membership as well as the company’s continued focus on operating cost reductions.

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 ASO products and health and wellness solutions businesses primarily marketed to employer groups.

Employer Group Segment Highlights

Pretax results:

 

   

Employer Group Segment pretax income of $127 million in 2Q13 compares to pretax income of $117 million in 2Q12, reflecting the company’s improved operating performance over the prior year. The year-over-year improvement was primarily driven by group Medicare membership growth and a lower operating cost ratio for this segment.

 

   

For 1H13, pretax earnings for the Employer Group Segment of $332 million increased by $86 million versus 1H12 pretax earnings of $246 million. The first-half increase reflects the same factors impacting the 2Q13 year-over-year comparison as well as a lower benefit cost ratio year to date.

 

5


Enrollment:

 

   

Fully-insured group Medicare Advantage membership was 416,600 at June 30, 2013, an increase of 56,100 members, or 15.6 percent from 360,500 at June 30, 2012 and up 45,800, or 12.4 percent from 370,800 at December 31, 2012, reflecting on-going success in demonstrating the company’s value proposition to employers for retirees. On January 1, 2013, the company lost its sole ASO group Medicare Advantage account which had 27,900 members at June 30, 2012 and 27,700 members at December 31, 2012.

 

   

Group fully-insured commercial medical membership was 1,196,100 at June 30, 2013, roughly flat to June 30, 2012 levels and down 15,700, or 1.3 percent, from 1,211,800 at December 31, 2012, as higher small group business membership was 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 June 30, 2013 versus 58 percent at June 30, 2012 and 59 percent at December 31, 2012.

 

   

Group ASO commercial medical membership declined to 1,199,600 at June 30, 2013, a decrease of 29,200, or 2.4 percent from 1,228,800 at June 30, 2012 and down 38,100, or 3.1 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) rose to 7,256,800 at June 30, 2013, an increase of 299,000, or 4.3 percent, from 6,957,800 at June 30, 2012 and was up 120,600, or 1.7 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:

 

   

2Q13 premiums and services revenue for the Employer Group Segment were $2.81 billion, up approximately 7.2 percent from $2.62 billion in 2Q12, primarily reflecting the impacts of higher average group Medicare Advantage membership.

Benefits expense:

 

   

The 2Q13 benefit ratio for the Employer Group Segment was 82.5 percent, an increase of 70 basis points from 81.8 percent for 2Q12. The year-over-year increase in the benefit ratio primarily reflected growth in the company’s group Medicare Advantage products, which generally carry a higher benefit ratio than fully-insured commercial group products, partially offset by higher favorable prior-year medical claims reserve development. Unfavorable timing differences for weekday seasonality for 2Q13 versus 2Q12 also negatively impacted this segment’s benefit ratio year over year.

Operating costs:

 

   

The Employer Group Segment’s operating cost ratio was 15.3 percent in 2Q13, a decline of 100 basis points from 16.3 percent in 2Q12, primarily reflecting cost savings associated with operating cost reduction initiatives and a higher percentage of members in group Medicare Advantage plans (which carry a lower operating cost ratio than commercial fully-insured group accounts).

 

6


HEALTHCARE 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 $131 million in 2Q13 increased from $128 million in 2Q12, as revenue growth and the profit contribution from the Metropolitan Health Networks, Inc. (Metropolitan) acquisition and our home care services business were generally offset by previously-planned investment spending associated with the integration and build-out of provider practices and chronic care centers.

 

   

For 1H13, pretax earnings for the Healthcare Services Segment of $256 million increased by $3 million from 1H12 pretax earnings of $253 million, reflecting the same factors impacting the second quarter year-over-year comparison.

Revenues:

 

   

Revenues of $3.86 billion in 2Q13 for the Healthcare Services Segment increased $667 million, or 20.9 percent from $3.20 billion in 2Q12, primarily due to growth in the company’s pharmacy solutions and provider services businesses and its 2012 acquisitions of Metropolitan and SeniorBridge.

Operating costs:

 

   

The Healthcare Services Segment’s operating cost ratio of 95.7 percent in 2Q13 was relatively unchanged from 95.4 percent in 2Q12.

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.

 

7


Other Businesses Highlights

Recent event:

 

   

On June 26, 2013, the Puerto Rico Health Insurance Administration notified Humana of its election not to renew the company’s three-year Medicaid contracts for the East, Southeast, and Southwest regions which ended June 30, 2013. Contractual transition provisions require the continuation of insurance coverage for beneficiaries through September 30, 2013 and an additional period of time thereafter to process claims. During 2Q13, Humana accrued expenses of $31 million on these contracts primarily related to benefits and administrative costs.

Pretax results:

 

   

Other Businesses reported a pretax loss of $30 million in 2Q13 versus a pretax loss of $56 million in 2Q12. The 2Q13 results included the $31 million in Puerto Rico Medicaid expenses noted above, while the 2Q12 results included expenses associated with a previously disclosed litigation settlement.

 

   

For 1H13, Other Businesses reported pretax income of $28 million compared to a pretax loss of $51 million in 1H12. In addition to the factors impacting second quarter comparisons year-over-year for Other Businesses described above, 1H13 results include the beneficial effect of settlement of contract claims with the DoD.

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.
(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.

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.

 

8


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, or disputes that could lead to legal actions (such as, among other things, provider contract disputes relating to rate adjustments resulting from the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, commonly referred to as “sequestration”; other provider contract claims; and qui tam litigation brought by individuals on behalf of the government) and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages. 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.

 

   

The Health Care Reform Law, including The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010, could have a material adverse effect on Humana’s results of operations, including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products, lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee 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 health insurance industry fee 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 health insurance industry fee 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.

 

9


   

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 (as amended by the Form 10-K/A filed on April 12, 2013);

 

   

Form 10-Q for the quarter ended March 31, 2013;

 

   

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.

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 July 31, 2013

 

(in accordance with Generally Accepted Accounting
Principles)

 

For the year ending December 31, 2013

 

Comments

Diluted earnings per common share

   

Full Year

  $8.65 to $8.75  
Revenues    

Consolidated

  $40.75 billion to $41.25 billion  

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

Retail Segment

  $26.75 billion to $27.25 billion  

Segment-level revenues include intersegment amounts that eliminate in consolidation.

Employer Group Segment

  $11.0 billion to $11.5 billion  

Healthcare Services Segment

  $15.0 billion to $15.5 billion  

Other Businesses

  $1.1 billion to $1.3 billion  

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

  Up 7,000 to 8,000  

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 70,000 to 80,000  
Benefit ratios    

Retail Segment

  84.0% to 84.5%  

Benefits expense as a percent of

    premiums.

Employer Group Segment

  83.75% to 84.25%  

Operating cost ratios

Consolidated

  14.75% to 15.25%   Operating costs as a percent of total     revenues excluding investment income

Healthcare Services Segment

  95.5% to 96.0%  

 

11


Humana Inc. – Earnings Guidance Points as of July 31, 2013

 

(in accordance with Generally Accepted Accounting
Principles)

 

For the year ending December 31, 2013

 

Comments

Consolidated depreciation and amortization (D&A)

   

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

Income statement

 

$325 million to $345 million

 

Cash flows statement

  $415 million to $435 million  
Consolidated interest expense   $140 million to $145 million  
Pretax results    

Retail Segment

 

$1.3 billion to $1.4 billion

Approximately 5% pretax margin

 

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

Employer Group Segment

 

$250 million to $270 million

2% to 2.5% pretax margin

 

Healthcare Services Segment

 

$525 million to $550 million

Approximately 3.5% pretax margin

 
Effective Tax Rate   Approximately 36%  
Diluted shares  

Approximately 160 million

 

Projections exclude the impact of future share repurchases

Cash flows from operations  

$2.0 billion to $2.2 billion

 
Capital expenditures   $425 million to $450 million  

 

12


Humana Inc.

Statistical Schedules

And

Supplementary Information

2Q13 Earnings Release

 

S-1


Humana Inc.

Statistical Schedules and Supplementary Information

2Q13 Earnings Release

Contents

 

Page

  

Description

S-3-4

   Consolidated Statements of Income

S-5-6

   Quarterly Segment Financial Information

S-7-8

   YTD Segment Financial Information

S-9

   Consolidated Balance Sheets

S-10-11

   Consolidated Statements of Cash Flows

S-12

   Key Income Statement Ratios and Segment Operating Results

S-13-15

   Healthcare Services Segment Metrics

S-16

   Membership Detail

S-17-18

   Premiums and Services Revenue Detail

S-19

   Medicare Summary

S-20

   Investments

S-21-23

   Benefits Payable Detail and Statistics

S-24

   Footnotes

 

S-2


Humana Inc.

Consolidated Statements of Income

Dollars in millions, except per common share results

 

     Three Months Ended June 30,      Dollar
Change
    Percentage
Change
 
     2013      2012       

Revenues:

          

Premiums

   $ 9,701       $ 9,166       $ 535        5.8

Services

     528         434         94        21.7

Investment income

     92         99         (7     -7.1
  

 

 

    

 

 

    

 

 

   

Total revenues

     10,321         9,699         622        6.4
  

 

 

    

 

 

    

 

 

   

Operating expenses:

          

Benefits

     8,091         7,652         439        5.7

Operating costs

     1,461         1,384         77        5.6

Depreciation and amortization

     80         73         7        9.6
  

 

 

    

 

 

    

 

 

   

Total operating expenses

     9,632         9,109         523        5.7
  

 

 

    

 

 

    

 

 

   

Income from operations

     689         590         99        16.8

Interest expense

     35         26         9        34.6
  

 

 

    

 

 

    

 

 

   

Income before income taxes

     654         564         90        16.0

Provision for income taxes

     234         208         26        12.5
  

 

 

    

 

 

    

 

 

   

Net income

   $ 420       $ 356       $ 64        18.0
  

 

 

    

 

 

    

 

 

   

Basic earnings per common share

   $ 2.66       $ 2.19       $ 0.47        21.5

Diluted earnings per common share

   $ 2.63       $ 2.16       $ 0.47        21.8

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

     157,975         162,816        

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

     159,521         164,639        

 

S-3


Humana Inc.

Consolidated Statements of Income

Dollars in millions, except per common share results

 

     Six Months Ended June 30,      Dollar
Change
    Percentage
Change
 
     2013      2012       

Revenues:

          

Premiums

   $ 19,569       $ 18,941       $ 628        3.3

Services

     1,053         784         269        34.3

Investment income

     185         193         (8     -4.1
  

 

 

    

 

 

    

 

 

   

Total revenues

     20,807         19,918         889        4.5
  

 

 

    

 

 

    

 

 

   

Operating expenses:

          

Benefits

     16,286         16,002         284        1.8

Operating costs

     2,907         2,767         140        5.1

Depreciation and amortization

     160         143         17        11.9
  

 

 

    

 

 

    

 

 

   

Total operating expenses

     19,353         18,912         441        2.3
  

 

 

    

 

 

    

 

 

   

Income from operations

     1,454         1,006         448        44.5

Interest expense

     70         52         18        34.6
  

 

 

    

 

 

    

 

 

   

Income before income taxes

     1,384         954         430        45.1

Provision for income taxes

     491         350         141        40.3
  

 

 

    

 

 

    

 

 

   

Net income

   $ 893       $ 604       $ 289        47.8
  

 

 

    

 

 

    

 

 

   

Basic earnings per common share

   $ 5.64       $ 3.70       $ 1.94        52.4

Diluted earnings per common share

   $ 5.58       $ 3.65       $ 1.93        52.9

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

     158,446         163,267        

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

     159,962         165,363        

 

S-4


Humana Inc.

2Q13 Segment Financial Information

In millions

 

     Retail     Employer
Group
    Healthcare
Services
    Other
Businesses
    Eliminations/
Corporate
    Consolidated  

Revenues - external customers

            

Premiums:

            

Medicare Advantage

   $ 5,572      $ 1,160      $ —        $ —        $ —        $ 6,732   

Medicare stand-alone PDP

     785        2        —          —          —          787   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     6,357        1,162        —          —          —          7,519   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     285        1,273        —          —          —          1,558   

Specialty

     52        275        —          —          —          327   

Military services

     —          —          —          5        —          5   

Medicaid and other (A)

     72        —          —          220        —          292   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     6,766        2,710        —          225        —          9,701   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —          4        313        —          —          317   

ASO and other (B)

     2        82        —          114        —          198   

Pharmacy

     —          —          13        —          —          13   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     2        86        326        114        —          528   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues - external customers

     6,768        2,796        326        339        —          10,229   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     —          12        2,858        —          (2,870     —     

Products

     —          —          680        —          (680     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     —          12        3,538        —          (3,550     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     18        10        —          15        49        92   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     6,786        2,818        3,864        354        (3,501     10,321   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     5,696        2,235        —          251        (91     8,091   

Operating costs

     640        429        3,697        129        (3,434     1,461   

Depreciation and amortization

     32        27        36        4        (19     80   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     6,368        2,691        3,733        384        (3,544     9,632   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     418        127        131        (30     43        689   

Interest expense

     —          —          —          —          35        35   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 418      $ 127      $ 131      $ (30   $ 8      $ 654   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     84.2     82.5       111.6       83.4

Operating cost ratio

     9.5     15.3     95.7     38.1       14.3

 

S-5


Humana Inc.

2Q12 Segment Financial Information (Recast) (C)

In millions

 

     Retail     Employer
Group
    Healthcare
Services
    Other
Businesses
    Eliminations/
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.

YTD 2Q13 Segment Financial Information

In millions

 

     Retail     Employer
Group
    Healthcare
Services
    Other
Businesses
    Eliminations/
Corporate
    Consolidated  

Revenues - external customers

            

Premiums:

            

Medicare Advantage

   $ 11,308      $ 2,350      $ —        $ —        $ —        $ 13,658   

Medicare stand-alone PDP

     1,546        4        —          —          —          1,550   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     12,854        2,354        —          —          —          15,208   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     564        2,541        —          —          —          3,105   

Specialty

     101        550        —          —          —          651   

Military services

     —          —          —          16        —          16   

Medicaid and other (A)

     151        —          —          438        —          589   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     13,670        5,445        —          454        —          19,569   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —          8        619        —          —          627   

ASO and other (B)

     4        166        —          234        —          404   

Pharmacy

     —          —          22        —          —          22   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     4        174        641        234        —          1,053   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues - external customers

     13,674        5,619        641        688        —          20,622   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     —          23        5,607        —          (5,630     —     

Products

     —          —          1,334        —          (1,334     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     —          23        6,941        —          (6,964     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     36        21        —          30        98        185   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     13,710        5,663        7,582        718        (6,866     20,807   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     11,625        4,412        —          438        (189     16,286   

Operating costs

     1,253        869        7,254        244        (6,713     2,907   

Depreciation and amortization

     64        50        72        8        (34     160   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     12,942        5,331        7,326        690        (6,936     19,353   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     768        332        256        28        70        1,454   

Interest expense

     —          —          —          —          70        70   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

   $ 768      $ 332      $ 256      $ 28      $ —        $ 1,384   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     85.0     81.0       96.5       83.2

Operating cost ratio

     9.2     15.4     95.7     35.5       14.1

 

S-7


Humana Inc.

YTD 2Q12 Segment Financial Information (Recast) (C)

In millions

 

     Retail     Employer
Group
    Healthcare
Services
    Other
Businesses
    Eliminations/
Corporate
    Consolidated  

Revenues - external customers

            

Premiums:

            

Medicare Advantage

   $ 10,401      $ 2,036      $ —        $ —        $ —        $ 12,437   

Medicare stand-alone PDP

     1,471        4        —          —          —          1,475   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total Medicare

     11,872        2,040        —          —          —          13,912   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Fully-insured

     494        2,489        —          —          —          2,983   

Specialty

     80        522        —          —          —          602   

Military services

     —          —          —          937        —          937   

Medicaid and other (A)

     91        —          —          416        —          507   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     12,537        5,051        —          1,353        —          18,941   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Services revenue:

            

Provider

     —          4        474        —          —          478   

ASO and other (B)

     11        178        —          109        —          298   

Pharmacy

     —          —          8        —          —          8   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total services revenue

     11        182        482        109        —          784   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues - external customers

     12,548        5,233        482        1,462        —          19,725   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Intersegment revenues

            

Services

     1        17        4,824        —          (4,842     —     

Products

     —          —          1,175        —          (1,175     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     1        17        5,999        —          (6,017     —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     39        20        —          29        105        193   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     12,588        5,270        6,481        1,491        (5,912     19,918   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

            

Benefits

     10,755        4,116        —          1,317        (186     16,002   

Operating costs

     1,275        864        6,189        217        (5,778     2,767   

Depreciation and amortization

     63        44        39        8        (11     143   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     12,093        5,024        6,228        1,542        (5,975     18,912   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     495        246        253        (51     63        1,006   

Interest expense

     —          —          —          —          52        52   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 495      $ 246      $ 253      $ (51   $ 11      $ 954   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Benefit ratio

     85.8     81.5       97.3       84.5

Operating cost ratio

     10.2     16.5     95.5     14.8       14.0

 

S-8


Humana Inc.

Consolidated Balance Sheets

Dollars in millions, except share amounts

 

     June  30,
2013
    December 31,
2012
    YTD Change  
         Dollar      Percent  

Assets

         

Current assets:

         

Cash and cash equivalents

   $ 1,519      $ 1,306        

Investment securities

     7,556        8,001        

Receivables, net

     1,593        733        

Other current assets

     1,960        1,670        
  

 

 

   

 

 

      

Total current assets

     12,628        11,710      $ 918         7.8

Property and equipment, net

     1,133        1,098        

Long-term investment securities

     1,770        1,846        

Goodwill

     3,638        3,640        

Other long-term assets

     1,679        1,685        
  

 

 

   

 

 

      

Total assets

     20,848        19,979      $ 869         4.3
  

 

 

   

 

 

      

Liabilities and Stockholders’ Equity

         

Current liabilities:

         

Benefits payable

     4,157        3,779        

Trade accounts payable and accrued expenses

     2,174        2,042        

Book overdraft

     246        324        

Unearned revenues

     193        230        
  

 

 

   

 

 

      

Total current liabilities

     6,770        6,375      $ 395         6.2

Long-term debt

     2,606        2,611        

Future policy benefits payable

     1,810        1,858        

Other long-term liabilities

     327        288        
  

 

 

   

 

 

      

Total liabilities

     11,513        11,132      $ 381         3.4
  

 

 

   

 

 

      

Commitments and contingencies

         

Stockholders’ equity:

         

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

     —          —          

Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 195,678,752 issued at June 30, 2013

     32        32        

Capital in excess of par value

     2,190        2,101        

Retained earnings

     8,688        7,881        

Accumulated other comprehensive income

     209        386        

Treasury stock, at cost, 39,215,632 shares at June 30, 2013

     (1,784     (1,553     
  

 

 

   

 

 

      

Total stockholders’ equity

     9,335        8,847      $ 488         5.5
  

 

 

   

 

 

      

Total liabilities and stockholders’ equity

   $ 20,848      $ 19,979      $ 869         4.3
  

 

 

   

 

 

      

Debt-to-total capitalization ratio

     21.8     22.8     

Return on Invested Capital (ROIC) - trailing 12 months

     13.5     11.5     

 

S-9


Humana Inc.

Consolidated Statements of Cash Flows

Dollars in millions

 

     Three Months Ended June 30,     Dollar
Change
    Percentage
Change
 
     2013     2012      

Cash flows from operating activities

        

Net income

   $ 420      $ 356       

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

        

Depreciation and amortization

     104        82       

Net realized capital gains

     (5     (10    

Stock-based compensation

     19        14       

Benefit for deferred income taxes

     (8     —         

Changes in operating assets and liabilities, net of effect of businesses acquired:

        

Receivables

     (272     432       

Other assets

     22        (112    

Benefits payable

     67        (114    

Other liabilities

     (138     (1    

Unearned revenues

     (50     43       

Other, net

     14        16       
  

 

 

   

 

 

     

Net cash provided by operating activities

     173        706      ($ 533     -75.5
  

 

 

   

 

 

     

Cash flows from investing activities

        

Acquisitions, net of cash acquired

     (7     (20    

Purchases of property and equipment

     (97     (99    

Proceeds from sale of business

     33        —         

Purchases of investment securities

     (602     (650    

Maturities of investment securities

     255        333       

Proceeds from sales of investment securities

     662        287       
  

 

 

   

 

 

     

Net cash provided by (used in) investing activities

     244        (149   $ 393        263.8
  

 

 

   

 

 

     

Cash flows from financing activities

        

Receipts (withdrawals) from contract deposits, net

     (104     (146    

Change in book overdraft

     (44     (34    

Common stock repurchases

     (137     (127    

Excess tax benefit from stock-based compensation

     (1     1       

Dividends paid

     (41     (41    

Proceeds from stock option exercises and other

     31        3       
  

 

 

   

 

 

     

Net cash used in financing activities

     (296     (344   $ 48        14.0
  

 

 

   

 

 

     

Increase in cash and cash equivalents

     121        213       

Cash and cash equivalents at beginning of period

     1,398        3,656       
  

 

 

   

 

 

     

Cash and cash equivalents at end of period

   $ 1,519      $ 3,869       
  

 

 

   

 

 

     

 

S-10


Humana Inc.

Consolidated Statements of Cash Flows

Dollars in millions

 

     Six Months Ended June 30,     Dollar
Change
    Percentage
Change
 
     2013     2012      

Cash flows from operating activities

        

Net income

   $ 893      $ 604       

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

        

Depreciation and amortization

     206        160       

Net realized capital gains

     (10     (14    

Stock-based compensation

     51        54       

Benefit for deferred income taxes

     (8     (9    

Changes in operating assets and liabilities, net of effect of businesses acquired:

        

Receivables

     (860     177       

Other assets

     (108     (250    

Benefits payable

     378        170       

Other liabilities

     52        51       

Unearned revenues

     (37     2,077       

Other, net

     28        32       
  

 

 

   

 

 

     

Net cash provided by operating activities

     585        3,052      ($ 2,467     -80.8
  

 

 

   

 

 

     

Cash flows from investing activities

        

Acquisitions, net of cash acquired

     (12     (76    

Purchases of property and equipment

     (187     (185    

Proceeds from sale of business

     33        —         

Purchases of investment securities

     (1,385     (1,364    

Maturities of investment securities

     549        757       

Proceeds from sales of investment securities

     854        529       
  

 

 

   

 

 

     

Net cash used in investing activities

     (148     (339   $ 191        56.3
  

 

 

   

 

 

     

Cash flows from financing activities

        

Receipts (withdrawals) from contract deposits, net

     132        152       

Repayment of long-term debt

     —          (36    

Change in book overdraft

     (78     (46    

Common stock repurchases

     (231     (278    

Excess tax benefit from stock-based compensation

     —          21       

Dividends paid

     (83     (82    

Proceeds from stock option exercises and other

     36        48       
  

 

 

   

 

 

     

Net cash used in financing activities

     (224     (221   ($ 3     -1.4
  

 

 

   

 

 

     

Increase in cash and cash equivalents

     213        2,492       

Cash and cash equivalents at beginning of period

     1,306        1,377       
  

 

 

   

 

 

     

Cash and cash equivalents at end of period

   $ 1,519      $ 3,869       
  

 

 

   

 

 

     

 

S-11


Humana Inc.

Key Income Statement Ratios and Segment Operating Results

Dollars in millions

 

     Three Months Ended June 30,           Percentage
Change
    Six Months Ended June 30,           Percentage
Change
 
     2013     2012     Difference       2013     2012     Difference    

Benefit ratio

                

Retail

     84.2     84.2     0.0       85.0     85.8     -0.8  

Employer Group

     82.5     81.8     0.7       81.0     81.5     -0.5  

Other Businesses

     111.6     118.5     -6.9       96.5     97.3     -0.8  

Consolidated

     83.4     83.5     -0.1       83.2     84.5     -1.3  

Operating cost ratio

                

Retail

     9.5     10.0     -0.5       9.2     10.2     -1.0  

Employer Group

     15.3     16.3     -1.0       15.4     16.5     -1.1  

Healthcare Services

     95.7     95.4     0.3       95.7     95.5     0.2  

Other Businesses

     38.1     32.2     5.9       35.5     14.8     20.7  

Consolidated

     14.3     14.4     -0.1       14.1     14.0     0.1  

Detail of pretax income (loss)

                

Retail

   $ 418      $ 367      $ 51        13.9   $ 768      $ 495      $ 273        55.2

Employer Group

   $ 127      $ 117      $ 10        8.5   $ 332      $ 246      $ 86        35.0

Healthcare Services

   $ 131      $ 128      $ 3        2.3   $ 256      $ 253      $ 3        1.2

Other Businesses

   $ (30)      $ (56)      $ 26        46.4   $ 28      $ (51)      $ 79        154.9

Consolidated

   $ 654      $ 564      $ 90        16.0   $ 1,384      $ 954      $ 430        45.1

 

S-12


Humana Inc.

Healthcare Services Segment Metrics

 

     Quarter Ended
June 30, 2013
     Quarter Ended
June 30, 2012
     Difference           Quarter Ended
March 31,  2013
     Difference         

Primary Care Providers:

                  

Risk (D)

                  

Owned / JV

     4,200         1,000         3,200        320.0     4,100         100         2.4

Contracted

     3,700         5,100         (1,400     -27.5     3,600         100         2.8

Path-to-Risk (E)

     21,800         16,900         4,900        29.0     21,600         200         0.9

Care Management Professionals:

                  

Employed

     3,600         2,400         1,200        50.0     3,400         200         5.9

Contracted

     5,400         3,000         2,400        80.0     4,200         1,200         28.6
  

 

 

    

 

 

    

 

 

     

 

 

    

 

 

    

Total

     9,000         5,400         3,600        66.7     7,600         1,400         18.4
  

 

 

    

 

 

    

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

Care Management Statistics:

                  

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

     212,000         143,000         69,000          180,300         31,700      

Number of high-risk discharges enrolled in Humana Transitions Program

     5,500         —           5,500          4,100         1,400      

 

S-13


Humana Inc.

Healthcare Services Segment Metrics (Continued)

Script volume in thousands

 

     Quarter Ended
June 30, 2013
    Quarter Ended
June 30, 2012
    Year-over-Year
Difference
          Quarter Ended
March 31,  2013
    Sequential
Difference
       

Pharmacy:

              

Generic Dispense Rate

              

Retail

     86.4     84.1     2.3       86.2     0.2  

Employer Group

     79.4     75.5     3.9       79.3     0.1  

Total

     85.6     83.2     2.4       85.4     0.2  
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Mail-Order Penetration

              

Retail

     22.6     23.2     -0.6       22.9     -0.3  

Employer Group

     14.2     16.0     -1.8       14.6     -0.4  

Total

     21.6     22.4     -0.8       21.9     -0.3  
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   
                 Difference     Percentage
Change
          Difference     Percentage
Change
 

Script volume

              

Retail

     60,000        52,600        7,400        14.1     58,900        1,100        1.9

Employer Group

     7,800        6,300        1,500        23.8     7,700        100        1.3
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total

     67,800        58,900        8,900        15.1     66,600        1,200        1.8
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

S-14


Humana Inc.

Healthcare Services Segment Metrics (Continued)

Script volume in thousands

 

 

     Six Months Ended
June 30, 2013
    Six Months Ended
June 30, 2012
    Year-over-Year
Difference
       

Pharmacy:

        

Generic Dispense Rate

        

Retail

     86.3     83.3     3.0  

Employer Group

     79.4     74.8     4.6  

Total

     85.5     82.4     3.1  
  

 

 

   

 

 

   

 

 

   

Mail-Order Penetration

        

Retail

     22.7     23.1     -0.4  

Employer Group

     14.4     15.8     -1.4  

Total

     21.8     22.3     -0.5  
  

 

 

   

 

 

   

 

 

   
                 Difference     Percentage
Change
 

Script volume

        

Retail

     118,800        104,600        14,200        13.6

Employer Group

     15,500        12,600        2,900        23.0
  

 

 

   

 

 

   

 

 

   

Total

     134,300        117,200        17,100        14.6
  

 

 

   

 

 

   

 

 

   

 

 

 

 

S-15


Humana Inc.

Membership Detail

In thousands

 

     Ending
June 30,  2013
     Average
2Q13
     Ending
June 30,  2012
     Year-over-Year  Change     Ending
December 31,  2012
     YTD Change  
              Amount     Percent        Amount     Percent  

Medical Membership:

                    

Retail

                    

Medicare Advantage

     2,029.7         2,024.0         1,895.8         133.9        7.1     1,927.6         102.1        5.3

Medicare stand-alone PDPs

     3,220.6         3,219.7         2,970.1         250.5        8.4     3,052.7         167.9        5.5

Individual commercial

     478.0         472.3         443.8         34.2        7.7     444.0         34.0        7.7

State-based Medicaid

     70.6         70.9         46.5         24.1        51.8     52.1         18.5        35.5

Medicare Supplement

     90.3         89.3         70.5         19.8        28.1     77.4         12.9        16.7
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Retail

     5,889.2         5,876.2         5,426.7         462.5        8.5     5,553.8         335.4        6.0
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Employer Group

                    

Medicare Advantage fully-insured

     416.6         415.5         360.5         56.1        15.6     370.8         45.8        12.4

Medicare Advantage ASO

     —           —           27.9         (27.9     -100.0     27.7         (27.7     -100.0

Medicare stand-alone PDPs

     3.7         3.6         4.4         (0.7     -15.9     4.4         (0.7     -15.9

Fully-insured medical commercial

     1,196.1         1,197.5         1,196.9         (0.8     -0.1     1,211.8         (15.7     -1.3

ASO commercial

     1,199.6         1,201.4         1,228.8         (29.2     -2.4     1,237.7         (38.1     -3.1
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Employer Group

     2,816.0         2,818.0         2,818.5         (2.5     -0.1     2,852.4         (36.4     -1.3
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Other Businesses

                    

Military services

     3,104.6         3,103.7         3,133.5         (28.9     -0.9     3,123.9         (19.3     -0.6

Puerto Rico Medicaid and other

     560.8         559.7         560.6         0.2        0.0     558.7         2.1        0.4
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Other Businesses

     3,665.4         3,663.4         3,694.1         (28.7     -0.8     3,682.6         (17.2     -0.5
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Medical Membership

     12,370.6         12,357.6         11,939.3         431.3        3.6     12,088.8         281.8        2.3
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Specialty Membership:

                    

Retail

                    

Dental - fully-insured

     723.7         714.3         662.7         61.0        9.2     691.5         32.2        4.7

Vision

     145.7         141.5         103.8         41.9        40.4     118.7         27.0        22.7

Other supplemental benefits (F)

     142.3         141.9         139.7         2.6        1.9     138.5         3.8        2.7
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Retail

     1,011.7         997.7         906.2         105.5        11.6     948.7         63.0        6.6
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Employer Group

                    

Dental - fully-insured

     2,508.3         2,505.9         2,416.4         91.9        3.8     2,446.4         61.9        2.5

Dental - ASO

     863.8         865.6         849.4         14.4        1.7     868.3         (4.5     -0.5

Vision

     2,538.4         2,540.0         2,456.3         82.1        3.3     2,525.0         13.4        0.5

Other supplemental benefits (F)

     1,346.3         1,348.3         1,235.7         110.6        9.0     1,296.5         49.8        3.8
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Employer Group

     7,256.8         7,259.8         6,957.8         299.0        4.3     7,136.2         120.6        1.7
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Specialty Membership

     8,268.5         8,257.5         7,864.0         404.5        5.1     8,084.9         183.6        2.3
  

 

 

    

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

 

S-16


Humana Inc.

Premiums and Services Revenue Detail

Dollars in millions, except per member per month

 

     Three Months Ended June 30,      Dollar
Change
    Percentage
Change
    Per Member per Month  (G)
Three Months Ended June 30,
 
     2013      2012          2013      2012  

Premiums and Services Revenue

               

Retail:

               

Medicare Advantage

   $ 5,572       $ 5,308       $ 264        5.0   $ 918       $ 936   

Medicare stand-alone PDPs

     785         745         40        5.4     81         84   

Individual commercial

     241         215         26        12.1     170         162   

State-based Medicaid

     72         45         27        60.0     339         323   

Medicare Supplemental

     44         35         9        25.7     164         168   

Specialty

     52         42         10        23.8     17         16   

ASO & other services (B)

     2         6         (4     -66.7     
  

 

 

    

 

 

    

 

 

        

Total Retail

     6,768         6,396         372        5.8     
  

 

 

    

 

 

    

 

 

        

Employer Group:

               

Medicare Advantage fully-insured

     1,160         1,011         149        14.7     931         938   

Medicare stand-alone PDPs

     2         2         —          0.0     

Fully-insured medical commercial

     1,273         1,247         26        2.1     354         349   

Specialty

     275         262         13        5.0     14         14   

ASO & other services (B)

     98         98         —          0.0     
  

 

 

    

 

 

    

 

 

        

Total Employer Group

     2,808         2,620         188        7.2     
  

 

 

    

 

 

    

 

 

        

Healthcare Services:

               

Pharmacy solutions

     3,225         2,833         392        13.8     

Provider services

     513         292         221        75.7     

Home care services

     95         42         53        126.2     

Integrated behavioral health

     31         30         1        3.3     
  

 

 

    

 

 

    

 

 

        

Total Healthcare Services

     3,864         3,197         667        20.9     
  

 

 

    

 

 

    

 

 

        

Other Businesses:

               

Military services (H)

     101         130         (29     -22.3     

Puerto Rico Medicaid and other (I)

     238         215         23        10.7     131         125   
  

 

 

    

 

 

    

 

 

        

Total Other Businesses

   $ 339       $ 345       $ (6     -1.7     
  

 

 

    

 

 

    

 

 

        

 

S-17


Humana Inc.

Premiums and Services Revenue Detail

Dollars in millions, except per member per month

 

     Six Months Ended June 30,      Dollar
Change
    Percentage
Change
    Per Member per Month  (G)
Six Months Ended June 30,
 
     2013      2012          2013      2012  

Premiums and Services Revenue

               

Retail:

               

Medicare Advantage

   $ 11,308       $ 10,401       $ 907        8.7   $ 934       $ 930   

Medicare stand-alone PDPs

     1,546         1,471         75        5.1     80         83   

Individual commercial

     477         426         51        12.0     172         161   

State-based Medicaid

     151         91         60        65.9     342         322   

Medicare Supplemental

     87         68         19        27.9     164         167   

Specialty

     101         80         21        26.3     17         16   

ASO & other services (B)

     4         12         (8     -66.7     
  

 

 

    

 

 

    

 

 

        

Total Retail

     13,674         12,549         1,125        9.0     
  

 

 

    

 

 

    

 

 

        

Employer Group:

               

Medicare Advantage fully-insured

     2,350         2,036         314        15.4     947         947   

Medicare stand-alone PDPs

     4         4         —          0.0     

Fully-insured medical commercial

     2,541         2,489         52        2.1     353         349   

Specialty

     550         522         28        5.4     14         14   

ASO & other services (B)

     197         199         (2     -1.0     
  

 

 

    

 

 

    

 

 

        

Total Employer Group

     5,642         5,250         392        7.5     
  

 

 

    

 

 

    

 

 

        

Healthcare Services:

               

Pharmacy solutions

     6,319         5,766         553        9.6     

Provider services

     1,022         573         449        78.4     

Home care services

     178         78         100        128.2     

Integrated behavioral health

     63         64         (1     -1.6     
  

 

 

    

 

 

    

 

 

        

Total Healthcare Services

     7,582         6,481         1,101        17.0     
  

 

 

    

 

 

    

 

 

        

Other Businesses:

               

Military services (H)

     211         1,036         (825     -79.6     

Puerto Rico Medicaid and other (I)

     477         426         51        12.0     131         125   
  

 

 

    

 

 

    

 

 

        

Total Other Businesses

   $ 688       $ 1,462       $ (774     -52.9     
  

 

 

    

 

 

    

 

 

        

 

S-18


Humana Inc.

Medicare Summary

Premiums in millions, except per member per month

Membership in thousands

 

     Three Months Ended June 30,      Year-over-year  Change     Per Member per Month  (G)
Three Months Ended June 30,
 
     2013      2012      Amount      Percent     2013      2012  

Premiums

                

Medicare Advantage

   $ 6,732       $ 6,319       $ 413         6.5   $ 920       $ 936   

Medicare stand-alone PDPs

     787         747         40         5.4     81       $ 84   
  

 

 

    

 

 

    

 

 

         

Total Medicare

   $ 7,519       $ 7,066       $ 453         6.4     
  

 

 

    

 

 

    

 

 

         
     Six Months Ended June 30,      Year-over-year  Change     Per Member per Month (G)
Six Months Ended June 30,
 
     2013      2012      Amount      Percent     2013      2012  

Premiums

                

Medicare Advantage

   $ 13,658       $ 12,437       $ 1,221         9.8   $ 936       $ 932   

Medicare stand-alone PDPs

     1,550         1,475         75         5.1     80         84   
  

 

 

    

 

 

    

 

 

         

Total Medicare

   $ 15,208       $ 13,912       $ 1,296         9.3     
  

 

 

    

 

 

    

 

 

         

 

     Ending
June 30, 2013
     Ending
June 30, 2012
     Year-over-year  Change  
           Amount     Percent  

Fully-Insured Membership

          

Medicare Advantage

     2,446.3         2,256.3         190.0        8.4

Medicare stand-alone PDPs

     3,224.3         2,974.5         249.8        8.4
  

 

 

    

 

 

    

 

 

   

Total Medicare

     5,670.6         5,230.8         439.8        8.4
  

 

 

    

 

 

    

 

 

   
                   Member Mix  
     Ending
June 30,  2013
     Ending
June 30, 2012
     June 30,
2013
    June 30,
2012
 

Retail Segment Detail

          

Medicare Advantage Membership

          

HMO

     1,027.7         917.4         50.6     48.4

PPO

     1,002.0         978.4         49.4     51.6
  

 

 

    

 

 

    

 

 

   

 

 

 

Total Individual Medicare

     2,029.7         1,895.8         100.0     100.0
  

 

 

    

 

 

    

 

 

   

 

 

 

Medicare Advantage Membership

          

Risk (D)

     541.4         502.5         26.7     26.5

Path-to-Risk (E)

     404.9         325.4         19.9     17.2

Other

     1,083.4         1,067.9         53.4     56.3
  

 

 

    

 

 

    

 

 

   

 

 

 

Total Individual Medicare

     2,029.7         1,895.8         100.0     100.0
  

 

 

    

 

 

    

 

 

   

 

 

 

 

S-19


Humana Inc.

Investments

Dollars in millions

 

     Fair value  
     6/30/2013      3/31/2013      12/31/2012  

Investment Portfolio:

        

Cash & cash equivalents

   $ 1,519       $ 1,398       $ 1,306   

Investment securities

     7,556         8,141         8,001   

Long-term investment securities

     1,770         1,824         1,846   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

   $ 10,845       $ 11,363       $ 11,153   
  

 

 

    

 

 

    

 

 

 

Duration (J)

     4.13         4.21         4.02   
  

 

 

    

 

 

    

 

 

 

Average Credit Rating

     AA-         AA-         AA-   
  

 

 

    

 

 

    

 

 

 

Investment Portfolio Detail:

        

Cash and cash equivalents

   $ 1,519       $ 1,398       $ 1,306   
  

 

 

    

 

 

    

 

 

 

U.S. Government and agency obligations

        

U.S. Treasury and agency obligations

     571         552         618   

U.S. Government residential mortgage-backed

     1,407         1,585         1,569   

U.S. Government commercial mortgage-backed

     33         33         34   
  

 

 

    

 

 

    

 

 

 

Total U.S. Government and agency obligations

     2,011         2,170         2,221   
  

 

 

    

 

 

    

 

 

 

Tax-exempt municipal securities

        

Pre-refunded

     310         322         311   

Insured

     602         613         627   

Other

     2,103         2,235         2,120   

Auction rate securities

     13         13         13   
  

 

 

    

 

 

    

 

 

 

Total tax-exempt municipal securities

     3,028         3,183         3,071   
  

 

 

    

 

 

    

 

 

 

Residential mortgage-backed

        

Prime residential mortgages

     26         29         32   

Alt-A residential mortgages

     1         1         1   

Sub-prime residential mortgages

     1         1         1   
  

 

 

    

 

 

    

 

 

 

Total residential mortgage-backed

     28         31         34   
  

 

 

    

 

 

    

 

 

 

Commercial mortgage-backed

     573         694         659   
  

 

 

    

 

 

    

 

 

 

Asset-backed securities

     53         85         68   
  

 

 

    

 

 

    

 

 

 

Corporate securities

        

Financial services

     863         889         864   

Other

     2,770         2,913         2,930   
  

 

 

    

 

 

    

 

 

 

Total corporate securities

     3,633         3,802         3,794   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

   $ 10,845       $ 11,363       $ 11,153   
  

 

 

    

 

 

    

 

 

 

 

S-20


Humana Inc.

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

Dollars in millions

 

     June 30,
2013
    June 30,
2012
    December 31,
2012
 

Detail of benefits payable

      

IBNR and other benefits payable (K)

   $ 3,297      $ 3,085      $ 3,158   

Unprocessed claim inventories (L)

     380        310        302   

Processed claim inventories (M)

     334        359        230   

Payable to pharmacy benefit administrator (N)

     149        163        85   
  

 

 

   

 

 

   

 

 

 

Benefits payable, excluding military services

     4,160        3,917        3,775   

Military services benefits payable (O)

     (3     77        4   
  

 

 

   

 

 

   

 

 

 

Total Benefits Payable

   $ 4,157      $ 3,994      $ 3,779   
  

 

 

   

 

 

   

 

 

 
     Six Months Ended
June 30, 2013
    Six Months Ended
June 30, 2012
    Year Ended
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

     16,632        15,233        30,198   

Prior years (Q)

     (366     (181     (257
  

 

 

   

 

 

   

 

 

 

Total incurred

     16,266        15,052        29,941   
  

 

 

   

 

 

   

 

 

 

Paid related to:

      

Current year

     (12,884     (11,869     (26,738

Prior years

     (2,997     (2,751     (2,909
  

 

 

   

 

 

   

 

 

 

Total paid

     (15,881     (14,620     (29,647
  

 

 

   

 

 

   

 

 

 

Balances at end of period

   $ 4,160      $ 3,917      $ 3,775   
  

 

 

   

 

 

   

 

 

 
     Six Months Ended
June 30, 2013
    Six Months Ended
June 30, 2012
    Year Ended
December 31, 2012
 

Summary of Consolidated Benefit Expense:

      

Total benefit expense incurred, per above

   $ 16,266      $ 15,052      $ 29,941   

Military services benefit expense

     (37     890        908   

Future policy benefit expense (R)

     57        60        136   
  

 

 

   

 

 

   

 

 

 

Consolidated Benefit Expense

   $ 16,286      $ 16,002      $ 30,985   
  

 

 

   

 

 

   

 

 

 

 

S-21


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

     13.1         13.7         (0.6     -4.4

3rd Quarter Average

        13.0         n/a        n/a   

4th Quarter Average

        12.8         n/a        n/a   
  

 

 

    

 

 

    

 

 

   

Full Year Average

     12.8         13.1         (0.3     -2.3
  

 

 

    

 

 

    

 

 

   

Unprocessed Claims Inventories

 

Date

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

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   
  

 

 

    

 

 

    

 

 

 

6/30/2013

   $ 380         1,274         4.7   
  

 

 

    

 

 

    

 

 

 

 

S-22


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
 

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
  

 

 

    

 

 

   

 

 

 

6/30/2013

     50.7         (0.3     -0.6
  

 

 

    

 

 

   

 

 

 

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

 

     2013     FY 2012  

DCP - beginning of period

     48.5        52.5   

Components of change in DCP:

    

Change in unprocessed claims inventories

     1.0        (0.1

Change in processed claims inventories

     1.3        0.3   

Change in pharmacy payment cutoff

     —          (0.1

Change in capitation/provider settlements

     (0.1     (4.3

All other

     —          0.2   
  

 

 

   

 

 

 

DCP - end of period

     50.7        48.5   
  

 

 

   

 

 

 

 

S-23


Humana Inc.

Footnotes to Statistical Schedules and Supplementary Information

2Q13 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.

 

  (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-24