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8-K - 8-K - HEALTH NET INCd722996d8k.htm

Exhibit 99.1

 

LOGO

 

Investor Contact:   Media Contact:
David Olson   Brad Kieffer
The Abernathy MacGregor Group   (818) 676-6833
(818) 917-1469   brad.kieffer@healthnet.com

dwo@abmac.com

 

HEALTH NET REPORTS FIRST QUARTER 2014 GAAP NET INCOME

OF $28.8 MILLION, OR $0.36 PER DILUTED SHARE

WESTERN REGION OPERATIONS AND GOVERNMENT CONTRACTS SEGMENTS PRODUCE

COMBINED NET INCOME OF $0.39 PER DILUTED SHARE IN FIRST QUARTER 2014

HEALTH PLAN ENROLLMENT CLIMBS 6.7 PERCENT YEAR-OVER-YEAR,

DRIVEN BY COMMERCIAL EXCHANGES AND MEDICAID EXPANSION

COMMERCIAL MCR IMPROVES MORE THAN 500 BASIS POINTS YEAR-OVER-YEAR

HEALTH NET MAINTAINS FULL YEAR 2014 GAAP

EARNINGS PER DILUTED SHARE GUIDANCE OF AT LEAST $3.00

DUAL ELIGIBLES ENROLLMENT UNDERWAY

LOS ANGELES, May 7, 2014 – Health Net, Inc. (NYSE:HNT) today announced 2014 first quarter GAAP net income of $28.8 million, or $0.36 per diluted share, compared with GAAP net income of $50.1 million, or $0.62 per diluted share, for the first quarter of 2013.

The company’s Western Region Operations (Western Region) and Government Contracts segments produced combined net income of $31.3 million, or $0.39 per diluted share, in the first quarter of 2014 compared with $50.1 million, or $0.62 per diluted share, in the first quarter of 2013.

The first quarter 2014 results include approximately $4.1 million, or $0.03 per diluted share, in pretax expenses, primarily related to litigation costs.

Highlights from the first quarter of 2014 include:

 

  1. The company achieved 6.7 percent enrollment growth in its Western Region health plans in the first quarter of 2014 compared with the first quarter of 2013;


  2. Small group and individual commercial enrollment climbed by 20.1 percent in the first quarter of 2014 compared with the first quarter of 2013, primarily driven by approximately 155,000 new individual members from the Affordable Care Act (ACA) exchanges in California and Arizona;

 

  3. Medicaid enrollment increased by 17.9 percent in the first quarter of 2014 compared with the first quarter of 2013. This was primarily the result of approximately 166,000 new members added in Arizona and California in the first quarter of 2014 from the expansion of Medicaid eligibility under the ACA; and

 

  4. The company’s Western Region health plan Medical Care Ratios (MCRs) all improved in the first quarter of 2014 compared with the first quarter of 2013. The Western Region commercial MCR improved by more than 500 basis points year-over-year.

“Our first quarter performance demonstrated substantial commercial and Medicaid enrollment momentum thanks primarily to new ACA-related programs,” said Jay Gellert, Health Net’s chief executive officer. “We expect the second quarter to show further commercial growth as we enrolled approximately 54,000 new individual members in April. We expect to enroll an additional 60,000 to 70,000 individual exchange members in May.

“We believe our Medicaid enrollment gains from ACA-driven expansion will continue throughout 2014, with approximately 120,000 incremental members in the last three quarters of this year,” Gellert noted.

“We are encouraged by the ongoing moderate health care cost trends that particularly benefited our commercial and Medicaid businesses in the first quarter of 2014,” he added.

“In recent weeks, we have begun to enroll the first of our new dual eligible members, a new beginning for Health Net and for these important beneficiaries,” commented Gellert.

CONSOLIDATED RESULTS

Health Net’s total revenues of approximately $3.0 billion in the first quarter of 2014 increased approximately 8.6 percent compared with the first quarter of 2013.

Health plan services premium revenues of approximately $2.9 billion in the first quarter of 2014 increased by approximately 9.5 percent compared with the first quarter of 2013.

Health plan services expenses of approximately $2.4 billion in the first quarter of 2014 increased by approximately 5.9 percent compared with the first quarter of 2013.

WESTERN REGION OPERATIONS SEGMENT

Health Plan Membership

Total enrollment in the Western Region at March 31, 2014 was approximately 2.6 million members, an increase of 6.7 percent from enrollment at March 31, 2013.

Total enrollment in the company’s California health plans at March 31, 2014 increased approximately 6.1 percent compared with March 31, 2013.

Western Region commercial enrollment was approximately 1.1 million members at March 31, 2014, a decrease of approximately 4.7 percent compared with enrollment at March 31, 2013, and an increase of 0.6 percent from December 31, 2013.

Membership in tailored network products represented 48.6 percent of the company’s Western Region commercial membership at March 31, 2014 compared with 37.1 percent at March 31, 2013.

 

2


“Total California small group and individual enrollment increased 22.2 percent from March 31, 2013 to March 31, 2014,” said Jim Woys, Health Net’s chief operating officer. “We are pleased that our strategy to use our tailored network product structure to build plans for the individual exchanges has worked so well.”

Enrollment in Health Net’s Medicare Advantage (MA) plans was 255,000 members at March 31, 2014, a 9.4 percent increase compared with enrollment of 233,000 members at March 31, 2013.

Medicaid enrollment increased 17.9 percent to approximately 1.3 million members at March 31, 2014 compared with approximately 1.1 million members as of March 31, 2013 due to Medicaid expansion and the company’s entry into an Arizona Medicaid program on October 1, 2013.

Revenues

Total revenues for the Western Region for the first quarter of 2014 were approximately $2.9 billion compared with approximately $2.7 billion in the first quarter of 2013.

Net investment income for the Western Region was $11.1 million in the first quarter of 2014 compared with $29.6 million in the first quarter of 2013 and $11.6 million in the fourth quarter of 2013. The year-over-year decrease was due to the absence of investment gains in 2014’s first quarter. In the first quarter of 2013, Health Net recorded approximately $17.3 million in investment gains.

Health Plan Services Expenses

Health plan services expenses in the Western Region were approximately $2.4 billion in the first quarter of 2014 compared with approximately $2.3 billion in the first quarter of 2013.

Commercial Premium Yields and Health Care Costs

In the Western Region, commercial premiums per member per month (PMPM) increased by 3.9 percent to approximately $400 in the first quarter of 2014 compared with approximately $385 in the first quarter of 2013.

Commercial health care costs PMPM in the Western Region decreased 2.2 percent to approximately $324 in the first quarter of 2014 compared with approximately $331 in the first quarter of 2013.

“We believe we will be able to maintain a positive commercial spread between premiums and health care costs throughout 2014 as we expect overall health care cost trends to remain moderate,” Woys noted.

Medical Care Ratios (MCR)

The health plan services MCR in the Western Region was 83.4 percent in the first quarter of 2014 compared with 86.2 percent in the first quarter of 2013.

The Western Region commercial MCR improved by more than 500 basis points and was 80.9 percent in the first quarter of 2014 compared with 85.9 percent in the first quarter of 2013.

“With rapid expansion of our individual enrollment, our mix of business has improved and this has helped the MCR performance,” noted Woys. “We also saw revenue benefits related to the ACA in the first quarter of 2014.”

The MA MCR in the Western Region was 91.8 percent in the first quarter of 2014 compared with 91.9 percent in the first quarter of 2013.

The Medicaid MCR in the Western Region was 79.8 percent in the first quarter of 2014 compared with 80.0 percent in the first quarter of 2013.

 

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General and Administrative (G&A) Expenses

G&A expense in the Western Region was approximately $357.9 million in the first quarter of 2014 compared with approximately $245.2 million in the first quarter of 2013. The G&A expense ratio was 12.4 percent in the first quarter of 2014 compared with 9.3 percent in the first quarter of 2013.

“The increase in the G&A expense ratio year-over-year reflects significantly higher spending to support our growth and address ACA-related fees and expenses,” commented Woys. “We expect the ratio will decline over the last three quarters of 2014 as we anticipate absolute spending to remain approximately equal to the first quarter level while revenues build over the balance of the year due to our new businesses.”

GOVERNMENT CONTRACTS SEGMENT

Government Contracts revenues were $144.1 million in the first quarter of 2014 and $134.5 million in the first quarter of 2013.

Government Contracts expenses were approximately $131.1 million in the first quarter of 2014 and $125.5 million in the first quarter of 2013.

BALANCE SHEET

Cash and investments as of March 31, 2014 were approximately $2.4 billion compared with approximately $2.1 billion as of December 31, 2013 and $2.0 billion as of March 31, 2013.

Reserves for claims and other settlements as of March 31, 2014 were approximately $1.2 billion compared with $1.1 billion at March 31, 2013 and $984.1 million at December 31, 2013.

Days claims payable (DCP) for the first quarter of 2014 was 43.2 days compared with 43.5 days for the first quarter of 2013 and 40.6 days for the fourth quarter of 2013.

On an adjusted1 basis, DCP for the first quarter of 2014 was 63.1 days compared with 62.1 days for the first quarter of 2013 and 57.9 days for the fourth quarter of 2013.

“We are very pleased with the growth of adjusted DCP. It reflects a cautious view as we manage the rapid changes in our enrollee population,” Woys explained.

The company’s debt-to-total capital ratio was 22.9 percent as of March 31, 2014 compared with 24.6 percent as of March 31, 2013 and 23.5 percent as of December 31, 2013.

Interest expense was approximately $7.8 million in the first quarter of 2014 compared with $8.3 million in the first quarter of 2013.

CASH FLOWS FROM OPERATIONS

Operating cash flow was $311.5 million in the first quarter of 2014.

“This strong cash flow was primarily the result of timing related to claims and capitation payments, and ACA-related expenses,” said Joseph Capezza, Health Net’s chief financial officer. “For the full year, we expect operating cash flow to be approximately equal to net income plus depreciation and amortization.”

 

1  For a reconciliation of adjusted days claims payable to the comparable GAAP financial measure, see “Management’s Discussion and Analysis of Financial Condition and Results of Operations — Results of Operations — Days Claims Payable” in the company’s Form 10-Q for the quarter ended March 31, 2014, and Item 2.02 in the company’s Form 8-K filed with the Securities and Exchange Commission on May 7, 2014.

 

4


The company noted that cash and investments at the parent was approximately $212.0 million at March 31, 2014.

SHARE REPURCHASE UPDATE

Health Net did not repurchase any shares of its common stock in the first quarter of 2014. At March 31, 2014, approximately $280 million of authorization under the company’s existing $400 million share repurchase program remains.

2014 GUIDANCE

The company continues to expect GAAP earnings per diluted share of at least $3.00 for the full year 2014. The table included in this release provides specific 2014 guidance metrics, including updates to expectations for commercial and Medicaid membership, premium revenues, tax rate, and MA, Medicaid and dual eligible MCRs.

CONFERENCE CALL

As previously announced, Health Net will discuss the company’s first quarter 2014 financial results during a conference call on Wednesday, May 7, 2014, beginning at approximately 11:30 a.m. Eastern time. The conference call should be accessed at least 15 minutes prior to its start with the following numbers:

 

(877) 407-4019 (Domestic toll-free)

  (877) 660-6853 (Replay – Domestic toll-free)

(201) 689-8337 (International)

  (201) 612-7415 (Replay – International)

An access code is not required for the live conference call on May 7, 2014. The access code for the replay is 13580432. The replay of the conference call will be available through May 12, 2014. A live webcast and replay of the conference call also will be available at www.healthnet.com under “Investor Relations.” The conference call webcast is open to all interested parties. Anyone listening to the company’s conference call will be presumed to have read Health Net’s Annual Report on Form 10-K for the year ended December 31, 2013, and other reports filed by the company from time to time with the Securities and Exchange Commission.

ABOUT HEALTH NET

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net provides and administers health benefits to approximately 5.5 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net also offers behavioral health, substance abuse and employee assistance programs, managed health care products related to prescription drugs, managed health care product coordination for multi-region employers, and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit the company’s website at www.healthnet.com.

 

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CAUTIONARY STATEMENTS

The company and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. All statements in this press release, other than statements of historical information provided herein, including the guidance for future periods and the assumptions underlying such projections, may be deemed to be forward-looking statements and as such are intended to be covered by the safe harbor for “forward-looking statements” provided by PSLRA. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to changes in circumstances and a number of risks and uncertainties. Without limiting the foregoing, the guidance as to expected future period results and statements including the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend,” “feels,” “will,” “projects” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially from those expressed in, or implied or projected by the forward-looking information and statements due to, among other things, health care reform and other increased government participation in and taxation or regulation of health benefits and managed care operations, including but not limited to the implementation of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, the “ACA”) and related fees, assessments and taxes; the company’s ability to successfully participate in California’s Coordinated Care Initiative, which is subject to a number of risks inherent in untested health care initiatives and requires the company to adequately predict the costs of providing benefits to individuals that are generally among the most chronically ill within each of Medicare and Medi-Cal and implement delivery systems for benefits with which the company has limited operating experience; the company’s ability to successfully participate in the federal and state health insurance exchanges under the ACA, which have experienced technical challenges in implementation and which involve uncertainties related to the mix and volume of business that could negatively impact the adequacy of our premium rates and may not be sufficiently offset by the risk apportionment provisions of the ACA; increasing health care costs, including but not limited to costs associated with the introduction of new treatments or therapies; our ability to reduce administrative expenses while maintaining targeted levels of service and operating performance; negative prior period claims reserve developments; rate cuts and other risks and uncertainties affecting the company’s Medicare or Medicaid businesses; the company’s ability to successfully participate in Arizona’s Medicaid program; trends in medical care ratios; membership declines or negative changes in our health care product mix; unexpected utilization patterns or unexpectedly severe or widespread illnesses; the timing of collections on amounts receivable from state and federal governments and agencies, including collections of amounts owed under the T-3 contract; litigation costs; regulatory issues with federal and state agencies including, but not limited to, the California Department of Managed Health Care, the Centers for Medicare & Medicaid Services, the Office of Civil Rights of the U.S. Department of Health and Human Services and state departments of insurance; operational issues; changes in economic or market conditions including a further decline in the economy; failure to effectively oversee our third-party vendors; noncompliance by the company or the company’s business associates with any privacy laws or any security breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information; impairment of the company’s goodwill or other intangible assets; investment portfolio impairment charges; volatility in the financial markets; liabilities incurred in connection with the company’s divested operations; and general business and market conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within the company’s most recent Annual Report on Form 10-K filed with the SEC and the other risks discussed in the company’s filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. Except as may be required by law, the company undertakes no obligation to address or publicly update any of its guidance, the assessment of the underlying assumptions or forward-looking statements to reflect events or circumstances that arise after the date of this release.

 

6


Eight pages of tables follow.

#     #     #

 

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Health Net, Inc.

2014 GAAP Guidance(1)

 

     
MEMBERSHIP at 12/31/2014    Current
(updated  5/7/14)
    Previous
(as of  2/11/14)
 
   
      Enrollment
at 12/31/2014
    Enrollment
at 12/31/2014
 

Commercial

      

Large Group

     560,000        580,000   

Small Group

     280,000        300,000   

Individual

     380,000        270,000   
   

Total Commercial

     1,220,000        1,150,000   
   

Medicare Advantage

     260,000        260,000   
   

Medicaid

     1,535,000        1,590,000   
   

Dual Eligibles

     38,000        38,000   
   

Total Health Plan Membership

     3,053,000        3,040,000   
   
                  
    
     

Premium Revenues

   FY2014     FY2014  

Commercial

   $ 5.6 billion      $ 5.4 billion   

Medicare Advantage

   $ 3.0 billion      $ 3.0 billion   

State Health Plans

   $ 4.4 billion      $ 5.1 billion   

Dual Eligibles

   $ 342 million      $ 342 million   

Total Health Plans

   $ 13.3 billion      $ 13.8 billion   
   

Total Consolidated Revenues

   $ 14.0 billion      $ 14.4 billion   
   

Medical Care Ratios (MCR)

   FY2014     FY2014  

Commercial

     83.0%        83.0%   

Medicare Advantage

     90.9%        89.6%   

Medicaid

     83.9%        85.2%   

Dual Eligibles

     86.5%        86.9%   
   

G&A Expense Ratio

     10.8%        10.8%   
   

Tax Rate(2)

     34.6%        34.2%   
   

Western Region and Government Contracts Tax Rate(3)

     52.2%        52.0%   
   

Weighted-average fully diluted shares outstanding

     77 million        77 million   
   

GAAP Earnings per Diluted Share (EPS)(2)

     At least $3.00        At least $3.00   
   

Western Region and Government Contracts EPS(3)

     At least $2.22        At least $2.22   
   
                  

 

(1) All guidance metrics are approximations

 

(2) Includes a $60 million tax benefit

 

(3) Excludes the $60 million tax benefit

 

8


Health Net, Inc.

Enrollment Data - By State

(In thousands)

 

                          Change from  
                          December 31, 2013     March 31, 2013  
     March 31,      December 31,      March 31,      Increase/     %     Increase/     %  
     2014      2013      2013      (Decrease)     Change     (Decrease)     Change  

California

                 

Large Group

     499         565         628         (66     (11.7 )%      (129     (20.5 )% 

Small Group and Individual

     397         344         325         53        15.4     72        22.2
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     896         909         953         (13     (1.4 )%      (57     (6.0 )% 

Medicare Advantage

     156         153         143         3        2.0     13        9.1

Medi-Cal

     1,279         1,113         1,100         166        14.9     179        16.3

Total California

     2,331         2,175         2,196         156        7.2     135        6.1

Arizona

                 

Large Group

     50         57         69         (7     (12.3 )%      (19     (27.5 )% 

Small Group and Individual

     87         51         57         36        70.6     30        52.6
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     137         108         126         29        26.9     11        8.7

Medicare Advantage

     46         43         43         3        7.0     3        7.0

Medicaid

     18         4            14        350.0     18     

Total Arizona

     201         155         169         46        29.7     32        18.9

Northwest

                 

Large Group

     29         29         21         0        0.0     8        38.1

Small Group and Individual

     29         39         45         (10     (25.6 )%      (16     (35.6 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     58         68         66         (10     (14.7 )%      (8     (12.1 )% 

Medicare Advantage

     53         48         47         5        10.4     6        12.8

Total Northwest

     111         116         113         (5     (4.3 )%      (2     (1.8 )% 

Total Health Plan Enrollment

                 

Large Group

     578         651         718         (73     (11.2 )%      (140     (19.5 )% 

Small Group and Individual

     513         434         427         79        18.2     86        20.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     1,091         1,085         1,145         6        0.6     (54     (4.7 )% 

Medicare Advantage

     255         244         233         11        4.5     22        9.4

Medi-Cal/Medicaid

     1,297         1,117         1,100         180        16.1     197        17.9
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Western Region Operations

     2,643         2,446         2,478         197        8.1     165        6.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

TRICARE - North Contract Eligibles

     2,851         2,851         2,883         0        0.0     (32     (1.1 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

 

9


Health Net, Inc.

Enrollment Data - Line of Business

(In thousands)

 

                          Change from  
                          December 31, 2013     March 31, 2013  
     March 31,      December 31,      March 31,      Increase/     %     Increase/     %  
     2014      2013      2013      (Decrease)     Change     (Decrease)     Change  

Large Group

                 

California

     499         565         628         (66     (11.7 )%      (129     (20.5 )% 

Arizona

     50         57         69         (7     (12.3 )%      (19     (27.5 )% 

Northwest

     29         29         21         0        0.0     8        38.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     578         651         718         (73     (11.2 )%      (140     (19.5 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Small Group and Individual

                 

California

     397         344         325         53        15.4     72        22.2

Arizona

     87         51         57         36        70.6     30        52.6

Northwest

     29         39         45         (10     (25.6 )%      (16     (35.6 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     513         434         427         79        18.2     86        20.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

                 

California

     896         909         953         (13     (1.4 )%      (57     (6.0 )% 

Arizona

     137         108         126         29        26.9     11        8.7

Northwest

     58         68         66         (10     (14.7 )%      (8     (12.1 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     1,091         1,085         1,145         6        0.6     (54     (4.7 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Medicare Advantage

                 

California

     156         153         143         3        2.0     13        9.1

Arizona

     46         43         43         3        7.0     3        7.0

Northwest

     53         48         47         5        10.4     6        12.8
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     255         244         233         11        4.5     22        9.4
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Medi-Cal/Medicaid

                 

California

     1,279         1,113         1,100         166        14.9     179        16.3

Arizona

     18         4            14        350.0     18     
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     1,297         1,117         1,100         180        16.1     197        17.9
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total Health Plan Enrollment

                 

Large Group

     578         651         718         (73     (11.2 )%      (140     (19.5 )% 

Small Group and Individual

     513         434         427         79        18.2     86        20.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     1,091         1,085         1,145         6        0.6     (54     (4.7 )% 

Medicare Advantage

     255         244         233         11        4.5     22        9.4

Medi-Cal/Medicaid

     1,297         1,117         1,100         180        16.1     197        17.9
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Western Region Operations

     2,643         2,446         2,478         197        8.1     165        6.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

TRICARE - North Contract Eligibles

     2,851         2,851         2,883         0        0.0     (32     (1.1 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

10


Health Net, Inc.

Consolidated Statements of Operations

($ in thousands, except per share data)

 

     Quarter Ended
March 31,
2014
     Quarter Ended
December 31,
2013
     Quarter Ended
March 31,
2013
 

REVENUES:

        

Health plan services premiums

   $ 2,881,345       $ 2,559,376       $ 2,632,069   

Government contracts

     144,090         148,470         134,512   

Net investment income

     11,102         11,643         29,551   

Administrative services fees and other income

     2,398         23,755         905   
  

 

 

    

 

 

    

 

 

 

Total revenues

     3,038,935         2,743,244         2,797,037   
  

 

 

    

 

 

    

 

 

 

EXPENSES:

        

Health plan services

     2,402,342         2,229,332         2,268,736   

Government contracts

     131,974         124,709         125,475   

General and administrative

     361,023         279,339         245,235   

Selling

     64,152         63,600         58,561   

Depreciation and amortization

     9,663         10,234         9,439   

Interest

     7,821         7,988         8,288   
  

 

 

    

 

 

    

 

 

 

Total expenses

     2,976,975         2,715,202         2,715,734   
  

 

 

    

 

 

    

 

 

 

Income from operations before income taxes

     61,960         28,042         81,303   

Income tax provision

     33,173         8,289         31,253   
  

 

 

    

 

 

    

 

 

 

Net income

   $ 28,787       $ 19,753       $ 50,050   
  

 

 

    

 

 

    

 

 

 

Net income per share:

        

Basic

   $ 0.36       $ 0.25       $ 0.63   

Diluted

   $ 0.36       $ 0.25       $ 0.62   

Weighted average shares outstanding:

        

Basic

     79,802         79,511         79,508   

Diluted

     80,922         80,600         80,489   

 

11


Health Net, Inc.

Condensed Consolidated Balance Sheets

(Amounts in thousands, except ratio data)

 

     March 31,     December 31,     March 31,  
     2014     2013     2013  

ASSETS

      

Current Assets

      

Cash and cash equivalents

   $ 737,024      $ 433,155      $ 230,335   

Investments - available for sale

     1,685,009        1,567,020        1,767,156   

Premiums receivable, net

     450,224        430,012        519,287   

Amounts receivable under government contracts

     188,843        194,041        207,891   

Other receivables

     54,251        68,919        66,520   

Deferred taxes

     75,321        94,060        62,027   

Other assets

     254,702        132,683        120,233   
  

 

 

   

 

 

   

 

 

 

Total current assets

     3,445,374        2,919,890        2,973,449   

Property and equipment, net

     206,410        201,395        188,038   

Goodwill

     565,886        565,886        565,886   

Other intangible assets, net

     13,949        13,842        16,414   

Deferred taxes

     4,195        5,793        8,006   

Investments - available for sale - noncurrent

     4,255        59,768        —     

Other noncurrent assets

     190,550        162,551        123,514   
  

 

 

   

 

 

   

 

 

 

Total Assets

   $ 4,430,619      $ 3,929,125      $ 3,875,307   
  

 

 

   

 

 

   

 

 

 

LIABILITIES AND STOCKHOLDERS’ EQUITY

      

Current Liabilities

      

Reserves for claims and other settlements

   $ 1,151,958      $ 984,075      $ 1,097,744   

Health care and other costs payable under government contracts

     80,232        72,098        77,380   

Unearned premiums

     127,593        123,969        139,584   

Accounts payable and other liabilities

     669,406        397,036        302,171   
  

 

 

   

 

 

   

 

 

 

Total current liabilities

     2,029,189        1,577,178        1,616,879   

Senior notes payable

     399,351        399,300        399,146   

Deferred taxes

     18,057        10,409        —     

Borrowings under revolving credit facility

     100,000        100,000        100,000   

Other noncurrent liabilities

     205,521        213,427        230,666   
  

 

 

   

 

 

   

 

 

 

Total Liabilities

     2,752,118        2,300,314        2,346,691   
  

 

 

   

 

 

   

 

 

 

Stockholders’ Equity

      

Common stock

     152        150        150   

Additional paid-in capital

     1,397,962        1,377,624        1,352,458   

Treasury common stock, at cost

     (2,197,538     (2,179,744     (2,177,840

Retained earnings

     2,492,435        2,463,648        2,343,572   

Accumulated other comprehensive (loss) income

     (14,510     (32,867     10,276   
  

 

 

   

 

 

   

 

 

 

Total Stockholders’ Equity

     1,678,501        1,628,811        1,528,616   
  

 

 

   

 

 

   

 

 

 

Total Liabilities and Stockholders’ Equity

   $ 4,430,619      $ 3,929,125      $ 3,875,307   
  

 

 

   

 

 

   

 

 

 

Debt-to-Total Capital Ratio

     22.9     23.5     24.6

 

12


Health Net, Inc.

Condensed Consolidated Statements of Cash Flows

(Amounts in thousands)

 

     Quarter Ended     Quarter Ended     Quarter Ended  
     March 31,     December 31,     March 31,  
     2014     2013     2013  

CASH FLOWS FROM OPERATING ACTIVITIES:

      

Net income

   $ 28,787      $ 19,753      $ 50,050   

Adjustments to reconcile net income to net cash provided by (used in) operating activities:

      

Amortization and depreciation

     9,663        10,234        9,439   

Share-based compensation expense

     9,164        6,542        9,935   

Deferred income taxes

     18,129        (9,676     3,579   

Excess tax benefits from share-based compensation

     (997     (169     (394

Net realized gain on sale on investments

     (308     (755     (17,289

Other changes

     9,562        7,975        8,679   

Changes in assets and liabilities:

      

Premiums receivable and unearned premiums

     (16,588     (91,622     (157,482

Other current assets, receivables and noncurrent assets

     (147,387     (24,528     7,427   

Amounts receivable/payable under government contracts

     34,089        (10,168     25,891   

Reserves for claims and other settlements

     167,883        (6,120     59,771   

Accounts payable and other liabilities

     199,461        26,648        (27,791
  

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

     311,458        (71,886     (28,185
  

 

 

   

 

 

   

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES:

      

Sales of investments

     66,499        42,748        354,813   

Maturities of investments

     24,469        20,415        30,068   

Purchases of investments

     (125,564     (70,179     (365,081

Purchases of property and equipment

     (17,437     (16,929     (13,690

Sales and purchases of restricted investments and other

     3,537        (2,735     (1,171
  

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by investing activities

     (48,496     (26,680     4,939   
  

 

 

   

 

 

   

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES:

      

Proceeds from exercise of stock options and employee stock purchases

     3,746        120        6,957   

Repurchases of common stock

     (11,292     (241     (77,394

Excess tax benefits from share-based compensation

     997        169        394   

Borrowings under financing arrangements

     —          22,000        90,000   

Repayment of borrowings under financing arrangements

     —          (22,000     (90,000

Net increase (decrease) in checks outstanding, net of deposits

     713        —          (23,816

Customer funds administered

     46,743        (154,466     7,330   
  

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities

     40,907        (154,418     (86,529
  

 

 

   

 

 

   

 

 

 

Net increase (decrease) in cash and cash equivalents

     303,869        (252,984     (109,775

Cash and cash equivalents, beginning of period

     433,155        686,139        340,110   
  

 

 

   

 

 

   

 

 

 

Cash and cash equivalents, end of period

   $ 737,024      $ 433,155      $ 230,335   
  

 

 

   

 

 

   

 

 

 

 

13


Health Net, Inc.

SEGMENT INFORMATION

($ in thousands, except per share and PMPM data)

The following table presents Health Net’s operating segment information.

 

    Quarter Ended March 31, 2014     Quarter Ended December 31, 2013     Quarter Ended March 31, 2013  
    Western
Region

Operations1
    Government
Contracts2
    Corporate/
Other3
    Consolidated     Western
Region

Operations1
    Government
Contracts2
    Corporate/
Other3
    Consolidated     Western
Region

Operations1
    Government
Contracts2
    Corporate/
Other
  Consolidated  

Commercial premiums

  $ 1,264,177          $ 1,264,177      $ 1,271,553          $ 1,271,553      $ 1,325,414          $ 1,325,414   

Medicare premiums

    755,158            755,158        691,114            691,114        706,398            706,398   

Medicaid premiums

    862,010            862,010        596,709            596,709        600,257            600,257   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Health plan services premiums

    2,881,345            2,881,345        2,559,376            2,559,376      $ 2,632,069            2,632,069   

Government contracts

      144,090          144,090          148,470          148,470          134,512          134,512   

Net investment income

    11,102            11,102        11,643            11,643        29,551            29,551   

Administrative services fees and other income

    2,398            2,398        23,755            23,755        905            905   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Total revenues

    2,894,845        144,090          3,038,935        2,594,774        148,470          2,743,244        2,662,525        134,512          2,797,037   

Health plan services

    2,402,342            2,402,342        2,229,332            2,229,332        2,268,736            2,268,736   

Government contracts

      131,070        904        131,974          124,638        71        124,709          125,475          125,475   
Premium tax     42,458            42,458        31,601            31,601        8,193            8,193   
Health insurer fee     36,293            36,293        —              —          —              —     
Other ACA fees     22,527            22,527        836            836        573            573   
Administrative expenses     256,594          3,151        259,745        247,946          (1,044     246,902        236,469            236,469   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Total general and administrative

    357,872          3,151        361,023        280,383          (1,044     279,339        245,235            245,235   

Selling

    64,152            64,152        63,600            63,600        58,561            58,561   

Depreciation and amortization

    9,663            9,663        10,234            10,234        9,439            9,439   

Interest

    7,821            7,821        7,988            7,988        8,288            8,288   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Total expenses

    2,841,850        131,070        4,055        2,976,975        2,591,537        124,638        (973     2,715,202        2,590,259        125,475          2,715,734   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Income (loss) from continuing operations before income taxes

    52,995        13,020        (4,055     61,960        3,237        23,832        973        28,042        72,266        9,037          81,303   

Income tax provision (benefit)

    29,371        5,386        (1,584     33,173        (2,215     10,148        356        8,289        27,629        3,624          31,253   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Income (loss) from continuing operations

  $ 23,624      $ 7,634      $ (2,471   $ 28,787      $ 5,452      $ 13,684      $ 617      $ 19,753      $ 44,637      $ 5,413        $ 50,050   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

 

Basic earnings (loss) per share from continuing operations

  $ 0.30      $ 0.10      $ (0.03   $ 0.36      $ 0.07      $ 0.17      $ 0.01      $ 0.25      $ 0.56      $ 0.07        $ 0.63   

Diluted earnings (loss) per share from continuing operations

  $ 0.29      $ 0.10      $ (0.03   $ 0.36      $ 0.07      $ 0.17      $ 0.01      $ 0.25      $ 0.55      $ 0.07        $ 0.62   

Basic weighted average shares outstanding

    79,802        79,802        79,802        79,802        79,511        79,511        79,511        79,511        79,508        79,508          79,508   

Diluted weighted average shares outstanding

    80,922        80,922        79,802        80,922        80,600        80,600        80,600        80,600        80,489        80,489          80,489   

Pretax margin

    1.8           0.1           2.7      

Commercial premium yield

    3.9           3.4           2.9      

Commercial premium PMPM

  $ 400.34            $ 388.41            $ 385.29         

Commercial health care cost trend

    -2.2           2.0           -3.3      

Commercial health care cost PMPM

  $ 323.92            $ 339.53            $ 331.13         

Commercial MCR

    80.9           87.4           85.9      

Medicare Advantage MCR

    91.8           90.5           91.9      

Medicaid MCR

    79.8           82.7           80.0      

Health plan services MCR

    83.4           87.1           86.2      

Administrative expense ratio

    8.9           9.6           9.0      

Total G&A expense ratio

    12.4           10.9           9.3      

Selling costs ratio

    2.2           2.5           2.2      
1 Includes the operations of the company's commercial, Medicare and Medicaid health plans in California, Arizona, Oregon and Washington, as well as the operations of the company's health and life insurance companies, primarily in Arizona, California, Oregon and Washington, and the operations of the company's behavioral health and pharmaceutical services subsidiaries in several states including California, Arizona and Oregon.

 

2 Includes administrative services provided under the T-3 Managed Care Support Contract for the TRICARE North Region and other health care-related Department of Defense and Veterans Affairs government contracts.

 

3 Includes litigation reserve true-up related to previous accrual for lawsuit and related legal expenses. Also includes severance expense.

 

 

14


Health Net, Inc.

Reconciliation of Reserves for Claims and Other Settlements

($ in millions)

 

     Health Plan Services  
     YTD 3/2014     FY 2013     FY 2012  

Reserve for claims (a), beginning of period

   $ 807.4      $ 808.7      $ 720.8   

Incurred claims related to:

      

Current Year (f)

     1,229.6        4,666.0        4,950.9   

Prior Years (c)

     (22.9     (56.2     34.5   
  

 

 

   

 

 

   

 

 

 

Total Incurred (b)

     1,206.7        4,609.8        4,985.4   

Paid claims related to:

      

Current Year

     488.4        3,872.5        4,156.6   

Prior Years

     657.3        738.6        740.9   
  

 

 

   

 

 

   

 

 

 

Total Paid (b)

     1,145.7        4,611.1        4,897.5   
  

 

 

   

 

 

   

 

 

 

Reserve for claims (a), end of period

     868.4        807.4        808.7   

Add:

      

Claims Payable (d)

     93.5        67.0        91.6   

Other (e)

     190.1        109.7        137.7   
  

 

 

   

 

 

   

 

 

 

Reserves for claims and other settlements, end of period

   $ 1,152.0      $ 984.1      $ 1,038.0   
  

 

 

   

 

 

   

 

 

 

 

(a) Consists of incurred but not reported claims and received but unprocessed claims and reserves for loss adjustment expenses.

 

(b) Includes medical claims only. Capitation, pharmacy and other payments including provider settlements are not included.

 

(c) This line represents the change in reserves attributable to the difference between the original estimate of incurred claims for prior years and the revised estimate. Negative amounts in this line represent favorable development in estimated prior years’ health care costs. Positive amounts in this line represent unfavorable development in estimated prior years’ health care costs. For a detailed description of reserve development for the three months ended March 31, 2014, see Note 2 to the Consolidated Financial Statements in the company’s Form 10-Q for the quarter ended March 31, 2014. For a detailed description of reserve development for fiscal years 2013 and 2012, see Note 2 to the Consolidated Financial Statements in the company’s Form 10-K for the year ended December 31, 2013.

 

(d) Includes amount accrued for litigation and regulatory-related expenses.

 

(e) Includes accrued capitation, shared risk settlements, provider incentives and other reserve items.

 

(f) Our IBNR estimate also includes a provision for adverse deviation, which is an estimate for known environmental factors that are reasonably likely to affect the required level of IBNR reserves. Such amounts were $57 million, $53 million and $53 million as of March 31, 2014, December 31, 2013, and December 31, 2012, respectively.

 

15