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Segment Information
 9 Months Ended
Sep. 30, 2020
Segment Reporting [Abstract]  
Segment Information Segment Information
The results of our operations are now described through four reportable segments: Commercial & Specialty Business, Government Business, IngenioRx and Other.
Our Commercial & Specialty Business segment includes our Local Group, National Accounts, Individual and Specialty businesses. Business units in the Commercial & Specialty Business segment offer fully-insured health products; provide a broad array of managed care services to self-funded customers including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs and other administrative services; and provide an array of specialty and other insurance products and services such as dental, vision, life and disability insurance benefits.
Our Government Business segment includes our Medicare and Medicaid businesses, National Government Services, or NGS, and services provided to the federal government in connection with the FEHB program. Our Medicare business includes services such as Medicare Supplement plans; Medicare Advantage, including Special Needs Plans; Medicare Part D; and dual-eligible programs through Medicare-Medicaid Plans. Our Medicaid business includes our managed care alternatives through publicly funded healthcare programs, including Medicaid, Medicaid expansion programs related to the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended, Temporary Assistance for Needy Families, programs for seniors and people with disabilities, Children’s Health Insurance Programs, and specialty programs such as those focused on long-term services and support, HIV/AIDS, foster care, behavioral health and/or substance abuse disorders, and intellectual disabilities or developmental disabilities. NGS acts as a Medicare contractor for the federal government in several regions across the nation.
Our IngenioRx segment includes our PBM business, which began its operations during the second quarter of 2019. IngenioRx markets and offers PBM services to fully-insured and self-funded Anthem health plan customers, as well as to external customers outside of the health plans we own. IngenioRx has a comprehensive PBM services portfolio, which includes services such as formulary management, pharmacy networks, prescription drug database, member services and mail order capabilities. In 2019, IngenioRx was included in our Other reportable segment. Beginning in 2020, IngenioRx meets
the quantitative thresholds for a reportable segment based on the FASB guidance. Amounts for the three and nine months ended September 30, 2019 have been reclassified to conform to the current year presentation for comparability.
Our Other segment includes our Diversified Business Group, or DBG, which is our integrated health services business, and certain eliminations and corporate expenses not allocated to our other reportable segments. We reclassified DBG from our Government Business segment to the Other segment during the second quarter of 2019 to reflect changes in how our segments are being managed. Also, beginning on February 28, 2020, DBG includes Beacon.
For our 2019 segment reporting, operating gains (losses) generated from IngenioRx and DBG affiliated activity were included in our Commercial & Specialty Business and Government Business segments based upon their utilization of services from IngenioRx and DBG, which aligns with the method by which we assessed the 2019 operating performance of our reportable segments. Beginning January 1, 2020, we are managing the operating performance of each of our segments on a standalone basis.
Affiliated revenues represent revenues or cost for services provided by IngenioRx and DBG to our subsidiaries, are recorded at cost or management’s estimate of fair market value, and are eliminated in consolidation.
Financial data by reportable segment for the three and nine months ended September 30, 2020 and 2019 is as follows:
Commercial
& Specialty
Business		Government
Business		IngenioRxOtherEliminationsTotal
Three Months Ended September 30, 2020
Operating revenue - unaffiliated$9,326 $18,101 $2,598 $624 $— $30,649 
Operating revenue - affiliated— — 2,984 1,174 (4,158)— 
Operating (loss) gain(234)246 345 (156)— 201 
Three Months Ended September 30, 2019
Operating revenue - unaffiliated$9,284 $15,955 $774 $431 $— $26,444 
Operating revenue - affiliated— — 1,148 155 (1,303)— 
Operating gain (loss)924 616 — (12)— 1,528 
Nine Months Ended September 30, 2020
Operating revenue - unaffiliated$27,476 $52,809 $7,485 $1,505 $— $89,275 
Operating revenue - affiliated— — 8,563 2,772 (11,335)— 
Operating gain (loss)2,558 2,275 998 (76)— 5,755 
Nine Months Ended September 30, 2019
Operating revenue - unaffiliated$28,093 $46,419 $880 $617 $— $76,009 
Operating revenue - affiliated— — 1,290 1,063 (2,353)— 
Operating gain (loss)3,505 1,470 — (74)— 4,901 
The major product revenues for each of the reportable segments for the three and nine months ended September 30, 2020 and 2019 are as follows:
Three Months Ended 
 September 30		Nine Months Ended 
 September 30
2020201920202019
Commercial & Specialty Business
Managed care products
$7,523 $7,542 $22,209 $22,806 
Managed care services
1,391 1,330 4,036 4,049 
Dental/Vision products and services
318 325 917 975 
Other
94 87 314 263 
Total Commercial & Specialty Business
9,326 9,284 27,476 28,093 
Government Business
Managed care products
17,999 15,847 52,523 46,111 
Managed care services
102 108 286 308 
Total Government Business
18,101 15,955 52,809 46,419 
IngenioRx
Pharmacy products and services5,582 1,922 16,048 2,170 
Total IngenioRx
5,582 1,922 16,048 2,170 
Other
Other
1,798 586 4,277 1,680 
Eliminations
Eliminations
(4,158)(1,303)(11,335)(2,353)
Total product revenues
$30,649 $26,444 $89,275 $76,009 
The classification between managed care products and managed care services in the above table primarily distinguishes between the levels of risk assumed. Managed care products represent insurance products where we bear the insurance risk, whereas managed care services represent product offerings where we provide claims adjudication and other administrative services to the customer, but the customer principally bears the insurance risk. 
A reconciliation of reportable segments’ operating revenue to the amounts of total revenues included in our consolidated statements of income for the three and nine months ended September 30, 2020 and 2019 is as follows:
 Three Months Ended 
 September 30		Nine Months Ended 
 September 30
 2020201920202019
Reportable segments’ operating revenue$30,649 $26,444 $89,275 $76,009 
Net investment income280 242 591 737 
Net realized gains on financial instruments247 1 241 90 
Impairment losses recognized in income(18)(13)(64)(30)
Total revenues$31,158 $26,674 $90,043 $76,806 
A reconciliation of reportable segments’ operating gain to income before income tax expense included in our consolidated statements of income for the three and nine months ended September 30, 2020 and 2019 is as follows:
 Three Months Ended 
 September 30		Nine Months Ended 
 September 30
 2020201920202019
Reportable segments’ operating gain$201 $1,528 $5,755 $4,901 
Net investment income280 242 591 737 
Net realized gains on financial instruments247 1 241 90 
Impairment losses recognized in income(18)(13)(64)(30)
Interest expense(198)(185)(593)(556)
Amortization of other intangible assets(93)(84)(269)(256)
(Loss) gain on extinguishment of debt(30)— (34)1 
Income before income tax expense$389 $1,489 $5,627 $4,887