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Segment Information
 12 Months Ended
Dec. 31, 2020
Segment Reporting [Abstract]  
Segment Information Segment Information
Beginning in 2020, IngenioRx meets the quantitative threshold for a reportable segment based on the FASB guidance. 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, stop loss insurance, provider network access, medical cost management, disease management, wellness programs, underwriting, actuarial services 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 (“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. Medicare Advantage membership also includes Medicare Advantage members in our Group Retiree Solutions business who are related to National Accounts, retired members of Local Group accounts, or retired members of groups who are not affiliated with our Commercial accounts who have selected a Medicare Advantage product through us. Our Medicaid business includes our managed care alternatives through publicly funded healthcare programs, including Medicaid, ACA-related Medicaid expansion programs, Temporary Assistance for Needy Families programs, 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 our affiliated 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. Amounts for 2019 have been reclassified to conform to the current year presentation for comparability.
Our Other segment includes our Diversified Business Group (“DBG”), which is our integrated health services business, and certain eliminations and corporate expenses not allocated to our other reportable segments. Also, beginning on February 28, 2020, our Other segment includes Beacon.
We define operating revenues to include premium income, product revenue and administrative fees and other revenues. Operating revenues are derived from premiums and fees received, primarily from the sale and administration of health benefit products. Operating gain is calculated as total operating revenue less benefit expense, cost of products sold and selling, general and administrative expense.
Through our participation in various federal government programs, we generated approximately 20.3%, 20.7% and 19.8% of our total consolidated revenues from agencies of the U.S. government for the years ended December 31, 2020, 2019, and 2018, respectively. These revenues are contained in the Government Business segment.
The accounting policies of the segments are consistent with those described in the summary of significant accounting policies in Note 2, “Basis of Presentation and Significant Accounting Policies,” except that certain shared administrative expenses for each segment are recognized on a pro rata allocated basis, which in the aggregate approximates the consolidated expense. Any difference between the allocated expenses and actual consolidated expense is included in other expenses not allocated to reportable segments. 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. We evaluate performance of the reportable segments based on operating gain or loss as defined above. We evaluate net investment income, net realized gains (losses) on financial instruments, interest expense, amortization expense, gain or loss on extinguishment of debt, income taxes and assets and liabilities on a consolidated basis, as these items are managed in a corporate shared service environment and are not the responsibility of segment operating management.
For our 2019 segment reporting, operating gain generated from IngenioRx activities were allocated and included in our Commercial & Specialty Business and Government Business based upon their utilization of those services, 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. Prior year 2019 allocations were not restated to conform to the 2020 presentation; however, operating margins for IngenioRx were approximately 8% in 2019.

Financial data by reportable segment for the years ended December 31, 2020, 2019 and 2018 is as follows:
Commercial & Specialty BusinessGovernment BusinessIngenioRxOtherEliminationsTotal
Year ended December 31, 2020
Operating revenue - unaffiliated
$36,699 $71,572 10,384 $2,153 $— $120,808 
Operating revenue - affiliated
— — 11,527 3,904 (15,431)— 
Operating gain (loss)
2,681 2,444 1,361 (126)— 6,360 
Depreciation and amortization of property and equipment
— — — 638 — 638 
Year ended December 31, 2019
Operating revenue - unaffiliated
$37,421 $62,632 2,007 $1,081 $— $103,141 
Operating revenue - affiliated
— — 3,395 1,212 (4,607)— 
Operating gain (loss)
4,032 2,056 — (89)— 5,999 
Depreciation and amortization of property and equipment
— — — 675 — 675 
Year ended December 31, 2018
Operating revenue - unaffiliated
$35,782 $55,348 — $211 $— $91,341 
Operating revenue - affiliated
— — — 1,308 (1,308)— 
Operating gain (loss)
3,600 1,928 — (102)— 5,426 
Depreciation and amortization of property and equipment
— — — 652 — 652 
 The major product revenues for each of the reportable segments for the years ended December 31, 2020, 2019 and 2018 are as follows:
202020192018
Commercial & Specialty Business
Managed care products
$29,815 $30,311 $29,012 
Managed care services
5,296 5,451 5,218 
Dental/Vision products and services
1,231 1,302 1,220 
Other
357 357 332 
Total Commercial & Specialty Business
36,699 37,421 35,782 
Government Business
Managed care products
71,188 62,229 54,889 
Managed care services
384 403 459 
Total Government Business
71,572 62,632 55,348 
IngenioRx
Pharmacy products and services21,911 5,402 — 
Other
Integrated health services5,787 2,149 1,489 
Other
270 144 30 
Total Other Business6,057 2,293 1,519 
Eliminations
Eliminations
(15,431)(4,607)(1,308)
Total product revenues
$120,808 $103,141 $91,341 
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. 
Asset, liability and equity details by reportable segment have not been disclosed, as we do not internally report such information. 
A reconciliation of reportable segments’ operating revenue to the amounts of total revenues included in our consolidated statements of income for the years ended December 31, 2020, 2019 and 2018 is as follows:
202020192018
Reportable segments operating revenues$120,808 $103,141 $91,341 
Net investment income877 1,005 970 
Net realized gains (losses) on financial instruments182 67 (206)
Total revenues$121,867 $104,213 $92,105 
A reconciliation of reportable segments’ operating gain to income before income tax expense included in our consolidated statements of income for the years ended December 31, 2020, 2019 and 2018 is as follows:
202020192018
Reportable segments operating gain$6,360 $5,999 $5,426 
Net investment income877 1,005 970 
Net realized gains (losses) on financial instruments182 67 (206)
Interest expense(784)(746)(753)
Amortization of other intangible assets(361)(338)(358)
Loss on extinguishment of debt(36)(2)(11)
Income before income tax expense$6,238 $5,985 $5,068