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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Cash Flows from Operating Activities      
Net Income $ 2,646 $ 2,232 $ 1,843
Adjustments to reconcile net income to net cash provided by (used in) operating activities:      
Depreciation and amortization 695 566 610
Realized investment (gains) losses 81 (237) (169)
Deferred income taxes (benefits) (101) 242 74
Debt extinguishment costs 0 321 0
Net changes in assets and liabilities, net of non-operating effects:      
Accounts receivable 705 (233) 663
Inventories (107) (72) 30
Deferred policy acquisition costs (237) (282) (213)
Reinsurance recoverables and other assets (234) 115 246
Insurance liabilities 560 506 683
Pharmacy and service costs payable (842) 35 (46)
Accounts payable, accrued expenses and other liabilities 332 696 171
Other, net 272 197 134
Net cash provided by (used in) operating activities 3,770 4,086 4,026
Proceeds from investments sold:      
Fixed maturities and equity securities 2,655 2,012 1,544
Investment maturities and repayments:      
Fixed maturities and equity securities 2,151 2,051 1,755
Commercial mortgage loans 215 335 316
Other sales, maturities and repayments (primarily short-term and other long-term investments) 734 1,702 1,431
Investments purchased or originated:      
Fixed maturities and equity securities (5,637) (5,628) (5,191)
Commercial mortgage loans (312) (430) (165)
Other (primarily short-term and other long-term investments) (1,189) (1,065) (1,698)
Property and equipment purchases (528) (471) (461)
Acquisitions, net of cash acquired (24,455) (209) (4)
Other, net (12) 0 (101)
Net cash provided by (used in) investing activities (26,378) (1,703) (2,574)
Cash Flows from Financing Activities      
Deposits and interest credited to contractholder deposit funds 1,040 1,230 1,460
Withdrawals and benefit payments from contractholder deposit funds (1,151) (1,363) (1,362)
Net change in short-term debt 1,487 80 (148)
Payments for debt extinguishment 0 (313) 0
Repayment of long-term debt (131) (1,250) 0
Net proceeds on issuance of long-term debt 22,856 1,581 0
Repurchase of common stock (342) (2,725) (139)
Issuance of common stock 68 131 36
Other, net (312) (22) (72)
Net cash provided by (used in) financing activities 23,515 (2,651) (225)
Effect of foreign currency rate changes on cash and cash equivalents (24) 55 (10)
Net increase / (decrease) in cash and cash equivalents 883 (213) 1,217
Cash and cash equivalents, January 1, 2,972 3,185 1,968
Cash and cash equivalents, December 31, 3,855 2,972 3,185
Supplemental Disclosure of Cash Information:      
Income taxes paid, net of refunds 1,019 1,036 1,064
Interest paid $ 267 $ 240 $ 244