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Segment Information
 9 Months Ended
Sep. 30, 2020
Segment Reporting [Abstract]  
Segment Information Segment Information
See Note 1 for a description of our segments. A description of our basis for reporting segment operating results is outlined below. Intersegment revenues primarily reflect pharmacy related transactions between the Evernorth and U.S. Medical segments.
The Company uses “pre-tax adjusted income from operations” and “adjusted revenues” as its principal financial measures of segment operating performance because management believes they best reflect the underlying results of business operations and permit analysis of trends in underlying revenue, expenses and profitability. Pre-tax adjusted income from operations is defined as income before taxes excluding realized investment results, amortization of acquired intangible assets, special items and, for periods prior to 2020, earnings contribution from transitioning clients Anthem Inc. and Coventry Health Care, Inc. (the “transitioning clients”). As of December 31, 2019, the transition of these clients was substantially complete; therefore, beginning in 2020, we no longer exclude results of transitioning clients from our adjusted revenues and adjusted income from operations. Income or expense amounts that are excluded from adjusted income from operations because they are not indicative of underlying performance or the responsibility of operating segment management include:
•Realized investment gains (losses) including changes in market values of certain financial instruments between balance sheet dates, as well as gains and losses associated with invested asset sales.
•Amortization of acquired intangible assets because these relate to costs incurred for acquisitions.
•Results of transitioning clients, for periods prior to 2020, because those results were not indicative of ongoing results.
•Special items, if any, that management believes are not representative of the underlying results of operations due to the nature or size of these matters.
The Company does not report total assets by segment because this is not a metric used to allocate resources or evaluate segment performance.
Adjusted revenues is defined as revenues excluding: 1) revenue contribution from transitioning clients for periods prior to 2020; 2) the Company’s share of certain realized investment results of its joint ventures reported in the International Markets segment using the equity method of accounting; and 3) special items, if any.
The following tables present the special items recorded by the Company for the three and nine months ended September 30, 2020 and 2019.


Three Months Ended
(In millions)September 30, 2020September 30, 2019
Description of Special Item Charges (Benefits) and Financial Statement Line Item(s)After-taxBefore-taxAfter-taxBefore-tax
Integration and transaction-related costs (Selling, general and administrative expenses)$83 $112 $88 $114 
(Benefits) charges associated with litigation matters (Selling, general and administrative expenses)— — (23)(30)
Risk corridors recovery (Selling, general and administrative expenses)$(76)$(101)$— $— 
Contractual adjustment for a former client (Pharmacy revenues)(89)(117)— — 
Total impact from special items$(82)$(106)$65 $84 

Nine Months Ended
(In millions)September 30, 2020September 30, 2019
Description of Special Item Charges (Benefits) and Financial Statement Line Item(s)After-taxBefore-taxAfter-taxBefore-tax
Integration and transaction-related costs (Selling, general and administrative expenses)$256 $339 $311 $405 
Debt extinguishment costs (Debt extinguishment costs)151 199 — — 
Charge for organizational efficiency plan (Selling, general and administrative expenses)24 31 — — 
(Benefits) charges associated with litigation matters (Selling, general and administrative expenses)19 25 41 51 
Risk corridors recovery (Selling, general and administrative expenses)(76)(101)— — 
Contractual adjustment for a former client (Pharmacy revenues)$(155)$(204)$— $— 
Total impact from special items$219 $289 $352 $456 
Summarized segment financial information for the three and nine months ended September 30 was as follows:
(In millions)
Evernorth
U.S. Medical
International Markets
Group Disability and Other
Corporate and Eliminations
Total
Three months ended September 30, 2020
Revenues from external customers $29,016 $9,047 $1,439 $1,156 $— $40,658 
Inter-segment revenues926 478 — 6 (1,410)
Net investment income2 104 38 152 1 297 
Total revenues29,944 9,629 1,477 1,314 (1,409)40,955 
Net realized investment results from certain equity method investments — — (37)— — (37)
Special item related to contractual adjustment for a former client(117)— — — — (117)
Adjusted revenues$29,827 $9,629 $1,440 $1,314 $(1,409)$40,801 
Income (loss) before taxes$1,086 $846 $253 $97 $(478)$1,804 
Pre-tax adjustments to reconcile to adjusted income from operations
(Income) attributable to noncontrolling interests(5)— (5)— — (10)
Net realized investment (gains) losses — 6 (48)(27)— (69)
Amortization of acquired intangible assets479 6 8 — — 493 
Special items
Integration and transaction-related costs— — — — 112 112 
Risk corridors recovery— (101)— — — (101)
Contractual adjustment for a former client(117)— — — — (117)
Pre-tax adjusted income (loss) from operations$1,443 $757 $208 $70 $(366)$2,112 
(In millions)
Evernorth
U.S. Medical
International Markets
Group Disability and Other
Corporate and Eliminations
Total
Three months ended September 30, 2019
Revenues from external customers $27,084 $8,648 $1,368 $1,107 $— $38,207 
Inter-segment revenues499 376 — 7 (882)
Net investment income15 124 39 170 1 349 
Total revenues27,598 9,148 1,407 1,284 (881)38,556 
Revenue contributions from transitioning clients(2,718)— — — — (2,718)
Net realized investment results from certain equity method investments— — (5)— — (5)
Adjusted revenues$24,880 $9,148 $1,402 $1,284 $(881)$35,833 
Income (loss) before taxes$965 $1,011 $184 $159 $(556)$1,763 
Pre-tax adjustments to reconcile to adjusted income from operations
Adjustment for transitioning clients(274)— — — — (274)
(Income) attributable to noncontrolling interests— — (4)— — (4)
Net realized investment (gains) losses— (43)5 (18)— (56)
Amortization of acquired intangible assets708 15 9 2 — 734 
Special items
Integration and transaction-related costs— — — — 114 114 
(Benefits) charges associated with litigation matters— (30)— — — (30)
Pre-tax adjusted income (loss) from operations$1,399 $953 $194 $143 $(442)$2,247 
(In millions)
Evernorth
U.S. Medical
International Markets
Group Disability and Other
Corporate and Eliminations
Total
Nine months ended September 30, 2020
Revenues from external customers$82,986 $26,999 $4,325 $3,506 $— $117,816 
Inter-segment revenues2,785 1,448 — 17 (4,250)— 
Net investment income30 279 104 458 2 873 
Total revenues85,801 28,726 4,429 3,981 (4,248)118,689 
Net realized investment results from certain equity method investments
— — (87)— — (87)
Special item related to contractual adjustment for a former client(204)— — — — (204)
Adjusted revenues$85,597 $28,726 $4,342 $3,981 $(4,248)$118,398 
Income (loss) before taxes$2,551 $3,529 $877 $298 $(1,765)$5,490 
Pre-tax adjustments to reconcile to adjusted income from operations
(Income) attributable to noncontrolling interests(12)— (15)— — (27)
Net realized investment (gains) losses— 28 (75)(22)— (69)
Amortization of acquired intangible assets1,439 23 22 3 — 1,487 
Special items
Integration and transaction-related costs— — — — 339339
Debt extinguishment costs— — — — 199 199 
Charge for organizational efficiency plan — — — — 31 31 
(Benefits) charges associated with litigation matters— — — — 25 25 
Risk corridors recovery— (101)— — — (101)
Contractual adjustment for a former client(204)— — — — (204)
Pre-tax adjusted income (loss) from operations$3,774 $3,479 $809 $279 $(1,171)$7,170 
(In millions)
Evernorth
U.S. Medical
International Markets
Group Disability and Other
Corporate and Eliminations
Total
Nine months ended September 30, 2019
Revenues from external customers
$80,618 $26,226 $4,095 $3,347 $— $114,286 
Inter-segment revenues1,869 727 — 21 (2,617)
Net investment income (loss)47 358 117 521 (8)1,035 
Total revenues82,534 27,311 4,212 3,889 (2,625)115,321 
Revenue contribution from transitioning clients(11,657)— — — — (11,657)
Net realized investment results from certain equity method investments— — (27)— — (27)
Adjusted revenues$70,877 $27,311 $4,185 $3,889 $(2,625)$103,637 
Income (loss) before taxes$3,015 $3,157 $601 $407 $(1,871)$5,309 
Pre-tax adjustments to reconcile to adjusted income from operations
Adjustment for transitioning clients(1,589)— — — — (1,589)
(Income) attributable to noncontrolling interests(1)— (12)— — (13)
Net realized investment (gains) losses— (65)(10)(36)— (111)
Amortization of acquired intangible assets2,130 51 28 5 — 2,214 
Special items
Integration and transaction-related costs— — — — 405 405 
(Benefits) charges associated with litigation matters— (30)— — 81 51 
Pre-tax adjusted income (loss) from operations$3,555 $3,113 $607 $376 $(1,385)$6,266 
Revenue from external customers includes pharmacy revenues, premiums and fees and other revenues. The following table presents these revenues by product, premium and service type for the three and nine months ended September 30:

Three Months Ended September 30,Nine Months Ended September 30,
(In millions)2020201920202019
Products (Pharmacy revenues) (ASC 606)
Network revenues$13,968 $12,923 $39,200 $37,954 
Home delivery and specialty revenues12,422 11,837 36,319 35,893 
Other1,412 1,227 3,945 3,607 
Total pharmacy revenues27,802 25,987 79,464 77,454 
Insurance premiums (ASC 944)
U.S. Medical premiums
U.S. Commercial
Health Insurance3,397 3,174 9,948 9,278 
Stop loss1,146 1,085 3,459 3,221 
Other281 260 853 779 
U.S. Government
Medicare Advantage1,895 1,562 5,680 4,779 
Medicare Part D360 404 1,242 1,329 
Other1,117 1,059 3,246 3,137 
Total U.S. Medical premiums
8,196 7,544 24,428 22,523 
International Markets premiums
1,360 1,309 4,079 3,914 
Domestic disability, life and accident premiums1,106 1,049 3,346 3,165 
Other premiums20 33 75 107 
Total premiums10,682 9,935 31,928 29,709 
Services (ASC 606)
Fees2,120 2,249 6,253 7,015 
Other external revenues54 36 171 108 
Total services2,174 2,285 6,424 7,123 
Total revenues from external customers$40,658 $38,207 $117,816 $114,286 
Evernorth may provide certain financial and performance guarantees, including a minimum level of discounts a client may receive, generic utilization rates and various service levels. Clients may be entitled to receive compensation if we fail to meet these guarantees. Actual performance is compared to the contractual guarantee for each measure throughout the period and the Company defers revenue for any estimated payouts within Accrued expenses and other liabilities (current). These estimates are adjusted at the end of the guarantee period. Historically, adjustments to original estimates have not been material. The performance guarantee liability was $1.0 billion as of September 30, 2020 and December 31, 2019.