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BENEFITS PAYABLE
12 Months Ended
Dec. 31, 2016
Defined Benefit Plans and Other Postretirement Benefit Plans Disclosures [Abstract]  
BENEFITS PAYABLE
BENEFITS PAYABLE
On a consolidated basis, activity in benefits payable, excluding military services, was as follows for the years ended December 31, 2016, 2015 and 2014:
 
 
2016
 
2015
 
2014
 
 
(in millions)
Balances at January 1
 
$
4,976

 
$
4,475

 
$
3,893

Less: Premium deficiency reserve
 
(176
)
 

 

Less: Reinsurance recoverables
 
(85
)
 
(78
)
 

Balances at January 1, net
 
4,715

 
4,397

 
3,893

Incurred related to:
 
 
 
 
 
 
Current year
 
45,318

 
44,397

 
38,641

Prior years
 
(582
)
 
(236
)
 
(518
)
Total incurred
 
44,736

 
44,161

 
38,123

Paid related to:
 
 
 
 
 
 
Current year
 
(40,852
)
 
(39,802
)
 
(34,357
)
Prior years
 
(4,112
)
 
(4,041
)
 
(3,262
)
Total paid
 
(44,964
)
 
(43,843
)
 
(37,619
)
Premium deficiency reserve
 

 
176

 

Reinsurance recoverable
 
76

 
85

 
78

Balances at December 31
 
$
4,563

 
$
4,976

 
$
4,475


Amounts incurred related to prior years vary from previously estimated liabilities as the claims ultimately are settled. Negative amounts reported for incurred related to prior years result from claims being ultimately settled for amounts less than originally estimated (favorable development).
As previously discussed, our reserving practice is to consistently recognize the actuarial best estimate of our ultimate liability for claims. Actuarial standards require the use of assumptions based on moderately adverse experience, which generally results in favorable reserve development, or reserves that are considered redundant. We experienced favorable medical claims reserve development related to prior fiscal years of $582 million in 2016, $236 million in 2015, and $518 million in 2014. The table below details our favorable medical claims reserve development related to prior fiscal years by segment for 2016, 2015, and 2014.
 
Favorable Medical Claims Reserve
Development
 
2016
 
2015
 
2014
 
 
Retail Segment
$
(535
)
 
$
(228
)
 
$
(488
)
Group Segment
(46
)
 
(7
)
 
(29
)
Other Businesses
(1
)
 
(1
)
 
(1
)
Total
$
(582
)
 
$
(236
)
 
$
(518
)

The favorable medical claims reserve development for 2016, 2015, and 2014 primarily reflects the consistent application of trend and completion factors estimated using an assumption of moderately adverse conditions. Favorable prior period development in 2016 primarily resulted from our Medicare Advantage and individual commercial medical businesses. The decline in favorable prior period development in 2015 primarily was due to the impact of lower financial claim recoveries due in part to our gradual implementation during 2014 of inpatient authorization review prior to admission as opposed to post adjudication, as well as higher than expected flu associated claims from the fourth quarter of 2014 and continued volatility in claims associated with individual commercial medical products. The favorable prior period development during 2014 resulted from increased membership, better than originally expected utilization across most of our major business lines and increased financial recoveries. The increase in financial recoveries primarily resulted from claim audit process enhancements as well as increased volume of claim audits and expanded audit scope. All lines of business benefited from these improvements.
Benefits expense excluded from the previous table was as follows for the years ended December 31, 2016, 2015 and 2014:
 
 
2016
 
2015
 
2014
 
 
(in millions)
Premium deficiency reserve for short-duration policies
 
$
(176
)
 
$
176

 
$

Military services
 
8

 
12

 
11

Future policy benefits
 
439

 
(80
)
 
32

Total
 
$
271

 
$
108

 
$
43


In the fourth quarter of 2015, we recognized a premium deficiency reserve for our individual commercial medical business compliant with the Health Care Reform Law associated with the 2016 coverage year as discussed in more detail in Note 7.
Military services benefits expense for each year in the table above reflect expenses associated with our contracts with the Veterans Administration.
The higher benefits expense associated with future policy benefits payable during 2016 primarily relates to reserve strengthening for our closed block of long-term care insurance policies acquired in connection with the 2007 KMG America Corporation, or KMG, acquisition more fully described in Note 18. The decrease in benefits expense associated with future policy benefits payable in 2015 primarily reflects the release of reserves as individual commercial medical members transitioned to plans compliant with the Health Care Reform Law.
Incurred and Paid Claims Development
The following discussion provides information about incurred and paid claims development for our Retail and Group segments as of December 31, 2016, net of reinsurance, as well as cumulative claim frequency and the total of IBNR included within the net incurred claims amounts. The information about incurred and paid claims development for the years ended December 31, 2014 and 2015 is presented as supplementary information.
For both our Retail and Group segments, claims frequency is measured as medical fee-for-service claims for each service encounter with a unique provider identification number. Our claims frequency measure includes claims covered by deductibles as well as claims under capitated arrangements. Claim counts may vary based on product mix and the percentage of delegated capitation arrangements.
Retail Segment
Activity in benefits payable for our Retail segment was as follows for the years ended December 31, 2016, 2015 and 2014:
 
 
2016
 
2015
 
2014
 
 
(in millions)
Balances at January 1
 
$
4,296

 
$
3,879

 
$
3,268

Less: Premium deficiency reserve
 
(176
)
 

 

Less: Reinsurance recoverables
 
(85
)
 
(78
)
 

Balances at January 1, net
 
4,035

 
3,801

 
3,268

Incurred related to:
 
 
 
 
 
 
Current year
 
40,854

 
39,760

 
33,996

Prior years
 
(535
)
 
(228
)
 
(488
)
Total incurred
 
40,319

 
39,532

 
33,508

Paid related to:
 
 
 
 
 
 
Current year
 
(36,967
)
 
(35,835
)
 
(30,305
)
Prior years
 
(3,487
)
 
(3,463
)
 
(2,670
)
Total paid
 
(40,454
)
 
(39,298
)
 
(32,975
)
Premium deficiency reserve
 

 
176

 

Reinsurance recoverable
 
76

 
85

 
78

Balances at December 31
 
$
3,976

 
$
4,296

 
$
3,879

At December 31, 2016, benefits payable for our Retail segment included IBNR of approximately $2.9 billion, primarily associated with claims incurred in 2016. The cumulative number of reported claims as of December 31, 2016 was approximately 87.7 million for claims incurred in 2016, 88.8 million for claims incurred in 2015, and 74.3 million for claims incurred in 2014.
The following tables provide information about incurred and paid claims development for the Retail segment as of December 31, 2016, net of reinsurance.
 
 
Incurred Claims, Net of Reinsurance
 
 
For the Years Ended December 31,
Claims Incurred Year
 
2014
Unaudited
 
2015
Unaudited
 
2016


(in millions)
2014
 
$
33,996

 
$
33,800

 
$
33,749

2015
 

 
39,760

 
39,289

2016
 

 

 
40,854

 Total
 
 
 
 
 
$
113,892



Cumulative Paid Claims, Net of Reinsurance


For the Years Ended December 31,
Claims Incurred Year

2014
Unaudited

2015
Unaudited

2016


(in millions)
2014

$
30,305


$
33,704


$
33,740

2015



35,835


39,285

2016





36,967

 Total





$
109,992

All outstanding benefit liabilities before 2014, net of reinsurance

N/A

Benefits payable, net of reinsurance

$
3,900

Group Segment
Activity in benefits payable for our Group segment, excluding military services, was as follows for the years ended December 31, 2016, 2015 and 2014:
 
 
2016
 
2015
 
2014
 
 
(in millions)
Balances at January 1
 
$
600

 
$
578

 
$
577

Less: Reinsurance recoverables
 

 

 

Balances at January 1, net
 
600

 
578

 
577

Incurred related to:
 
 
 
 
 
 
Current year
 
5,160

 
5,261

 
5,148

Prior years
 
(46
)
 
(7
)
 
(29
)
Total incurred
 
5,114

 
5,254

 
5,119

Paid related to:
 
 
 
 
 
 
Current year
 
(4,605
)
 
(4,671
)
 
(4,574
)
Prior years
 
(546
)
 
(561
)
 
(544
)
Total paid
 
(5,151
)
 
(5,232
)
 
(5,118
)
Balances at December 31
 
$
563

 
$
600

 
$
578

At December 31, 2016, benefits payable for our Group segment included IBNR of approximately $468 million, primarily associated with claims incurred in 2016. The cumulative number of reported claims as of December 31, 2016 was approximately 23.3 million for claims incurred in 2016, 29.1 million for claims incurred in 2015, and 27.3 million for claims incurred in 2014.
    
The following tables provide information about incurred and paid claims development for the Group segment as of December 31, 2016, net of reinsurance.
 
 
Incurred Claims, Net of Reinsurance
 
 
For the Years Ended December 31,
Claims Incurred Year
 
2014
Unaudited
 
2015
Unaudited
 
2016


(in millions)
2014
 
$
5,148

 
$
5,135

 
$
5,135

2015
 

 
5,261

 
5,217

2016
 

 

 
5,160

 Total
 
 
 
 
 
$
15,512



Cumulative Paid Claims, Net of Reinsurance


For the Years Ended December 31,
Claims Incurred Year

2014
Unaudited

2015
Unaudited

2016


(in millions)
2014

$
4,574


$
5,126


$
5,134

2015



4,671


5,210

2016





4,605

Total






$
14,949

All outstanding benefit liabilities before 2014, net of reinsurance

N/A

Benefits payable, net of reinsurance

$
563

Reconciliation to Consolidated
The reconciliation of the net incurred and paid claims development tables to benefits payable in the consolidated statement of financial position is as follows:    
 
December 31, 2016
Net outstanding liabilities
 
Retail
$
3,900

Group
563

Other insurance lines
24

    Benefits payable, net of reinsurance
4,487

Reinsurance recoverable on unpaid claims
 
Retail
76

Group

Other insurance lines

     Total reinsurance recoverable on unpaid claims
76

     Total benefits payable, gross
$
4,563