EX-99.2 3 d916231dex992.htm EX-99.2 EX-99.2

Exhibit 99.2

 

LOGO

   

Humana Inc.

500 West Main Street

P.O. Box 1438

Louisville, KY 40201-1438

http://www.humana.com

   
   
   

 

FOR MORE INFORMATION CONTACT:

 

Regina Nethery

 

Humana Investor Relations

 

(502) 580-3644

e-mail: Rnethery@humana.com

 

Tom Noland

Humana Corporate Communications

  LOGO         
 
 

(502) 580-3674

e-mail: Tnoland@humana.com

 

Humana Reports First Quarter Financial Results;

Reaffirms 2015 Financial Guidance

 

    2015 Adjusted EPS(a) guidance of $8.50 to $9.00 reaffirmed, a growth rate of approximately 17 percent from 2014 Adjusted EPS(a)

 

    1Q15 EPS of $2.82 (including $0.35 per share of tax benefit related to the pending sale of Concentra)

 

    Strong pretax income of $744 million reflect a year-over-year increase of over 8 percent, with improved results across each of the company’s business segments

 

    2015 individual Medicare Advantage membership growth estimate reaffirmed at 300,000 to 350,000, up approximately 13 percent versus 2014

 

    2015 Medicare stand-alone PDP membership growth estimate raised to 450,000 to 500,000, up approximately 12 percent versus 2014

 

    Increased quarterly dividend to $0.29 per share

LOUISVILLE, KY (April 29, 2015) – Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended March 31, 2015 (1Q15) of $2.82, including $0.35 per share tax benefit related to the pending sale of its wholly-owned subsidiary, Concentra Inc. (Concentra), compared to diluted earnings per share of $2.35 for the quarter ended March 31, 2014 (1Q14).

 

Consolidated Results of Operations

   1Q15 EPS      1Q14 EPS  

GAAP

   $ 2.82       $ 2.35   

Tax benefit related to pending sale of Concentra (a)

     (0.35      —     

Adjusted (non-GAAP) (a)

   $ 2.47       $ 2.35   

Effective tax rate

     42.2%         46.4%   

 

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The requirement to recognize the tax benefit in 1Q15 was triggered by the signing in March 2015 of a definitive agreement to sell Concentra for approximately $1.055 billion in cash, subject to customary adjustments. The company’s effective tax rate of 42.2 percent in 1Q15 declined from 46.4 percent in 1Q14, reflecting a reduction of approximately 700 basis points associated with this tax benefit, partially offset by a year-over-year increase in the non-deductible health insurance fee.

Strong pretax income of $744 million in 1Q15 increased $58 million, or 8.5 percent, versus $686 million for 1Q14 primarily due to improved year-over-year results in each of the company’s business segments.

The company reaffirmed its estimate for Adjusted EPS(a) for the year ending December 31, 2015 (FY15) to be in the range of $8.50 to $9.00. The company’s 2015 EPS estimate reflects expected strong growth and operating efficiencies in the company’s Medicare offerings, year-over-year improvement in the Healthcare Services businesses, break-even results in its HumanaOne business and reduced investment spending in state-based contracts(b), partially offset by the tax implications of the expected increase in the non-deductible health insurance industry fee.

“Our first-quarter achievements included substantial revenue and membership growth, announcement of the launch of our population health technology business, Transcend Insights, the pending sale of Concentra, and the completion of our accelerated share repurchase program, as well as strong pretax income,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. “These achievements contributed meaningfully to the advancement of our integrated care delivery model with its data-driven focus on the consumer, powered by our disciplined approach to capital allocation –which, taken together, represents a sustainable competitive advantage for Humana.”

CONSOLIDATED HIGHLIGHTS

Total revenues

Consolidated total revenues (including investment income) for 1Q15 were $13.8 billion, an increase of 18.1 percent from $11.71 billion in 1Q14, with total premiums and services revenue up 18.2 percent compared to the prior year’s quarter. The year-over-year increase in premiums and services revenue was primarily driven by higher membership in the Retail segment.

Consolidated benefits expense

The 1Q15 consolidated benefit ratio (benefits expense as a percent of premiums) of 83.1 percent increased by 80 basis points from 82.3 percent for the prior year’s quarter primarily reflecting higher ratios in both the Retail and Group segments.

The company experienced lower favorable prior-year medical claims reserve development of $194 million in 1Q15 compared to $297 million in 1Q14. This decline in favorable prior-year development was primarily expected due to unusually high prior-year development in 1Q14, previously implemented process changes that improved the initial accuracy of claim payment processing, as well as higher-than-expected flu costs in the fourth quarter of 2014.

 

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Consolidated operating expenses

The consolidated operating cost ratio (operating costs as a percent of total revenues less investment income) of 14.2 percent for 1Q15 decreased 120 basis points from 15.4 percent in 1Q14, primarily reflecting a lower ratio in the Group segment.

Balance sheet

At March 31, 2015, the company had cash, cash equivalents, and investment securities of $11.52 billion, up $36 million from $11.48 billion at December 31, 2014.

Parent company cash and short-term investments of $1.21 billion at March 31, 2015 decreased $200 million from $1.41 billion at December 31, 2014, primarily reflecting capital expenditures, share repurchases, and payment of a cash dividend to shareholders in 1Q15.

At March 31, 2015, net receivables of $732 million were associated with premium stabilization programs established under health care reform, commonly referred to as the 3Rs(c), including $668 million associated with the 2014 coverage year that the company expects to collect in the second half of 2015. Approximately 80 percent of the total net 3Rs receivables were related to reinsurance recoverables. At March 31, 2015, net receivables for the 3Rs were as follows:

 

Net Amounts Accrued for the 3Rs

($ in millions)

Assets (liabilities)

   Balances
Related

to 2014
     Balances
Related
to 2015
     Total
Balances
at 3/31/15
 

Reinsurance recoverables

   $ 535       $ 47       $ 582   

Net risk adjustment settlement

     42         (2      40   

Net risk corridor settlement

     91         19         110   
  

 

 

    

 

 

    

 

 

 

Total Net Amounts Accrued for the 3Rs

$ 668    $ 64    $ 732   
  

 

 

    

 

 

    

 

 

 

Days in claims payable of 42.8 at March 31, 2015 decreased from 43.5 days at December 31, 2014. The decline primarily reflects the typical first-quarter increase in Part D claims associated with the company’s Medicare Advantage business. The company’s responsibility for these costs is greater in the beginning of the year, compared to later in the year as the members’ and government’s responsibilities increase.

Debt-to-total capitalization at March 31, 2015 was 27.6 percent, down from 28.4 percent at December 31, 2014. As of March 31, 2015, the company had no balance outstanding on its commercial paper program.

Cash flows from operations

Cash flows provided by operations for 1Q15 were $107 million compared to cash flows provided by operations of $671 million in 1Q14. The year-over-year decrease in cash flow reflects an increase in net income more than offset by changes in the timing of working capital items.

 

3


Share repurchases and cash dividends

In September 2014, the company’s Board of Directors approved a new $2 billion share repurchase authorization with an expiration date of December 31, 2016 replacing its previous $1 billion share repurchase authorization. As previously announced, the company expects to repurchase $1 billion of its outstanding shares no later than June 30, 2015 under this authorization. As of April 28, 2015, approximately $1.23 billion of the current repurchase authorization was remaining. In March 2015, the company entered into a pre-arranged 10b5-1 plan pursuant to which it expects to repurchase an aggregate of $365 million shares of common stock by June 30, 2015, fulfilling its expectation to repurchase $1 billion by that date.

In March 2015, the company completed a $500 million accelerated share repurchase program announced in November 2014. Under the terms of the program, the company repurchased a total of approximately 3,419,700 shares at an average price of $146.21 per share. The accelerated share repurchase program was completed as part of the company’s current $2 billion share repurchase authorization.

During 1Q15, in addition to the completion of the accelerated share repurchase program described above, the company executed share repurchases of $26 million, or 145,000 of its outstanding shares, at an average price of $179.89 per share under its existing share repurchase authorization. The company executed repurchases of 100,000 shares for $11 million during 1Q14.

Subsequent to March 31, 2015, the company executed repurchases of $112 million, or 627,200 shares, under the 10b5-1 plan through April 28, 2015.

All in, since the commitment was made in September 2014, the company has repurchased approximately 5,226,800 shares for $773 million, at an average price of $147.80 per share.

The company paid cash dividends to its stockholders totaling $44 million in each of 1Q15 and 1Q14. In April 2015, the company’s Board of Directors declared a cash dividend of $0.29 per share, payable on July 31, 2015 to stockholders of record on June 30, 2015, an increase from the company’s previous dividend of $0.28 per share.

RETAIL SEGMENT(d)

This segment consists of Medicare benefits, marketed to individuals or directly via group accounts, as well as individual commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products. In addition, the segment also includes the company’s contract with the Centers for Medicare and Medicaid Services to administer the Limited Income Newly Eligible Transition (LI-NET) prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services (LTSS) benefits, collectively, its state-based contracts.

Retail Segment Highlights

Enrollment:

 

    Individual Medicare Advantage membership was 2,685,900 as of March 31, 2015, an increase of 355,100, or 15.2 percent, from 2,330,800 at March 31, 2014, and up 258,000, or 10.6 percent from 2,427,900 as of December 31, 2014, primarily due to net membership additions associated with the 2015 plan year, particularly HMO offerings.

 

4


    Group Medicare Advantage membership was 470,900 as of March 31, 2015, a decrease of 6,700, or 1.4 percent, from 477,600 at March 31, 2014 and down 18,800, or 3.8 percent, from 489,700 at December 31, 2014.

 

    Membership in the company’s stand-alone Prescription Drug Plans (PDPs) was 4,381,400 as of March 31, 2015, an increase of 524,900, or 13.6 percent, from 3,856,500 at March 31, 2014, and up 387,400, or 9.7 percent from 3,994,000 as of December 31, 2014. These increases primarily resulted from growth in the company’s low-priced Humana-Walmart plan offering.

 

    HumanaOne membership increased to 1,108,900 as of March 31, 2015, an increase of 393,300, or 55.0 percent, from 715,600 at March 31, 2014, and up 92,700, or 9.1 percent from 1,016,200 at December 31, 2014. This membership growth primarily reflects new sales and better retention for plans compliant with the changes mandated by health care reform, both on-exchange and off-exchange.

 

    State-based Medicaid membership was 339,000 as of March 31, 2015 (including 18,400 dual-eligible demonstration members), an increase of 209,400, or 161.6 percent, from 129,600 at March 31, 2014, and up 22,200, or 7.0 percent, from 316,800 (including 18,300 dual-eligible demonstration members) at December 31, 2014. This increase was primarily driven by the addition of membership from state-based contracts for the Florida Medicaid business.

 

    Membership in individual specialty products(e) was 1,173,300 as of March 31, 2015, an increase of 49,600, or 4.4 percent, from 1,123,700 at March 31, 2014, and up 7,500 from 1,165,800 at December 31, 2014, primarily due to increased membership in dental offerings.

Premiums and services revenue:

 

    The 1Q15 premiums and services revenue for the Retail segment was $11.58 billion, an increase of 22.2 percent from $9.48 billion in 1Q14. The increase resulted primarily from a 12.6 percent increase in average Medicare Advantage membership year over year, along with membership growth in the company’s individual commercial and state-based Medicaid businesses and stand-alone PDP plans.

Benefits expense:

 

    The 1Q15 benefit ratio for the Retail segment of 85.8 percent increased 40 basis points from 85.4 percent in 1Q14 primarily due to lower favorable prior period claims development and higher benefit ratios associated with members from state-based contracts, partially offset by the increase in the health insurance fee included in product pricing.

 

    Retail segment benefits expense for 1Q15 included the beneficial effect of $188 million in favorable prior-year development compared to $277 million in 1Q14. This decline in favorable prior-year development was primarily expected due to unusually high prior-year development in 1Q14, previously implemented process changes that improved the initial accuracy of claim payment processing, as well as higher than expected flu costs in 4Q14.

Operating costs:

 

    The Retail segment’s operating cost ratio of 10.8 percent in 1Q15 increased 10 basis points from 10.7 percent in 1Q14. The increase primarily resulted from an increase in the non-deductible health insurance industry fee mandated by health care reform, partially offset by scale efficiencies associated with medical membership growth in the segment. The non-deductible health insurance industry fee impacted the Retail segment’s operating cost ratio by approximately 170 basis points in 1Q15 and 120 basis points in 1Q14.

 

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Pretax results:

 

    Retail segment pretax income of $375 million in 1Q15 compared to $369 million in 1Q14, an increase of $6 million, as growth in Medicare Advantage and individual commercial medical membership was substantially offset by an increase in the benefit ratio.

GROUP SEGMENT(d)

This segment consists of employer group commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and voluntary insurance benefits, as well as Administrative Services Only (ASO) products. In addition, the Group segment includes health and wellness products (primarily marketed to employer groups) and military services business, primarily the TRICARE South Region contract.

Group Segment Highlights

Enrollment:

 

    Group fully-insured commercial medical membership was 1,189,600 at March 31, 2015, a decrease of 10,600, or 0.9 percent, from 1,200,200 at March 31, 2014, and down 45,900, or 3.7 percent, from 1,235,500 at December 31, 2014, as higher small group business (less than 100 lives) membership year over year was offset by lower membership in large group accounts. Approximately 65 percent of group fully-insured commercial medical membership was in small group accounts at March 31, 2015 and December 31, 2014, and 62 percent at March 31, 2014.

 

    Group ASO commercial medical membership was 736,800 at March 31, 2015, a decline of 405,200, or 35.5 percent, from 1,142,000 at March 31, 2014, and down 367,500, or 33.3 percent from 1,104,300 at December 31, 2014. This decline reflects the loss of certain large group accounts due to continued discipline in pricing of services for self-funded accounts amid a highly competitive environment.

 

    Military services membership was 3,085,600 at March 31, 2015, a decrease of 12,400 from 3,098,000 at March 31, 2014, and down 4,800 from 3,090,400 at December 31, 2014.

 

    Membership in Group specialty products was 6,251,200 at March 31, 2015, a decline of 349,700, or 5.3 percent, from 6,600,900 at March 31, 2014, and down 251,500, or 3.9 percent, from 6,502,700 at December 31, 2014. This decrease primarily resulted from the loss of certain fully-insured group accounts.

 

    Membership in HumanaVitality®, the company’s wellness and loyalty rewards program, was 3,947,900 at March 31, 2015, an increase of 392,200, or 11.0 percent, from 3,555,700 at March 31, 2014, and up 91,100, or 2.4 percent, from 3,856,800 at December 31, 2014 primarily due to individual Medicare Advantage and HumanaOne membership growth.

 

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Premiums and services revenue:

 

    The 1Q15 premiums and services revenue for the Group segment was $1.85 billion, up 1.6 percent from $1.82 billion in 1Q14, primarily reflecting an increase in fully-insured commercial medical per member premiums, partially offset by a net decline in fully-insured commercial medical membership and a decline in ASO commercial membership.

Benefits expense:

 

    The 1Q15 benefit ratio for the Group segment was 73.9 percent, an increase of 140 basis points from 72.5 percent for 1Q14. The year-over-year increase in the benefit ratio primarily reflects anticipated higher specialty drug costs and lower favorable prior period development, partially offset by an increase in the health insurance industry fee included in pricing of the company’s products.

Operating costs:

 

    The Group segment’s operating cost ratio was 24.5 percent in 1Q15, a decrease of 260 basis points from 27.1 percent in 1Q14, primarily reflecting the loss of certain large ASO accounts resulting in a lower percentage of ASO business which carries a higher operating cost ratio than fully-insured commercial business, as well as operating cost efficiencies associated with the fully-insured business as a result of cost reduction initiatives. These decreases were partially offset by the increase of the non-deductible health insurance industry fee mandated by health care reform. The non-deductible health insurance industry fee impacted the Group segment’s operating cost ratio by approximately 140 basis points in 1Q15 and 100 basis points in 1Q14.

Pretax results:

 

    The 1Q15 Group segment pretax income of $154 million increased from a pretax income of $144 million in 1Q14, primarily reflecting an improvement in the segment’s operating cost ratio, partially offset by an increase in the segment’s benefit ratio.

HEALTHCARE SERVICES SEGMENT(d)

This segment includes services offered to the company’s health plan members as well as to third parties, including pharmacy solutions, provider services, home based services, and clinical programs, as well as services and capabilities to advance population health.

Healthcare Services Segment Highlights

Revenues:

 

    Revenue of $5.88 billion in 1Q15 for the Healthcare Services segment increased $1.22 billion, or 26.3 percent, from $4.66 billion in 1Q14, primarily due to substantial growth in the company’s Medicare membership which resulted in higher utilization of the pharmacy solutions and home based services businesses.

Operating costs:

 

    The Healthcare Services segment’s operating cost ratio of 95.4 percent in 1Q15 was relatively unchanged compared to 95.3 percent in 1Q14.

 

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Operating statistics:

 

    Primary care providers in value-based (shared risk and path to risk) relationships of approximately 45,500 at March 31, 2015 increased 12.9 percent from 40,300 at March 31, 2014, and increased 7.6 percent from 42,300 at December 31, 2014. At March 31, 2015, 54.2 percent of the company’s individual Medicare Advantage members were in value-based relationships, compared to 53.6 percent at December 31, 2014, and 53.3 percent at March 31, 2014.

 

    Medicare Advantage membership in the Humana Chronic Care Program rose to 463,000 at March 31, 2015, up 55.6 percent from 297,500 at March 31, 2014, and up 10.1 percent to 420,700 at December 31, 2014, reflecting enhanced predictive modeling capabilities and focus on proactive clinical outreach and member engagement.

 

    Pharmacy script volumes of 96.1 million for the quarter ended March 31, 2015 increased 22.3 percent compared to 78.6 million for the quarter ended March 31, 2014, driven primarily by higher average medical membership.

Pretax results:

 

    Healthcare Services segment pretax income of $230 million in 1Q15 increased from $185 million in 1Q15, primarily due to revenue growth from the pharmacy solutions and home based services businesses, as they serve the company’s growing Medicare membership.

Footnotes

 

(a) Adjusted EPS for the quarter ended March 31, 2015 (1Q15) excludes approximately $0.35 per share of tax benefit associated with the recognition of a deferred tax asset in connection with the held-for-sale classification resulting from the company’s announcement in March of an agreement to sell its wholly-owned subsidiary, Concentra Inc. Adjusted EPS for 2014 excludes approximately $0.15 per share associated with the early retirement of debt in the fourth quarter of 2014. Adjusted EPS guidance for 2015 excludes an expected one-time gain from the pending sale of Concentra of approximately $1.35 to $1.45 per share, which includes the $0.35 per share tax benefit recognized in 1Q15. The company has included these financial measures (not in accordance with Generally Accepted Accounting Principles (GAAP)) in its summary of financial results within this earnings press release as management believes that these measures, when presented in conjunction with the comparable GAAP measures, are useful to both management and its investors in analyzing the company’s ongoing business and operating performance. The excluded items described herein are not a recurring part of the company’s operating plan. Consequently, management uses these non-GAAP financial measures as indicators of business performance, as well as for operational planning and decision making purposes. Non-GAAP financial measures should be considered in addition to, but not as a substitute for, or superior to, financial measures prepared in accordance with GAAP.
(b) State-based contracts include the company’s operations and membership associated with Medicaid benefits provided for dual- eligible demonstration, Temporary Assistance for Needy Families (TANF), and Long-Term Support Services (LTSS) programs.
(c) Under health care reform, premium stabilization programs, commonly referred to as the 3Rs, became effective January 1, 2014. These programs include a permanent risk adjustment program, a transitional reinsurance program, and a temporary risk corridors program designed to more evenly spread the financial risk borne by issuers and to mitigate the risk that issuers would have mispriced products. In each case, operation of the program is subject to federal administrative action.
(d) On January 1, 2015, the company realigned certain of its businesses among its financial reporting segments to correspond with internal management reporting changes and renamed its Employer Group segment the Group segment. The company’s three reportable segments remain Retail, Group, and Healthcare Services.
(e) The company provides a full range of insured specialty products including dental, vision, other supplemental health, financial protection, and voluntary insurance benefits. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products. Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies.

Conference Call & Virtual Slide Presentation

Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings. A live virtual presentation (audio with slides) may be accessed via Humana’s Investor Relations page at www.humana.com. The company suggests web participants sign on at least 15 minutes in advance of the call. The company also suggests web participants visit the site well in advance of the call to run a system test and to download any free software needed to view the presentation.

 

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All parties interested in the audio-only portion of the conference call are invited to dial 888-625-7430. No password is required. The company suggests participants dial in at least ten minutes in advance of the call. For those unable to participate in the live event, the virtual presentation archive may be accessed via the Historical Webcasts & Presentations section of the Investor Relations page at www.humana.com.

Cautionary Statement

This news release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:

 

    If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of health care services delivered to its members, if the company is unable to implement clinical initiatives to provide a better health care experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. These estimates, however, involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in claim payment patterns and medical cost trends.

 

    If Humana fails to effectively implement its operational and strategic initiatives, particularly its Medicare initiatives, state- based contract strategy, and its participation in the new health insurance exchanges, the company’s business may be materially adversely affected, which is of particular importance given the concentration of the company’s revenues in these products.

 

    If Humana fails to properly maintain the integrity of its data, to strategically implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks, the company’s business may be materially adversely affected.

 

    Humana’s business may be materially adversely impacted by the adoption of a new coding set for diagnoses (commonly known as ICD-10), the implementation of which has been deferred to at least October 1, 2015.

 

    Humana is involved in various legal actions, or disputes that could lead to legal actions (such as, among other things, provider contract disputes relating to rate adjustments resulting from the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, commonly referred to as “sequestration”; other provider contract disputes; and qui tam litigation brought by individuals on behalf of the government) and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages or changes in its business practices. Increased litigation and negative publicity could also increase the company’s cost of doing business.

 

    As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government health care programs including, among other things, loss of material government contracts, governmental audits and investigations, potential inadequacy of government-determined payment rates, potential restrictions on profitability, including by comparison of profitability of the company’s Medicare Advantage business to non-Medicare Advantage business, or other changes in the governmental programs in which Humana participates.

 

    The Health Care Reform Law, including The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010, could have a material adverse effect on Humana’s results of operations, including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products, lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee and other assessments; the company’s financial position, including the company’s ability to maintain the value of its goodwill; and the company’s cash flows.

 

    Humana’s participation in the new federal and state health care exchanges, which entail uncertainties associated with mix, volume of business, and the operation of premium stabilization programs, which are subject to federal administrative action, could adversely affect the company’s results of operations, financial position, and cash flows.

 

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    Humana’s business activities are subject to substantial government regulation. New laws or regulations, or changes in existing laws or regulations or their manner of application could increase the company’s cost of doing business and may adversely affect the company’s business, profitability and cash flows.

 

    If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected.

 

    Humana’s pharmacy business is highly competitive and subjects it to regulations in addition to those the company faces with its core health benefits businesses.

 

    Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance.

 

    If Humana does not continue to earn and retain purchase discounts and volume rebates from pharmaceutical manufacturers at current levels, Humana’s gross margins may decline.

 

    Humana’s ability to obtain funds from certain of its licensed subsidiaries is restricted by state insurance regulations.

 

    Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition.

 

    The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.

In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.

Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:

 

    Form 10-K for the year ended December 31, 2014;

 

    Form 8-Ks filed during 2015.

About Humana

Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

 

    Annual reports to stockholders

 

    Securities and Exchange Commission filings

 

    Most recent investor conference presentations

 

    Quarterly earnings news releases

 

    Replays of most recent earnings release conference calls

 

    Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors)

 

    Corporate Governance information

 

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Humana Inc. – Earnings Guidance Points as of April 29, 2015

 

(in accordance with Generally

Accepted Accounting

Principles, or GAAP, unless

otherwise noted)

  

Current guidance for the year
ending

December 31, 2015 (FY15) – as of
April 29, 2015

  

Prior guidance for
FY15 – Recast to reflect
segment

realignments

  

Prior guidance for

FY15 – As of

February 4, 2015

  

Comments

Diluted earnings per common share

            See footnote (a) on page 8 of this press release.

GAAP basis

   $9.85 to $10.45*    $8.50 to $9.00    $8.50 to $9.00   
     

 

  

 

  

Less one-time gain on sale of Concentra

($1.35 to $1.45)

No adjusted guidance

previously given

No adjusted guidance

previously given

  

 

        

Adjusted basis(a)

$8.50 to $9.00
  

 

        

Revenues
Consolidated

Revenues include expected interest income

$54.25B to $54.75B* $54.5B to $55.0B $54.5B to $55.0B

Segments
Retail Segment

$45.5B to $46.0B $45.0B to $46.0B $39.75B to $40.25B

Segment-level revenues include intersegment amounts that eliminate in consolidation.

Group Segment

$7.0B to $8.0B $7.0B to $8.0B $12.0B to $13.0B

Healthcare Services Segment

$22.5B to $23.5B*

$22.5B to $23.5B $22.5B to $23.5B

Consolidated investment income

$350M to $400M $350M to $400M $350M to $400M

Investment income is included in revenue

guidance above.

Benefit ratios

Benefits expense as a percent of premiums.

Retail Segment

84.0% to 85.0% 84.0% to 85.0% 83.5% to 84.5%

Group Segment

79.5% to 80.5% 79.5% to 80.5% 83.5% to 84.5%

Operating cost ratios Consolidated

13.5% to 14.5%* 14.5% to 15.5% 14.5% to 15.5%

Operating costs as a percent of total revenues excluding investment income.

Healthcare Services Segment

95.5% to 96.0%* 95.5% to 96.0% 95.5% to 96.0%

Consolidated depreciation and amortization (D&A)

Certain D&A is included in benefits expense on the income statement

Income statement

$330M to $350M* $370M to $390M $370M to $390M

but shown as a non-

cash item on the cash

Cash flows statement

$440M to $460M* $490M to $510M $490M to $510M

flows statement.

 

* Incorporates the assumption of completion of the sale of Concentra in May 2015.

 

11


Humana Inc. – Earnings Guidance Points as of April 29, 2015

 

(in accordance with
Generally

Accepted Accounting

Principles, or GAAP,
unless

otherwise noted)

  

Current guidance for the year ending
December 31, 2015 (FY15) – as of

April 29, 2015

  

Prior guidance for

FY15 – Recast to reflect
segment realignments

  

Prior guidance for

FY15 – As of

February 4, 2015

  

Comments

Consolidated interest expense

   $185M to $190M    $185M to $190M    $185M to $190M   

Pretax results

           

Segment-level pretax results include the impact of net investment income.

Retail Segment

   $1.6B to $1.7B    $1.6B to $1.7B    $1.425B to $1.525B   

Retail segment pretax includes $75 to $85 million ($0.30 to $0.35 per share) of investments in state-based contracts.

Group Segment

   $175M to $225M    $175M to $225M    $275M to $325M   

Healthcare Services Segment

   $1.0B to $1.1B*    $775M to $825M    $775M to $825M   

Healthcare services segment includes pre-tax gain from sale of Concentra of $245 million to $265 million ($1.35 to $1.45 per share).

           
           
           

Effective Tax Rate

   46.0% to 47.0%*    48.75% to 49.75%    48.75% to 49.75%   

Reflects the non-deductibility of the industry fee.

Weighted average shares for diluted earnings per common share

   Approximately 150.5M to 151.0M    Approximately 150M    Approximately 150M   

Reflects impact of anticipated share repurchases.

Cash flows from operations

   $1.5B to $1.7B*    $1.7B to $2.0B    $1.7B to $2.0B   

Change primarily related to the change in premium stabilization program net receivables.

Premium Stabilization Program Net Receivables

   $450M to $550M      $275M to $350M    $275M to $350M   

Approximately 75% of current estimate relates to the reinsurance program.

Capital expenditures

   $525M to $575M*    $575M to $625M    $575M to $625M   

Commercial group fully-insured medical cost trend

   5.5% to 6.5%    5.5% to 6.5%    5.5% to 6.5%   

 

* Incorporates the assumption of completion of the sale of Concentra in May 2015.

 

12


Humana Inc. – Earnings Guidance Points as of April 29, 2015

 

(in accordance with Generally

Accepted Accounting

Principles, or GAAP, unless

otherwise noted)

  

Current guidance for the year
ending

December 31, 2015 (FY15) – as of

April 29, 2015

  

Prior guidance for

FY15 – Recast to reflect
segment

realignments

  

Prior guidance for

FY15 – As of

February 4, 2015

  

Comments

Change in ending medical membership

           

Retail Segment

           

Medicare Advantage (MA) – individual

   Up 300k to 350k    Up 300k to 350k    Up 300k to 350k   

MA – group

   Flat to down 10k    Flat to down 10k    Flat to down 10k   

Medicare stand-alone PDP

   Up 450k to 500k    Up 400k to 450k    Up 400k to 450k   

Medicare stand-alone PDP excludes Limited Income

           

Newly Eligible Transition (LI- NET) membership.

State-based Medicaid

   Up 20k to 25k    Up 20k to 25k    Flat to up 5k   

State-based Medicaid Includes Temporary Assistance for Needy Families (TANF) , Long-Term Support Services (LTSS) membership from state-based contracts, as well as dual-eligible members associated with demonstration projects.

HumanaOne

   Down 25k to 50k    Down 80k to 90k    Down 80k to 90k   

HumanaOne includes membership expectations for both on-exchange and off-exchange enrollment.

Medicare Supplement

   Up 35k to 45k    Up 35k to 45k    Up 35k to 45k   

 

* Incorporates the assumption of completion of the sale of Concentra in May 2015.

 

13


Humana Inc. – Earnings Guidance Points as of April 29, 2015

 

(in accordance with
Generally

Accepted Accounting

Principles, or GAAP, unless

otherwise noted)

  

Current guidance for the year
ending

December 31, 2015 (FY15) – as of

April 29, 2015

  

Prior guidance for
FY15 –Recast to reflect
segment realignments

  

Prior guidance for

FY15 –As of

February 4, 2015

  

Comments

Change in ending medical membership

           

Group Segment

           

Commercial fully-insured

   Down 45k to 55k    Down 35k to 45k    Down 35k to 45k   

Commercial ASO

   Down 400k to 425k    Down 400k to 425k    Down 400k to 425k   

 

* Incorporates the assumption of completion of the sale of Concentra in May 2015.

 

14


Humana Inc.

Statistical Schedules

And

Supplementary Information

1Q15 Earnings Release

 

S-1


Humana Inc.

Statistical Schedules and Supplementary Information

1Q15 Earnings Release

Contents

 

Page   Description

S-3

  Consolidated Statements of Income

S-4-5

  Quarterly Segment Financial Information

S-6

  Consolidated Balance Sheets

S-7

  Consolidated Statements of Cash Flows

S-8

  Key Income Statement Ratios and Segment Operating Results

S-9-10

  Healthcare Services Segment Metrics

S-11

  Ending Membership Detail

S-12

  Premiums and Services Revenue Detail

S-13

  Medicare Summary

S-14

  Investments

S-15-17

  Benefits Payable Detail and Statistics

S-18

  Footnotes

 

S-2


Humana Inc.

Consolidated Statements of Income

Dollars in millions, except per common share results

 

     Three Months Ended March 31,      Dollar     Percentage  
     2015      2014      Change     Change  

Revenues:

          

Premiums

   $ 13,248       $ 11,083       $ 2,165        19.5

Services

     490         538         (48     -8.9

Investment income

     95         91         4        4.4
  

 

 

    

 

 

    

 

 

   

Total revenues

  13,833      11,712      2,121      18.1
  

 

 

    

 

 

    

 

 

   

Operating expenses:

Benefits

  11,005      9,124      1,881      20.6

Operating costs

  1,945      1,785      160      9.0

Depreciation and amortization

  93      82      11      13.4
  

 

 

    

 

 

    

 

 

   

Total operating expenses

  13,043      10,991      2,052      18.7
  

 

 

    

 

 

    

 

 

   

Income from operations

  790      721      69      9.6

Interest expense

  46      35      11      31.4
  

 

 

    

 

 

    

 

 

   

Income before income taxes

  744      686      58      8.5

Provision for income taxes

  314      318      (4   -1.3
  

 

 

    

 

 

    

 

 

   

Net income

$ 430    $ 368    $ 62      16.8
  

 

 

    

 

 

    

 

 

   

Basic earnings per common share

$ 2.86    $ 2.37    $ 0.49      20.7

Diluted earnings per common share

$ 2.82    $ 2.35    $ 0.47      20.0

Shares used in computing basic earnings per common share (000’s)

  150,490      155,091   

Shares used in computing diluted earnings per common share (000’s)

  152,349      156,647   

 

S-3


Humana Inc.

1Q15 Segment Financial Information

In millions

 

                 Healthcare     Other      Eliminations/        
     Retail     Group     Services     Businesses      Corporate     Consolidated  

Revenues—external customers

             

Premiums:

             

Individual Medicare Advantage

   $ 7,433      $ —        $ —        $ —         $ —        $ 7,433   

Group Medicare Advantage

     1,394        —          —          —           —          1,394   

Medicare stand-alone PDP

     1,003        —          —          —           —          1,003   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total Medicare

  9,830      —        —        —        —        9,830   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Fully-insured

  1,094      1,384      —        —        —        2,478   

Specialty

  63      270      —        —        —        333   

Medicaid and other (A)

  591      6      —        10      —        607   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total premiums

  11,578      1,660      —        10      —        13,248   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Services revenue:

Provider

  —        9      308      —        —        317   

ASO and other (B)

  4      160      —        2      —        166   

Pharmacy

  —        —        7      —        —        7   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total services revenue

  4      169      315      2      —        490   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues—external customers

  11,582      1,829      315      12      —        13,738   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Intersegment revenues

Services

  —        22      4,413      —        (4,435   —     

Products

  —        —        1,150      —        (1,150   —     
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total intersegment revenues

  —        22      5,563      —        (5,585   —     
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Investment income

  27      5      —        15      48      95   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues

  11,609      1,856      5,878      27      (5,537   13,833   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Operating expenses:

Benefits

  9,936      1,226      —        23      (180   11,005   

Operating costs

  1,254      453      5,606      3      (5,371   1,945   

Depreciation and amortization

  44      23      42      —        (16   93   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total operating expenses

  11,234      1,702      5,648      26      (5,567   13,043   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income from operations

  375      154      230      1      30      790   

Interest expense

  —        —        —        —        46      46   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income before income taxes

$ 375    $ 154    $ 230    $ 1    $ (16 $ 744   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Benefit ratio

  85.8   73.9   83.1

Operating cost ratio

  10.8   24.5   95.4   14.2 %

 

S-4


Humana Inc.

1Q14 Segment Financial Information (Recast) (C)

In millions

 

                 Healthcare     Other      Eliminations/        
     Retail     Group     Services     Businesses      Corporate     Consolidated  

Revenues—external customers

             

Premiums:

             

Individual Medicare Advantage

   $ 6,460      $ —        $ —        $ —         $ —        $ 6,460   

Group Medicare Advantage

     1,384        —          —          —           —          1,384   

Medicare stand-alone PDP

     865        —          —          —           —          865   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total Medicare

  8,709      —        —        —        —        8,709   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Fully-insured

  525      1,329      —        —        —        1,854   

Specialty

  59      275      —        —        —        334   

Medicaid and other (A)

  169      6      —        11      —        186   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total premiums

  9,462      1,610      —        11      —        11,083   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Services revenue:

Provider

  —        5      307      —        —        312   

ASO and other (B)

  14      188      —        3      —        205   

Pharmacy

  —        —        21      —        —        21   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total services revenue

  14      193      328      3      —        538   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues—external customers

  9,476      1,803      328      14      —        11,621   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Intersegment revenues

Services

  —        19      3,481      —        (3,500   —     

Products

  —        —        846      —        (846   —     
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total intersegment revenues

  —        19      4,327      —        (4,346   —     
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Investment income

  23      6      —        15      47      91   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues

  9,499      1,828      4,655      29      (4,299   11,712   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Operating expenses:

Benefits

  8,080      1,167      —        24      (147   9,124   

Operating costs

  1,010      493      4,434      4      (4,156   1,785   

Depreciation and amortization

  40      24      36      1      (19   82   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total operating expenses

  9,130      1,684      4,470      29      (4,322   10,991   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income from operations

  369      144      185      —        23      721   

Interest expense

  —        —        —        —        35      35   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income before income taxes

$ 369    $ 144    $ 185    $ —      $ (12 $ 686   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Benefit ratio

  85.4   72.5   82.3

Operating cost ratio

  10.7   27.1   95.3   15.4 %

 

S-5


Humana Inc.

Consolidated Balance Sheets

Dollars in millions, except share amounts

 

     March 31,     December 31,     YTD Change  
     2015     2014     Dollar      Percent  

Assets

         

Current assets:

         

Cash and cash equivalents

   $ 1,946      $ 1,935        

Investment securities

     7,600        7,598        

Receivables, net

     1,690        1,053        

Assets of held-for-sale operations

     952        943        

Other current assets

     5,214        4,007        
  

 

 

   

 

 

      

Total current assets

  17,402      15,536    $ 1,866      12.0

Property and equipment, net

  1,258      1,228   

Long-term investment securities

  1,972      1,949   

Goodwill

  3,231      3,231   

Other long-term assets

  1,761      1,583   
  

 

 

   

 

 

      

Total assets

$ 25,624    $ 23,527    $ 2,097      8.9
  

 

 

   

 

 

      

Liabilities and Stockholders’ Equity

Current liabilities:

Benefits payable

$ 4,764    $ 4,475   

Trade accounts payable and accrued expenses

  3,554      2,095   

Book overdraft

  288      334   

Unearned revenues

  378      361   

Liabilities of held-for-sale operations

  193      206   
  

 

 

   

 

 

      

Total current liabilities

  9,177      7,471    $ 1,706      22.8

Long-term debt

  3,824      3,825   

Future policy benefits payable

  2,298      2,349   

Other long-term liabilities

  281      236   
  

 

 

   

 

 

      

Total liabilities

  15,580      13,881    $ 1,699      12.2
  

 

 

   

 

 

      

Commitments and contingencies

Stockholders’ equity:

Preferred stock, $1 par; 10,000,000 shares authorized, none issued

  —        —     

Common stock, $0.16 2/3 par; 300,000,000 shares authorized;
198,223,040 issued at March 31, 2015

  33      33   

Capital in excess of par value

  2,465      2,330   

Retained earnings

  10,302      9,916   

Accumulated other comprehensive income

  227      223   

Treasury stock, at cost, 48,441,768 shares at March 31, 2015

  (2,983   (2,856
  

 

 

   

 

 

      

Total stockholders’ equity

  10,044      9,646    $ 398      4.1
  

 

 

   

 

 

      

Total liabilities and stockholders’ equity

$ 25,624    $ 23,527    $ 2,097      8.9
  

 

 

   

 

 

      

Debt-to-total capitalization ratio

  27.6   28.4

Return on Invested Capital (ROIC) based on Net Operating Profit

  10.2   10.0

After Tax (NOPAT)—trailing 12 months

 

S-6


Humana Inc.

Consolidated Statements of Cash Flows

Dollars in millions

 

     Three Months Ended March 31,     Dollar     Percentage  
     2015     2014     Change     Change  

Cash flows from operating activities

        

Net income

   $ 430      $ 368       

Adjustments to reconcile net income to net cash provided by operating activities:

        

Depreciation and amortization

     114        107       

Net realized capital gains

     (9     (1    

Stock-based compensation

     44        33       

Benefit for deferred income taxes

     (58     (26    

Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions:

        

Receivables

     (644     (524    

Other assets

     (1,145     (566    

Benefits payable

     289        539       

Other liabilities

     1,051        684       

Unearned revenues

     17        57       

Other, net

     18        —         
  

 

 

   

 

 

     

Net cash provided by operating activities

  107      671    ($ 564   -84.1
  

 

 

   

 

 

     

Cash flows from investing activities

Acquisitions, net of cash acquired

  —        (6

Purchases of property and equipment

  (123   (106

Proceeds from sale of business

  —        72   

Purchases of investment securities

  (829   (507

Maturities of investment securities

  330      258   

Proceeds from sales of investment securities

  528      118   
  

 

 

   

 

 

     

Net cash used in investing activities

  (94   (171 $ 77      45.0
  

 

 

   

 

 

     

Cash flows from financing activities

Receipts (withdrawals) from contract deposits, net

  123      220   

Change in book overdraft

  (46   (136

Common stock repurchases

  (66   (49

Excess tax benefit from stock-based compensation

  13      8   

Dividends paid

  (44   (44

Proceeds from stock option exercises and other

  18      25   
  

 

 

   

 

 

     

Net cash (used in) provided by financing activities

  (2   24    ($ 26   -108.3
  

 

 

   

 

 

     

Increase in cash and cash equivalents

  11      524   

Cash and cash equivalents at beginning of period

  1,935      1,138   
  

 

 

   

 

 

     

Cash and cash equivalents at end of period

$ 1,946    $ 1,662   
  

 

 

   

 

 

     

 

S-7


Humana Inc.

Key Income Statement Ratios and Segment Operating Results

Dollars in millions

 

     Three Months Ended March 31,           Percentage  
     2015     2014     Difference     Change  

Benefit ratio

        

Retail

     85.8     85.4     0.4  

Group

     73.9     72.5     1.4  

Consolidated

     83.1     82.3     0.8  

Operating cost ratio

        

Retail

     10.8     10.7     0.1  

Group

     24.5     27.1     -2.6  

Healthcare Services

     95.4     95.3     0.1  

Consolidated

     14.2     15.4     -1.2  

Detail of pretax income

        

Retail

   $ 375      $ 369      $ 6        1.6

Group

   $ 154      $ 144      $ 10        6.9

Healthcare Services

   $ 230      $ 185      $ 45        24.3

Consolidated

   $ 744      $ 686      $ 58        8.5

 

S-8


Humana Inc.

Healthcare Services Segment Metrics

 

     Quarter Ended      Quarter Ended                  Quarter Ended               
     March 31, 2015      March 31, 2014      Difference           December 31, 2014      Difference        

Primary Care Providers:

                 

Shared Risk (D)

                 

Owned / JV

     2,700         2,900         (200     -6.9     2,800         (100     -3.6

Contracted

     14,200         10,300         3,900        37.9     11,800         2,400        20.3

Path to Risk (E)

     28,600         27,100         1,500        5.5     27,700         900        3.2
  

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total Value-based

  45,500      40,300      5,200      12.9   42,300      3,200      7.6
  

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Medicare Care Management Professionals:

Employed (F)

  6,000      4,600      1,400      30.4   5,800      200      3.4

Contracted (G)

  10,700      8,600      2,100      24.4   12,200      (1,500   -12.3
  

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Total

  16,700      13,200      3,500      26.5   18,000      (1,300   -7.2
  

 

 

    

 

 

    

 

 

     

 

 

    

 

 

   

Care Management Statistics:

Number of Medicare Advantage members with complex chronic conditions in Humana Chronic Care Program

  463,000      297,500      165,500      55.6   420,700      42,300      10.1

Number of high-risk discharges enrolled in Humana Transitions Program (H)

  52,100      23,800      28,300      118.9   45,700      6,400      14.0

 

S-9


Humana Inc.

Healthcare Services Segment Metrics (Continued)

Script volume in thousands

 

     Quarter Ended     Quarter Ended     Year-over-Year           Quarter Ended     Sequential        
     March 31, 2015     March 31, 2014     Difference           December 31, 2014     Difference        

Pharmacy:

              

Generic Dispense Rate

              

Retail

     89.5     88.1     1.4       88.9     0.6  

Group

     83.0     80.7     2.3       81.4     1.6  

Total

     89.1     87.7     1.4       88.4     0.7  
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Mail-Order Penetration

Retail

  25.8   24.2   1.6   24.1   1.7

Group

  8.4   9.1   -0.7   9.2   -0.8

Total

  24.8   23.2   1.6   23.0   1.8
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   
                       Percentage                 Percentage  
                 Difference     Change           Difference     Change  

Script volume

              

Retail

     91,000        73,600        17,400        23.6     80,000        11,000        13.8

Group

     5,100        5,000        100        2.0     5,300        (200     -3.8
  

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total

  96,100      78,600      17,500      22.3   85,300      10,800      12.7
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

S-10


Humana Inc.

Ending Membership Detail

In thousands

 

          Average           Year-over-Year Change           Sequential Change  
    March 31, 2015     1Q15     March 31, 2014     Amount     Percent     December 31, 2014     Amount     Percent  

Medical Membership:

               

Retail

               

Individual Medicare Advantage

    2,685.9        2,681.2        2,330.8        355.1        15.2     2,427.9        258.0        10.6

Group Medicare Advantage

    470.9        470.0        477.6        (6.7     -1.4     489.7        (18.8     -3.8

Medicare stand-alone PDPs

    4,381.4        4,428.6        3,856.5        524.9        13.6     3,994.0        387.4        9.7
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Medicare

  7,538.2      7,579.8      6,664.9      873.3      13.1   6,911.6      626.6      9.1
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Individual commercial

  1,108.9      1,008.0      715.6      393.3      55.0   1,016.2      92.7      9.1

State-based Medicaid (I)

  339.0      332.8      129.6      209.4      161.6   316.8      22.2      7.0

Medicare Supplement

  149.2      148.2      118.4      30.8      26.0   131.9      17.3      13.1
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Retail

  9,135.3      9,068.8      7,628.5      1,506.8      19.8   8,376.5      758.8      9.1
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Group

Fully-insured medical commercial

  1,189.6      1,196.9      1,200.2      (10.6   -0.9   1,235.5      (45.9   -3.7

ASO commercial

  736.8      739.2      1,142.0      (405.2   -35.5   1,104.3      (367.5   -33.3

Military services

  3,085.6      3,084.9      3,098.0      (12.4   -0.4   3,090.4      (4.8   -0.2
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Employer Group

  5,012.0      5,021.0      5,440.2      (428.2   -7.9   5,430.2      (418.2   -7.7
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Other Businesses

Long-term care and other

  34.2      34.6      37.9      (3.7   -9.8   35.0      (0.8   -2.3
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Other Businesses

  34.2      34.6      37.9      (3.7   -9.8   35.0      (0.8   -2.3
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Medical Membership

  14,181.5      14,124.4      13,106.6      1,074.9      8.2   13,841.7      339.8      2.5
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Detail of Individual commercial

ACA compliant:

On-Exchange

  730.8      630.4      223.5      507.3      227.0   554.8      176.0      31.7

Off-Exchange

  213.3      205.0      72.4      140.9      194.6   131.5      81.8      62.2

Non-ACA compliant (legacy)

  164.8      172.6      419.7      (254.9   -60.7   329.9      (165.1   -50.0
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total individual commercial

  1,108.9      1,008.0      715.6      393.3      55.0   1,016.2      92.7      9.1
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Specialty Membership:

Retail

Dental—fully-insured

  860.8      836.9      803.2      57.6      7.2   828.5      32.3      3.9

Vision

  189.3      182.6      176.7      12.6      7.1   208.4      (19.1   -9.2

Other supplemental benefits (J)

  123.2      123.3      143.8      (20.6   -14.3   128.9      (5.7   -4.4
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Retail

  1,173.3      1,142.8      1,123.7      49.6      4.4   1,165.8      7.5      0.6
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Group

Dental—fully-insured

  2,272.7      2,286.1      2,397.6      (124.9   -5.2   2,370.5      (97.8   -4.1

Dental—ASO

  759.2      760.6      800.4      (41.2   -5.1   772.4      (13.2   -1.7

Vision

  2,033.3      2,035.3      2,072.3      (39.0   -1.9   2,103.3      (70.0   -3.3

Other supplemental benefits (J)

  1,186.0      1,192.5      1,330.6      (144.6   -10.9   1,256.5      (70.5   -5.6
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Employer Group

  6,251.2      6,274.5      6,600.9      (349.7   -5.3   6,502.7      (251.5   -3.9
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

Total Specialty Membership

  7,424.5      7,417.3      7,724.6      (300.1   -3.9   7,668.5      (244.0   -3.2
 

 

 

   

 

 

   

 

 

   

 

 

     

 

 

   

 

 

   

 

S-11


Humana Inc.

Premiums and Services Revenue Detail

Dollars in millions, except per member per month

 

     Three Months Ended March 31,      Dollar     Percentage     Per Member per Month (K)
Three Months Ended March 31,
 
     2015      2014      Change     Change     2015      2014  

Premiums and Services Revenue

               

Retail:

               

Medicare Advantage-individual

   $ 7,433       $ 6,460       $ 973        15.1   $ 924       $ 927   

Medicare Advantage-group

     1,394         1,384         10        0.7     989         970   

Medicare stand-alone PDPs

     1,003         865         138        16.0     75         75   

Individual commercial

     1,021         468         553        118.2     338         242   

State-based Medicaid (I)

     591         169         422        249.7     592         475   

Medicare Supplemental

     73         57         16        28.1     164         162   

Specialty

     63         59         4        6.8     18         18   

Other services

     4         14         (10     -71.4     
  

 

 

    

 

 

    

 

 

        

Total Retail

  11,582      9,476      2,106      22.2
  

 

 

    

 

 

    

 

 

        

Group:

Fully-insured medical commercial

  1,384      1,329      55      4.1   385      368   

Specialty

  270      275      (5   -1.8   16      16   

Commercial ASO & other services (B)

  96      108      (12   -11.1

Military services (L)

  101      110      (9   -8.2
  

 

 

    

 

 

    

 

 

        

Total Group

  1,851      1,822      29      1.6
  

 

 

    

 

 

    

 

 

        

Healthcare Services:

Pharmacy solutions

  4,967      3,878      1,089      28.1

Provider services

  643      586      57      9.7

Home based services

  219      141      78      55.3

Clinical programs

  49      50      (1   -2.0
  

 

 

    

 

 

    

 

 

        

Total Healthcare Services

  5,878      4,655      1,223      26.3
  

 

 

    

 

 

    

 

 

        

 

S-12


Humana Inc.

Medicare Summary

Premiums in millions, except per member per month

Membership in thousands

 

     Three Months Ended March 31,      Year-over-year Change     Per Member per Month (K)
Three Months Ended March 31,
 
     2015      2014      Amount     Percent     2015      2014  

Premiums

               

Medicare Advantage

   $ 8,827       $ 7,844       $ 983        12.5   $ 934       $ 934   

Medicare stand-alone PDPs

     1,003         865         138        16.0   $ 75       $ 75   
  

 

 

    

 

 

    

 

 

        

Total Medicare

$ 9,830    $ 8,709    $ 1,121      12.9
  

 

 

    

 

 

    

 

 

        
                   Year-over-year Change               
     March 31, 2015      March 31, 2014      Amount     Percent               

Fully-Insured Membership

               

Medicare Advantage

     3,156.8         2,808.4         348.4        12.4     

Medicare stand-alone PDPs

     4,381.4         3,856.5         524.9        13.6     
  

 

 

    

 

 

    

 

 

        

Total Medicare

  7,538.2      6,664.9      873.3      13.1
  

 

 

    

 

 

    

 

 

   

 

 

      
                   Member Mix               
     March 31, 2015      March 31, 2014      March 31,
2015
    March 31,
2014
              

Individual Medicare Advantage Membership

               

HMO

     1,506.0         1,232.6         56.1     52.9     

PPO

     1,179.9         1,098.2         43.9     47.1     
  

 

 

    

 

 

    

 

 

        

Total Individual Medicare Advantage

  2,685.9      2,330.8      100.0   100.0
  

 

 

    

 

 

    

 

 

   

 

 

      

Individual Medicare Advantage Membership

Shared Risk (D)

  838.3      656.1      31.2   28.1

Path to Risk (E)

  618.5      587.4      23.0   25.2
  

 

 

    

 

 

    

 

 

   

 

 

      

Total Value-based

  1,456.8      1,243.5      54.2   53.3

Other

  1,229.1      1,087.3      45.8   46.7
  

 

 

    

 

 

    

 

 

   

 

 

      

Total Individual Medicare Advantage

  2,685.9      2,330.8      100.0   100.0
  

 

 

    

 

 

    

 

 

   

 

 

      

 

S-13


Humana Inc.

Investments

Dollars in millions

 

     Fair value  
     3/31/2015      12/31/2014      3/31/2014  

Investment Portfolio:

        

Cash & cash equivalents

   $ 1,946       $ 1,935       $ 1,662   

Investment securities

     7,600         7,598         8,248   

Long-term investment securities

     1,972         1,949         1,800   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

$ 11,518    $ 11,482    $ 11,710   
  

 

 

    

 

 

    

 

 

 

Duration (M)

  4.15      4.14      4.36   
  

 

 

    

 

 

    

 

 

 

Average Credit Rating

  AA-      AA-      AA-   
  

 

 

    

 

 

    

 

 

 

Investment Portfolio Detail:

Cash and cash equivalents

$ 1,946    $ 1,935    $ 1,662   
  

 

 

    

 

 

    

 

 

 

U.S. Government and agency obligations

U.S. Treasury and agency obligations

  366      374      520   

U.S. Government residential mortgage-backed

  1,739      1,477      1,845   

U.S. Government commercial mortgage-backed

  19      21      27   
  

 

 

    

 

 

    

 

 

 

Total U.S. Government and agency obligations

  2,124      1,872      2,392   
  

 

 

    

 

 

    

 

 

 

Tax-exempt municipal securities

Pre-refunded

  189      199      200   

Insured

  444      484      556   

Other

  2,117      2,376      2,397   

Auction rate securities

  6      9      13   
  

 

 

    

 

 

    

 

 

 

Total tax-exempt municipal securities

  2,756      3,068      3,166   
  

 

 

    

 

 

    

 

 

 

Residential mortgage-backed

  16      17      20   

Commercial mortgage-backed

  891      843      665   

Asset-backed securities

  139      29      50   

Corporate securities

Financial services

  810      772      811   

Other

  2,836      2,946      2,944   
  

 

 

    

 

 

    

 

 

 

Total corporate securities

  3,646      3,718      3,755   
  

 

 

    

 

 

    

 

 

 

Total investment portfolio

$ 11,518    $ 11,482    $ 11,710   
  

 

 

    

 

 

    

 

 

 

 

S-14


Humana Inc.

Detail of Benefits Payable Balance and Year-to-Date Changes

Dollars in millions

 

     March 31,
2015
    March 31,
2014
    December 31,
2014
 

Detail of benefits payable

      

IBNR (N)

   $ 3,398      $ 2,940      $ 3,254   

Reported Claims in Process (O)

     553        545        475   

Other Benefits Payable (P)

     813        946        746   

Military services benefits payable

     —          1        —     
  

 

 

   

 

 

   

 

 

 

Total Benefits Payable

$ 4,764    $ 4,432    $ 4,475   
  

 

 

   

 

 

   

 

 

 
     Three Months Ended     Three Months Ended     Year Ended  
     March 31, 2015     March 31, 2014     December 31, 2014  

Year-to-date changes in benefits payable,
excluding military services (Q)

      

Balances at January 1

   $ 4,475      $ 3,893      $ 3,893   

Less: Reinsurance recoverables (R)

     (78     —          —     
  

 

 

   

 

 

   

 

 

 

Balances at January 1, net

$ 4,397    $ 3,893    $ 3,893   

Incurred related to:

Current year

  11,293      9,427      38,641   

Prior years (S)

  (194   (297   (518
  

 

 

   

 

 

   

 

 

 

Total incurred

  11,099      9,130      38,123   
  

 

 

   

 

 

   

 

 

 

Paid related to:

Current year

  (7,270   (5,737   (34,357

Prior years

  (3,555   (2,855   (3,262
  

 

 

   

 

 

   

 

 

 

Total paid

  (10,825   (8,592   (37,619
  

 

 

   

 

 

   

 

 

 

Reinsurance recoverables (R)

  93      —        78   
  

 

 

   

 

 

   

 

 

 

Balances at end of period

$ 4,764    $ 4,431    $ 4,475   
  

 

 

   

 

 

   

 

 

 
     Three Months Ended     Three Months Ended     Year Ended  
     March 31, 2015     March 31, 2014     December 31, 2014  

Summary of Consolidated Benefit Expense:

      

Total benefit expense incurred, per above

   $ 11,099      $ 9,130      $ 38,123   

Military services benefit expense

     4        1        11   

Future policy benefit expense (T)

     (98     (7     32   
  

 

 

   

 

 

   

 

 

 

Consolidated Benefit Expense

$ 11,005    $ 9,124    $ 38,166   
  

 

 

   

 

 

   

 

 

 

 

S-15


Humana Inc.

Benefits Payable Statistics (U)

Receipt Cycle Time (V)

     2015      2014      Change      Percentage
Change
 

1st Quarter Average

     13.9         13.6         0.3         2.2

2nd Quarter Average

     n/a         13.5         n/a         n/a   

3rd Quarter Average

     n/a         13.4         n/a         n/a   

4th Quarter Average

     n/a         13.5         n/a         n/a   
  

 

 

    

 

 

    

 

 

    

 

 

 

Full Year Average

  13.9      13.5      0.4      3.0
  

 

 

    

 

 

    

 

 

    

 

 

 

Unprocessed Claims Inventories

 

Date

   Estimated Valuation
(millions)
     Claim Item
Counts (000s)
     Number of Days
on Hand
 

3/31/2013

   $ 327         1,247         4.7   

6/30/2013

   $ 380         1,274         4.7   

9/30/2013

   $ 404         1,879         7.4   

12/31/2013

   $ 313         1,240         4.5   

3/31/2014

   $ 363         1,334         4.9   

6/30/2014

   $ 400         1,422         4.5   

9/30/2014

   $ 453         1,778         5.2   

12/31/2014

   $ 378         1,819         5.1   
  

 

 

    

 

 

    

 

 

 

3/31/2015

$ 457      1,893      5.2   
  

 

 

    

 

 

    

 

 

 

 

S-16


Humana Inc.

Benefits Payable Statistics (Continued) (U)

Days in Claims Payable (W)

 

Quarter Ended

   Days in Claims
Payable (DCP)
     Change Last 4
Quarters
    Percentage
Change
 

3/31/2013

     49.0         (1.1     -2.2

6/30/2013

     50.7         (0.3     -0.6

9/30/2013

     49.5         (2.1     -4.1

12/31/2013

     47.8         (0.7     -1.4

3/31/2014

     47.7         (1.3     -2.7

6/30/2014

     48.7         (2.0     -3.9

9/30/2014

     46.6         (2.9     -5.9

12/31/2014

     43.5         (4.3     -9.0
  

 

 

    

 

 

   

 

 

 

3/31/2015

  42.8      (4.9   -10.3
  

 

 

    

 

 

   

 

 

 

Year-to-Date Change in Days in Claims Payable (X)

 

     1Q
2015
    1Q
2014
    FY
2014
 

DCP—beginning of period

     43.5        47.8        47.8   

Components of change in DCP:

      

Change in unprocessed claims inventories

     0.7        0.5        0.6   

Change in processed claims inventories

     0.2        1.3        0.4   

Change in pharmacy payment cutoff

     0.2        0.1        —     

Change in capitation/provider settlements

     (0.4     (1.5     (3.8

All other

     (1.4     (0.5     (1.5
  

 

 

   

 

 

   

 

 

 

DCP—end of period

  42.8      47.7      43.5   
  

 

 

   

 

 

   

 

 

 

 

S-17


Humana Inc.

Footnotes to Statistical Schedules and Supplementary Information

1Q15 Earnings Release

 

(A) The Medicaid and other category includes the company’s Medicaid and military services businesses as well as the closed block of long-term care insurance policies.
(B) The ASO and other category is primarily comprised of ASO fees and other ancillary services fees.
(C) On January 1, 2015, the company realigned certain of its businesses among its financial reporting segments to correspond with internal management reporting changes and renamed its Employer Group segment the Group segment. The company’s three reportable segments remain Retail, Group, and Healthcare Services.
(D) In certain circumstances, the company contracts with providers to accept financial risk for a defined set of Medicare Advantage membership. In transferring this risk, the company prepays these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their Medicare Advantage members assigned or attributed to their provider panel, including some health benefit administrative functions and claims processing. For these capitated Shared Risk arrangements, the company generally agrees to payment rates that target a benefit expense ratio. The result is a high level of engagement on the part of the provider.
(E) A Path to Risk provider is one who has a high level of engagement and participates in one of Humana’s pay-for-performance programs (Model Practice or Medical Home) or has a risk contract in place with a trigger (future date or membership threshold) which has not yet been met. In addition to earning incentives, these providers may also have a shared savings component by which they can share in achieved surpluses when the actual cost of the medical services provided to patients assigned or attributed to their panel is less than the agreed upon medical expense target.
(F) Based on full-time employee equivalent counts that include clinicians responsible for managing and coordinating member care. Excludes professionals that support the non-clinical aspects of care.
(G) Based on employee headcount figures that include clinicians responsible for managing and coordinating member care. Excludes professionals that support the non-clinical aspects of care.
(H) Includes the number of high-risk discharges enrolled in the Humana Transitions Program over the last 12 months.
(I) Includes Medicaid Temporary Assistance for Needy Families (TANF), which contracts are generally reinsured through partnering relationships, dual-eligible demonstration, and Long-Term Support Services (LTSS) from state-based contracts.
(J) Other supplemental benefits include life, disability, and fixed benefit products including cancer and critical illness policies.
(K) Computed based on average membership for the period (i.e., monthly ending membership during the period divided by the number of months in the period).
(L) The majority of Military services revenues are generally not contracted on a per-member basis.
(M) Duration is the time-weighted average of the present value of the fixed income portfolio cash flows.
(N) IBNR represents an estimate of benefits expense payable for claims incurred but not reported (IBNR) at the balance sheet date. The level of IBNR is primarily impacted by membership levels, medical claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received (i.e. a shorter time span results in a lower IBNR).
(O) Reported claims in process represents the estimated valuation of processed claims that are in the post-claim adjudication process, which consists of administrative functions such as audit and check batching and handling, as well as amounts owed to the company’s pharmacy benefit administrator, which fluctuate due to bi-weekly payments and the month-end cutoff.
(P) Other benefits payable primarily include amounts owed to providers under capitated and risk sharing arrangements.
(Q) The table excludes activity associated with military services benefits payable related to the previous contract that expired March 31, 2012.
(R) Represents reinsurance recoverables associated with the company’s state-based Medicaid contract in Kentucky.
(S) 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). There were no changes in the approach used to determine the company’s estimate of medical claim reserves during the quarter.
(T) Future policy benefit expense has a related liability classified as a long-term liability on the balance sheet.
(U) Benefits payable statistics represents fully-insured medical claims data and exclude military services claims data and specialty benefits.
(V) The receipt cycle time measures the average length of time between when a claim was initially incurred and when the claim form was received. Receipt cycle time data for the company’s largest claim processing platforms represent approximately 98% of the company’s fully-insured medical claims volume. Pharmacy and specialty claims, including dental, vision and other supplemental benefits are excluded from this measurement.
(W) A common metric for monitoring benefits payable levels relative to the benefit expense is days in claims payable, or DCP, which represents the benefits payable at the end of the period divided by average benefits expense per day in the quarterly period. This metric excludes military services, Medicare stand-alone PDPs, and reinsurance expense related to commercial individual and long duration products.
(X) DCP fluctuates due to a number of factors, the more significant of which are detailed in this roll forward. Growth in certain product lines can also impact DCP for the quarter since a provision for claims would not have been recorded for members that had not yet enrolled earlier in the quarter, yet those members would have a provision and corresponding medical claims reserve recorded upon enrollment later in the quarter. This metric excludes military services, Medicare stand-alone PDPs, and reinsurance expense relate to commercial individual and long-duration products.

 

S-18