Exhibit 99.1
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Triple-S Management Corporation
|
|
|
1441 F.D. Roosevelt Ave.
|
|
|
San Juan, PR 00920
|
|
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www.triplesmanagement.com
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FOR FURTHER INFORMATION:
|
AT THE COMPANY:
|
INVESTOR RELATIONS:
|
|
Juan José Román-Jiménez
|
Mr. Garrett Edson
|
|
EVP and Chief Financial Officer
|
ICR
|
|
(787) 749-4949
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(787) 792-6488
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Triple-S Management Corporation Reports Fourth Quarter 2020 Results
SAN JUAN, Puerto Rico, February 25, 2021 – Triple-S Management Corporation (NYSE:GTS), a leading healthcare company in Puerto Rico, today announced its fourth quarter
2020 results.
Roberto Garcia-Rodriguez, President and Chief Executive Officer, commented: “During the fourth quarter, our enhanced Medicare Advantage and Medicaid offerings, along
with our superior service and premier brand, enabled us to further increase our membership numbers and premiums. Our solid performance was due, in great part, to our team’s outstanding efforts to provide critical support to our members, providers
and communities throughout an extremely challenging year.”
“In 2021 we will continue investing in informatics and clinical management capabilities that improve service and health outcomes for our members. As we implement our
integrated healthcare-delivery agenda over the next four years, we will be firmly positioned to generate sustainable and profitable growth as the preferred healthcare services company in Puerto Rico.”
Fourth Quarter 2020 Consolidated Results and Other Highlights
| ● |
Net income of $26.2 million, or $1.13 per diluted share, versus net income of $13.2 million, or $0.55 per diluted share, in the prior-year period;
|
| ● |
Adjusted net income of $4.2 million, or $0.18 per diluted share, versus adjusted net income of $6.0 million, or $0.25 per diluted share, in the prior-year period;
|
| ● |
Operating revenues of $969.8 million, a 16.7% increase from the prior-year period, primarily reflecting higher Managed Care net premiums earned;
|
| ● |
Consolidated loss ratio of 86.2%, a 520 basis point increase from the fourth quarter of 2019, reflecting higher Managed Care utilization;
|
| ● |
Medical loss ratio (MLR) of 89.4%, 570 basis points higher than the same period last year;
|
| ● |
Consolidated operating loss of $3.9 million, compared with operating income of $8.7 million in the prior-year period.
|
1
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Triple-S Management Corporation
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Selected Segment Quarterly Details
Managed Care
| ● |
Managed Care premiums earned were $873.1 million, up 17.7% year-over-year.
|
| º |
Medicare premiums earned of $392.5 million increased 14.7% from the prior-year period. The increase was largely due to an addition of approximately 27,000 member months, which primarily
reflects a more competitive product offering and higher premium rates resulting from an increase in the premium rate benchmark and membership risk score.
|
| º |
Medicaid premiums earned of $270.3 million increased 34.8% from the prior-year period, primarily reflecting higher member months of approximately 168,000; higher average premium rates
following two premium rate increases in 2020; and the reinstatement of the HIP Fee pass-through in 2020.
|
| º |
Commercial premiums earned of $210.3 million increased 5.8% from the prior-year period, mainly reflecting
higher average premium rates, the reinstatement of the HIP Fee pass-through in 2020 and a reduction in the estimated MLR rebate accrual (which was originally recorded as a reduction of premiums) as utilization of services trended to almost-normalized levels. These increases were partially offset by a reduction of approximately 10,000 fully insured member months.
|
| ● |
Reported MLR of 89.4% increased 570 basis points from the prior-year period, primarily reflecting unfavorable prior period reserve development, higher non-COVID-19 utilization of services,
higher costs associated with the treatment of COVID-19 and increased benefits in the Medicare product offering in 2020.
|
| ● |
Managed care operating expenses of $119.9 million decreased by $5.7 million, or 4.5%, from the prior-year period, primarily reflecting lower provision for bad debts and professional
services, offset in part by the reinstatement of the HIP fee in 2020. The segment operating expense ratio was 13.7%, a 320 basis-point improvement from the prior-year quarter.
|
| ● |
Premiums earned, net of $51.1 million increased 8.5% from the prior-year period, resulting from new sales and the acquisition of a life insurance portfolio in the second quarter of 2020.
|
| ● |
Operating income was $7.6 million, a 72.7% increase compared to $4.4 million in the prior-year period, primarily reflecting higher premiums in the 2020 quarter.
|
Property and Casualty Segment
| ● |
Premiums earned, net of $25.1 million increased 10.1% from the prior-year period.
|
| ● |
Operating income was $8.9 million, compared with an operating loss of $0.5 million during the prior-year period, primarily driven by lower losses and operating expenses in the 2020 quarter.
|
| ● |
Reserves related to Hurricane Maria were $183 million as of December 31, 2020. As of December 31, 2020, 355 of the total 17,783 Maria-related claims remained outstanding.
|
2
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Triple-S Management Corporation
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2021 Outlook
The Company is initiating the following full year 2021 guidance:
| ● |
Consolidated operating revenue is expected to be between $3.98 billion and $4.02 billion, which includes Managed Care premiums earned, net between $3.58 billion and $3.62 billion;
|
| ● |
Consolidated claims incurred ratio is expected to be between 83.0% and 84.0%, while Managed Care MLR is expected to be between 86.0% and 87.0%;
|
| ● |
Consolidated operating expense ratio is expected to be between 15.5% and 16.5%;
|
| ● |
The effective tax rate is expected to be between 29.0% and 31.0%; and
|
| ● |
Adjusted net income per diluted share is expected to be between $2.95 and $3.15. Adjusted net income per diluted share does not account for any potential share repurchase activity during
2021. The Company is assuming a weighted average diluted share count for full year 2021 of 23.6 million shares.
|
Conference Call and Webcast
Management will host a conference call and webcast today at 8:30 a.m. Eastern Time to discuss its financial results for the three months ended December 31, 2020. To
participate, callers within the U.S. and Canada should dial 1-877-300-8521 and international callers should dial 1-412-317-6026 at least ten minutes before the call.
To listen to the webcast, participants should visit the “Investor Relations” section of the Company’s website at www.triplesmanagement.com several minutes before the event is broadcast and follow the instructions provided to ensure they have the necessary audio application downloaded and installed. This program is provided at no
charge to the user. An archived version of the call, also located on the “Investor Relations” section of Triple-S Management’s website, will be available about two hours after the call ends for one year. This news release, along with other
information relating to the call, will be available on the “Investor Relations” section of the website.
3
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Triple-S Management Corporation
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About Triple-S Management Corporation
Triple-S Management Corporation is a healthcare services company and one of the top
players in the Puerto Rico healthcare industry, with over 60 years of experience as the premier brand serving more people through the most attractive provider networks on the island. We have the exclusive right to use the Blue Cross Blue Shield
name and mark throughout Puerto Rico, the U.S. Virgin Islands, Costa Rica, the British Virgin Islands and Anguilla, and we offer a broad portfolio of managed care and related products in the Commercial, Medicare Advantage and Medicaid markets.
Triple-S is also a well-known brand in the life insurance and property and casualty insurance markets in Puerto Rico, with strong customer relationships and a significant market share. For more information about Triple-S Management, visit www.triplesmanagement.com or contact investorrelations@ssspr.com.
Non-GAAP Financial Measures
This earnings release presents information about the Company’s adjusted net income, which is a non-GAAP financial metric provided as a complement to the results provided
in accordance with accounting principles generally accepted in the United States of America (GAAP). A reconciliation of adjusted net income to net income, the most comparable GAAP financial measure, is provided in the accompanying tables found at the
end of this release.
Forward-Looking Statements
This document contains forward-looking statements, as defined in the Private Securities Litigation Reform Act of 1995. Forward-looking statements include information
about possible or assumed future sales, results of operations, developments, regulatory approvals or other circumstances. Sentences that include “believe”, “expect”, “plan”, “intend”, “estimate”, “anticipate”, “project”, “may”, “will”, “shall”,
“should” and similar expressions, whether in the positive or negative, are intended to identify forward-looking statements.
All forward-looking statements in this news release reflect management’s current views about future events and are based on assumptions and subject to risks and
uncertainties. Consequently, actual results may differ materially from those expressed here as a result of various factors, including all the risks discussed and identified in public filings with the U.S. Securities and Exchange Commission (SEC).
In addition, the Company operates in a highly competitive, constantly changing environment, influenced by very large organizations that have resulted from business
combinations, aggressive marketing and pricing practices of competitors, and regulatory oversight. The following factors, if markedly different from the Company’s planning assumptions (either individually or in combination), could cause Triple-S
Management’s results to differ materially from those expressed in any forward-looking statements shared here:
| ● |
Trends in health care costs and utilization rates
|
| ● |
Ability to secure sufficient premium rate increases
|
| ● |
Competitor pricing below market trends of increasing costs
|
| ● |
Re-estimates of policy and contract liabilities and reserves
|
| ● |
Changes in government laws and regulations of managed care, life insurance or property and casualty insurance
|
| ● |
Significant acquisitions or divestitures by major competitors
|
| ● |
Introduction and use of new prescription drugs and technologies
|
| ● |
A downgrade in the Company’s financial strength ratings
|
| ● |
Litigation or legislation targeted at managed care, life insurance or property and casualty insurance companies
|
4
|
Triple-S Management Corporation
|
| ● |
Ability to contract with providers and government agencies consistent with past practice
|
| ● |
Ability to successfully implement the Company’s disease management, utilization management and Star ratings programs
|
| ● |
Ability to maintain Federal Employees, Medicare and Medicaid contracts
|
| ● |
Volatility in the securities markets and investment losses and defaults
|
| ● |
General economic downturns, major disasters and epidemics
|
This list is not exhaustive. Management believes the forward-looking statements in this release are reasonable. However, there is no assurance that the actions, events
or results anticipated by the forward-looking statements will occur or, if any of them do, what impact they will have on the Company’s results of operations or financial condition. In view of these uncertainties, investors should not place undue
reliance on any forward-looking statements, which are based on current expectations. In addition, forward-looking statements are based on information available the day they are made, and (other than as required by applicable law, including the
securities laws of the United States) the Company does not intend to update or revise any of them in light of new information or future events.
Readers are advised to carefully review and consider the various disclosures in the Company’s SEC reports.
5
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Triple-S Management Corporation
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Earnings Release Schedules and Supplemental Information
|
Condensed Consolidated Balance Sheets
|
Exhibit I
|
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Condensed Consolidated Statements of Earnings
|
Exhibit II
|
|
Condensed Consolidated Statements of Cash Flows
|
Exhibit III
|
|
Segment Performance Supplemental Information
|
Exhibit IV
|
|
Reconciliation of Non-GAAP Financial Measures
|
Exhibit V
|
6
|
Triple-S Management Corporation
|
Exhibit I
Condensed Consolidated Balance Sheets
(dollar amounts in thousands)
Unaudited
|
December 31,
2020
|
December 31,
2019
|
|||||||
|
Assets
|
||||||||
|
Investments
|
$
|
1,874,024
|
$
|
1,643,637
|
||||
|
Cash and cash equivalents
|
110,989
|
109,837
|
||||||
|
Premium and other receivables, net
|
488,840
|
567,692
|
||||||
|
Deferred policy acquisition costs and value of business acquired
|
248,325
|
234,885
|
||||||
|
Property and equipment, net
|
131,974
|
88,588
|
||||||
|
Other assets
|
234,266
|
174,187
|
||||||
|
Total assets
|
$
|
3,088,418
|
$
|
2,818,826
|
||||
|
Liabilities and Stockholders' Equity
|
||||||||
|
Policy liabilities and accruals
|
$
|
1,550,798
|
$
|
1,425,477
|
||||
|
Accounts payable and accrued liabilities
|
487,356
|
370,483
|
||||||
|
Short-term borrowings
|
30,000
|
54,000
|
||||||
|
Long-term borrowings
|
52,751
|
25,694
|
||||||
|
Total liabilities
|
2,120,905
|
1,875,654
|
||||||
|
Stockholders’ equity:
|
||||||||
|
Common stock
|
23,430
|
23,800
|
||||||
|
Other stockholders’ equity
|
944,800
|
920,065
|
||||||
|
Total Triple-S Management Corporation stockholders’ equity
|
968,230
|
943,865
|
||||||
|
Non-controlling interest in consolidated subsidiary
|
(717
|
)
|
(693
|
)
|
||||
|
Total stockholders’ equity
|
967,513
|
943,172
|
||||||
|
Total liabilities and stockholders’ equity
|
$
|
3,088,418
|
$
|
2,818,826
|
||||
7
|
Triple-S Management Corporation
|
Exhibit II
Condensed Consolidated Statements of Earnings
(dollar amounts in thousands, except per share data)
Unaudited
|
For the Three Months Ended
December 31,
|
For the Twelve Months Ended
December 31,
|
|||||||||||||||
|
2020
|
2019
|
2020
|
2019
|
|||||||||||||
|
Revenues:
|
||||||||||||||||
|
Premiums earned, net
|
$
|
948,084
|
$
|
810,364
|
$
|
3,605,450
|
$
|
3,252,880
|
||||||||
|
Administrative service fees
|
3,830
|
2,251
|
12,585
|
9,946
|
||||||||||||
|
Net investment income
|
15,253
|
16,393
|
57,547
|
62,007
|
||||||||||||
|
Other operating revenues
|
2,597
|
2,218
|
8,991
|
8,553
|
||||||||||||
|
Total operating revenues
|
969,764
|
831,226
|
3,684,573
|
3,333,386
|
||||||||||||
|
Net realized investment gains on sale of securities
|
821
|
1,077
|
641
|
5,843
|
||||||||||||
|
Net unrealized investment gains on equity investments
|
25,067
|
7,892
|
7,639
|
32,151
|
||||||||||||
|
Other income, net
|
3,368
|
847
|
9,585
|
4,206
|
||||||||||||
|
Total revenues
|
999,020
|
841,042
|
3,702,438
|
3,375,586
|
||||||||||||
|
Benefits and expenses:
|
||||||||||||||||
|
Claims incurred
|
817,419
|
656,752
|
2,946,820
|
2,666,256
|
||||||||||||
|
Operating expenses
|
156,230
|
165,777
|
655,899
|
569,406
|
||||||||||||
|
Total operating costs
|
973,649
|
822,529
|
3,602,719
|
3,235,662
|
||||||||||||
|
Interest expense
|
2,173
|
1,991
|
7,986
|
7,672
|
||||||||||||
|
Total benefits and expenses
|
975,822
|
824,520
|
3,610,705
|
3,243,334
|
||||||||||||
|
|
||||||||||||||||
|
Income before taxes
|
23,198
|
16,522
|
91,733
|
132,252
|
||||||||||||
|
Income tax expense (benefit)
|
(2,952
|
)
|
3,300
|
24,568
|
39,375
|
|||||||||||
|
Net income
|
26,150
|
13,222
|
67,165
|
92,877
|
||||||||||||
|
Net loss attributable to the non-controlling interest
|
(4
|
)
|
(7
|
)
|
(24
|
)
|
(17
|
)
|
||||||||
|
Net income attributable to Triple-S Management Corporation
|
$
|
26,154
|
$
|
13,229
|
$
|
67,189
|
$
|
92,894
|
||||||||
|
Earnings per share attributable to Triple-S Management Corporation:
|
||||||||||||||||
|
Basic net income per share
|
$
|
1.13
|
$
|
0.55
|
$
|
2.90
|
$
|
3.98
|
||||||||
|
Diluted net income per share
|
$
|
1.13
|
$
|
0.55
|
$
|
2.88
|
$
|
3.97
|
||||||||
|
|
||||||||||||||||
|
Weighted average of common shares
|
23,067,274
|
23,839,165
|
23,179,544
|
23,318,742
|
||||||||||||
|
Diluted weighted average of common shares
|
23,237,694
|
23,901,874
|
23,309,742
|
23,385,293
|
||||||||||||
8
|
Triple-S Management Corporation
|
Exhibit III
Condensed Consolidated Statements of Cash Flows
(dollar amounts in thousands)
Unaudited
|
For the Twelve Months Ended
December 31,
|
||||||||
|
2020
|
2019
|
|||||||
|
Net cash provided by (used in) operating activities
|
$
|
257,845
|
$
|
(16,826
|
)
|
|||
|
Cash flows from investing activities:
|
||||||||
|
Proceeds from investments sold or matured:
|
||||||||
|
Securities available for sale:
|
||||||||
|
Fixed maturities sold
|
149,265
|
424,239
|
||||||
|
Fixed maturities matured/called
|
84,416
|
21,258
|
||||||
|
Securities held to maturity - fixed maturities matured/called
|
1,079
|
1,708
|
||||||
|
Equity investments sold
|
134,926
|
169,153
|
||||||
|
Other invested assets sold
|
17,013
|
4,554
|
||||||
|
Acquisition of investments:
|
||||||||
|
Securities available for sale - fixed maturities
|
(287,998
|
)
|
(449,043
|
)
|
||||
|
Securities held to maturity - fixed maturities
|
(1,088
|
)
|
(1,078
|
)
|
||||
|
Equity investments
|
(248,123
|
)
|
(143,972
|
)
|
||||
|
Other invested assets
|
(30,178
|
)
|
(28,501
|
)
|
||||
|
Increase in other investments
|
(5,683
|
)
|
(2,981
|
)
|
||||
|
Net change in policy loans
|
402
|
(1,392
|
)
|
|||||
|
Net capital expenditures
|
(57,873
|
)
|
(20,820
|
)
|
||||
|
Capital contribution to equity method investees
|
(8,184
|
)
|
(11,418
|
)
|
||||
|
Net cash used in investing activities
|
(252,026
|
)
|
(38,293
|
)
|
||||
|
Cash flows from financing activities:
|
||||||||
|
Change in outstanding checks in excess of bank balances
|
(3,249
|
)
|
(2,384
|
)
|
||||
|
Net change in short-term borrowings
|
(24,000
|
)
|
54,000
|
|||||
|
Proceeds of long-term borrowings
|
30,841
|
-
|
||||||
|
Repayments of long-term borrowings
|
(3,883
|
)
|
(3,236
|
)
|
||||
|
Repurchase and retirement of common stock
|
(14,982
|
)
|
(9,989
|
)
|
||||
|
Dividends paid
|
-
|
(11
|
)
|
|||||
|
Proceeds from policyholder deposits
|
25,740
|
28,879
|
||||||
|
Surrender of policyholder deposits
|
(15,134
|
)
|
(19,847
|
)
|
||||
|
|
||||||||
|
Net cash (used in) provided by financing activities
|
(4,667
|
)
|
47,412
|
|||||
|
|
||||||||
|
Net increase (decrease) in cash and cash equivalents
|
1,152
|
(7,707
|
)
|
|||||
|
Cash and cash equivalents, beginning of period
|
109,837
|
117,544
|
||||||
|
Cash and cash equivalents, end of period
|
$
|
110,989
|
$
|
109,837
|
||||
9
|
Triple-S Management Corporation
|
Exhibit IV
Segment Performance Supplemental Information
|
(Unaudited)
|
Three months ended December 31,
|
Twelve months ended December 31,
|
||||||||||||||||||||||
|
(dollar amounts in millions)
|
2020
|
2019
|
Percentage Change
|
2020
|
2019
|
Percentage Change
|
||||||||||||||||||
|
Premiums earned, net:
|
||||||||||||||||||||||||
|
Managed Care:
|
||||||||||||||||||||||||
|
Commercial
|
$
|
210.3
|
$
|
198.8
|
5.8
|
%
|
$
|
815.6
|
$
|
801.2
|
1.8
|
%
|
||||||||||||
|
Medicare
|
392.5
|
342.3
|
14.7
|
%
|
1,553.5
|
1,408.0
|
10.3
|
%
|
||||||||||||||||
|
Medicaid
|
270.3
|
200.5
|
34.8
|
%
|
953.2
|
778.3
|
22.5
|
%
|
||||||||||||||||
|
Total Managed Care
|
873.1
|
741.6
|
17.7
|
%
|
3,322.3
|
2,987.5
|
11.2
|
%
|
||||||||||||||||
|
Life Insurance
|
51.1
|
47.1
|
8.5
|
%
|
196.0
|
182.2
|
7.6
|
%
|
||||||||||||||||
|
Property and Casualty
|
25.1
|
22.8
|
10.1
|
%
|
92.0
|
87.7
|
4.9
|
%
|
||||||||||||||||
|
Other
|
(1.2
|
)
|
(1.1
|
)
|
(9.1
|
%)
|
(4.8
|
)
|
(4.5
|
)
|
(6.7
|
%)
|
||||||||||||
|
Consolidated premiums earned, net
|
$
|
948.1
|
$
|
810.4
|
17.0
|
%
|
$
|
3,605.5
|
$
|
3,252.9
|
10.8
|
%
|
||||||||||||
|
Operating revenues: 1
|
||||||||||||||||||||||||
|
Managed Care
|
$
|
882.3
|
$
|
751.5
|
17.4
|
%
|
$
|
3,356.1
|
$
|
3,025.3
|
10.9
|
%
|
||||||||||||
|
Life Insurance
|
57.8
|
54.4
|
6.3
|
%
|
223.3
|
209.5
|
6.6
|
%
|
||||||||||||||||
|
Property and Casualty
|
27.5
|
25.1
|
9.6
|
%
|
101.0
|
97.5
|
3.6
|
%
|
||||||||||||||||
|
Other
|
2.2
|
0.2
|
1000.0
|
%
|
4.2
|
1.1
|
281.8
|
%
|
||||||||||||||||
|
Consolidated operating revenues
|
$
|
969.8
|
$
|
831.2
|
16.7
|
%
|
$
|
3,684.6
|
$
|
3,333.4
|
10.5
|
%
|
||||||||||||
|
Operating income (loss): 2
|
||||||||||||||||||||||||
|
Managed Care
|
$
|
(18.2
|
)
|
$
|
5.1
|
(456.9
|
%)
|
$
|
38.3
|
$
|
61.9
|
(38.1
|
%)
|
|||||||||||
|
Life Insurance
|
7.6
|
4.4
|
72.7
|
%
|
27.8
|
21.9
|
26.9
|
%
|
||||||||||||||||
|
Property and Casualty
|
8.9
|
(0.5
|
)
|
1880.0
|
%
|
19.9
|
14.5
|
37.2
|
%
|
|||||||||||||||
|
Other
|
(2.2
|
)
|
(0.3
|
)
|
633.3
|
%
|
(4.1
|
)
|
(0.6
|
)
|
583.3
|
%
|
||||||||||||
|
Consolidated operating (loss) income
|
$
|
(3.9
|
)
|
$
|
8.7
|
(144.8
|
%)
|
$
|
81.9
|
$
|
97.7
|
(16.2
|
%)
|
|||||||||||
|
Operating margin: 3
|
||||||||||||||||||||||||
|
Managed Care
|
(2.1
|
%)
|
0.7
|
%
|
-280
|
bp
|
1.1
|
%
|
2.0
|
%
|
-90
|
bp
|
||||||||||||
|
Life Insurance
|
13.1
|
%
|
8.1
|
%
|
500
|
bp
|
12.4
|
%
|
10.5
|
%
|
190
|
bp
|
||||||||||||
|
Property and Casualty
|
32.4
|
%
|
(2.0
|
%)
|
3,440
|
bp
|
19.7
|
%
|
14.9
|
%
|
480
|
bp
|
||||||||||||
|
Consolidated
|
(0.4
|
%)
|
1.0
|
%
|
-140
|
bp
|
2.2
|
%
|
2.9
|
%
|
-70
|
bp
|
||||||||||||
|
Depreciation and amortization expense
|
$
|
3.5
|
$
|
3.9
|
(10.3
|
%)
|
$
|
14.4
|
$
|
14.6
|
(1.4
|
%)
|
||||||||||||
| 1 |
Operating revenues include premiums earned, net, administrative service fees and net investment income.
|
| 2 |
Operating income or loss include operating revenues minus operating costs. Operating costs include claims incurred and operating expenses.
|
| 3 |
Operating margin is defined as operating income or loss divided by operating revenues.
|
10
|
Triple-S Management Corporation
|
Managed Care Additional Data
|
Managed Care Additional Data
|
Three months ended
December 31,
|
Twelve months ended
December 31,
|
||||||||||||||
|
(Unaudited)
|
2020
|
2019
|
2020
|
2019
|
||||||||||||
|
Member months enrollment:
|
||||||||||||||||
|
Commercial:
|
||||||||||||||||
|
Fully-insured
|
961,725
|
971,270
|
3,882,185
|
3,844,106
|
||||||||||||
|
Self-insured
|
303,732
|
353,843
|
1,285,366
|
1,426,353
|
||||||||||||
|
Total Commercial
|
1,265,457
|
1,325,113
|
5,167,551
|
5,270,459
|
||||||||||||
|
Medicare Advantage
|
410,779
|
384,038
|
1,631,059
|
1,540,476
|
||||||||||||
|
Medicaid
|
1,237,098
|
1,069,428
|
4,515,196
|
4,257,181
|
||||||||||||
|
Total member months
|
2,913,334
|
2,778,579
|
11,313,806
|
11,068,116
|
||||||||||||
|
Claim liabilities (in millions)
|
$
|
445.7
|
$
|
341.3
|
||||||||||||
|
Days claim payable
|
58
|
49
|
||||||||||||||
|
Premium PMPM:
|
||||||||||||||||
|
Managed Care
|
$
|
334.57
|
$
|
305.85
|
$
|
331.29
|
$
|
309.85
|
||||||||
|
Commercial
|
218.67
|
204.68
|
210.09
|
208.42
|
||||||||||||
|
Medicare Advantage
|
955.50
|
891.32
|
952.45
|
914.00
|
||||||||||||
|
Medicaid
|
218.50
|
187.48
|
211.11
|
182.82
|
||||||||||||
|
Medical loss ratio:
|
89.4
|
%
|
83.7
|
%
|
84.5
|
%
|
84.6
|
%
|
||||||||
|
Commercial
|
87.8
|
%
|
81.3
|
%
|
79.1
|
%
|
82.4
|
%
|
||||||||
|
Medicare Advantage
|
82.7
|
%
|
75.0
|
%
|
80.9
|
%
|
79.8
|
%
|
||||||||
|
Medicaid
|
100.3
|
%
|
100.9
|
%
|
94.9
|
%
|
95.4
|
%
|
||||||||
|
Adjusted medical loss ratio: 1
|
87.1
|
%
|
85.7
|
%
|
83.5
|
%
|
86.1
|
%
|
||||||||
|
Commercial
|
82.8
|
%
|
80.6
|
%
|
78.0
|
%
|
84.0
|
%
|
||||||||
|
Medicare Advantage
|
82.8
|
%
|
81.9
|
%
|
79.9
|
%
|
81.4
|
%
|
||||||||
|
Medicaid
|
96.7
|
%
|
97.1
|
%
|
94.1
|
%
|
96.8
|
%
|
||||||||
|
Operating expense ratio:
|
||||||||||||||||
|
Consolidated
|
16.4
|
%
|
20.4
|
%
|
18.1
|
%
|
17.5
|
%
|
||||||||
|
Managed Care
|
13.7
|
%
|
16.9
|
%
|
15.4
|
%
|
14.5
|
%
|
||||||||
| 1 |
The adjusted medical loss ratio accounts for subsequent adjustments to estimates, such as prior-period reserve developments and Medicare premium adjustments and presents them in their
corresponding period.
|
11
|
Triple-S Management Corporation
|
Managed Care Membership by Segment
|
Managed Care Membership by Segment
|
As of December 31,
|
|||||||
|
2020
|
2019
|
|||||||
|
Members:
|
||||||||
|
Commercial:
|
||||||||
|
Fully-insured
|
320,180
|
322,973
|
||||||
|
Self-insured
|
99,478
|
117,696
|
||||||
|
Total Commercial
|
419,658
|
440,669
|
||||||
|
Medicare Advantage
|
137,092
|
127,789
|
||||||
|
Medicaid
|
422,023
|
355,465
|
||||||
|
Total members
|
978,773
|
923,923
|
||||||
12
|
Triple-S Management Corporation
|
Exhibit V
Reconciliation of Non-GAAP Financial Measures
|
Adjusted Net Income
|
||||||||||||||||
|
(Unaudited)
|
Three months ended
December 31,
|
Twelve months ended
December 31,
|
||||||||||||||
|
(dollar amounts in millions)
|
2020
|
2019
|
2020
|
2019
|
||||||||||||
|
Net income
|
$
|
26.2
|
$
|
13.2
|
$
|
67.2
|
$
|
92.9
|
||||||||
|
Less adjustments:
|
||||||||||||||||
|
Net realized investment gains, net of tax
|
0.7
|
0.8
|
0.5
|
4.7
|
||||||||||||
|
Unrealized gains on equity investments
|
20.1
|
6.3
|
6.1
|
25.7
|
||||||||||||
|
Private equity investment income, net of tax
|
1.2
|
0.1
|
3.7
|
1.0
|
||||||||||||
|
Contingency accrual
|
-
|
-
|
(20.0
|
)
|
-
|
|||||||||||
|
Adjusted net income
|
$
|
4.2
|
$
|
6.0
|
$
|
76.9
|
$
|
61.5
|
||||||||
|
Diluted adjusted net income per share
|
$
|
0.18
|
$
|
0.25
|
$
|
3.30
|
$
|
2.63
|
||||||||
Adjusted net income is a non-GAAP financial metric and should not be considered a substitute for, or superior to, financial measures calculated in accordance with GAAP.
Management believes that the use of this adjusted net income and adjusted net income per share provides investors and management useful information about the earnings impact of realized and unrealized investment gains or losses, as well as other
non-recurring items impacting the Company’s results of operations. This non-GAAP metric does not consider all the items associated with the Company’s operations as determined in accordance with GAAP. As a result, one should not consider these
measures in isolation.
13