EX-99.1B 4 erstpg13.htm HUMANA INC. 1ST QUARTER EARNINGS RELEASE STAT PAGES erstpg13

Humana Inc.

Page 1 of 9

In thousands

March 31,

Percent

Ending Medical Membership

2003

2002

Difference

Change

Commercial:

Fully insured

2,348.8

2,332.4

16.4

0.7

ASO

654.6

621.8

32.8

5.3

Total Commercial

3,003.4

2,954.2

49.2

1.7

Government:

Medicare+Choice

327.1

363.7

(36.6)

(10.1)

Medicaid

491.4

476.8

14.6

3.1

TRICARE

1,752.5

1,742.3

10.2

0.6

TRICARE ASO

1,050.8

997.9

52.9

5.3

Total Government

3,621.8

3,580.7

41.1

1.1

Total ending medical membership

6,625.2

6,534.9

90.3

1.4

March 31,

Percent

Ending Specialty Membership

2003

2002

Difference

Change

Commercial:

Dental-fully insured

741.7

786.8

(45.1)

(5.7)

Dental-ASO

367.9

306.5

61.4

20.0

Total Dental

1,109.6

1,093.3

16.3

1.5

Group life

519.0

542.1

(23.1)

(4.3)

Short-term disability

21.5

23.9

(2.4)

(10.0)

Total ending specialty membership

1,650.1

1,659.3

(9.2)

(0.6)

Three months ended

March 31,

Premiums

2003

2002

Commercial:

Fully insured medical

$1,536,953

$1,343,261

Specialty

78,603

82,727

Total Commercial

1,615,556

1,425,988

Government:

Medicare+Choice

635,842

672,186

Medicaid

121,230

111,253

TRICARE

470,321

432,385

Total Government

1,227,393

1,215,824

Total premiums

$2,842,949

$ 2,641,812

Three months ended

March 31,

Administrative services fees

2003

2002

Commercial

$ 29,590

$ 25,147

Government

31,546

39,866

Total Administrative services fees

$ 61,136

$ 65,013

 

 

 

 

Humana Inc.

Page 2 of 9

Dollars in thousands, except per share results

-----------------Three months ended----------------------

Adjusted

March 31,

Restructuring

March 31,

March 31,

Consolidated Statement of Income

2003

Charge

2003

2002

Revenues:

  Premiums

$ 2,842,949

$ -

$ 2,842,949

$ 2,641,812

  Administrative services fees

61,136

-

61,136

65,013

  Investment income

25,817

-

25,817

24,308

  Other income

1,814

-

1,814

1,449

  Total revenues

2,931,716

-

2,931,716

2,732,582

Operating Expenses:

  Medical

2,371,434

-

2,371,434

2,194,539

  Selling, general and    administrative

447,045

-

447,045

435,064

  Depreciation

27,209

-

27,209

25,865

  Other intangible amortization

3,931

-

3,931

3,931

  Restructuring charge

30,760

(30,760)

-

-

  Total operating expenses

2,880,379

(30,760)

2,849,619

2,659,399

Income from operations

51,337

30,760

82,097

73,183

  Interest expense

3,935

-

3,935

4,404

Income before income taxes

47,402

30,760

78,162

68,779

  Provision for income taxes

16,172

11,966

28,138

22,009

Net Income

$ 31,230

$ 18,794

$ 50,024

$ 46,770

Basic earnings per common share

$ 0.20

$ 0.12

$ 0.32

$ 0.28

Diluted earnings per common share

$ 0.19

$ 0.12

$ 0.31

$ 0.28

Shares used in basic earnings per common share computation (000)

157,739

157,739

157,739

164,255

Shares used in diluted earnings per common share computation (000)

161,406

161,406

161,406

167,704

Key Ratios

Medical expense ratio

  Commercial

81.3%

-

81.3%

81.9%

  Government

86.2%

-

86.2%

84.5%

  Total

83.4%

-

83.4%

83.1%

Selling, general, and administrative expense ratio

  Commercial

16.8%

-

16.8%

17.6%

  Government

13.6%

-

13.6%

14.3%

  Total

15.4%

-

15.4%

16.1%

 

Humana Inc.

Page 3 of 9

Dollars in thousands, except per share results

----------------Three months ended----------------

Adjusted

March 31,

Restructuring

March 31,

March 31,

Operating Results by Segment

2003

Charge

2003

2002

Commercial:

Income before income taxes

$ 37,239

$ 17,852

$ 55,091

$ 26,095

Interest expense

3,063

-

3,063

3,059

Depreciation and amortization

19,228

-

19,228

17,167

Commercial EBITDA*

59,530

17,852

77,382

46,321

Government:

Income before income taxes

10,163

12,908

23,071

42,684

Interest expense

872

-

872

1,345

Depreciation and amortization

11,912

-

11,912

12,629

Government EBITDA*

22,947

12,908

35,855

56,658

Consolidated:

Income before income taxes

47,402

30,760

78,162

68,779

Interest expense

3,935

-

3,935

4,404

Depreciation and amortization

31,140

-

31,140

29,796

Consolidated EBITDA*

$ 82,477

$ 30,760

$ 113,237

$ 102,979

*

EBITDA represents earnings (including investment and other income) before interest expense, income taxes, depreciation and amortization. EBITDA is not a measure under accounting principles generally accepted in the United States and may not be similar to EBITDA measures of other companies. EBITDA also is a measure commonly used by analysts, investors and other interested parties in the health care industry. We believe EBITDA is an important indicator of the cash content of the Company's operating income, and as such the quality of net income.

 

 

Humana Inc.

Page 4 of 9

Dollars in thousands, except per share results

March 31,

December 31,

Consolidated Balance Sheets

2003

2002

Assets

Current assets:

Cash and cash equivalents

$ 532,652

$ 721,357

Investment securities

1,411,356

1,405,833

Receivables, net:

Premiums

472,972

348,562

Administrative services fees

55,726

68,316

Other

258,481

250,857

Total current assets

2,731,187

2,794,925

Property and equipment, net

423,465

459,842

Other assets:

Long-term investment securities

312,517

288,724

Goodwill

776,874

776,874

Other

185,144

279,665

Total other assets

1,274,535

1,345,263

Total assets

$ 4,429,187

$ 4,600,030

Liabilities and Stockholders' Equity

Current liabilities:

Medical and other expenses payable

$ 1,226,043

$ 1,142,131

Trade accounts payable and accrued expenses

512,723

552,689

Book overdraft

84,579

94,882

Unearned premium revenues

117,604

335,757

Short-term debt

265,000

265,000

Total current liabilities

2,205,949

2,390,459

Long-term debt

334,328

339,913

Other long-term liabilities

268,131

263,184

Total liabilities

2,808,408

2,993,556

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;

171,371,759 shares issued at March 31, 2003 and 171,334,893shares issued at December 31, 2002

28,562

28,556

Capital in excess of par value

931,460

931,089

Retained earnings

752,107

720,877

Accumulated other comprehensive income

23,257

22,455

Unearned restricted stock compensation

(3,961)

(6,516)

Treasury stock, at cost, 10,584,719 shares at March 31, 2003 and 8,362,537 shares at December 31, 2002

(110,646)

(89,987)

Total stockholders' equity

1,620,779

1,606,474

Total liabilities and stockholders' equity

$ 4,429,187

$ 4,600,030

Debt to total capitalization ratio

27.0%

27.4%

 

 

Humana Inc.

Page 5 of 9

Dollars in thousands

Three months ended

March 31,

Consolidated Statements of Cash Flows

2003

2002

Cash flows from operating activities

Net income

$ 31,230

$ 46,770

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

Non-cash restructuring charge

30,760

-

Depreciation and amortization

31,140

29,796

Provision for deferred income taxes

3,646

12,880

Changes in operating assets and liabilities excluding effects of acquisitions and divestitures:

Receivables

(48,553)

(45,810)

Other assets

5,685

(2,398)

Medical and other expenses payable

83,912

63,977

Other liabilities

(29,012)

(10,804)

Unearned premium revenues

(218,153)

(237,758)

Other

1,115

3,210

Net cash used in operating activities

(108,230)

(140,137)

Timing of Medicare+Choice premium payment from CMS

205,755

216,628

Normalized net cash provided by operating activities

97,525

76,491

Cash flows from investing activities

Purchases of property and equipment, net

(21,634)

(31,256)

Purchases of marketable securities

(1,545,241)

(425,135)

Proceeds from maturities of marketable securities

196,923

115,954

Proceeds from sales of marketable securities

1,320,246

303,896

Net cash used in investing activities

(49,706)

(36,541)

Cash flows from financing activities

Debt issue costs

(153)

(559)

Change in book overdraft

(10,303)

10,673

Common stock repurchases

(20,817)

-

Other

504

1,026

Net cash (used in) provided by financing activities

(30,769)

11,140

Decrease in cash and cash equivalents

(188,705)

(165,538)

Cash and cash equivalents at beginning of period

721,357

651,420

Cash and cash equivalents at end of period

$ 532,652

$ 485,882

 

 

Humana Inc.

Page 6 of 9

Percentage of Ending Membership Under Capitation Arrangements

Commercial Segment

Government Segment

Consol.

Fully

Total

Medicare+

TRICARE

Total

Total

Insured

ASO

Segment

Choice

Medicaid

TRICARE

ASO

Segment

Medical

March 31, 2003

Capitated HMO hospital system based A

6.3%

-

4.9%

12.9%

2.5%

-

-

1.5%

3.0%

Capitated HMO physician group based A

3.2%

-

2.5%

2.0%

56.2%

-

-

7.8%

5.4%

Risk-sharing B

3.1%

-

2.4%

47.8%

33.9%

-

-

8.9%

6.0%

All other membership

87.4%

100.0%

90.2%

37.3%

7.4%

100.0%

100.0%

81.8%

85.6%

Total

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

March 31, 2002

Capitated HMO hospital system based A

6.7%

-

5.3%

13.3%

2.2%

-

-

1.6%

3.3%

Capitated HMO physician group based A

4.1%

-

3.2%

4.1%

57.6%

-

-

8.1%

5.9%

Risk-sharing B

3.2%

-

2.5%

45.7%

34.3%

-

-

9.2%

6.2%

All other membership

86.0%

100.0%

89.0%

36.9%

5.9%

100.0%

100.0%

81.1%

84.6%

Total

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

A

In a limited number of circumstances, we contract with hospitals and physicians to accept financial risk for a defined set of HMO membership. In transferring this risk, we prepay these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their capitated HMO membership, including some health benefit administrative functions and claims processing. For these capitated HMO arrangements, we generally agree to reimbursement rates that target a medical expense ratio ranging from 82% to 89%. Providers participating in hospital-based capitated HMO arrangements generally receive a monthly payment for all of the services within their system for their HMO membership. Providers participating in physician-based capitated HMO arrangements generally have subcontracted directly with hospitals and specialist physicians, and are responsible for reimbursing such hospitals and physicians for services rendered to their HMO membership.

B

In some circumstances, we contract with physicians under risk-sharing arrangements whereby physicians have assumed some level of risk for all or a portion of the medical costs of their HMO membership. Although these arrangements do include capitation payments for services rendered, we process substantially all of the claims under these arrangements.

 

Humana Inc.

Page 7 of 9

Medical Claim Reserves - Details and Statistics

Change in medical and other expenses payable:

The change in medical and other expenses payable is summarized as follows:

For the Three

For the Twelve

Months Ended

Months Ended

March 31, 2003

December 31, 2002

Balances at January 1

$ 1,142,131

$ 1,086,386

Incurred related to:

Current year

2,425,464

9,125,915

Prior years - TRICARE

(18,890)

25,685

(1)

Prior years - non-TRICARE (2)

(35,140)

(13,404)

Total incurred

2,371,434

9,138,196

Paid related to:

Current year

(1,403,792)

(8,002,610)

Prior years

(883,730)

(1,079,841)

Total paid

(2,287,522)

(9,082,451)

Balances at end of period

$ 1,226,043

$ 1,142,131

(1)

Changes in estimates of medical expenses payable for TRICARE may result from issues that entitle us to additional revenues derived from change orders or the bid price adjustment process, which was the case with substantially all of the unfavorable development for prior periods recognized during 2002.

(2)

Changes in estimates of non-TRICARE incurred claims for prior years recognized during 2003 and 2002 related primarily to our commercial lines of business. The impact of any reduction of "incurred related to prior years" claims may be offset as we re-establish the "incurred related to current year". Our reserving practice is to consistently recognize the actuarial best estimate of our ultimate liability for our claims within a level of confidence required to meet actuarial standards. Thus, only when the release of a prior year reserve is not offset with the same level of conservatism in estimating the current year reserve will the redundancy reduce medical expense. We believe we have consistently applied this methodology in determining our best estimate for unpaid claims liability in each period.

 

 

Humana Inc.

Page 8 of 9

Dollars in thousands

Medical Claim Reserves - Details and Statistics

Medical and Other Expenses Payable Detail:

March 31,

December 31,

2003

2002

A

IBNR and other medical expenses payable

$ 703,910

$ 650,606

B

TRICARE IBNR

232,249

212,826

C

TRICARE other medical expenses payable

30,055

37,793

D

Unprocessed claim inventories

99,000

92,300

E

Processed claim inventories

118,300

105,422

F

Payable to pharmacy benefit administrator

42,529

43,184

Total medical and other expenses payable

$ 1,226,043

$ 1,142,131

A

IBNR represents an estimate of medical expenses 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 lower reserves for claims IBNR).

B

TRICARE IBNR has increased primarily due to an increase in claim inventories at our third party claim administrator for claims not submitted electronically.

C

TRICARE other medical expense payable may include liabilities to subcontractors and/or risk share payables to the Department of Defense. The level of these balances may fluctuate from period to period due to the timing of payment (cutoff) and whether or not the balances are payables or receivables (receivables from the Department of Defense are classified as "receivables" in our balance sheet).

D

Unprocessed claim inventories represent the estimated valuation of claims received but not yet fully processed. TRICARE claim inventories are not included in this amount as an independent third party administrator processes all TRICARE medical claims on our behalf. Reserves for TRICARE claims inventory are included in TRICARE IBNR.

E

Processed claim inventories represent 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.

F

The balance due to our pharmacy benefit administrator fluctuates due to bi-weekly payments and the month-end cutoff.

Receipt Cycle Time:

Due to increasing electronic connectivity and other efficiencies gained by our providers with regards to the claim submission process, the average length of time between when a claim was initially incurred and when the claim form was received has generally shortened over the past several years. Below is a summary:

Average # of Days from Incurred Date to Receipt Date (1)

2003

2002

Change

% Change

1st Quarter Average

17.1

19.0

(1.9)

-10.0%

2nd Quarter Average

-

18.1

n/a

n/a

3rd Quarter Average

-

17.3

n/a

n/a

4th Quarter Average

-

16.9

n/a

n/a

Full Year Average

17.1

17.8

(0.7)

-3.9%

(1) Receipt cycle time data for our 2 largest claim processing platforms representing approximately 90% of our claims volume.

 

Humana Inc.

Page 9 of 9

Medical Claim Reserves - Details and Statistics

Unprocessed Claim Inventories:

The estimated valuation and number of claims on hand that are yet to be processed are as follows:

Estimated

Number

Valuation

Claim Item

of Days

Date

(000)

Counts

On Hand

12/31/2001

$ 125,400

518,100

5.0

03/31/2002

$ 121,000

559,600

5.2

06/30/2002

$ 110,300

513,100

4.8

09/30/2002

$ 108,800

496,200

4.8

12/31/2002

$ 92,300

424,200

4.1

03/31/2003

$ 99,000

421,700

4.0

Days in Claims Payable (Quarterly):

A common metric for monitoring medical claim reserve levels relative to the medical claim expenses is days in claims payable, or DCP, which represents the medical claim liabilities at the end of the period divided by average medical expenses per day in the quarterly period. Since we have some providers under capitation payment arrangements (which do not require a medical claim IBNR reserve), we have also summarized this metric excluding capitation expenses.

Days

DCP

in Claims

Annual

Excluding

Annual

Quarter Ended

Payable (DCP)

Change

% Change

Capitation

Change

% Change

12/31/2001

47.4

(3.9)

-7.6%

57.1

(4.4)

-7.2%

03/31/2002

47.2

(2.3)

-4.6%

56.2

(3.4)

-5.7%

06/30/2002

46.8

(3.1)

-6.2%

55.3

(4.7)

-7.8%

09/30/2002

46.6

(2.5)

-5.1%

55.3

(3.9)

-6.6%

12/31/2002

45.2

(2.2)

-4.6%

53.3

(3.8)

-6.7%

03/31/2003

46.5

(0.7)

-1.5%

54.7

(1.5)

-2.7%

This metric fluctuates due to all of the issues reviewed above, including the change in the receipt cycle time, the change in medical claim inventories, the change in TRICARE liability balances, and the timing of our bi-weekly payment to our pharmacy benefits administrator. An annual recap follows:

2003

2002

4th quarter-prior year

45.2

47.4

Impact of change in claim receipt cycle time

0.3

(2.6)

Impact of change in unprocessed claim inventories

0.3

(1.3)

Impact of changing TRICARE reserve balances

0.7

0.3

Impact of change in pharmacy payment cutoff

-

0.7

All other

-

0.7

Year to date-current year

46.5

45.2