-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JHX2fOAD9SgPmX2sAzDBmuf+GxmZmuMDyRlK3vdRIVHQ9QOFAYZY3DdmnmRobyzy 5ukwoHSt/H6YYpYfpGXBQw== 0000049071-04-000073.txt : 20041101 0000049071-04-000073.hdr.sgml : 20041101 20041101082932 ACCESSION NUMBER: 0000049071-04-000073 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20040930 ITEM INFORMATION: Results of Operations and Financial Condition ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20041101 DATE AS OF CHANGE: 20041101 FILER: COMPANY DATA: COMPANY CONFORMED NAME: HUMANA INC CENTRAL INDEX KEY: 0000049071 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 610647538 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-05975 FILM NUMBER: 041108177 BUSINESS ADDRESS: STREET 1: 500 W MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 BUSINESS PHONE: 5025801000 MAIL ADDRESS: STREET 1: 500 W. MAIN ST CITY: LOUISVILLE STATE: KY ZIP: 40202 FORMER COMPANY: FORMER CONFORMED NAME: EXTENDICARE INC DATE OF NAME CHANGE: 19740404 FORMER COMPANY: FORMER CONFORMED NAME: HERITAGE HOUSE OF AMERICA INC DATE OF NAME CHANGE: 19671129 8-K 1 er8k10-04.htm RESULTS OF SEPT. 30, 2004 QUARTER - 2.02 er8k10-04


UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

 

FORM 8-K

 

CURRENT REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE
SECURITIES EXCHANGE ACT OF 1934

 

Date of report (Date of earliest event reported)    November 1, 2004

Humana Inc.
(Exact Name of Registrant as Specified in Its Charter)

Delaware
(State or Other Jurisdiction of Incorporation)

1-5975                                          61-0647538
(Commission File Number)                      (IRS Employer Identification No.)

 

500 West Main Street, Louisville, KY                          40202
(Address of Principal Executive Offices)                         (Zip Code)

502-580-1000
(Registrant's Telephone Number, Including Area Code)

 

(Former Name or Former Address, if Changed Since Last Report)

      Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions (see General Instruction A.2. below):


      o    Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
      o    Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
      o    Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
      o    Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))


Item 2.02   Results of Operation and Financial Condition.

                  An earnings release for the period ending September 30, 2004 was issued by Humana Inc. this morning, a copy of which is attached hereto as Exhibit 99 and is incorporated herein by reference.

 

 

Item 9.01   Financial Statements and Exhibits.

(c)   Exhibits:


Exhibit No.                                          Description                                                                  

       99              Earnings Release

 

 

SIGNATURES

          Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this Report to be signed on its behalf by the undersigned hereunto duly authorized.

HUMANA INC.

BY: __/s/ Arthur P. Hipwell_____________
           Arthur P. Hipwell
           Senior Vice President
           and General Counsel

 

Dated:    November 1, 2004


 

INDEX TO EXHIBITS


Exhibit No.                                                  Description                                                                 

       99              Earnings Release

EX-99 2 er3q04.htm EARNINGS RELEASE - SEPT. 30, 2004 - 9.01 500 West Main Street

500 West Main Street
P.O. Box 1438
Louisville, KY 40201-1438
www.humana.com

news release
For More Information Contact:
Regina Nethery
Humana Investor Relations
(502) 580-3644
E-mail: Rnethery@humana.com

Tom Noland
Humana Corporate Communications
(502) 580-3674
E-mail: Tnoland@humana.com

 

 

 

Humana Inc. Reports Financial Results for Third Quarter 2004 of $0.52 Diluted Earnings per Common Share

  • Diluted earnings per common share increased 37 percent
  • Government segment earnings up 32 percent; Commercial segment earnings up 49 percent
  • Year-to-date operating cash flows increased 167 percent
  • Earnings and cash flow guidance raised

 

     LOUISVILLE, KY (November 1, 2004) - Humana Inc. (NYSE: HUM) today reported a 37 percent rise in diluted earnings per common share for the third quarter ended September 30, 2004 (3Q04), with $0.52 in diluted earnings per common share in 3Q04 compared to $0.38 for the third quarter ended September 30, 2003 (3Q03). Results for 3Q04 reflect the combination of several positive elements: solid performance by the company's Medicare business, a more profitable Commercial segment customer risk mix, the continuation of a smooth transition to the company's new TRICARE contract, TRICARE bid price adjustments coming in higher than expected, and on-going administrative cost discipline.

     "Humana's diversification strategy is playing out very well, as evidenced by this quarter's results," said Michael B. McCallister, Humana's president and chief executive officer. "We've exceeded our previous expectations for this quarter as a result of higher contributions from our Government segment, while our Commercial segment continues to show great improvement over the prior year. Our broad portfolio of traditional and consumer-choice Commercial products and Medicare offerings, together with our TRICARE business, have created numerous earnings opportunities while mitigating risks associated with any one particular line of business."

     Humana is raising its earnings guidance for 2004 to a range of $1.66 to $1.69 per diluted share and expects that momentum to continue into 2005 when the company forecasts diluted earnings per common share of between $1.90 and $1.95, with higher year-over-year earnings anticipated in each of its business segments.

     Diluted earnings per common share for the nine months ended September 30, 2004 (the 2004 Period) increased 42 percent to $1.43 compared to $1.01 diluted earnings per common share for the nine months ended September 30, 2003 (the 2003 Period). This year-to-date increase in earnings includes higher contributions from each of the company's business segments. The 2003 Period includes $0.05 in net expenses per diluted share for the write-down in building and equipment, gain on the sale of a venture capital investment, and software abandonment charges.

     Projected earnings for the full year 2004 include estimated fourth quarter diluted earnings per common share of $0.23 to $0.26. To further enhance the company's 2005 MedicareAdvantage sales prospects, it anticipates higher 4Q04 investment spending in the related sales support processes than previously planned.

     As discussed in the company's second quarter 2004 earnings release dated July 26, 2004, 2004 unusual items are anticipated to offset each other. No related earnings impact on the full year is expected. The company's earnings guidance for 2005 does not include any unusual items.

     Commercial Segment Results

     Commercial segment pretax earnings rose 49 percent versus 3Q03 to $38.7 million in 3Q04, reflecting a more profitable business mix with the lapse of certain under-performing at-risk accounts and significant increases in self-funded and Individual-product members.

     Pretax earnings for the 2004 Period in the Commercial segment of $114.7 million rose 7 percent compared to those for the 2003 Period, the combined effect of operating improvements from the previously discussed changes in Commercial membership, together with the beneficial effect of $5.4 million in unusual net pretax expenses in the 2003 Period.

     The company continues to forecast Commercial segment pretax earnings of approximately $140 million for the full year 2004 and expects the related 2005 earnings to increase between 10 and 15 percent. The projected 2005 beneficial effect from the lapse of a large unprofitable account and growth in self-funded and Individual product membership is expected to be partially offset by reduced income associated with lower average membership in the 3-to-300 case size fully insured customers.

     Commercial Segment Enrollment

     Commercial segment medical membership of 3,315,200 at September 30, 2004 increased 9 percent from the prior year, driven by membership added through the April 2004 acquisition of Ochsner Health Plan as well as significant gains in the company's self-funded and Individual product lines. As expected, during 3Q04 certain under-performing accounts lapsed, with total membership in these accounts approximating 94,000 members. These non-renewals contributed to a net sequential decline in commercial medical membership of approximately 89,200.

     Membership in the company's consumer-choice Smart plans increased to 241,400 at September 30, 2004, up 121 percent from a year ago and up 6,800 members versus June 30, 2004.

     The company anticipates total Commercial medical enrollment growth for 2004 to approximate 220,000 to 230,000 members, including 152,600 members acquired through the April 2004 Ochsner Health Plan acquisition. Significant year-to-date membership gains in self-funded and Individual product lines are anticipated to be partially offset by continued attrition in the company's fully insured business lines due to the ongoing competitive environment within the 3-to-300 case size fully insured customers.

     The company has received notice that it will not retain an 89,000-member fully insured account effective January 1, 2005. This account had not been profitable for the company during 2004. Excluding the impact of this one account, Humana is forecasting its commercial segment medical membership to be slightly higher in 2005 versus 2004.

     Commercial Segment Premiums and Medical Costs

     Premiums and administrative services fees for the Commercial segment increased 7 percent to $1.8 billion in 3Q04 compared to the prior year's quarter. For the 2004 Period, Commercial segment premiums and administrative services fees increased 8 percent to $5.4 billion versus $5.0 billion in the 2003 Period.

     Commercial segment premiums for fully insured medical membership increased in the range of 6 to 8 percent on a per-member basis during 3Q04 compared to the same period in the prior year. This increase reflects the same changes in business mix discussed by the company in prior 2004 quarters (primarily a shift towards more Individual product membership).

     The company anticipates its full year 2004 commercial premiums for fully insured membership to increase in the range of 6 to 8 percent on a per-member basis. This range includes the estimated impact of an increasing mix of fully insured membership in the company's Individual product, the premium for which lowers Humana's overall average per-member premium increase by approximately 150 to 200 basis points as this product has a correspondingly lower benefit than other fully insured Commercial medical products.

     In 3Q04, the Commercial segment medical expense ratio (medical expenses divided by premium revenues) of 83.6 percent was 10 basis points lower than in 3Q03, despite the 2004 impact of the large unprofitable account, due in large part to the 3Q04 lapses of the underperforming accounts previously described. For the 2004 Period, the medical expense ratio of 83.9 percent increased 120 basis points year over year, due to a combination of the effect of this unprofitable account and strategically planned pricing actions.

     Per-member medical costs for the Commercial fully insured business are now forecast to rise in the range of 6.5 percent to 8.5 percent, including the lowering effect of approximately 200 basis points from a higher mix of Individual membership year over year.

     For 2005, increases in Commercial fully insured medical product per-member premiums and medical costs are both anticipated to be in the 6.5 to 8.5 percent range, including similar effects related to the Individual product as experienced in 2004.

     Government Segment Results

     Government segment pretax earnings increased 32 percent versus 3Q03 to $88.8 million in 3Q04. Results reflected the combination of lower medical and SG&A expense ratios for its Medicare products and higher earnings associated with TRICARE bid price adjustments accrued and collected in 3Q04.

     For the 2004 Period, Government segment pretax earnings of $237.9 million increased 72 percent versus the 2003 Period driven by similar improved performance for its MedicareAdvantage products, changes in TRICARE quarterly earnings patterns, and the net negative impact upon the 2003 Period of $10.1 million in pretax expense for unusual items.

     For 2005, the company expects a continuing increase in earnings in its Government segment, driven by increases in results from both Medicare and TRICARE operations.

     TRICARE South Region Contract

     On November 1, 2004, the company's subsidiary, Humana Military Healthcare Services, Inc., added approximately 1 million TRICARE members in Texas, Oklahoma, Arkansas, and Louisiana to its South Region contract with the Department of Defense. The addition of these members completes the membership transition associated with the implementation of this contract, which began on August 1, 2004.

     Government Segment Enrollment

     MedicareAdvantage membership continued to increase in 3Q04, totaling 371,300 at September 30, 2004, up 46,700 members year over year and up 3,400 members sequentially. The previously described Ochsner Health Plan transaction resulted in the addition of 33,100 MedicareAdvantage members.

     The company expects total MedicareAdvantage membership growth (including the previously described acquisition) for 2004 to approximate 15 percent.

     For 2005, investments in sales support processes, continued growth in the company's Medicare HMO products, expanded participation in the Private Fee for Service program and expected participation in local PPOs are together anticipated to result in year-over-year organic growth in MedicareAdvantage membership of approximately 10 to 15 percent.

     TRICARE membership of 1,813,300 at September 30, 2004 declined by 990,000 members year over year. As expected, on July 1, 2004, approximately 1.1 million members transitioned to another contractor in connection with the new TRICARE contracts being implemented by the Department of Defense, resulting in the sequential decline in membership for the quarter.

     As described above, on November 1, 2004, Humana added approximately 1 million TRICARE members as the final membership transition associated with its new South Region contract with the Department of Defense became effective, increasing total TRICARE membership to approximately 2.8 million.

     The company anticipates its TRICARE membership to remain at this higher level through the end of 2004, with no material changes forecast for 2005.

     Government Segment Premiums and Medical Costs

     MedicareAdvantage premiums per member increased substantially year over year during 3Q04 as a result of changes enacted into law during 2003. Per-member premiums for the company's MedicareAdvantage business increased in the range of 12 to 14 percent during 3Q04 primarily driven by results of the company's efforts to ensure its premium allocations from the Centers for Medicare and Medicaid Services ("CMS") accurately reflect the risk profile of its membership.

     Inclusive of the run-rate effect of the higher 3Q04 risk-adjustment premium, the company continues to anticipate MedicareAdvantage per-member premium increases to be in the range of 9 to 11 percent for the full year 2004, with a range of 5 to 7 percent forecast for 2005.

     Increases in year-over-year MedicareAdvantage medical costs per member are forecast to be in the range of 9 to 11 percent for all of 2004, with a range of 5 to 7 percent anticipated for 2005.

      TRICARE premiums and administrative services fees during 3Q04 of $405.0 million reflect the implementation of the new South Region contract with the Department of Defense, which included a reduction in the benefits and services previously provided, and thus, lower revenues. On a year-over-year basis, TRICARE premiums and administrative services fees declined approximately 38 percent in 3Q04 and increased less than 1 percent for the 2004 Period, as expected.

      The company forecasts TRICARE premiums and administrative services fees for the full year 2004 will approximate $2.2 billion, including the effect of higher 3Q04 bid price adjustment premium.

      Impact of Hurricanes

     During 3Q04, the company's operations in Florida and Louisiana experienced an unusually strong hurricane season. However, the company estimates that aggregated medical expenses associated with claims for these regions were not significantly affected during the quarter. The company indicated that the expected reduction or deferral of planned elective procedures and physician office visits was offset by higher hospital admissions resulting from limited access to more efficient care during the temporary closure of physician offices and nursing homes.

     Selling, General & Administrative Expenses

     Continued discipline in operational spending resulted in a 30 basis point year-over-year decline in the company's consolidated Selling, General, & Administrative ("SG&A") ratio (SG&A expenses as a percent of premiums plus administrative services fees) of 14.6 percent for 3Q04.

     Each of the segments also saw improvement in the SG&A ratio during 3Q04, with the Commercial segment's ratio declining by 30 basis points and the Government segment's ratio down by 40 basis points. For the 2004 Period, the year-over-year declines were even more substantial with the consolidated SG&A ratio of 14.5 percent declining 80 basis points, the combined effect of a 50 basis point decline in the Commercial segment SG&A ratio and a 110 basis point decline in the Government segment ratio.

     For the full year 2004, the company expects its consolidated SG&A ratio to range between 14 and 15 percent, with a forecasted range of 16 to 17 percent for the Commercial segment and 11 to 12 percent for the Government segment. The company's 2005 consolidated SG&A ratio is projected to be in the range of 13.5 to 14.5 percent.

     Cash Flows from Operations

     Cash flows provided by operations for 3Q04 of $303.5 million compares favorably to cash flows provided by operations for 3Q03 of $69.7 million as the rise in net income combined with the timing of the collection of TRICARE bid price adjustment receivables in the current year versus the prior year more than offset the negative effect of timing associated with TRICARE members that transitioned to the new contract on August 1, 2004. For the 2004 Period, cash flows from operations increased over that for the prior year's period by 167 percent to $328.3 million.

     For the full year 2004, cash flows from operations under generally accepted accounting principles ("GAAP") are anticipated to be in the range of $288 million to $338 million, an average increase of approximately $25 million from the company's cash flow guidance issued on September 30, 2004. This revised forecast includes the negative impact of $211.9 million related to the December 2003 receipt of the January 2004 MedicareAdvantage premium payment from CMS. The full year 2004 projected cash flows from operations also gives consideration to the negative effect of timing associated with TRICARE members that transitioned to the new contract on November 1, 2004.

     During 3Q04 CMS published its 2005 monthly Medicare premium payment schedule, which included a change from its previous practice. As a result of this change, the payment originally scheduled to be made to health plans on Friday, December 31, 2004, has been changed to Monday, January 3, 2005, or one business day later, resulting in the anticipated receipt of only 11 monthly Medicare premium payments from CMS during 2004.

     Non-GAAP Cash Flows from Operations

     When reviewing and analyzing Humana's cash flow position, company management apportions the CMS premium payment in each month to match disbursements. To do otherwise distorts meaningful analysis of our operating cash flow. Therefore, decisions such as management's forecasting and business plans regarding cash flow use this non-GAAP financial measure.

     For 3Q04 and 3Q03, the non-GAAP cash flows from operations were the same as the cash flows from operations under GAAP due to the timing of the premium payments received from CMS.

     The following is a reconciliation of the most directly comparable historical and projected financial measures prepared in accordance with GAAP, to the historical and projected non-GAAP financial measures:

($ in millions)

 

2004 Period Actual

 

2003 Period Actual

 

 Full Year 2004 Projected

Full Year 2004 Number of Monthly CMS Receipts

GAAP cash flows provided by operations

$

328.3

$

122.9

$

288 to 338

11

Timing of premium payment receipt from CMS

211.9

205.8

212

 1

Non-GAAP cash flows provided by operations

$

540.2

$

 328.7

$

500 to 550

12

 

     Balance Sheet

     The company's financial liquidity remained strong in 3Q04 with 56 percent of total assets in cash and investment securities at September 30, 2004 versus 55 percent at December 31, 2003.

     Debt as a percent of total capitalization (debt plus stockholders' equity) of 23.8 percent was down 210 basis points from December 31, 2003 and 80 basis points sequentially.

     Days in claims payable increased sequentially to 51.8 at September 30, 2004 from 47.4 days at June 30, 2004, primarily as a result of the temporary effect upon this statistic of the transition between TRICARE contracts. Components of Humana's medical claims reserves and historical trends in the related operational statistics are disclosed in detail in the statistics pages included with this earnings press release.

     Share Repurchase Program

     During 3Q04, the company acquired 782,500 of its common shares for an aggregate price of $13.6 million, or an average cost of $17.35 per share. During the 2004 Period, the company acquired 3,636,000 of its common shares for an aggregate price of $63.6 million, or an average cost of $17.49 per share. As of October 31, 2004 the company had approximately $36 million remaining on its currently authorized $100 million share repurchase program.

     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.

     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 approximately ten minutes in advance of the call.

     A live virtual presentation (audio with slides) will be available and may be accessed via Humana's Investor Relations page at www.humana.com. The company suggests web participants sign on approximately 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.

     For those unable to participate in the live event, the virtual presentation archive will be available in the Presentations section of the Investor Relations page at www.humana.com approximately two hours following the live web cast.

     Cautionary Statement

     This news release contains forward-looking statements. The forward-looking statements made in this earnings press release are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may be significantly impacted by certain risks and uncertainties described in the following documents, as filed by Humana with the Securities and Exchange Commission:

  • Form 10-K for the year ended December 31, 2003;
  • Form 10-Qs for the quarters ended March 31, 2004 and June 30, 2004.

     About Humana

     Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 7 million medical members located primarily in 15 states and Puerto Rico. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

     Over its 43-year history, Humana has consistently seized opportunities to meet changing customer needs.

     Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

     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 report to stockholders;
  • Securities and Exchange Commission filings;
  • Most recent investor conference presentation;
  • Quarterly earnings press releases (including detailed description of unusual items, where applicable);
  • Audio archive of most recent earnings release conference call;
  • Calendar of events (includes upcoming earnings conference call dates, times, and access number, as well as planned interaction with institutional investors);
  • Corporate Governance Information.

  

Humana Inc.

In thousands

September 30,

Percent

Ending Medical Membership

2004

 

2003

Difference

Change

Commercial:

 

  Fully insured

2,296.4

2,324.6

(28.2)

(1.2)

  Administrative Services Only (ASO)

1,018.8

711.8

307.0

43.1

Total Commercial

3,315.2

 

3,036.4

278.8

9.2

 

Government:

 

  MedicareAdvantage

371.3

324.6

46.7

14.4

  Medicaid

475.8

460.8

15.0

3.3

  TRICARE

1,138.6

1,746.3

(607.7)

(34.8)

  TRICARE ASO

674.7

1,057.0

(382.3)

(36.2)

 Total TRICARE

1,813.3

2,803.3

(990.0)

(35.3)

Total Government

2,660.4

 

3,588.7

(928.3)

(25.9)

  Total ending medical membership

5,975.6

 

6,625.1

(649.5)

(9.8)

 

 

 

 

 

 

 

September 30,

Percent

Ending Specialty Membership

2004

 

2003

Difference

Change

Commercial:

 

  Dental-fully insured

808.4

753.0

55.4

7.4

  Dental-ASO

419.4

 

362.7

56.7

15.6

   Total Dental

1,227.8

1,115.7

112.1

10.0

  Group life

469.2

504.4

(35.2)

(7.0)

  Short-term disability

17.3

19.0

(1.7)

(8.9)

  Total ending specialty membership

1,714.3

 

1,639.1

75.2

4.6

 

 

Three months ended
September 30,

Nine months ended
September 30,

Premiums

2004

 

2003

2004

2003

Commercial:

 

 

  Fully insured medical

$1,663,363

 

$1,567,284

$4,981,242

$4,655,856

  Specialty

87,822

 

81,199

259,932

238,737

Total Commercial

1,751,185

 

1,648,483

5,241,174

4,894,593

 

 

 

 

Government:

 

 

 

 

  MedicareAdvantage

814,612

 

626,840

2,295,534

1,893,114

  TRICARE

386,439

 

620,477

1,651,844

1,627,212

  Medicaid

131,318

 

120,498

377,895

357,733

Total Government

1,332,369

 

1,367,815

4,325,273

3,878,059

Total premiums

$3,083,554

 

$3,016,298

$9,566,447

$8,772,652

 

 

 

Three months ended
September 30,

Nine months ended
September 30,

Administrative services fees

2004

 

2003

2004

2003

Commercial

$41,324

$31,035

$123,788

$90,981

Government

18,513

35,949

95,632

108,807

Total Administrative services fees

$59,837

 

$66,984

$219,420

$199,788

 

 

.

Humana Inc.

Dollars in thousands, except per share results

Three months ended
September 30,

Nine months ended
September 30,

Consolidated Statements of Income

2004

2003

 

2004

2003

Revenues:

  Premiums

$3,083,554

$3,016,298

$9,566,447

$8,772,652

  Administrative services fees

59,837

66,984

219,420

199,788

  Investment income

30,146

26,219

101,463

95,264

  Other income

2,736

2,264

7,370

5,735

    Total revenues

3,176,273

3,111,765

 

9,894,700

9,073,439

Operating expenses:

  Medical

2,550,911

2,528,123

8,024,167

7,344,534

  Selling, general and administrative

460,171

458,381

1,416,695

1,371,196

  Depreciation

28,451

24,723

76,646

91,009

  Other intangible amortization

2,787

2,389

8,069

9,223

    Total operating expenses

3,042,320

3,013,616

 

9,525,577

8,815,962

Income from operations

133,953

98,149

369,123

257,477

  Interest expense

6,480

4,737

 

16,524

12,473

Income before income taxes

127,473

93,412

352,599

245,004

  Provision for income taxes

43,170

31,293

 

119,713

82,379

Net income

$84,303

$62,119

 

$232,886

$162,625

Basic earnings per common share

$0.53

$0.39

$1.45

$1.03

Diluted earnings per common share

$0.52

$0.38

$1.43

$1.01

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

159,308

159,454

160,697

158,202

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

160,997

162,549

162,564

161,384

Operating Results by Segment

 

 

 

 

 

Pretax income

  Commercial

$38,706

$25,952

$114,704

$106,948

  Government

88,767

67,460

 

237,895

138,056

    Consolidated

$127,473

$93,412

$352,599

$245,004

 

 

 

 

 

 

Key Ratios

 

 

 

 

 

Medical expense ratio

  Commercial

83.6%

83.7%

83.9%

82.7%

  Government

81.6%

84.0%

83.8%

85.0%

    Consolidated

82.7%

83.8%

 

83.9%

83.7%

Selling, general, and administrative expense ratio

  Commercial

16.3%

16.6%

16.3%

16.8%

  Government

12.5%

12.9%

12.3%

13.4%

    Consolidated

14.6%

14.9%

 

14.5%

15.3%

Humana Inc.

Dollars in thousands, except per share results

 

 

September 30,
2004

June 30,
2004

December 31,
2003

Consolidated Balance Sheets

Assets

 

 

Current assets:

 

 

  Cash and cash equivalents

$375,090

$203,636

$931,404

  Investment securities

2,332,522

2,322,282

1,676,642

  Receivables, net:

 

 

    Premiums

405,067

528,078

452,404

    Administrative services fees

19,803

15,608

13,583

  Other

273,240

334,319

247,298

    Total current assets

3,405,722

3,403,923

3,321,331

 

 

Property and equipment, net

390,735

392,956

416,472

 

 

Other assets:

 

 

  Long-term investment securities

333,796

323,667

319,167

  Goodwill

859,734

813,399

776,874

  Other

421,623

408,964

459,479

    Total other assets

1,615,153

1,546,030

1,555,520

Total assets

$5,411,610

$5,342,909

$5,293,323

Liabilities and Stockholders' Equity

 

 

Current liabilities:

 

 

  Medical and other expenses payable

$1,436,135

$1,454,225

$1,272,156

  Trade accounts payable and accrued expenses

504,892

499,978

440,340

  Book overdraft

116,106

172,062

219,054

  Unearned revenues

132,659

109,066

333,071

    Total current liabilities

2,189,792

2,235,331

2,264,621

  Long-term debt

630,912

623,677

642,638

  Other long-term liabilities

568,911

570,518

550,115

    Total liabilities

3,389,615

3,429,526

3,457,374

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;
    175,062,193 shares issued at September 30, 2004

-

-

-

 

 

29,177

29,106

28,984

  Capital in excess of par value

994,975

987,495

974,975

  Retained earnings

1,182,697

1,098,394

949,811

  Accumulated other comprehensive income

13,797

(16,756)

16,909

  Unearned stock compensation

(203)

(9)

(754)

  Treasury stock, at cost, 15,689,251 shares at September 30, 2004

(198,448)

(184,847)

(133,976)

    Total stockholders' equity

2,021,995

1,913,383

1,835,949

  Total liabilities and stockholders' equity

$5,411,610

$5,342,909

$5,293,323

 

 

Debt to total capitalization ratio

23.8%

24.6%

25.9%

 

 

Humana Inc.

Dollars in thousands

Three months ended
September 30,

Nine months ended
September 30,

Consolidated Statements of Cash Flows

2004

2003

 

2004

2003

Cash flows from operating activities

 

 

  Net income

$84,303

$62,119

$232,886

$162,625

  Adjustments to reconcile net income to net

 

 

    cash provided by operating activities:

 

 

    Writedown of property and equipment

-

-

-

17,233

    Depreciation and amortization

31,238

27,112

84,715

100,232

    Provision for deferred income taxes

(2,419)

19,159

27,545

30,213

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

 

 

 

 

      Receivables

122,227

(29,717)

106,709

13,516

      Other assets

5,108

2,195

(18,776)

42,435

      Medical and other expenses payable

(18,090)

9,202

92,916

154,435

      Other liabilities

58,850

(25,830)

26,675

(151,363)

      Unearned revenues

23,593

7,716

(204,426)

(227,596)

    Other

(1,341)

(2,302)

 

(19,920)

(18,810)

    Net cash provided by operating activities

303,469

69,654

 

328,324

122,920

 

 

Cash flows from investing activities

 

 

    Acquisition, net of cash and cash equivalents acquired

(47,237)

-

(115,972)

-

    Purchases of property and equipment

(24,854)

(22,013)

(72,900)

(64,980)

    Proceeds from sales of property and equipment

244

1,993

28,972

2,483

    Purchases of investment securities

(1,373,585)

(1,398,118)

(3,614,781)

(3,659,394)

    Proceeds from maturities of investment securities

494,088

200,535

840,275

585,461

    Proceeds from sales of investment securities

887,029

871,272

2,203,853

2,768,446

    Net cash used in investing activities

(64,315)

(346,331)

 

(730,553)

(367,984)

 

 

Cash flows from financing activities

 

 

    Change in book overdraft

(55,956)

139,215

(102,948)

123,869

    Proceeds from issuance of senior notes

-

299,139

-

299,139

    Net commercial paper conduit repayments

-

(265,000)

-

(265,000)

    Proceeds from swap exchange

-

-

-

31,556

    Common stock repurchases

(15,670)

(23,127)

(64,472)

(44,147)

    Proceeds from stock option exercises and other

3,926

7,345

13,335

14,127

    Net cash (used in) provided by financing activities

(67,700)

157,572

 

(154,085)

159,544

 

 

    Increase (decrease) in cash and cash equivalents

171,454

(119,105)

(556,314)

(85,520)

    Cash and cash equivalents at beginning of period

203,636

754,942

 

931,404

721,357

    Cash and cash equivalents at end of period

$375,090

$635,837

 

$375,090

$635,837

 

 

 

 

Humana Inc.

 

Percentage of Ending Membership Under Capitation Arrangements

 

 

 

 

Commercial Segment

Government Segment

Consol.

Fully

Total

Medicare

TRICARE

Total

Total

Insured

ASO

Segment

Advantage

Medicaid

TRICARE

ASO

Segment

Medical

September 30, 2004

 

 

 

 

 

 

 

 

 

 

 

Capitated HMO

 

  hospital system based A

3.2%

-

2.2%

10.3%

3.5%

-

-

2.1%

2.1%

Capitated HMO

 

  physician group based A

2.5%

-

1.7%

1.2%

41.7%

-

-

7.6%

4.3%

Risk-sharing B

2.5%

-

1.7%

55.9%

47.3%

-

-

16.3%

8.2%

All other membership

91.8%

100.0%

94.4%

32.6%

7.5%

100.0%

100.0%

74.0%

85.4%

  Total

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

September 30, 2003

Capitated HMO

hospital system based A

5.6%

-

4.3%

12.2%

2.9%

-

-

1.5%

2.8%

Capitated HMO

physician group based A

3.3%

-

2.5%

1.8%

47.2%

-

-

6.2%

4.5%

Risk-sharing B

2.7%

-

2.1%

48.7%

44.0%

-

-

10.0%

6.4%

All other membership

88.4%

100.0%

91.1%

37.3%

5.9%

100.0%

100.0%

82.3%

86.3%

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 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.

Dollars in thousands

 

 

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 Nine
Months Ended
September 30, 2004

For the Twelve
Months Ended
December 31, 2003

 

Balances at January 1

$1,272,156

$1,142,131

 

Acquisition

71,063

-

 

Incurred related to:

 

   Current year

8,111,613

9,955,491

   Prior years - non-TRICARE (1)

(62,545)

(33,432)

   Prior years - TRICARE (2)

(24,901)

(42,638)

Total incurred

8,024,167

 

9,879,421

 

Paid related to:

 

   Current year

(6,848,598)

(8,710,393)

   Prior years

(1,082,653)

(1,039,003)

Total paid

(7,931,251)

 

(9,749,396)

 

Balances at end of period

$1,436,135

 

$1,272,156

 

The impact of any change in "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 have consistently applied this methodology in determining our best estimate for unpaid claims liability in each period.

(1) The $29.1 million increase in non-TRICARE favorable development from $33.4 million to $62.5 million related primarily to better than expected utilization in the latter half of 2003 for our Medicare line of business.

(2) Changes in estimates of TRICARE incurred claims for prior years recognized during 2003 and 2004 resulted primarily from claim costs and utilization levels developing favorably from the levels originally estimated for the second half of the prior year. As a result of substantial risk-sharing provisions with the Department of Defense and with subcontractors, any resulting impact on operations from the change in estimates of incurred related to prior years is substantially reduced, whether positive or negative.

 

 

Humana Inc.

Dollars in thousands

Medical Claim Reserves - Details and Statistics

Medical and Other Expenses Payable Detail:

September 30,
2004

December 31,
2003

A

IBNR and other medical expenses payable

$945,972

$767,712

B

TRICARE IBNR

238,474

267,146

C

TRICARE other medical expenses payable

16,923

37,849

D

Unprocessed claim inventories

122,300

109,700

E

Processed claim inventories

79,895

74,262

F

Payable to pharmacy benefit administrator

32,571

15,487

Total medical and other expenses payable

$1,436,135

$1,272,156

 

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 decreased because of lower medical expenses due to the transition to the new South region contract.

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:

The receipt cycle time measures the average length of time between when a claim was initially incurred and when the claim form was received. Below is a summary:

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

2004

2003

Change

% Change

1st Quarter Average

17.4

17.1

0.3

1.8%

2nd Quarter Average

16.7

16.7

-

0.0%

3rd Quarter Average

16.9

16.6

0.3

1.8%

4th Quarter Average

-

16.6

N/A

N/A

Full Year Average

17.0

16.7

0.3

1.8%

(1)

Receipt cycle time data for our 3 largest claim processing platforms representing approximately 90% of our claims volume.

 

Humana Inc.

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:

Date

Estimated
Valuation
(000)

Claim Item
Counts

Number
of Days
On Hand

 

9/30/2002

$108,800

496,200

4.8

12/31/2002

$92,300

424,200

4.5

3/31/2003

$99,000

421,700

4.4

6/30/2003

$92,100

446,600

4.7

9/30/2003

$106,800

528,400

5.8

12/31/2003

$109,700

443,000

4.9

3/31/2004

$94,800

400,900

3.9

6/30/2004

 

$98,100

387,000

3.7

9/30/2004

 

$122,300

453,300

4.4

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.

Quarter Ended

Days
in Claims
Payable (DCP)

Annual
Change

% Change

DCP
Excluding
Capitation

Annual
Change

% Change

 

9/30/2002

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%

3/31/2003

46.5

(0.7)

-1.5%

54.7

(1.5)

-2.7%

6/30/2003

47.9

1.1

2.4%

56.2

0.9

1.6%

9/30/2003

47.2

0.6

1.3%

54.5

(0.8)

-1.4%

12/31/2003

46.2

1.0

2.2%

53.2

(0.1)

-0.2%

3/31/2004

47.4

0.9

1.9%

54.3

(0.4)

-0.7%

6/30/2004

 

47.4

(0.5)

-1.0%

54.1

(2.1)

-3.7%

9/30/2004

 

51.8

4.6

9.7%

59.1

4.6

8.4%

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:

2004

2003

4th quarter-prior year

46.2

45.2

  Impact of change in claim receipt cycle time

0.6

(0.5)

  Impact of change in unprocessed claim inventories

0.4

0.6

  Impact of change in processed claim inventories

0.3

(1.1)

  Impact of changing TRICARE reserve balances

2.6

2.0

  Impact of change in pharmacy payment cutoff

0.5

(1.0)

  All other

1.2

1.0

Year to date-current year

51.8

46.2

 

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