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SEGMENT INFORMATION
3 Months Ended
Mar. 31, 2016
Segment Reporting [Abstract]  
SEGMENT INFORMATION
SEGMENT INFORMATION
We manage our business with three reportable segments: Retail, Group, and Healthcare Services. In addition, the Other Businesses category includes businesses that are not individually reportable because they do not meet the quantitative thresholds required by generally accepted accounting principles. These segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer to assess performance and allocate resources.
The Retail 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 Retail segment also includes our contract with CMS to administer the Limited Income Newly Eligible Transition, or LI-NET, prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, collectively our state-based contracts. The Group 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, or ASO products. In addition, our Group segment includes our health and wellness products (primarily marketed to employer groups) and military services business, primarily our TRICARE South Region contract. The Healthcare Services segment includes services offered to our 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. We will continue to report under the category of Other Businesses those businesses which do not align with the reportable segments described above, primarily our closed-block long-term care insurance policies.
Our Healthcare Services intersegment revenues primarily relate to managing prescription drug coverage for members of our other segments through Humana Pharmacy Solutions®, or HPS, and includes the operations of Humana Pharmacy, Inc., our mail order pharmacy business. These revenues consist of the prescription price (ingredient cost plus dispensing fee), including the portion to be settled with the member (co-share) or with the government (subsidies), plus any associated administrative fees. Services revenues related to the distribution of prescriptions by third party retail pharmacies in our networks are recognized when the claim is processed and product revenues from dispensing prescriptions from our mail order pharmacies are recorded when the prescription or product is shipped. Our pharmacy operations, which are responsible for designing pharmacy benefits, including defining member co-share responsibilities, determining formulary listings, contracting with retail pharmacies, confirming member eligibility, reviewing drug utilization, and processing claims, act as a principal in the arrangement on behalf of members in our other segments. As principal, our Healthcare Services segment reports revenues on a gross basis including co-share amounts from members collected by third party retail pharmacies at the point of service.
In addition, our Healthcare Services intersegment revenues include revenues earned by certain owned providers derived from risk-based and non risk-based managed care agreements with our health plans. Under risk based agreements, the provider receives a monthly capitated fee that varies depending on the demographics and health status of the member, for each member assigned to these owned providers by our health plans. The owned provider assumes the economic risk of funding the assigned members’ healthcare services. Under non risk-based agreements, our health plans retain the economic risk of funding the assigned members' healthcare services. Our Healthcare Services segment reports provider services revenues associated with risk-based agreements on a gross basis, whereby capitation fee revenue is recognized in the period in which the assigned members are entitled to receive healthcare services. Provider services revenues associated with non risk-based agreements are presented net of associated healthcare costs.
We present our consolidated results of operations from the perspective of the health plans. As a result, the cost of providing benefits to our members, whether provided via a third party provider or internally through a stand-alone subsidiary, is classified as benefits expense and excludes the portion of the cost for which the health plans do not bear responsibility, including member co-share amounts and government subsidies of $2.9 billion and $2.5 billion for the three months ended March 31, 2016 and 2015, respectively. In addition, depreciation and amortization expense associated with certain businesses in our Healthcare Services segment delivering benefits to our members, primarily associated with our provider services and pharmacy operations, are included with benefits expense. The amount of this expense was $27 million and $21 million for the three months ended March 31, 2016 and 2015, respectively.
Other than those described previously, the accounting policies of each segment are the same and are described in Note 2 to the consolidated financial statements included in our 2015 Form 10-K. Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and home based services as well as clinical programs, to our Retail and Group customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations in the tables presenting segment results below.
Our segment results were as follows for the three months ended March 31, 2016 and 2015:
 
Retail
 
Group
 
Healthcare
Services
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended March 31, 2016
 
 
 
 
 
 
 
 
 
 
Revenues - external customers
 
 
 
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
8,027

 
$

 
$

 
$

 
$

 
$
8,027

Group Medicare Advantage
1,077

 

 

 

 

 
1,077

Medicare stand-alone PDP
1,039

 

 

 

 

 
1,039

Total Medicare
10,143

 

 

 

 

 
10,143

Fully-insured
997

 
1,337

 

 

 

 
2,334

Specialty
65

 
253

 

 

 

 
318

Medicaid and other
630

 
5

 

 
10

 

 
645

Total premiums
11,835

 
1,595

 

 
10

 

 
13,440

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
Provider

 
13

 
58

 

 

 
71

ASO and other
2

 
177

 

 
3

 

 
182

Pharmacy

 

 
7

 

 

 
7

Total services revenue
2

 
190

 
65

 
3

 

 
260

Total revenues - external customers
11,837

 
1,785

 
65

 
13

 

 
13,700

Intersegment revenues
 
 
 
 
 
 
 
 
 
 
 
Services

 
21

 
4,754

 

 
(4,775
)
 

Products

 

 
1,360

 

 
(1,360
)
 

Total intersegment revenues

 
21

 
6,114

 

 
(6,135
)
 

Investment income
27

 
5

 
7

 
15

 
46

 
100

Total revenues
11,864

 
1,811

 
6,186

 
28

 
(6,089
)
 
13,800

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
Benefits
10,378

 
1,193

 

 
25

 
(199
)
 
11,397

Operating costs
1,276

 
436

 
5,913

 
4

 
(5,861
)
 
1,768

Depreciation and amortization
56

 
24

 
32

 

 
(24
)
 
88

Total operating expenses
11,710

 
1,653

 
5,945

 
29

 
(6,084
)
 
13,253

Income (loss) from operations
154

 
158

 
241

 
(1
)
 
(5
)
 
547

Interest expense

 

 

 

 
47

 
47

Income (loss) before income taxes
$
154

 
$
158

 
$
241

 
$
(1
)
 
$
(52
)
 
$
500


 
Retail
 
Group
 
Healthcare
Services
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended March 31, 2015
 
 
 
 
 
 
 
 
 
 
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
591

 
6

 

 
10

 

 
607

Total premiums
11,578

 
1,660

 

 
10

 

 
13,248

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
Provider

 
9

 
308

 

 

 
317

ASO and other
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

 
4,367

 

 
(4,389
)
 

Products

 

 
1,150

 

 
(1,150
)
 

Total intersegment revenues

 
22

 
5,517

 

 
(5,539
)
 

Investment income
27

 
5

 

 
15

 
48

 
95

Total revenues
11,609

 
1,856

 
5,832

 
27

 
(5,491
)
 
13,833

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
Benefits
9,936

 
1,226

 

 
23

 
(180
)
 
11,005

Operating costs
1,254

 
453

 
5,560

 
3

 
(5,325
)
 
1,945

Depreciation and amortization
44

 
23

 
42

 

 
(16
)
 
93

Total operating expenses
11,234

 
1,702

 
5,602

 
26

 
(5,521
)
 
13,043

Income from operations
375

 
154

 
230

 
1

 
30

 
790

Interest expense

 

 

 

 
46

 
46

Income (loss) before income taxes
$
375

 
$
154

 
$
230

 
$
1

 
$
(16
)
 
$
744