-----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, DXOhB0/eH82+Uj/eyCgZF1pjbrw3lyHjRo0wAQ6uOVRjUq6+4qDmFggYoCwAtcHu IXu6WF70dGlRNzBJRGAj9g== 0001157523-07-001008.txt : 20070205 0001157523-07-001008.hdr.sgml : 20070205 20070205063058 ACCESSION NUMBER: 0001157523-07-001008 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20070205 ITEM INFORMATION: Results of Operations and Financial Condition ITEM INFORMATION: Regulation FD Disclosure ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20070205 DATE AS OF CHANGE: 20070205 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: 0331 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-05975 FILM NUMBER: 07578300 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 a5325624.htm HUMANA INC. 8-K
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)    February 5, 2007

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 Operations and Financial Condition.
Item 7.01     Regulation FD Disclosure.

                  An earnings release for the period ending December 31, 2006 and guidance for 2007 was issued by Humana Inc. on Monday, February 5, 2007, a copy of which is attached hereto as Exhibit 99 and is incorporated herein by reference.

Item 9.01    Financial Statements and Exhibits.

(d)   Exhibits:

Exhibit No.
Description
 
99
Earnings Release & Statistical Pages  
 

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:     February 5, 2007
 
INDEX TO EXHIBITS
Exhibit No.
Description
 
99
Earnings Release & Statistical Pages  
 
EX-99.1 2 a5325624ex991.htm HUMANA INC. EXHIBIT 99
Exhibit 99
 
n e w s r e l e a s e    
Humana Inc.
500 West Main Street
P.O. Box 1438
Louisville, KY 40201-1438
http://www.humana.com
FOR MORE INFORMATION CONTACT:
     
   
Regina Nethery
Humana Investor Relations
(502) 580-3644
e-mail: Rnethery@humana.com
 
 
     
Tom Noland
Humana Corporate Communications
(502) 580-3674
e-mail: Tnoland@humana.com
   
 

Humana Inc. Reports Financial Results for Fourth Quarter
And Full Year 2006; Raises 2007 EPS Guidance

·
Raising 2007 EPS estimate to a range of $4.00 to $4.20
   
·
2006 EPS of $2.90, above company’s expectations
   
·
2006 consolidated revenues of $21.4 billion, up nearly 50 percent
   
·
Medical membership grew 4.2 million in 2006 to 11.3 million
 
LOUISVILLE, KY (February 5, 2007) - Humana Inc. (NYSE: HUM) today reported $0.92 in diluted earnings per common share (EPS) for the quarter ended December 31, 2006 (4Q06), above the company’s previous guidance for EPS of $0.84 to $0.90. The 4Q06 EPS compares to $0.37(a)(e) EPS for the quarter ended December 31, 2005 (4Q05). Excluding 4Q05 expenses of $0.07 per share related to Hurricane Katrina(e), EPS for 4Q06 is up 109 percent(b) versus the prior year. The year-over-year improvement in the quarter results from substantial earnings increases from membership growth in the company’s Government segment.

For the year ended December 31, 2006 (FY06), the company reported EPS of $2.90(f) versus $1.79(a)(d)(e)(g) for the year ended December 31, 2005 (FY05), an increase of 62 percent.

Humana now estimates EPS for the year ending December 31, 2007 (FY07E) in the range of $4.00 to $4.20 versus the company’s previous estimate of $3.90 to $4.10. The company’s revised outlook for 2007 equates to a growth rate of 38 to 45 percent over the FY06 EPS of $2.90(f).

Strong fourth quarter results capped off a record-breaking year in which Medicare membership growth dramatically increased Humana’s size, geographic reach and brand awareness,” said Michael B. McCallister, Humana’s president and chief executive officer. “This enabled us to exceed our EPS estimates for the quarter and the year. Just as importantly, it positioned us for further progress in 2007, as shown by our raising full-year EPS guidance this morning.”

1


Revenues - 4Q06 consolidated revenues rose 54 percent to $5.66 billion from $3.66 billion in 4Q05, with total premium and administrative services fees up 53 percent compared to the prior year’s quarter. Investment income increased by 87 percent year over year in 4Q06 to $79.9 million driven by higher invested balances during 4Q06 and the timing of venture capital investment gains in FY06 versus FY05. Other income increased to $25.9 million in 4Q06 from $4.6 million in 4Q05 primarily because of operations of the company’s mail order pharmacy facility which opened during the first half of FY06.

FY06 consolidated revenues rose 49 percent to $21.42 billion from $14.42 billion in FY05 with total premium and administrative services fees up 48 percent compared to the prior year’s period. Both the quarter and full year increases were primarily the result of higher enrollment in the company’s Medicare Advantage plans and new 2006 revenues from stand-alone Prescription Drug Plans (PDPs) for Medicare beneficiaries.

Medical costs - The company’s consolidated medical expense ratio (medical expenses as a percent of premium revenue or MER) of 83.2 percent in 4Q06 was 110 basis points higher than the 4Q05 MER of 82.1 percent(e) due to an increase in the Government Segment MER outweighing an improvement in that for the Commercial Segment. The change in MER in the Government Segment was primarily due to the stand-alone PDP results in 2006, as described more fully in the Government Segment results discussion below.

The consolidated MER for FY06 of 84.0 percent was 80 basis points higher than the FY05 consolidated MER of 83.2 percent(e), driven by the same factors impacting the fourth quarter year-over-year comparison.

Selling, general, & administrative (SG&A) expenses - The company’s consolidated SG&A expense ratio (SG&A expenses as a percent of premiums plus administrative services fees) decreased to 14.7 percent for 4Q06 from 16.9 percent(a) in 4Q05. The year-over-year decline of 220 basis points was primarily the result of administrative cost leverage associated with revenues from higher average medical membership. Administrative spending associated with the 2007 open enrollment period for Medicare primarily led to a 160 basis-point increase in the consolidated SG&A expense ratio in 4Q06 compared to the third quarter of 2006.

The SG&A expense ratio for FY06 of 14.3 percent was 110 basis points lower than the FY05 ratio of 15.4 percent(a)(d)(e), primarily due to the administrative cost leverage provided by revenues from higher average medical membership. Additionally, the FY06 ratio improved year-over-year as a result of administrative costs in FY05 for the settlement of class action litigation(d) which did not recur in FY06.

Government Segment Results Summary

Pretax results:
·
Government Segment pretax earnings were $187.3 million in 4Q06 compared to $55.8 million(a)(e) in 4Q05. This increase reflects higher earnings in the company’s Medicare Advantage plans resulting from significantly higher membership, partially offset by results for new Medicare PDP offerings in 2006.
 
2

 
·
For FY06, pretax earnings for the Government Segment of $513.8 million were 62 percent higher than FY05 pretax earnings for the segment of $316.7 million(a)(d)(e) with the increase in results year over year primarily due to higher earnings in the company’s Medicare Advantage plans resulting from significantly higher membership, partially offset by results for new Medicare PDP offerings in 2006. In addition, the year-over-year improvement was impacted by approximately $39.3 million of FY05 expenses related to the settlement of class action litigation(d) and Hurricane Katrina(e) that did not recur in FY06.

Enrollment:
·
Medicare Advantage membership grew to 1,002,600 at December 31, 2006, an increase of 444,800, or 80 percent, from December 31, 2005 and 9,600, or 1 percent, from September 30, 2006. The company’s expanded participation in various Medicare products and markets combined with the company’s increased sales and marketing efforts for these programs led to the higher membership level year over year. Medicare Advantage membership for January 2007 approximated 1.1 million members.
 
 
·
Membership in the company’s stand-alone PDPs totaled 3,536,600 at December 31, 2006. January 2007 stand-alone PDP membership also approximated 3.5 million.
   
·
As expected, TRICARE membership of 2,880,000 at December 31, 2006 was essentially unchanged from both December 31, 2005 and September 30, 2006.
   
·
Medicaid membership of 569,100 at December 31, 2006 increased 111,200 from December 31, 2005 and 156,500 from September 30, 2006 due primarily to the award of a new Puerto Rico regional ASO contract during 4Q06, partially offset by eligible Puerto Rico Medicaid members choosing to move into the Medicare Advantage program.
 
Revenues:
·
Medicare Advantage premiums of $2.30 billion in 4Q06 increased 89 percent compared to $1.22 billion in 4Q05, primarily the result of the expanded geography across which Medicare Advantage products were offered together with higher enrollment in geographies where these products were offered in FY05. Medicare Advantage premiums per member increased 1 percent year over year during 4Q06, reflecting the shift in membership mix to a higher percentage of lower premium Private Fee-for-Service products.
   
·
Medicare PDP premiums added $882.0 million in new revenues in 4Q06 versus 4Q05.
   
·
TRICARE premiums and administrative services fees during 4Q06 of $660.4 million compared to $585.3 million in 4Q05.
 
Medical Expenses:
·
The Government Segment MER increased 240 basis points to 83.7 percent in 4Q06 compared to 81.3 percent(e) in the prior year’s quarter. This increase is primarily the result of the stand-alone PDPs first offered in January 2006.
   
·
The FY06 MER for the company’s stand-alone PDP business was 92.5 percent, primarily driven by a FY06 MER of 115.9 percent in the company’s Complete plan offering.
 
SG&A Expenses:
·
The Government Segment’s SG&A expense ratio for 4Q06 of 12.3 percent was 330 basis points lower than that for 4Q05 of 15.6 percent(a) primarily driven by the expense leverage provided by revenues associated with higher average membership for this segment. On a sequential basis, the segment’s SG&A expense ratio increased 220 basis points, primarily driven by the expenses associated with the 2007 Medicare open enrollment period.
 
3

 
Commercial Segment Results Summary

Pretax results:
·
Commercial Segment pretax earnings were $53.9 million in 4Q06 compared to $38.9 million(a)(e) in 4Q05. Commercial Segment operating earnings in 4Q06 continue to reflect the company’s commitment to underwriting discipline and the strategic shift to a higher mix of ASO members. Additionally, 4Q05 results included approximately $15.9 million in expenses related to Hurricane Katrina(e) that did not recur in 4Q06.
   
·
For FY06, pretax earnings for the Commercial Segment of $248.2 million(f) were 188 percent higher than FY05 pretax earnings for the segment of $86.2 million(a)(d)(e) primarily reflecting the absence of litigation(d) and Hurricane Katrina(e) expenses incurred in FY05 that did not recur in FY06 together with higher-than-usual annual venture capital gains, continued underwriting discipline, and year-over-year improvement in medical cost utilization trends.
 
Enrollment:
·
Commercial Segment medical membership of 3,283,800 at December 31, 2006 increased approximately 113,000 or 4 percent, from December 31, 2005 and declined 8,100, or less than 1 percent, from September 30, 2006.
   
·
Membership in the company’s Smart plans and other consumer offerings increased year over year by 51,900 or 13 percent to 437,900 at December 31, 2006. Medical members in these products comprise over 13 percent of Commercial medical membership at December 31, 2006 compared to 12 percent at December 31, 2005.
 
Revenues:
·
Premiums and administrative services fees for the Commercial Segment decreased 6 percent to $1.57 billion in 4Q06 compared to $1.67 billion in the prior year’s quarter, as an increase in administrative services fees resulting from a 31 percent increase in ASO membership was more than offset by lower premiums due to declines in at-risk enrollment.
   
·
Commercial Segment medical premiums for fully insured groups increased approximately 6 percent on a per-member basis during 4Q06 compared to 4Q05. This increase primarily reflects a higher percentage of lower-premium small group members in 4Q06 than in 4Q05.
 
Medical Expenses:
·
In 4Q06, the Commercial Segment MER of 82.1 percent was 80 basis points lower than the 4Q05 MER of 82.9 percent(e), primarily reflecting improving medical cost utilization trends and the company’s commitment to underwriting discipline.
   
·
The company experienced commercial medical cost same-store trend components for FY06 as follows: inpatient hospital utilization - flat to 1 percent; inpatient and outpatient hospital rates - upper single digits; outpatient hospital utilization - low to mid single digits; physician - mid single digits; and pharmacy - high single digits to low double digits. This is also consistent with the same-store medical cost trend components the company is projecting for FY07.
 
4

 
SG&A Expenses:
·
The Commercial Segment SG&A expense ratio of 20.8 percent for 4Q06 compares to 18.3 percent(a) in 4Q05, primarily the result of lower average fully-insured medical enrollment and an increase in the percentage of Commercial medical membership related to ASO. The segment’s SG&A expense ratio increased 10 basis points from that for the third quarter of 2006.
 
Balance Sheet
·
Cash and cash equivalents of $1.74 billion increased $559.1 million or 47 percent sequentially primarily as a result of an increase in operating cash flows during 4Q06.
   
·
Parent company cash and investments increased to $424.4 million at December 31, 2006 from $419.6 million at December 31, 2005.
   
·
Debt-to-total capitalization at December 31, 2006 was 29.4 percent, up 430 basis points from September 30, 2006 due primarily to 4Q06 borrowings against the company’s credit facility.
   
·
The company’s working capital at December 31, 2006 included approximately $738.7 million in net Part D risk-share payables to CMS associated with the company’s Medicare Advantage and stand-alone PDP offerings.
   
·
Days in claims payable declined one day on a sequential basis to 60.2 days at December 31, 2006 from 61.2 days at September 30, 2006. This sequential decline primarily related to the timing of payments to the company’s pharmacy benefit manager.

Cash Flows from Operations

Cash flows provided by operations for 4Q06 of $534.9 million compared to cash used in operations of $250.8 million(a) in 4Q05. The company also evaluates operating cash flows on a non-GAAP basis(b)(c).
 

Cash flows from operations
($ in millions)
4Q06
4Q05(a)
FY06
FY05(a)
 
GAAP cash flows provided by (used in) operations
 
$534.9
 
($250.8) 
 
$1,686.7
 
$610.1 
 
Timing of premium payment from CMS(c)
 
  
 
384.8
 
  
 
19.8 
 
Non-GAAP cash flows provided by operations(b)(c)
 
$534.9
 
$134.0 
 
$1,686.7
 
$629.9 

Non-GAAP cash flows provided by operations rose to $534.9 million in 4Q06 from $134.0 million(a)(b)(c) in 4Q05 driven by growth in the company’s Medicare operations including the associated increase in Part D risk-share payables to CMS.
 
5

 
Footnotes

(a)  
In accordance with Generally Accepted Accounting Principles (GAAP), Humana adopted the retrospective method for implementing new stock option accounting rules on January 1, 2006. Consequently, prior period results in this news release have been adjusted to retrospectively reflect the expensing of stock options.
   
(b)  
The company has included certain financial measures that are not in accordance with GAAP within this news release. The company believes that these non-GAAP measures, when presented in conjunction with comparable GAAP measures, are useful to both management and its investors in analyzing the company's ongoing business and operating performance. Internally, management uses these non-GAAP financial measures as indicators of business performance, as well as for operational planning and decision making purposes. Non-GAAP financial measures should be considered in addition to, but not as a substitute for, or superior to, financial measures prepared in accordance with GAAP.
   
(c)  
When reviewing and analyzing Humana’s operating cash flows, company management applies the CMS premium payment in each month to match the corresponding disbursements. To do otherwise distorts meaningful analysis of the company’s operating cash flow. Therefore, decisions such as management’s forecasting and business plans regarding cash flow use this non-GAAP financial measure.
   
(d)  
On October 18, 2005, the company announced it had reached an agreement to settle a nationwide class action suit that had been pending in U.S. District Court in Miami for more than six years. Pursuant to the settlement, Humana’s 3Q05 financial results included pretax expenses of $72 million ($45 million after tax or $0.27 per share) in connection with the settlement and other related litigation costs.
   
(e)  
During the latter half of 2005, certain of Humana’s operations were affected by the unusually harsh impact of Hurricane Katrina. Expenses related to Hurricane Katrina primarily stem from the company’s efforts, in close cooperation with Departments of Insurance in the affected states, to help our members by offering participating-provider benefits at non-participating providers, paying claims for members who were unable at that time to meet their premium obligations and similar measures. Hurricane Katrina related pretax expenses of $7 million ($4 million after tax or $0.03 per share) were included in the company’s 3Q05 financial results with another $20 million in pretax expenses ($13 million after tax or $0.07 per share) included in the company’s 4Q05 financial results.
   
(f)  
During the first quarter of 2006, the company realized a gain on the sale of an investment totaling approximately $52 million on a pretax basis, which was $34 million higher than the pretax capital gains anticipated for 2006. The company, in turn, donated $0.02 per share of the $0.13 per share in excess capital gains to the Humana Foundation.
   
(g)  
During the first quarter of 2005, the company realized a favorable tax contingency of $23 million or $0.14 per share.

Conference Call & Virtual Slide Presentation

Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings. A live virtual presentation (audio with slides) may be accessed via Humana’s Investor Relations page at www.humana.com. The company suggests web participants sign on 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.

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. For those unable to participate in the live event, the virtual presentation archive will be available in the Historical Presentations section of the Investor Relations page at www.humana.com.
 
6

 
Cautionary Statement

This news release contains forward-looking statements and earnings guidance points. The forward-looking statements herein 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 filed by Humana with the Securities and Exchange Commission:
·
Form 10-K for the year ended December 31, 2005,
   
·
Form 10-Qs for the quarters ended March 31, 2006, June 30, 2006, and September 30, 2006.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health benefits companies, with over 11 million medical members. 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 46-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.

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 news releases;
   
·
Replay 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 research analysts and institutional investors);
   
·
Corporate Governance information.

7


Humana Inc.
 
GAAP Guidance Points as of February 5, 2007
For the year ending December 31, 2007
Comments
   
Diluted earnings per common share
FY07: $4.00 to $4.20
2007 growth rate of 38% to 45%
 
1Q07: $0.35 to $0.40
 
Revenues
Consolidated revenues: $24 billion to $26 billion;
Medicare Advantage: $10.5 billion to $12.0 billion;
Medicare stand-alone PDPs: $3.0 billion to $3.5 billion;
TRICARE: $2.7 billion to $3.0 billion;
Commercial: $6.0 billion to $7.0 billion
 
Ending medical membership
Medicare Advantage: approximately 1,130,000 to 1,200,000;
Medicare stand-alone PDPs: approximately 3.6 million;
TRICARE: No material change from prior year;
Medicaid: No material change from prior year;
 
 
Commercial: Up approximately 50,000 to 75,000 from prior year
Commercial represents combined ASO and fully insured medical membership
Medical costs
Total Medicare products (Medicare Advantage and stand-alone PDP combined) MER in the range of 82% to 84%;
 
 
Commercial fully insured groups: Medical cost trends in the range of 5% to 6%; premium yields in line with medical cost trends
2007 same-store trends for Commercial medical cost detailed components are not anticipated to be materially different from 2006
Selling, general & administrative expenses
Consolidated SG&A expense ratio of 13% to 14%
 
Investment income and interest expense
Investment income of $280 million to $290 million with no material benefit from venture capital gains;
2007 is not forecast to include any material gains from venture capital investments due to fewer such investments now held by the company
 
Interest expense of approximately $70 million
 
 
Net investment income by segment:
55% to 60% Government Segment; 40% to 45% Commercial Segment
Investment income (net of interest expense) is recorded to the business segments based upon changes in working capital that fund cash available for investment
 
8

 
 
GAAP Guidance Points as of February 5, 2007
For the year ending December 31, 2007
Comments
Pretax results
Total Medicare products (Medicare Advantage and stand-alone PDP combined): 4% to 5% pretax margin including pretax income on stand-alone PDP;
Investment and other income and interest expense are recorded at the segment level but not at the line-of-business level
 
TRICARE: Approximately 3% to 4% pretax margin;
Commercial Segment: $190 million to $210 million including no material benefit from venture capital gains
 
Cash flows from operations
$1.0 billion to $1.8 billion
Updated to reflect detailed review of 12/31/06 balance sheet and intricacies of Part D risk-share calculations
Capital expenditures
Approximately $200 million
 
Effective tax rate
Approximately 36% to 37%
 
Shares used in computing EPS
Approximately 171 million
 
 
9



 
 
 
 
 
Statistical Schedules
 
 
 
And
 
 
 
Supplementary Information
 
 
 
4Q06 Earnings Release
 

 
S-1

 
 
Statistical Schedules and Supplementary Information
 
 
4Q06 Earnings Release
 
       
 
Contents
   
       
 
Page
Description
 
       
 
S-3
4th Quarter Consolidated Statements of Income
 
 
S-4
YTD Consolidated Statements of Income
 
 
S-5
Consolidated Balance Sheets
 
 
S-6
4th Quarter Consolidated Statements of Cash Flows
 
 
S-7
YTD Consolidated Statements of Cash Flows
 
 
S-8
Key Income Statement Ratios and Segment Operating Results
 
 
S-9
Membership Detail
 
 
S-10
4th Quarter Premiums and Administrative Services Fees Detail
 
 
S-11
YTD Premiums and Administrative Services Fees Detail
 
 
S-12
Percentage of Ending Membership under Capitation Arrangements
 
 
S-13
Detail of Medical and Other Expenses Payable Balance and Year-to-Date Changes
 
 
S-14-15
Medical Claims Reserves Statistics
 
 
S-16
4Q05 GAAP to Non-GAAP Reconciliation
 
 
S-17
YTD GAAP to Non-GAAP Reconciliation
 
 
S-18
2005 Quarters Adjusted to Reflect Retrospective Application of Expensing Stock Options
 
 
S-19
2003 Through 2005 Adjusted to Reflect Retrospective Application of Expensing Stock Options
 
S-20
Footnotes
 
 
S-2

 
                 
4th Quarter Consolidated Statements of Income
             
In thousands, except per common share results
                 
   
Three Months Ended December 31,
         
           
Dollar
 
Percentage
 
   
2006
 
2005 (A)
 
Change
 
Change
 
Revenues:
 
 
             
Premiums
 
$
5,456,853
 
$
3,552,393
 
$
1,904,460
   
53.6
%
Administrative services fees
   
92,490
   
63,197
   
29,293
   
46.4
%
Investment income
   
79,937
   
42,856
   
37,081
   
86.5
%
Other revenue
   
25,939
   
4,634
   
21,305
   
459.8
%
Total revenues
   
5,655,219
   
3,663,080
   
1,992,139
   
54.4
%
Operating expenses:
                       
Medical
   
4,541,775
   
2,914,831
   
1,626,944
   
55.8
%
Selling, general and administrative
   
817,038
   
609,519
   
207,519
   
34.0
%
Depreciation
   
34,607
   
28,769
   
5,838
   
20.3
%
Other intangible amortization
   
4,812
   
4,958
   
(146
)
 
-2.9
%
Total operating expenses
   
5,398,232
   
3,558,077
   
1,840,155
   
51.7
%
Income from operations
   
256,987
   
105,003
   
151,984
   
144.7
%
Interest expense
   
15,806
   
10,329
   
5,477
   
53.0
%
Income before income taxes
   
241,181
   
94,674
   
146,507
   
154.7
%
Provision for income taxes
   
86,160
   
32,898
   
53,262
   
161.9
%
Net income
 
$
155,021
 
$
61,776
 
$
93,245
   
150.9
%
                         
Basic earnings per common share
 
$
0.94
 
$
0.38
 
$
0.56
   
147.4
%
Diluted earnings per common share
 
$
0.92
 
$
0.37
 
$
0.55
   
148.6
%
                         
Shares used in computing basic earnings per common share
   
165,338
   
162,405
             
Shares used in computing diluted earnings per common share
   
168,748
   
166,521
             
 
S-3


Humana Inc.
                 
YTD Consolidated Statements of Income
                 
In thousands, except per common share results
                 
   
Twelve Months Ended December 31,
         
           
Dollar
 
Percentage
 
   
2006
 
2005 (A)
 
Change
 
Change
 
Revenues:
 
 
             
Premiums
 
$
20,729,182
 
$
14,001,591
 
$
6,727,591
   
48.0
%
Administrative services fees
   
341,211
   
259,437
 
$
81,774
   
31.5
%
Investment income
   
291,880
   
142,976
 
$
148,904
   
104.1
%
Other revenue
   
54,264
   
14,123
 
$
40,141
   
284.2
%
Total revenues
   
21,416,537
   
14,418,127
 
$
6,998,410
   
48.5
%
Operating expenses:
                       
Medical
   
17,421,204
   
11,651,470
 
$
5,769,734
   
49.5
%
Selling, general and administrative
   
3,021,509
   
2,195,604
 
$
825,905
   
37.6
%
Depreciation
   
128,634
   
105,051
 
$
23,583
   
22.4
%
Other intangible amortization
   
19,964
   
23,807
   
($3,843
)
 
-16.1
%
Total operating expenses
   
20,591,311
   
13,975,932
 
$
6,615,379
   
47.3
%
Income from operations
   
825,226
   
442,195
 
$
383,031
   
86.6
%
Interest expense
   
63,141
   
39,315
 
$
23,826
   
60.6
%
Income before income taxes
   
762,085
   
402,880
 
$
359,205
   
89.2
%
Provision for income taxes
   
274,662
   
106,150
 
$
168,512
   
158.7
%
Net income
 
$
487,423
 
$
296,730
 
$
190,693
   
64.3
%
                         
Basic earnings per common share
 
$
2.97
 
$
1.83
 
$
1.14
   
62.3
%
Diluted earnings per common share
 
$
2.90
 
$
1.79
 
$
1.11
   
62.0
%
                         
Shares used in computing basic earnings per common share
   
164,137
   
161,714
             
Shares used in computing diluted earnings per common share
   
167,996
   
165,560
             
 
S-4

 
                     
Consolidated Balance Sheets
                     
Dollars in thousands, except share amounts
 
 
                 
   
December 31,
 
September 30,
 
December 31,
 
Sequential Change
 
   
2006
 
2006
 
2005 (A)
 
Dollar
 
Percent
 
Assets
 
 
                 
Current assets:
 
 
                 
Cash and cash equivalents
 
$
1,740,304
 
$
1,181,234
 
$
732,016
             
Investment securities
   
3,192,273
   
3,242,711
   
2,354,904
             
Receivables, net:
                             
Premiums
   
667,657
   
729,949
   
723,190
             
Administrative services fees
   
13,284
   
15,055
   
15,462
             
Securities lending collateral
   
627,990
   
917,325
   
47,610
             
Other
   
1,091,465
   
1,015,717
   
333,004
             
Total current assets
   
7,332,973
   
7,101,991
   
4,206,186
 
 
$230,982
   
3.3
%
Property and equipment
   
545,004
   
518,930
   
484,412
             
Other assets:
                             
Long-term investment securities
   
414,877
   
408,281
   
391,035
             
Goodwill
   
1,310,631
   
1,307,231
   
1,264,575
             
Other
   
524,011
   
569,718
   
523,406
             
Total other assets
   
2,249,519
   
2,285,230
   
2,179,016
             
Total assets
 
$
10,127,496
 
$
9,906,151
 
$
6,869,614
 
 
$221,345
   
2.2
%
                               
Liabilities and Stockholders' Equity
                             
Current liabilities:
                             
Medical and other expenses payable
 
$
2,488,261
 
$
2,562,943
 
$
1,909,682
             
Trade accounts payable and accrued expenses
   
1,626,658
   
1,477,977
   
560,550
             
Book overdraft
   
293,605
   
281,244
   
280,005
             
Securities lending payable
   
627,990
   
917,325
   
47,610
             
Unearned revenues
   
155,298
   
146,320
   
120,489
             
Current portion of long-term debt
   
-
   
-
   
301,254
             
Total current liabilities
   
5,191,812
   
5,385,809
   
3,219,590
   
($193,997
)
 
-3.6
%
Long-term debt
   
1,269,100
   
970,144
   
513,790
             
Other long-term liabilities
   
612,698
   
657,735
   
627,360
             
Total liabilities
   
7,073,610
   
7,013,688
   
4,360,740
 
 
$59,922
   
0.9
%
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;
                             
182,947,691 issued at December 31, 2006
   
30,491
   
30,391
   
29,843
             
Capital in excess of par value
   
1,357,077
   
1,333,503
   
1,235,888
             
Retained earnings
   
1,909,098
   
1,754,077
   
1,421,675
             
Accumulated other comprehensive (loss) income
   
(13,205
)
 
(6,574
)
 
24,832
             
Treasury stock, at cost, 16,314,151 shares at December 31, 2006
   
(229,575
)
 
(218,934
)
 
(203,364
)
           
Total stockholders' equity
   
3,053,886
   
2,892,463
   
2,508,874
 
 
$161,423
   
5.6
%
Total liabilities and stockholders' equity
 
$
10,127,496
 
$
9,906,151
 
$
6,869,614
 
 
$221,345
   
2.2
%
                               
Debt to total capitalization ratio
   
29.4
%
 
25.1
%
 
24.5
%
           
 
S-5

 
 
 
 
 
 
 
 
 
 
4th Quarter Consolidated Statements of Cash Flows
 
 
 
 
 
 
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended December 31,
 
 
 
 
 
 
 
 
 
 
 
Dollar
 
Percentage
 
 
 
2006
 
2005 (A)
 
Change
 
Change
 
Cash flows from operating activities
 
 
 
 
 
 
 
 
 
Net income
 
$
155,021
 
$
61,776
         
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
                 
Depreciation and amortization
   
39,419
   
33,727
         
Stock-based compensation
   
8,157
   
7,716
         
Provision (benefit) for deferred income taxes
   
47,793
   
(9,784
)
       
Changes in operating assets and liabilities excluding the effects of acquisitions:
                 
Receivables
   
64,063
   
(27,512
)
       
Other assets
   
23,559
   
(32,675
)
       
Medical and other expenses payable
   
(74,682
)
 
92,456
         
Other liabilities
   
268,725
   
46,246
         
Unearned revenues
   
8,978
   
(413,419
)
       
Other
   
(6,132
)
 
(9,315
)
       
Net cash provided by (used in) operating activities
   
534,901
   
(250,784
)
 
$785,685
   
313.3
%
 
                 
Cash flows from investing activities
                 
Acquisitions, net of cash acquired
   
(1,700
)
 
(50,028
)
       
Purchases of property and equipment
   
(56,549
)
 
(53,528
)
       
Proceeds from sales of property and equipment
   
171
   
1,849
         
Purchases of investment securities
   
(763,830
)
 
(2,023,793
)
       
Proceeds from maturities of investment securities
   
186,315
   
1,165,312
         
Proceeds from sales of investment securities
   
523,238
   
730,595
         
Change in securities lending collateral
   
289,335
   
69,943
         
Net cash provided by (used in) investing activities
   
176,980
   
(159,650
)
 
$336,630
   
210.9
%
 
                 
Cash flows from financing activities
                 
Receipts from CMS contract deposits
   
574,602
   
-
         
Withdrawals from CMS contract deposits
   
(753,855
)
 
-
         
Borrowings under credit agreement
   
300,000
   
200,000
         
Debt issue costs
   
(184
)
 
-
         
Change in book overdraft
   
12,361
   
21,572
         
Change in securities lending payable
   
(289,335
)
 
(69,943
)
       
Common stock repurchases
   
(10,641
)
 
(293
)
       
Tax benefit from stock-based compensation
   
8,048
   
4,287
         
Proceeds from stock option exercises and other
   
6,193
   
7,891
         
Net cash (used in) provided by financing activities
   
(152,811
)
 
163,514
   
($316,325
)
 
-193.5
%
 
                 
Increase/(decrease) in cash and cash equivalents
   
559,070
   
(246,920
)
       
Cash and cash equivalents at beginning of period
   
1,181,234
   
978,936
         
 
                 
Cash and cash equivalents at end of period
 
$
1,740,304
 
$
732,016
         
 
S-6

 
 
 
 
 
 
 
 
 
 
YTD Consolidated Statements of Cash Flows
 
 
 
 
 
 
 
 
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
Twelve Months Ended December 31,
 
 
 
 
 
 
 
 
 
 
 
Dollar
 
Percentage
 
 
 
2006
 
2005 (A)
 
Change
 
Change
 
Cash flows from operating activities
 
 
 
 
 
 
 
 
 
Net income
 
$
487,423
 
$
296,730
         
Adjustments to reconcile net income to net cash provided by operating activities:
                 
Depreciation and amortization
   
148,598
   
128,858
         
Stock-based compensation
   
32,558
   
30,153
         
Provision (benefit) for deferred income taxes
   
70,062
   
(39,007
)
       
Changes in operating assets and liabilities excluding the effects of acquisitions:
                 
Receivables
   
58,554
   
(156,748
)
       
Other assets
   
(365,454
)
 
(63,962
)
       
Medical and other expenses payable
   
557,381
   
450,297
         
Other liabilities
   
734,718
   
25,617
         
Unearned revenues
   
29,870
   
(45,610
)
       
Other
   
(66,998
)
 
(16,246
)
       
Net cash provided by operating activities
   
1,686,712
   
610,082
 
 
$1,076,630
   
176.5
%
 
                 
Cash flows from investing activities
                 
Acquisitions, net of cash acquired
   
(28,062
)
 
(402,844
)
       
Purchases of property and equipment
   
(193,151
)
 
(165,846
)
       
Proceeds from sales of property and equipment
   
9,623
   
4,497
         
Purchases of investment securities
   
(4,269,221
)
 
(3,717,916
)
       
Proceeds from maturities of investment securities
   
1,664,332
   
1,761,588
         
Proceeds from sales of investment securities
   
1,742,793
   
1,723,015
         
Change in securities lending collateral
   
(580,380
)
 
30,230
         
Net cash used in investing activities
   
(1,654,066
)
 
(767,276
)
 
($886,790
)
 
-115.6
%
 
                 
Cash flows from financing activities
                 
Receipts from CMS contract deposits
   
2,002,451
   
-
         
Withdrawals from CMS contract deposits
   
(2,124,717
)
 
-
         
Borrowings under credit agreement
   
550,000
   
494,000
         
Repayments under credit agreement
   
(300,000
)
 
(294,000
)
       
Proceeds from issuance of senior notes
   
498,545
   
-
         
Repayment of senior notes
   
(300,000
)
 
-
         
Debt issue costs
   
(5,980
)
 
-
         
Change in book overdraft
   
13,600
   
87,945
         
Change in securities lending payable
   
580,380
   
(30,230
)
       
Common stock repurchases
   
(26,211
)
 
(2,364
)
       
Tax benefit from stock-based compensation
   
38,839
   
15,545
         
Proceeds from stock option exercises and other
   
48,735
   
38,235
         
Net cash provided by financing activities
   
975,642
   
309,131
 
 
$666,511
   
215.6
%
 
                 
Increase in cash and cash equivalents
   
1,008,288
   
151,937
         
Cash and cash equivalents at beginning of period
   
732,016
   
580,079
         
 
                 
Cash and cash equivalents at end of period
 
$
1,740,304
 
$
732,016
         
 
S-7

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Key Income Statement Ratios and Segment Operating Results
 
 
 
 
 
 
 
 
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended December 31,
 
 
 
 
 
Twelve Months Ended December 31,
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage
 
 
 
 
 
 
 
Percentage
 
 
 
2006
 
2005 (A)
 
Difference
 
Change
 
2006
 
2005 (A)
 
Difference
 
Change
 
Medical expense ratio
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
   
83.7
%
 
81.3
%
 
2.4
%
     
85.0
%
 
83.1
%
 
1.9
%
   
Commercial Segment
   
82.1
%
 
82.9
%
 
-0.8
%
     
81.7
%
 
83.3
%
 
-1.6
%
   
Consolidated
   
83.2
%
 
82.1
%
 
1.1
%
     
84.0
%
 
83.2
%
 
0.8
%
   
 
                                 
Selling, general, and administrative expense ratio
                                 
Government Segment
   
12.3
%
 
15.6
%
 
-3.3
%
     
11.8
%
 
12.7
%
 
-0.9
%
   
Commercial Segment
   
20.8
%
 
18.3
%
 
2.5
%
     
20.2
%
 
18.5
%
 
1.7
%
   
Consolidated
   
14.7
%
 
16.9
%
 
-2.2
%
     
14.3
%
 
15.4
%
 
-1.1
%
   
 
                                 
Detail of Pretax Income
                                 
Government Segment
 
$
187,288
 
$
55,805
 
$
131,483
   
235.6
%
$
513,845
 
$
316,676
 
$
197,169
   
62.3
%
Commercial Segment
   
53,893
   
38,869
   
15,024
   
38.7
%
 
248,240
   
86,204
   
162,036
   
188.0
%
Consolidated
 
$
241,181
 
$
94,674
 
$
146,507
   
154.7
%
$
762,085
 
$
402,880
 
$
359,205
   
89.2
%
 
                                 
Detail of Pretax Margins
                                 
Government Segment
   
4.6
%
 
2.9
%
 
1.7
%
     
3.5
%
 
4.2
%
 
-0.7
%
   
Commercial Segment
   
3.3
%
 
2.3
%
 
1.0
%
     
3.7
%
 
1.3
%
 
2.4
%
   
Consolidated
   
4.3
%
 
2.6
%
 
1.7
%
     
3.6
%
 
2.8
%
 
0.8
%
   
 
S-8

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Membership Detail
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In thousands
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ending
 
 
 
Ending
 
Year-over-year Change
 
Ending
 
Sequential Change
 
 
 
December 31, 2006
 
Average - 4Q06
 
December 31, 2005
 
Amount
 
Percent
 
September 30, 2006
 
Amount
 
Percent
 
Medical Membership:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare Advantage - HMO
   
457.9
   
457.1
   
427.9
   
30.0
   
7.0
%
 
455.4
   
2.5
   
0.5
%
Medicare Advantage - PPO
   
71.7
   
72.1
   
8.6
   
63.1
   
733.7
%
 
71.1
   
0.6
   
0.8
%
Medicare Advantage - PFFS
   
473.0
   
472.7
   
121.3
   
351.7
   
289.9
%
 
466.5
   
6.5
   
1.4
%
Total Medicare Advantage
   
1,002.6
   
1,001.9
   
557.8
   
444.8
   
79.7
%
 
993.0
   
9.6
   
1.0
%
Medicare - PDP - Standard
   
2,097.2
   
2,093.9
   
-
   
2,097.2
   
100.0
%
 
2,081.7
   
15.5
   
0.7
%
Medicare - PDP - Enhanced
   
1,025.4
   
1,027.9
   
-
   
1,025.4
   
100.0
%
 
1,021.6
   
3.8
   
0.4
%
Medicare - PDP - Complete
   
414.0
   
418.1
   
-
   
414.0
   
100.0
%
 
417.7
   
(3.7
)
 
-0.9
%
Total Medicare stand-alone PDPs
   
3,536.6
   
3,539.9
   
-
   
3,536.6
   
100.0
%
 
3,521.0
   
15.6
   
0.4
%
Total Medicare
   
4,539.2
   
4,541.8
   
557.8
   
3,981.4
   
713.8
%
 
4,514.0
   
25.2
   
0.6
%
TRICARE insured
   
1,716.4
   
1,718.1
   
1,750.9
   
(34.5
)
 
-2.0
%
 
1,721.3
   
(4.9
)
 
-0.3
%
TRICARE ASO
   
1,163.6
   
1,158.7
   
1,138.2
   
25.4
   
2.2
%
 
1,141.4
   
22.2
   
1.9
%
Total TRICARE
   
2,880.0
   
2,876.8
   
2,889.1
   
(9.1
)
 
-0.3
%
 
2,862.7
   
17.3
   
0.6
%
Medicaid insured
   
390.7
   
398.7
   
457.9
   
(67.2
)
 
-14.7
%
 
412.6
   
(21.9
)
 
-5.3
%
Medicaid ASO
   
178.4
   
121.0
   
-
   
178.4
   
100.0
%
 
-
   
178.4
   
100.0
%
Total Medicaid
   
569.1
   
519.7
   
457.9
   
111.2
   
24.3
%
 
412.6
   
156.5
   
37.9
%
Total Government Segment
   
7,988.3
   
7,938.3
   
3,904.8
   
4,083.5
   
104.6
%
 
7,789.3
   
199.0
   
2.6
%
Commercial Segment:
                                 
Fully insured medical:
                                 
Group
   
1,563.9
   
1,565.0
   
1,836.9
   
(273.0
)
 
-14.9
%
 
1,597.1
   
(33.2
)
 
-2.1
%
Individual
   
182.6
   
180.3
   
158.1
   
24.5
   
15.5
%
 
175.4
   
7.2
   
4.1
%
Medicare supplement
   
7.7
   
7.7
   
4.8
   
2.9
   
60.4
%
 
7.4
   
0.3
   
4.1
%
Total fully insured medical
   
1,754.2
   
1,753.0
   
1,999.8
   
(245.6
)
 
-12.3
%
 
1,779.9
   
(25.7
)
 
-1.4
%
ASO
   
1,529.6
   
1,526.4
   
1,171.0
   
358.6
   
30.6
%
 
1,512.0
   
17.6
   
1.2
%
Total Commercial Segment
   
3,283.8
   
3,279.4
   
3,170.8
   
113.0
   
3.6
%
 
3,291.9
   
(8.1
)
 
-0.2
%
 
                                 
Total medical membership
   
11,272.1
   
11,217.7
   
7,075.6
   
4,196.5
   
59.3
%
 
11,081.2
   
190.9
   
1.7
%
 
                                 
Specialty Membership (all Commercial Segment)
                           
Dental - fully insured
   
959.8
   
960.0
   
960.5
   
(0.7
)
 
-0.1
%
 
960.5
   
(0.7
)
 
-0.1
%
Dental - ASO
   
492.2
   
490.8
   
496.0
   
(3.8
)
 
-0.8
%
 
488.2
   
4.0
   
0.8
%
Total dental
   
1,452.0
   
1,450.8
   
1,456.5
   
(4.5
)
 
-0.3
%
 
1,448.7
   
3.3
   
0.2
%
Group life
   
436.8
   
437.1
   
429.2
   
7.6
   
1.8
%
 
436.1
   
0.7
   
0.2
%
Short-term disability
   
14.0
   
14.5
   
16.4
   
(2.4
)
 
-14.6
%
 
14.9
   
(0.9
)
 
-6.0
%
Total specialty membership
   
1,902.8
   
1,902.4
   
1,902.1
   
0.7
   
0.0
%
 
1,899.7
   
3.1
   
0.2
%
 
S-9

 
 
 
 
 
 
 
 
 
 
 
 
 
 
4th Quarter Premiums and Administrative Services Fees Detail
 
 
 
 
 
 
 
Dollars in thousands, except per member per month
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Per Member per Month (B)
 
 
 
Three Months Ended December 31,
 
 
 
 
 
Three Months Ended December 31,
 
 
 
 
 
 
 
Dollar
 
Percentage
 
 
 
 
 
 
 
2006
 
2005
 
Change
 
Change
 
2006
 
2005
 
Premium revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare Advantage
 
$
2,302,609
 
$
1,218,036
 
$
1,084,573
   
89.0
%
$
766
 
$
755
 
Medicare stand-alone PDPs
   
881,994
   
-
   
881,994
   
100.0
%
$
83
   
-
 
Total Medicare
   
3,184,603
   
1,218,036
   
1,966,567
   
161.5
%
       
TRICARE insured (C)
   
645,892
   
575,127
   
70,765
   
12.3
%
$
125
 
$
110
 
Medicaid insured
   
133,877
   
139,609
   
(5,732
)
 
-4.1
%
$
112
 
$
101
 
Total Government Segment premiums
   
3,964,372
   
1,932,772
   
2,031,600
   
105.1
%
       
Commercial Segment:
                         
Fully insured medical
   
1,387,855
   
1,518,472
   
(130,617
)
 
-8.6
%
$
264
 
$
253
 
Specialty
   
104,626
   
101,149
   
3,477
   
3.4
%
$
21
 
$
20
 
Total Commercial Segment premiums
   
1,492,481
   
1,619,621
   
(127,140
)
 
-7.8
%
       
Total premium revenues
 
$
5,456,853
 
$
3,552,393
 
$
1,904,460
   
53.6
%
       
 
                         
Administrative services fees
                         
TRICARE ASO (C)
 
$
14,548
 
$
10,189
 
$
4,359
   
42.8
%
$
4
 
$
3
 
Medicaid ASO
   
1,423
   
-
   
1,423
   
100.0
%
$
4
   
-
 
Total Government Segment
   
15,971
   
10,189
   
5,782
   
56.7
%
       
Commercial Segment
   
76,519
   
53,008
   
23,511
   
44.4
%
$
13
 
$
11
 
Total administrative services fees
 
$
92,490
 
$
63,197
 
$
29,293
   
46.4
%
       
 
S-10

 
 
 
 
 
 
 
 
 
 
 
 
 
 
YTD Premiums and Administrative Services Fees Detail
 
 
 
 
 
 
 
Dollars in thousands, except per member per month
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Per Member per Month (B)
 
 
 
Twelve Months Ended December 31,
 
 
 
 
 
Twelve Months Ended December 31,
 
 
 
 
 
 
 
Dollar
 
Percentage
 
 
 
 
 
 
 
2006
 
2005
 
Change
 
Change
 
2006
 
2005
 
Premium revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare Advantage
 
$
8,499,064
 
$
4,590,362
 
$
3,908,702
   
85.2
%
$
794
 
$
799
 
Medicare stand-alone PDPs
   
3,050,304
   
-
   
3,050,304
   
100.0
%
$
88
   
-
 
Total Medicare
   
11,549,368
   
4,590,362
   
6,959,006
   
151.6
%
       
TRICARE insured (C)
   
2,543,930
   
2,407,653
   
136,277
   
5.7
%
$
123
 
$
115
 
Medicaid insured
   
520,520
   
548,714
   
(28,194
)
 
-5.1
%
$
104
 
$
97
 
Total Government Segment premiums
   
14,613,818
   
7,546,729
   
7,067,089
   
93.6
%
       
Commercial Segment:
                         
Fully insured medical
   
5,704,378
   
6,068,115
   
(363,737
)
 
-6.0
%
$
260
 
$
249
 
Specialty
   
410,986
   
386,747
   
24,239
   
6.3
%
$
21
 
$
20
 
Total Commercial Segment premiums
   
6,115,364
   
6,454,862
   
(339,498
)
 
-5.3
%
       
Total premium revenues
 
$
20,729,182
 
$
14,001,591
 
$
6,727,591
   
48.0
%
       
 
                         
Administrative services fees
                         
TRICARE ASO (C)
 
$
48,019
 
$
50,059
   
($2,040
)
 
-4.1
%
$
3
 
$
4
 
Medicaid ASO
   
1,423
   
-
   
1,423
   
100.0
%
$
4
   
-
 
Total Government Segment
   
49,442
   
50,059
   
(617
)
 
-1.2
%
       
Commercial Segment
   
291,769
   
209,378
   
82,391
   
39.4
%
$
12
 
$
10
 
Total administrative services fees
 
$
341,211
 
$
259,437
 
$
81,774
   
31.5
%
       
 
S-11

 
Humana Inc.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage of Ending Membership under Capitation Arrangements
 
 
 
 
 
 
 
 
 
 
 
Government Segment
 
Commercial Segment
 
 
 
December 31, 2006
 
Medicare Advantage
 
Medicare stand-alone PDPs
 
TRICARE
 
Medicaid
 
Total Govt. Segment
 
Fully insured
 
ASO
 
Total Comm. Segment
 
Total Medical Membership
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Capitated HMO hospital system based (D)
   
3.0
%
 
-
   
-
   
-
   
0.4
%
 
1.9
%
 
-
   
1.0
%
 
0.6
%
Capitated HMO physician group based (D)
   
2.4
%
 
-
   
-
   
26.1
%
 
2.2
%
 
1.7
%
 
-
   
0.9
%
 
1.8
%
Risk-sharing (E)
   
27.9
%
 
-
   
-
   
42.1
%
 
6.4
%
 
1.5
%
 
-
   
0.8
%
 
4.8
%
All other membership
   
66.7
%
 
100.0
%
 
100.0
%
 
31.8
%
 
91.0
%
 
94.9
%
 
100.0
%
 
97.3
%
 
92.8
%
Total medical membership
   
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
                                     
December 31, 2005
                                     
 
                                     
Capitated HMO hospital system based (D)
   
6.3
%
 
-
   
-
   
-
   
0.9
%
 
2.1
%
 
-
   
1.3
%
 
1.1
%
Capitated HMO physician group based (D)
   
4.2
%
 
-
   
-
   
37.2
%
 
5.0
%
 
2.0
%
 
-
   
1.2
%
 
3.3
%
Risk-sharing (E)
   
41.3
%
 
-
   
-
   
59.9
%
 
12.9
%
 
2.5
%
 
-
   
1.6
%
 
7.8
%
All other membership
   
48.2
%
 
-
   
100.0
%
 
2.9
%
 
81.2
%
 
93.4
%
 
100.0
%
 
95.9
%
 
87.8
%
Total medical membership
   
100.0
%
 
-
   
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
S-12

 
 
 
 
 
 
 
 
Detail of Medical and Other Expenses Payable Balance and Year-to-Date Changes
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
December 31,
 
September 30,
 
December 31,
 
 
 
2006
 
2006
 
2005
 
Detail of medical and other expenses payable
 
 
 
 
 
 
 
IBNR and other medical expenses payable (F)
 
$
1,686,051
 
$
1,715,791
 
$
1,125,205
 
TRICARE IBNR (G)
   
318,583
   
332,962
   
409,413
 
TRICARE other medical expenses payable (H)
   
94,699
   
95,593
   
88,443
 
Unprocessed claim inventories (I)
   
218,400
   
187,900
   
148,200
 
Processed claim inventories (J)
   
115,424
   
89,500
   
83,635
 
Payable to pharmacy benefit administrator (K)
   
55,104
   
141,197
   
54,786
 
Total medical and other expenses payable
 
$
2,488,261
 
$
2,562,943
 
$
1,909,682
 
 
             
 
   
Year Ended
   
Nine Months Ended
   
Year Ended
 
 
   
December 31, 2006
   
September 30, 2006
   
December 31, 2005
 
Year-to-date changes in medical and other expenses payable
             
 
             
Balances at January 1
 
$
1,909,682
 
$
1,909,682
 
$
1,422,010
 
 
             
Acquisitions
   
21,198
   
21,198
   
37,375
 
 
             
Incurred related to:
             
Current year (L)
   
17,696,654
   
13,163,725
   
11,765,662
 
Prior years - non-TRICARE (L)
   
(178,998
)
 
(173,223
)
 
(72,868
)
Prior years - TRICARE (M)
   
(96,452
)
 
(111,073
)
 
(41,324
)
Total incurred
   
17,421,204
   
12,879,429
   
11,651,470
 
 
             
Paid related to:
             
Current year
   
(15,532,079
)
 
(10,912,017
)
 
(9,979,449
)
Prior years
   
(1,331,744
)
 
(1,335,349
)
 
(1,221,724
)
Total paid
   
(16,863,823
)
 
(12,247,366
)
 
(11,201,173
)
 
             
Balances at end of period
 
$
2,488,261
 
$
2,562,943
 
$
1,909,682
 
 
S-13

 
 
 
 
 
 
 
 
 
 
Medical Claims Reserves Statistics
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Receipt Cycle Time (N)
 
 
 
 
 
 
 
 
 
2006
 
2005
 
Change
 
Percentage Change
 
1st Quarter Average
   
16.1
   
16.6
   
(0.5
)
 
-3.0
%
2nd Quarter Average
   
15.8
   
15.9
   
(0.1
)
 
-0.6
%
3rd Quarter Average
   
16.0
   
16.7
   
(0.7
)
 
-4.2
%
4th Quarter Average
   
15.8
   
16.9
   
(1.1
)
 
-6.5
%
Full Year Average
   
15.9
   
16.5
   
(0.6
)
 
-3.6
%
 
   
   
   
   
 
Unprocessed Claims Inventories
 
   
   
 
 
   
   
   
   
 
Date
   
Estimated Valuation (000's)
 
 
Claim Item Counts
   
Number of Days on Hand
   
 
12/31/2004
 
$
115,300
   
394,400
   
3.7
   
 
3/31/2005
 
$
111,200
   
393,200
   
3.6
   
 
6/30/2005
 
$
119,500
   
443,600
   
4.0
   
 
9/30/2005
 
$
136,700
   
512,800
   
4.7
   
 
12/31/2005
 
$
148,200
   
498,400
   
4.6
   
 
3/31/2006
 
$
185,300
   
683,900
   
5.6
   
 
6/30/2006
 
$
193,700
   
702,000
   
4.8
   
 
9/30/2006
 
$
187,900
   
623,900
   
5.4
   
 
12/31/2006
 
$
218,400
   
757,700
   
6.1
   
 

S-14


Humana Inc.
         
Medical Claims Reserves Statistics (Continued)
         
               
Days in Claims Payable (O)
         
 
Quarter Ended
Days in Claim Payable (DCP)
Annual Change
Percentage Change
DCP Excluding Capitation
Annual Change
Percentage Change
 
12/31/2004
49.5
3.3
7.1%
54.8
1.6
3.0%
 
3/31/2005
50.5
3.1
6.5%
56.1
1.8
3.3%
 
6/30/2005
52.8
5.4
11.4%
58.6
4.5
8.3%
 
9/30/2005
54.0
2.2
4.2%
60.8
1.7
2.9%
 
12/31/2005
60.3
10.8
21.8%
66.6
11.8
21.5%
 
3/31/2006
59.1
8.6
17.0%
65.5
9.4
16.8%
 
6/30/2006
59.5
6.7
12.7%
65.5
6.9
11.8%
 
9/30/2006
61.2
7.2
13.3%
67.1
6.3
10.4%
 
12/31/2006
60.2
(0.1)
-0.2%
66.5
(0.1)
-0.2%
               
Year-to-Date Change in Days in Claims Payable (P) (Q)
       
       
2006
2005
   
DCP - 4th quarter of prior year
 
60.3
49.5
   
 
Components of year-to-date change in DCP:
         
 
Change in claims receipt cycle time
 
(1.6)
0.2
   
 
Change in unprocessed claims inventories
 
1.7
1.0
   
 
Change in processed claims inventories
 
0.8
(0.4)
   
 
Change in TRICARE reserve balances
 
(2.1)
3.9
   
 
Change in pharmacy payment cutoff
 
(1.3)
1.5
   
 
Change in provider payables under risk arrangements
 
1.9
1.4
   
 
All other
 
0.5
3.2
   
DCP - current quarter
   
60.2
60.3
   
 
S-15

 
                 
4Q05 GAAP to Non-GAAP Reconciliation
         
Dollars in thousands, except EPS
             
   
4Q06
 
4Q05
 
   
 
 
GAAP (A)
 
Adjustments
 
Non-GAAP
 
   
 
 
 
 
Hurricane Katrina
 
 
 
Consolidated
 
 
             
Pretax income
 
$
241,181
 
$
94,674
 
$
20,314
 
$
114,988
 
Pretax margin
   
4.3
%
 
2.6
%
 
0.5
%
 
3.1
%
Net income
 
$
155,021
 
$
61,776
 
$
12,676
 
$
74,452
 
EPS
 
$
0.92
 
$
0.37
 
$
0.07
 
$
0.44
 
Growth rate vs. P/Y GAAP
   
148.6
%
                 
Growth rate vs. P/Y Non-GAAP
   
109.1
%
                 
MER
   
83.2
%
 
82.1
%
 
-0.6
%
 
81.5
%
SG&A ratio
   
14.7
%
 
16.9
%
 
-
   
16.9
%
     
                   
Government Segment
   
                   
Pretax income
 
$
187,288
 
$
55,805
 
$
4,388
 
$
60,193
 
Pretax margin
   
4.6
%
 
2.9
%
 
0.2
%
 
3.1
%
MER
   
83.7
%
 
81.3
%
 
-0.2
%
 
81.1
%
SG&A ratio
   
12.3
%
 
15.6
%
 
-
   
15.6
%
     
                   
Commercial Segment
   
                   
Pretax income
 
$
53,893
 
$
38,869
 
$
15,926
 
$
54,795
 
Pretax margin
   
3.3
%
 
2.3
%
 
0.9
%
 
3.2
%
MER
   
82.1
%
 
82.9
%
 
-1.0
%
 
81.9
%
SG&A ratio
   
20.8
%
 
18.3
%
 
-
   
18.3
%
 
S-16

 
Humana Inc.
                                  
YTD GAAP to Non-GAAP Reconciliation
                                  
Dollars in thousands, except EPS
                                  
   
FY06
 
FY05
 
   
GAAP
 
Adjustments
 
Non-GAAP
 
 GAAP (A)
 
Adjustments
 
Non-GAAP
 
       
Excess Net Realized Capital Gains - 1Q06
          
Realization of Tax Gain Contingency
 
Class Action Litigation Settlement
 
Hurricane Katrina
     
Consolidated
                                  
Pretax income
 
$
762,085
   
($29,113
)
$
732,972
 
$
402,880
   
-
 
$
71,850
 
$
27,013
 
$
501,743
 
Pretax margin
   
3.6
%
 
-0.2
%
 
3.4
%
 
2.8
%
 
-
   
0.5
%
 
0.2
%
 
3.5
%
Net income
   
487,423
   
($18,167
)
$
469,256
 
$
296,730
   
($22,800
)
$
44,834
 
$
16,857
 
$
335,621
 
EPS
 
$
2.90
   
($0.11
)
$
2.79
 
$
1.79
   
($0.14
)
$
0.27
 
$
0.10
 
$
2.02
 
Growth rate
   
62.0
%
       
38.1
%
                             
MER
   
84.0
%
 
-
   
84.0
%
 
83.2
%
 
-
   
-
   
-0.2
%
 
83.0
%
SG&A ratio
   
14.3
%
 
-
   
14.3
%
 
15.4
%
 
-
   
-0.5
%
 
-
   
14.9
%
                                                   
Government Segment
                                                 
Pretax income
 
$
513,845
   
($1,872
)
$
511,973
 
$
316,676
   
-
 
$
33,360
 
$
5,917
 
$
355,953
 
Pretax margin
   
3.5
%
 
-
   
3.5
%
 
4.2
%
 
-
   
0.4
%
 
0.1
%
 
4.7
%
MER
   
85.0
%
 
-
   
85.0
%
 
83.1
%
 
-
   
-
   
-0.1
%
 
83.0
%
SG&A ratio
   
11.8
%
 
-
   
11.8
%
 
12.7
%
 
-
   
-0.5
%
 
-
   
12.2
%
                                                   
Commercial Segment
                                                 
Pretax income
 
$
248,240
   
($27,241
)
$
220,999
 
$
86,204
   
-
 
$
38,490
 
$
21,096
 
$
145,790
 
Pretax margin
   
3.7
%
 
-0.4
%
 
3.3
%
 
1.3
%
 
-
   
0.5
%
 
0.3
%
 
2.1
%
MER
   
81.7
%
 
-
   
81.7
%
 
83.3
%
 
-
   
-
   
-0.3
%
 
83.0
%
SG&A ratio
   
20.2
%
 
-0.1
%
 
20.1
%
 
18.5
%
 
-
   
-0.6
%
 
-
   
17.9
%
 
S-17

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2005 Quarters Adjusted to Reflect Retrospective Application of Expensing Stock Options
 
In thousands, except per common share results
 
 
 
 
 
1Q05
 
2Q05
 
3Q05
 
4Q05
 
 
 
Reported
 
Adjusted (A)
 
Reported
 
Adjusted (A)
 
Reported
 
Adjusted (A)
 
Reported
 
Adjusted (A)
 
Revenues
 
$
3,387,225
 
$
3,387,225
 
$
3,546,361
 
$
3,546,361
 
$
3,821,461
 
$
3,821,461
 
$
3,663,080
 
$
3,663,080
 
 
   
   
   
   
   
   
   
   
 
Pretax income (loss):
   
   
   
   
   
   
   
   
 
Government
 
$
72,224
 
$
70,472
 
$
104,092
 
$
102,531
 
$
89,557
 
$
87,868
 
$
57,395
 
$
55,805
 
Commercial
   
49,463
   
46,208
   
25,215
   
22,317
   
(18,053
)
 
(21,190
)
 
41,821
   
38,869
 
Consolidated
 
$
121,687
 
$
116,680
 
$
129,307
 
$
124,848
 
$
71,504
 
$
66,678
 
$
99,216
 
$
94,674
 
 
   
   
   
   
   
   
   
   
 
Net income
 
$
109,795
 
$
106,735
 
$
84,137
 
$
81,412
 
$
49,944
 
$
46,807
 
$
64,607
 
$
61,776
 
 
   
   
   
   
   
   
   
   
 
Diluted earnings per common share
 
$
0.67
 
$
0.65
 
$
0.51
 
$
0.49
 
$
0.30
 
$
0.28
 
$
0.39
 
$
0.37
 
 
   
   
   
   
   
   
   
   
 
Shares used in computing diluted earnings per
   
164,179
   
164,496
   
164,908
   
165,149
   
166,037
   
166,076
   
166,371
   
166,521
 
common share
   
   
   
   
   
   
   
   
 
 
   
   
   
   
   
   
   
   
 
SG&A expense ratio:
   
   
   
   
   
   
   
   
 
Government
   
10.8
%
 
10.9
%
 
10.6
%
 
10.6
%
 
13.1
%
 
13.2
%
 
15.5
%
 
15.6
%
Commercial
   
17.6
%
 
17.8
%
 
17.5
%
 
17.7
%
 
20.0
%
 
20.2
%
 
18.1
%
 
18.3
%
Consolidated
   
14.1
%
 
14.3
%
 
13.8
%
 
14.0
%
 
16.2
%
 
16.3
%
 
16.7
%
 
16.9
%
 
   
   
   
   
   
   
   
   
 
Total assets
 
$
6,149,593
 
$
6,149,593
 
$
6,277,907
 
$
6,277,907
 
$
6,832,421
 
$
6,832,421
 
$
6,869,614
 
$
6,869,614
 
Total liabilities
 
$
3,949,788
 
$
3,916,471
 
$
3,961,719
 
$
3,927,862
 
$
4,466,451
 
$
4,432,166
 
$
4,395,509
 
$
4,360,740
 
Total stockholders' equity
 
$
2,199,805
 
$
2,233,122
 
$
2,316,188
 
$
2,350,045
 
$
2,365,970
 
$
2,400,255
 
$
2,474,105
 
$
2,508,874
 
 
   
   
   
   
   
   
   
   
 
Net cash provided by (used in) operating activities
 
$
99,228
 
$
95,573
 
$
181,857
 
$
179,287
 
$
591,039
 
$
586,006
   
($246,497
)
 
($250,784
)
Net cash used in investing activities
   
($451,322
)
 
($451,322
)
 
($59,909
)
 
($59,909
)
 
($96,395
)
 
($96,395
)
 
($159,650
)
 
($159,650
)
Net cash provided by (used in) financing activities
 
$
332,279
 
$
335,934
   
($78,422
)
 
($75,852
)
 
($119,498
)
 
($114,465
)
$
159,227
 
$
163,514
 
 
S-18

 
Humana Inc.
 
 
 
 
 
 
 
 
 
 
 
 
 
2003 Through 2005 Adjusted to Reflect Retrospective Application of Expensing Stock Options
 
In thousands, except per common share results
 
 
 
 
 
For the year ended
 
For the year ended
 
For the year ended
 
 
 
December 31, 2005
 
December 31, 2004
 
December 31, 2003
 
 
 
Reported
 
Adjusted (A)
 
Reported
 
Adjusted (A)
 
Reported
 
Adjusted (A)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Revenues
 
$
14,418,127
 
$
14,418,127
 
$
13,104,325
 
$
13,104,325
 
$
12,226,311
 
$
12,226,311
 
 
   
   
   
   
   
   
 
Pretax income:
   
   
   
   
   
   
 
Government
 
$
323,268
 
$
316,676
 
$
273,840
 
$
269,063
 
$
223,706
 
$
221,240
 
Commercial
   
98,446
   
86,204
   
142,010
   
130,315
   
121,010
   
114,973
 
Consolidated
 
$
421,714
 
$
402,880
 
$
415,850
 
$
399,378
 
$
344,716
 
$
336,213
 
 
   
   
   
   
   
   
 
Net income
 
$
308,483
 
$
296,730
 
$
280,012
 
$
269,947
 
$
228,934
 
$
223,739
 
 
   
   
   
   
   
   
 
Diluted earnings per common share
 
$
1.87
 
$
1.79
 
$
1.72
 
$
1.66
 
$
1.41
 
$
1.38
 
 
   
   
   
   
   
   
 
Shares used in computing diluted earnings per common share
   
165,374
   
165,560
   
162,456
   
162,905
   
161,960
   
162,406
 
 
   
   
   
   
   
   
 
SG&A expense ratio:
   
   
   
   
   
   
 
Government
   
12.6
%
 
12.7
%
 
12.2
%
 
12.3
%
 
13.4
%
 
13.5
%
Commercial
   
18.3
%
 
18.5
%
 
16.4
%
 
16.5
%
 
16.9
%
 
17.0
%
Consolidated
   
15.3
%
 
15.4
%
 
14.5
%
 
14.6
%
 
15.4
%
 
15.4
%
 
   
   
   
   
   
   
 
Total assets
 
$
6,869,614
 
$
6,869,614
 
$
5,657,617
 
$
5,657,617
 
$
5,379,814
 
$
5,379,814
 
Total liabilities
 
$
4,395,509
 
$
4,360,740
 
$
3,567,493
 
$
3,533,369
 
$
3,543,865
 
$
3,510,842
 
Total stockholders' equity
 
$
2,474,105
 
$
2,508,874
 
$
2,090,124
 
$
2,124,248
 
$
1,835,949
 
$
1,868,972
 
 
   
   
   
   
   
   
 
Net cash provided by operating activities
 
$
625,627
 
$
610,082
 
$
347,809
 
$
344,061
 
$
413,140
 
$
397,921
 
Net cash used in investing activities
   
($767,276
)
 
($767,276
)
 
($624,081
)
 
($624,081
)
 
($382,837
)
 
($382,837
)
Net cash provided by (used in) financing activities
 
$
293,586
 
$
309,131
   
($75,053
)
 
($71,305
)
$
179,744
 
$
194,963
 
 
   
   
   
   
   
   
 
 
   
   
   
   
   
   
 
 
S-19

 
 
Footnotes to Statistical Schedules and Supplementary Information
 
4Q06 Earnings Release
 
 
 
 
Footnote
 
(A)
Adjusted to include stock-based compensation expense. Under SFAS 123R, which the company adopted effective January 1, 2006 using the modified retrospective method, stock-based compensation expense is recognized based on the grant date fair value over the vesting period.
 
(B)
Computed based on average membership for the period (i.e., monthly ending membership during the period divided by the number of months in the period).
 
(C)
TRICARE revenues are not contracted on a per member basis.
 
(D)
In a limited number of circumstances, the company contracts with hospitals and physicians to accept financial risk for a defined set of HMO membership. In transferring this risk, the company prepays these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their capitated HMO membership, including some health benefit administrative functions and claims processing. For these capitated HMO arrangements, the company generally agrees 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.
 
(E)
In some circumstances, the company contracts 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, the company processes substantially all of the claims under these arrangements.
 
(F)
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). Other medical expenses payable includes amounts payable to providers under capitation arrangements.
 
(G)
TRICARE IBNR decreased since the prior year end due to favorable development as more fully discussed in Footnote M below.
 
(H)
TRICARE other medical expenses 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 the company's balance sheet).
 
(I)
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 the company's behalf. Reserves for TRICARE unprocessed claims inventory are included in TRICARE IBNR.
 
(J)
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.
 
(K)
The balance due to the company's pharmacy benefit administrator fluctuates as a result of the number of business days in the last payment cycle of the month. Payment cycles are every 10 days (10th & 20th of month) and the last day of the month.
 
(L)
Amounts incurred related to prior years vary from previously estimated liabilities as the claims ultimately are settled. Negative amounts reported for incurred related to prior years result from claims being ultimately settled for amounts less than originally estimated (favorable development). There were no changes in the approach used to determine our estimate of claim reserves during the quarter.
 
(M)
Changes in estimates of TRICARE incurred claims for prior years recognized during 2006 and 2005 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.
 
(N)
The receipt cycle time measures the average length of time between when a claim was initially incurred and when the claim form was received. Receipt cycle time data for our largest claim processing platforms represents approximately 70% of the company's fully insured claims volume. Pharmacy claims are excluded from this measurement.
 
(O)
A common metric for monitoring medical claim reserve levels relative to the medical claims expense 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 the company has some providers under capitation payment arrangements (which do not require a medical claim IBNR reserve), the company has also summarized this metric excluding capitation expense. In addition, this calculation excludes the impact of the company's stand-alone PDP business.
 
(P)
Excludes the impact of Medicare stand-alone PDPs.
 
(Q)
DCP fluctuates due to a number of issues, the more significant of which are detailed in the rollforward of DCP from the fourth quarter of the prior year. Growth in certain product lines can also impact DCP for the quarter since a provision for claims would not have been recorded for members that had not yet enrolled earlier in the quarter, yet those members would have a provision and corresponding reserve recorded upon enrollment later in the quarter.
 

S-20
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-----END PRIVACY-ENHANCED MESSAGE-----