EX-99 2 a5385745ex99.htm EXHIBIT 99 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 First Quarter 2007 Financial Results;
2007 EPS Guidance Raised

·  
1Q07 EPS of $0.42, above company’s previous expectations
·  
2007 EPS outlook raised to $4.10 to $4.25
·  
Commercial operations performing ahead of expectations
·  
Medicare operations on target
·  
Medicare Advantage enrollment increased 50 percent year over year



LOUISVILLE, KY (April 30, 2007) - Humana Inc. (NYSE: HUM) today reported $0.42 in diluted earnings per common share (EPS) for the quarter ended March 31, 2007 (1Q07), above the company’s previous guidance for 1Q07 EPS of $0.35 to $0.40. The company earned $0.50 per share for the quarter ended March 31, 2006 (1Q06), including a $0.19 per share benefit from the sale of a venture capital investment. Excluding the venture capital gain, the significant year-over-year increase in quarterly earnings resulted primarily from higher operating earnings in the company’s Commercial Segment.

Humana now estimates EPS for the year ending December 31, 2007 (FY07E) will be in the range of $4.10 to $4.25 versus $2.90 for the year ended December 31, 2006 (FY06), a growth rate of 41 to 47 percent.
 
“We were well prepared in the first quarter to execute successfully on another year's Medicare open enrollment while simultaneously improving Commercial results," said Michael B. McCallister, Humana's president and chief executive officer. "Based on our first quarter results, we feel comfortable raising our 2007 EPS guidance to a range that represents an increase of more than 40 percent over our record-breaking 2006 results.”

Revenues - 1Q07 consolidated revenues rose 32 percent to $6.20 billion from $4.70 billion in 1Q06, with total premium and administrative services fees up 33 percent compared to the prior year’s quarter primarily driven by higher average Medicare membership than in 1Q06.

1

Investment income of $73.5 million in 1Q07 compared to $98.9 million for 1Q06. The change in investment income resulted from the $51.7 million venture capital gain in 1Q06 that did not recur in 1Q07, partially offset by the ongoing investment income derived from higher average invested balances in 1Q07. Higher invested balances have resulted primarily from the company’s substantial growth in operations.

Other revenue of $30.9 million for 1Q07 compares favorably to $5.3 million for 1Q06. The increase was primarily driven by higher specialty product revenue associated with RightSourceSM, the company’s mail order pharmacy.

Medical costs - The company’s consolidated medical expense ratio (medical expenses as a percent of premium revenue or MER) of 86.8 percent in 1Q07 was 310 basis points higher than the 1Q06 MER of 83.7 percent due to an expected increase in the Government Segment MER outweighing significant improvement in that for the Commercial Segment.

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 260 basis points to 13.5 percent for 1Q07 from 16.1 percent in 1Q06. The year-over-year decline was primarily the result of administrative cost leverage associated with increased revenues from higher average medical membership.


Government Segment Results Summary

Pretax results:
·  
Government Segment pretax earnings were $17.9 million in 1Q07 compared to $21.6 million in 1Q06. As expected, this primarily reflects the higher first quarter MER associated with higher average Medicare membership with Part D benefits partially offset by administrative cost leverage and increasing investment income primarily derived from higher average invested balances.

Enrollment:
·  
Medicare Advantage membership grew to 1,113,400 at March 31, 2007, an increase of 372,200, or 50 percent, from March 31, 2006 and 110,800, or 11 percent, from December 31, 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 both year over year and sequentially. Medicare Advantage membership for April 2007 approximates 1,137,000, the result of strong sales results during the final two weeks of the open enrollment season for Medicare Advantage.
·  
Membership in the company’s stand-alone PDPs totaled 3,473,700 at March 31, 2007 compared to 1,959,000 at March 31, 2006.
·  
As expected, TRICARE membership of 2,878,400 at March 31, 2007 was essentially unchanged from both March 31, 2006 and December 31, 2006.
·  
Medicaid membership of 559,400 at March 31, 2007 increased 132,400 from March 31, 2006 due primarily to the award of a new Puerto Rico regional ASO contract during the fourth quarter of 2006, partially offset by eligible Puerto Rico Medicaid members choosing to move into the Medicare Advantage program.

2

Premiums and administrative services fees:
·  
Medicare Advantage premiums of $2.74 billion in 1Q07 increased 59 percent compared to $1.72 billion in 1Q06, 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 2006. Medicare Advantage premiums per member increased less than 1 percent year over year during 1Q07, reflecting the shift in membership mix to a higher percentage of lower premium Private Fee-for-Service products.
·  
TRICARE premiums and administrative services fees during 1Q07 increased to $741.5 million compared to $611.9 million in 1Q06.

Medical Expenses:
·  
The Government Segment MER increased 370 basis points to 89.3 percent in 1Q07 compared to 85.6 percent in the prior year’s quarter. This anticipated change in the MER for the Government Segment included the combined effect of the seasonally higher first quarter MER associated with Part D benefits together with approximately twice the average stand-alone PDP membership for 1Q07 versus 1Q06.

SG&A Expenses:
·  
The Government Segment’s SG&A expense ratio for 1Q07 of 10.8 percent was 300 basis points lower than that for 1Q06 of 13.8 percent primarily driven by the expense leverage provided by revenues associated with higher average medical membership for this segment.


Commercial Segment Results Summary

Pretax results:
·  
Commercial Segment pretax earnings were $94.4 million in 1Q07 compared to $109.6 million in 1Q06. Investment income for this segment in 1Q06 included a pretax gain of $45.3 million associated with the sale of a venture capital investment that did not recur in 1Q07. Commercial Segment operating earnings in 1Q07 continue to reflect the company’s commitment to underwriting discipline and strategic growth in select lines of business.

Enrollment:
·  
Commercial Segment medical membership of 3,257,500 at March 31, 2007 was essentially unchanged from March 31, 2006 and declined 26,300, or less than 1 percent, from December 31, 2006.
·  
Membership in the company’s Smart plans and other consumer offerings increased year over year by 56,300 or 14 percent to 471,300 at March 31, 2007. Medical members in these products comprise approximately 15 percent of Commercial medical membership at March 31, 2007 compared to 13 percent at March 31, 2006.
 
3

Premiums and administrative services fees:
·  
Premiums and administrative services fees for the Commercial Segment decreased 3 percent to $1.58 billion in 1Q07 compared to $1.62 billion in the prior year’s quarter, as an increase in administrative services fees resulting from a 10 percent increase in ASO membership was more than offset by lower premiums due to a year-over-year decline in at-risk enrollment.
·  
Commercial Segment medical premiums for fully insured groups increased approximately 5 percent on a per-member basis during 1Q07 compared to 1Q06.

Medical Expenses:
·  
In 1Q07, the Commercial Segment MER of 79.4 percent was 70 basis points lower than the 1Q06 MER of 80.1 percent, primarily reflecting improving medical cost utilization trends and the company’s continued commitment to underwriting discipline.

SG&A Expenses:
·  
The Commercial Segment SG&A expense ratio of 20.9 percent for 1Q07 compares to 20.4 percent in 1Q06, primarily the result of lower average fully-insured medical enrollment and an increase in the percentage of Commercial medical membership related to ASO.


Balance Sheet

·  
Cash and cash equivalents of $3.69 billion increased $1.95 billion or 112 percent sequentially primarily due to the early receipt of the April Medicare premium from the Centers for Medicare and Medicaid Services (CMS) and an increase in non-GAAP operating cash flows(a) during 1Q07.
 
·  
Unearned revenues of $1.33 billion increased significantly from the December 31, 2006 balance of $155.3 million also due to the timing of the receipt of Medicare premiums from CMS.
·  
Debt-to-total capitalization at March 31, 2007 was 29.6 percent, up 20 basis points from December 31, 2006 due primarily to 1Q07 borrowings against the company’s credit facility.
·  
The company’s working capital at March 31, 2007 included approximately $787.0 million in net Part D risk-share payables to CMS associated with the company’s Medicare Advantage and stand-alone PDP offerings. Approximately 94 percent of this liability relates to Part D plan offerings for the year ended December 31, 2006.
·  
Days in claims payable rose 1.8 days on a sequential basis to 62.0 days at March 31, 2007 from 60.2 days at December 31, 2006. The sequential increase in this metric is primarily due to the timing of the company’s payment to its pharmacy benefit administrator together with higher TRICARE reserve balances.


Cash Flows from Operations

Cash flows provided by operations for 1Q07 of $1.57 billion compared to cash provided by operations of $1.01 billion in 1Q06. The company also evaluates operating cash flows on a non-GAAP basis(a)(b).

4



Cash flows from operations
($ in millions)
 
1Q07
 
1Q06
 
GAAP cash flows provided by operations
 
$
1,574.5
 
$
1,008.0
 
Timing of premium payment from CMS(a)
   
(1,129.8
)
 
(774.7
)
Non-GAAP cash flows provided by operations(a)(b)
 
$
444.7
 
$
233.3
 

Non-GAAP cash flows provided by operations rose to $444.7 million(a)(b) in 1Q07 from $233.3 million(a)(b) in 1Q06 driven by growth in the company’s Medicare operations.


Footnotes

(a)
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.
(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.



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 Webcasts & Presentations section of the Investor Relations page at www.humana.com.

5

Cautionary Statement

This news release contains statements and earnings guidance points that are forward-looking. The forward-looking items herein are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking items may be significantly impacted by certain risks and uncertainties described in the company’s Form 10-K for the year ended December 31, 2006, as filed with the Securities and Exchange Commission.


About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health benefits companies, with approximately 11.3 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 reports to stockholders;
·
Securities and Exchange Commission filings;
·
Most recent investor conference presentations;
·
Quarterly earnings news releases;
·
Replay of most recent earnings release conference calls;
·
Calendar of events (includes upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors);
·
Corporate Governance information.
 
6

Humana Inc.
GAAP Guidance Points as of April 30, 2007
For the year ending  December 31, 2007
Comments
Diluted earnings per common share
FY07: $4.10 to $4.25 
2Q07: $1.15 to $1.20
2007 growth rate of 41% to 47%
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: 1,150,000 to 1,180,000; 
Medicare stand-alone PDPs: approximately 3.5 million;
TRICARE: No material change from prior year;
Medicaid: Down approximately 10,000;
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 4.5% to 5.5%; premium yields in line with medical cost trends
After the reset of the benefits on January 1 each year, progression through the Part D benefit stages results in a sequential quarterly improvement in the Medicare MER.
 
2007 secular Commercial medical cost trend components as follows: inpatient hospital utilization - flat to 1 percent; inpatient and outpatient hospital rates - mid to upper single digits; outpatient hospital utilization - low to mid single digits; physician - mid single digits; and pharmacy - low double digits.
Selling, general & administrative expenses
Consolidated SG&A expense ratio of 13% to 14%
 
Investment income and interest expense
Investment income of $290 million to $300 million;
Interest expense of approximately $70 million;
Net investment income by segment:
Approximately 60% Government; Approximately 40% Commercial
2007 is not forecast to include any material gains from venture capital investments due to fewer such investments now held by the company
 
Pretax results
Total Medicare products (Medicare Advantage and stand-alone PDP combined): 4% to 5% pretax margin;
TRICARE: Approximately 3% to 4% pretax margin;
Commercial Segment: $210 million to $230 million including no material benefit from venture capital gains
 
Cash flows from operations
$1.1 billion to $1.6 billion
Includes accrual for estimated Part D risk share payable for 2007 in the range of zero to $400 million
Capital expenditures
Approximately $200 million
 
Effective tax rate
Approximately 36% to 37%
 
Shares used in computing EPS
Approximately 171 million
 
 
7

 
Statistical Schedules
And
Supplementary Information
1Q07 Earnings Release

S-1

 
     
     
 
Humana Inc.
 
Statistical Schedules and Supplementary Information
 
1Q07 Earnings Release
     
 
Contents
 
     
 
Page
Description
     
 
S-3
1st Quarter Consolidated Statements of Income
 
S-4
Consolidated Balance Sheets
 
S-5
1st Quarter Consolidated Statements of Cash Flows
 
S-6
Key Income Statement Ratios and Segment Operating Results
 
S-7
Membership Detail
 
S-8
1st Quarter Premiums and Administrative Services Fees Detail
 
S-9
Percentage of Ending Membership under Capitation Arrangements
 
S-10
Detail of Medical and Other Expenses Payable Balance and Year-to-Date Changes
 
S-11-12
Medical Claims Reserves Statistics
 
S-13
Footnotes
     
 
S-2

 
                 
1st Quarter Consolidated Statements of Income
             
In thousands, except per common share results
                 
                   
   
Three Months Ended March 31,
         
           
Dollar
 
Percentage
 
   
2007
 
2006
 
Change
 
Change
 
Revenues:
 
 
             
Premiums
 
$
6,004,563
 
$
4,521,486
 
$
1,483,077
   
32.8
%
Administrative services fees
   
95,864
   
78,678
   
17,186
   
21.8
%
Investment income
   
73,527
   
98,902
   
(25,375
)
 
-25.7
%
Other revenue
   
30,859
   
5,299
   
25,560
   
482.4
%
Total revenues
   
6,204,813
   
4,704,365
   
1,500,448
   
31.9
%
Operating expenses:
   
                   
Medical
   
5,214,000
   
3,783,926
   
1,430,074
   
37.8
%
Selling, general and administrative
   
820,610
   
740,886
   
79,724
   
10.8
%
Depreciation
   
35,509
   
29,852
   
5,657
   
19.0
%
Other intangible amortization
   
4,555
   
5,054
   
(499
)
 
-9.9
%
Total operating expenses
   
6,074,674
   
4,559,718
   
1,514,956
   
33.2
%
Income from operations
   
130,139
   
144,647
   
(14,508
)
 
-10.0
%
Interest expense
   
17,918
   
13,439
   
4,479
   
33.3
%
Income before income taxes
   
112,221
   
131,208
   
(18,987
)
 
-14.5
%
Provision for income taxes
   
40,980
   
47,493
   
(6,513
)
 
-13.7
%
Net income
 
$
71,241
 
$
83,715
   
($12,474
)
 
-14.9
%
     
                   
Basic earnings per common share
 
$
0.43
 
$
0.51
   
($0.08
)
 
-15.7
%
Diluted earnings per common share
 
$
0.42
 
$
0.50
   
($0.08
)
 
-16.0
%
     
                   
Shares used in computing basic earnings per common share
   
165,813
   
163,116
             
Shares used in computing diluted earnings per common share
   
168,956
   
167,325
             
                           
 
S-3

 
                 
Consolidated Balance Sheets
                 
Dollars in thousands, except share amounts
 
 
             
   
March 31,
 
December 31,
 
Sequential Change
 
   
2007
 
2006
 
Dollar
 
Percent
 
Assets
 
 
             
Current assets:
 
 
             
Cash and cash equivalents
 
$
3,694,059
 
$
1,740,304
             
Investment securities
   
3,154,920
   
3,192,273
             
Receivables, net:
   
   
             
Premiums
   
826,314
   
667,657
             
Administrative services fees
   
10,806
   
13,284
             
Securities lending collateral
   
1,049,195
   
627,990
             
Other
   
1,135,298
   
1,091,465
             
Total current assets
   
9,870,592
   
7,332,973
 
$
2,537,619
   
34.6
%
Property and equipment
   
571,405
   
545,004
             
Other assets:
   
   
             
Long-term investment securities
   
380,138
   
414,877
             
Goodwill
   
1,331,418
   
1,310,631
             
Other
   
552,572
   
524,011
             
Total other assets
   
2,264,128
   
2,249,519
             
Total assets
 
$
12,706,125
 
$
10,127,496
 
$
2,578,629
   
25.5
%
     
   
             
Liabilities and Stockholders' Equity
   
   
             
Current liabilities:
   
   
             
Medical and other expenses payable
 
$
2,886,214
 
$
2,488,261
             
Trade accounts payable and accrued expenses
   
1,977,465
   
1,626,658
             
Book overdraft
   
284,572
   
293,605
             
Securities lending payable
   
1,049,195
   
627,990
             
Unearned revenues
   
1,330,325
   
155,298
             
Total current liabilities
   
7,527,771
   
5,191,812
 
$
2,335,959
   
45.0
%
Long-term debt
   
1,329,334
   
1,269,100
             
Other long-term liabilities
   
689,493
   
612,698
             
Total liabilities
   
9,546,598
   
7,073,610
 
$
2,472,988
   
35.0
%
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;
   
   
             
184,476,052 issued at March 31, 2007
   
30,746
   
30,491
             
Capital in excess of par value
   
1,393,582
   
1,357,077
             
Retained earnings
   
1,980,339
   
1,909,098
             
Accumulated other comprehensive loss
   
(8,378
)
 
(13,205
)
           
Treasury stock, at cost, 16,439,060 shares at March 31, 2007
   
(236,762
)
 
(229,575
)
           
Total stockholders' equity
   
3,159,527
   
3,053,886
 
$
105,641
   
3.5
%
Total liabilities and stockholders' equity
 
$
12,706,125
 
$
10,127,496
 
$
2,578,629
   
25.5
%
     
   
             
Debt-to-total capitalization ratio
   
29.6
%
 
29.4
%
           
S-4

 
Humana Inc.
 
 
 
 
 
 
 
 
 
1st Quarter Consolidated Statements of Cash Flows
 
 
 
 
 
 
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended March 31,
 
 
 
 
 
 
 
 
 
 
 
Dollar
 
Percentage
 
 
 
2007
 
2006
 
Change
 
Change
 
Cash flows from operating activities
 
 
 
 
 
 
 
 
 
Net income
 
$
71,241
 
$
83,715
   
   
 
Adjustments to reconcile net income to net cash provided by operating activities:
   
   
   
   
 
Depreciation and amortization
   
40,064
   
34,906
   
   
 
Stock-based compensation
   
9,802
   
6,580
   
   
 
Benefit for deferred income taxes
   
(6,111
)
 
(3,705
)
 
   
 
Changes in operating assets and liabilities excluding
   
   
   
   
 
the effects of acquisitions:
   
   
   
   
 
Receivables
   
(156,179
)
 
(46,061
)
 
   
 
Other assets
   
(18,945
)
 
(185,250
)
 
   
 
Medical and other expenses payable
   
397,953
   
259,807
   
   
 
Other liabilities
   
58,652
   
114,752
   
   
 
Unearned revenues
   
1,175,027
   
800,189
   
   
 
Other
   
2,977
   
(56,960
)
 
   
 
Net cash provided by operating activities
   
1,574,481
   
1,007,973
 
$
566,508
   
56.2
%
 
   
   
   
   
 
Cash flows from investing activities
   
   
   
   
 
Acquisitions, net of cash acquired
   
(26,781
)
 
(113
)
 
   
 
Purchases of property and equipment
   
(70,744
)
 
(45,261
)
 
   
 
Proceeds from sales of property and equipment
   
4,070
   
2,138
   
   
 
Purchases of investment securities
   
(965,051
)
 
(1,663,658
)
 
   
 
Proceeds from maturities of investment securities
   
557,485
   
910,108
   
   
 
Proceeds from sales of investment securities
   
481,911
   
559,830
   
   
 
Change in securities lending collateral
   
(421,205
)
 
(202,712
)
 
   
 
Net cash used in investing activities
   
(440,315
)
 
(439,668
)
 
($647
)
 
-0.1
%
 
   
   
   
   
 
Cash flows from financing activities
   
   
   
   
 
Receipts from CMS contract deposits
   
843,637
   
494,194
   
   
 
Withdrawals from CMS contract deposits
   
(515,705
)
 
(273,444
)
 
   
 
Borrowings under credit agreement
   
310,000
   
100,000
   
   
 
Repayments under credit agreement
   
(250,000
)
 
-
   
   
 
Change in book overdraft
   
(9,033
)
 
(4,418
)
 
   
 
Change in securities lending payable
   
421,205
   
202,712
   
   
 
Common stock repurchases
   
(7,187
)
 
(105
)
 
   
 
Tax benefit from stock-based compensation
   
9,128
   
8,404
   
   
 
Proceeds from stock option exercises and other
   
17,544
   
15,741
   
   
 
Net cash provided by financing activities
   
819,589
   
543,084
 
$
276,505
   
50.9
%
 
   
   
   
   
 
Increase in cash and cash equivalents
   
1,953,755
   
1,111,389
   
   
 
Cash and cash equivalents at beginning of period
   
1,740,304
   
732,016
   
   
 
 
   
   
   
   
 
Cash and cash equivalents at end of period
 
$
3,694,059
 
$
1,843,405
   
   
 
 
S-5


Humana Inc.
 
 
 
 
 
 
 
 
 
Key Income Statement Ratios and Segment Operating Results
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended March 31,
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage
 
 
 
2007
 
2006
 
Difference
 
Change
 
Medical expense ratio
 
 
 
 
 
 
 
 
 
Government Segment
   
89.3
%
 
85.6
%
 
3.7
%
 
 
Commercial Segment
   
79.4
%
 
80.1
%
 
-0.7
%
 
 
Consolidated
   
86.8
%
 
83.7
%
 
3.1
%
 
 
 
   
   
   
   
 
Selling, general, and administrative
   
   
   
   
 
expense ratio
   
   
   
   
 
Government Segment
   
10.8
%
 
13.8
%
 
-3.0
%
 
 
Commercial Segment
   
20.9
%
 
20.4
%
 
0.5
%
 
 
Consolidated
   
13.5
%
 
16.1
%
 
-2.6
%
 
 
 
   
   
   
   
 
 
   
   
   
   
 
Detail of Pretax Income
   
   
   
   
 
Government Segment
 
$
17,865
 
$
21,572
   
($3,707
)
 
-17.2
%
Commercial Segment
   
94,356
   
109,636
   
(15,280
)
 
-13.9
%
Consolidated
 
$
112,221
 
$
131,208
   
($18,987
)
 
-14.5
%
 
   
   
   
   
 
Detail of Pretax Margins
   
   
   
   
 
Government Segment
   
0.4
%
 
0.7
%
 
-0.3
%
 
 
Commercial Segment
   
5.8
%
 
6.4
%
 
-0.6
%
 
 
Consolidated
   
1.8
%
 
2.8
%
 
-1.0
%
 
 

S-6

 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
Membership Detail
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
In thousands
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
     
 
     
Year-over-year Change
   
Ending
 
Sequential Change
 
 
 
Ending
March 31, 2007
 
Average - 1Q07
 
Ending
March 31, 2006
 
Amount
 
Percent
   
December 31, 2006
 
Amount
 
Percent
 
Medical Membership:
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
Medicare Advantage - HMO
   
462.1
   
461.4
   
443.7
   
18.4
   
4.1
%
   
457.9
   
4.2
   
0.9
%
Medicare Advantage - PPO
   
64.6
   
63.9
   
35.4
   
29.2
   
82.5
%
   
71.7
   
(7.1
)
 
-9.9
%
Medicare Advantage - PFFS
   
586.7
   
574.6
   
262.1
   
324.6
   
123.8
%
   
473.0
   
113.7
   
24.0
%
Total Medicare Advantage
   
1,113.4
   
1,099.9
   
741.2
   
372.2
   
50.2
%
   
1,002.6
   
110.8
   
11.1
%
Medicare - PDP - Standard
   
2,146.2
   
2,151.9
   
1,289.2
   
857.0
   
66.5
%
   
2,097.2
   
49.0
   
2.3
%
Medicare - PDP - Enhanced
   
1,084.0
   
1,090.7
   
421.0
   
663.0
   
157.5
%
   
1,025.4
   
58.6
   
5.7
%
Medicare - PDP - Complete
   
243.5
   
250.2
   
248.8
   
(5.3
)
 
-2.1
%
   
414.0
   
(170.5
)
 
-41.2
%
Total Medicare stand-alone
PDPs
   
3,473.7
   
3,492.8
   
1,959.0
   
1,514.7
   
77.3
%
   
3,536.6
   
(62.9
)
 
-1.8
%
Total Medicare
   
4,587.1
   
4,592.7
   
2,700.2
   
1,886.9
   
69.9
%
   
4,539.2
   
47.9
   
1.1
%
TRICARE insured
   
1,712.9
   
1,718.0
   
1,724.7
   
(11.8
)
 
-0.7
%
   
1,716.4
   
(3.5
)
 
-0.2
%
TRICARE ASO
   
1,165.5
   
1,168.3
   
1,149.3
   
16.2
   
1.4
%
   
1,163.6
   
1.9
   
0.2
%
Total TRICARE
   
2,878.4
   
2,886.3
   
2,874.0
   
4.4
   
0.2
%
   
2,880.0
   
(1.6
)
 
-0.1
%
Medicaid insured
   
384.0
   
387.4
   
427.0
   
(43.0
)
 
-10.1
%
   
390.7
   
(6.7
)
 
-1.7
%
Medicaid ASO
   
175.4
   
178.2
   
-
   
175.4
   
100.0
%
   
178.4
   
(3.0
)
 
-1.7
%
Total Medicaid
   
559.4
   
565.6
   
427.0
   
132.4
   
31.0
%
   
569.1
   
(9.7
)
 
-1.7
%
Total Government Segment
   
8,024.9
   
8,044.6
   
6,001.2
   
2,023.7
   
33.7
%
   
7,988.3
   
36.6
   
0.5
%
Commercial Segment:
   
   
   
   
   
     
   
   
 
Fully insured medical:
   
   
   
   
   
     
   
   
 
Group
   
1,528.6
   
1,531.8
   
1,695.1
   
(166.5
)
 
-9.8
%
   
1,563.9
   
(35.3
)
 
-2.3
%
Individual
   
192.1
   
187.9
   
163.1
   
29.0
   
17.8
%
   
182.6
   
9.5
   
5.2
%
Medicare supplement
   
7.4
   
7.5
   
6.0
   
1.4
   
23.3
%
   
7.7
   
(0.3
)
 
-3.9
%
Total fully insured medical
   
1,728.1
   
1,727.2
   
1,864.2
   
(136.1
)
 
-7.3
%
   
1,754.2
   
(26.1
)
 
-1.5
%
ASO
   
1,529.4
   
1,533.0
   
1,395.2
   
134.2
   
9.6
%
   
1,529.6
   
(0.2
)
 
0.0
%
Total Commercial Segment
   
3,257.5
   
3,260.2
   
3,259.4
   
(1.9
)
 
-0.1
%
   
3,283.8
   
(26.3
)
 
-0.8
%
 
   
   
   
   
   
     
   
   
 
Total medical membership
   
11,282.4
   
11,304.8
   
9,260.6
   
2,021.8
   
21.8
%
   
11,272.1
   
10.3
   
0.1
%
 
   
   
   
   
   
     
   
   
 
 
   
   
   
   
   
     
   
   
 
Specialty Membership (all Commercial Segment)
 
   
   
   
     
   
   
 
Dental - fully insured
   
980.5
   
984.2
   
950.6
   
29.9
   
3.1
%
   
959.8
   
20.7
   
2.2
%
Dental - ASO
   
503.7
   
499.2
   
494.7
   
9.0
   
1.8
%
   
492.2
   
11.5
   
2.3
%
Total dental
   
1,484.2
   
1,483.4
   
1,445.3
   
38.9
   
2.7
%
   
1,452.0
   
32.2
   
2.2
%
Group life
   
437.9
   
437.3
   
421.3
   
16.6
   
3.9
%
   
436.8
   
1.1
   
0.3
%
Short-term disability
   
13.1
   
13.4
   
15.7
   
(2.6
)
 
-16.6
%
   
14.0
   
(0.9
)
 
-6.4
%
Total specialty membership
   
1,935.2
   
1,934.1
   
1,882.3
   
52.9
   
2.8
%
   
1,902.8
   
32.4
   
1.7
%
 
   
   
   
   
   
     
   
   
 
 
S-7

 
 
 
 
 
 
 
 
 
   
 
 
 
 
1st Quarter Premiums and Administrative Services Fees Detail
 
 
   
 
 
 
 
Dollars in thousands, except per member per month
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
Per Member per Month (A)
 
 
 
Three Months Ended March 31,
 
 
 
 
   
Three Months Ended March 31,
 
 
 
 
 
 
 
Dollar
 
Percentage
   
 
 
 
 
 
 
2007
 
2006
 
Change
 
Change
   
2007
 
2006
 
Premium revenues
 
 
 
 
 
 
 
 
   
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
   
 
 
 
 
Medicare Advantage
 
$
2,742,711
 
$
1,720,843
 
$
1,021,868
   
59.4
%
 
$
831
 
$
830
 
Medicare stand-alone PDPs
   
906,426
   
515,157
 
$
391,269
   
76.0
%
 
$
87
 
$
99
 
Total Medicare
   
3,649,137
   
2,236,000
   
1,413,137
   
63.2
%
   
   
 
TRICARE insured (B)
   
727,215
   
600,754
   
126,461
   
21.1
%
 
$
141
 
$
116
 
Medicaid insured
   
129,325
   
129,467
   
(142
)
 
-0.1
%
 
$
111
 
$
99
 
Total Government Segment premiums
   
4,505,677
   
2,966,221
   
1,539,456
   
51.9
%
   
   
 
Commercial Segment:
   
   
   
   
     
   
 
Fully insured medical
   
1,390,805
   
1,453,932
   
(63,127
)
 
-4.3
%
 
$
268
 
$
259
 
Specialty
   
108,081
   
101,333
   
6,748
   
6.7
%
 
$
22
 
$
21
 
Total Commercial Segment premiums
   
1,498,886
   
1,555,265
   
(56,379
)
 
-3.6
%
   
   
 
Total premium revenues
 
$
6,004,563
 
$
4,521,486
 
$
1,483,077
   
32.8
%
   
   
 
 
   
   
   
   
     
   
 
 
   
   
   
   
     
   
 
Administrative services fees
   
   
   
   
     
   
 
TRICARE ASO (B)
 
$
14,294
 
$
11,191
 
$
3,103
   
27.7
%
 
$
4
 
$
3
 
Medicaid ASO
   
2,096
   
-
   
2,096
   
100.0
%
 
$
4
   
-
 
Total Government Segment
   
16,390
   
11,191
   
5,199
   
46.5
%
   
   
 
Commercial Segment
   
79,474
   
67,487
   
11,987
   
17.8
%
 
$
13
 
$
12
 
Total administrative services fees
 
$
95,864
 
$
78,678
 
$
17,186
   
21.8
%
   
   
 
 
   
   
   
   
     
   
 
 
S-8

 
Humana Inc.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage of Ending Membership under Capitation Arrangements
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
 
Commercial Segment
 
 
 
March 31, 2007
 
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 (C)
   
2.5
%
 
-
   
-
   
-
   
0.4
%
 
1.5
%
 
-
   
0.8
%
 
0.5
%
Capitated HMO physician group based (C)
   
2.1
%
 
-
   
-
   
25.9
%
 
2.1
%
 
1.5
%
 
-
   
0.8
%
 
1.7
%
Risk-sharing (D)
   
25.5
%
 
-
   
-
   
42.3
%
 
6.5
%
 
1.6
%
 
-
   
0.8
%
 
4.9
%
All other membership
   
69.9
%
 
100.0
%
 
100.0
%
 
31.8
%
 
91.0
%
 
95.4
%
 
100.0
%
 
97.6
%
 
92.9
%
Total medical membership
   
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
   
   
   
   
   
   
   
   
   
 
March 31, 2006
   
   
   
   
   
   
   
   
   
 
 
   
   
   
   
   
   
   
   
   
 
Capitated HMO hospital system based (C)
   
4.5
%
 
-
   
-
   
-
   
0.6
%
 
2.0
%
 
-
   
1.1
%
 
0.8
%
Capitated HMO physician group based (C)
   
3.2
%
 
-
   
-
   
35.5
%
 
2.9
%
 
1.8
%
 
-
   
1.0
%
 
2.2
%
Risk-sharing (D)
   
31.9
%
 
-
   
-
   
59.6
%
 
8.2
%
 
2.3
%
 
-
   
1.3
%
 
5.8
%
All other membership
   
60.4
%
 
100.0
%
 
100.0
%
 
4.9
%
 
88.3
%
 
93.9
%
 
100.0
%
 
96.6
%
 
91.2
%
Total medical membership
   
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
   
   
   
   
   
   
   
   
   
 

S-9

 
Humana Inc.
 
 
 
 
 
 
 
Detail of Medical and Other Expenses Payable Balance and Year-to-Date Changes
 
Dollars in thousands
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
March 31,
 
March 31,
 
December 31,
 
 
 
2007
 
2006
 
2006
 
Detail of medical and other expenses payable
 
 
 
 
 
 
 
IBNR and other medical expenses payable (E)
 
$
1,869,209
 
$
1,313,806
 
$
1,686,051
 
TRICARE IBNR (F)
   
361,786
   
346,774
   
318,583
 
TRICARE other medical expenses payable (G)
   
97,994
   
90,073
   
94,699
 
Unprocessed claim inventories (H)
   
222,300
   
185,300
   
218,400
 
Processed claim inventories (I)
   
135,241
   
83,945
   
115,424
 
Payable to pharmacy benefit administrator (J)
   
199,684
   
149,591
   
55,104
 
Total medical and other expenses payable
 
$
2,886,214
 
$
2,169,489
 
$
2,488,261
 
 
 
 
 
 
 
 
 
 
 
 
Three Months Ended
 
Three Months Ended
 
Year Ended
 
 
 
March 31, 2007
 
March 31, 2006
 
December 31, 2006
 
Year-to-date changes in medical and other
 
 
 
 
 
 
 
expenses payable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balances at January 1
 
$
2,488,261
 
$
1,909,682
 
$
1,909,682
 
 
   
   
   
 
Acquisitions
   
-
   
-
   
21,198
 
 
   
   
   
 
Incurred related to:
   
   
   
 
Current year (K)
   
5,370,722
   
3,968,602
   
17,696,654
 
Prior years - non-TRICARE (K)
   
(148,777
)
 
(125,469
)
 
(178,998
)
Prior years - TRICARE (L)
   
(7,945
)
 
(59,207
)
 
(96,452
)
Total incurred
   
5,214,000
   
3,783,926
   
17,421,204
 
 
   
   
   
 
Paid related to:
   
   
   
 
Current year
   
(3,800,981
)
 
(2,644,110
)
 
(15,532,079
)
Prior years
   
(1,015,066
)
 
(880,009
)
 
(1,331,744
)
Total paid
   
(4,816,047
)
 
(3,524,119
)
 
(16,863,823
)
 
   
   
   
 
Balances at end of period
 
$
2,886,214
 
$
2,169,489
 
$
2,488,261
 
 
S-10

 
 
 
 
 
 
 
 
 
 
Medical Claims Reserves Statistics
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Receipt Cycle Time (M)
 
 
 
 
 
 
 
 
 
2007
 
2006
 
Change
 
Percentage Change
 
1st Quarter Average
   
15.6
   
16.1
   
(0.5
)
 
-3.1
%
2nd Quarter Average
   
-
   
15.8
   
N/A
   
N/A
 
3rd Quarter Average
   
-
   
16.0
   
N/A
   
N/A
 
4th Quarter Average
   
-
   
15.8
   
N/A
   
N/A
 
Full Year Average
   
15.6
   
15.9
   
(0.3
)
 
-1.9
%
 
   
   
   
   
 
 
   
   
   
   
 
Unprocessed Claims Inventories
 
   
   
 
 
   
   
   
   
 
Date
   
Estimated Valuation (000's)
 
 
Claim Item Counts
   
Number of Days on Hand
   
 
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
   
 
3/31/2007
 
$
222,300
   
747,200
   
5.5
   
 
 
   
   
   
   
 
 
S-11

 
 
 
 
 
 
 
 
 
 
Medical Claims Reserves Statistics (Continued)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Days in Claims Payable (N)
 
 
 
 
 
 
 
 
 
Quarter Ended
Days in Claim Payable (DCP)
Annual Change
Percentage Change
 
DCP Excluding Capitation
 
Annual Change
Percentage Change
 
 
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%
 
 
3/31/2007
62.0
2.9  
4.9%
 
67.8
 
2.3  
3.5%
 
 
 
 
 
 
 
 
 
 
 
 
Year-to-Date Change in Days in Claims Payable (O) (P)
 
 
 
 
 
 
 
 
 
 
 
2007
 
2006
 
 
 
 
DCP - 4th quarter of prior year
 
60.2  
 
60.3  
 
 
 
 
 
Components of year-to-date change in DCP:
 
 
 
 
 
 
 
 
 
Change in claims receipt cycle time
 
(0.7 )
)
(1.6 )
 
 
 
 
Change in unprocessed claims inventories
 
0.1 
 
1.7  
 
 
 
 
 
Change in processed claims inventories
 
0.4 
 
0.8  
 
 
 
 
 
Change in TRICARE reserve balances
 
1.0 
 
(2.1 )
)
 
 
 
 
Change in pharmacy payment cutoff
 
1.2 
 
(1.3 )
)
 
 
 
 
Change in provider payables under risk arrangements
0.2 
 
1.9  
 
 
 
 
 
All other
 
 
(0.4  )
)
0.5  
 
 
 
 
DCP - current quarter
 
 
62.0  
 
60.2  
 
 
 
 

S-12

 
 
Footnotes to Statistical Schedules and Supplementary Information
 
1Q07 Earnings Release
 
 
 
Footnote
 
(A)
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).
 
(B)
TRICARE revenues are not contracted on a per member basis.
 
(C)
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. 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 physicians and hospitals for services rendered to their HMO membership.
 
(D)
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.
 
(E)
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.
 
(F)
TRICARE IBNR primarily fluctuates due to medical expense inflation and changes in the utilization of benefits.
 
(G)
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).
 
(H)
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.
 
(I)
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.
 
(J)
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.
 
(K)
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.
 
(L)
Changes in estimates of TRICARE incurred claims for prior years result 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.
 
(M)
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 75% of the company's fully insured claims volume. Pharmacy claims are excluded from this measurement.
 
(N)
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.
 
(O)
Excludes the impact of Medicare stand-alone PDPs.
 
(P)
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-13