EX-99 2 a5456028ex99.htm EXHIBIT 99 a5456028ex99.htm
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 Reports Detailed Second Quarter 2007 Financial Results

 
·
Full year EPS expected to grow more than 50 percent in 2007
 
·
Lower administrative costs primarily from efficiency and productivity gains
 
·
Improving medical expense ratios in both segments
 
·
GAAP cash flows from operations up 33 percent year to date
 
·
Non-GAAP cash flows from operations up 71 percent year to date
 
 
LOUISVILLE, KY (July 30, 2007) – Humana Inc. (NYSE: HUM) today reported financial results for the quarter ended June 30, 2007 (2Q07) including diluted earnings per common share (EPS) of $1.28, as announced in the company’s July 18, 2007 press release.  The company earned $0.53 per share for the quarter ended June 30, 2006 (2Q06).  The year-over-year improvement in second quarter results reflected higher operating earnings in both of the company’s business segments, primarily driven by efficiency gains in its consolidated administrative costs as well as medical expense ratio improvement.

As also announced on July 18, 2007, the company estimates EPS for the year ending December 31, 2007 (FY07E) will be in the range of $4.40 to $4.50 versus $2.90 for the year ended December 31, 2006 (FY06).

“An across-the-board focus on operational excellence led to an extremely strong second quarter,” said Michael B. McCallister, Humana's president and chief executive officer. “These same dynamics are expected to fuel Humana’s performance for the remainder of the year and position us well for growth into the future.”

For the six months ended June 30, 2007 (1H07) the company reported $1.70 in EPS compared to $1.03 for the six months ended June 30, 2006 (1H06).  Results for 1H06 included approximately $0.19 per share of venture capital gains that did not recur in 1H07.  The year-over-year increase in 1H07 financial results was primarily due to better operating performance in both business segments.
1

 
Revenues– 2Q07 consolidated revenues rose 19 percent to $6.43 billion from $5.41 billion in 2Q06, with total premium and administrative services fees up 18 percent compared to the prior year’s quarter. This year-over-year increase was primarily driven by higher average Medicare membership versus 2Q06.

1H07 consolidated revenues rose 25 percent to $12.63 billion from $10.11 billion in 1H06 with total premium and administrative services fees up 25 percent compared to the prior year’s period, also primarily driven by higher average enrollment in the company’s Medicare plans.

Medical costs– The 2Q07 consolidated medical expense ratio (medical expenses as a percent of premium revenues or MER) of 83.4 percent was 170 basis points lower than the 2Q06 MER of 85.1 percent as a result of MER improvement in both the Government and Commercial segments.

The consolidated MER for 1H07 of 85.1 percent was 70 basis points higher than the 1H06 consolidated MER of 84.4 percent, as the year-over-year increase in the Government Segment MER resulting from the Medicare Part D claims pattern outweighed the improvement in the Commercial Segment MER.

Selling, general, & administrative (SG&A) expenses– The 2Q07 consolidated SG&A expense ratio (SG&A expenses as a percent of premiums, administrative services fees and other revenue) decreased 70 basis points to 13.0 percent for 2Q07 from 13.7 percent in 2Q06.  The year-over-year decline was primarily the result of improving administrative cost efficiency and productivity gains associated with servicing the company’s 11.3 million medical members.

The SG&A expense ratio for 1H07 of 13.2 percent was 160 basis points lower than that for 1H06 of 14.8 percent also primarily driven by efficiency and productivity gains.
 
Government Segment Results Summary

Pretax results:
 
·
Government Segment pretax earnings were $288.8 million in 2Q07 compared to $98.0 million in 2Q06.  As expected, this primarily reflects a more normal MER pattern for the Part D benefit for 2007 as well as administrative cost efficiency associated with higher average Medicare medical membership.  The extended enrollment period for this benefit during 2006 distorted the claims pattern associated with the beneficiaries’ progression through the Part D benefit stages in the prior year.
 
·
For 1H07, pretax earnings for the Government Segment of $306.7 million increased by $187.1 million, or 157 percent versus 1H06 pretax earnings for the segment of $119.6 million, primarily reflecting the same factors impacting the year-over-year comparison for the second quarter.

Enrollment:
 
·
Medicare Advantage membership grew to 1,133,700 at June 30, 2007, an increase of 173,900, or 18 percent, from June 30, 2006 and 20,300, or 2 percent, from March 31, 2007.  Average Medicare Advantage membership for 2Q07 was up 28 percent compared to that for 2Q06.  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.
 
2

 
 
·
Membership in the company’s stand-alone Prescription Drug Plans (PDPs) totaled 3,440,100 at June 30, 2007 compared to 3,458,800 at June 30, 2006 and 3,473,700 at March 31, 2007.  Average stand-alone PDP membership was 21 percent higher in 2Q07 than 2Q06.
 
·
TRICARE membership of 2,868,200 at June 30, 2007 was essentially unchanged from both June 30, 2006 and March 31, 2007.
 
·
Medicaid membership of 567,600 at June 30, 2007 increased 149,100 from June 30, 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.

Premiums and administrative services fees:
 
·
Medicare Advantage premiums of $2.80 billion in 2Q07 increased 33 percent compared to $2.11 billion in 2Q06, primarily the result of higher average membership.
 
·
Medicare stand-alone Part D premiums of $1.05 billion in 2Q07 increased 31 percent compared to $801.8 million in 2Q06, primarily the result of higher average membership.
 
·
TRICARE premiums and administrative services fees during 2Q07 increased $71.8 million to $740.6 million compared to $668.8 million in 2Q06.

Medical Expenses:
 
·
The Government Segment MER decreased 170 basis points to 84.3 percent in 2Q07 compared to 86.0 percent in the prior year’s quarter.  This decrease reflects a more normalized MER pattern for the Medicare Part D benefit for 2007.  The extended enrollment period for this benefit during the prior year distorted the claims pattern associated with the beneficiaries’ progression through the Part D benefit stages in 2006.

SG&A Expenses:
 
·
The Government Segment’s SG&A expense ratio for 2Q07 of 10.0 percent was 150 basis points lower than that for 2Q06 of 11.5 percent primarily driven by efficiency and productivity gains associated with servicing higher average Medicare membership.  The 2Q07 SG&A expense ratio was approximately 30 basis points lower than previously expected primarily due to improving staffing metrics and enhanced processes associated with servicing its Medicare business.

Commercial Segment Results Summary

Pretax results:
 
·
Commercial Segment pretax earnings were $50.8 million in 2Q07 compared to $42.3 million in 2Q06. Commercial Segment operating earnings in 2Q07 continue to reflect the company’s commitment to underwriting discipline and strategic growth in select lines of business.
 
·
For 1H07, pretax earnings for the Commercial Segment of $145.2 million were $6.8 million, or 5 percent lower than 1H06 pretax earnings for the segment of $152.0 million as a result of a $45.3 million pretax gain associated with the sale of a venture capital investment that occurred in 1Q06.
 
3

 
Enrollment:
 
·
Commercial Segment medical membership of 3,278,700 at June 30, 2007 was essentially unchanged from both June 30, 2006 and March 31, 2007.
 
·
Membership in the company’s Smart plans and other consumer offerings grew to 480,900 at June 30, 2007, an increase of 64,500, or 15 percent, from June 30, 2006 and 9,600, or 2 percent, from March 31, 2007. Medical members in these products comprise approximately 15 percent of Commercial medical membership at June 30, 2007 and March 31, 2007 compared to 13 percent at June 30, 2006.

Premiums and administrative services fees:
 
·
Premiums and administrative services fees for the Commercial Segment decreased 3 percent to $1.59 billion in 2Q07 compared to $1.64 billion in the prior year’s quarter, primarily due to lower average commercial fully-insured membership, down 8 percent year over year, as well as a shift in business mix from fully-insured to ASO enrollment.
 
·
Commercial Segment medical premiums for fully-insured groups increased approximately 5 percent on a per-member basis during 2Q07 compared to 2Q06.

Medical Expenses:
 
·
In 2Q07, the Commercial Segment MER of 80.7 percent was 220 basis points lower than the 2Q06 MER of 82.9 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 21.8 percent for 2Q07 compares to 18.7 percent in 2Q06, primarily the combined result of higher average ASO membership and administrative costs associated with increased business for the company’s mail order pharmacy.  Average ASO membership increased 8 percent versus the prior year’s quarter.

Balance Sheet

 
·
Cash and cash equivalents of $3.72 billion increased $26.7 million or 1 percent sequentially.  The early receipt of the April Medicare premium from the Centers for Medicare and Medicaid Services (CMS) during 1Q07 was essentially offset by the early receipt of the July Medicare premium from CMS during 2Q07.
 
·
Parent company cash and investments decreased to $419.3 million at June 30, 2007 from $424.4 million at December 31, 2006.
 
·
Unearned revenues of $1.36 billion increased 2 percent from the March 31, 2007 balance of $1.33 billion also due to the timing of the receipts of Medicare premiums from CMS.
 
·
Debt-to-total capitalization at June 30, 2007 was 26.1 percent, down 350 basis points from March 31, 2007 due primarily to the repayment of 1Q07 borrowings against the company’s credit facility.
 
·
The company’s working capital at June 30, 2007 included approximately $690.2 million in net Part D risk-share payables to CMS associated with the company’s Medicare Advantage and stand-alone PDP offerings.  Approximately $728.1 million of this net liability related to Part D plan offerings for the year ended December 31, 2006.
 
4

 
 
·
Days in claims payable excluding the impact of Medicare stand-alone PDPs were up slightly to 62.4 days at June 30, 2007 from 62.0 days at March 31, 2007.

Cash Flows from Operations

Cash flows provided by operations for 2Q07 of $477.3 million compared to cash provided by operations of $534.9 million in 2Q06.
 
 
Cash flows from operations
($ in millions)
2Q07
   
2Q06
   
1H07
   
1H06
 
 
Cash flows provided by operations in accordance with Generally Accepted Accounting Principles (GAAP)
$
477.3
    $
534.9
    $
2,051.7
    $
1,542.8
 
 
Timing of premium payment from CMS(a)
  (45.6 )     (257.2 )     (1,175.3 )     (1,031.7 )
 
Non-GAAP cash flows provided by operations(a)(b)
$
431.7
    $
277.7
    $
876.4
    $
511.1
 
 
The company also evaluates operating cash flows on a non-GAAP basis(a)(b).  Non-GAAP cash flows provided by operations rose to $431.7 million(a)(b) in 2Q07 from $277.7 million(a)(b) in 2Q06 driven primarily 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 believes that this non-GAAP measure, when presented in conjunction with the comparable GAAP measure, is useful to both management and its investors in analyzing the company's ongoing business and operating performance.  Internally, management uses this non-GAAP financial measure as an indicator 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.
 
5

 
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 may be accessed via the Historical Webcasts & Presentations section of the Investor Relations page at www.humana.com.

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 following documents filed by Humana with the Securities and Exchange Commission
 
 
·
Form 10-K for the year ended December, 31, 2006,
 
·
Form 10-Q for the quarter ended March 31, 2007,
 
·
Form 8-Ks filed during 2007.
 
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.
 
Guidance Points as of July 30, 2007
 
For the year ending December 31, 2007
(in accordance with Generally Accepted Accounting Principles)
 
Comments
Diluted earnings per common share (EPS)
 
Full year 2007: $4.40 to $4.50
3Q07: $1.45 to $1.50
   
Revenues
 
Consolidated revenues: $24.5 billion to $25.5 billion;
 
Premiums and ASO fees:
Medicare Advantage:  $10.5 billion to $11.0 billion;
Medicare stand-alone PDPs:  Approximately $3.5 billion;
TRICARE:  Approximately $3.0 billion;
Commercial:  $6.5 billion to $7.0 billion;
 
Investment income: $290 million to $300 million;
 
 
 
 
 
 
 
 
 
 
   
Other revenue: $150 million to $155 million
  Other revenue primarily relates to revenues associated with the company’s mail order pharmacy; related administrative costs are in SG&A expenses
Ending medical membership (fully-insured and ASO combined)
 
Medicare Advantage: 1,120,000 to 1,130,000;
 
Medicare stand-alone PDPs: 3.4 million to 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
   
 
7

 
 
Guidance Points as of July 30, 2007
 
For the year ending December 31, 2007
(in accordance with Generally Accepted Accounting Principles)
 
Comments
Medical costs
 
Total Medicare products: MER in the range of 82.5% to 83.5%;
 
Medicare Advantage and stand-alone PDP combined
 
   
Commercial fully-insured groups:  Medical cost trends in the range of 4.5% to 5.0%; premium yields in line with medical cost trends
 
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%
 
SG&A expenses as a percent of premiums, administrative costs, and other revenue
Depreciation & amortization
 
Approximately $185 million
   
Interest expense
 
Approximately $70 million
   
Pretax results
 
 
Total Medicare products: Approximately 5% pretax margin;
 
TRICARE: Approximately 3.5% pretax margin;
 
 
Medicare Advantage and stand-alone PDP combined
   
Commercial Segment: $230 million to $240 million
  Includes no material benefit from venture capital gains
Cash flows from operations
 
$1.2 billion to $1.5 billion
 
Includes accrual for estimated 2007 Part D risk-share payable in the range of zero to $200 million
Capital expenditures
 
Approximately $220 million
   
Effective tax rate
 
Approximately 36% to 37%
   
Shares used in computing EPS
 
Approximately 171 million
   
 
 
8

 
Statistical Schedules
And
Supplementary Information
2Q07 Earnings Release
 
 
 
S-1

 
       
   
Humana Inc.
   
Statistical Schedules and Supplementary Information
   
2Q07 Earnings Release
       
   
Contents
 
       
   
Page
Description
       
   
S-3-4
Consolidated Statements of Income
   
S-5
Consolidated Balance Sheets
   
S-6-7
Consolidated Statements of Cash Flows
   
S-8
Key Income Statement Ratios and Segment Operating Results
   
S-9
Membership Detail
   
S-10-11
Premiums and Administrative Services Fees Detail
   
S-12
Percentage of Ending Membership under Capitation Arrangements
   
S-13-15
Medical Claims Reserves
   
S-16
Footnotes
       


S-2

 
                       
Consolidated Statements of Income
                   
In thousands, except per common share results
                       
                         
   
Three Months Ended June 30,
             
               
Dollar
   
Percentage
 
   
2007
   
2006
   
Change
   
Change
 
Revenues:
 
 
                   
Premiums
  $
6,223,250
    $
5,264,475
    $
958,775
      18.2 %
Administrative services fees
   
97,093
     
83,711
     
13,382
      16.0 %
Investment income
   
72,052
     
50,567
     
21,485
      42.5 %
Other revenue
   
34,402
     
8,416
     
25,986
      308.8 %
    Total revenues
   
6,426,797
     
5,407,169
     
1,019,628
      18.9 %
Operating expenses:
                               
Medical
   
5,190,418
     
4,479,501
     
710,917
      15.9 %
Selling, general and administrative
   
826,459
     
733,863
     
92,596
      12.6 %
Depreciation
   
48,820
     
31,613
     
17,207
      54.4 %
Other intangible amortization
   
5,444
     
4,983
     
461
      9.3 %
    Total operating expenses
   
6,071,141
     
5,249,960
     
821,181
      15.6 %
Income from operations
   
355,656
     
157,209
     
198,447
      126.2 %
Interest expense
   
16,066
     
16,887
      (821 )     -4.9 %
Income before income taxes
   
339,590
     
140,322
     
199,268
      142.0 %
Provision for income taxes
   
122,744
     
50,833
     
71,911
      141.5 %
Net income
  $
216,846
    $
89,489
    $
127,357
      142.3 %
                                 
Basic earnings per common share
  $
1.30
    $
0.55
    $
0.75
      136.4 %
Diluted earnings per common share
  $
1.28
    $
0.53
    $
0.75
      141.5 %
                                 
Shares used in computing basic earnings per common share
   
166,614
     
163,706
                 
Shares used in computing diluted earnings per common share
   
169,596
     
167,536
                 
                                 


S-3

 
                       
Consolidated Statements of Income
                       
In thousands, except per common share results
                       
                         
   
Six Months Ended June 30,
             
               
Dollar
   
Percentage
 
   
2007
   
2006
   
Change
   
Change
 
Revenues:
 
 
                   
Premiums
  $
12,227,813
    $
9,785,961
    $
2,441,852
      25.0 %
Administrative services fees
   
192,957
     
162,389
     
30,568
      18.8 %
Investment income
   
145,579
     
149,469
      (3,890 )     -2.6 %
Other revenue
   
65,261
     
13,715
     
51,546
      375.8 %
    Total revenues
   
12,631,610
     
10,111,534
     
2,520,076
      24.9 %
Operating expenses:
                               
Medical
   
10,404,418
     
8,263,427
     
2,140,991
      25.9 %
Selling, general and administrative
   
1,647,069
     
1,474,749
     
172,320
      11.7 %
Depreciation
   
84,329
     
61,465
     
22,864
      37.2 %
Other intangible amortization
   
9,999
     
10,037
      (38 )     -0.4 %
    Total operating expenses
   
12,145,815
     
9,809,678
     
2,336,137
      23.8 %
Income from operations
   
485,795
     
301,856
     
183,939
      60.9 %
Interest expense
   
33,984
     
30,326
     
3,658
      12.1 %
Income before income taxes
   
451,811
     
271,530
     
180,281
      66.4 %
Provision for income taxes
   
163,724
     
98,326
     
65,398
      66.5 %
Net income
  $
288,087
    $
173,204
    $
114,883
      66.3 %
                                 
Basic earnings per common share
  $
1.73
    $
1.06
    $
0.67
      63.2 %
Diluted earnings per common share
  $
1.70
    $
1.03
    $
0.67
      65.0 %
                                 
Shares used in computing basic earnings per common share
   
166,213
     
163,411
                 
Shares used in computing diluted earnings per common share
   
169,276
     
167,430
                 
                                 


S-4


                             
Consolidated Balance Sheets
                             
Dollars in thousands, except share amounts
 
 
                         
   
June 30,
   
March 31,
   
December 31,
   
Sequential Change
 
   
2007
   
2007
   
2006
   
Dollar
   
Percent
 
Assets
 
 
   
 
                   
Current assets:
 
 
   
 
                   
Cash and cash equivalents
  $
3,720,769
    $
3,694,059
    $
1,740,304
             
Investment securities
   
3,323,536
     
3,154,920
     
3,192,273
             
Receivables, net:
                                   
    Premiums
   
685,479
     
826,314
     
667,657
             
    Administrative services fees
   
12,074
     
10,806
     
13,284
             
Securities lending collateral
   
1,346,065
     
1,049,195
     
627,990
             
Other
   
1,318,003
     
1,135,298
     
1,091,465
             
    Total current assets
   
10,405,926
     
9,870,592
     
7,332,973
    $
535,334
      5.4 %
Property and equipment, net
   
569,412
     
571,405
     
545,004
                 
Other assets:
                                       
Long-term investment securities
   
400,775
     
380,138
     
414,877
                 
Goodwill
   
1,330,585
     
1,331,418
     
1,310,631
                 
Other
   
628,267
     
552,572
     
524,011
                 
    Total other assets
   
2,359,627
     
2,264,128
     
2,249,519
                 
Total assets
  $
13,334,965
    $
12,706,125
    $
10,127,496
    $
628,840
      4.9 %
                                         
Liabilities and Stockholders' Equity
                                       
Current liabilities:
                                       
Medical and other expenses payable
  $
2,954,146
    $
2,886,214
    $
2,488,261
                 
Trade accounts payable and accrued expenses
   
2,084,463
     
1,977,465
     
1,626,658
                 
Book overdraft
   
289,646
     
284,572
     
293,605
                 
Securities lending payable
   
1,346,065
     
1,049,195
     
627,990
                 
Unearned revenues
   
1,355,017
     
1,330,325
     
155,298
                 
    Total current liabilities
   
8,029,337
     
7,527,771
     
5,191,812
    $
501,566
      6.7 %
Long-term debt
   
1,189,570
     
1,329,334
     
1,269,100
                 
Other long-term liabilities
   
740,560
     
689,493
     
612,698
                 
    Total liabilities
   
9,959,467
     
9,546,598
     
7,073,610
    $
412,869
      4.3 %
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;
                                       
   185,002,041 issued at June 30, 2007
   
30,833
     
30,746
     
30,491
                 
Capital in excess of par value
   
1,422,370
     
1,393,582
     
1,357,077
                 
Retained earnings
   
2,197,185
     
1,980,339
     
1,909,098
                 
Accumulated other comprehensive loss
    (38,112 )     (8,378 )     (13,205 )                
Treasury stock, at cost, 16,439,317 shares at June 30, 2007
    (236,778 )     (236,762 )     (229,575 )                
    Total stockholders' equity
   
3,375,498
     
3,159,527
     
3,053,886
    $
215,971
      6.8 %
Total liabilities and stockholders' equity
  $
13,334,965
    $
12,706,125
    $
10,127,496
    $
628,840
      4.9 %
                                         
Debt-to-total capitalization ratio
    26.1 %     29.6 %     29.4 %                
                                         
                                         
 

S-5

 
 
 
   
 
   
 
   
 
 
Consolidated Statements of Cash Flows
   
 
   
 
   
 
 
Dollars in thousands
 
 
   
 
   
 
   
 
 
 
 
Three Months Ended June 30,
   
 
   
 
 
 
 
 
   
 
   
Dollar
   
Percentage
 
 
 
2007
   
2006
   
Change
   
Change
 
Cash flows from operating activities
 
 
   
 
   
 
   
 
 
Net income
  $
216,846
    $
89,489
   
 
   
 
 
Adjustments to reconcile net income to net cash provided by operating activities:
                 
 
   
 
 
    Depreciation and amortization
   
54,264
     
36,596
   
 
   
 
 
    Stock-based compensation
   
10,462
     
8,471
   
 
   
 
 
    (Benefit) provision for deferred income taxes
    (17,900 )    
2,479
   
 
   
 
 
    Changes in operating assets and liabilities excluding
                 
 
   
 
 
      the effects of acquisitions:
                 
 
   
 
 
        Receivables
   
139,567
     
3,104
   
 
   
 
 
        Other assets
    (107,522 )     (174,050 )  
 
   
 
 
        Medical and other expenses payable
   
67,932
     
266,956
   
 
   
 
 
        Other liabilities
   
75,771
     
57,967
   
 
   
 
 
        Unearned revenues
   
24,692
     
244,661
   
 
   
 
 
    Other
   
13,154
      (818 )  
 
   
 
 
Net cash provided by operating activities
   
477,266
     
534,855
    $ (57,589 )     -10.8 %
 
                               
Cash flows from investing activities
                               
Acquisitions, net of cash acquired
    (224 )     (25,818 )                
Purchases of property and equipment
    (43,973 )     (36,712 )                
Proceeds from sales of property and equipment
   
2
     
18
                 
Purchases of investment securities
    (908,244 )     (594,890 )                
Proceeds from maturities of investment securities
   
212,471
     
100,289
                 
Proceeds from sales of investment securities
   
444,692
     
152,855
                 
Change in securities lending collateral
    (296,870 )    
9,473
                 
Net cash used in investing activities
    (592,146 )     (394,785 )   $ (197,361 )     -50.0 %
 
                               
Cash flows from financing activities
                               
Receipts from CMS contract deposits
   
639,722
     
550,868
                 
Withdrawals from CMS contract deposits
    (708,277 )     (462,981 )                
Borrowings under credit agreement
   
400,000
     
-
                 
Repayments under credit agreement
    (510,000 )     (300,000 )                
Proceeds from issuance of senior notes
   
-
     
498,545
                 
Debt issue costs
   
-
      (3,825 )                
Change in book overdraft
   
5,074
      (3,763 )                
Change in securities lending payable
   
296,870
      (9,473 )                
Common stock repurchases
    (16 )     (4,832 )                
Tax benefit from stock-based compensation
   
5,426
     
5,252
                 
Proceeds from stock option exercises and other
   
12,791
     
5,198
                 
Net cash provided by financing activities
   
141,590
     
274,989
    $ (133,399 )     -48.5 %
 
                               
Increase in cash and cash equivalents
   
26,710
     
415,059
                 
Cash and cash equivalents at beginning of period
   
3,694,059
     
1,843,405
                 
 
                               
Cash and cash equivalents at end of period
  $
3,720,769
    $
2,258,464
                 
 
                               
 
                               
 

S-6


Humana Inc.
 
 
   
 
   
 
   
 
 
Consolidated Statements of Cash Flows
   
 
   
 
   
 
 
Dollars in thousands
 
 
   
 
   
 
   
 
 
 
 
Six Months Ended June 30,
   
 
   
 
 
 
 
 
   
 
   
Dollar
   
Percentage
 
 
 
2007
   
2006
   
Change
   
Change
 
Cash flows from operating activities
 
 
   
 
   
 
   
 
 
Net income
  $
288,087
    $
173,204
   
 
   
 
 
Adjustments to reconcile net income to net cash provided by operating activities:
                 
 
   
 
 
    Depreciation and amortization
   
94,328
     
71,502
   
 
   
 
 
    Stock-based compensation
   
20,264
     
15,051
   
 
   
 
 
    Benefit for deferred income taxes
    (24,011 )     (1,226 )  
 
   
 
 
    Changes in operating assets and liabilities excluding
                 
 
   
 
 
      the effects of acquisitions:
                 
 
   
 
 
        Receivables
    (16,612 )     (42,957 )  
 
   
 
 
        Other assets
    (126,467 )     (359,300 )  
 
   
 
 
        Medical and other expenses payable
   
465,885
     
526,763
   
 
   
 
 
        Other liabilities
   
134,423
     
172,719
   
 
   
 
 
        Unearned revenues
   
1,199,719
     
1,044,850
   
 
   
 
 
    Other
   
16,131
      (57,778 )  
 
   
 
 
Net cash provided by operating activities
   
2,051,747
     
1,542,828
    $
508,919
      33.0 %
 
                               
Cash flows from investing activities
                               
Acquisitions, net of cash acquired
    (27,005 )     (25,931 )                
Purchases of property and equipment
    (114,717 )     (81,973 )                
Proceeds from sales of property and equipment
   
4,072
     
2,156
                 
Purchases of investment securities
    (1,873,295 )     (2,258,548 )                
Proceeds from maturities of investment securities
   
769,956
     
1,010,397
                 
Proceeds from sales of investment securities
   
926,603
     
712,685
                 
Change in securities lending collateral
    (718,075 )     (193,239 )                
Net cash used in investing activities
    (1,032,461 )     (834,453 )   $ (198,008 )     -23.7 %
 
                               
Cash flows from financing activities
                               
Receipts from CMS contract deposits
   
1,483,359
     
1,045,062
                 
Withdrawals from CMS contract deposits
    (1,223,982 )     (736,425 )                
Borrowings under credit agreement
   
710,000
     
100,000
                 
Repayments under credit agreement
    (760,000 )     (300,000 )                
Proceeds from issuance of senior notes
   
-
     
498,545
                 
Debt issue costs
   
-
      (3,825 )                
Change in book overdraft
    (3,959 )     (8,181 )                
Change in securities lending payable
   
718,075
     
193,239
                 
Common stock repurchases
    (7,203 )     (4,937 )                
Tax benefit from stock-based compensation
   
14,554
     
13,656
                 
Proceeds from stock option exercises and other
   
30,335
     
20,939
                 
Net cash provided by financing activities
   
961,179
     
818,073
    $
143,106
      17.5 %
 
                               
Increase in cash and cash equivalents
   
1,980,465
     
1,526,448
                 
Cash and cash equivalents at beginning of period
   
1,740,304
     
732,016
                 
 
                               
Cash and cash equivalents at end of period
  $
3,720,769
    $
2,258,464
                 
 
                               
 
                               


S-7


Key Income Statement Ratios and Segment Operating Results
Dollars in thousands

 
 
Three Months Ended June 30,
 
 
 
 
Six Months Ended June 30,
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage
 
 
 
 
 
Percentage
 
 
 
 
 
2007
2006
 
Difference
Change
 
2007
2006
 
Difference
Change
 
Medical expense ratio
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
84.3%
86.0%
 
-1.7%
 
 
86.7%
85.8%
 
0.9%
 
 
 
Commercial Segment
80.7%
82.9%
 
-2.2%
 
 
80.1%
81.5%
 
-1.4%
 
 
 
Consolidated
83.4%
85.1%
 
-1.7%
 
 
85.1%
84.4%
 
0.7%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Selling, general, and administrative
 
 
 
 
 
 
 
 
 
 
 
   expense ratio
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
10.0%
11.5%
 
-1.5%
 
 
10.4%
12.5%
 
-2.1%
 
 
 
Commercial Segment
21.8%
18.7%
 
3.1%
 
 
21.2%
19.5%
 
1.7%
 
 
 
Consolidated
13.0%
13.7%
 
-0.7%
 
 
13.2%
14.8%
 
-1.6%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Detail of Pretax Income
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
$288,790
$97,981
 
$190,809
194.7%
 
$306,655
$119,553
 
$187,102
156.5%
 
 
Commercial Segment
50,800
42,341
 
8,459
20.0%
 
145,156
151,977
 
(6,821)
-4.5%
 
 
Consolidated
$339,590
$140,322
 
$199,268
142.0%
 
$451,811
$271,530
 
$180,281
66.4%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Detail of Pretax Margins
 
 
 
 
 
 
 
 
 
 
 
 
 
Government Segment
6.0%
2.6%
 
3.4%
 
 
3.3%
1.8%
 
1.5%
 
 
 
Commercial Segment
3.1%
2.5%
 
0.6%
 
 
4.4%
4.5%
 
-0.1%
 
 
 
Consolidated
5.3%
2.6%
 
2.7%
 
 
3.6%
2.7%
 
0.9%
 
 
 

S-8

 
 
 
 
 
 
 
 
 
 
 
 
Membership Detail
 
 
 
 
 
 
 
 
 
 
 
In thousands
 
 
 
 
 
 
 
 
 
 
 
 
 
Ending
 
Ending
 
Year-over-year Change
 
Ending
 
Sequential Change
 
 
June 30, 2007
Average - 2Q07
June 30, 2006
 
Amount
Percent
 
March 31, 2007
 
Amount
Percent
Medical Membership:
 
 
 
 
 
 
 
 
 
 
 
Government Segment:
 
 
 
 
 
 
 
 
 
 
 
 
Medicare Advantage - HMO
452.4
454.2
457.0
 
(4.6)
-1.0%
 
462.1
 
(9.7)
-2.1%
 
Medicare Advantage - PPO
66.9
66.5
64.6
 
2.3
3.6%
 
64.6
 
2.3
3.6%
 
Medicare Advantage - PFFS
614.4
611.9
438.2
 
176.2
40.2%
 
586.7
 
27.7
4.7%
 
    Total Medicare Advantage
1,133.7
1,132.6
959.8
 
173.9
18.1%
 
1,113.4
 
20.3
1.8%
 
Medicare - PDP - Standard
2,131.0
2,133.1
2,066.5
 
64.5
3.1%
 
2,146.2
 
(15.2)
-0.7%
 
Medicare - PDP - Enhanced
1,075.9
1,075.2
977.2
 
98.7
10.1%
 
1,084.0
 
(8.1)
-0.7%
 
Medicare - PDP - Complete
233.2
235.7
415.1
 
(181.9)
-43.8%
 
243.5
 
(10.3)
-4.2%
 
    Total Medicare stand-alone PDPs
3,440.1
3,444.0
3,458.8
 
(18.7)
-0.5%
 
3,473.7
 
(33.6)
-1.0%
 
        Total Medicare
4,573.8
4,576.6
4,418.6
 
155.2
3.5%
 
4,587.1
 
(13.3)
-0.3%
 
TRICARE insured
1,717.6
1,719.4
1,732.6
 
(15.0)
-0.9%
 
1,712.9
 
4.7
0.3%
 
TRICARE ASO
1,150.6
1,161.1
1,141.9
 
8.7
0.8%
 
1,165.5
 
(14.9)
-1.3%
 
    Total TRICARE
2,868.2
2,880.5
2,874.5
 
(6.3)
-0.2%
 
2,878.4
 
(10.2)
-0.4%
 
Medicaid insured
384.9
384.0
418.5
 
(33.6)
-8.0%
 
384.0
 
0.9
0.2%
 
Medicaid ASO
182.7
181.7
-
 
182.7
100.0%
 
175.4
 
7.3
4.2%
 
    Total Medicaid
567.6
565.7
418.5
 
149.1
35.6%
 
559.4
 
8.2
1.5%
 
Total Government Segment
8,009.6
8,022.8
7,711.6
 
298.0
3.9%
 
8,024.9
 
(15.3)
-0.2%
Commercial Segment:
 
 
 
 
 
 
 
 
 
 
 
 
Fully-insured medical:
 
 
 
 
 
 
 
 
 
 
 
 
    Group
1,533.0
1,530.1
1,716.4
 
(183.4)
-10.7%
 
1,528.6
 
4.4
0.3%
 
    Individual
205.0
200.3
170.0
 
35.0
20.6%
 
192.1
 
12.9
6.7%
 
    Medicare supplement
8.3
7.8
6.7
 
1.6
23.9%
 
7.4
 
0.9
12.2%
 
Total fully-insured medical
1,746.3
1,738.2
1,893.1
 
(146.8)
-7.8%
 
1,728.1
 
18.2
1.1%
 
ASO
1,532.4
1,525.8
1,420.8
 
111.6
7.9%
 
1,529.4
 
3.0
0.2%
 
Total Commercial Segment
3,278.7
3,264.0
3,313.9
 
(35.2)
-1.1%
 
3,257.5
 
21.2
0.7%
 
 
 
 
 
 
 
 
 
 
 
 
 
Total medical membership
11,288.3
11,286.8
11,025.5
 
262.8
2.4%
 
11,282.4
 
5.9
0.1%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Specialty Membership (all Commercial Segment)
 
 
 
 
 
 
 
 
 
 
 
Dental – fully-insured
978.1
979.9
955.6
 
22.5
2.4%
 
980.5
 
(2.4)
-0.2%
 
Dental - ASO
499.9
497.8
496.5
 
3.4
0.7%
 
503.7
 
(3.8)
-0.8%
 
    Total dental
1,478.0
1,477.7
1,452.1
 
25.9
1.8%
 
1,484.2
 
(6.2)
-0.4%
 
Group life
439.8
439.2
427.2
 
12.6
2.9%
 
437.9
 
1.9
0.4%
 
Short-term disability
12.2
12.5
15.6
 
(3.4)
-21.8%
 
13.1
 
(0.9)
-6.9%
Total specialty membership
1,930.0
1,929.4
1,894.9
 
35.1
1.9%
 
1,935.2
 
(5.2)
-0.3%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
S-9

 
 
 
   
 
   
 
   
 
   
 
   
 
 
Premiums and Administrative Services Fees Detail
   
 
   
 
 
Dollars in thousands, except per member per month
   
 
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
Per Member per Month (A)
 
 
 
Three Months Ended June 30,
   
 
   
 
   
Three Months Ended June 30,
 
 
 
 
   
 
   
Dollar
   
Percentage
   
 
   
 
 
 
 
2007
   
2006
   
Change
   
Change
   
2007
   
2006
 
Premium revenues
 
 
   
 
   
 
   
 
   
 
   
 
 
Government Segment:
 
 
   
 
   
 
   
 
   
 
   
 
 
Medicare Advantage
  $
2,804,438
    $
2,109,406
    $
695,032
      32.9 %   $
825
    $
792
 
Medicare stand-alone PDPs
   
1,051,259
     
801,755
     
249,504
      31.1 %   $
102
    $
94
 
    Total Medicare
   
3,855,697
     
2,911,161
     
944,536
      32.4 %                
TRICARE insured (B)
   
725,040
     
657,627
     
67,413
      10.3 %   $
141
    $
127
 
Medicaid insured
   
132,486
     
129,158
     
3,328
      2.6 %   $
115
    $
102
 
Total Government Segment premiums
   
4,713,223
     
3,697,946
     
1,015,277
      27.5 %                
Commercial Segment:
                                               
Fully-insured medical
   
1,402,082
     
1,464,646
      (62,564 )     -4.3 %   $
269
    $
259
 
Specialty
   
107,945
     
101,883
     
6,062
      5.9 %   $
22
    $
21
 
Total Commercial Segment premiums
   
1,510,027
     
1,566,529
      (56,502 )     -3.6 %                
Total premium revenues
  $
6,223,250
    $
5,264,475
    $
958,775
      18.2 %                
 
                                               
 
                                               
Administrative services fees
                                               
TRICARE ASO (B)
  $
15,535
    $
11,144
    $
4,391
      39.4 %   $
4
    $
3
 
Medicaid ASO
   
2,136
     
-
     
2,136
      100.0 %   $
4
     
-
 
Total Government Segment
   
17,671
     
11,144
     
6,527
      58.6 %                
Commercial Segment
   
79,422
     
72,567
     
6,855
      9.4 %   $
13
    $
13
 
Total administrative services fees
  $
97,093
    $
83,711
    $
13,382
      16.0 %                
 
                                               
 
                                               
 

S-10

 
Humana Inc.
 
 
   
 
   
 
   
 
   
 
   
 
 
Premiums and Administrative Services Fees Detail
   
 
   
 
   
 
 
Dollars in thousands, except per member per month
   
 
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
Per Member per Month (A)
 
 
 
Six Months Ended June 30,
   
 
   
 
   
Six Months Ended June 30,
 
 
 
 
   
 
   
Dollar
   
Percentage
   
 
   
 
 
 
 
2007
   
2006
   
Change
   
Change
   
2007
   
2006
 
Premium revenues
 
 
   
 
   
 
   
 
   
 
   
 
 
Government Segment:
 
 
   
 
   
 
   
 
   
 
   
 
 
Medicare Advantage
  $
5,547,149
    $
3,830,249
    $
1,716,900
      44.8 %   $
828
    $
808
 
Medicare stand-alone PDPs
   
1,957,685
     
1,316,912
     
640,773
      48.7 %   $
94
    $
96
 
    Total Medicare
   
7,504,834
     
5,147,161
     
2,357,673
      45.8 %                
TRICARE insured (B)
   
1,452,255
     
1,258,381
     
193,874
      15.4 %   $
141
    $
121
 
Medicaid insured
   
261,811
     
258,625
     
3,186
      1.2 %   $
113
    $
101
 
Total Government Segment premiums
   
9,218,900
     
6,664,167
     
2,554,733
      38.3 %                
Commercial Segment:
                                               
Fully-insured medical
   
2,792,887
     
2,918,578
      (125,691 )     -4.3 %   $
269
    $
259
 
Specialty
   
216,026
     
203,216
     
12,810
      6.3 %   $
22
    $
21
 
Total Commercial Segment premiums
   
3,008,913
     
3,121,794
      (112,881 )     -3.6 %                
Total premium revenues
  $
12,227,813
    $
9,785,961
    $
2,441,852
      25.0 %                
 
                                               
 
                                               
Administrative services fees
                                               
TRICARE ASO (B)
  $
29,829
    $
22,335
    $
7,494
      33.6 %   $
4
    $
3
 
Medicaid ASO
   
4,232
     
-
     
4,232
      100.0 %   $
4
     
-
 
Total Government Segment
   
34,061
     
22,335
     
11,726
      52.5 %                
Commercial Segment
   
158,896
     
140,054
     
18,842
      13.5 %   $
13
    $
12
 
Total administrative services fees
  $
192,957
    $
162,389
    $
30,568
      18.8 %                
 
                                               
 
                                               
 
 
S-11


Humana Inc.
 
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
 
Percentage of Ending Membership under Capitation Arrangements
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
 
 
 
Government Segment
   
Commercial Segment
   
 
 
June 30, 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 %    
-
     
-
     
-
      0.3 %     1.4 %    
-
      0.8 %     0.5 %
Capitated HMO physician group based (C)
    2.0 %    
-
     
-
      26.0 %     2.1 %     1.5 %    
-
      0.8 %     1.8 %
Risk-sharing (D)
    24.3 %    
-
     
-
      41.4 %     6.4 %     1.5 %    
-
      0.8 %     4.8 %
All other membership
    71.2 %     100.0 %     100.0 %     32.6 %     91.2 %     95.6 %     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 %
 
                                                                       
June 30, 2006
                                                                       
 
                                                                       
Capitated HMO hospital system based (C)
    3.4 %    
-
     
-
     
-
      0.4 %     1.8 %    
-
      1.1 %     0.6 %
Capitated HMO physician group based (C)
    2.5 %    
-
     
-
      34.7 %     2.2 %     1.7 %    
-
      1.0 %     1.8 %
Risk-sharing (D)
    27.9 %    
-
     
-
      64.6 %     7.0 %     2.3 %    
-
      1.3 %     5.3 %
All other membership
    66.2 %     100.0 %     100.0 %     0.7 %     90.4 %     94.2 %     100.0 %     96.6 %     92.3 %
    Total medical membership
    100.0 %     100.0 %     100.0 %     100.0 %     100.0 %     100.0 %     100.0 %     100.0 %     100.0 %
 
                                                                       
 

S-12

 
Humana Inc.
 
 
   
 
   
 
 
Detail of Medical and Other Expenses Payable Balance and Year-to-Date Changes
 
Dollars in thousands
 
 
   
 
   
 
 
 
 
 
   
 
   
 
 
 
 
June 30,
   
March 31,
   
December 31,
 
 
 
2007
   
2007
   
2006
 
Detail of medical and other expenses payable
 
 
   
 
   
 
 
IBNR and other medical expenses payable (E)
  $
2,028,722
    $
1,869,209
    $
1,686,051
 
TRICARE IBNR (F)
   
308,112
     
361,786
     
318,583
 
TRICARE other medical expenses payable (G)
   
100,975
     
97,994
     
94,699
 
Unprocessed claim inventories (H)
   
211,300
     
222,300
     
218,400
 
Processed claim inventories (I)
   
142,171
     
135,241
     
115,424
 
Payable to pharmacy benefit administrator (J)
   
162,866
     
199,684
     
55,104
 
Total medical and other expenses payable
  $
2,954,146
    $
2,886,214
    $
2,488,261
 
 
                       
 
                       

 
 
 
   
 
   
 
 
 
 
Six Months Ended
   
Three Months Ended
   
Year Ended
 
 
 
June 30, 2007
   
March 31, 2007
   
December 31, 2006
 
Year-to-date changes in medical and other
 
 
   
 
   
 
 
expenses payable
 
 
   
 
   
 
 
 
 
 
   
 
   
 
 
Balances at January 1
  $
2,488,261
    $
2,488,261
    $
1,909,682
 
 
                       
Acquisitions
   
-
     
-
     
21,198
 
 
                       
Incurred related to:
                       
    Current year (K)
   
10,574,111
     
5,370,722
     
17,696,654
 
    Prior years - non-TRICARE (K)
    (156,032 )     (148,777 )     (178,998 )
    Prior years - TRICARE (L)
    (13,661 )     (7,945 )     (96,452 )
Total incurred
   
10,404,418
     
5,214,000
     
17,421,204
 
 
                       
Paid related to:
                       
    Current year
    (8,275,133 )     (3,800,981 )     (15,532,079 )
    Prior years
    (1,663,400 )     (1,015,066 )     (1,331,744 )
Total paid
    (9,938,533 )     (4,816,047 )     (16,863,823 )
 
                       
Balances at end of period
  $
2,954,146
    $
2,886,214
    $
2,488,261
 
 
                       


S-13


 
 
 
 
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
15.6
15.8
(0.2)
-1.3%
 
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
 
 
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
 
 
6/30/2007
$211,300
751,600
4.9
 
 
 
 
 
 
 


S-14

 
Humana Inc.
 
 
 
 
 
 
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
 
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%
 
6/30/2007
62.4
2.9
4.9%
69.7
4.2
6.4%
 
 
 
 
 
 
 
 

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
 
(0.8)
(1.6)
 
 
 
    Change in unprocessed claims inventories
 
(0.2)
1.7
 
 
 
    Change in processed claims inventories
 
0.6
0.8
 
 
 
    Change in TRICARE reserve balances
 
(0.1)
(2.1)
 
 
 
    Change in pharmacy payment cutoff
 
-
(1.3)
 
 
 
    Change in provider payables under risk arrangements
2.5
1.9
 
 
 
    All other
 
 
0.2
0.5
 
 
DCP - current quarter
 
 
62.4
60.2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


S-15

 
 
Footnotes to Statistical Schedules and Supplementary Information
 
2Q07 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 70% to 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-16