EX-99.3 5 d783300dex993.htm EX-99.3 EX-99.3

Exhibit 99.3

Explanatory Note

During the first quarter of 2014, we reclassified certain of our businesses from our Healthcare Services segment to our Employer Group segment to correspond with internal management reporting changes. Financial statements and supplementary data set forth in this Exhibit 99.3 have been revised from the financial statements and supplementary data included in “Item 8” to Humana’s Annual Report on Form 10-K for the year ended December 31, 2013 (which we refer to as the “2013 Form 10-K”) to reflect retrospective application of the new reporting structure and reclassified historical results to conform to the new presentation. Revisions are highlighted in blue font. Financial statements and supplementary data set forth below have not been revised to reflect events or developments subsequent to February 19, 2014, the date that Humana filed the 2013 Form 10-K. For a discussion of events and developments subsequent to the filing date of the 2013 Form 10-K, please refer to the reports and other information Humana has filed with the Securities and Exchange Commission since that date, including Humana’s Quarterly Reports on Form 10-Q for the quarterly periods ended March 31, 2014 and June 30, 2014.

 

1


ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
  WITH RETROSPECTIVE APPLICATION OF SEGMENTS

Humana Inc.

CONSOLIDATED BALANCE SHEETS

 

     December 31,  
     2013     2012  
     (in millions, except
share amounts)
 

ASSETS

    

Current assets:

    

Cash and cash equivalents

   $ 1,138      $ 1,306   

Investment securities

     8,090        8,001   

Receivables, less allowance for doubtful accounts of $118 in 2013 and $94 in 2012:

     950        733   

Other current assets

     2,122        1,670   
  

 

 

   

 

 

 

Total current assets

     12,300        11,710   
  

 

 

   

 

 

 

Property and equipment, net

     1,218        1,098   

Long-term investment securities

     1,710        1,846   

Goodwill

     3,733        3,640   

Other long-term assets

     1,774        1,685   
  

 

 

   

 

 

 

Total assets

   $ 20,735      $ 19,979   
  

 

 

   

 

 

 

LIABILITIES AND STOCKHOLDERS’ EQUITY

    

Current liabilities:

    

Benefits payable

   $ 3,893      $ 3,779   

Trade accounts payable and accrued expenses

     1,821        2,042   

Book overdraft

     403        324   

Unearned revenues

     206        230   
  

 

 

   

 

 

 

Total current liabilities

     6,323        6,375   

Long-term debt

     2,600        2,611   

Future policy benefits payable

     2,207        1,858   

Other long-term liabilities

     289        288   
  

 

 

   

 

 

 

Total liabilities

     11,419        11,132   
  

 

 

   

 

 

 

Commitments and contingencies (Note 15)

    

Stockholders’ equity:

    

Preferred stock, $1 par; 10,000,000 shares authorized; none issued

     0        0   

Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 196,275,506 shares issued in 2013 and 194,470,820 shares issued in 2012

     33        32   

Capital in excess of par value

     2,267        2,101   

Retained earnings

     8,942        7,881   

Accumulated other comprehensive income

     158        386   

Treasury stock, at cost, 42,245,097 shares in 2013 and 36,138,955 shares in 2012

     (2,084     (1,553
  

 

 

   

 

 

 

Total stockholders’ equity

     9,316        8,847   
  

 

 

   

 

 

 

Total liabilities and stockholders’ equity

   $ 20,735      $ 19,979   
  

 

 

   

 

 

 

The accompanying notes are an integral part of the consolidated financial statements.

 

2


Humana Inc.

CONSOLIDATED STATEMENTS OF INCOME

 

     For the year ended December 31,  
     2013      2012      2011  
     (in millions, except per share
results)
 

Revenues:

        

Premiums

   $ 38,829       $ 37,009       $ 35,106   

Services

     2,109         1,726         1,360   

Investment income

     375         391         366   
  

 

 

    

 

 

    

 

 

 

Total revenues

     41,313         39,126         36,832   
  

 

 

    

 

 

    

 

 

 

Operating expenses:

        

Benefits

     32,564         30,985         28,823   

Operating costs

     6,355         5,830         5,395   

Depreciation and amortization

     333         295         270   
  

 

 

    

 

 

    

 

 

 

Total operating expenses

     39,252         37,110         34,488   
  

 

 

    

 

 

    

 

 

 

Income from operations

     2,061         2,016         2,344   

Interest expense

     140         105         109   
  

 

 

    

 

 

    

 

 

 

Income before income taxes

     1,921         1,911         2,235   

Provision for income taxes

     690         689         816   
  

 

 

    

 

 

    

 

 

 

Net income

   $ 1,231       $ 1,222       $ 1,419   
  

 

 

    

 

 

    

 

 

 

Basic earnings per common share

   $ 7.81       $ 7.56       $ 8.58   
  

 

 

    

 

 

    

 

 

 

Diluted earnings per common share

   $ 7.73       $ 7.47       $ 8.46   
  

 

 

    

 

 

    

 

 

 

Dividends declared per common share

   $ 1.07       $ 1.03       $ 0.75   
  

 

 

    

 

 

    

 

 

 

The accompanying notes are an integral part of the consolidated financial statements.

 

3


Humana Inc.

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME

 

     For the year ended
December 31,
 
     2013     2012     2011  
     (in millions)  

Net income

   $ 1,231      $ 1,222      $ 1,419   

Other comprehensive (loss) income:

      

Change in gross unrealized investment gains/losses

     (338     164        299   

Effect of income taxes

     124        (60     (109
  

 

 

   

 

 

   

 

 

 

Total change in unrealized investment gains/losses, net of tax

     (214     104        190   
  

 

 

   

 

 

   

 

 

 

Reclassification adjustment for net realized gains included in investment income

     (22     (33     (11

Effect of income taxes

     8        12        4   
  

 

 

   

 

 

   

 

 

 

Total reclassification adjustment, net of tax

     (14     (21     (7
  

 

 

   

 

 

   

 

 

 

Other comprehensive (loss) income, net of tax

     (228     83        183   
  

 

 

   

 

 

   

 

 

 

Comprehensive income

   $ 1,003      $ 1,305      $ 1,602   
  

 

 

   

 

 

   

 

 

 

The accompanying notes are an integral part of the consolidated financial statements.

 

4


Humana Inc.

CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY

 

    

 

Common Stock

     Capital
In
Excess
of Par
Value
           Accumulated
Other
Comprehensive
Income (Loss)
          Total
Stockholders’
Equity
 
     Issued
Shares
    Amount         Retained
Earnings
      Treasury
Stock
   
                  
     (dollars in millions, share amounts in thousands)  

Balances, January 1, 2011

     190,245      $ 32       $ 1,737       $ 5,529      $ 120      $ (494   $ 6,924   

Net income

             1,419            1,419   

Other comprehensive income

               183          183   

Common stock repurchases

                 (541     (541

Dividends declared

          0         (123         (123

Stock-based compensation

          67               67   

Restricted stock grants and restricted stock unit vesting

     11        0                  0   

Restricted stock forfeitures

     (105     0         0               0   

Stock option exercises

     3,079        0         134               134   

Stock option and restricted stock tax benefit

          0               0   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Balances, December 31, 2011

     193,230        32         1,938         6,825        303        (1,035     8,063   

Net income

             1,222            1,222   

Other comprehensive income

               83          83   

Common stock repurchases

                 (518     (518

Dividends declared

          0         (166         (166

Stock-based compensation

          82               82   

Restricted stock grants and restricted stock unit vesting

     15        0                  0   

Restricted stock forfeitures

     (1     0         0               0   

Stock option exercises

     1,227        0         60               60   

Stock option and restricted stock tax benefit

          21               21   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Balances, December 31, 2012

     194,471        32         2,101         7,881        386        (1,553     8,847   

Net income

             1,231            1,231   

Other comprehensive loss

               (228       (228

Common stock repurchases

                 (531     (531

Dividends declared

          0         (170         (170

Stock-based compensation

          92               92   

Restricted stock unit vesting

     563        0                  0   

Stock option exercises

     1,242        1         66               67   

Stock option and restricted stock tax benefit

          8               8   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Balances, December 31, 2013

     196,276      $ 33       $ 2,267       $ 8,942      $ 158      $ (2,084   $ 9,316   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

The accompanying notes are an integral part of the consolidated financial statements.

 

5


Humana Inc.

CONSOLIDATED STATEMENTS OF CASH FLOWS

 

     For the year ended
December 31,
 
     2013     2012     2011  
     (in millions)  

Cash flows from operating activities

      

Net income

   $ 1,231      $ 1,222      $ 1,419   

Adjustments to reconcile net income to net cash provided by operating activities:

      

Depreciation and amortization

     426        338        303   

Stock-based compensation

     92        82        67   

Net realized capital gains

     (22     (33     (11

Provision (benefit) for deferred income taxes

     42        (80     22   

Provision for doubtful accounts

     37        26        31   

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

      

Receivables

     (251     326        (106

Other assets

     (330     (253     (183

Benefits payable

     109        (41     256   

Other liabilities

     313        300        194   

Unearned revenues

     (24     (43     26   

Other

     93        79        61   
  

 

 

   

 

 

   

 

 

 

Net cash provided by operating activities

     1,716        1,923        2,079   
  

 

 

   

 

 

   

 

 

 

Cash flows from investing activities

      

Acquisitions, net of cash acquired

     (187     (1,235     (226

Proceeds from sale of business

     34        0        0   

Purchases of property and equipment

     (441     (410     (346

Proceeds from sales of property and equipment

     4        0        10   

Purchases of investment securities

     (3,261     (3,221     (3,678

Maturities of investment securities

     1,077        1,497        1,623   

Proceeds from sales of investment securities

     1,592        1,404        1,259   
  

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

     (1,182     (1,965     (1,358
  

 

 

   

 

 

   

 

 

 

Cash flows from financing activities

      

Receipts (withdrawals) from contract deposits, net

     (150     (397     (378

Proceeds from issuance of senior notes, net

     0        990        0   

Repayment of long-term debt

     0        (36     0   

Common stock repurchases

     (531     (518     (541

Dividends paid

     (168     (165     (82

Excess tax benefit from stock-based compensation

     8        22        15   

Change in book overdraft

     79        18        (103

Proceeds from stock option exercises and other, net

     60        57        72   
  

 

 

   

 

 

   

 

 

 

Net cash used in financing activities

     (702     (29     (1,017
  

 

 

   

 

 

   

 

 

 

Decrease in cash and cash equivalents

     (168     (71     (296

Cash and cash equivalents at beginning of year

     1,306        1,377        1,673   
  

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of year

   $ 1,138      $ 1,306      $ 1,377   
  

 

 

   

 

 

   

 

 

 

Supplemental cash flow disclosures:

      

Interest payments

   $ 146      $ 110      $ 114   

Income tax payments, net

   $ 734      $ 745      $ 874   

Details of businesses acquired in purchase transactions:

      

Fair value of assets acquired, net of cash acquired

   $ 196      $ 1,535      $ 266   

Less: Fair value of liabilities assumed

     (9     (300     (40
  

 

 

   

 

 

   

 

 

 

Cash paid for acquired businesses, net of cash acquired

   $ 187      $ 1,235      $ 226   
  

 

 

   

 

 

   

 

 

 

The accompanying notes are an integral part of the consolidated financial statements.

 

6


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

1. REPORTING ENTITY

Nature of Operations

Headquartered in Louisville, Kentucky, Humana is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. References throughout these notes to consolidated financial statements to “we,” “us,” “our,” “Company,” and “Humana,” mean Humana Inc. and its subsidiaries. We derived approximately 75% of our total premiums and services revenue from contracts with the federal government in 2013, including 15% related to our federal government contracts with the Centers for Medicare and Medicaid Services, or CMS, to provide health insurance coverage for individual Medicare Advantage members in Florida. CMS is the federal government’s agency responsible for administering the Medicare program.

Health Care Reform

The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010 (which we collectively refer to as the Health Care Reform Law) enacted significant reforms to various aspects of the U.S. health insurance industry. While regulations and interpretive guidance on many provisions of the Health Care Reform Law have been issued to date by the Department of Health and Human Services, or HHS, the Department of Labor, the Treasury Department, and the National Association of Insurance Commissioners, or NAIC, there are certain provisions of the law that will require additional guidance and clarification in the form of regulations and interpretations in order to fully understand the impact of the law on our overall business.

Certain significant provisions of the Health Care Reform Law include, among others, mandated coverage requirements, mandated benefits and guarantee issuance associated with commercial medical insurance, rebates to policyholders based on minimum benefit ratios, adjustments to Medicare Advantage premiums, the establishment of federally facilitated or state-based exchanges coupled with programs designed to spread risk among insurers, an annual insurance industry premium-based assessment, and a three-year commercial reinsurance fee. Implementation dates of the Health Care Reform Law began in September 2010 and continue through 2018.

2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation

Our financial statements and accompanying notes are prepared in accordance with accounting principles generally accepted in the United States of America. Our consolidated financial statements include the accounts of Humana Inc. and subsidiaries that the Company controls, including variable interest entities associated with medical practices for which we are the primary beneficiary. We do not own many of our medical practices but instead enter into exclusive long-term management agreements with the affiliated Professional Associations, or P.A.s, that operate these medical practices. Based upon the provisions of these agreements, these affiliated P.A.s are variable interest entities and we are the primary beneficiary, and accordingly we consolidated the affiliated P.A.s. All significant intercompany balances and transactions have been eliminated.

The preparation of financial statements in accordance with accounting principles generally accepted in the United States of America requires us to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. The areas involving the most significant use of estimates are the estimation of benefits payable, future policy benefits payable, the impact of risk sharing provisions related to our Medicare contracts, the valuation and related impairment recognition of investment

 

7


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

securities, and the valuation and related impairment recognition of long-lived assets, including goodwill. These estimates are based on knowledge of current events and anticipated future events, and accordingly, actual results may ultimately differ materially from those estimates.

Business Segment Reclassifications

On January 1, 2013, we reclassified certain of our businesses to correspond with internal management reporting changes and renamed our Health and Well-Being Services segment as Healthcare Services. Our Employer Group segment now includes our health and wellness businesses, including HumanaVitality and Lifesynch’s employee assistance programs, which had historically been reported in our Healthcare Services segment. The Retail segment now includes our contract with the Centers for Medicare and Medicaid Services, or CMS, to administer the Limited Income Newly Eligible Transition, or LI-NET, prescription drug plan program as well as our state-based contracts for Medicaid members, both of which had historically been reported in our Other Businesses category. On January 1, 2014, we reclassified certain of our businesses from our Healthcare Services segment to our Employer Group segment to correspond with additional internal management reporting changes. Prior period segment financial information has been recast to conform to the 2013 presentation. See Note 16 for segment financial information.

Cash and Cash Equivalents

Cash and cash equivalents include cash, time deposits, money market funds, commercial paper, other money market instruments, and certain U.S. Government securities with an original maturity of three months or less. Carrying value approximates fair value due to the short-term maturity of the investments.

Investment Securities

Investment securities, which consist entirely of debt securities, have been categorized as available for sale and, as a result, are stated at fair value. Investment securities available for current operations are classified as current assets. Investment securities available for our long-term insurance products and professional liability funding requirements, as well as restricted statutory deposits, are classified as long-term assets. For the purpose of determining gross realized gains and losses, which are included as a component of investment income in the consolidated statements of income, the cost of investment securities sold is based upon specific identification. Unrealized holding gains and losses, net of applicable deferred taxes, are included as a component of stockholders’ equity and comprehensive income until realized from a sale or other-than-temporary impairment.

Under the other-than-temporary impairment model for debt securities held, we recognize an impairment loss in income in an amount equal to the full difference between the amortized cost basis and the fair value when we have the intent to sell the debt security or it is more likely than not we will be required to sell the debt security before recovery of our amortized cost basis. However, if we do not intend to sell the debt security, we evaluate the expected cash flows to be received as compared to amortized cost and determine if a credit loss has occurred. In the event of a credit loss, only the amount of the impairment associated with the credit loss is recognized currently in income with the remainder of the loss recognized in other comprehensive income.

When we do not intend to sell a security in an unrealized loss position, potential other-than-temporary impairment is considered using a variety of factors, including the length of time and extent to which the fair value has been less than cost; adverse conditions specifically related to the industry, geographic area or financial condition of the

 

8


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

issuer or underlying collateral of a security; payment structure of the security; changes in credit rating of the security by the rating agencies; the volatility of the fair value changes; and changes in fair value of the security after the balance sheet date. For debt securities, we take into account expectations of relevant market and economic data. For example, with respect to mortgage and asset-backed securities, such data includes underlying loan level data and structural features such as seniority and other forms of credit enhancements. A decline in fair value is considered other-than-temporary when we do not expect to recover the entire amortized cost basis of the security. We estimate the amount of the credit loss component of a debt security as the difference between the amortized cost and the present value of the expected cash flows of the security. The present value is determined using the best estimate of future cash flows discounted at the implicit interest rate at the date of purchase.

Receivables and Revenue Recognition

We generally establish one-year commercial membership contracts with employer groups, subject to cancellation by the employer group on 30-day written notice. Our Medicare contracts with CMS renew annually. Our military services contracts with the federal government and our contracts with various state Medicaid programs generally are multi-year contracts subject to annual renewal provisions.

Premiums Revenue

We bill and collect premium remittances from employer groups and members in our Medicare and other individual products monthly. We receive monthly premiums from the federal government and various states according to government specified payment rates and various contractual terms. Changes in revenues from CMS for our Medicare products resulting from the periodic changes in risk-adjustment scores derived from medical diagnoses for our membership are recognized when the amounts become determinable and the collectibility is reasonably assured.

Premiums revenue is estimated by multiplying the membership covered under the various contracts by the contractual rates. Premiums revenue is recognized as income in the period members are entitled to receive services, and is net of estimated uncollectible amounts, retroactive membership adjustments, and adjustments to recognize rebates under the minimum benefit ratios required under the Health Care Reform Law. We estimate policyholder rebates by projecting calendar year minimum benefit ratios for the individual, small group, and large group markets, as defined by the Health Care Reform Law using a methodology prescribed by the Department of Health and Human Services, separately by state and legal entity. Beginning in 2014, Medicare Advantage are also subject to minimum benefit ratio requirements under the Health Care Reform Law. Estimated calendar year rebates recognized ratably during the year are revised each period to reflect current experience. Retroactive membership adjustments result from enrollment changes not yet processed, or not yet reported by an employer group or the government. We routinely monitor the collectibility of specific accounts, the aging of receivables, historical retroactivity trends, estimated rebates, as well as prevailing and anticipated economic conditions, and reflect any required adjustments in current operations. Premiums received prior to the service period are recorded as unearned revenues.

Medicare Part D

We cover prescription drug benefits in accordance with Medicare Part D under multiple contracts with CMS. The payments we receive monthly from CMS and members, which are determined from our annual bid, represent amounts for providing prescription drug insurance coverage. We recognize premiums revenue for providing this insurance coverage ratably over the term of our annual contract. Our CMS payment is subject to risk sharing through the Medicare Part D risk corridor provisions. In addition, receipts for reinsurance and low-income cost subsidies as well as receipts for certain discounts on brand name prescription drugs in the coverage gap represent payments for prescription drug costs for which we are not at risk.

 

9


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

The risk corridor provisions compare costs targeted in our bids to actual prescription drug costs, limited to actual costs that would have been incurred under the standard coverage as defined by CMS. Variances exceeding certain thresholds may result in CMS making additional payments to us or require us to refund to CMS a portion of the premiums we received. As risk corridor provisions are considered in our overall annual bid process, we estimate and recognize an adjustment to premiums revenue related to these provisions based upon pharmacy claims experience to date as if the annual contract were to terminate at the end of the reporting period. Accordingly, this estimate provides no consideration to future pharmacy claims experience. We record a receivable or payable at the contract level and classify the amount as current or long-term in the consolidated balance sheets based on the timing of expected settlement.

Reinsurance and low-income cost subsidies represent funding from CMS in connection with the Medicare Part D program for which we assume no risk. Reinsurance subsidies represent funding from CMS for its portion of prescription drug costs which exceed the member’s out-of-pocket threshold, or the catastrophic coverage level. Low-income cost subsidies represent funding from CMS for all or a portion of the deductible, the coinsurance and co-payment amounts above the out-of-pocket threshold for low-income beneficiaries. Monthly prospective payments from CMS for reinsurance and low-income cost subsidies are based on assumptions submitted with our annual bid. A reconciliation and related settlement of CMS’s prospective subsidies against actual prescription drug costs we paid is made after the end of the year. The Health Care Reform Law mandates consumer discounts of 50% on brand name prescription drugs for Part D plan participants in the coverage gap. These discounts are funded by CMS and pharmaceutical manufacturers while we administer the application of these funds. We account for these subsidies and discounts as a deposit in our consolidated balance sheets and as a financing activity in our consolidated statements of cash flows. We do not recognize premiums revenue or benefit expenses for these subsidies or discounts. Receipt and payment activity is accumulated at the contract level and recorded in our consolidated balance sheets in other current assets or trade accounts payable and accrued expenses depending on the contract balance at the end of the reporting period.

Settlement of the reinsurance and low-income cost subsidies as well as the risk corridor payment is based on a reconciliation made approximately 9 months after the close of each calendar year. Settlement with CMS for brand name prescription drug discounts is based on a reconciliation made approximately 14 to 18 months after the close of each calendar year. We continue to revise our estimates with respect to the risk corridor provisions based on subsequent period pharmacy claims data. See Note 6 for detail regarding amounts recorded to the consolidated balance sheets related to the risk corridor settlement and subsidies from CMS.

Military services

Military services premiums and services revenue primarily is derived from our TRICARE South Region contract with the Department of Defense, or DoD. On April 1, 2012, we began delivering services under the current TRICARE South Region contract with the DoD. Under the current contract, we provide administrative services, including offering access to our provider networks and clinical programs, claim processing, customer service, enrollment, and other services, while the federal government retains all of the risk of the cost of health benefits. Under the terms of the current TRICARE South Region contract, we do not record premiums revenue or benefits expense in our consolidated statements of income related to these health care costs and related reimbursements. Instead, we account for revenues under the current contract net of estimated health care costs similar to an administrative services fee only agreement.

Our TRICARE members are served by both in-network and out-of-network providers in accordance with the current contract. We pay health care costs related to these services to the providers and are subsequently reimbursed by the DoD for such payments. We account for the payments of the federal government’s claims and the related reimbursements under deposit accounting in our consolidated balance sheets and as a financing activity under receipts (withdrawals) from contract deposits in our consolidated statements of cash flows. For the first nine

 

10


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

months of the current contract, April 1, 2012 to December 31, 2012, health care cost payments were $2.1 billion, exceeding reimbursements of $2.0 billion by $56 million. For 2013, health care cost reimbursements were $3.2 billion, exceeding payments of $3.2 billion by $5 million.

Our previous TRICARE South Region contract that expired on March 31, 2012 provided a financial interest in the underlying health care cost; therefore, we reported revenues on a gross basis. We shared the risk with the federal government for the cost of health benefits incurred under our previous contract, earning more revenue or incurring additional cost based on the variance of actual health care costs from an annually negotiated target health care cost. TRICARE revenues consisted generally of (1) an insurance premium for assuming underwriting risk for the cost of civilian health care services delivered to eligible beneficiaries; (2) health care services provided to beneficiaries which were in turn reimbursed by the federal government; and (3) administrative services fees related to claim processing, customer service, enrollment, and other services. We recognized the insurance premium as revenue ratably over the period coverage was provided. Health care services reimbursements were recognized as revenue in the period health services were provided. Administrative services fees were recognized as revenue in the period services were performed. We deferred the recognition of any contingent revenues for favorable variances until the end of the contract period when the amount was determinable and the collectibility was reasonably assured. We estimated and recognized contingent benefits expense for unfavorable variances currently in our results of operations.

Services Revenue

Patient services revenue

Patient services include workers’ compensation injury care and related services as well as other healthcare services related to employer needs or statutory requirements. Patient services revenues are recognized in the period services are provided to the customer when the sales price is fixed or determinable, and are net of contractual allowances.

Administrative services fees

Administrative services fees cover the processing of claims, offering access to our provider networks and clinical programs, and responding to customer service inquiries from members of self-funded groups. Revenues from providing administration services, also known as administrative services only, or ASO, are recognized in the period services are performed and are net of estimated uncollectible amounts. ASO fees are estimated by multiplying the membership covered under the various contracts by the contractual rates. Under ASO contracts, self-funded employers retain the risk of financing substantially all of the cost of health benefits. However, many ASO customers purchase stop loss insurance coverage from us to cover catastrophic claims or to limit aggregate annual costs. Accordingly, we have recorded premiums revenue and benefits expense related to these stop loss insurance contracts. We routinely monitor the collectibility of specific accounts, the aging of receivables, as well as prevailing and anticipated economic conditions, and reflect any required adjustments in current operations. ASO fees received prior to the service period are recorded as unearned revenues.

On April 1, 2012, we began delivering services under our current TRICARE South Region contract with the DoD. As discussed previously, under the current contract, we provide administrative services, including offering access to our provider networks and clinical programs, claim processing, customer service, enrollment, and other services, while the federal government retains all of the risk of the cost of health benefits. We account for revenues under the current contract net of estimated health care costs similar to an administrative services fee only agreement. The current contract includes fixed administrative services fees and incentive fees and penalties. Administrative services fees are recognized as services are performed.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Receivables

Receivables, including premium receivables, patient services revenue receivables, and ASO fee receivables, are shown net of allowances for estimated uncollectible accounts, retroactive membership adjustments, and contractual allowances.

Policy Acquisition Costs

Policy acquisition costs are those costs that relate directly to the successful acquisition of new and renewal insurance policies. Such costs include commissions, costs of policy issuance and underwriting, and other costs we incur to acquire new business or renew existing business. We expense policy acquisition costs related to our employer-group prepaid health services policies as incurred. These short-duration employer-group prepaid health services policies typically have a one-year term and may be cancelled upon 30 days notice by the employer group.

Life insurance, annuities, and certain health and other supplemental policies sold to individuals are accounted for as long-duration insurance products because they are expected to remain in force for an extended period beyond one year and premium received in the earlier years is intended to pay anticipated benefits to be incurred in future years. As a result, we defer policy acquisition costs, primarily consisting of commissions, and amortize them over the estimated life of the policies in proportion to premiums earned. Deferred acquisition costs are reviewed to determine if they are recoverable from future income. See Note 17.

Beginning in 2014, health policies sold to individuals that conform to the Health Care Reform Law are accounted for under a short-duration model and accordingly policy acquisition costs are expensed as incurred because premiums received in the current year are intended to pay anticipated benefits in that year.

Long-Lived Assets

Property and equipment is recorded at cost. Gains and losses on sales or disposals of property and equipment are included in operating costs. Certain costs related to the development or purchase of internal-use software are capitalized. Depreciation is computed using the straight-line method over estimated useful lives ranging from 3 to 10 years for equipment, 3 to 7 years for computer software, and 20 to 40 years for buildings. Improvements to leased facilities are depreciated over the shorter of the remaining lease term or the anticipated life of the improvement.

We periodically review long-lived assets, including property and equipment and other intangible assets, for impairment whenever adverse events or changes in circumstances indicate the carrying value of the asset may not be recoverable. Losses are recognized for a long-lived asset to be held and used in our operations when the undiscounted future cash flows expected to result from the use of the asset are less than its carrying value. We recognize an impairment loss based on the excess of the carrying value over the fair value of the asset. A long-lived asset held for sale is reported at the lower of the carrying amount or fair value less costs to sell. Depreciation expense is not recognized on assets held for sale. Losses are recognized for a long-lived asset to be abandoned when the asset ceases to be used. In addition, we periodically review the estimated lives of all long-lived assets for reasonableness.

Goodwill and Other Intangible Assets

Goodwill represents the unamortized excess of cost over the fair value of the net tangible and other intangible assets acquired. We are required to test at least annually for impairment at a level of reporting referred to as the reporting unit, and more frequently if adverse events or changes in circumstances indicate that the asset may be

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

impaired. A reporting unit either is our operating segments or one level below the operating segments, referred to as a component, which comprise our reportable segments. A component is considered a reporting unit if the component constitutes a business for which discrete financial information is available that is regularly reviewed by management. We aggregate the components of an operating segment into one reporting unit if they have similar economic characteristics. Goodwill is assigned to the reporting unit that is expected to benefit from a specific acquisition.

We use a two-step process to review goodwill for impairment. The first step is a screen for potential impairment, and the second step measures the amount of impairment, if any. Impairment tests are performed, at a minimum, in the fourth quarter of each year supported by our long-range business plan and annual planning process. We rely on an evaluation of future discounted cash flows to determine fair value of our reporting units. Impairment tests completed for 2013, 2012, and 2011 did not result in an impairment loss.

Other intangible assets primarily relate to acquired customer contracts/relationships and are included with other long-term assets in the consolidated balance sheets. Other intangible assets are amortized over the useful life, based upon the pattern of future cash flows attributable to the asset. This sometimes results in an accelerated method of amortization for customer contracts because the asset tends to dissipate at a more rapid rate in earlier periods. Other than customer contracts, other intangible assets generally are amortized using the straight-line method. We review other finite-lived intangible assets for impairment under our long-lived asset policy.

Benefits Payable and Benefits Expense Recognition

Benefits expense includes claim payments, capitation payments, pharmacy costs net of rebates, allocations of certain centralized expenses and various other costs incurred to provide health insurance coverage to members, as well as estimates of future payments to hospitals and others for medical care and other supplemental benefits provided prior to the balance sheet date. Capitation payments represent monthly contractual fees disbursed to primary care and other providers who are responsible for providing medical care to members. Pharmacy costs represent payments for members’ prescription drug benefits, net of rebates from drug manufacturers. Receivables for such pharmacy rebates are included in other current assets in the consolidated balance sheets. Other supplemental benefits include dental, vision, and other supplemental health and financial protection products.

We estimate the costs of our benefits expense payments using actuarial methods and assumptions based upon claim payment patterns, medical cost inflation, historical developments such as claim inventory levels and claim receipt patterns, and other relevant factors, and record benefit reserves for future payments. We continually review estimates of future payments relating to claims costs for services incurred in the current and prior periods and make necessary adjustments to our reserves.

We reassess the profitability of our contracts for providing insurance coverage to our members when current operating results or forecasts indicate probable future losses. We establish a premium deficiency liability in current operations to the extent that the sum of expected future costs, claim adjustment expenses, and maintenance costs exceeds related future premiums under contracts without consideration of investment income. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with our method of acquiring, servicing, and measuring the profitability of such contracts. Losses recognized as a premium deficiency result in a beneficial effect in subsequent periods as operating losses under these contracts are charged to the liability previously established. Because the majority of our member contracts renew annually, we do not anticipate recording a material premium deficiency liability, except when unanticipated adverse events or changes in circumstances indicate otherwise.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

We believe our benefits payable are adequate to cover future claims payments required. However, such estimates are based on knowledge of current events and anticipated future events. Therefore, the actual liability could differ materially from the amounts provided.

Future policy benefits payable

Future policy benefits payable include liabilities for long-duration insurance policies including long-term care, life insurance, annuities, and certain health and other supplemental policies sold to individuals for which some of the premium received in the earlier years is intended to pay anticipated benefits to be incurred in future years. At policy issuance, these reserves are recognized on a net level premium method based on interest rates, mortality, morbidity, and maintenance expense assumptions. Interest rates are based on our expected net investment returns on the investment portfolio supporting the reserves for these blocks of business. Mortality, a measure of expected death, and morbidity, a measure of health status, assumptions are based on published actuarial tables, modified based upon actual experience. Changes in estimates of these reserves are recognized as an adjustment to benefits expense in the period the changes occur. We perform loss recognition tests at least annually in the fourth quarter, and more frequently if adverse events or changes in circumstances indicate that the level of the liability, together with the present value of future gross premiums, may not be adequate to provide for future expected policy benefits and maintenance costs. We adjust future policy benefits payable for the additional liability that would have been recorded if investment securities backing the liability had been sold at their stated aggregate fair value and the proceeds reinvested at current yields. We include the impact of this adjustment, if any, net of applicable deferred taxes, with the change in unrealized investment gain (loss) in accumulated other comprehensive income in stockholders’ equity. As discussed above, beginning in 2014, health policies sold to individuals that conform to the Health Care Reform Law are accounted for under a short-duration model under which policy reserves are not established because premiums received in the current year are intended to pay anticipated benefits in that year.

Book Overdraft

Under our cash management system, checks issued but not yet presented to banks that would result in negative bank balances when presented are classified as a current liability in the consolidated balance sheets. Changes in book overdrafts from period to period are reported in the consolidated statement of cash flows as a financing activity.

Income Taxes

We recognize an asset or liability for the deferred tax consequences of temporary differences between the tax bases of assets or liabilities and their reported amounts in the consolidated financial statements. These temporary differences will result in taxable or deductible amounts in future years when the reported amounts of the assets or liabilities are recovered or settled. We also recognize the future tax benefits such as net operating and capital loss carryforwards as deferred tax assets. A valuation allowance is provided against these deferred tax assets if it is more likely than not that some portion or all of the deferred tax assets will not be realized. Future years’ tax expense may be increased or decreased by adjustments to the valuation allowance or to the estimated accrual for income taxes.

We record tax benefits when it is more likely than not that the tax return position taken with respect to a particular transaction will be sustained. A liability, if recorded, is not considered resolved until the statute of limitations for the relevant taxing authority to examine and challenge the tax position has expired, or the tax position is ultimately settled through examination, negotiation, or litigation. We classify interest and penalties associated with uncertain tax positions in our provision for income taxes.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Derivative Financial Instruments

At times, we may use interest-rate swap agreements to manage our exposure to interest rate risk. The differential between fixed and variable rates to be paid or received is accrued and recognized over the life of the agreements as adjustments to interest expense in the consolidated statements of income. We were not party to any interest-rate swap agreements in 2013, 2012, or 2011.

Stock-Based Compensation

We generally recognize stock-based compensation expense, as determined on the date of grant at fair value, on a straight-line basis over the period during which an employee is required to provide service in exchange for the award (the vesting period). However, for awards granted to retirement eligible employees, the compensation expense is recognized on a straight-line basis over the shorter of the requisite service period or the period from the date of grant to an employee’s eligible retirement date. We estimate expected forfeitures and recognize compensation expense only for those awards which are expected to vest. We estimate the grant-date fair value of stock options using the Black-Scholes option-pricing model. In addition, we report certain tax effects of stock-based compensation as a financing activity rather than an operating activity in the consolidated statement of cash flows. Additional detail regarding our stock-based compensation plans is included in Note 12.

Earnings Per Common Share

We compute basic earnings per common share on the basis of the weighted-average number of unrestricted common shares outstanding. Diluted earnings per common share is computed on the basis of the weighted-average number of unrestricted common shares outstanding plus the dilutive effect of outstanding employee stock options and restricted shares, or units, using the treasury stock method.

Fair Value

Assets and liabilities measured at fair value are categorized into a fair value hierarchy based on whether the inputs to valuation techniques are observable or unobservable. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect our own assumptions about the assumptions market participants would use. The fair value hierarchy includes three levels of inputs that may be used to measure fair value as described below.

Level 1 – Quoted prices in active markets for identical assets or liabilities. Level 1 assets and liabilities include debt securities that are traded in an active exchange market.

Level 2 – Observable inputs other than Level 1 prices such as quoted prices in active markets for similar assets or liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 2 assets and liabilities include debt securities with quoted prices that are traded less frequently than exchange-traded instruments as well as debt securities whose value is determined using a pricing model with inputs that are observable in the market or can be derived principally from or corroborated by observable market data.

Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Level 3 includes assets and liabilities whose value is determined using pricing models, discounted cash flow methodologies, or similar techniques reflecting our own assumptions about the assumptions market participants would use as well as those requiring significant management judgment.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Fair value of actively traded debt securities are based on quoted market prices. Fair value of other debt securities are based on quoted market prices of identical or similar securities or based on observable inputs like interest rates generally using a market valuation approach, or, less frequently, an income valuation approach and are generally classified as Level 2. We obtain at least one quoted price for each security from a third party pricing service. These prices are generally derived from recently reported trades for identical or similar securities, including adjustments through the reporting date based upon observable market information. When quoted prices are not available, the third party pricing service may use quoted market prices of comparable securities or discounted cash flow analyses, incorporating inputs that are currently observable in the markets for similar securities. Inputs that are often used in the valuation methodologies include benchmark yields, reported trades, credit spreads, broker quotes, default rates, and prepayment speeds. We are responsible for the determination of fair value and as such we perform analysis on the prices received from the third party pricing service to determine whether the prices are reasonable estimates of fair value. Our analysis includes a review of monthly price fluctuations as well as a quarterly comparison of the prices received from the pricing service to prices reported by our third party investment advisor. In addition, on a quarterly basis we examine the underlying inputs and assumptions for a sample of individual securities across asset classes, credit rating levels, and various durations.

Fair value of privately held debt securities, as well as auction rate securities, are estimated using a variety of valuation methodologies, including both market and income approaches, where an observable quoted market does not exist and are generally classified as Level 3. For privately-held debt securities, such methodologies include reviewing the value ascribed to the most recent financing, comparing the security with securities of publicly-traded companies in similar lines of business, and reviewing the underlying financial performance including estimating discounted cash flows. Auction rate securities are debt instruments with interest rates that reset through periodic short-term auctions. From time to time, liquidity issues in the credit markets have led to failed auctions. Given the liquidity issues, fair value could not be estimated based on observable market prices, and as such, unobservable inputs were used. For auction rate securities, valuation methodologies include consideration of the quality of the sector and issuer, underlying collateral, underlying final maturity dates, and liquidity.

Recently Issued Accounting Pronouncements

There are no recently issued accounting standards that apply to us or that will have a material impact on our results of operations, financial condition, or cash flows.

3. ACQUISITIONS

On September 6, 2013, we acquired American Eldercare Inc., or American Eldercare, the largest provider of nursing home diversion services in the state of Florida, serving frail and elderly individuals in home and community-based settings. American Eldercare complements our core capabilities and strength in serving seniors and disabled individuals with a unique focus on individualized and integrated care, and has contracts to provide Medicaid long-term support services across the entire state of Florida. The enrollment effective dates for the various regions range from August 2013 to March 2014. The allocation of the purchase price resulted in goodwill of $76 million and other intangible assets of $75 million. The goodwill was assigned to the Retail segment and is deductible for tax purposes. The other intangible assets, which primarily consist of customer contracts and technology, have a weighted average useful life of 9.3 years. The purchase price allocation is preliminary, subject to completion of valuation analyses, including, for example, refining assumptions used to calculate the fair value of other intangible assets.

On December 21, 2012, we acquired Metropolitan Health Networks, Inc., or Metropolitan, a Medical Services Organization, or MSO, that coordinates medical care for Medicare Advantage beneficiaries and Medicaid recipients, primarily in Florida. We acquired all of the outstanding shares of Metropolitan and repaid all

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

outstanding debt of Metropolitan for a transaction value of $851 million, plus transaction expenses. The total consideration of $851 million exceeded our estimated fair value of the net tangible assets acquired by approximately $827 million, of which we allocated $263 million to other intangible assets and $564 million to goodwill. A majority of the goodwill was assigned to the Healthcare Services segment and a portion to our Retail segment. The goodwill is not deductible for tax purposes. The other intangible assets, which primarily consist of customer contracts and trade names, have a weighted average useful life of 8.4 years.

On October 29, 2012, we acquired a noncontrolling equity interest in MCCI Holdings, LLC, or MCCI, a privately held MSO headquartered in Miami, Florida that coordinates medical care for Medicare Advantage and Medicaid beneficiaries primarily in Florida and Texas.

The Metropolitan and MCCI transactions provide us with components of a successful integrated care delivery model that has demonstrated scalability to new markets. A substantial portion of the revenues for both Metropolitan and MCCI are derived from services provided to Humana Medicare Advantage members under capitation contracts with our health plans. In addition, Metropolitan and MCCI provide services to Medicare Advantage and Medicaid members under capitation contracts with third party health plans. Under these capitation agreements with Humana and third party health plans, Metropolitan and MCCI assume financial risk associated with these Medicare Advantage and Medicaid members.

On July 6, 2012, we acquired SeniorBridge Family Companies, Inc., or SeniorBridge, a chronic-care provider of in-home care for seniors, expanding our existing clinical and home health capabilities and strengthening our offerings for members with complex chronic-care needs. The allocation of the purchase price resulted in goodwill of $99 million and other intangible assets of $14 million. The goodwill was assigned to the Healthcare Services segment and is not deductible for tax purposes. The other intangible assets, which primarily consist of customer contracts, trade name, and technology, have a weighted average useful life of 5.2 years.

Effective March 31, 2012, we acquired Arcadian Management Services, Inc., or Arcadian, a Medicare Advantage health maintenance organization (HMO) serving members in 15 U.S. states, increasing Medicare membership and expanding our Medicare footprint and future growth opportunities in these areas. The allocation of the purchase price resulted in goodwill of $44 million and other intangible assets of $38 million. The goodwill was assigned to the Retail segment and is not deductible for tax purposes. The other intangible assets, which primarily consist of customer contracts and provider contracts, have a weighted average useful life of 9.7 years.

On December 6, 2011, we acquired Anvita, Inc., or Anvita, a San Diego-based health care analytics company. The Anvita acquisition provides scalable analytics solutions that produce clinical insights which we expect to enhance our ability to improve the quality and lower the cost of health care for our members and customers. The allocation of the purchase price resulted in goodwill of $116 million and other intangible assets of $60 million. The goodwill was assigned to the Retail segment and is not deductible for tax purposes. The other intangible assets, which primarily consist of technology, have a weighted average useful life of 6.5 years.

The results of operations and financial condition of American Eldercare, Metropolitan, SeniorBridge, Arcadian, and Anvita have been included in our consolidated statements of income and consolidated balance sheets from the acquisition dates. In addition, during 2013, 2012 and 2011, we acquired other health and wellness and technology related businesses which, individually or in the aggregate, have not had, or are not expected to have, a material impact on our results of operations, financial condition, or cash flows. Acquisition-related costs recognized in each of 2013, 2012, and 2011 were not material to our results of operations. The pro forma financial information assuming the acquisitions had occurred as of the beginning of the calendar year prior to the year of acquisition, as well as the revenues and earnings generated during the current year were not material for disclosure purposes.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

4. INVESTMENT SECURITIES

Investment securities classified as current and long-term were as follows at December 31, 2013 and 2012, respectively:

 

     Amortized
Cost
     Gross
Unrealized
Gains
     Gross
Unrealized
Losses
    Fair
Value
 
     (in millions)  

December 31, 2013

          

U.S. Treasury and other U.S. government corporations and agencies:

          

U.S. Treasury and agency obligations

   $ 584       $ 6       $ (6   $ 584   

Mortgage-backed securities

     1,834         34         (48     1,820   

Tax-exempt municipal securities

     2,911         93         (33     2,971   

Mortgage-backed securities:

          

Residential

     22         0         0        22   

Commercial

     662         20         (9     673   

Asset-backed securities

     63         1         (1     63   

Corporate debt securities

     3,474         223         (30     3,667   
  

 

 

    

 

 

    

 

 

   

 

 

 

Total debt securities

   $ 9,550       $ 377       $ (127   $ 9,800   
  

 

 

    

 

 

    

 

 

   

 

 

 

December 31, 2012

          

U.S. Treasury and other U.S. government corporations and agencies:

          

U.S. Treasury and agency obligations

   $ 602       $ 16       $ 0      $ 618   

Mortgage-backed securities

     1,519         85         (1     1,603   

Tax-exempt municipal securities

     2,890         185         (4     3,071   

Mortgage-backed securities:

          

Residential

     33         2         (1     34   

Commercial

     615         44         0        659   

Asset-backed securities

     66         2         0        68   

Corporate debt securities

     3,394         402         (2     3,794   
  

 

 

    

 

 

    

 

 

   

 

 

 

Total debt securities

   $ 9,119       $ 736       $ (8   $ 9,847   
  

 

 

    

 

 

    

 

 

   

 

 

 

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Gross unrealized losses and fair values aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position were as follows at December 31, 2013 and 2012, respectively:

 

     Less than 12 months     12 months or more     Total  
     Fair
Value
     Gross
Unrealized
Losses
    Fair
Value
     Gross
Unrealized
Losses
    Fair
Value
     Gross
Unrealized
Losses
 
     (in millions)  

December 31, 2013

               

U.S. Treasury and other U.S. government corporations and agencies:

               

U.S. Treasury and agency obligations

   $ 231       $ (6   $ 5       $ 0      $ 236       $ (6

Mortgage-backed securities

     1,076         (47     21         (1     1,097         (48

Tax-exempt municipal securities

     693         (28     57         (5     750         (33

Mortgage-backed securities:

               

Residential

     6         0        1         0        7         0   

Commercial

     270         (8     40         (1     310         (9

Asset-backed securities

     35         (1     0         0        35         (1

Corporate debt securities

     594         (28     17         (2     611         (30
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Total debt securities

   $ 2,905       $ (118   $ 141       $ (9   $ 3,046       $ (127
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

December 31, 2012

               

U.S. Treasury and other U.S. government corporations and agencies:

               

U.S. Treasury and agency obligations

   $ 56       $ 0      $ 2       $ 0      $ 58       $ 0   

Mortgage-backed securities

     38         0        25         (1     63         (1

Tax-exempt municipal securities

     233         (3     27         (1     260         (4

Mortgage-backed securities:

               

Residential

     0         0        4         (1     4         (1

Commercial

     94         0        0         0        94         0   

Asset-backed securities

     2         0        4         0        6         0   

Corporate debt securities

     104         (2     4         0        108         (2
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Total debt securities

   $ 527       $ (5   $ 66       $ (3   $ 593       $ (8
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Approximately 95% of our debt securities were investment-grade quality, with a weighted average credit rating of AA- by S&P at December 31, 2013. Most of the debt securities that were below investment-grade were rated BB, the higher end of the below investment-grade rating scale. At December 31, 2013, 7% of our tax-exempt municipal securities were pre-refunded, generally with U.S. government and agency securities. Tax-exempt municipal securities that were not pre-refunded were diversified among general obligation bonds of U.S. states and local municipalities as well as special revenue bonds. General obligation bonds, which are backed by the taxing power and full faith of the issuer, accounted for 40% of the tax-exempt municipals that were not pre-refunded in the portfolio. Special revenue bonds, issued by a municipality to finance a specific public works project such as utilities, water and sewer, transportation, or education, and supported by the revenues of that project, accounted for the remaining 60% of these municipals. Our general obligation bonds are diversified across the United States with no individual state exceeding 12%. In addition, 18% of our tax-exempt securities were insured by bond insurers and had an equivalent weighted average S&P credit rating of AA- exclusive of the bond insurers’ guarantee. Our investment policy limits investments in a single issuer and requires diversification among various asset types.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

The recoverability of our non-agency residential and commercial mortgage-backed securities is supported by factors such as seniority, underlying collateral characteristics and credit enhancements. These residential and commercial mortgage-backed securities at December 31, 2013 primarily were composed of senior tranches having high credit support, with over 99% of the collateral consisting of prime loans. The weighted average credit rating of all commercial mortgage-backed securities was AA+ at December 31, 2013.

The percentage of corporate securities associated with the financial services industry at December 31, 2013 and 2012 was 23%.

All issuers of securities we own that were trading at an unrealized loss at December 31, 2013 remain current on all contractual payments. After taking into account these and other factors previously described, we believe these unrealized losses primarily were caused by an increase in market interest rates and tighter liquidity conditions in the current markets than when the securities were purchased. At December 31, 2013, we did not intend to sell the securities with an unrealized loss position in accumulated other comprehensive income, and it is not likely that we will be required to sell these securities before recovery of their amortized cost basis. As a result, we believe that the securities with an unrealized loss were not other-than-temporarily impaired at December 31, 2013.

The detail of realized gains (losses) related to investment securities and included within investment income was as follows for the years ended December 31, 2013, 2012, and 2011:

 

     2013     2012     2011  
     (in millions)  

Gross realized gains

   $ 33      $ 38      $ 33   

Gross realized losses

     (11     (5     (22
  

 

 

   

 

 

   

 

 

 

Net realized capital gains

   $ 22      $ 33      $ 11   
  

 

 

   

 

 

   

 

 

 

There were no material other-than-temporary impairments in 2013, 2012, or 2011.

The contractual maturities of debt securities available for sale at December 31, 2013, regardless of their balance sheet classification, are shown below. Expected maturities may differ from contractual maturities because borrowers may have the right to call or prepay obligations with or without call or prepayment penalties.

 

     Amortized
Cost
     Fair
Value
 
     (in millions)  

Due within one year

   $ 395       $ 398   

Due after one year through five years

     2,011         2,096   

Due after five years through ten years

     2,759         2,870   

Due after ten years

     1,804         1,858   

Mortgage and asset-backed securities

     2,581         2,578   
  

 

 

    

 

 

 

Total debt securities

   $ 9,550       $ 9,800   
  

 

 

    

 

 

 

 

20


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

5. FAIR VALUE

Financial Assets

The following table summarizes our fair value measurements at December 31, 2013 and 2012, respectively, for financial assets measured at fair value on a recurring basis:

 

            Fair Value Measurements Using  
     Fair
Value
     Quoted
Prices in
Active
Markets

(Level 1)
     Other
Observable
Inputs

(Level 2)
     Unobservable
Inputs

(Level 3)
 
     (in millions)  

December 31, 2013

           

Cash equivalents

   $ 876       $ 876       $ 0       $ 0   

Debt securities:

           

U.S. Treasury and other U.S. government corporations and agencies:

           

U.S. Treasury and agency obligations

     584         0         584         0   

Mortgage-backed securities

     1,820         0         1,820         0   

Tax-exempt municipal securities

     2,971         0         2,958         13   

Mortgage-backed securities:

           

Residential

     22         0         22         0   

Commercial

     673         0         673         0   

Asset-backed securities

     63         0         62         1   

Corporate debt securities

     3,667         0         3,644         23   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total debt securities

     9,800         0         9,763         37   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total invested assets

   $ 10,676       $ 876       $ 9,763       $ 37   
  

 

 

    

 

 

    

 

 

    

 

 

 

December 31, 2012

           

Cash equivalents

   $ 1,177       $ 1,177       $ 0       $ 0   

Debt securities:

           

U.S. Treasury and other U.S. government corporations and agencies:

           

U.S. Treasury and agency obligations

     618         0         618         0   

Mortgage-backed securities

     1,603         0         1,603         0   

Tax-exempt municipal securities

     3,071         0         3,058         13   

Mortgage-backed securities:

           

Residential

     34         0         34         0   

Commercial

     659         0         659         0   

Asset-backed securities

     68         0         67         1   

Corporate debt securities

     3,794         0         3,770         24   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total debt securities

     9,847         0         9,809         38   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total invested assets

   $ 11,024       $ 1,177       $ 9,809       $ 38   
  

 

 

    

 

 

    

 

 

    

 

 

 

There were no material transfers between Level 1 and Level 2 during 2013 or 2012.

 

21


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Our Level 3 assets had a fair value of $37 million at December 31, 2013, or less than 0.4% of our total invested assets. During the years ended December 31, 2013, 2012, and 2011, the changes in the fair value of the assets measured using significant unobservable inputs (Level 3) were comprised of the following:

 

     For the years ended December 31,  
     2013     2012     2011  
     Private
Placements
    Auction
Rate
Securities
     Total     Private
Placements
     Auction
Rate
Securities
    Total     Private
Placements
    Auction
Rate
Securities
    Total  
     (in millions)  

Beginning balance at January 1

   $ 25      $ 13       $ 38      $ 25       $ 16      $ 41      $ 14      $ 52      $ 66   

Total gains or losses:

                    

Realized in earnings

     0        0         0        0         0        0        1        1        2   

Unrealized in other comprehensive income

     0        0         0        0         0        0        0        1        1   

Purchases

     0        0         0        0         0        0        17        0        17   

Sales

     0        0         0        0         (3     (3     (7     (38     (45

Settlements

     (1     0         (1     0         0        0        0        0        0   
  

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Balance at December 31

   $ 24      $ 13       $ 37      $ 25       $ 13      $ 38      $ 25      $ 16      $ 41   
  

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Financial Liabilities

Our long-term debt, recorded at carrying value in our consolidated balance sheets, was $2,600 million at December 31, 2013 and $2,611 million at December 31, 2012. The fair value of our long-term debt was $2,751 million at December 31, 2013 and $2,923 million at December 31, 2012. The fair value of our long-term debt is determined based on Level 2 inputs, including quoted market prices for the same or similar debt, or if no quoted market prices are available, on the current prices estimated to be available to us for debt with similar terms and remaining maturities.

Assets and Liabilities Measured at Fair Value on a Nonrecurring Basis

As disclosed in Note 3, we completed our acquisitions of American Eldercare, Metropolitan, SeniorBridge, Arcadian, Anvita, and other companies during 2013, 2012, and 2011. The values of net tangible assets acquired and the resulting goodwill and other intangible assets were recorded at fair value using Level 3 inputs. The majority of the related tangible assets acquired and liabilities assumed were recorded at their carrying values as of the respective dates of acquisition, as their carrying values approximated their fair values due to their short-term nature. The fair values of goodwill and other intangible assets acquired in these acquisitions were internally estimated primarily based on the income approach. The income approach estimates fair value based on the present value of the cash flows that the assets are expected to generate in the future. We developed internal estimates for the expected cash flows and discount rates in the present value calculations. Other than assets acquired and liabilities assumed in these acquisitions, there were no assets or liabilities measured at fair value on a nonrecurring basis during 2013, 2012, or 2011.

 

22


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

6. MEDICARE PART D

As discussed in Note 2, we cover prescription drug benefits in accordance with Medicare Part D under multiple contracts with CMS. The consolidated balance sheets include the following amounts associated with Medicare Part D as of December 31, 2013 and 2012:

 

     2013     2012  
     Risk
Corridor
Settlement
    CMS
Subsidies/

Discounts
    Risk
Corridor
Settlement
    CMS
Subsidies/

Discounts
 
     (in millions)  

Other current assets

   $ 45      $ 743      $ 37      $ 635   

Trade accounts payable and accrued expenses

     (71     (30     (393     (77
  

 

 

   

 

 

   

 

 

   

 

 

 

Net current (liability) asset

   $ (26   $ 713      $ (356   $ 558   
  

 

 

   

 

 

   

 

 

   

 

 

 

At December 31, 2012, the net risk corridor payable balance included a payable of $158 million related to the 2011 contract year that was paid in January 2013.

7. PROPERTY AND EQUIPMENT, NET

Property and equipment was comprised of the following at December 31, 2013 and 2012:

 

     2013     2012  
     (in millions)  

Land

   $ 20      $ 20   

Buildings and leasehold improvements

     693        620   

Equipment

     639        728   

Computer software

     1,396        1,145   
  

 

 

   

 

 

 
     2,748        2,513   

Accumulated depreciation

     (1,530     (1,415
  

 

 

   

 

 

 

Property and equipment, net

   $ 1,218      $ 1,098   
  

 

 

   

 

 

 

Depreciation expense was $309 million in 2013, $263 million in 2012, and $249 million in 2011, including amortization expense for capitalized internally developed and purchased software of $172 million in 2013, $151 million in 2012, and $139 million in 2011.

 

23


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

8. GOODWILL AND OTHER INTANGIBLE ASSETS

The carrying amount of goodwill for our reportable segments has been retrospectively adjusted to conform to the 2013 and 2014 segment changes discussed in Note 2, as well as refinements in our estimates regarding the allocation of purchase price associated with our Metropolitan acquisition discussed in Note 3. Changes in the carrying amount of goodwill for our reportable segments for the years ended December 31, 2013 and 2012 were as follows:

 

     Retail     Employer
Group
     Healthcare
Services
    Other
Businesses
     Total  
     (in millions)  

Balance at December 31, 2011

   $ 762      $ 354       $ 1,575      $ 49       $ 2,740   

Acquisitions

     172        0         679        43         894   

Subsequent payments/adjustments

     (3     9         0        0         6   
  

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Balance at December 31, 2012

   $ 931      $ 363       $ 2,254      $ 92       $ 3,640   

Acquisitions

     76        0         40        0         116   

Dispositions

     0        0         (17     0         (17

Subsequent payments/adjustments

     0        0         (6     0         (6
  

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Balance at December 31, 2013

   $ 1,007      $ 363       $ 2,271      $ 92       $ 3,733   
  

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

The following table presents details of our other intangible assets included in other long-term assets in the accompanying consolidated balance sheets at December 31, 2013 and 2012:

 

     Weighted
Average

Life
     2013      2012  
        Cost      Accumulated
Amortization
     Net      Cost      Accumulated
Amortization
     Net  
            (in millions)  

Other intangible assets:

                    

Customer contracts/relationships

     9.6 yrs       $ 792       $ 310       $ 482       $ 733       $ 237       $ 496   

Trade names and technology

     13.1 yrs         200         40         160         190         21         169   

Provider contracts

     15.0 yrs         51         23         28         51         19         32   

Noncompetes and other

     6.5 yrs         52         29         23         51         17         34   
     

 

 

    

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Total other intangible assets

     10.3 yrs       $ 1,095       $ 402       $ 693       $ 1,025       $ 294       $ 731   
     

 

 

    

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Amortization expense for other intangible assets was approximately $117 million in 2013, $75 million in 2012, and $54 million in 2011. The following table presents our estimate of amortization expense for each of the five next succeeding fiscal years:

 

     (in millions)  

For the years ending December 31,:

  

2014

   $ 114   

2015

     103   

2016

     95   

2017

     85   

2018

     78   

 

24


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

9. BENEFITS PAYABLE

Activity in benefits payable, excluding military services, was as follows for the years ended December 31, 2013, 2012 and 2011:

 

     2013     2012     2011  
     (in millions)  

Balances at January 1

   $ 3,775      $ 3,415      $ 3,214   

Acquisitions

     5        66        29   

Incurred related to:

      

Current year

     32,711        30,198        25,834   

Prior years

     (474     (257     (372
  

 

 

   

 

 

   

 

 

 

Total incurred

     32,237        29,941        25,462   
  

 

 

   

 

 

   

 

 

 

Paid related to:

      

Current year

     (29,103     (26,738     (22,742

Prior years

     (3,021     (2,909     (2,548
  

 

 

   

 

 

   

 

 

 

Total paid

     (32,124     (29,647     (25,290
  

 

 

   

 

 

   

 

 

 

Balances at December 31

   $ 3,893      $ 3,775      $ 3,415   
  

 

 

   

 

 

   

 

 

 

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).

Actuarial standards require the use of assumptions based on moderately adverse experience, which generally results in favorable reserve development, or reserves that are considered redundant. We experienced favorable medical claims reserve development related to prior fiscal years of $474 million in 2013, $257 million in 2012, and $372 million in 2011. The favorable medical claims reserve development for 2013, 2012, and 2011 primarily reflects the consistent application of trend and completion factors estimated using an assumption of moderately adverse conditions. In addition, the favorable medical claims reserve development during 2013 reflects better than originally expected utilization across most of our major business lines and increased financial recoveries. The increase in financial recoveries primarily resulted from claim audit process enhancements as well as increased volume of claim audits and expanded audit scope. All lines of business benefitted from these improvements. Favorable development during 2011 reflects improvements in the claims processing environment and, to a lesser extent, better than originally estimated utilization. The improvements during 2011 resulted from increased audits of provider billings as well as system enhancements that improved claim recovery functionality.

Benefits expense associated with military services and provisions associated with future policy benefits excluded from the previous table was as follows for the years ended December 31, 2013, 2012 and 2011:

 

     2013     2012      2011  
     (in millions)  

Military services

   $ (27   $ 908       $ 3,247   

Future policy benefits

     354        136         114   
  

 

 

   

 

 

    

 

 

 

Total

   $ 327      $ 1,044       $ 3,361   
  

 

 

   

 

 

    

 

 

 

 

25


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Military services benefit expense for 2013 reflects the beneficial effect of a favorable settlement of contract claims with the DoD partially offset by expenses associated with our contracts with the Veterans Administration. Military services benefits payable of $4 million and $339 million at December 31, 2012 and 2011, respectively, primarily consisted of our estimate of incurred healthcare services provided to beneficiaries under our previous TRICARE South Region contract which were in turn reimbursed by the federal government, as more fully described in Note 2. This amount was generally offset by a corresponding receivable due from the federal government. There was no military services benefits payable at December 31, 2013 due to the transition to the current TRICARE South Region contract on April 1, 2012, which is accounted for as an administrative services only contract as more fully described in Note 2. This transition is also the primary reason for the decline in military services benefits expense from 2011 to 2013.

The higher benefits expense associated with future policy benefits payable during 2013 relates to reserve strengthening for our closed block of long-term care insurance policies acquired in connection with the 2007 KMG America Corporation, or KMG, acquisition more fully described in Note 17.

10. INCOME TAXES

The provision for income taxes consisted of the following for the years ended December 31, 2013, 2012 and 2011:

 

     2013      2012     2011  
     (in millions)  

Current provision:

       

Federal

   $ 595       $ 708      $ 732   

States and Puerto Rico

     53         61        62   
  

 

 

    

 

 

   

 

 

 

Total current provision

     648         769        794   

Deferred provision (benefit)

     42         (80     22   
  

 

 

    

 

 

   

 

 

 

Provision for income taxes

   $ 690       $ 689      $ 816   
  

 

 

    

 

 

   

 

 

 

The provision for income taxes was different from the amount computed using the federal statutory rate for the years ended December 31, 2013, 2012 and 2011 due to the following:

 

     2013     2012     2011  
     (in millions)  

Income tax provision at federal statutory rate

   $ 672      $ 669      $ 782   

States, net of federal benefit, and Puerto Rico

     32        27        35   

Tax exempt investment income

     (26     (26     (25

Nondeductible executive compensation

     6        14        11   

Other, net

     6        5        13   
  

 

 

   

 

 

   

 

 

 

Provision for income taxes

   $ 690      $ 689      $ 816   
  

 

 

   

 

 

   

 

 

 

The provision for income taxes for 2013, 2012, and 2011 reflects a $6 million, $14 million, and $11 million, respectively, estimated impact from limitations on the deductibility of annual compensation in excess of $500,000 per employee as mandated by the Health Care Reform Law.

As of December 31, 2013, we do not have material uncertain tax positions reflected in our consolidated balance sheet.

 

26


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Deferred income tax balances reflect the impact of temporary differences between the tax bases of assets or liabilities and their reported amounts in our consolidated financial statements, and are stated at enacted tax rates expected to be in effect when the reported amounts are actually recovered or settled. Principal components of our net deferred tax balances at December 31, 2013 and 2012 were as follows:

 

     Assets
(Liabilities)
 
     2013     2012  
     (in millions)  

Future policy benefits payable

   $ 303      $ 246   

Compensation and other accrued expenses

     185        174   

Benefits payable

     111        91   

Net operating loss carryforward

     49        203   

Deferred acquisition costs

     46        37   

Unearned premiums

     10        11   

Capital loss carryforward

     0        13   

Other

     12        9   
  

 

 

   

 

 

 

Total deferred income tax assets

     716        784   
  

 

 

   

 

 

 

Valuation allowance

     (28     (28
  

 

 

   

 

 

 

Total deferred income tax assets, net of valuation allowance

     688        756   
  

 

 

   

 

 

 

Depreciable property and intangible assets

     (453     (465

Investment securities

     (78     (265

Prepaid expenses

     (83     (59
  

 

 

   

 

 

 

Total deferred income tax liabilities

     (614     (789
  

 

 

   

 

 

 

Total net deferred income tax assets (liabilities)

   $ 74      $ (33
  

 

 

   

 

 

 

Amounts recognized in the consolidated balance sheets:

    

Other current assets

   $ 60      $ 0   

Other long-term assets

     14        12   

Trade accounts payable and accrued expenses

     0        (45
  

 

 

   

 

 

 

Total net deferred income tax assets (liabilities)

   $ 74      $ (33
  

 

 

   

 

 

 

At December 31, 2013, we had approximately $134 million of net operating losses to carry forward related to prior acquisitions. These net operating loss carryforwards, if not used to offset future taxable income, will expire from 2014 through 2031. A significant portion of these losses are in a subsidiary that was not included in the Humana Inc. consolidated tax return until 2013, and, therefore, were not used until 2013 which resulted in a decrease to the deferred tax asset associated with net operating loss carryforwards. Due to limitations and uncertainty regarding our ability to use some of the carryforwards, a valuation allowance was established on $77 million of net operating loss carryforwards related to prior acquisitions. For the remainder of the net operating loss carryforwards, based on our historical record of producing taxable income and profitability, we have concluded that future operating income will be sufficient to give rise to tax expense to recover all deferred tax assets.

We provide for income taxes on the undistributed earnings of our Puerto Rico operations using that jurisdiction’s tax rate, which has been lower historically than the U.S. statutory tax rate. Permanent investment of these earnings has resulted in cumulative unrecognized deferred tax liabilities of approximately $40 million as of December 31, 2013.

 

27


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

We file income tax returns in the United States and certain foreign jurisdictions. The U.S. Internal Revenue Service, or IRS, has completed its examinations of our consolidated income tax returns for 2011 and prior years. Our 2012 tax return is in the post-filing review period under the Compliance Assurance Process (CAP). Our 2013 tax return is under advance review by the IRS under CAP. With few exceptions, which are immaterial in the aggregate, we no longer are subject to state, local and foreign tax examinations for years before 2010. As of December 31, 2013, we are not aware of any material adjustments that may be proposed.

11. DEBT

The carrying value of long-term debt outstanding was as follows at December 31, 2013 and 2012:

 

     2013      2012  
     (in millions)  

Long-term debt:

     

Senior notes:

     

$500 million, 6.45% due June 1, 2016

   $ 517       $ 523   

$500 million, 7.20% due June 15, 2018

     505         506   

$300 million, 6.30% due August 1, 2018

     314         317   

$600 million, 3.15% due December 1, 2022

     598         598   

$250 million, 8.15% due June 15, 2038

     266         267   

$400 million, 4.625% due December 1, 2042

     400         400   
  

 

 

    

 

 

 

Total long-term debt

   $ 2,600       $ 2,611   
  

 

 

    

 

 

 

Senior Notes

In December 2012, we issued $600 million of 3.15% senior notes due December 1, 2022 and $400 million of 4.625% senior notes due December 1, 2042. Our net proceeds, reduced for the discount and cost of the offering, were $990 million. We used the proceeds from the offering primarily to finance the acquisition of Metropolitan, including the retirement of Metropolitan’s indebtedness, and to pay related fees and expenses.

Our senior notes, which are unsecured, may be redeemed at our option at any time at 100% of the principal amount plus accrued interest and a specified make-whole amount. The 7.20% and 8.15% senior notes are subject to an interest rate adjustment if the debt ratings assigned to the notes are downgraded (or subsequently upgraded). In addition, our 7.20%, 8.15%, 3.15%, and 4.625% senior notes contain a change of control provision that may require us to purchase the notes under certain circumstances.

Prior to 2009, we were parties to interest-rate swap agreements that exchanged the fixed interest rate under our senior notes for a variable interest rate based on LIBOR. As a result, the carrying value of the senior notes was adjusted to reflect changes in value caused by an increase or decrease in interest rates. During 2008, we terminated all of our swap agreements. The cumulative adjustment to the carrying value of our senior notes was $103 million as of the termination date which is being amortized as a reduction to interest expense over the remaining term of the senior notes. The unamortized carrying value adjustment was $54 million as of December 31, 2013 and $64 million as of December 31, 2012.

 

28


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Credit Agreement

In July 2013, we amended and restated our 5-year $1.0 billion unsecured revolving credit agreement to, among other things, extend its maturity to July 2018 from November 2016. Under the amended and restated credit agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion bears interest at either LIBOR plus a spread or the base rate plus a spread. The LIBOR spread, currently 110 basis points, varies depending on our credit ratings ranging from 90.0 to 150.0 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently 15.0 basis points, may fluctuate between 10.0 and 25.0 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate based on LIBOR, at our option.

The terms of the credit agreement include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow additional funds. In addition, the credit agreement contains customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of a minimum level of net worth of $7.3 billion at December 31, 2013 and a maximum leverage ratio of 3.0:1. We are in compliance with the financial covenants, with actual net worth of $9.3 billion and actual leverage ratio of 1.0:1, as measured in accordance with the credit agreement as of December 31, 2013. In addition, the credit agreement includes an uncommitted $250 million incremental loan facility.

At December 31, 2013, we had no borrowings outstanding under the credit agreement. We have outstanding letters of credit of $5 million issued under the credit agreement at December 31, 2013. No amounts have been drawn on these letters of credit. Accordingly, as of December 31, 2013, we had $995 million of remaining borrowing capacity under the credit agreement, none of which would be restricted by our financial covenant compliance requirement. We have other customary, arms-length relationships, including financial advisory and banking, with some parties to the credit agreement.

12. EMPLOYEE BENEFIT PLANS

Employee Savings Plan

We have defined contribution retirement savings plans covering eligible employees which include matching contributions based on the amount of our employees’ contributions to the plans. The cost of these plans amounted to approximately $155 million in 2013, $138 million in 2012, and $126 million in 2011, all of which was funded currently to the extent it was deductible for federal income tax purposes. The Company’s cash match is invested pursuant to the participant’s contribution direction. Based on the closing price of our common stock of $103.22 on December 31, 2013, approximately 11% of the retirement and savings plan’s assets were invested in our common stock, or approximately 3.0 million shares, representing 2% of the shares outstanding as of December 31, 2013. At December 31, 2013, approximately 4.5 million shares of our common stock were reserved for issuance under our defined contribution retirement savings plans.

Stock-Based Compensation

We have plans under which options to purchase our common stock and restricted stock, including both restricted stock units and restricted stock awards, have been granted to executive officers, directors and key employees. The terms and vesting schedules for stock-based awards vary by type of grant. Generally, the awards vest upon time-based conditions. The stock awards of retirement-eligible participants will continue to vest upon retirement from the Company. Our equity award program includes a retirement provision that generally treats employees with a combination of age and years of services with the Company totaling 65 or greater, with a

 

29


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

minimum required age of 55 and a minimum requirement of 5 years of service, as retirement-eligible. Upon exercise, stock-based compensation awards are settled with authorized but unissued company stock or treasury stock. The compensation expense that has been charged against income for these plans was as follows for the years ended December 31, 2013, 2012, and 2011:

 

     2013     2012     2011  
     (in millions)  

Stock-based compensation expense by type:

      

Restricted stock

   $ 84      $ 66      $ 51   

Stock options

     8        16        16   
  

 

 

   

 

 

   

 

 

 

Total stock-based compensation expense

     92        82        67   

Tax benefit recognized

     (22     (21     (19
  

 

 

   

 

 

   

 

 

 

Stock-based compensation expense, net of tax

   $ 70      $ 61      $ 48   
  

 

 

   

 

 

   

 

 

 

The tax benefit recognized in our consolidated financial statements is based on the amount of compensation expense recorded for book purposes. The actual tax benefit realized in our tax return is based on the intrinsic value, or the excess of the market value over the exercise or purchase price, of stock options exercised and restricted stock vested during the period. The actual tax benefit realized for the deductions taken on our tax returns from option exercises and restricted stock vesting totaled $20 million in 2013, $43 million in 2012, and $44 million in 2011. There was no capitalized stock-based compensation expense during these years.

At December 31, 2013, there were 21.1 million shares reserved for stock award plans. These reserved shares included giving effect to, under the 2011 Plan, 13.4 million shares of common stock available for future grants assuming all stock options or 5.8 million shares available for future grants assuming all restricted stock. Shares may be issued from authorized but unissued company stock or treasury stock.

Restricted Stock

Restricted stock is granted with a fair value equal to the market price of our common stock on the date of grant and generally vests three years from the date of grant. The weighted-average grant date fair value of our restricted stock was $73.50 in 2013, $85.29 in 2012, and $67.70 in 2011. Activity for our restricted stock was as follows for the year ended December 31, 2013:

 

     Shares     Weighted-
Average
Grant-
Date Fair
Value
 
     (shares in thousands)  

Nonvested restricted stock at December 31, 2012

     2,954      $ 67.29   

Granted

     1,546        73.50   

Vested

     (619     53.45   

Forfeited

     (239     66.83   
  

 

 

   

 

 

 

Nonvested restricted stock at December 31, 2013

     3,642      $ 71.84   
  

 

 

   

 

 

 

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

The fair value of shares vested during the years ended was $52 million in 2013, $75 million in 2012, and $36 million in 2011. Total compensation expense not yet recognized related to nonvested restricted stock was $81 million at December 31, 2013. We expect to recognize this compensation expense over a weighted-average period of approximately 1.9 years. There are no other contractual terms covering restricted stock once vested.

Stock Options

Stock options are granted with an exercise price equal to the fair market value of the underlying common stock on the date of grant. Our stock plans, as approved by the Board of Directors and stockholders, define fair market value as the average of the highest and lowest stock prices reported on the composite tape by the New York Stock Exchange on a given date. Exercise provisions vary, but most options vest in whole or in part 1 to 3 years after grant and expire 7 to 10 years after grant.

The weighted-average fair value of each option granted during 2013, 2012, and 2011 is provided below. The fair value was estimated on the date of grant using the Black-Scholes pricing model with the weighted-average assumptions indicated below:

 

     2013     2012     2011  

Weighted-average fair value at grant date

   $ 21.8      $ 30.15      $ 28.29   

Expected option life (years)

     4.4        4.4        4.8   

Expected volatility

     38.8     46.3     46.8

Risk-free interest rate at grant date

     0.8     0.8     1.7

Dividend yield (1)

     1.5     1.2     0.5

 

(1) As discussed in Note 14, in April 2011, our Board of Directors approved the initiation of a quarterly cash dividend policy.

When valuing employee stock options, we stratify the employee population into three homogenous groups that historically have exhibited similar exercise behaviors. These groups are executive officers, directors, and all other employees. We value the stock options based on the unique assumptions for each of these employee groups.

We calculate the expected term for our employee stock options based on historical employee exercise behavior and base the risk-free interest rate on a traded zero-coupon U.S. Treasury bond with a term substantially equal to the option’s expected term.

The volatility used to value employee stock options is based on historical volatility. We calculate historical volatility using a simple-average calculation methodology based on daily price intervals as measured over the expected term of the option.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Activity for our option plans was as follows for the year ended December 31, 2013:

 

     Shares
Under
Option
    Weighted-
Average
Exercise
Price
 
     (shares in thousands)  

Options outstanding at December 31, 2012

     2,233      $ 61.68   

Granted

     334        76.03   

Exercised

     (1,242     53.63   

Cancelled

     (4     86.61   

Forfeited

     (49     72.72   
  

 

 

   

 

 

 

Options outstanding at December 31, 2013

     1,272      $ 72.81   
  

 

 

   

 

 

 

Options exercisable at December 31, 2013

     524      $ 69.74   

As of December 31, 2013, outstanding stock options, substantially all of which are expected to vest, had an aggregate intrinsic value of $37 million, and a weighted-average remaining contractual term of 4.0 years. As of December 31, 2013, exercisable stock options had an aggregate intrinsic value of $17 million, and a weighted-average remaining contractual term of 2.8 years. The total intrinsic value of stock options exercised during 2013 was $39 million, compared with $45 million during 2012 and $88 million during 2011. Cash received from stock option exercises totaled $67 million in 2013, $60 million in 2012, and $134 million in 2011.

Total compensation expense not yet recognized related to nonvested options was $7 million at December 31, 2013. We expect to recognize this compensation expense over a weighted-average period of approximately 1.8 years.

13. EARNINGS PER COMMON SHARE COMPUTATION

Detail supporting the computation of basic and diluted earnings per common share was as follows for the years ended December 31, 2013, 2012 and 2011:

 

     2013      2012      2011  
     (dollars in millions, except per common
share results, number of shares/options in
thousands)
 

Net income available for common stockholders

   $ 1,231       $ 1,222       $ 1,419   
  

 

 

    

 

 

    

 

 

 

Weighted-average outstanding shares of common stock used to compute basic earnings per common share

     157,503         161,484         165,413   

Dilutive effect of:

        

Employee stock options

     322         576         959   

Restricted stock

     1,326         1,397         1,455   
  

 

 

    

 

 

    

 

 

 

Shares used to compute diluted earnings per common share

     159,151         163,457         167,827   
  

 

 

    

 

 

    

 

 

 

Basic earnings per common share

   $ 7.81       $ 7.56       $ 8.58   
  

 

 

    

 

 

    

 

 

 

Diluted earnings per common share

   $ 7.73       $ 7.47       $ 8.46   
  

 

 

    

 

 

    

 

 

 

Number of antidilutive stock options and restricted stock awards excluded from computation

     704         754         864   

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

14. STOCKHOLDERS’ EQUITY

Dividends

The following table provides details of dividend payments in 2011, 2012, and 2013 under our Board approved quarterly cash dividend policy:

 

Record Date

  Payment
Date
  Amount
per
Share
    Total
Amount
 
          (in millions)  

2011 payments

     

6/30/2011

  7/28/2011   $ 0.25      $ 41   

9/30/2011

  10/28/2011   $ 0.25      $ 41   

2012 payments

     

12/30/2011

  1/31/2012   $ 0.25      $ 41   

3/30/2012

  4/27/2012   $ 0.25      $ 41   

6/29/2012

  7/27/2012   $ 0.26      $ 42   

9/28/2012

  10/26/2012   $ 0.26      $ 41   

2013 payments

     

12/31/2012

  1/25/2013   $ 0.26      $ 42   

3/28/2013

  4/26/2013   $ 0.26      $ 41   

6/28/2013

  7/26/2013   $ 0.27      $ 42   

9/30/2013

  10/25/2013   $ 0.27      $ 42   

In October 2013, the Board declared a cash dividend of $0.27 per share that was paid on January 31, 2014 to stockholders of record on December 31, 2013, for an aggregate amount of $42 million. Declaration and payment of future quarterly dividends is at the discretion of the Board and may be adjusted as business needs or market conditions change.

Stock Repurchases

In April 2013, the Board of Directors replaced its previously approved share repurchase authorization of up to $1 billion (of which $557 million remained unused) with the current authorization for repurchases of up to $1 billion of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on June 30, 2015. Under the current share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, or in privately-negotiated transactions, subject to certain regulatory restrictions on volume, pricing, and timing. During 2013, we repurchased 1.22 million shares in open market transactions for $82 million at an average price of $67.59 under a previously approved share repurchase authorization and we repurchased 4.55 million shares in open market transactions for $420 million at an average price of $92.17 under the current authorization. During 2012, we repurchased 6.25 million shares in open market transactions for $460 million at an average price of $73.66 under previously approved share repurchase authorizations. During 2011, we repurchased 6.8 million shares in open market transactions for $492 million at an average price of $72.75 under previously approved share repurchase authorizations. As of February 1, 2014, the remaining authorized amount under the current authorization totaled approximately $580 million.

In connection with employee stock plans, we acquired 0.3 million common shares for $29 million in 2013, 0.7 million common shares for $58 million in 2012, and 0.8 million common shares for $49 million in 2011.

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Regulatory Requirements

Certain of our insurance subsidiaries operate in states that regulate the payment of dividends, loans, or other cash transfers to Humana Inc., our parent company, and require minimum levels of equity as well as limit investments to approved securities. The amount of dividends that may be paid to Humana Inc. by these insurance subsidiaries, without prior approval by state regulatory authorities, or ordinary dividends, is limited based on the entity’s level of statutory income and statutory capital and surplus. In most states, prior notification is provided before paying a dividend even if approval is not required. Actual dividends paid may vary due to consideration of excess statutory capital and surplus and expected future surplus requirements related to, for example, premium volume and product mix.

Although minimum required levels of equity are largely based on premium volume, product mix, and the quality of assets held, minimum requirements vary significantly at the state level. Our state regulated insurance subsidiaries had aggregate statutory capital and surplus of approximately $5.5 billion and $5.1 billion as of December 31, 2013 and 2012, respectively, which exceeded aggregate minimum regulatory requirements of $3.5 billion and $3.4 billion, respectively. Excluding Puerto Rico subsidiaries, the amount of ordinary dividends that may be paid to our parent company in 2014 is approximately $840 million in the aggregate. This compares to dividends that were paid to our parent company in 2013 of approximately $967 million. However, actual dividends paid from the subsidiaries to the parent in 2014 could be reduced as a result of the proposed statutory accounting for the health insurance industry fee, discussed below, combined with higher surplus requirements associated with premium growth due to increases in membership.

The NAIC is continuing discussions regarding the statutory accounting for the health insurance industry fee required by the Health Care Reform Law which in its present form would restrict surplus in the year preceding payment, beginning in 2014. Accordingly, in addition to recording the full-year 2014 assessment in the first quarter of 2014, we may be required to restrict surplus for the 2015 assessment ratably in 2014. This proposal does not affect our financial statements prepared in accordance with generally accepted accounting principles, under which the fee is expensed ratably throughout the payment year.

15. COMMITMENTS, GUARANTEES AND CONTINGENCIES

Leases

We lease facilities, computer hardware, and other furniture and equipment under long-term operating leases that are noncancelable and expire on various dates through 2025. We sublease facilities or partial facilities to third party tenants for space not used in our operations. Rent with scheduled escalation terms are accounted for on a straight-line basis over the lease term. Rent expense and sublease rental income, which are recorded net as an operating cost, for all operating leases were as follows for the years ended December 31, 2013, 2012 and 2011:

 

     2013     2012     2011  
     (in millions)  

Rent expense

   $ 227      $ 218      $ 207   

Sublease rental income

     (11     (11     (10
  

 

 

   

 

 

   

 

 

 

Net rent expense

   $ 216      $ 207      $ 197   
  

 

 

   

 

 

   

 

 

 

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Future annual minimum payments due subsequent to December 31, 2013 under all of our noncancelable operating leases with initial terms in excess of one year are as follows:

 

     Minimum
Lease
Payments
     Sublease
Rental
Receipts
    Net Lease
Commitments
 
     (in millions)  

For the years ending December 31:

       

2014

   $ 228       $ (12   $ 216   

2015

     193         (10     183   

2016

     153         (9     144   

2017

     115         (7     108   

2018

     72         (6     66   

Thereafter

     143         (7     136   
  

 

 

    

 

 

   

 

 

 

Total

   $ 904       $ (51   $ 853   
  

 

 

    

 

 

   

 

 

 

Purchase Obligations

We have agreements to purchase services, primarily information technology related services, or to make improvements to real estate, in each case that are enforceable and legally binding on us and that specify all significant terms, including: fixed or minimum levels of service to be purchased; fixed, minimum or variable price provisions; and the appropriate timing of the transaction. We have purchase obligation commitments of $132 million in 2014, $70 million in 2015, $21 million in 2016, $16 million in 2017, and $14 million thereafter. Purchase obligations exclude agreements that are cancelable without penalty.

Off-Balance Sheet Arrangements

As part of our ongoing business, we do not participate or knowingly seek to participate in transactions that generate relationships with unconsolidated entities or financial partnerships, such as entities often referred to as structured finance or special purpose entities, or SPEs, which would have been established for the purpose of facilitating off-balance sheet arrangements or other contractually narrow or limited purposes. As of December 31, 2013, we were not involved in any SPE transactions.

Guarantees and Indemnifications

Through indemnity agreements approved by the state regulatory authorities, certain of our regulated subsidiaries generally are guaranteed by Humana Inc., our parent company, in the event of insolvency for (1) member coverage for which premium payment has been made prior to insolvency; (2) benefits for members then hospitalized until discharged; and (3) payment to providers for services rendered prior to insolvency. Our parent also has guaranteed the obligations of our military services subsidiaries.

In the ordinary course of business, we enter into contractual arrangements under which we may agree to indemnify a third party to such arrangement from any losses incurred relating to the services they perform on behalf of us, or for losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims relating to past performance. Such indemnification obligations may not be subject to maximum loss clauses. Historically, payments made related to these indemnifications have been immaterial.

Government Contracts

Our Medicare products, which accounted for approximately 74% of our total premiums and services revenue for the year ended December 31, 2013, primarily consisted of products covered under the Medicare Advantage

 

35


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

and Medicare Part D Prescription Drug Plan contracts with the federal government. These contracts are renewed generally for a calendar year term unless CMS notifies us of its decision not to renew by May 1 of the calendar year in which the contract would end, or we notify CMS of our decision not to renew by the first Monday in June of the calendar year in which the contract would end. All material contracts between Humana and CMS relating to our Medicare products have been renewed for 2014, and all of our product offerings filed with CMS for 2014 have been approved.

CMS uses a risk-adjustment model which apportions premiums paid to Medicare Advantage plans according to health severity. The risk-adjustment model pays more for enrollees with predictably higher costs. Under this model, rates paid to Medicare Advantage plans are based on actuarially determined bids, which include a process whereby our prospective payments are based on a comparison of our beneficiaries’ risk scores, derived from medical diagnoses, to those enrolled in the government’s original Medicare program. Under the risk-adjustment methodology, all Medicare Advantage plans must collect and submit the necessary diagnosis code information from hospital inpatient, hospital outpatient, and physician providers to CMS within prescribed deadlines. The CMS risk-adjustment model uses the diagnosis data to calculate the risk-adjusted premium payment to Medicare Advantage plans, which CMS adjusts for coding pattern differences between the health plans and the government fee-for-service program. We generally rely on providers, including certain providers in our network who are our employees, to code their claim submissions with appropriate diagnoses, which we send to CMS as the basis for our payment received from CMS under the actuarial risk-adjustment model. We also rely on these providers to document appropriately all medical data, including the diagnosis data submitted with claims.

CMS is continuing to perform audits of various companies’ selected Medicare Advantage contracts related to this risk adjustment diagnosis data. We refer to these audits as Risk-Adjustment Data Validation Audits, or RADV audits. RADV audits review medical records in an attempt to validate provider medical record documentation and coding practices which influence the calculation of premium payments to Medicare Advantage plans.

On February 24, 2012, CMS released a “Notice of Final Payment Error Calculation Methodology for Part C Medicare Advantage Risk Adjustment Data Validation (RADV) Contract-Level Audits.” The payment error calculation methodology provides that, in calculating the economic impact of audit results for a Medicare Advantage contract, if any, the results of the audit sample will be extrapolated to the entire Medicare Advantage contract based upon a comparison to “benchmark” audit data in the government fee-for-service program. This comparison to the government program benchmark audit is necessary to determine the economic impact, if any, of audit results because the government program data set, including any attendant errors that are present in that data set, provides the basis for Medicare Advantage plans risk adjustment to payment rates. CMS already makes other adjustments to payment rates based on a comparison of coding pattern differences between Medicare Advantage plans and the government fee-for-service program data (such as for frequency of coding for certain diagnoses in Medicare Advantage plan data versus the government program data set).

The final methodology, including the first application of extrapolated audit results to determine audit settlements, is expected to be applied to the next round of RADV contract level audits to be conducted on 2011 premium payments. Selected Medicare Advantage contracts will be notified of an audit at some point after the close of the final reconciliation for the payment year being audited. The final reconciliation occurs in August of the calendar year following the payment year. On November 5, 2013, we were notified that one of our Medicare Advantage contracts had been selected for audit for contract year 2011.

Estimated audit settlements are recorded as a reduction of premiums revenue in our consolidated statements of income, based upon available information. During 2012, we completed internal contract level audits of certain

 

36


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

2011 contracts based on the RADV audit methodology prescribed by CMS. Included in these internal contract level audits was an audit of our Private Fee-For-Service business which we used to represent a proxy of the benchmark audit data in the government fee-for-service program which has not yet been released. We based our accrual of estimated audit settlements for contract years 2011 (the first year that application of extrapolated audit results is applicable), 2012, and 2013 on the results of these internal contract level audits for contract year 2011. Estimates derived from these results were not material to our results of operations, financial position, or cash flows. However, as indicated, we are awaiting additional guidance from CMS regarding the benchmark audit data in the government fee-for-service program. Accordingly, we cannot determine whether such audits will have a material adverse effect on our results of operations, financial position, or cash flows.

At December 31, 2013, our military services business, which accounted for approximately 1% of our total premiums and services revenue for the years ended December 31, 2013, primarily consisted of the TRICARE South Region contract. On April 1, 2012, we began delivering services under the current TRICARE South Region contract that the Defense Health Agency, or DHA (formerly known as the TRICARE Management Activity), awarded to us on February 25, 2011. The current 5-year South Region contract, which expires March 31, 2017, is subject to annual renewals on April 1 of each year during its term at the government’s option. On January 27, 2014, we received notice from the DHA of its intent to exercise its option to extend the TRICARE South Region contract through March 31, 2015.

The loss of any of the contracts above or significant changes in these programs as a result of legislative or regulatory action, including reductions in premium payments to us, or increases in member benefits without corresponding increases in premium payments to us, may have a material adverse effect on our results of operations, financial position, and cash flows.

Our Medicaid business, which accounted for approximately 2% of our total premiums and services revenue for the year ended December 31, 2013, primarily consisted of contracts in Puerto Rico, Florida, and Kentucky, with the vast majority in Puerto Rico. On June 26, 2013, the Puerto Rico Health Insurance Administration notified us of its election not to renew our three-year Medicaid contracts for the East, Southeast, and Southwest regions which ended June 30, 2013. Contractual transition provisions required the continuation of insurance coverage for beneficiaries through September 30, 2013 and also require an additional period of time thereafter to process residual claims.

Legal Proceedings and Certain Regulatory Matters

Florida Matters

On December 16, 2010, an individual filed a qui tam suit captioned United States of America ex rel. Marc Osheroff v. Humana et al. in the Southern District of Florida, against us, several of our health plan subsidiaries, and certain other companies that operate medical centers in Miami-Dade County, Florida. After the U.S. government declined to intervene, the Court ordered the complaint unsealed, and the individual plaintiff amended his complaint and served the Company on December 8, 2011. The amended complaint alleges certain civil violations by our CAC Medical Centers in Florida, including offering various amenities such as transportation and meals, to Medicare and dual eligible individuals in our community center settings. The amended complaint also alleges civil violations by our Medicare Advantage health plans in Florida, arising from the alleged activities of our CAC Medical Centers and the codefendants in the complaint. The amended complaint seeks damages and penalties on behalf of the United States under the Anti-Inducement and Anti-Kickback Statutes and the False Claims Act. On September 28, 2012, the Court dismissed, with prejudice, all causes of action that were asserted in the suit. On November 19, 2013, the individual plaintiff appealed the dismissal of the complaint, and we are awaiting the decision of the Court on the appeal.

 

37


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

On January 6, 2012, the Civil Division of the United States Attorney’s Office for the Southern District of Florida advised us that it is seeking documents and information from us and several of our affiliates relating to several matters including the coding of medical claims by one or more South Florida medical providers, and loans to physician practices. We are responding to the information requests.

Other Lawsuits and Regulatory Matters

Our current and past business practices are subject to review or other investigations by various state insurance and health care regulatory authorities and other state and federal regulatory authorities. These authorities regularly scrutinize the business practices of health insurance and benefits companies. These reviews focus on numerous facets of our business, including claims payment practices, provider contracting, risk adjustment, competitive practices, commission payments, privacy issues, utilization management practices, and sales practices, among others. Some of these reviews have historically resulted in fines imposed on us and some have required changes to some of our practices. We continue to be subject to these reviews, which could result in additional fines or other sanctions being imposed on us or additional changes in some of our practices.

We also are involved in various other lawsuits that arise, for the most part, in the ordinary course of our business operations, certain of which may be styled as class-action lawsuits. Among other matters, this litigation may include employment matters, claims of medical malpractice, bad faith, nonacceptance or termination of providers, anticompetitive practices, improper rate setting, provider contract rate disputes, failure to disclose network discounts and various other provider arrangements, general contractual matters, intellectual property matters, and challenges to subrogation practices. A number of hospitals and other providers have also asserted that, under their network provider contracts, we are not entitled to reduce Medicare Advantage payments to these providers in connection with changes in Medicare payment systems in accordance with the Balanced Budget and Emergency Deficit Control Act of 1985, as amended (commonly referred to as “sequestration”). Those challenges have led and could lead to arbitration demands or other litigation. Also, under state guaranty assessment laws, we may be assessed (up to prescribed limits) for certain obligations to the policyholders and claimants of insolvent insurance companies that write the same line or lines of business as we do. As a government contractor, we may also be subject to qui tam litigation brought by individuals who seek to sue on behalf of the government, alleging that the government contractor submitted false claims to the government including, among other allegations, resulting from coding and review practices under the Medicare risk-adjustment model. Qui tam litigation is filed under seal to allow the government an opportunity to investigate and to decide if it wishes to intervene and assume control of the litigation. If the government does not intervene, the lawsuit is unsealed, and the individual may continue to prosecute the action on his or her own, on behalf of the government. We also are subject to allegations of non-performance of contractual obligations to providers, members, and others, including failure to properly pay claims, improper policy terminations, challenges to our implementation of the Medicare Part D prescription drug program and other litigation.

A limited number of the claims asserted against us are subject to insurance coverage. Personal injury claims, claims for extracontractual damages, care delivery malpractice, and claims arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future.

We record accruals for the contingencies discussed above to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters specifically described above because of the inherently unpredictable nature of legal proceedings, which also may be exacerbated by various factors, including: (i) the damages sought in the proceedings are unsubstantiated or

 

38


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

indeterminate; (ii) discovery is not complete; (iii) the proceeding is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties (including where it is uncertain how liability, if any, will be shared among multiple defendants); or (vii) there is a wide range of potential outcomes.

The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. Nevertheless, it is reasonably possible that any such outcome of litigation, penalties, fines or other sanctions could be substantial, and the outcome of these matters may have a material adverse effect on our results of operations, financial position, and cash flows, and may also affect our reputation.

16. SEGMENT INFORMATION

On January 1, 2013, we reclassified certain of our businesses to correspond with internal management reporting changes and renamed our Health and Well-Being Services segment as Healthcare Services. Our Employer Group segment now includes our health and wellness businesses, including HumanaVitality and Lifesynch’s employee assistance programs, which had historically been reported in our Healthcare Services segment. The Retail segment now includes our contract with CMS to administer the LI-NET prescription drug plan program as well as our state-based contracts for Medicaid members, both of which had historically been reported in our Other Businesses category. On January 1, 2014, we reclassified certain of our businesses from our Healthcare Services segment to our Employer Group segment to correspond with additional internal management reporting changes. Prior period segment financial information has been recast to conform to the new presentation.

We manage our business with three reportable segments: Retail, Employer Group, and Healthcare Services. In addition, the Other Businesses category includes businesses that are not individually reportable because they do not meet the quantitative thresholds required by generally accepted accounting principles. These segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer to assess performance and allocate resources.

The Retail segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, marketed directly to individuals, and includes our contract with CMS to administer the LI-NET prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, collectively our state-based contracts. The Employer Group segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and voluntary benefit products, as well as administrative services only, or ASO, products and our health and wellness products primarily marketed to employer groups. The Healthcare Services segment includes services offered to our health plan members as well as to third parties including pharmacy, provider services, home based services, integrated behavioral health services and predictive modeling and informatics services. The Other Businesses category consists of our military services, primarily our TRICARE South Region contract, Puerto Rico Medicaid, and closed-block long-term care insurance policies.

Our Healthcare Services intersegment revenues primarily relate to managing prescription drug coverage for members of our other segments through Humana Pharmacy Solutions®, or HPS, and includes the operations of RightSourceRx®, our mail order pharmacy business. These revenues consist of the prescription price (ingredient cost plus dispensing fee), including the portion to be settled with the member (co-share) or with the government (subsidies), plus any associated administrative fees. Services revenues related to the distribution of prescriptions

 

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Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

by third party retail pharmacies in our networks are recognized when the claim is processed and product revenues from dispensing prescriptions from our mail order pharmacies are recorded when the prescription or product is shipped. Our pharmacy operations, which are responsible for designing pharmacy benefits, including defining member co-share responsibilities, determining formulary listings, contracting with retail pharmacies, confirming member eligibility, reviewing drug utilization, and processing claims, act as a principal in the arrangement on behalf of members in our other segments. As principal, our Healthcare Services segment reports revenues on a gross basis including co-share amounts from members collected by third party retail pharmacies at the point of service.

In addition, our Healthcare Services intersegment revenues include revenues earned by certain owned providers derived from risk-based managed care agreements with our health plans. Under these agreements, the provider receives a monthly capitated fee that varies depending on the demographics and health status of the member, for each member assigned to these owned providers by our health plans. The owned provider assumes the economic risk of funding the assigned members’ healthcare services and related administrative costs. Accordingly, our Healthcare Services segment reports provider services related revenues on a gross basis. Capitation fee revenue is recognized in the period in which the assigned members are entitled to receive healthcare services.

We present our consolidated results of operations from the perspective of the health plans. As a result, the cost of providing benefits to our members, whether provided via a third party provider or internally through a stand-alone subsidiary, is classified as benefits expense and excludes the portion of the cost for which the health plans do not bear responsibility, including member co-share amounts and government subsidies of $7.3 billion in 2013, $6.3 billion in 2012, and $5.4 billion in 2011. In addition, depreciation and amortization expense associated with certain businesses in our Healthcare Services segment delivering benefits to our members, primarily associated with our provider services and pharmacy operations, are included with benefits expense. The amount of this expense was $93 million in 2013, $43 million in 2012, and $33 million in 2011. The increase in 2013 primarily was due to amortization expense associated with the December 21, 2012 acquisition of Metropolitan.

Other than those described previously, the accounting policies of each segment are the same and are described in Note 2. Transactions between reportable segments consist of sales of services rendered by our Healthcare Services segment, primarily provider, pharmacy, and behavioral health services, to our Retail and Employer Group customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often utilize the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and included with intersegment eliminations in the tables presenting segment results below.

 

40


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Our segment results were as follows for the years ended December 31, 2013, 2012, and 2011:

 

     Retail      Employer
Group
     Healthcare
Services
     Other
Businesses
    Eliminations/
Corporate
    Consolidated  
     (in millions)  

2013

               

Revenues – external customers

               

Premiums:

               

Medicare Advantage

   $ 22,481       $ 4,710       $ 0       $ 0      $ 0      $ 27,191   

Medicare stand-alone PDP

     3,025         8         0         0        0        3,033   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total Medicare

     25,506         4,718         0         0        0        30,224   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Fully-insured

     1,160         5,117         0         0        0        6,277   

Specialty

     210         1,095         0         0        0        1,305   

Military services

     0         0         0         25        0        25   

Medicaid and other

     328         0         0         670        0        998   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total premiums

     27,204         10,930         0         695        0        38,829   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Services revenue:

          

Provider

     0         21         1,221         0        0        1,242   

ASO and other

     16         338         0         454        0        808   

Pharmacy

     0         0         59         0        0        59   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total services revenue

     16         359         1,280         454        0        2,109   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total revenues – external customers

     27,220         11,289         1,280         1,149        0        40,938   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Intersegment revenues

          

Services

     0         51         11,808         0        (11,859 )      0   

Products

     0         0         2,803         0        (2,803     0   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     0         51         14,611         0        (14,662 )      0   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Investment income

     74         42         0         59        200        375   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total revenues

     27,294         11,382         15,891         1,208        (14,462     41,313   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Operating expenses:

          

Benefits

     22,914         9,124         0         935        (409     32,564   

Operating costs

     2,963         1,806         15,223         446        (14,083 )      6,355   

Depreciation and amortization

     134         102         147         20        (70     333   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total operating expenses

     26,011         11,032         15,370         1,401        (14,562 )      39,252   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     1,283         350         521         (193     100        2,061   

Interest expense

     0         0         0         0        140        140   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 1,283       $ 350       $ 521       $ (193   $ (40   $ 1,921   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Premium and services revenues derived from our contracts with the federal government, as a percentage of our total premium and services revenues, were approximately 75% for 2013, 75% for 2012, and 76% for 2011.

Benefits expense for Other Businesses for 2013 includes $243 million for reserve strengthening associated with our closed block of long-term care insurance policies as discussed more fully in Note 17.

 

41


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

     Retail      Employer
Group
     Healthcare
Services
     Other
Businesses
    Eliminations/
Corporate
    Consolidated  
     (in millions)  

2012

               

Revenues – external customers

               

Premiums:

               

Medicare Advantage

   $ 20,788       $ 4,064       $ 0       $ 0      $ 0      $ 24,852   

Medicare stand-alone PDP

     2,853         8         0         0        0        2,861   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total Medicare

     23,641         4,072         0         0        0        27,713   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Fully-insured

     1,004         4,996         0         0        0        6,000   

Specialty

     171         1,070         0         0        0        1,241   

Military services

     0         0         0         1,017        0        1,017   

Medicaid and other

     185         0         0         853        0        1,038   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total premiums

     25,001         10,138         0         1,870        0        37,009   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Services revenue:

               

Provider

     0         13         1,007         0        0        1,020   

ASO and other

     24         358         0         308        0        690   

Pharmacy

     0         0         16         0        0        16   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total services revenue

     24         371         1,023         308        0        1,726   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total revenues – external customers

     25,025         10,509         1,023         2,178        0        38,735   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Intersegment revenues

               

Services

     2         31         9,680         0        (9,713 )      0   

Products

     0         0         2,342         0        (2,342     0   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total intersegment revenues

     2         31         12,022         0        (12,055 )      0   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Investment income

     79         42         0         58        212        391   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total revenues

     25,106         10,582         13,045         2,236        (11,843 )      39,126   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Operating expenses:

               

Benefits

     21,048         8,471         0         1,802        (336     30,985   

Operating costs

     2,767         1,710         12,530         436        (11,613 )      5,830   

Depreciation and amortization

     130         89         87         16        (27     295   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Total operating expenses

     23,945         10,270         12,617         2,254        (11,976 )      37,110   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Income (loss) from operations

     1,161         312         428         (18     133        2,016   

Interest expense

     0         0         0         0        105        105   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

   $ 1,161       $ 312       $ 428       $ (18   $ 28      $ 1,911   
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

 

 

42


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

     Retail      Employer
Group
     Healthcare
Services
     Other
Businesses
     Eliminations/
Corporate
    Consolidated  
     (in millions)  

2011

                

Revenues – external customers

                

Premiums:

                

Medicare Advantage

   $ 18,100       $ 3,152       $ 0       $ 0       $ 0      $ 21,252   

Medicare stand-alone PDP

     2,570         8         0         0         0        2,578   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total Medicare

     20,670         3,160         0         0         0        23,830   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Fully-insured

     861         4,782         0         0         0        5,643   

Specialty

     124         935         0         0         0        1,059   

Military services

     0         0         0         3,616         0        3,616   

Medicaid and other

     176         0         0         782         0        958   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total premiums

     21,831         8,877         0         4,398         0        35,106   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Services revenue:

                

Provider

     0         1         891         0         0        892   

ASO and other

     16         356         0         85         0        457   

Pharmacy

     0         0         11         0         0        11   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total services revenue

     16         357         902         85         0        1,360   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total revenues – external customers

     21,847         9,234         902         4,483         0        36,466   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Intersegment revenues

                

Services

     0         18         8,650         0         (8,668 )      0   

Products

     0         0         1,820         0         (1,820     0   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total intersegment revenues

     0         18         10,470         0         (10,488 )      0   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Investment income

     76         48         0         54         188        366   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total revenues

     21,923         9,300         11,372         4,537         (10,300 )      36,832   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Operating expenses:

                

Benefits

     17,753         7,318         0         4,041         (289     28,823   

Operating costs

     2,421         1,641         10,951         445         (10,063 )      5,395   

Depreciation and amortization

     119         88         79         10         (26     270   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Total operating expenses

     20,293         9,047         11,030         4,496         (10,378 )      34,488   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Income (loss) from operations

     1,630         253         342         41         78        2,344   

Interest expense

     0         0         0         0         109        109   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

Income (loss) before income taxes

   $ 1,630       $ 253       $ 342       $ 41       $ (31   $ 2,235   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

   

 

 

 

 

43


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

17. EXPENSES ASSOCIATED WITH LONG-DURATION INSURANCE PRODUCTS

Premiums associated with our long-duration insurance products accounted for approximately 2% of our consolidated premiums and services revenue for the year ended December 31, 2013. We use long-duration accounting for products such as long-term care, life insurance, annuities, and certain health and other supplemental policies sold to individuals because they are expected to remain in force for an extended period beyond one year and because premium received in the earlier years is intended to pay anticipated benefits to be incurred in future years. As a result, we defer policy acquisition costs, primarily consisting of commissions, and amortize them over the estimated life of the policies in proportion to premiums earned.

In addition, we establish reserves for future policy benefits in recognition of the fact that some of the premium received in the earlier years is intended to pay anticipated benefits to be incurred in future years. At policy issuance, these reserves are recognized on a net level premium method based on interest rates, mortality, morbidity, and maintenance expense assumptions. The assumptions used to determine the liability for future policy benefits are established and locked in at the time each contract is issued and only change if our expected future experience deteriorates to the point that the level of the liability, together with the present value of future gross premiums, are not adequate to provide for future expected policy benefits and maintenance costs (i.e. the loss recognition date).

The table below presents deferred acquisition costs and future policy benefits payable associated with our long-duration insurance products for the years ended December 31, 2013 and 2012.

 

     2013     2012  
     Deferred
acquisition

costs
     Future
policy
benefits
payable
    Deferred
acquisition

costs
     Future
policy
benefits
payable
 
     (in millions)  

Other long-term assets

   $ 166       $ 0      $ 149       $ 0   

Trade accounts payable and accrued expenses

     0         (67     0         (63

Long-term liabilities

     0         (2,207     0         (1,858
  

 

 

    

 

 

   

 

 

    

 

 

 

Total asset (liability)

   $ 166       $ (2,274   $ 149       $ (1,921
  

 

 

    

 

 

   

 

 

    

 

 

 

In addition, future policy benefits payable include amounts of $215 million at December 31, 2013 and $220 million at December 31, 2012 which are subject to 100% coinsurance agreements as more fully described in Note 18.

Benefits expense associated with future policy benefits payable was $354 million in 2013, $136 million in 2012, and $114 million in 2011. Benefits expense for 2013 included net charges of $243 million associated with our closed block of long-term care insurance policies discussed further below. Amortization of deferred acquisition costs included in operating costs was $55 million in 2013, $44 million in 2012, and $34 million in 2011.

Future policy benefits payable include $1.4 billion at December 31, 2013 and $1.1 billion at December 31, 2012 associated with a non-strategic closed block of long-term care insurance policies acquired in connection with the 2007 acquisition of KMG. Future policy benefits payable includes amounts charged to accumulated other comprehensive income for an additional liability that would exist on our closed-block of long-term care insurance policies if unrealized gains on the sale of the investments backing such products had been realized and the proceeds reinvested at then current yields. There was no additional liability at December 31, 2013 and $119 million of additional liability at December 31, 2012. Amounts charged to accumulated other comprehensive income are net of applicable deferred taxes.

 

44


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

Long-term care insurance policies provide nursing home and home health coverage for which premiums are collected many years in advance of benefits paid, if any. Therefore, our actual claims experience will emerge many years after assumptions have been established. The risk of a deviation of the actual interest, morbidity, mortality, and maintenance expense assumptions from those assumed in our reserves are particularly significant to our closed block of long-term care insurance policies. We monitor the loss experience of these long-term care insurance policies and, when necessary, apply for premium rate increases through a regulatory filing and approval process in the jurisdictions in which such products were sold. To the extent premium rate increases and/or loss experience vary from our loss recognition date assumptions, future adjustments to reserves could be required.

During 2013, we recorded a loss for a premium deficiency. The premium deficiency was based on current and anticipated experience that had deteriorated from our locked-in assumptions from the previous December 31, 2010 loss recognition date, particularly as they related to emerging experience due to an increase in life expectancies and utilization of home health care services. Based on this deterioration, and combined with lower interest rates, we determined that our existing future policy benefits payable, together with the present value of future gross premiums, associated with our closed block of long-term care insurance policies were not adequate to provide for future policy benefits and maintenance costs under these policies; therefore we unlocked and modified our assumptions based on current expectations. Accordingly, during 2013 we recorded $243 million of additional benefits expense, with a corresponding increase in future policy benefits payable of $350 million partially offset by a related reinsurance recoverable of $107 million included in other long-term assets.

During 2012, we recorded a change in estimate associated with future policy benefits payable for our closed-block of long-term care insurance policies resulting in additional benefits expense of $29 million. This change in estimate was based on current claim experience demonstrating an increase in the length of the time policyholders already in payment status remained in such status. Future policy benefits payable was increased to cover future payments to policyholders currently in payment status.

Deferred acquisition costs included $66 million and $62 million associated with our individual commercial medical policies at December 31, 2013 and December 31, 2012, respectively. Future policy benefits payable associated with our individual commercial medical policies were $327 million at December 31, 2013 and $282 million at December 31, 2012. As discussed in Note 2, beginning in 2014, health policies sold to individuals that conform to the Health Care Reform Law will be accounted for under a short-duration model because premiums received in the current year are intended to pay anticipated benefits in that year.

18. REINSURANCE

Certain blocks of insurance assumed in acquisitions, primarily life, long-term care, and annuities in run-off status, are subject to reinsurance where some or all of the underwriting risk related to these policies has been ceded to a third party. In addition, a large portion of our reinsurance takes the form of 100% coinsurance agreements where, in addition to all of the underwriting risk, all administrative responsibilities, including premium collections and claim payment, have also been ceded to a third party. We acquired these policies and related reinsurance agreements with the purchase of stock of companies in which the policies were originally written. We acquired these companies for business reasons unrelated to these particular policies, including the companies’ other products and licenses necessary to fulfill strategic plans.

A reinsurance agreement between two entities transfers the underwriting risk of policyholder liabilities to a reinsurer while the primary insurer retains the contractual relationship with the ultimate insured. As such, these

 

45


Humana Inc.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

 

reinsurance agreements do not completely relieve us of our potential liability to the ultimate insured. However, given the transfer of underwriting risk, our potential liability is limited to the credit exposure which exists should the reinsurer be unable to meet its obligations assumed under these reinsurance agreements.

Reinsurance recoverables represent the portion of future policy benefits payable that are covered by reinsurance. Amounts recoverable from reinsurers are estimated in a manner consistent with the methods used to determine future policy benefits payable as detailed in Note 2. Reinsurance recoverables, included in other long-term assets, were $578 million at December 31, 2013 and $461 million at December 31, 2012. The percentage of these reinsurance recoverables resulting from 100% coinsurance agreements was approximately 37% at December 31, 2013 and approximately 48% at December 31, 2012. Premiums ceded were $33 million in 2013 and $34 million in each of 2012 and 2011.

We evaluate the financial condition of these reinsurers on a regular basis. These reinsurers are well-known and well-established, as evidenced by the strong financial ratings at December 31, 2013 presented below:

 

Reinsurer

   Total
Recoverable
     A.M. Best Rating at December 31,
2013
 
     (in millions)         

Protective Life Insurance Company

   $ 192         A+ (superior)   

Munich American Reassurance Company

     167         A+ (superior)   

Employers Reassurance Corporation

     83         A-(excellent)   

General Re Life Corporation

     82         A++ (superior)   

All others

     54         A+ to B++ (superior to good)   
  

 

 

    
   $ 578      
  

 

 

    

The all other category represents 15 reinsurers with individual balances less than $20 million. Two of these reinsurers have placed $23 million of cash and securities in trusts, an amount at least equal to the recoverable from each of these reinsurers.

 

46


REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

To the Board of Directors and Stockholders of Humana Inc.:

In our opinion, the consolidated balance sheets and the related consolidated statements of income, of comprehensive income, of stockholders’ equity and of cash flows present fairly, in all material respects, the financial position of Humana Inc. and its subsidiaries (“Company”) at December 31, 2013 and 2012, and the results of their operations and their cash flows for each of the three years in the period ended December 31, 2013 in conformity with accounting principles generally accepted in the United States of America. In addition, in our opinion, the financial statement schedules (not appearing herein) listed in the index appearing under Item 15(a)(2) present fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements. Also in our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2013, based on criteria established in Internal Control – Integrated Framework (1992) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). The Company’s management is responsible for these financial statements and financial statement schedules, for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in Management’s Report on Internal Control Over Financial Reporting appearing under Item 9A (not appearing herein). Our responsibility is to express opinions on these financial statements, on the financial statement schedules, and on the Company’s internal control over financial reporting based on our integrated audits. We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the financial statements are free of material misstatement and whether effective internal control over financial reporting was maintained in all material respects. Our audits of the financial statements included examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, and evaluating the overall financial statement presentation. Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. Our audits also included performing such other procedures as we considered necessary in the circumstances. We believe that our audits provide a reasonable basis for our opinions.

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures that (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

/s/ PricewaterhouseCoopers LLP

Louisville, Kentucky

February 19, 2014 (except with respect to our opinion on the consolidated financial statements insofar as it relates to the effects of the business segment reclassification as discussed in Note 2, to which the date is September 16, 2014)

 

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