Medical claims payable for the Global Health Care segment reflects estimates of the ultimate cost of claims that have been incurred but not yet reported, those that have been reported but not yet paid (reported claims in process), and other medical expenses payable that is primarily comprised of accruals for incentives and other amounts payable to health care professionals and facilities, as follows:

	September 30,		December 31,
(In millions)	2014		2013
Incurred but not yet reported	$	1,872	$	1,615
Reported claims in process		252		355
Physician incentives and other medical expense payable		106		80
Medical claims payable	$	2,230	$	2,050

	For the period ended
	September 30,		December 31,
(In millions)	2014		2013
Balance at January 1,	$	2,050	$	1,856
Less: Reinsurance and other amounts recoverable		194		242
Balance at January 1, net		1,856		1,614


Incurred claims related to:
Current year		12,558		16,049
Prior years		(155)		(182)
Total incurred		12,403		15,867
Paid claims related to:
Current year		10,670		14,267
Prior years		1,605		1,358
Total paid		12,275		15,625
Ending Balance, net		1,984		1,856
Add: Reinsurance and other amounts recoverable		246		194
Ending Balance	$	2,230	$	2,050

Reinsurance and other amounts recoverable includes amounts due from reinsurers and policyholders to cover incurred but not reported and pending claims for minimum premium products and certain administrative services only business where the right of offset does not exist. See Note 5 for additional information on reinsurance. For the nine months ended September 30, 2014, actual experience differed from the Company's key assumptions resulting in favorable incurred claims related to prior years' medical claims payable of $155 million, or 1.0% of the current year incurred claims as reported for the year ended December 31, 2013. Actual completion factors accounted for $60 million, or 0.4% of the favorability, while actual medical cost trend resulted in the remaining $95 million, or 0.6%.

For the year ended December 31, 2013, actual experience differed from the Company's key assumptions, resulting in favorable incurred claims related to prior years' medical claims payable of $182 million, or 1.3% of the current year incurred claims as reported for the year ended December 31, 2012. Actual completion factors accounted for $74 million, or 0.5% of favorability, while actual medical cost trend resulted in the remaining $108 million, or 0.7%.

The impact of prior year development on shareholders' net income was $53 million for the nine months ended September 30, 2014 compared with $77 million for the nine months ended September 30, 2013. The favorable effect of prior year development for both years primarily reflects low utilization of medical services. The change in the amount of the incurred claims related to prior years in the medical claims payable liability does not directly correspond to an increase or decrease in the Company's shareholders' net income recognized for the following reasons:

First, the Company consistently recognizes the actuarial best estimate of the ultimate liability within a level of confidence, as required by actuarial standards of practice that require the liabilities be adequate under moderately adverse conditions. As the Company establishes the liability for each incurral year, the Company ensures that its assumptions appropriately consider moderately adverse conditions. When a portion of the development relates to a release of the prior year's provision for moderately adverse conditions, the Company does not consider that amount as impacting shareholders' net income to the extent that it is offset by an increase determined appropriate to address moderately adverse conditions for the current year incurred claims.

Second, as a result of the medical loss ratio (“MLR”) provisions of Health Care Reform, changes in medical claim estimates due to prior year development may be offset by a change in the MLR rebate accrual.

Third, changes in reserves for the Company's retrospectively experience-rated business for accounts in surplus do not usually impact shareholders' net income because such amounts are generally offset by a change in the liability to the policyholder. An account is in surplus when the accumulated premium received exceeds the accumulated medical costs and administrative charges, including profit charges. For additional information regarding the Company's retrospectively experience-rated business, see page 3 of the Company's 2013 Form 10-K.

The determination of liabilities for the Global Health Care medical claims payable requires the Company to make critical accounting estimates. See Note 2(N) to the Consolidated Financial Statements in the Company's 2013 Form 10-K.