EX-99.1 2 dex991.htm PRESS RELEASE Press Release

Exhibit 99.1

 

LOGO   

Health Net, Inc.

21650 Oxnard Street

Woodland Hills, CA 91367

818.676.6000

800.291.6911

www.healthnet.com

 

Contacts: David Olson

818.676.6978

david.w.olson@healthnet.com

 

Michael Engelhard

818.676.7620

michael.engelhard@healthnet.com

 

HEALTH NET REPORTS NET INCOME

OF $54 MILLION OR $.47 PER DILUTED SHARE

 

Results Include Approximately $16 Million Pretax Charge for Litigation Costs

 

Improvements in Health Plan MCR and TRICARE Highlight Results

 

LOS ANGELES, August 4, 2005 – Health Net, Inc. (NYSE: HNT) today announced 2005 second quarter net income per diluted share of $.47 compared with net income per diluted share of $.36 in the second quarter of 2004.

 

Included in the results for the second quarter of 2005 is the full effect of a $16,237,000 pretax charge, or $.08 per diluted share after tax, primarily consisting of $15.9 million for litigation costs associated with a case arising from the 1999 sale of three of the company’s health


plan subsidiaries and $0.3 million for severance and related benefits associated with a workforce reduction announced in May 2004.

 

Health Net reported net income of $53,563,000 in the second quarter of 2005 compared to net income of $41,366,000 in the second quarter of 2004. The second quarter of 2004 included the full effect of a $17,402,000 pretax charge, or $.09 per diluted share after tax, for severance and related benefits for the workforce reduction.

 

The year-over-year improvement in net income was primarily the result of a lower health plan medical care ratio (MCR) and improved Government contracts pretax income.

 

“We believe this quarter represents a turning point for Health Net. The repricing of our commercial book is now complete and the new TRICARE option period shows the anticipated improvement in profitability from the first quarter,” said Jay Gellert, president and chief executive officer of Health Net.

 

Positive developments for the second quarter of 2005 included:

 

    Health Net’s Health Plan MCR was 84.6 percent, a 140 basis point improvement compared to the 86.0 percent reported in the second quarter of 2004 and a 40 basis point improvement compared to the 85.0 percent reported in the first quarter of 2005;

 

    Commercial revenue per member per month (PMPM) increased by more than 11 percent in the second quarter of 2005 compared to the second quarter of 2004, consistent with the company’s expectations;

 

    The Government contracts cost ratio improved by 150 basis points in the second quarter of 2005 compared to the first quarter of 2005; and

 

    Significant progress was made in strengthening statutory capital in its regulated entities.

 

2


Revenues

 

Health Net’s total revenues increased 3.5 percent in the second quarter of 2005 to $3,019,857,000 from $2,918,815,000 in the second quarter of 2004. Health plan services premiums declined 0.3 percent to $2,390,679,000 in the second quarter of 2005 compared to $2,398,943,000 in the second quarter of 2004, primarily as a result of lower health plan enrollment. In the second quarter of 2005, Health Net’s Government contracts revenue rose 21.1 percent from the second quarter of 2004, increasing by $106,339,000 to $610,656,000.

 

In the second quarter of 2005, the overall health plan revenue PMPM, including commercial, Medicare and Medicaid enrollment, rose 8.8 percent compared to the same period in 2004. Commercial premium yields climbed 11.4 percent compared to the second quarter of 2004.

 

“The premium yields we achieved in the second quarter of 2005 were consistent with our disciplined pricing,” said Buddy Piszel, executive vice president and chief financial officer of Health Net.

 

Total health plan enrollment fell by 24,000 members, or less than 0.7 percent, in the second quarter of 2005 compared to the first quarter of 2005. Medicare enrollment rose by approximately 1,600 members, while Medicaid enrollment increased by approximately 4,700 members. Commercial enrollment declined by 29,000 members in the second quarter of 2005 compared to the first quarter of 2005. Year-over-year, total health plan enrollment declined by 265,000 members, or 7.0 percent.

 

Commercial enrollment, including both at-risk and Administrative Services Only (ASO) membership, was down 1.2 percent in the second quarter of 2005 compared with the first quarter of 2005.

 

3


“We believe the commercial enrollment trend is stabilizing,” Piszel added, “and we are encouraged by the sequential growth in Medicare enrollment.”

 

Government contracts revenue increased by $113,946,000 in the second quarter of 2005 compared to the first quarter of 2005 and by $106,339,000 compared to the second quarter of 2004. “This increase reflects higher revenues for the second option period of our five-year TRICARE contract for the North Region. The increase also included continued high levels of private sector health care utilization due to overseas deployment of military health care personnel,” noted Piszel.

 

Health Care Costs

 

The health plan MCR decreased to 84.6 percent in the second quarter of 2005 from 86.0 percent in the second quarter of 2004. This decrease in the health plan MCR primarily reflects improvement in the commercial MCR.

 

Overall PMPM health plan health care costs rose by 7.1 percent in the second quarter of 2005 compared to the second quarter of 2004. Commercial health care cost PMPMs rose between 9 and 10 percent over the same period.

 

The Government contracts cost ratio rose by 10 basis points to 95.1 percent for the second quarter of 2005 compared to the second quarter of 2004 but decreased by 150 basis points compared to the first quarter of 2005. “We anticipated that this ratio would improve as we began the second option period,” Piszel noted. “We are pleased with the performance of our TRICARE operations.”

 

Administrative Expenses

 

In the second quarter of 2005, total general, administrative and depreciation expenses increased by $19,522,000 to $244,190,000 compared to expenses of $224,668,000 in the second

 

4


quarter of 2004. “Our performance allowed us to expand our investment in Medicare and increase commercial marketing expenses,” commented Piszel.

 

Health Net’s selling expenses decreased by $3,911,000 to $56,082,000 in the second quarter of 2005 compared with $59,993,000 in the same period in 2004, consistent with the decline in Small Group and Individual enrollment over the same periods. The selling costs ratio was 2.3 percent for the second quarter of 2005, compared with 2.5 percent in the same period last year.

 

Balance Sheet Highlights

 

Cash and investments as of June 30, 2005 were $1,999,993,000 compared with $1,895,602,000 as of March 31, 2005.

 

Reserves for claims and other settlements decreased by $89,826,000 to $1,065,465,000 at June 30, 2005 from $1,155,291,000 at March 31, 2005. This decline was the result of $37 million in total provider settlement payments, lower at-risk enrollment and an acceleration in claims payments.

 

“We are seeing the effects of our recontracting efforts and operational improvements. The simpler provider contracts allow us to process more claims correctly the first time through and reduce inventories on hand,” noted Piszel. “As a result, our paid claims in the second quarter were more than $50 million higher than the first quarter of 2005. Recent experience confirms the strength of our level of reserves.”

 

Days claims payable (DCP), excluding provider settlement reserves and capitation expenses, increased by 0.4 day for the second quarter of 2005 to 60.3 days compared to 59.9 days for the first quarter of 2005. Including all reserves, DCP were 49.9 days for the second

 

5


quarter of 2005 compared to 46.6 days in the second quarter of 2004. A table reconciling the calculation of DCP is attached to this release.

 

Debt increased by $11,678,000 from March 31, 2005 to $400,659,000 as of June 30, 2005, primarily due to the mark-to-market adjustment of the interest rate swap contracts on our senior notes. Despite this increase, the company’s debt-to-total capital ratio was 22.3 percent as of June 30, 2005 compared to 22.9 percent as of March 31, 2005.

 

Interest expense was $3,239,000 higher in the second quarter of 2005 compared to the second quarter of 2004 due to higher interest payments resulting from rating agency downgrades on our senior unsecured debt rating in the third quarter of 2004 and higher market interest rates in the second quarter of 2005 compared to rates in the second quarter of 2004.

 

Cash Flow

 

Operating cash flow was a negative $10,720,000 in the second quarter of 2005 compared to positive operating cash flow of $12,514,000 in the second quarter of 2004. The company noted that the payment of $37 million for provider settlements and a sequential increase in paid claims of more than $50 million contributed to the use of operating cash flow in the quarter.

 

Medicare

 

The company is the fifth largest Medicare Advantage contractor in the United States based on enrollment, with approximately 171,000 members in its Medicare Advantage plans. The company has filed to expand its Medicare Advantage plan to all counties in Connecticut, where it currently only provides service in Fairfield County. The company also has filed applications with the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Part D prescription drug program, the stand-alone Part D drug benefit, and both local

 

6


and regional Preferred Provider Organization (PPO) plans as part of the Medicare Modernization Act of 2003.

 

“We are excited about the opportunities in Medicare,” Gellert added, “and we’ll have more to say about our 2006 outlook after CMS announces the results of Part D applications later this summer.”

 

Outlook

 

Health Net believes its earnings per diluted share for the full year 2005 will be between $1.85 and $2.05, including the effect of charges related to litigation recorded in the first and second quarters of 2005. Excluding these charges, the full year earnings per diluted share range remains between $2.30 and $2.50.

 

The company’s effective tax rate in the second quarter of 2005 was 39.2 percent, and the company expects its tax rate to end the full year at 38.7 percent.

 

The company’s diluted shares outstanding have increased to over 114 million shares as of the second quarter of 2005, and the company expects diluted shares outstanding to exceed 116 million shares for the fourth quarter of 2005.

 

“This is more than 2 percent higher than our expectation at the beginning of the year,” stated Piszel.

 

Conference Call

 

As previously announced, Health Net will discuss the company’s second quarter 2005 results during a conference call with investors on Thursday, August 4, 2005, at approximately 11:00 a.m. EDT. To listen to the call, please dial 719.955.1568, code 8330914. A live webcast and replay of the conference call also will be available at www.healthnet.com. The conference call webcast is open to all interested parties. The replay of the conference call will be available

 

7


following the call on Thursday, August 4, 2005 through August 8, 2005, by dialing 719.457.0820, code 8330914. Anyone listening to the company’s conference call will be presumed to have read Health Net’s Annual Report on Form 10-K for the year ended December 31, 2004 and Quarterly Report on Form 10-Q for the first quarter ended March 31, 2005, and other reports filed by the company from time to time with the Securities and Exchange Commission.

 

About Health Net

 

Health Net, Inc. is among the nation’s largest publicly traded managed health care companies. Its mission is to help people be healthy, secure and comfortable. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.4 million individuals in 27 states and the District of Columbia through group, individual, Medicare, Medicaid and TRICARE programs. Health Net’s behavioral health services subsidiary, MHN, provides behavioral health, substance abuse and employee assistance programs (EAPs) to approximately 7.4 million individuals in various states, including the company’s own health plan members. The company’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.

 

For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com.

 

Cautionary Statements

 

Certain matters discussed in this release contain forward-looking statements within the meaning of Section 21E of the Securities Exchange Act of 1934, as amended, and Section 27A

 

8


of the Securities Act of 1933, as amended, that involve a number of risks and uncertainties. All statements, other than statements of historical information provided herein, may be deemed to be forward-looking statements. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to uncertainty and changes in circumstances. Without limiting the foregoing, the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially due to, among other things, rising health care costs, negative prior period claims reserve developments, trends in medical care ratios, issues relating to provider contracts, litigation costs, operational issues, health care reform and general business conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within the company’s most recent Annual Report on Form 10-K filed with the SEC and the risks discussed in the company’s other periodic filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. The company undertakes no obligation to publicly revise these forward-looking statements to reflect events or circumstances that arise after the date of this release.

 

#    #    #

 

[Six pages of tables follow]

 

9


Health Net, Inc.

Condensed Consolidated Statements of Operations

(Amounts in thousands, except per share and ratio data)

 

     Second Quarter
Ended
June 30,
2004


    Third Quarter
Ended
September 30,
2004


    Fourth Quarter
Ended
December 31,
2004


    First Quarter
Ended
March 31,
2005


    Second Quarter
Ended
June 30,
2005


 

REVENUES:

                                        

Health plan services premiums

   $ 2,398,943     $ 2,393,160     $ 2,363,786     $ 2,397,689     $ 2,390,679  

Government contracts

     504,317       525,783       487,823       496,710       610,656  

Net investment income

     13,818       14,750       14,378       15,763       17,213  

Other income

     1,737       1,540       1,606       1,583       1,309  
    


 


 


 


 


Total revenues

     2,918,815       2,935,233       2,867,593       2,911,745       3,019,857  
    


 


 


 


 


EXPENSES:

                                        

Health plan services

     2,062,277       2,022,870       2,221,404 (e)     2,036,873       2,023,174  

Government contracts

     478,927       501,628       466,138       479,974       580,685  

General and administrative

     214,244       207,187       235,564 (e)     215,227       233,723  

Selling

     59,993       60,410       56,137       57,273       56,082  

Depreciation

     10,424       10,487       10,532       11,556       10,467  

Amortization

     606       789       861       861       861  

Interest

     7,304       8,044       9,347       10,609       10,543  
    


 


 


 


 


       2,833,775       2,811,415       2,999,983       2,812,373       2,915,535  

Litigation, asset impairments and restructuring charges

     17,402 (a)     5,172 (a)     10,319 (d)     67,042 (f)     16,237 (h)

Loss on sale of businesses

     —         400 (b)     305 (c)     —         —    
    


 


 


 


 


Total expenses

     2,851,177       2,816,987       3,010,607       2,879,415       2,931,772  
    


 


 


 


 


Income (loss) from continuing operations before income taxes

     67,638       118,246       (143,014 )     32,330       88,085  

Income tax provision (benefit)

     26,272       46,391       (57,385 )     10,982 (g)     34,522  
    


 


 


 


 


Net income (loss)

   $ 41,366     $ 71,855     $ (85,629 )     21,348       53,563  
    


 


 


 


 


Basic earnings (loss) per share

   $ 0.37     $ 0.64     $ (0.77 )   $ 0.19     $ 0.48  

Diluted earnings (loss) per share

   $ 0.36     $ 0.64     $ (0.77 )   $ 0.19     $ 0.47  

Weighted average shares outstanding:

                                        

Basic

     112,574       111,440       110,844       111,544       112,451  

Diluted

     113,460       112,397       110,844       113,235       114,851  

Health plan services MCR

     86.0 %     84.5 %     94.0 %     85.0 %     84.6 %

Government contracts cost ratio

     95.0 %     95.4 %     95.6 %     96.6 %     95.1 %

Administrative ratio ((G&A+Dep) / (HP serv rev + Other income))

     9.4 %     9.1 %     10.4 %     9.5 %     10.2 %

Selling costs ratio (Selling costs / HP serv rev)

     2.5 %     2.5 %     2.4 %     2.4 %     2.3 %

Days claims payable (i)

     46.6       46.2       44.7       51.4       49.9  

Days claims payable (excluding capitation and provider settlements) (i)

     63.9       62.5       59.2       59.9       60.3  

Effective tax rate

     38.84 %     39.23 %     40.13 %     33.97 %     39.19 %

Health plan services premiums PMPM

   $ 215.98     $ 219.09     $ 222.30     $ 231.84     $ 235.03  

Health plan services costs PMPM

   $ 185.67     $ 185.19     $ 208.91     $ 196.96     $ 198.90  

 

Page 10


Health Net, Inc.

Condensed Consolidated Balance Sheets

(Amounts in thousands, except ratio data)

 

     June 30,
2004


    September 30,
2004


    December 31,
2004


    March 31,
2005


    June 30,
2005


 

ASSETS

                                        

Current Assets

                                        

Cash and cash equivalents

   $ 467,565     $ 622,903     $ 722,102     $ 765,842     $ 939,057  

Investments - available for sale

     1,153,222       1,082,969       1,060,000       1,129,760       1,060,936  

Premiums receivable, net

     151,619       118,201       118,521       124,041       119,776  

Amounts receivable under government contracts

     128,960       136,335       129,483       134,447       139,540  

Incurred but not reported (IBNR) health care costs receivable under TRICARE North contract

     —         114,618       173,951       216,740       184,214  

Other receivables

     93,920       102,494       92,435       82,401       89,437  

Deferred taxes

     40,652       41,162       98,659       106,150       100,277  

Other assets

     103,907       99,578       97,163       112,044       118,904  
    


 


 


 


 


Total current assets

     2,139,845       2,318,260       2,492,314       2,671,425       2,752,141  

Property and equipment, net

     186,570       185,291       184,643       183,176       103,314  

Goodwill, net

     723,595       723,595       723,595       723,595       723,595  

Other intangible assets, net

     21,505       22,716       21,855       20,993       20,132  

Deferred taxes

     41,868       18,327       23,737       24,917       26,941  

Other noncurrent assets

     282,258       249,912       207,050       163,732       148,647  
    


 


 


 


 


Total Assets

   $ 3,395,641     $ 3,518,101     $ 3,653,194     $ 3,787,838     $ 3,774,770  
    


 


 


 


 


LIABILITIES AND STOCKHOLDERS’ EQUITY

                                        

Current Liabilities

                                        

Reserves for claims and other settlements

   $ 1,042,831     $ 990,240     $ 1,169,297     $ 1,155,291     $ 1,065,465  

Health care and other costs payable under government contracts

     216,816       201,494       119,219       128,570       131,909  

IBNR health care costs payable under TRICARE North contract

     —         114,618       173,951       216,740       184,214  

Unearned premiums

     85,894       78,832       139,766       115,859       97,038  

Accounts payable and other liabilities

     254,453       296,782       258,923       348,068       385,995  
    


 


 


 


 


Total current liabilities

     1,599,994       1,681,966       1,861,156       1,964,528       1,864,621  

Senior notes payable

     384,220       401,750       397,760       388,981       400,659  

Other noncurrent liabilities

     95,243       81,657       121,398       126,471       116,824  
    


 


 


 


 


Total Liabilities

     2,079,457       2,165,373       2,380,314       2,479,980       2,382,104  
    


 


 


 


 


Stockholders’ Equity

                                        

Common stock and additional paid-in capital

     798,432       805,426       811,426       834,412       857,513  

Restricted common stock

     5,855       6,483       7,188       7,859       7,505  

Unearned compensation

     (3,121 )     (3,999 )     (4,110 )     (4,095 )     (3,423 )

Treasury common stock, at cost

     (580,634 )     (632,926 )     (632,926 )     (632,926 )     (632,926 )

Retained earnings

     1,108,154       1,180,009       1,094,380       1,115,728       1,169,291  

Accumulated other comprehensive loss

     (12,502 )     (2,265 )     (3,078 )     (13,120 )     (5,294 )
    


 


 


 


 


Total Stockholders’ Equity

     1,316,184       1,352,728       1,272,880       1,307,858       1,392,666  
    


 


 


 


 


Total Liabilities and Stockholders’ Equity

   $ 3,395,641     $ 3,518,101     $ 3,653,194     $ 3,787,838     $ 3,774,770  
    


 


 


 


 


Debt-to-Total Capital Ratio

     22.6 %     22.9 %     23.8 %     22.9 %     22.3 %

 

Page 11


Health Net, Inc.

Condensed Consolidated Statements of Cash Flows

(Amounts in thousands)

 

     Second Quarter
Ended
June 30,
2004


    Third Quarter
Ended
September 30,
2004


    Fourth Quarter
Ended
December 31,
2004


    First Quarter
Ended
March 31,
2005


    Second Quarter
Ended
June 30,
2005


 

CASH FLOWS FROM OPERATING ACTIVITIES:

                                        

Net income (loss)

   $ 41,366     $ 71,855     $ (85,629 )   $ 21,348     $ 53,563  

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

                                        

Amortization and depreciation

     11,030       11,276       11,393       12,417       11,328  

Loss on sale of businesses

     —         400       305       —         —    

Asset impairments

     —         —         5,916       —         —    

Other changes

     1,518       546       2,803       3,189       3,100  

Changes in assets and liabilities, net of the effects of dispositions:

                                        

Premiums receivable and unearned premiums

     24,839       26,356       60,614       (29,427 )     (14,556 )

Other receivables, deferred taxes and other assets

     515       5,140       (96,872 )     (6,685 )     (14,336 )

Amounts receivable/payable under government contracts

     (24,438 )     (22,697 )     (75,423 )     4,387       (1,754 )

Reserves for claims and other settlements

     (26,416 )     (52,591 )     179,057       (14,006 )     (89,826 )

Accounts payable and other liabilities

     (15,900 )     44,267       433       103,928       41,761  
    


 


 


 


 


Net cash provided by (used in) operating activities

     12,514       84,552       2,597       95,151       (10,720 )
    


 


 


 


 


CASH FLOWS FROM INVESTING ACTIVITIES:

                                        

Sales of investments

     65,320       79,438       12,751       23,090       184,483  

Maturities of investments

     84,102       30,632       47,171       13,777       38,653  

Purchases of investments

     (284,446 )     (22,774 )     (4,846 )     (125,650 )     (143,776 )

Purchases / sales of property and equipment

     (10,045 )     (9,178 )     (12,870 )     (10,392 )     71,954  

Cash received (paid) from the sale of businesses

     —         (400 )     486       1,949       —    

Sales and purchases of restricted investments and other

     (84,552 )     39,307       48,697       29,246       13,460  
    


 


 


 


 


Net cash (used in) provided by investing activities

     (229,621 )     117,025       91,389       (67,980 )     164,774  
    


 


 


 


 


CASH FLOWS FROM FINANCING ACTIVITIES:

                                        

Proceeds from exercise of stock options and employee stock purchases

     3,040       6,053       5,213       16,569       19,161  

Repurchases of common stock

     (3,150 )     (52,292 )     —         —         —    
    


 


 


 


 


Net cash (used in) provided by financing activities

     (110 )     (46,239 )     5,213       16,569       19,161  
    


 


 


 


 


Net (decrease) increase in cash and cash equivalents

     (217,217 )     155,338       99,199       43,740       173,215  

Cash and cash equivalents, beginning of period

     684,782       467,565       622,903       722,102       765,842  
    


 


 


 


 


Cash and cash equivalents, end of period

   $ 467,565     $ 622,903     $ 722,102     $ 765,842     $ 939,057  
    


 


 


 


 


 

Page 12


Health Net, Inc.

Notes to Condensed Consolidated Statements of Operations

 

Notes:

 

(a) Pretax severance and related benefit costs related to our workforce reduction announced in May 2004.

 

(b) Pretax $0.4 million additional loss on the sale of our Florida health plan resulting from the stock purchase and reinsurance settlement agreements dated September 30, 2004.

 

(c) Pretax $0.3 million additional loss on the sale of Denticare and Vision subsidiaries.

 

(d) Pretax $10.3 million asset impairments and restructuring charges due to the following:

 

$5.9 million asset impairment charge taken on certain investments and fixed assets

$2.7 million for severance and related benefit costs related to our workforce reduction announced in May 2004

$1.7 million for lease termination costs

 

(e) Pretax $158 million provider dispute charge and related legal costs of $11 million.

 

(f) Pretax $67.0 million litigation settlement and restructuring charges due to the following:

 

$65.6 million related to settlement of MDL physician-class lawsuit

$1.4 million for severance and related benefit costs related to our workforce reduction announced in May 2004

 

(g) Includes $2.2 million of income tax benefit related to the sale of a small subsidiary.

 

(h) Pretax $15.9 million charge representing total estimated legal defense costs associated with the AmCareco case $0.3 million for severance and related benefit costs related to our workforce reduction announced in May 2004

 

(i)    Health Net, Inc.

Calculation of Days Claims Payable (Excluding Capitation and Provider Settlements)

Dollars in Thousands

 

     Q2 2004

    Q3 2004

    Q4 2004

    Q1 2005

    Q2 2005

 

Reserve for Claims and Other Settlements

   $ 1,042,831     $ 990,240     $ 1,169,297     $ 1,155,291     $ 1,065,465  

Less: Capitation Payable and Provider Settlements

     (62,104 )     (72,968 )     (203,753 )     (169,733 )     (132,795 )
    


 


 


 


 


Adjusted Reserve for Claims and Other Settlements

   $ 980,727     $ 917,272     $ 965,544     $ 985,558     $ 932,670  

(1)    Average Reserve for Claims and Other Settlements

   $ 1,056,039     $ 1,016,536     $ 1,079,769     $ 1,162,294     $ 1,110,378  

(2)    Average Adjusted Reserve for Claims and Other Settlements

   $ 999,948     $ 949,000     $ 941,408     $ 975,551     $ 959,114  

(3)    Health Plan Services Cost

     2,062,277       2,022,870       2,221,404       2,036,873       2,023,174  

Less: Capitation Expense and Provider Settlements

     (637,331 )     (626,795 )     (757,496 )     (571,593 )     (576,367 )
    


 


 


 


 


(4)    Adjusted Health Plan Services Cost

   $ 1,424,946     $ 1,396,075     $ 1,463,908     $ 1,465,280     $ 1,446,807  

(5)    Number of Days in Period

     91       92       92       90       91  

= (1) / (3) * (5) Days Claims Payable

     46.6       46.2       44.7       51.4       49.9  

= (2) / (4) * (5) Days Claims Payable (Excl. Capitation & Provider Settlements)

     63.9       62.5       59.2       59.9       60.3  

 

Page 13


HEALTH NET, INC.

Medical Covered Lives at June 30, 2005

(in Thousands)

 

     Commercial -Large Group*

   Commercial - Small Group & Individual

   Commercial Risk Subtotal

   ASO

   Commercial Subtotal

     06/05

   03/05

   06/04

   06/05

   03/05

   06/04

   06/05

   03/05

   06/04

   06/05

   03/05

   06/04

   06/05

   03/05

   06/04

Arizona

   66    66    71    52    54    54    119    120    125    —      —      —      119    120    125

California

   1,104    1,113    1,170    413    433    515    1,517    1,546    1,685    7    7    3    1,524    1,552    1,688

Connecticut

   181    182    200    35    38    44    216    220    244    69    48    51    285    268    296

New Jersey

   67    71    122    90    98    135    157    169    257    18    18    18    176    188    274

New York

   121    124    156    104    106    112    224    230    268    21    21    6    245    251    274

Oregon

   102    103    95    35    34    33    138    137    128    1    1    —      138    138    128
    
  
  
  
  
  
  
  
  
  
  
  
  
  
  

Total

   1,642    1,659    1,815    729    763    893    2,371    2,422    2,707    116    95    79    2,487    2,516    2,786
    
  
  
  
  
  
  
  
  
  
  
  
  
  
  

Year over Year

        (10)%              (18)%              (12)%              47%              (11)%     

Sequential

        (1)%              (4)%              (2)%              22%              (1)%     

 

     Medicare Risk

   Medicaid

   Health Plan Total

     06/05

   03/05

   06/04

   06/05

   03/05

   06/04

   06/05

   03/05

   06/04

Arizona

   31    32    36    —      —      —      150    152    161

California

   93    93    97    700    696    662    2,316    2,341    2,447

Connecticut

   27    27    27    94    93    96    406    388    419

New Jersey

   —      —      —      42    42    44    217    229    318

New York

   6    6    5    —      —      —      251    256    280

Oregon

   14    12    5    —      —      —      153    150    133
    
  
  
  
  
  
  
  
  

Total

   171    169    170    836    831    803    3,493    3,517    3,758
    
  
  
  
  
  
  
  
  

Year over Year

        1%              4%              (7)%     

Sequential

        1%              1%              (1)%     

 

     06/05

   03/05

   06/04

TRICARE

              

Previous TRICARE Contracts **

   —      —      1,477

North Contract ***

   2,946    2,941    —  
    
  
  

Total TRICARE

   2,946    2,941    1,477

 

* Commercial Large Group includes Medicare Supplement

 

** Includes only Tricare eligible for which we have health care risk

 

*** Includes Tricare eligible for which we have health care risk, and those for which we provide Administrative Services Only (ASO), primarily active duty

 

Page 14


Health Net, Inc.

Reconciliation of Reserve for Claims and Other Settlements

(In thousands)

 

     Health Plan Services

 
     6-Months Ended
June 30, 2005


    Year 2004

   Year 2003

 

Reserve for claims (a), beginning of period

   $ 794,614     $ 777,059    $ 787,317  

Divested health plans (b)

     —         —        (5,119 )

Incurred claims related to:

                       

Current Year

     2,626,348       5,048,289      4,487,698  

Prior Years (d)

     (59,771 )     8,769      (33,812 )
    


 

  


Total Incurred (c )

     2,566,577       5,057,058      4,453,886  

Paid claims related to:

                       

Current Year

     1,987,220       4,286,929      3,738,599  

Prior Years

     598,095       752,574      720,426  
    


 

  


Total Paid (c )

     2,585,314       5,039,503      4,459,025  

Reserve for claims (a), end of period

     775,877       794,614      777,059  

Add:

                       

Claims Payable

     200,447       288,331      167,361  

Other (e)

     89,141       86,352      80,130  
    


 

  


Reserves for claims and other settlements, end of period

   $ 1,065,465     $ 1,169,297    $ 1,024,550  
    


 

  


 

(a) Consists of incurred but not reported claims and received but unprocessed claims and reserves for loss adjustment expenses.

 

(b) Adjustment for 2003 consists primarily of reductions in reserves for claims resulting from the sales of our dental and vision plans.

 

(c) Includes medical claims only. Capitation, pharmacy and other payments including provider settlements are not included.

 

(d) Our liabilities are estimated within a confidence level required under actuarial standards of practice. As such, a change in “incurred claims related to prior years” will be offset by maintaining a consistent level of confidence within the estimate of “incurred claims related to current years.” Therefore, a change, which is offset in this manner, would not indicate that health care services were lower than previously estimated.

 

(e) Includes accrued capitation, shared risk settlements, provider incentives and other reserve items.

 

Page 15