EX-99.1 2 dex991.htm PRESS RELEASE DATED NOVEMBER 1, 2005 Press Release dated November 1, 2005
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 $78 MILLION OR $.67 PER DILUTED SHARE

 

Significant Sequential Increase in Pretax Margin Drives Improved Performance

 

LOS ANGELES, November 1, 2005 – Health Net, Inc. (NYSE: HNT) today announced 2005 third quarter net income per diluted share of $.67 compared with net income per diluted share of $.64 in the third quarter of 2004.

 

Health Net reported net income of $78,205,000 in the third quarter of 2005 compared to net income of $71,855,000 in the third quarter of 2004. The third quarter of 2004 included the full effect of a $5,172,000, or $.03 per diluted share, pretax charge for severance and related benefits for a workforce reduction announced in May 2004, and a $0.4 million pretax charge for the loss on the sale of a business.


Positive developments for the third quarter of 2005 included:

 

    Pretax margin was 4.2 percent, a 130 basis point sequential improvement compared to the 2.9 percent reported in the second quarter of 2005;

 

    Commercial gross margin per member per month (PMPM) rose by more than $6, climbing above $42 on a PMPM basis;

 

    Commercial PMPM yield increases were more than 11 percent in the third quarter of 2005 compared to the third quarter of 2004;

 

    Health Net’s Health Plan Medical Care Ratio (MCR) was 83.4 percent, a 110 basis point improvement compared to the 84.5 percent reported in the third quarter of 2004, and a 120 basis point improvement compared to the 84.6 percent reported in the second quarter of 2005. The sequential improvement is better than historical performance; and

 

    The company’s debt-to-total capital ratio was 20.7 percent, a 220 basis point improvement compared to the 22.9 percent reported in the third quarter of 2004, another sign of a stronger balance sheet, a key Health Net goal for 2005.

 

“The significant sequential improvement in our pretax margin was driven by growth in our commercial gross margin. While we did see a decline in commercial enrollment, we exceeded expectations because of our discipline and focus,” said Jay Gellert, president and chief executive officer of Health Net.

 

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Revenues

 

Health Net’s total revenues increased 4.2 percent in the third quarter of 2005 to $3,058,773,000 from $2,935,233,000 in the third quarter of 2004. Health plan services premiums increased 0.2 percent to $2,398,100,000 in the third quarter of 2005 compared to $2,393,160,000 in the third quarter of 2004. In the third quarter of 2005, Health Net’s Government contracts revenue rose 21.7 percent from the third quarter of 2004, increasing by $113,843,000 to $639,626,000.

 

“This increase reflects higher revenues for the second option period of our five-year TRICARE contract for the North Region, continuing a trend driven by increased military activity,” said Buddy Piszel, executive vice president and chief financial officer of Health Net.

 

In the third quarter of 2005, the overall health plan revenue PMPM, including commercial, Medicare and Medicaid enrollment, rose 9.6 percent compared to the same period in 2004. Commercial premium yields climbed 11.3 percent compared to the third quarter of 2004.

 

“The premium yields we achieved in the third quarter of 2005 resulted from focused pricing actions,” noted Piszel.

 

Total health plan enrollment fell by approximately 66,000 members, or 1.9 percent, in the third quarter of 2005 compared to the second quarter of 2005. Medicare enrollment rose by approximately 1,000 members while Medicaid enrollment decreased by approximately 3,000 members. Commercial enrollment, including both at-risk and Administrative Services Only (ASO) membership, declined by approximately 65,000 members, or 2.6 percent, in the third quarter of 2005 compared to the second quarter of 2005. Year-over-year, total health plan enrollment declined by approximately 269,000 members, or 7.3 percent.

 

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“Even though our commercial enrollment trails expectations, we are encouraged by improving retention rates and expanding margins,” Piszel said.

 

Health Care Costs

 

The health plan MCR improved to 83.4 percent in the third quarter of 2005 from 84.5 percent in the third quarter of 2004. This decrease in the health plan MCR reflects the impact of disciplined pricing and improved hospital cost experience.

 

Overall PMPM health plan health care costs rose by 8.2 percent in the third quarter of 2005 compared to the third quarter of 2004. Commercial health care costs PMPM rose by 8.6 percent over the same period.

 

The Government contracts cost ratio decreased by 70 basis points to 96.1 percent for the third quarter of 2005 compared to the third quarter of 2004 and by 100 basis points compared to the second quarter of 2005. “We expect this margin to fluctuate somewhat from quarter to quarter due to the higher levels of private sector utilization,” Piszel noted.

 

Medicare

 

The company is the fifth largest Medicare Advantage contractor in the United States based on enrollment, with approximately 172,000 members in its Medicare Advantage plans at the end of the third quarter of 2005. In the third quarter of 2005, Health Net unveiled an expansion of the company’s Medicare health plans. The company will offer 98 new health plans, including participation in the new Part D stand-alone drug benefit that includes entry in five new states. The premiums for the company’s Part D bids in all six regions (10 states) in which it bid were below the national benchmark, making it eligible for the auto-assignment of dual-eligible Medicare members by the Centers for Medicare & Medicaid Services (CMS).

 

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“We are pleased by the results of our Part D bids,” Gellert added, “and we expect to enroll in excess of 200,000 dual-eligible members beginning November 15. We’ll have more to say about our 2006 outlook for Medicare at our annual Investor Conference on November 11.”

 

Administrative Expenses

 

In the third quarter of 2005, total general, administrative and depreciation expenses increased by $28,180,000 to $245,854,000 compared to expenses of $217,674,000 in the third quarter of 2004. “Our administrative ratio remains steady, as expected, even though we’ve seen increased Medicare and commercial marketing expenses and expect they will continue in the fourth quarter of 2005,” commented Piszel.

 

Depreciation expense decreased by $6,460,000 in the third quarter of 2005 compared to the second quarter of 2005, reflecting the impact of the sale-leaseback transaction the company completed on June 30, 2005. The decrease in depreciation was partially offset by a $4.0 million increase in general and administrative expenses for lease payments associated with the transaction.

 

Health Net’s selling expenses decreased by $5,410,000 to $55,000,000 in the third quarter of 2005 compared with $60,410,000 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 third quarter of 2005, compared with 2.5 percent in the same period last year.

 

Balance Sheet Highlights

 

Cash and investments as of September 30, 2005 were $2,178,586,000 compared with $1,999,993,000 as of June 30, 2005.

 

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“We are very pleased that our reserve position continues to strengthen as we move through 2005. Days claims payable and favorable development in the roll-forward table both demonstrate that we have adequate reserve strength,” Piszel added.

 

Reserves for claims and other settlements decreased by $7,617,000 to $1,057,848,000 at September 30, 2005 from $1,065,465,000 at June 30, 2005. This includes a $37 million reduction for provider settlements paid during the third quarter of 2005.

 

Days claims payable (DCP), excluding provider settlement reserves related to the charge taken in the fourth quarter of 2004 and capitation expenses, increased by 0.8 day for the third quarter of 2005 to 61.1 days compared to 60.3 days for the second quarter of 2005. On a reported basis, DCP were 48.8 days for the third quarter of 2005 compared to 46.2 days in the third quarter of 2004. A table reconciling the calculation of DCP is attached to this release.

 

The company’s debt-to-total capital ratio was 20.7 percent as of September 30, 2005 compared to 22.3 percent as of June 30, 2005.

 

Interest expense was $1,246,000 higher in the third quarter of 2005 compared with the second quarter of 2005 due to higher market interest rates. Compared with the third quarter of 2004, interest expense was $3,745,000 higher resulting primarily from rating agency downgrades on the company’s senior unsecured debt rating in the third quarter of 2004.

 

Cash Flow

 

Operating cash flow was $174,771,000 in the third quarter of 2005 compared to operating cash flow of $84,552,000 in the third quarter of 2004. The company received an early payment from CMS in the third quarter of 2005 of approximately of $120 million. Excluding the early CMS payment, operating cash flow in the third quarter of 2005 would have been approximately $55 million.

 

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Outlook

 

Health Net believes its earnings per diluted share for the full year 2005 will be between $1.93 and $1.98, including the effect of charges per diluted share of $.44 recorded in the first and second quarters of 2005. Excluding these charges, the 2005 full year earnings per diluted share range is between $2.37 and $2.42. Attached to this press release is a Consolidated Statement of Operations. It provides specific detail on the impact of these charges to net income in the first two quarters of 2005.

 

Earnings for the fourth quarter of 2005 are expected to range between $.60 and $.65 per diluted share.

 

The company believes its earnings per diluted share for the full year 2006 will be at least $2.90. Included in this is the anticipated cost of between $.10 and $.12 per diluted share for expensing stock options. The company will discuss its 2006 outlook in more detail at its annual Investor Conference on November 11, 2005, in New York City.

 

The company’s effective tax rate in the third quarter of 2005 was 39.8 percent and the company expects its effective tax rate for the full year of 2005 to be 39.0 percent.

 

The company’s diluted shares outstanding have increased to over 116,543,000 shares as of the third quarter of 2005 and the company expects diluted shares outstanding of approximately 118 million shares by the fourth quarter of 2005.

 

Conference Call

 

As previously announced, Health Net will discuss the company’s third quarter 2005 results during a conference call with investors on Tuesday, November 1, 2005, at approximately 11:00 a.m. EST. To listen to the call, please dial 800.310.1961, code 4584273. A live webcast and replay of the conference call also will be available at www.healthnet.com. The conference

 

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call webcast is open to all interested parties. A replay of the conference call will be available following the call on Tuesday, November 1, 2005 through November 5, 2005, by dialing 888.203.1112, code 4584273. 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 Reports on Form 10-Q for the first and second quarters of 2005, and other reports filed by the company from time to time with the Securities and Exchange Commission.

 

Investor Conference

 

Health Net will host its annual Investor Conference on Friday, November 11, 2005, at the Millennium Broadway Hotel, 145 West 44th Street, New York, New York. The conference will begin at approximately 8:00 a.m. EST and conclude no later than 2:00 p.m. EST. For those unable to attend in person, the conference also will be accessible via Internet webcast and telephone conference call. To join the conference call, dial 800.262.1292 and enter the confirmation code 4998796. For the webcast, please go to the Investor Relations section of www.healthnet.com and click on the Investor Conference link. Anyone listening to the company’s Investor Conference webcast or conference call will be presumed to have read Health Net’s Annual Report on Form 10-K for the year ended December 31, 2004, Quarterly Reports on Form 10-Q for the first, second and third quarters ended March 31, 2005, June 30, 2005, and September 30, 2005, respectively, 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

 

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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 subsidiary, MHN, provides mental health benefits to approximately 7.3 million individuals in all 50 states. 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 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,

 

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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]

 

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Health Net, Inc.

Condensed Consolidated Statements of Operations

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

 

     Third Quarter
Ended
September 30,
2004


    Fourth Quarter
Ended
December 31,
2004


    First Quarter
Ended
March 31,
2005


   

Second Quarter
Ended

June 30,

2005


    Third Quarter
Ended
September 30,
2005


 

REVENUES:

                                        

Health plan services premiums

   $ 2,393,160     $ 2,363,786     $ 2,397,689     $ 2,390,679     $ 2,398,100  

Government contracts

     525,783       487,823       496,710       610,656       639,626  

Net investment income

     14,750       14,378       15,763       17,213       19,536  

Other income

     1,540       1,606       1,583       1,309       1,511  
    


 


 


 


 


Total revenues

     2,935,233       2,867,593       2,911,745       3,019,857       3,058,773  
    


 


 


 


 


EXPENSES:

                                        

Health plan services

     2,022,870       2,221,404 (e)     2,036,873       2,023,174       2,000,661  

Government contracts

     501,628       466,138       479,974       580,685       614,794  

General and administrative

     207,187       235,564 (e)     215,227       233,723       241,847  

Selling

     60,410       56,137       57,273       56,082       55,000  

Depreciation

     10,487       10,532       11,556       10,467       4,007  

Amortization

     789       861       861       861       861  

Interest

     8,044       9,347       10,609       10,543       11,789  
    


 


 


 


 


       2,811,415       2,999,983       2,812,373       2,915,535       2,928,959  

Litigation, asset impairments and restructuring charges

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

Loss on sale of businesses

     400 (b)     305 (c)     —         —         —    
    


 


 


 


 


Total expenses

     2,816,987       3,010,607       2,879,415       2,931,772       2,928,959  
    


 


 


 


 


Income (loss) from continuing operations before income taxes

     118,246       (143,014 )     32,330       88,085       129,814  

Income tax provision (benefit)

     46,391       (57,385 )     10,982 (g)     34,522       51,609  
    


 


 


 


 


Net income (loss)

   $ 71,855     $ (85,629 )     21,348       53,563       78,205  
    


 


 


 


 


Basic earnings (loss) per share

   $ 0.64     $ (0.77 )   $ 0.19     $ 0.48     $ 0.69  

Diluted earnings (loss) per share

   $ 0.64     $ (0.77 )   $ 0.19     $ 0.47     $ 0.67  

Weighted average shares outstanding:

                                        

Basic

     111,440       110,844       111,544       112,451       113,371  

Diluted

     112,397       110,844       113,235       114,851       116,543  

Pretax margin

     4.0 %     N/A       1.1 %     2.9 %     4.2 %

Health plan services MCR

     84.5 %     94.0 %     85.0 %     84.6 %     83.4 %

Government contracts cost ratio

     95.4 %     95.6 %     96.6 %     95.1 %     96.1 %

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

     9.1 %     10.4 %     9.5 %     10.2 %     10.2 %

Selling costs ratio (Selling costs / HP serv rev)

     2.5 %     2.4 %     2.4 %     2.3 %     2.3 %

Days claims payable (i)

     46.2       44.7       51.4       49.9       48.8  

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

     62.5       59.2       59.9       60.3       61.1  

Effective tax rate

     39.23 %     40.13 %     33.97 %     39.19 %     39.76 %

Health plan services premiums PMPM

   $ 219.09     $ 222.30     $ 231.84     $ 235.03     $ 240.10  

Health plan services costs PMPM

   $ 185.19     $ 208.91     $ 196.96     $ 198.90     $ 200.31  

 

 

11


Health Net, Inc.

Condensed Consolidated Balance Sheets

(Amounts in thousands, except ratio data)

 

     September 30,
2004


    December 31,
2004


    March 31,
2005


    June 30,
2005


    September 30,
2005


 

ASSETS

                                        

Current Assets

                                        

Cash and cash equivalents

   $ 622,903     $ 722,102     $ 765,842     $ 939,057     $ 1,027,848  

Investments - available for sale

     1,082,969       1,060,000       1,129,760       1,060,936       1,150,738  

Premiums receivable, net

     118,201       118,521       124,041       119,776       127,020  

Amounts receivable under government contracts

     136,335       129,483       134,447       139,540       122,295  

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

     114,618       173,951       216,740       184,214       263,329  

Other receivables

     102,494       92,435       82,401       89,437       85,873  

Deferred taxes

     41,162       98,659       106,150       100,277       110,445  

Other assets

     99,578       97,163       112,044       118,904       107,618  
    


 


 


 


 


Total current assets

     2,318,260       2,492,314       2,671,425       2,752,141       2,995,166  

Property and equipment, net

     185,291       184,643       183,176       103,314       112,218  

Goodwill, net

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

Other intangible assets, net

     22,716       21,855       20,993       20,132       19,271  

Deferred taxes

     18,327       23,737       24,917       26,941       29,527  

Other noncurrent assets

     249,912       207,050       163,732       148,647       143,555  
    


 


 


 


 


Total Assets

   $ 3,518,101     $ 3,653,194     $ 3,787,838     $ 3,774,770     $ 4,023,332  
    


 


 


 


 


LIABILITIES AND STOCKHOLDERS’ EQUITY

                                        

Current Liabilities

                                        

Reserves for claims and other settlements

   $ 990,240     $ 1,169,297     $ 1,155,291     $ 1,065,465     $ 1,057,848  

Health care and other costs payable under government contracts

     201,494       119,219       128,570       131,909       62,778  

IBNR health care costs payable under TRICARE North contract

     114,618       173,951       216,740       184,214       263,329  

Unearned premiums

     78,832       139,766       115,859       97,038       218,527  

Accounts payable and other liabilities

     296,782       258,923       348,068       385,995       404,362  
    


 


 


 


 


Total current liabilities

     1,681,966       1,861,156       1,964,528       1,864,621       2,006,844  

Senior notes payable

     401,750       397,760       388,981       400,659       391,106  

Other noncurrent liabilities

     81,657       121,398       126,471       116,824       123,376  
    


 


 


 


 


Total Liabilities

     2,165,373       2,380,314       2,479,980       2,382,104       2,521,326  
    


 


 


 


 


Stockholders’ Equity

                                        

Common stock and additional paid-in capital

     805,426       811,426       834,412       857,513       894,984  

Restricted common stock

     6,483       7,188       7,859       7,505       7,164  

Unearned compensation

     (3,999 )     (4,110 )     (4,095 )     (3,423 )     (2,748 )

Treasury common stock, at cost

     (632,926 )     (632,926 )     (632,926 )     (632,926 )     (633,153 )

Retained earnings

     1,180,009       1,094,380       1,115,728       1,169,291       1,247,496  

Accumulated other comprehensive loss

     (2,265 )     (3,078 )     (13,120 )     (5,294 )     (11,737 )
    


 


 


 


 


Total Stockholders’ Equity

     1,352,728       1,272,880       1,307,858       1,392,666       1,502,006  
    


 


 


 


 


Total Liabilities and Stockholders’ Equity

   $ 3,518,101     $ 3,653,194     $ 3,787,838     $ 3,774,770     $ 4,023,332  
    


 


 


 


 


Debt-to-Total Capital Ratio

     22.9 %     23.8 %     22.9 %     22.3 %     20.7 %

 

12


Health Net, Inc.

Condensed Consolidated Statements of Cash Flows

(Amounts in thousands)

 

     Third Quarter
Ended
September 30,
2004


    Fourth Quarter
Ended
December 31,
2004


    First Quarter
Ended
March 31,
2005


   

Second Quarter
Ended

June 30,

2005


    Third Quarter
Ended
September 30,
2005


 

CASH FLOWS FROM OPERATING ACTIVITIES:

                                        

Net income (loss)

   $ 71,855     $ (85,629 )   $ 21,348     $ 53,563     $ 78,205  

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

                                        

Amortization and depreciation

     11,276       11,393       12,417       11,328       4,868  

Loss on sale of businesses

     400       305       —         —         —    

Asset impairments

     —         5,916       —         —         —    

Other changes

     546       2,803       3,189       3,100       3,229  

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

                                        

Premiums receivable and unearned premiums

     26,356       60,614       (29,427 )     (14,556 )     114,245  

Other receivables, deferred taxes and other assets

     5,140       (96,872 )     (6,685 )     (14,336 )     4,901  

Amounts receivable/payable under government contracts

     (22,697 )     (75,423 )     4,387       (1,754 )     (51,886 )

Reserves for claims and other settlements

     (52,591 )     179,057       (14,006 )     (89,826 )     (7,617 )

Accounts payable and other liabilities

     44,267       433       103,928       41,761       28,826  
    


 


 


 


 


Net cash provided by (used in) operating activities

     84,552       2,597       95,151       (10,720 )     174,771  
    


 


 


 


 


CASH FLOWS FROM INVESTING ACTIVITIES:

                                        

Sales of investments

     79,438       12,751       23,090       184,483       13,283  

Maturities of investments

     30,632       47,171       13,777       38,653       20,215  

Purchases of investments

     (22,774 )     (4,846 )     (125,650 )     (143,776 )     (126,917 )

Purchases / sales of property and equipment

     (9,178 )     (12,870 )     (10,392 )     71,954       (12,825 )

Cash received (paid) from the sale of businesses

     (400 )     486       1,949       —         —    

Sales and purchases of restricted investments and other

     39,307       48,697       29,246       13,460       (8,840 )
    


 


 


 


 


Net cash (used in) provided by investing activities

     117,025       91,389       (67,980 )     164,774       (115,084 )
    


 


 


 


 


CASH FLOWS FROM FINANCING ACTIVITIES:

                                        

Proceeds from exercise of stock options and employee stock purchases

     6,053       5,213       16,569       19,161       29,331  

Repurchases of common stock

     (52,292 )     —         —         —         (227 )
    


 


 


 


 


Net cash (used in) provided by financing activities

     (46,239 )     5,213       16,569       19,161       29,104  
    


 


 


 


 


Net (decrease) increase in cash and cash equivalents

     155,338       99,199       43,740       173,215       88,791  

Cash and cash equivalents, beginning of period

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


 


 


 


 


Cash and cash equivalents, end of period

   $ 622,903     $ 722,102     $ 765,842     $ 939,057     $ 1,027,848  
    


 


 


 


 


 

 

13


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

 

     Q3 2004

    Q4 2004

    Q1 2005

    Q2 2005

    Q3 2005

 

Reserve for Claims and Other Settlements

   $ 990,240     $ 1,169,297     $ 1,155,291     $ 1,065,465     $ 1,057,848  

    Less: Capitation Payable and Provider Settlements

     (72,968 )     (203,753 )     (169,733 )     (132,795 )     (105,154 )
    


 


 


 


 


Adjusted Reserve for Claims and Other Settlements

   $ 917,272     $ 965,544     $ 985,558     $ 932,670     $ 952,694  

(1) Average Reserve for Claims and Other Settlements

   $ 1,016,536     $ 1,079,769     $ 1,162,294     $ 1,110,378     $ 1,061,657  

(2) Average Adjusted Reserve for Claims and Other Settlements

   $ 949,000     $ 941,408     $ 975,551     $ 959,114     $ 942,682  

(3) Health Plan Services Cost

     2,022,870       2,221,404       2,036,873       2,023,174       2,000,661  

              Less: Capitation Expense and Provider Settlements

     (626,795 )     (757,496 )     (571,593 )     (576,367 )     (580,791 )
    


 


 


 


 


(4) Adjusted Health Plan Services Cost

   $ 1,396,075     $ 1,463,908     $ 1,465,280     $ 1,446,807     $ 1,419,870  

(5) Number of Days in Period

     92       92       90       91       92  

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

     46.2       44.7       51.4       49.9       48.8  

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

     62.5       59.2       59.9       60.3       61.1  

 

 

14


HEALTH NET, INC.

Medical Covered Lives at September 30, 2005

(in Thousands)

 

     Commercial - Large Group*

  

Commercial - Small Group

& Individual


     09/05

   06/05

    09/04

   09/05

   06/05

    09/04

Arizona

   69    66     74    50    52     55

California

   1,088    1,104     1,130    391    413     489

Connecticut

   177    181     194    32    35     43

New Jersey

   61    67     109    83    90     123

New York

   116    121     153    103    104     110

Oregon

   102    102     100    36    35     33
    
  

 
  
  

 

Total

   1,612    1,642     1,760    695    729     853
    
  

 
  
  

 

Year over Year

        (8 )%             (19 )%    

Sequential

        (2 )%             (5 )%    
     Commercial Risk Subtotal

   ASO

     09/05

   06/05

    09/04

   09/05

   06/05

    09/04

Arizona

   119    119     129    —      —       —  

California

   1,478    1,517     1,619    7    7     3

Connecticut

   209    216     238    69    69     51

New Jersey

   145    157     232    18    18     18

New York

   218    224     262    20    21     7

Oregon

   138    138     133    —      1     1
    
  

 
  
  

 

Total

   2,307    2,371     2,613    115    116     80
    
  

 
  
  

 

Year over Year

        (12 )%             43 %    

Sequential

        (3 )%             (1 )%    
     Commercial Subtotal

   Medicare Risk

     09/05

   06/05

    09/04

   09/05

   06/05

    09/04

Arizona

   119    119     129    31    31     36

California

   1,485    1,524     1,622    94    93     97

Connecticut

   278    285     289    26    27     27

New Jersey

   163    176     250    —      —       —  

New York

   239    245     269    6    6     6

Oregon

   138    138     134    15    14     6
    
  

 
  
  

 

Total

   2,422    2,487     2,693    172    171     171
    
  

 
  
  

 

Year over Year

        (10 )%             1 %    

Sequential

        (3 )%             1 %    
     Medicaid

   Health Plan Total

     09/05

   06/05

    09/04

   09/05

   06/05

    09/04

Arizona

   —      —       —      149    150     164

California

   703    700     695    2,282    2,316     2,414

Connecticut

   90    94     95    394    406     411

New Jersey

   40    42     43    203    217     293

New York

   —      —       —      245    251     275

Oregon

   —      —       —      154    153     140
    
  

 
  
  

 

Total

   833    836     833    3,427    3,493     3,696
    
  

 
  
  

 

Year over Year

        0 %             (7 )%    

Sequential

        (0 )%             (2 )%    

 

     09/05

   06/05

   09/04

TRICARE

              

Previous TRICARE Contracts **

   —      —      642

North Contract ***

   2,962    2,946    2,929

Total TRICARE

   2,962    2,946    3,571

* 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

 

15


Health Net, Inc.

Reconciliation of Reserves for Claims and Other Settlements

(In thousands)

 

     Health Plan Services

 
     Nine-Month
Ended Sept. 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

     3,911,986       5,048,289      4,487,698  

Prior Years (d)

     (102,554 )     8,769      (33,812 )
    


 

  


Total Incurred (c )

     3,809,432       5,057,058      4,453,886  

Paid claims related to:

                       

Current Year

     3,203,765       4,286,929      3,738,599  

Prior Years

     619,264       752,574      720,426  
    


 

  


Total Paid (c )

     3,823,029       5,039,503      4,459,025  

Reserve for claims (a), end of period

     781,017       794,614      777,059  

Add:

                       

Claims Payable

     191,682       288,331      167,361  

Other (e)

     85,149       86,352      80,130  
    


 

  


Reserves for claims and other settlements, end of period

   $ 1,057,848     $ 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.

 

16