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

LOGO     

Contacts: David Olson

818.676.6978

david.w.olson@healthnet.com

Angie McCabe

818.676.8692

angeline.c.mccabe@healthnet.com

HEALTH NET REPORTS AN 18.5 PERCENT INCREASE IN

FIRST QUARTER 2007 EARNINGS PER SHARE

NET INCOME IS $88.6 MILLION, OR $0.77 PER DILUTED SHARE

LOS ANGELES, April 30, 2007 – Health Net, Inc. (NYSE:HNT) today announced that 2007 first quarter net income was $88.6 million, or $0.77 per diluted share. Net income for the first quarter of 2006 was $76.6 million, or $0.65 per diluted share.

Following are key highlights for the first quarter of 2007:

   

Pretax margin of 4.2 percent, a 30 basis point improvement compared to the first quarter of 2006;

   

Commercial gross margin per member per month (PMPM) increased 5.1 percent compared to the first quarter of 2006;

   

Medicare Advantage membership grew by 33,000 members, or 17.4 percent, compared to the first quarter of 2006;

   

Membership in the company’s individual, small group and mid-market accounts increased by 3.3 percent in the first quarter of 2007 compared to the first quarter of 2006, despite a commercial and administrative services only (ASO) enrollment decrease of 3.7 percent over the same period;

 


   

The administrative expense ratio of 10.7 percent improved 80 basis points from the first quarter of 2006 and 100 basis points from the fourth quarter of 2006;

   

The company completed the sale of its Shelton, Conn. campus effective March 29, 2007, and received net proceeds of $83.9 million in cash;

   

The company entered into an agreement with The Guardian Life Insurance Company of America to purchase The Guardian’s 50 percent interest in the Healthcare Solutions joint venture;

   

Health Net’s behavioral health care subsidiary, MHN, was awarded a five-year, $50 million contract to administer and monitor the Military and Family Life Counseling program for military service members and their families; and

   

The company repurchased 1.0 million shares during the first quarter, bringing its total share repurchases to nearly 6.5 million shares since it resumed repurchases under its stock repurchase program in November 2006. The company has approximately $178 million in remaining repurchase authority.

Membership

Total health plan enrollment during the first quarter of 2007 declined by nearly 74,000 members, or 2.2 percent, to 3.3 million members compared to the same period in 2006, and by 78,000 members, or 2.3 percent, sequentially. Most of the decline in membership occurred in the commercial large group segment.

“As expected, total health plan enrollment declined in the first quarter of 2007, driven mainly by lapses in unprofitable, large group accounts,” said Jay Gellert, Health Net’s chief executive officer.

Commercial enrollment, including both at-risk and ASO membership, declined by approximately 87,000 members, or 3.7 percent, to approximately 2.3 million members in the first quarter of 2007 compared to both the first and fourth quarters of 2006, which were at approximately 2.4 million members.

Health Net is the fifth largest Medicare contractor in the United States based on enrollment with approximately 223,000 members in its Medicare Advantage plans at the end of the first quarter of 2007. This reflects an increase of 33,000 members, or 17.4 percent, since the end of the first quarter of 2006, and an increase of 24,000 members, or 12.1 percent, since the

 

2


end of the fourth quarter of 2006. Membership in the company’s Medicare Part D plans at the end of the first quarter of 2007 was 341,000, an increase of 86,000 members, or 33.7 percent, from the end of the first quarter of 2006. Since the end of the fourth quarter of 2006, Medicare Part D membership increased by 41,000 members, or 13.7 percent.

State Health Plan enrollment at the end of the first quarter of 2007 was 825,000 members, a decline of 20,000 members since the end of the first quarter of 2006 and 15,000 members since the end of the fourth quarter of 2006.

Revenues and Health Care Costs

Health Net’s total revenues increased 7.6 percent in the first quarter of 2007 to $3.4 billion from $3.2 billion in the first quarter of 2006. Health plan services premium revenues increased 10.0 percent to $2.8 billion in the first quarter of 2007 compared to $2.5 billion in the first quarter of 2006.

Health Net’s Government contracts revenues decreased 2.7 percent in the first quarter of 2007 to $608 million from $625 million in the first quarter of 2006. “The decrease in revenues was driven by the government assuming payment responsibility for health care expenditures for active duty personnel in the civilian sector as of the third quarter of 2006 and by improved Option Period 3 health care costs,” said Jim Woys, Health Net’s interim chief financial officer.

The health plan medical care ratio (MCR) was 84.3 percent in the first quarter of 2007 compared to 83.4 percent in the first quarter of 2006. This expected increase was driven by a higher Medicare Advantage MCR of 86.4 percent, compared to 84.0 percent in the first quarter of 2006, and an increase in the Medicaid MCR, which was 120 basis points higher than the first quarter of 2006.

The commercial MCR in the first quarter of 2007 was 83.2 percent, up 20 basis points compared to the first quarter of 2006.

The commercial premium yield increased 6.2 percent in the first quarter of 2007 compared to the first quarter of 2006. Commercial health care costs rose by 6.4 percent on a PMPM basis in the first quarter of 2007 compared to the first quarter of 2006.

“The business we renewed in first quarter of 2007 experienced a yield increase in excess of 8 percent. The quarter-over-quarter comparison in the yield of 6.2 percent was impacted by two factors. First, lower cost, new business replaced higher cost, terminated business. Second,

 

3


the first quarter of 2007 includes the impact of the company’s Universal Care acquisition, which closed on March 31, 2006,” said Gellert. “We expect to see a continuation of lower cost business replacing higher cost business throughout the year. For 2007, we expect the premium yield to be approximately 7.0 percent, and health care costs to be 30 to 50 basis points below yield,” said Gellert.

The Government contracts cost ratio was 93.3 percent in the first quarter of 2007, representing a 200 basis point improvement compared with the first quarter of 2006. “We continue to see improvement in the Government contracts ratio due to both our strong partnership and ongoing care coordination with the Department of Defense and the Military Health System and our continuous efforts in cost and quality management. Through our partnership, we are in a position to assist the Military Health System in the delivery of health care services for our men and women in uniform and their families,” said Woys.

Administrative Expenses

In the first quarter of 2007, total general, administrative and depreciation expenses increased by $5.8 million to $297.8 million compared to $292.0 million in the first quarter of 2006. “The administrative expense ratio improved 80 basis points compared to the first quarter of 2006 as we continue to focus on expense management,” said Woys.

Health Net’s selling expenses of $69.1 million in the first quarter of 2007 increased by $12.6 million compared to the first quarter of 2006. “Consistent with our strategy of growing the individual, small and mid-market segments and partnering with the agents and brokers who sell our products, our commercial new sales increased 20 percent in the first quarter of 2007 compared to the first quarter of 2006,” said Gellert. “As a result, our selling ratio of 2.5 percent increased 30 basis points compared to the first quarter of 2006.”

Balance Sheet

Cash and investments as of March 31, 2007 were $2.3 billion compared with $2.1 billion as of December 31, 2006.

Reserves for claims and other settlements increased by $49.2 million to $1.1 billion at March 31, 2007, from $1.05 billion at December 31, 2006.

 

4


Days claims payable (DCP), including provider settlements, capitation payments and Medicare Part D expenses, declined by 2.0 days to 41.3 days in the first quarter of 2007, compared to 43.3 days in the first quarter of 2006. DCP decreased by 3.5 days compared to the fourth quarter of 2006, primarily as a result of inventory pay down during the first quarter of 2007 on the claims backlog that developed at the end of the fourth quarter of 2006.

Excluding provider settlements, capitation payments and Medicare Part D, DCP declined by 4.8 days to 54.4 days at March 31, 2007, from 59.2 days at December 31, 2006, and by 3.8 days compared with 58.2 days at March 31, 2006 (see footnote (a) in the Notes to Condensed Consolidated Financial Statements in the accompanying tables).

The company’s debt-to-total capital ratio was 17.9 percent as of March 31, 2007 compared to 21.9 percent as of December 31, 2006 and 18.5 percent on March 31, 2006. “Strong cash flow during the first quarter of 2007 allowed us to further reduce debt by $94 million sequentially,” said Woys.

Due to the redemption of the company’s Senior Notes in the third quarter of 2006, interest expense decreased by $2.7 million in the first quarter of 2007 compared to the first quarter of 2006.

On March 29, 2007, Health Net completed the sale of its commercial campus in Shelton, Conn., and entered into a 10-year operating leaseback agreement. In connection with the sale, the company received net proceeds of $83.9 million in cash and recorded a deferred gain of $60.9 million, which will be amortized over the term of the lease.

Cash Flow

Operating cash flow was $344 million in the first quarter of 2007, which included an extra payment of $245 million from the Centers for Medicare & Medicaid (CMS), compared to operating cash flow of $222 million in the first quarter of 2006, which included an extra CMS payment of $169 million. “Excluding the extra CMS payment, operating cash flow was approximately $99 million in the first quarter of 2007, which is greater than net income plus depreciation and amortization of $96 million. We continue to expect that operating cash flow will be greater than net income plus depreciation and amortization for the full year 2007,” said Woys.

 

5


Outlook

Health Net expects earnings per diluted share of $0.79 in the second quarter of 2007 and $3.65 for the full year 2007.

Conference Call

As previously announced, Health Net will discuss the company’s first quarter results during a conference call scheduled on Monday, April 30, 2007, at approximately 11:00 a.m. Eastern Time. To listen to the call, please dial 800.811.8824, code 4090549. 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. A replay of the conference call will be available from April 30, 2007 through May 4, 2007, by dialing 888.203.1112, code 4090549. 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, 2006, 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 health plans and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals across the country through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs 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

This release contains 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

 

6


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. 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.

# # #

 

7


Health Net, Inc.

Condensed Consolidated Statements of Operations

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

 

     Quarter Ended  
     March 31,
2006
    June 30,
2006
    September 30,
2006
    December 31,
2006
    March 31,
2007
 

REVENUES:

          

Health plan services premiums

   $ 2,524,374     $ 2,599,079     $ 2,622,065     $ 2,619,222     $ 2,777,259  

Government contracts

     624,637       626,957       578,514       545,906       607,995  

Net investment income

     23,359       26,256       33,198       28,229       31,364  

Administrative services fees and other income

     14,260       13,830       13,648       14,816       12,294  
                                        

Total revenues

     3,186,630       3,266,122       3,247,425       3,208,173       3,428,912  
                                        

EXPENSES:

          

Health plan services

     2,105,214       2,181,975       2,174,191       2,139,063       2,341,074  

Government contracts

     595,126       590,117       538,215       511,077       567,099  

General and administrative

     287,253       288,670       287,463       301,927       291,285  

Selling

     56,538       59,630       62,783       66,353       69,129  

Depreciation

     4,753       4,950       5,622       6,216       6,541  

Amortization

     591       1,275       1,092       1,092       1,092  

Interest

     12,226       13,449       15,411       10,093       9,560  
                                        
     3,061,701       3,140,066       3,084,777       3,035,821       3,285,780  

Litigation and severance costs

     —         —         —         37,093       —    

Debt refinancing

     —         —         70,095       —         —    
                                        

Total expenses

     3,061,701       3,140,066       3,154,872       3,072,914       3,285,780  
                                        

Income from operations before income taxes

     124,929       126,056       92,553       135,259       143,132  

Income tax provision

     48,336       49,023       1,651       50,474       54,547  
                                        

Net income

   $ 76,593     $ 77,033     $ 90,902     $ 84,785     $ 88,585  
                                        

Basic earnings per share

   $ 0.67     $ 0.67     $ 0.78     $ 0.74     $ 0.79  

Diluted earnings per share

   $ 0.65     $ 0.65     $ 0.76     $ 0.72     $ 0.77  

Weighted average shares outstanding:

          

Basic

     114,594       115,213       115,867       114,841       111,970  

Diluted

     118,398       118,305       118,830       117,707       114,759  

Pretax margin
(Income from operations before income taxes / Total revenues)

     3.9 %     3.9 %     2.9 %     4.2 %     4.2 %

Health plan services MCR

     83.4 %     84.0 %     82.9 %     81.7 %     84.3 %

Government contracts cost ratio

     95.3 %     94.1 %     93.0 %     93.6 %     93.3 %

Administrative ratio
((G&A+Dep) / (HP serv prem + admin serv fees and other income))

     11.5 %     11.2 %     11.1 %     11.7 %     10.7 %

Selling costs ratio (Selling costs / HP serv prem)

     2.2 %     2.3 %     2.4 %     2.5 %     2.5 %

Days claims payable (a)

     43.3       40.9       42.5       44.8       41.3  

Days claims payable - adjusted (a)

     58.2       52.9       55.2       59.2       54.4  

Effective tax rate

     38.7 %     38.9 %     1.8 %     37.3 %     38.1 %

Health plan services premiums PMPM

   $ 244.78     $ 241.75     $ 244.49     $ 243.82     $ 259.35  

Health plan services costs PMPM

   $ 204.14     $ 202.95     $ 202.73     $ 199.12     $ 218.62  

 

8


Health Net, Inc.

Condensed Consolidated Balance Sheets

(Amounts in thousands, except ratio data)

 

     March 31,
2006
    June 30,
2006
    September 30,
2006
    December 31,
2006
    March 31,
2007
 

ASSETS

          

Current Assets

          

Cash and cash equivalents

   $ 870,224     $ 825,925     $ 825,369     $ 704,806     $ 949,171  

Investments - available for sale

     1,356,386       1,382,583       1,399,478       1,416,038       1,393,161  

Premiums receivable, net

     163,237       214,173       235,267       302,355       234,795  

Amounts receivable under government contracts

     152,365       150,393       152,731       199,569       190,259  

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

     295,800       318,827       299,878       272,961       291,862  

Other receivables

     84,414       116,258       101,161       106,135       196,029  

Deferred taxes

     99,866       57,141       33,379       54,702       72,107  

Restricted assets for senior notes redemption

     —         499,557       —         —         —    

Other assets

     147,600       159,662       138,850       161,280       175,270  
                                        

Total current assets

     3,169,892       3,724,519       3,186,113       3,217,846       3,502,654  

Property and equipment, net

     136,727       144,436       155,395       151,184       157,464  

Goodwill, net

     751,949       751,949       751,949       751,949       751,949  

Other intangible assets, net

     47,062       45,532       44,183       42,835       41,486  

Deferred taxes

     46,560       48,574       51,557       33,137       90,953  

Other noncurrent assets

     137,645       132,186       101,719       100,071       182,158  
                                        

Total Assets

   $ 4,289,835     $ 4,847,196     $ 4,290,916     $ 4,297,022     $ 4,726,664  
                                        

LIABILITIES AND STOCKHOLDERS’ EQUITY

          

Current Liabilities

          

Reserves for claims and other settlements

   $ 986,117     $ 975,383     $ 1,035,374     $ 1,048,796     $ 1,097,953  

Health care and other costs payable under government contracts

     62,937       61,324       41,045       52,384       41,952  

IBNR health care costs payable under TRICARE North contract

     295,800       318,827       299,878       272,961       291,862  

Unearned premiums

     324,063       338,611       140,939       164,099       402,613  

Bridge loan

     —         200,000       200,000       200,000       —    

Senior notes payable

     —         376,052       —         —         —    

Accounts payable and other liabilities

     434,605       389,130       256,096       371,263       378,233  
                                        

Total current liabilities

     2,103,522       2,659,327       1,973,332       2,109,503       2,212,613  

Senior notes payable

     379,983       —         —         —         —    

Revolver payable and other financing arrangement

     —         300,000       300,000       300,000       406,000  

Other noncurrent liabilities

     129,507       108,222       106,897       108,554       245,477  
                                        

Total Liabilities

     2,613,012       3,067,549       2,380,229       2,518,057       2,864,090  
                                        

Stockholders’ Equity

          

Common stock and additional paid-in capital

     932,254       967,265       992,497       1,028,018       1,077,210  

Treasury common stock, at cost

     (636,252 )     (640,623 )     (640,623 )     (891,294 )     (947,187 )

Retained earnings

     1,400,758       1,477,791       1,568,693       1,653,478       1,743,985  

Accumulated other comprehensive loss

     (19,937 )     (24,786 )     (9,880 )     (11,237 )     (11,434 )
                                        

Total Stockholders’ Equity

     1,676,823       1,779,647       1,910,687       1,778,965       1,862,574  
                                        

Total Liabilities and Stockholders’ Equity

   $ 4,289,835     $ 4,847,196     $ 4,290,916     $ 4,297,022     $ 4,726,664  
                                        

Debt-to-Total Capital Ratio

     18.5 %     33.0 %     20.7 %     21.9 %     17.9 %

 

9


Health Net, Inc.

Condensed Consolidated Statements of Cash Flows

(Amounts in thousands)

 

     Quarter Ended  
     March 31,
2006
    June 30,
2006
    September
30, 2006
    December 31,
2006
    March 31,
2007
 

CASH FLOWS FROM OPERATING ACTIVITIES:

          

Net income

   $ 76,593     $ 77,033     $ 90,902     $ 84,785     $ 88,585  

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

          

Amortization and depreciation

     5,344       6,225       6,714       7,308       7,633  

Debt refinancing charge

     —         —         70,095       —         —    

Share-based compensation expense

     4,435       5,195       5,191       5,294       5,240  

Other changes

     4,349       4,007       3,685       1,583       (1,510 )

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

          

Premiums receivable and unearned premiums

     186,259       (36,388 )     (218,766 )     80,802       181,344  

Other receivables, deferred taxes and other assets

     (41,899 )     (107 )     46,574       (131,634 )     (16,980 )

Amounts receivable/payable under government contracts

     (29,168 )     359       (22,617 )     (35,499 )     (1,122 )

Reserves for claims and other settlements

     (54,055 )     (10,734 )     59,991       13,422       49,157  

Accounts payable and other liabilities

     70,191       (63,055 )     (107,593 )     121,409       31,680  
                                        

Net cash provided by (used in) operating activities (b)

     222,049       (17,465 )     (65,824 )     147,470       344,027  
                                        

CASH FLOWS FROM INVESTING ACTIVITIES:

          

Sales of investments

     228,995       44,374       47,397       144,021       383,857  

Maturities of investments

     15,770       30,248       29,683       37,424       60,004  

Purchases of investments

     (252,973 )     (110,683 )     (71,344 )     (200,611 )     (419,172 )

Proceeds from sale of property and equipment

     —         —         4,242       —         83,870  

Purchases of property and equipment

     (15,730 )     (12,679 )     (20,420 )     (23,978 )     (19,629 )

Net cash paid for acquisition of business

     (73,100 )     (494 )     (405 )     —         —    

Restricted assets related to the Guardian transaction

     —         —         —         —         (69,780 )

Sales and purchases of restricted investments and other

     (9,027 )     (496,943 )     523,336       (1,982 )     (9,970 )
                                        

Net cash (used in) provided by investing activities

     (106,065 )     (546,177 )     512,489       (45,126 )     9,180  
                                        

CASH FLOWS FROM FINANCING ACTIVITIES:

          

Proceeds from exercise of stock options and employee stock purchases

     10,380       20,895       15,136       23,883       30,652  

Repurchases of common stock

     (1,724 )     (1,107 )     —         (250,671 )     (55,893 )

Excess tax benefits from share-based compensation

     3,099       2,221       2,688       3,881       10,399  

Borrowings under revolver and other financing arrangement

     —         497,334       —         —         106,000  

Repayment of borrowings and interest rate swap settlement

     —         —         (465,045 )     —         (200,000 )
                                        

Net cash provided by (used in) financing activities (b)

     11,755       519,343       (447,221 )     (222,907 )     (108,842 )
                                        

Net increase (decrease) in cash and cash equivalents

     127,739       (44,299 )     (556 )     (120,563 )     244,365  

Cash and cash equivalents, beginning of period

     742,485       870,224       825,925       825,369       704,806  
                                        

Cash and cash equivalents, end of period

   $ 870,224     $ 825,925     $ 825,369     $ 704,806     $ 949,171  
                                        

 

10


Health Net, Inc.

Notes to Condensed Consolidated Financial Statements

Notes:

 

(a) Management believes that days claims payable (excluding capitation, provider settlements and Medicare Part D), a non-GAAP financial measure, provides useful information to investors because, in excluding those health care costs for which no or minimal reserves are maintained, it is a more accurate reflection of days claims payable calculated from claims-based reserves than is days claims payable, which does not exclude such costs. This non-GAAP financial information should be considered in addition to, not as a substitute for, financial information prepared in accordance with GAAP. The following table provides a reconciliation of the differences between days claims payable (excluding capitation, provider settlements and Medicare Part D) and days claims payable, the most directly comparable financial measure calculated and presented in accordance with GAAP:

 

     Q1 2006     Q2 2006     Q3 2006     Q4 2006     Q1 2007  
     (Dollars in millions)  

      Reserve for Claims and Other Settlements

   $ 986.1     $ 975.4     $ 1,035.4     $ 1,048.8     $ 1,098.0  

Less: Capitation Payable, Provider Settlements and Medicare Part D

     (120.5 )     (110.3 )     (100.5 )     (85.3 )     (101.1 )
                                        

      Adjusted Reserve for Claims and Other Settlements

     865.6       865.1       934.9       963.5       996.9  

(1) Average Reserve for Claims and Other Settlements

     1,013.2       980.8       1,005.4       1,042.1       1,073.4  

(2) Average Adjusted Reserve for Claims and Other Settlements

     905.2       865.4       900.0       949.2       980.2  

(3) Health Plan Services Cost

     2,105.2       2,182.0       2,174.2       2,139.1       2,341.1  

Less: Capitation Payments, Provider Settlements and Medicare Part D

     (705.9 )     (692.6 )     (674.1 )     (662.8 )     (720.9 )
                                        

(4) Adjusted Health Plan Services Cost

     1,399.3       1,489.4       1,500.1       1,476.3       1,620.2  

(5) Number of Days in Period

     90       91       92       92       90  

= (1) / (3) * (5) Days Claims Payable

     43.3       40.9       42.5       44.8       41.3  

= (2) / (4) * (5) Days Claims Payable (Excl. Capitation, Provider Settlements and Medicare Part D)

     58.2       52.9       55.2       59.2       54.4  

 

(b) 2006 operating cash flow amounts reflect reclassification of Medicare Part D net deposits from financing cash flow to conform to 2007 presentation.

 

11


HEALTH NET, INC.

Medical Covered Lives at March 31, 2007

(in Thousands)

 

     Commercial - Large Group*        Commercial - Small Group
& Individual
       Commercial Risk Subtotal        ASO        Commercial Subtotal
     3/07    12/06    3/06        3/07    12/06    3/06        3/07    12/06    3/06        3/07    12/06    3/06        3/07    12/06    3/06

Arizona

   78    75    71      52    50    47      130    125    118      —      —      —        130    125    118

California

   1,009    1,064    1,055      413    419    422      1,422    1,483    1,477      5    6    6      1,427    1,489    1,483

Connecticut

   143    153    161      29    30    28      172    183    189      57    67    70      229    250    259

New Jersey

   36    44    47      61    59    63      97    103    110      19    19    20      116    122    130

New York

   116    122    117      109    102    98      225    224    215      15    17    17      240    241    232

Oregon

   96    96    101      35    37    37      131    133    138      —      —      —        131    133    138
                                                                                  

Total

   1,478    1,554    1,552      699    697    695      2,177    2,251    2,247      96    109    113      2,273    2,360    2,360
                                                                                  

Year over Year

      (5)%            1%            (3)%            (15)%            (4)%   

Sequential

      (5)%            0%            (3)%            (12)%            (4)%   
     Medicare Advantage        Medicaid        Health Plan Total                                      
     3/07    12/06    3/06        3/07    12/06    3/06        3/07    12/06    3/06                                      

Arizona

   45    35    33      —      —      —        175    160    151                      

California

   108    104    103      694    710    713      2,229    2,303    2,299                      

Connecticut

   40    34    29      85    84    87      354    368    375                      

New Jersey

   —      —      —        46    46    45      162    168    175                      

New York

   8    6    7      —      —      —        248    247    239                      

Oregon

   20    20    18      —      —      —        151    153    156                      

Other States

   2    —      —        —      —      —        2    —      —                        
                                                                      

Total

   223    199    190      825    840    845      3,321    3,399    3,395                      
                                                                      

Year over Year

      17%            (2)%            (2)%                         

Sequential

      12%            (2)%            (2)%                         
     3/07    12/06    3/06                                                                            

Medicare PDP (Stand-Alone)

   341    300    255                                            
     3/07    12/06    3/06                                                                            

TRICARE

                                                    

North Contract **

   2,930    2,930    2,941                                            

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

 

12


Health Net, Inc.

Reconciliation of Reserves for Claims and Other Settlements

(In millions)

 

     Health Plan Services  
     Q1 2007     Year 2006     Year 2005  

Reserve for claims (a), beginning of period

   $ 754.2     $ 768.7     $ 794.6  

Incurred claims related to:

      

Current Year

     1,405.9       5,222.0       5,130.4  

Prior Years (c)

     (26.5 )     (77.3 )     (114.5 )
                        

Total Incurred (b)

     1,379.4       5,144.7       5,015.9  

Paid claims related to:

      

Current Year

     784.2       4,485.7       4,401.3  

Prior Years

     587.2       673.5       640.5  
                        

Total Paid (b)

     1,371.4       5,159.2       5,041.8  

Reserve for claims (a), end of period

     762.2       754.2       768.7  

Add:

      

Claims Payable

     225.3       203.9       177.2  

Other (d)

     110.5       90.7       94.3  
                        

Reserves for claims and other settlements, end of period

   $ 1,098.0     $ 1,048.8     $ 1,040.2  
                        

(a) Consists of incurred but not reported claims and received but unprocessed claims and reserves for loss adjustment expenses.
(b) Includes medical claims only. Capitation, pharmacy and other payments including provider settlements are not included.
(c) This line represents the change in reserves attributable to the difference between the original estimate of incurred claims for prior years and the revised estimate. In developing the revised estimate, there have been no changes in the approach used to determine the key actuarial assumptions, which are the completion factor and medical cost trend. Claims liabilities are estimated under actuarial standards of practice and generally accepted accounting principles. The majority of the reserve balance held at each quarter-end is associated with the most recent months’ incurred services because these are the services for which the fewest claims have been paid. The majority of the adjustments to reserves relate to variables and uncertainties associated with actuarial assumptions. The degree of uncertainty in the estimates of incurred claims is greater for the most recent months’ incurred services. Revised estimates for prior years are determined in each quarter based on the most recent updates of paid claims for prior years.
(d) Includes accrued capitation, shared risk settlements, provider incentives and other reserve items.

 

13