-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DFCy7ZmFgJk6iBO7aVdXBQC43gZSEQBIBkOvICDEU5pm32i6T2KpUzzWoCnPvqQB SjiXCWO1cSQ2eb8Tiuff1Q== 0001193125-09-016999.txt : 20090203 0001193125-09-016999.hdr.sgml : 20090203 20090203083040 ACCESSION NUMBER: 0001193125-09-016999 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20090203 ITEM INFORMATION: Results of Operations and Financial Condition ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20090203 DATE AS OF CHANGE: 20090203 FILER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTH NET INC CENTRAL INDEX KEY: 0000916085 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 954288333 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-12718 FILM NUMBER: 09563075 BUSINESS ADDRESS: STREET 1: 21650 OXNARD ST CITY: WOODLAND HILLS STATE: CA ZIP: 91367 BUSINESS PHONE: 8186766000 MAIL ADDRESS: STREET 1: 225 N MAIN ST CITY: PUEBLO STATE: CO ZIP: 81003 FORMER COMPANY: FORMER CONFORMED NAME: FOUNDATION HEALTH SYSTEMS INC DATE OF NAME CHANGE: 19970513 FORMER COMPANY: FORMER CONFORMED NAME: HEALTH SYSTEMS INTERNATIONAL INC DATE OF NAME CHANGE: 19940207 FORMER COMPANY: FORMER CONFORMED NAME: HN MANAGEMENT HOLDINGS INC/DE/ DATE OF NAME CHANGE: 19931213 8-K 1 d8k.htm FORM 8-K Form 8-K

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

Form 8-K

CURRENT REPORT

Pursuant to Section 13 or 15(d) of the

Securities Exchange Act of 1934

 

 

Date of Report (Date of earliest event reported): February 3, 2009

HEALTH NET, INC.

(Exact Name of Registrant as Specified in Charter)

 

Delaware   1-12718   95-4288333

(State or other Jurisdiction

of Incorporation)

  (Commission File Number)  

(IRS Employer

Identification No.)

21650 Oxnard Street

Woodland Hills, California 91367

(Address of Principal Executive Offices) (Zip Code)

(818) 676-6000

(Registrant’s telephone number, including area code)

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

¨ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

¨ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

¨ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

¨ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

 

 

 


Section 2- Financial Information

 

Item 2.02 Results of Operations and Financial Condition.

On February 3, 2009, Health Net, Inc. (the “Company”) issued a press release announcing its earnings for the quarter and year ended December 31, 2008. The press release discloses certain financial information that is considered non-GAAP financial information. The Company believes this non-GAAP financial information provides useful information to both management and investors by excluding certain expenses and other one-time items that are not indicative of our core operating results, and by adjusting for certain items related to timing. Management refers to this financial information to facilitate internal and external comparisons to the Company’s historical operating results and for forecasting purposes. This non-GAAP financial information should be considered in addition to, not as a substitute for, financial information prepared in accordance with GAAP. Detailed explanations of the non-GAAP financial information contained in the release and reconciliations to the comparable GAAP information are contained in the financial tables attached to the release. As used herein, “GAAP” refers to accounting principles generally accepted in the United States.

The press release is attached hereto as Exhibit 99.1 and hereby incorporated in this Item 2.02 by reference.

Section 9- Financial Statements and Exhibits

 

Item 9.01 Financial Statements and Exhibits.

 

(d) Exhibits

 

99.1

   Press Release dated February 3, 2009 announcing results for the quarter and year ended December 31, 2008 for Health Net, Inc.


SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

Date: February 3, 2009

 

HEALTH NET, INC.
By:   /s/ Linda V. Tiano
  Linda V. Tiano
  Senior Vice President, General Counsel and Secretary
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

 

Investor Contact    Media Contact
Angie McCabe    Margita Thompson
818.676.8692    818.676.7912
angie.mccabe@healthnet.com    margita.thompson@healthnet.com

HEALTH NET REPORTS ADJUSTED FOURTH QUARTER 2008

NET INCOME OF $63.1 MILLION, OR $0.61 PER DILUTED SHARE1

FULL YEAR 2008 ADJUSTED NET INCOME WAS $199.1 MILLION,

OR $1.85 PER DILUTED SHARE1

LOS ANGELES, February 3, 2009 – Health Net, Inc. (NYSE:HNT) today announced 2008 fourth quarter net income of $35.5 million, or $0.34 per diluted share, compared with fourth quarter 2007 net income of $116.9 million, or $1.04 per diluted share. The fourth quarter 2008 results include the effect of a $47.8 million pretax charge for severance and other expenses primarily relating to the company’s operations strategy that is designed to reduce general and administrative (G&A) expenses.

Adjusted1 net income in the fourth quarter of 2008 was $63.1 million, or $0.61 per diluted share. Adjusted1 net income in the fourth quarter of 2007 was $123.4 million, or $1.10 per diluted share.

For the full year 2008, Health Net reported net income of $95.0 million, or $0.88 per diluted share. Adjusted1 net income for the full year of 2008 was $199.1 million, or $1.85 per diluted share.

Health Net’s full year 2007 net income was $193.7 million, or $1.70 per diluted share. Adjusted1 net income for the full year 2007 was $416.1 million, or $3.66 per diluted share.

“Last November, we outlined a plan to improve operational performance and increase shareholder value. The fourth quarter results were consistent with that plan and set a solid foundation for 2009,” said Jay Gellert, president and chief executive officer of Health Net. “We are encouraged by the initial progress in Medicare and our California commercial business.

 

1

Detailed explanations of the non-GAAP financial measures referred to in this release and reconciliations to the comparable GAAP measures are included in the attached financial tables.


“In addition, we are actively engaged in the process we began late last year related to our businesses in Arizona and the Northeast,” Gellert added.

Membership

Total health plan enrollment as of December 31, 2008 was 3.7 million members, a decrease of 34,000 members, or approximately 1.0 percent, compared to December 31, 2007. Sequentially, total health plan enrollment decreased by 22,000 members, or nearly 1.0 percent.

Commercial risk enrollment declined by 201,000 members, or 9.0 percent, to more than 2.0 million members as of December 31, 2008 compared to December 31, 2007 and decreased by 54,000 members, or 2.6 percent, compared to September 30, 2008.

Enrollment in the company’s Medicare Advantage plans grew by 59,000 members, or 25.0 percent, to 295,000 members as of December 31, 2008 compared to December 31, 2007. During the fourth quarter of 2008, Medicare Advantage membership increased by 2,000 members, or approximately 1.0 percent compared with the third quarter of 2008. Membership in the company’s Medicare Part D plans as of December 31, 2008 was 545,000, an increase of 166,000 members, or 43.8 percent, from December 31, 2007. Sequentially, Medicare Part D membership increased by 7,000 members, or 1.3 percent.

Medicaid enrollment at December 31, 2008 was 812,000 members, a decrease of 34,000 members, or approximately 4.0 percent, since December 31, 2007. This year-over-year decrease primarily was the result of the company’s exit from the Connecticut Medicaid business in April 2008. Sequentially, Medicaid enrollment increased by 24,000 members, or 3.0 percent, with 23,000 new members in state programs in California.

Revenues, Health Care Costs and G&A Expenses

Health Net’s total revenues increased 8.0 percent in the fourth quarter of 2008 to $3.9 billion from $3.6 billion in the fourth quarter of 2007. Health plan services premium revenues increased 5.7 percent to $3.1 billion in the fourth quarter of 2008 compared to $2.9 billion in the fourth quarter of 2007.

Health Net’s Government contracts revenues increased 21.3 percent in the fourth quarter of 2008 to $751.6 million from $619.4 million in the fourth quarter of 2007. The increase was a result of higher Option Period 5 pricing for the company’s TRICARE contract, recognition of increased Option Period 5 health care costs, and growth in the Military Family Life Counseling contract with the Department of Defense that is administered by Health Net’s behavioral health subsidiary.

 

Page 2


The adjusted1 health plan medical care ratio (MCR) in the fourth quarter of 2008 was 85.5 percent compared to 82.6 percent in the fourth quarter of 2007.

The adjusted1 commercial MCR in the fourth quarter of 2008 was 84.4 percent compared to 81.8 percent in the fourth quarter of 2007 and improved by 230 basis points sequentially from the 2008 third quarter MCR of 86.7 percent.

Commercial premium yields per member per month (PMPM) increased by 7.9 percent compared to the fourth quarter of 2007.

Adjusted1 total commercial health care costs PMPM increased by 11.3 percent in the fourth quarter of 2008 compared to the fourth quarter of 2007.

Compared to the full year 2007, commercial premium yields PMPM increased by 8.6 percent in 2008 while adjusted1 commercial health care costs PMPM increased by 11.7 percent.

“The MCR, premium yields and commercial health care cost trends are consistent with the plan we outlined in November,” said Jim Woys, Health Net’s chief operating officer.

“For 2009, we expect commercial premium yields PMPM to be approximately 9.0 percent based on the business that has renewed to-date. In addition, we continue to believe we will achieve a positive spread of approximately 50 basis points in commercial premium yields versus health care costs in 2009,” added Woys.

The Government contracts cost ratio was 95.6 percent in the fourth quarter of 2008 compared to 89.9 percent in the fourth quarter of 2007 and 95.0 percent in the third quarter of 2008. “The higher costs reflect some increased usage of the TRICARE benefit by the eligible population. The ability to reset cost targets with each new Option Period allowed us to incorporate these costs into our 2009 expectations,” said Woys.

Total adjusted1 G&A expense was $293.6 million in the fourth quarter of 2008 compared with $307.1 million in the fourth quarter of 2007. “Health Net’s adjusted 1 G&A ratio improved 100 basis points quarter-over-quarter and 80 basis points year-over-year as we continue to focus on reducing costs through our operations strategy,” said Joseph Capezza, Health Net’s chief financial officer.

Health Net’s selling expenses of $92.3 million in the fourth quarter of 2008 increased by approximately $2.0 million compared to the fourth quarter of 2007.

 

Page 3


Balance Sheet

Cash and investments as of December 31, 2008 were $2.2 billion compared with $2.2 billion as of September 30, 2008 and $2.6 billion as of December 31, 2007.

Reserves for claims and other settlements increased by $37.7 million to $1.3 billion at December 31, 2008 from December 31, 2007.

Days claims payable (DCP), including provider and other claim settlements, capitation payments and Medicare Part D expenses, decreased by 2.9 days to 47.0 days in the fourth quarter of 2008 compared to 49.9 days in the fourth quarter of 2007 and increased by 0.7 days compared to the third quarter of 2008.

Excluding provider and other claim settlements, capitation payments and Medicare Part D, DCP in the fourth quarter of 2008 decreased by 0.1 days to 54.8 days compared to the 2007 fourth quarter and increased by 2.1 days sequentially.2

The company’s debt-to-total capital ratio was 27.9 percent as of December 31, 2008 compared to 22.5 percent as of December 31, 2007 and 27.6 percent on September 30, 2008.

Interest expense increased by $2.8 million in the fourth quarter of 2008 compared to the fourth quarter of 2007 due to higher debt levels.

Cash Flow

Operating cash flow was negative $53.6 million in the fourth quarter of 2008. This decrease was primarily driven by an increase of approximately $150 million in a receivable for Medicare Part D catastrophic reinsurance.

“Because the Medicare Part D receivable will be paid in 2009, the company currently expects operating cash flow to be approximately 1.5 times net income in 2009,” said Capezza.

Outlook

Including the impact of $60 million to $70 million in expected pretax operations strategy-related charges in 2009, Health Net expects full-year 2009 GAAP earnings per diluted share of $1.85 to $2.10 based on expected diluted weighted average shares outstanding of 104 million to 105 million shares. Excluding the charges, the company expects full-year 2009 earnings per diluted share of $2.25 to $2.40. The following table updates previously issued full-year 2009 guidance on a number of operating metrics.

 

2

See footnote (a) in the Notes to Consolidated Financial Statements in the financial schedules attached to this release for a reconciliation of this information to the comparable GAAP financial measure.

 

Page 4


Full-Year 2009 Guidance Table

 

      2009 Guidance
   

Year-end Membership

  

Commercial Risk: -3% to -5%

Medicaid: +2% to +3%

Medicare Advantage: -1% to -2%

PDP: -15% to -20%

   

Consolidated Revenues

   $15.5 billion to $16.0 billion
   

Commercial Yields

   ~ 9.0%
   

Commercial

Health Care Cost Trends

   ~ 8.5%
   

Selling Cost Ratio

Government Contracts Ratio

G&A Expense Ratio*

  

~ 2.9%

~ 95.0% to 95.5%

~ 9.6% to 9.8%

   

Tax Rate

   38.5% to 38.7%
   

Weighted-average Fully

Diluted Shares Outstanding

   104 million to 105 million
   

GAAP EPS

Non-GAAP EPS*

  

$1.85 to $2.10

$2.25 to $2.40

 

* Excludes the impact of expected operations strategy-related pretax charges of $60 million to $70 million in 2009.

 

Page 5


Conference Call

As previously announced, Health Net will discuss the company’s fourth quarter and full year 2008 results during a conference call on Tuesday, February 3, 2009, beginning at approximately 11:00 a.m. Eastern time. The conference call should be accessed at least 15 minutes prior to its start with the following numbers:

 

877.857.6161 (Domestic)    888.203.1112 (Replay – Domestic)
719.325.4820 (International)    719.457.0820 (Replay – International)

The access code for both the live conference call and the replay is 3548771. A replay of the conference call will be available through 2:00 p.m. Eastern time on February 8, 2009. A live webcast and replay of the conference call also will be available at www.healthnet.com under “Investor Relations.” The conference call webcast is open to all interested parties. 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, 2007, Quarterly Reports on Form 10-Q for the quarters ended March 31, 2008, June 30, 2008, and September 30, 2008, 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 6.7 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 6.9 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

All statements in this press release, other than statements of historical information provided herein, may be deemed to be forward-looking statements and as such are subject to a number of risks and uncertainties. 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, statements including 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, additional investment portfolio impairment charges, changes in the economy, volatility in the financial markets, trends in medical care ratios,

 

Page 6


unexpected utilization patterns or unexpectedly severe or widespread illnesses, membership declines, rate cuts affecting our Medicare or Medicaid business, issues relating to provider contracts, litigation costs, regulatory issues, operational issues, health care reform and general business and market 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 and subsequent quarterly reports on Form 10-Q 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 any of its forward-looking statements to reflect events or circumstances that arise after the date of this release.

 

# # #

[Nine pages of tables follow]

 

Page 7


Health Net, Inc.

Enrollment Data—By State

(In thousands)

 

                    Change from  
                    September 30, 2008     December 31, 2007  
     Dec 31,
2008
   Sept 30,
2008
   Dec 31,
2007
   Increase/
(Decrease)
    %
Change
    Increase/
(Decrease)
    %
Change
 

California

                 

Large Group

   938    954    991    (16 )   (1.7 )%   (53 )   (5.3 )%

Small Group and Individual

   414    431    477    (17 )   (3.9 )%   (63 )   (13.2 )%
                                       

Commercial Risk

   1,352    1,385    1,468    (33 )   (2.4 )%   (116 )   (7.9 )%

ASO

   5    5    6    0     0.0 %   (1 )   (16.7 )%
                                       

Total Commercial

   1,357    1,390    1,474    (33 )   (2.4 )%   (117 )   (7.9 )%

Medicare Advantage

   133    131    112    2     1.5 %   21     18.8 %

Medi-Cal

   765    742    712    23     3.1 %   53     7.4 %
                                       

Total California

   2,255    2,263    2,298    (8 )   (0.4 )%   (43 )   (1.9 )%
                                       

Connecticut

                 

Large Group

   114    117    136    (3 )   (2.6 )%   (22 )   (16.2 )%

Small Group and Individual

   25    26    25    (1 )   (3.8 )%   0     0.0 %
                                       

Commercial Risk

   139    143    161    (4 )   (2.8 )%   (22 )   (13.7 )%

ASO

   25    25    32    0     0.0 %   (7 )   (21.9 )%
                                       

Total Commercial

   164    168    193    (4 )   (2.4 )%   (29 )   (15.0 )%

Medicare Advantage

   57    57    45    0     0.0 %   12     26.7 %

Medicaid

   0    0    90    0     0.0 %   (90 )   (100.0 )%
                                       

Total Connecticut

   221    225    328    (4 )   (1.8 )%   (107 )   (32.6 )%
                                       

New York

                 

Large Group

   101    101    116    0     0.0 %   (15 )   (12.9 )%

Small Group and Individual

   103    107    118    (4 )   (3.7 )%   (15 )   (12.7 )%
                                       

Commercial Risk

   204    208    234    (4 )   (1.9 )%   (30 )   (12.8 )%

ASO

   11    11    13    0     0.0 %   (2 )   (15.4 )%
                                       

Total Commercial

   215    219    247    (4 )   (1.8 )%   (32 )   (13.0 )%

Medicare Advantage

   6    6    3    0     0.0 %   3     100.0 %
                                       

Total New York

   221    225    250    (4 )   (1.8 )%   (29 )   (11.6 )%
                                       

New Jersey

                 

Large Group

   19    20    30    (1 )   (5.0 )%   (11 )   (36.7 )%

Small Group and Individual

   54    55    60    (1 )   (1.8 )%   (6 )   (10.0 )%
                                       

Commercial Risk

   73    75    90    (2 )   (2.7 )%   (17 )   (18.9 )%

ASO

   3    4    17    (1 )   (25.0 )%   (14 )   (82.4 )%
                                       

Total Commercial

   76    79    107    (3 )   (3.8 )%   (31 )   (29.0 )%

Medicaid

   47    46    44    1     2.2 %   3     6.8 %
                                       

Total New Jersey

   123    125    151    (2 )   (1.6 )%   (28 )   (18.5 )%
                                       

Arizona

                 

Large Group

   77    80    81    (3 )   (3.8 )%   (4 )   (4.9 )%

Small Group and Individual

   46    50    56    (4 )   (8.0 )%   (10 )   (17.9 )%
                                       

Commercial Risk

   123    130    137    (7 )   (5.4 )%   (14 )   (10.2 )%

Medicare Advantage

   67    67    51    0     0.0 %   16     31.4 %
                                       

Total Arizona

   190    197    188    (7 )   (3.6 )%   2     1.1 %
                                       

Oregon

                 

Large Group

   93    99    101    (6 )   (6.1 )%   (8 )   (7.9 )%

Small Group and Individual

   40    38    34    2     5.3 %   6     17.6 %
                                       

Commercial Risk

   133    137    135    (4 )   (2.9 )%   (2 )   (1.5 )%

Medicare Advantage

   22    22    21    0     0.0 %   1     4.8 %
                                       

Total Oregon

   155    159    156    (4 )   (2.5 )%   (1 )   (0.6 )%
                                       

Other States

                 

Medicare Advantage

   10    10    4    0     0.0 %   6     150.0 %
                                       

Medicare PDP (stand-alone)

   545    538    379    7     1.3 %   166     43.8 %
                                       

Total Health Plan Enrollment

                 

Large Group

   1,342    1,371    1,455    (29 )   (2.1 )%   (113 )   (7.8 )%

Small Group and Individual

   682    707    770    (25 )   (3.5 )%   (88 )   (11.4 )%
                                       

Commercial Risk

   2,024    2,078    2,225    (54 )   (2.6 )%   (201 )   (9.0 )%

ASO

   44    45    68    (1 )   (2.2 )%   (24 )   (35.3 )%
                                       

Total Commercial

   2,068    2,123    2,293    (55 )   (2.6 )%   (225 )   (9.8 )%

Medicare Advantage

   295    293    236    2     0.7 %   59     25.0 %

Medicare PDP (stand-alone)

   545    538    379    7     1.3 %   166     43.8 %

Medi-Cal/Medicaid

   812    788    846    24     3.0 %   (34 )   (4.0 )%
                                       

Total Health Plans

   3,720    3,742    3,754    (22 )   (0.6 )%   (34 )   (0.9 )%
                                       

TRICARE—North Contract Eligibles

   3,004    2,951    2,895    53     1.8 %   109     3.8 %
                                       

 

Page 8


Health Net, Inc.

Enrollment Data—Line of Business

(In thousands)

 

                    Change from  
                    September 30, 2008     December 31, 2007  
     Dec 31,
2008
   Sept 30,
2008
   Dec 31,
2007
   Increase/
(Decrease)
    %
Change
    Increase/
(Decrease)
    %
Change
 

Large Group

                 

California

   938    954    991    (16 )   (1.7 )%   (53 )   (5.3 )%

Connecticut

   114    117    136    (3 )   (2.6 )%   (22 )   (16.2 )%

New York

   101    101    116    0     0.0 %   (15 )   (12.9 )%

New Jersey

   19    20    30    (1 )   (5.0 )%   (11 )   (36.7 )%

Arizona

   77    80    81    (3 )   (3.8 )%   (4 )   (4.9 )%

Oregon

   93    99    101    (6 )   (6.1 )%   (8 )   (7.9 )%
                                       
   1,342    1,371    1,455    (29 )   (2.1 )%   (113 )   (7.8 )%
                                       

Small Group and Individual

                 

California

   414    431    477    (17 )   (3.9 )%   (63 )   (13.2 )%

Connecticut

   25    26    25    (1 )   (3.8 )%   0     0.0 %

New York

   103    107    118    (4 )   (3.7 )%   (15 )   (12.7 )%

New Jersey

   54    55    60    (1 )   (1.8 )%   (6 )   (10.0 )%

Arizona

   46    50    56    (4 )   (8.0 )%   (10 )   (17.9 )%

Oregon

   40    38    34    2     5.3 %   6     17.6 %
                                       
   682    707    770    (25 )   (3.5 )%   (88 )   (11.4 )%
                                       

Commercial Risk

                 

California

   1,352    1,385    1,468    (33 )   (2.4 )%   (116 )   (7.9 )%

Connecticut

   139    143    161    (4 )   (2.8 )%   (22 )   (13.7 )%

New York

   204    208    234    (4 )   (1.9 )%   (30 )   (12.8 )%

New Jersey

   73    75    90    (2 )   (2.7 )%   (17 )   (18.9 )%

Arizona

   123    130    137    (7 )   (5.4 )%   (14 )   (10.2 )%

Oregon

   133    137    135    (4 )   (2.9 )%   (2 )   (1.5 )%
                                       
   2,024    2,078    2,225    (54 )   (2.6 )%   (201 )   (9.0 )%
                                       

ASO

                 

California

   5    5    6    0     0.0 %   (1 )   (16.7 )%

Connecticut

   25    25    32    0     0.0 %   (7 )   (21.9 )%

New York

   11    11    13    0     0.0 %   (2 )   (15.4 )%

New Jersey

   3    4    17    (1 )   (25.0 )%   (14 )   (82.4 )%
                                       
   44    45    68    (1 )   (2.2 )%   (24 )   (35.3 )%

Total Commercial

                 

California

   1,357    1,390    1,474    (33 )   (2.4 )%   (117 )   (7.9 )%

Connecticut

   164    168    193    (4 )   (2.4 )%   (29 )   (15.0 )%

New York

   215    219    247    (4 )   (1.8 )%   (32 )   (13.0 )%

New Jersey

   76    79    107    (3 )   (3.8 )%   (31 )   (29.0 )%

Arizona

   123    130    137    (7 )   (5.4 )%   (14 )   (10.2 )%

Oregon

   133    137    135    (4 )   (2.9 )%   (2 )   (1.5 )%
                                       
   2,068    2,123    2,293    (55 )   (2.6 )%   (225 )   (9.8 )%

Medicare Advantage

                 

California

   133    131    112    2     1.5 %   21     18.8 %

Connecticut

   57    57    45    0     0.0 %   12     26.7 %

New York

   6    6    3    0     0.0 %   3     100.0 %

Arizona

   67    67    51    0     0.0 %   16     31.4 %

Oregon

   22    22    21    0     0.0 %   1     4.8 %

Other States

   10    10    4    0     0.0 %   6     150.0 %
                                       
   295    293    236    2     0.7 %   59     25.0 %

Medi-Cal/Medicaid

                 

California

   765    742    712    23     3.1 %   53     7.4 %

Connecticut

   0    0    90    0     0.0 %   (90 )   (100.0 )%

New Jersey

   47    46    44    1     2.2 %   3     6.8 %
                                       
   812    788    846    24     3.0 %   (34 )   (4.0 )%

Medicare PDP (stand-alone)

   545    538    379    7     1.3 %   166     43.8 %
                                       
   

Total Health Plan Enrollment

                 

Large Group

   1,342    1,371    1,455    (29 )   (2.1 )%   (113 )   (7.8 )%

Small Group and Individual

   682    707    770    (25 )   (3.5 )%   (88 )   (11.4 )%
                                       

Commercial Risk

   2,024    2,078    2,225    (54 )   (2.6 )%   (201 )   (9.0 )%

ASO

   44    45    68    (1 )   (2.2 )%   (24 )   (35.3 )%
                                       

Total Commercial

   2,068    2,123    2,293    (55 )   (2.6 )%   (225 )   (9.8 )%

Medicare Advantage

   295    293    236    2     0.7 %   59     25.0 %

Medicare PDP (stand-alone)

   545    538    379    7     1.3 %   166     43.8 %

Medi-Cal/Medicaid

   812    788    846    24     3.0 %   (34 )   (4.0 )%
                                       

Total Health Plans

   3,720    3,742    3,754    (22 )   (0.6 )%   (34 )   (0.9 )%
                                       

TRICARE—North Contract Eligibles

   3,004    2,951    2,895    53     1.8 %   109     3.8 %
                                       

 

Page 9


Health Net, Inc.

Consolidated Statements of Operations

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

 

     Quarter Ended
December 31,
2007
    Year Ended
December 31,
2007
    Quarter Ended
September 30,
2008
    Quarter Ended
December 31,
2008
    Year Ended
December 31,
2008
 

REVENUES:

          

Health plan services premiums

   $ 2,916,718     $ 11,435,314     $ 3,072,717     $ 3,082,133       12,392,006  

Government contracts

     619,423       2,501,677       724,323       751,604       2,835,261  

Net investment income

     31,630       120,176       10,204       24,536       91,042  

Administrative services fees and other income

     15,482       51,104       11,607       11,209       48,280  
                                        
     3,583,253       14,108,271       3,818,851       3,869,482       15,366,589  
                                        
          

EXPENSES:

          

Health plan services

     2,409,332       9,762,896       2,689,790       2,629,398       10,762,657  

Government contracts

     556,648       2,307,610       687,848       718,893       2,702,573  

General and administrative

     317,099       1,275,555       294,178       347,128       1,291,059  

Selling

     90,332       327,827       93,232       92,314       360,381  

Depreciation and amortization

     13,598       42,982       17,255       17,271       59,878  

Interest

     7,712       32,497       10,413       10,523       42,909  
                                        
     3,394,721       13,749,367       3,792,716       3,815,527       15,219,457  

Income from operations before income taxes

     188,532       358,904       26,135       53,955       147,132  

Income tax provision

     71,605       165,207       7,665       18,420       52,129  
                                        

Net income

   $ 116,927     $ 193,697     $ 18,470     $ 35,535     $ 95,003  
                                        

Basic earnings per share

   $ 1.06     $ 1.74     $ 0.17     $ 0.34     $ 0.89  

Diluted earnings per share

   $ 1.04     $ 1.70     $ 0.17     $ 0.34     $ 0.88  

Weighted average shares outstanding:

          

Basic

     110,087       111,316       105,915       103,694       106,532  

Diluted

     112,255       113,829       106,869       104,063       107,610  

Pretax margin

     5.3 %     2.5 %     0.7 %     1.4 %     1.0 %

Health plan services MCR

     82.6 %     85.4 %     87.5 %     85.3 %     86.9 %

Government contracts cost ratio

     89.9 %     92.2 %     95.0 %     95.6 %     95.3 %

G&A expense ratio

     10.8 %     11.1 %     9.5 %     11.2 %     10.4 %

Selling costs ratio

     3.1 %     2.9 %     3.0 %     3.0 %     2.9 %

Days claims payable (a)

     49.9       43.9       46.3       47.0       44.9  

Days claims payable—adjusted (a)

     54.9       54.1       52.7       54.8       52.2  

Effective tax rate

     38.0 %     46.0 %     29.3 %     34.1 %     35.4 %

Health plan services premiums PMPM

   $ 266.88     $ 263.54     $ 276.29     $ 279.47     $ 277.79  

Health plan services costs PMPM

   $ 220.45     $ 225.00     $ 241.86     $ 238.42     $ 241.27  

 

Page 10


Health Net, Inc.

Reconciliation of Non-GAAP Financial Measures

Operating Results Excluding Charges

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

 

Note:

   This table presents the company’s consolidated operations for the periods presented below and the charges recorded in the consolidated statement of operations. Management believes that the presentation of certain financial information in the attached press release (such as Net investment income, Administrative services fees and other income, Health plan services expense, General and administrative expense, Income before income taxes, Income tax provision, Net income, Basic and diluted earnings per share, Pretax margin, MCR, G&A expense ratio, and effective tax rate), excluding the charges that were recorded, all of which are non-GAAP financial information, are important to investors as they exclude special items that are not indicative of our core operating results. This non-GAAP financial information should be considered in addition to, not as a substitute for, financial information prepared in accordance with GAAP.

 

     Quarter Ended December 31, 2007     Year Ended December 31, 2007  
     As Reported     Impact of
Charge1
    Excluding
Impact of
Charge
    As Reported     Impact of
Charge2
    Excluding
Impact of
Charge
 

REVENUES:

            

Health plan services premiums

   $ 2,916,718       $ 2,916,718     $ 11,435,314       $ 11,435,314  

Government contracts

     619,423         619,423       2,501,677         2,501,677  

Net investment income

     31,630         31,630       120,176         120,176  

Administrative services fees and other income

     15,482         15,482       51,104         51,104  
                                                
     3,583,253       —         3,583,253       14,108,271       —         14,108,271  
                                                

EXPENSES:

            

Health plan services

     2,409,332         2,409,332       9,762,896     $ 201,449       9,561,447  

Government contracts

     556,648         556,648       2,307,610         2,307,610  

General and administrative

     317,099     $ 10,000       307,099       1,275,555       105,308       1,170,247  

Selling

     90,332         90,332       327,827         327,827  

Depreciation and amortization

     13,598         13,598       42,982         42,982  

Interest

     7,712         7,712       32,497         32,497  
                                                
     3,394,721       10,000       3,384,721       13,749,367       306,757       13,442,610  

(Loss) income from operations before income taxes

     188,532       (10,000 )     198,532       358,904       (306,757 )     665,661  

Income tax (benefit) provision

     71,605       (3,544 )     75,149       165,207       (84,321 )     249,528  
                                                

Net (loss) income

   $ 116,927     $ (6,456 )   $ 123,383     $ 193,697     $ (222,436 )   $ 416,133  
                                                

Basic (loss) earnings per share

   $ 1.06     $ (0.06 )   $ 1.12     $ 1.74     $ (2.00 )   $ 3.74  

Diluted (loss) earnings per share

   $ 1.04     $ (0.06 )   $ 1.10     $ 1.70     $ (1.96 )   $ 3.66  

Weighted average shares outstanding:

            

Basic

     110,087         110,087       111,316         111,316  

Diluted

     112,255         112,255       113,829         113,829  

Pretax margin

     5.3 %     -0.2 %     5.5 %     2.5 %     -2.2 %     4.7 %

Health plan services MCR

     82.6 %     —         82.6 %     85.4 %     1.8 %     83.6 %

Government contracts cost ratio

     89.9 %     —         89.9 %     92.2 %     —         92.2 %

G&A expense ratio

     10.8 %     0.3 %     10.5 %     11.1 %     0.9 %     10.2 %

Selling costs ratio

     3.1 %     —         3.1 %     2.9 %     —         2.9 %

Effective tax rate

     38.0 %     0.1 %     37.9 %     46.0 %     8.5 %     37.5 %

 

1 Includes a $10 million pretax charge relating to rescission included in G&A expenses.
2 Includes a $296.8 million pretax litigation charge primarily related to the settlement of the McCoy, et al., lawsuits and regulatory issues with the New Jersey Department of Banking and Insurance taken in the third quarter of 2007 and a $10.0 million pretax charge relating to the above-referenced (footnote 1) rescission case taken in the fourth quarter of 2007. $201.5 million was included in health plan services expenses and $105.3 million was included in G&A expenses.

 

Page 11


Health Net, Inc.

Reconciliation of Non-GAAP Financial Measures

Operating Results Excluding Charges

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

(Continued)

 

     Quarter Ended September 30, 2008     Quarter Ended December 31, 2008     Year Ended December 31, 2008  
     As Reported     Impact of
Charge3
    Excluding
Impact of
Charge
    As Reported     Impact of
Charge4
    Excluding
Impact of
Charge
    As Reported     Impact of
Charge5
    Excluding
Impact of
Charge
 

REVENUES:

                  

Health plan services premiums

   $ 3,072,717       $ 3,072,717     $ 3,082,133       $ 3,082,133     $ 12,392,006       $ 12,392,006  

Government contracts

     724,323         724,323       751,604         751,604       2,835,261         2,835,261  

Net investment income

     10,204     $ (14,642 )     24,846       24,536         24,536       91,042     $ (14,642 )     105,684  

Administrative services fees and other income

     11,607         11,607       11,209         11,209       48,280       (3,400 )     51,680  
                                                                        
     3,818,851       (14,642 )     3,833,493       3,869,482       —         3,869,482       15,366,589       (18,042 )     15,384,631  
                                                                        

EXPENSES:

                  

Health plan services

     2,689,790         2,689,790       2,629,398     $ (5,700 )     2,635,098       10,762,657       37,496       10,725,161  

Government contracts

     687,848         687,848       718,893         718,893       2,702,573         2,702,573  

General and administrative

     294,178       17,145       277,033       347,128     $ 53,535       293,593       1,291,059       119,540       1,171,519  

Selling

     93,232         93,232       92,314         92,314       360,381         360,381  

Depreciation and amortization

     17,255         17,255       17,271         17,271       59,878         59,878  

Interest

     10,413         10,413       10,523         10,523       42,909         42,909  
                                                                        
     3,792,716       17,145       3,775,571       3,815,527       47,835       3,767,692       15,219,457       157,036       15,062,421  

(Loss) income from operations before income taxes

     26,135       (31,787 )     57,922       53,955       (47,835 )     101,790       147,132       (175,078 )     322,210  

Income tax (benefit) provision

     7,665       (12,498 )     20,163       18,420       (20,227 )     38,647       52,129       (70,951 )     123,080  
                                                                        

Net (loss) income

   $ 18,470     $ (19,289 )   $ 37,759     $ 35,535     $ (27,608 )   $ 63,143     $ 95,003     $ (104,127 )   $ 199,130  
                                                                        

Basic (loss) earnings per share

   $ 0.17     $ (0.19 )   $ 0.36     $ 0.34     $ (0.27 )   $ 0.61     $ 0.89     $ (0.98 )   $ 1.87  

Diluted (loss) earnings per share

   $ 0.17     $ (0.18 )   $ 0.35     $ 0.34     $ (0.27 )   $ 0.61     $ 0.88     $ (0.97 )   $ 1.85  

Weighted average shares outstanding:

                  

Basic

     105,915         105,915       103,694         103,694       106,532         106,532  

Diluted

     106,869         106,869       104,063         104,063       107,610         107,610  

Pretax margin

     0.7 %     -0.8 %     1.5 %     1.4 %     -1.2 %     2.6 %     1.0 %     -1.1 %     2.1 %

Health plan services MCR

     87.5 %     —         87.5 %     85.3 %     -0.2 %     85.5 %     86.9 %     0.4 %     86.5 %

Government contracts cost ratio

     95.0 %     —         95.0 %     95.6 %     —         95.6 %     95.3 %     —         95.3 %

G&A expense ratio

     9.5 %     0.5 %     9.0 %     11.2 %     1.7 %     9.5 %     10.4 %     1.0 %     9.4 %

Selling costs ratio

     3.0 %     —         3.0 %     3.0 %     —         3.0 %     2.9 %     —         2.9 %

Effective tax rate

     29.3 %     -5.5 %     34.8 %     34.1 %     -3.8 %     38.0 %     35.4 %     -2.8 %     38.2 %

 

3 Includes a $14.6 million pretax investment impairment charge which was included in net investment income as well as a $17.1 million pretax charge for severance and other expenses related to the company’s operations strategy and included in G&A expenses.
4 Includes a $5.7 million pretax benefit for a litigation reserve true-up included in health plan services expenses and a $53.5 million pretax charge primarily for severance and other expenses related to the company’s operations strategy and included in G&A expenses.
5 Includes a $175.1 million pretax charge in total of which:
  (a) $119.6 million was primarily related to severance and other expenses associated with the company's operations strategy and included in G&A expenses
  (b) $37.5 million was included in health plan services expenses for estimated litigation liability and regulatory actions for the company’s rescission practices in Arizona and California and for the execution of the settlement agreement for the McCoy, et al., lawsuits
  (c) $14.6 million investment impairment charge taken in the third quarter of 2008 and included in net investment income
  (d) $3.4 million pretax charge related to the estimated loss on the sale of the assets of a subsidiary taken in the first quarter of 2008 and included in other income

 

Page 12


Health Net, Inc.

Consolidated Statements of Cash Flows

(Amounts in thousands)

 

     Quarter Ended
December 31,
2007
    Year Ended
December 31,
2007
    Quarter Ended
September 30,
2008
    Quarter Ended
December 31,
2008
    Year Ended
December 31,
2008
 

CASH FLOWS FROM OPERATING ACTIVITIES:

 

     

Net income

   $ 116,927     $ 193,697     $ 18,470     $ 35,535     $ 95,003  

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

          

Amortization and depreciation

     13,598       42,982       17,255       17,271       59,878  

Share-based compensation expense

     6,457       24,298       8,216       1,294       24,065  

Deferred income taxes

     8,180       (98,629 )     52,249       (11,942 )     15,420  

Excess tax benefits from share-based compensation

     (487 )     (17,987 )     (35 )     —         (815 )

Other changes

     (3,498 )     (7,955 )     10,748       24,261       35,530  

Changes in assets and liabilities:

          

Premiums receivable and unearned premiums

     24,037       (74,184 )     112,741       (29,008 )     (39,271 )

Other receivables, deferred taxes and other assets

     30,704       143,783       (61,547 )     (107,787 )     (150,347 )

Amounts receivable/payable under government contracts

     1,213       26,223       5,977       7,166       (50,431 )

Reserves for claims and other settlements

     (12,672 )     251,636       (9,075 )     (10,532 )     37,717  

Accounts payable and other liabilities

     72,508       121,618       (62,558 )     20,164       (185,711 )
                                        

Net cash provided by (used in) operating activities

     256,967       605,482       92,441       (53,578 )     (158,962 )
                                        

CASH FLOWS FROM INVESTING ACTIVITIES:

 

     

Sales of investments

     242,421       807,649       154,478       514,047       1,219,291  

Maturities of investments

     65,606       213,833       58,400       62,117       257,149  

Purchases of investments

     (397,611 )     (1,180,854 )     (580,780 )     (218,258 )     (1,473,664 )

Proceeds from sale of property and equipment

     —         96,748       —         —         4  

Purchases of property and equipment

     (17,342 )     (64,850 )     (7,887 )     (12,911 )     (95,641 )

Cash paid for acquisition of assets and businesses

     —         (80,277 )     —         —         —    

Net sales and purchases of restricted investments and other

     7,127       (22,444 )     7,661       4,220       24,990  
                                        

Net cash (used in) provided by investing activities

     (99,799 )     (230,195 )     (368,128 )     349,215       (67,871 )
                                        

CASH FLOWS FROM FINANCING ACTIVITIES:

 

     

Proceeds from exercise of stock options and employee stock purchases

     2,525       72,622       235       —         6,636  

Repurchases of common stock

     (27,052 )     (232,220 )     (100,110 )     (17 )     (243,172 )

Excess tax benefits from share-based compensation

     487       17,987       35       —         815  

Borrowings under financing arrangements

     175,000       668,535       200,000       175,000       520,000  

Repayment of borrowings under financing arrangements

     —         (600,000 )     (245,000 )     (142,540 )     (396,262 )
                                        

Net cash provided (used in) by financing activities

     150,960       (73,076 )     (144,840 )     32,443       (111,983 )
                                        

Net increase (decrease) in cash and cash equivalents

     308,128       302,211       (420,527 )     328,080       (338,816 )

Cash and cash equivalents, beginning of period

     698,889       704,806       760,648       340,121       1,007,017  
                                        

Cash and cash equivalents, end of period

   $ 1,007,017     $ 1,007,017     $ 340,121     $ 668,201     $ 668,201  
                                        

 

Page 13


Health Net, Inc.

Consolidated Balance Sheet

(Amounts in thousands, except ratio data)

 

     December 31,
2007
    September 30,
2008
    December 31,
2008
 

ASSETS

      

Current Assets

      

Cash and cash equivalents

   $ 1,007,017     $ 340,121     $ 668,201  

Investments—available for sale

     1,557,278       1,838,951       1,504,658  

Premiums receivable, net

     264,691       295,854       307,529  

Amounts receivable under government contracts

     189,976       235,064       241,269  

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

     266,767       307,970       302,022  

Other receivables

     72,518       107,032       254,026  

Deferred taxes

     132,818       111,266       87,712  

Other assets

     210,039       238,615       179,649  
                        

Total current assets

     3,701,104       3,474,873       3,545,066  

Property and equipment, net

     178,758       228,256       202,356  

Goodwill, net

     751,949       751,949       751,949  

Other intangible assets, net

     109,386       96,122       91,289  

Deferred taxes

     47,765       58,555       81,771  

Other noncurrent assets

     144,093       132,427       143,919  
                        

Total Assets

   $ 4,933,055     $ 4,742,182     $ 4,816,350  
                        

LIABILITIES AND STOCKHOLDERS’ EQUITY

      

Current Liabilities

      

Reserves for claims and other settlements

   $ 1,300,432     $ 1,348,681     $ 1,338,149  

Health care and other costs payable under government contracts

     69,014       56,505       69,876  

IBNR health care costs payable under TRICARE North contract

     266,767       307,970       302,022  

Unearned premiums

     176,981       197,881       180,548  

Borrowings under amortizing financing facility

     35,000       26,693       27,335  

Accounts payable and other liabilities

     463,823       285,016       294,840  
                        

Total current liabilities

     2,312,017       2,222,746       2,212,770  

Senior notes payable

     398,071       398,224       398,276  

Borrowings under amortizing financing facility

     112,363       119,900       103,992  

Borrowings under revolving credit facility

     —         100,000       150,000  

Other noncurrent liabilities

     235,022       206,187       199,186  
                        

Total Liabilities

     3,057,473       3,047,057       3,064,224  
                        

Stockholders’ Equity

      

Common stock and additional paid-in capital

     1,151,395       1,181,481       1,182,211  

Treasury common stock, at cost

     (1,123,750 )     (1,367,302 )     (1,367,319 )

Retained earnings

     1,849,097       1,908,565       1,944,100  

Accumulated other comprehensive loss

     (1,160 )     (27,619 )     (6,866 )
                        

Total Stockholders’ Equity

     1,875,582       1,695,125       1,752,126  
                        

Total Liabilities and Stockholders’ Equity

   $ 4,933,055     $ 4,742,182     $ 4,816,350  
                        

Debt-to-Total Capital Ratio

     22.5 %     27.6 %     27.9 %

 

Page 14


Health Net, Inc.

Notes to Consolidated Financial Statements

Notes:

 

(a) Management believes that days claims payable (excluding capitation, provider and other claim 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 and other claim settlements and Medicare Part D) and days claims payable, the most directly comparable financial measure calculated and presented in accordance with GAAP:

 

     Q4 2007     FY 2007     Q3 2008     Q4 2008     FY 2008  
     (Dollars in millions)  

Reserve for Claims and Other Settlements

   $ 1,300.4     $ 1,300.4     $ 1,348.7     $ 1,338.1     $ 1,338.1  

Less: Capitation Payable, Provider and Other Claim Settlements and Medicare Part D

     (299.3 )     (299.3 )     (245.3 )     (233.8 )     (233.8 )
                                        

Adjusted Reserve for Claims and Other Settlements

     1,001.1       1,001.1       1,103.4       1,104.3       1,104.3  

(1)    Average Reserve for Claims and Other Settlements

     1,306.8       1,174.6       1,353.2       1,343.4       1,319.3  

(2)    Average Adjusted Reserve for Claims and Other Settlements

     1,011.8       982.3       1,084.0       1,103.8       1,052.7  

(3)    Health Plan Services Cost

     2,409.3       9,762.9       2,689.8       2,629.4       10,762.7  

Less: Capitation Payable, Provider and Other Claim Settlements and Medicare Part D

     (715.2 )     (3,129.7 )     (796.5 )     (776.8 )     (3,378.1 )
                                        

(4)    Adjusted Health Plan Services Cost

     1,694.1       6,633.2       1,893.3       1,852.6       7,384.6  

(5)    Number of Days in Period

     92       365       92       92       366  

= (1) / (3) * (5) Days Claims Payable

     49.9       43.9       46.3       47.0       44.9  

= (2) / (4) * (5) Days Claims Payable—Adjusted

     54.9       54.1       52.7       54.8       52.2  

 

Page 15


Health Net, Inc.

Reconciliation of Reserves for Claims and Other Settlements

(In millions)

 

     Health Plan Services  
     Year 2008     Year 2007    Year 2006  

Reserve for claims (a), beginning of period

   $ 838.7     $ 754.2    $ 768.7  

Incurred claims related to:

       

Current Year

     6,372.2       5,790.7      5,222.0  

Prior Years (c)

     (8.3 )     0.6      (77.3 )
                       

Total Incurred (b)

     6,363.9       5,791.3      5,144.7  

Paid claims related to:

       

Current Year

     5,443.2       4,972.3      4,485.7  

Prior Years

     802.3       734.5      673.5  
                       

Total Paid (b)

     6,245.5       5,706.8      5,159.2  

Reserve for claims (a), end of period

     957.1       838.7      754.2  

Add:

       

Claims Payable (d)

     284.8       365.6      203.9  

Other (e)

     96.2       96.1      90.7  
                       

Reserves for claims and other settlements, end of period

   $ 1,338.1     $ 1,300.4    $ 1,048.8  
                       

 

(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 amount accrued for litigation and regulatory-related expenses.
(e) Includes accrued capitation, shared risk settlements, provider incentives and other reserve items.

 

Page 16

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