Humana Inc. Reports 2004 Financial Results of $1.72 Earnings per Share
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LOUISVILLE, Ky., Feb 07, 2005 /PRNewswire-FirstCall via COMTEX/ -- Humana Inc. (NYSE: HUM) today reported a 22 percent increase in diluted earnings per common share (EPS) for the year ended December 31, 2004 (FY 2004), with $1.72 EPS compared to $1.41 EPS for the year ended December 31, 2003 (FY 2003). Factors contributing to the rise in the company's performance for the year include improvement in each of the company's business segments, with strong results from Medicare and further progress in commercial operations.
The company earned $0.29 per diluted common share for the quarter ended December 31, 2004 (4Q04), with pretax results consistent with the company's guidance raised in early December 2004.
"Our Medicare results confirmed how our commitment to this market enhanced our position both financially and strategically as we increased our already robust experience with the senior consumer. Additionally, our leadership in consumer-oriented health plans and an improving product mix fueled further progress in our commercial business," said Michael B. McCallister, Humana's president and chief executive officer. "The fourth quarter was a solid finish to a great year. As strong as 2004 was for us, emerging opportunities in both the Government and Commercial segments make our prospects for 2005 and beyond even stronger."
The company now expects EPS for the year ending December 31, 2005 (FY 2005) to approximate $2.05, an increase from its previous guidance of $1.95 EPS. The $0.10 increase in estimated EPS results primarily from the anticipated positive impact of a federal income tax gain contingency to be realized in the first quarter of 2005, partially offset by an increase in estimated average diluted shares outstanding for 2005 driven by recent share price appreciation. The company's estimate for pretax income in 2005 remains an increase in excess of 15 percent over 2004, with increases anticipated from both of the company's business segments.
FY 2004 EPS included net income of $0.03 per share from the gain on the sale of a venture capital investment, the adjustment of estimated federal income taxes payable, accelerated depreciation for software abandonment, and expenses primarily related to severance costs associated with corporate rightsizing. A favorable adjustment of estimated federal income taxes payable, totaling $0.03 per share, occurred during 4Q04 in connection with the company's assessment of income tax contingencies.
FY 2003 EPS included net expenses of $0.05 per share from the write-down of building and equipment, gain on the sale of a venture capital investment, and accelerated depreciation for software abandonment.
Results for 4Q04 of $0.29 EPS compare to $0.41 EPS for the quarter ended December 31, 2003 (4Q03). As previously discussed, this reduction resulted from the company entering into a new TRICARE contract in the latter half of 2004. The prior contracts resulted in a concentration of TRICARE earnings in the calendar fourth quarter of each year while the current contract results in more ratable earnings throughout the year. The 4Q04 effect of this TRICARE change was partially offset by improved fourth quarter performance in the company's Medicare and commercial operations.
Commercial Segment Results
Commercial segment pretax earnings rose to $27.3 million in 4Q04 from $14.1 million in 4Q03, reflecting a more profitable business mix with significant increases in administrative services only (ASO) and individual product (HumanaOne) members.
Pretax earnings for FY 2004 in the Commercial segment of $142.0 million rose 17 percent compared to those for FY 2003, driven by operating improvements from the previously discussed changes in commercial membership.
The company expects FY 2005 Commercial segment pretax earnings to increase between 10 and 15 percent over FY 2004. The projected 2005 beneficial effect from the lapse of a large unprofitable account and growth in ASO and HumanaOne product membership is expected to be partially offset by reduced income associated with lower average membership in the 3-to-300 case size fully insured customers.
Commercial Segment Enrollment
Commercial segment medical membership of 3,305,100 at December 31, 2004 increased 8 percent from the prior year, driven by net organic growth of 306,200 members in the company's ASO business, 152,600 members added through the April 2004 acquisition of Ochsner Health Plan, and nearly 59,000 new HumanaOne product members, partially offset by continued attrition in the company's fully insured business lines due to the ongoing competitive environment within the 3-to-300 case size fully insured customers. The company was successful in achieving organic commercial medical membership growth in excess of 87,000, or approximately 2.8 percent in FY 2004.
The company's leadership in engaging consumers continues to be evidenced through growth in both its Smart offerings and other consumer-focused high deductible plans. At December 31, 2004, 9 percent of the company's commercial medical membership was in these plans, up from 4 percent at December 31, 2003.
Effective January 1, 2005, an 89,000-member fully insured account, which had been unprofitable during FY 2004, lapsed. Excluding the impact of this account, Humana is forecasting its Commercial segment medical membership to be slightly higher for 2005 versus 2004.
Commercial Segment Premiums and Medical Costs
Premiums and administrative services fees for the Commercial segment increased 4 percent to $1.8 billion in 4Q04 compared to the prior year's quarter. For FY 2004, Commercial segment premiums and administrative services fees increased 7 percent to $7.1 billion versus $6.7 billion in FY 2003.
Commercial segment premiums for fully insured medical membership increased in the range of 5.5 to 7.5 percent on a per-member basis during 4Q04 compared to the same period in the prior year. FY 2004 commercial premiums for fully insured membership increased in the range of 6 to 8 percent on a per-member basis.
The ranges of per-member premium increase for both 4Q04 and FY 2004 include the estimated impact of an increasing mix of fully insured membership in the company's HumanaOne product, the premium for which lowered Humana's overall average per-member premium increase by approximately 150 to 200 basis points as this product has a correspondingly lower benefit than other fully insured commercial medical products.
In 4Q04, the Commercial segment medical expense ratio (medical expenses divided by premium revenues) of 83.9 percent was 30 basis points higher than in 4Q03, driven by the 2004 impact of the large unprofitable account. For FY 2004, the medical expense ratio of 83.9 percent increased 100 basis points year over year, in line with previous company guidance. This increase was driven by a combination of the effect of the unprofitable 89,000-member account and strategically planned pricing actions.
Per-member medical costs for the commercial fully insured business are forecast to rise in the range of 6.5 to 8.5 percent in 2005, including the lowering effect of approximately 200 basis points from a higher mix of HumanaOne membership year over year. These estimates are consistent with per- member increases in commercial medical costs experienced in FY 2004.
Government Segment Results
As expected, Government segment pretax earnings were $35.9 million in 4Q04 compared to $85.7 million in 4Q03. The profitability effect of the previously discussed TRICARE contract change in 4Q04 was partially offset by improvements in the performance of the segment's MedicareAdvantage business. Results for 4Q04 also include additional investment spending to position the company to take advantage of the substantial Medicare opportunities in 2005 and beyond.
For FY 2004, Government segment pretax earnings of $273.8 million increased 22 percent versus FY 2003, primarily from improved performance in its MedicareAdvantage products.
For 2005, the company expects a continuing increase in earnings in its Government segment, driven by improvements in results from both Medicare and TRICARE operations.
Government Segment Enrollment
MedicareAdvantage membership continued to increase in 4Q04, totaling 377,200 at December 31, 2004, up 48,600 members year over year and up 5,900 members sequentially. The previously described Ochsner Health Plan transaction resulted in the addition of 33,100 MedicareAdvantage members during the second quarter of 2004.
For 2005, year-over-year organic growth in MedicareAdvantage membership is anticipated to approximate 10 to 15 percent as a result of investments in sales and marketing, continued growth in the company's Medicare HMO products and expanded participation in Private-Fee-for-Service and local PPO programs. Humana's pending acquisition of CarePlus Health Plans of Florida (CarePlus) is expected to add approximately 50,000 more MedicareAdvantage members upon the completion of the transaction.
On November 1, 2004, Humana added approximately 1 million TRICARE members as the final membership transition associated with its new South Region contract with the Department of Defense became effective. TRICARE membership of 2,871,800 at December 31, 2004 compares to 2,906,900 at December 31, 2003. The company anticipates no material changes to its TRICARE membership levels in 2005.
Government Segment Premiums and Medical Costs
MedicareAdvantage premiums per member increased in the range of 8 to 10 percent year over year during 4Q04, reflecting higher reimbursement associated with the Medicare Modernization Act.
FY 2004 MedicareAdvantage premiums per member increased in the range of 9 to 11 percent. The company anticipates a range of 9 to 11 percent for 2005 as per-member premium continues to benefit from the processes the company has established to ensure its premiums from the Centers for Medicare and Medicaid Services (CMS) accurately reflect the risk profile of its membership.
MedicareAdvantage medical costs per member increased year over year in the range of 9 to 11 percent for FY 2004, with a range of 9 to 11 percent anticipated for 2005.
TRICARE premiums and administrative services fees during 4Q04 of $486.9 million reflect the implementation of the new South Region contract with the Department of Defense, which included a reduction in the benefits and services previously provided, and thus, lower revenues. Additionally, the timing of revenue recognition within each option period under the South Region contract differs from that under prior TRICARE contracts. Due to the South Region contract transition period, 4Q04 did not experience a full complement of revenues and membership. These differences accounted for the expected year-over-year decline in TRICARE premiums and administrative services fees of approximately 27 percent in 4Q04 and 7 percent for FY 2004.
For 2005, the company anticipates TRICARE premiums and administrative services fees to approximate $2.5 billion as the company experiences a full year under the new South Region contract with the second option period scheduled to begin April 1, 2005.
Selling, General & Administrative Expenses
The company's consolidated Selling, General, & Administrative (SG&A) expense ratio (SG&A expenses as a percent of premiums plus administrative services fees) was 14.5 percent for 4Q04, with continued discipline in administrative spending producing a 110 basis point year-over-year decline. Each of the segments also saw improvement in the SG&A expense ratio during 4Q04, with the Commercial segment's ratio declining by 70 basis points and the Government segment's ratio down by 160 basis points.
For FY 2004, the year-over-year decline was also substantial, resulting in a consolidated SG&A expense ratio of 14.5 percent, a decline of 90 basis points. This was the combined effect of a 50 basis point decline in the Commercial segment expense ratio and a 120 basis point decline in the Government segment ratio.
The company's 2005 consolidated SG&A expense ratio is projected to be in the range of 13.5 to 14.5 percent. The expected lower SG&A expense ratio should result from the beneficial effect of both growth in membership leveraging fixed costs and management's continued focus on streamlining administrative costs through process design and technology improvements.
Cash Flows from Operations
Cash flows provided by operations for FY 2004 of $347.8 million exceeded the company's expectations, but decreased 16 percent from $413.1 million in FY 2003 due to a change implemented by CMS in the timing of its January premium remittance. This change resulted in the company receiving only 11 monthly CMS premium payments in FY 2004.
Cash flows provided by operations during 4Q04 were $19.5 million compared to $290.2 million in 4Q03 and reflect the CMS revenue and TRICARE contract timing changes described above.
Cash flows from operations under generally accepted accounting principles (GAAP) for FY 2004 include the negative impact of $211.9 million related to the December 2003 receipt of the January 2004 MedicareAdvantage premium payment from CMS.
The company anticipates cash flows from operations for FY 2005 will be in the range of $600 million to $650 million driven by expected higher earnings.
Non-GAAP Cash Flows from Operations
When reviewing and analyzing Humana's cash flow position, company management applies the CMS premium payment in each month to match the corresponding disbursements. To do otherwise distorts meaningful analysis of the company's operating cash flow. Therefore, decisions such as management's forecasting and business plans regarding cash flow use this non-GAAP financial measure.
The following is a reconciliation of the most directly comparable historical and projected financial measures prepared in accordance with GAAP, to the historical and projected non-GAAP financial measures:
($ in
millions) FY 2003 FY 2004
Number Number
of of
FY FY Monthly Monthly
4Q03 4Q04 2003 2004 FY 2005 CMS CMS
Actual Actual Actual Actual Expected Receipts Receipts
GAAP
cash flows
provided
by $600 to
operations $ 290.2 $ 19.5 $ 413.1 $ 347.8 $650 12 11
Timing of
premium
payment
receipt
from CMS (211.9) - (6.1) 211.9 - - 1
Non-
GAAP
cash flows
provided
by $600 to
operations $ 78.3 $ 19.5 $ 407.0 $ 559.7 $650 12 12
Balance Sheet
The company's financial liquidity remained strong in 4Q04 with 54 percent of total assets in cash and investment securities at December 31, 2004, unchanged from December 31, 2003.
Debt as a percent of total capitalization (debt plus stockholders' equity) of 23.3 percent declined 260 basis points from December 31, 2003 and 50 basis points sequentially.
Cash and investment securities at the parent company of $439.3 million at December 31, 2004 compared to $399.4 million at December 31, 2003, an increase of 10 percent.
Acquisition of CarePlus
On December 14, 2004, the company announced an agreement to acquire CarePlus as well as its affiliated ten CAC-Florida Medical Centers, and PrescibIT Rx pharmacy management company. CarePlus provides MedicareAdvantage HMO plans and benefits to approximately 50,000 Medicare eligibles in Miami- Dade, Broward and Palm Beach counties. The transaction, which is subject to regulatory approval, is currently expected to close in the latter part of 1Q05.
The acquisition is anticipated to be immediately accretive to earnings, adding EPS of $0.15 to $0.18 during the initial 12 months, net of acquisition integration costs.
Conference Call & Virtual Slide Presentation
Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company's expectations for future earnings.
All parties interested in the audio only portion of the conference call are invited to dial 888-625-7430. No password is required. The company suggests participants dial in approximately ten minutes in advance of the call.
A live virtual presentation (audio with slides) will be available and may be accessed via Humana's Investor Relations page at http://www.humana.com . The company suggests web participants sign on approximately 15 minutes in advance of the call. The company also suggests web participants visit the site well in advance of the call to run a system test and to download any free software needed to view the presentation.
For those unable to participate in the live event, the virtual presentation archive will be available in the Presentations section of the Investor Relations page at http://www.humana.com , approximately two hours following the live web cast.
Cautionary Statement
This news release contains forward-looking statements. The forward- looking statements herein are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may be significantly impacted by certain risks and uncertainties described in the following documents, as filed by Humana with the Securities and Exchange Commission:
- Form 10-K for the year ended December 31, 2003;
- Form 10-Qs for the quarters ended March 31, 2004, June 30, 2004 and
September 30, 2004.
About Humana
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 7 million medical members located primarily in 15 states and Puerto Rico. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.
Over its 44-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.
More information regarding Humana is available to investors via the Investor Relations page of the company's web site at http://www.humana.com , including copies of:
- Annual report to stockholders;
- Securities and Exchange Commission filings;
- Most recent investor conference presentation;
- Quarterly earnings press releases;
- Audio archive of most recent earnings release conference call;
- Calendar of events (includes upcoming earnings conference call dates,
times, and access number, as well as planned interaction with
institutional investors);
- Corporate Governance Information.
Summary of Earnings Guidance Points
Note: The company's earnings guidance points described throughout this press release (including the table below) exclude any impact of the company's pending acquisition of CarePlus as well as any potential impact from new stock option accounting rules required for implementation by all companies in the latter half of 2005.
2005 Guidance Points
FY 2005 EPS Approximately $2.05
1Q05 EPS $0.59 to $0.61
Consolidated revenues Approximately $14 billion
Commercial segment pretax income Increase of 10% to 15%
Commercial medical membership Slightly higher excluding loss of
89K member account on January 1,
2005
Increase in Commercial segment fully 6.5% to 8.5% overall;
insured medical premiums on a per- 8.5% to 10.5% group only
member basis
Increase in Commercial segment fully 6.5% to 8.5% overall;
insured medical costs on a per-member 8.5% to 10.5% group only
basis
TRICARE pretax margin Approximately 3%
Medicare medical membership Organic growth of 10% to 15%
TRICARE medical membership No material change from 2004
ending membership
Increase in Medicare medical premiums 9% to 11%
on a per-member basis
Increase in Medicare medical costs on 9% to 11%
a per-member basis
TRICARE revenues Approximately $2.5 billion
Consolidated SG&A expense ratio 13.5% to 14.5%
Cash flows from operations for full $600 million to $650 million
year - GAAP and non-GAAP
Capital expenditures Approximately $115 million
Effective tax rate FY 2005 approximately 30 percent;
1Q05 approximately 12 percent
Shares used in computation of EPS FY 2005 approximately 166 million;
1Q05 approximately 165 million
Humana Inc.
In thousands
Ending Medical December 31, Percent
Membership 2004 2003 Difference Change
Commercial:
Fully insured 2,286.5 2,352.8 (66.3) (2.8)
ASO 1,018.6 712.4 306.2 43.0
Total Commercial 3,305.1 3,065.2 239.9 7.8
Government:
MedicareAdvantage 377.2 328.6 48.6 14.8
Medicaid 478.6 468.9 9.7 2.1
TRICARE 1,789.4 1,849.7 (60.3) (3.3)
TRICARE ASO 1,082.4 1,057.2 25.2 2.4
Total TRICARE 2,871.8 2,906.9 (35.1) (1.2)
Total Government 3,727.6 3,704.4 23.2 0.6
Total ending medical
membership 7,032.7 6,769.6 263.1 3.9
Ending Specialty December 31, Percent
Membership 2004 2003 Difference Change
Commercial:
Dental-fully insured 825.8 767.6 58.2 7.6
Dental-ASO 420.9 379.8 41.1 10.8
Total Dental 1,246.7 1,147.4 99.3 8.7
Group life 444.6 502.4 (57.8) (11.5)
Short-term disability 16.9 18.3 (1.4) (7.7)
Total ending
specialty
membership 1,708.2 1,668.1 40.1 2.4
Three months ended Twelve months ended
December 31, December 31,
Premiums 2004 2003 2004 2003
Commercial:
Fully insured
medical $1,633,240 $1,584,950 $6,614,482 $6,240,806
Specialty 89,632 81,469 349,564 320,206
Total Commercial 1,722,872 1,666,419 6,964,046 6,561,012
Government:
MedicareAdvantage 791,064 634,332 3,086,598 2,527,446
TRICARE 475,751 622,513 2,127,595 2,249,725
Medicaid 133,298 129,367 511,193 487,100
Total Government 1,400,113 1,386,212 5,725,386 5,264,271
Total premiums $3,122,985 $3,052,631 $12,689,432 $11,825,283
Three months ended Twelve months ended
Administrative December 31, December 31,
services fees 2004 2003 2004 2003
Commercial $42,244 $31,865 $166,032 $122,846
Government 11,132 40,023 106,764 148,830
Total administrative
services fees $53,376 $71,888 $272,796 $271,676
Humana Inc.
Dollars in thousands, except per share results
Consolidated Three months ended Twelve months ended
Statements of December 31, December 31,
Income 2004 2003 2004 2003
Revenues:
Premiums $3,122,985 $3,052,631 $12,689,432 $11,825,283
Administrative
services fees 53,376 71,888 272,796 271,676
Investment income 31,375 26,777 132,838 122,041
Other income 1,889 1,576 9,259 7,311
Total revenues 3,209,625 3,152,872 13,104,325 12,226,311
Operating expenses:
Medical 2,645,480 2,534,887 10,669,647 9,879,421
Selling, general
and administrative 461,169 486,832 1,877,864 1,858,028
Depreciation 30,640 24,158 107,286 115,167
Other intangible
amortization 2,437 2,389 10,506 11,612
Total operating
expenses 3,139,726 3,048,266 12,665,303 11,864,228
Income from
operations 69,899 104,606 439,022 362,083
Interest expense 6,648 4,894 23,172 17,367
Income before income
taxes 63,251 99,712 415,850 344,716
Provision for income
taxes 16,125 33,403 135,838 115,782
Net income $47,126 $66,309 $280,012 $228,934
Basic earnings per
common share $0.30 $0.41 $1.75 $1.44
Diluted earnings per
common share $0.29 $0.41 $1.72 $1.41
Shares used in computing
basic earnings per
common share (000's) 159,598 161,225 160,421 158,968
Shares used in computing
diluted earnings per
common share (000's) 162,138 163,724 162,456 161,960
Operating Results by Segment
Pretax income
Commercial $27,306 $14,062 $142,010 $121,010
Government 35,945 85,650 273,840 223,706
Consolidated $63,251 $99,712 $415,850 $344,716
Key Ratios
Medical expense ratio
Commercial 83.9% 83.6% 83.9% 82.9%
Government 85.7% 82.3% 84.3% 84.3%
Consolidated 84.7% 83.0% 84.1% 83.5%
Selling, general, and
administrative expense
ratio
Commercial 16.6% 17.3% 16.4% 16.9%
Government 11.9% 13.5% 12.2% 13.4%
Consolidated 14.5% 15.6% 14.5% 15.4%
Humana Inc.
Dollars in thousands, except per share results
December 31, September 30, December 31,
Consolidated Balance Sheets 2004 2004 2003
Assets
Current assets:
Cash and cash equivalents $580,079 $375,090 $931,404
Investment securities 2,145,645 2,332,522 1,676,642
Receivables, net:
Premiums 554,661 405,067 452,404
Administrative services
fees 24,954 19,803 13,583
Securities lending collateral 77,840 82,342 86,491
Other 212,958 273,240 247,298
Total current assets 3,596,137 3,488,064 3,407,822
Property and equipment, net 399,506 390,735 416,472
Other assets:
Long-term investment
securities 348,465 333,796 319,167
Goodwill 885,572 859,734 776,874
Other 427,937 421,623 459,479
Total other assets 1,661,974 1,615,153 1,555,520
Total assets $5,657,617 $5,493,952 $5,379,814
Liabilities and Stockholders' Equity
Current liabilities:
Medical and other expenses
payable $1,422,010 $1,436,135 $1,272,156
Trade accounts payable and
accrued expenses 488,332 504,892 440,340
Book overdraft 192,060 116,106 219,054
Securities lending payable 77,840 82,342 86,491
Unearned revenues 146,326 132,659 333,071
Total current liabilities 2,326,568 2,272,134 2,351,112
Long-term debt 636,696 630,912 642,638
Other long-term liabilities 604,229 568,911 550,115
Total liabilities 3,567,493 3,471,957 3,543,865
Commitments and contingencies
Stockholders' equity:
Preferred stock, $1 par;
10,000,000 shares
authorized; none issued - - -
Common stock, $0.16 2/3 par;
300,000,000 shares authorized;
176,044,649 shares issued at
December 31, 2004 29,340 29,177 28,984
Capital in excess of par
value 1,017,156 994,975 974,975
Retained earnings 1,229,823 1,182,697 949,811
Accumulated other
comprehensive income 16,526 13,797 16,909
Unearned stock compensation (1,721) (203) (754)
Treasury stock, at cost,
15,778,088 shares at
December 31, 2004 (201,000) (198,448) (133,976)
Total stockholders' equity 2,090,124 2,021,995 1,835,949
Total liabilities and
stockholders' equity $5,657,617 $5,493,952 $5,379,814
Debt to total capitalization
ratio 23.3% 23.8% 25.9%
Humana Inc.
Dollars in thousands
Three months ended Twelve months ended
Consolidated Statements December 31, December 31,
of Cash Flows 2004 2003 2004 2003
Cash flows from operating
activities
Net income $47,126 $66,309 $280,012 $228,934
Adjustments to reconcile
net income to net cash
provided by operating
activities:
Writedown of property
and equipment - - - 17,233
Depreciation and
amortization 33,077 26,547 117,792 126,779
Provision for deferred
income taxes 26,063 2,038 53,608 32,251
Changes in operating
assets and liabilities,
net of effect of
business acquired:
Receivables (151,334) (28,736) (44,625) (15,220)
Other assets 22,767 (17,325) 3,991 25,110
Medical and other
expenses payable (14,125) (24,410) 78,791 130,025
Other liabilities 39,057 43,931 65,732 (107,432)
Unearned revenues 13,667 224,910 (190,759) (2,686)
Other 3,187 (3,044) (16,733) (21,854)
Net cash provided by
operating activities 19,485 290,220 347,809 413,140
Cash flows from investing
activities
Acquisition, net of
cash and cash
equivalents acquired (25,838) - (141,810) -
Purchases of property
and equipment (41,196) (36,288) (114,096) (101,268)
Proceeds from sales
of property and
equipment 1,519 8,699 30,491 11,182
Purchases of investment
securities (486,927) (908,323) (4,097,559) (4,582,251)
Proceeds from maturities
of investment
securities 174,869 183,975 1,015,144 769,436
Proceeds from sales of
investment securities 479,896 751,618 2,683,749 3,520,064
Net cash provided by
(used in) investing
activities 102,323 (319) (624,081) (382,837)
Cash flows from financing
activities
Change in book overdraft 75,954 303 (26,994) 124,172
Proceeds from issuance
of senior notes - - - 299,139
Net commercial paper
conduit repayments - - - (265,000)
Proceeds from swap exchange - - - 31,556
Change in securities
lending payable (4,502) (4,860) (8,651) 9,674
Common stock repurchases (2,552) - (67,024) (44,147)
Proceeds from stock
option exercises and
other 14,281 10,223 27,616 24,350
Net cash provided by
(used in) financing
activities 83,181 5,666 (75,053) 179,744
Increase (decrease) in
cash and cash
equivalents 204,989 295,567 (351,325) 210,047
Cash and cash equivalents
at beginning of period 375,090 635,837 931,404 721,357
Cash and cash equivalents
at end of period $580,079 $931,404 $580,079 $931,404
Humana Inc.
Percentage of Ending Membership Under Capitation Arrangements
Commercial Segment
Fully Total
Insured ASO Segment
December 31, 2004
Capitated HMO
hospital system based A 3.1% - 2.1%
Capitated HMO
physician group based A 2.5% - 1.7%
Risk-sharing B 3.0% - 2.1%
All other membership 91.4% 100.0% 94.1%
Total 100.0% 100.0% 100.0%
December 31, 2003
Capitated HMO
hospital system based A 5.4% - 4.2%
Capitated HMO
physician group based A 3.0% - 2.3%
Risk-sharing B 2.9% - 2.2%
All other membership 88.7% 100.0% 91.3%
Total 100.0% 100.0% 100.0%
Humana Inc.
Percentage of Ending Membership Under Capitation Arrangements
Government Segment Consol.
Medicare TRICARE Total Total
Advantage Medicaid TRICARE ASO Segment Medical
December 31, 2004
Capitated HMO
hospital system
based A 10.2% 3.6% - - 1.5% 1.8%
Capitated HMO
physician group
based A 1.1% 39.3% - - 5.2% 3.5%
Risk-sharing B 55.2% 50.4% - - 12.0% 7.4%
All other
membership 33.5% 6.7% 100.0% 100.0% 81.3% 87.3%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
December 31, 2003
Capitated HMO
hospital system
based A 11.8% 2.9% - - 1.4% 2.7%
Capitated HMO
physician group
based A 1.8% 46.9% - - 6.1% 4.4%
Risk-sharing B 47.9% 43.7% - - 9.8% 6.4%
All other
membership 38.5% 6.5% 100.0% 100.0% 82.7% 86.5%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
A - In a limited number of circumstances, we contract with hospitals and
physicians to accept financial risk for a defined set of HMO
membership. In transferring this risk, we prepay these providers a
monthly fixed-fee per member to coordinate substantially all of the
medical care for their capitated HMO membership, including some health
benefit administrative functions and claims processing. For these
capitated HMO arrangements, we generally agree to reimbursement rates
that target a medical expense ratio ranging from 82% to 89%.
Providers participating in hospital-based capitated HMO arrangements
generally receive a monthly payment for all of the services within
their system for their HMO membership. Providers participating in
physician-based capitated HMO arrangements generally have
subcontracted specialist physicians and are responsible for
reimbursing such hospitals and physicians for services rendered to
their HMO membership.
B - In some circumstances, we contract with physicians under risk-sharing
arrangements whereby physicians have assumed some level of risk for
all or a portion of the medical costs of their HMO membership.
Although these arrangements do include capitation payments for
services rendered, we process substantially all of the claims under
these arrangements.
Humana Inc.
Dollars in thousands
Medical Claim Reserves - Details and Statistics
Change in medical and other expenses payable:
The change in medical and other expenses payable is summarized as follows:
For the Twelve For the Twelve
Months Ended Months Ended
December 31, 2004 December 31, 2003
Balances at January 1 $1,272,156 $1,142,131
Acquisition 71,063 -
Incurred related to:
Current year 10,763,105 9,955,491
Prior years - non-TRICARE (1) (68,448) (33,432)
Prior years - TRICARE (2) (25,010) (42,638)
Total incurred 10,669,647 9,879,421
Paid related to:
Current year (9,504,331) (8,710,393)
Prior years (1,086,525) (1,039,003)
Total paid (10,590,856) (9,749,396)
Balances at end of period $1,422,010 $1,272,156
The impact of any change in "incurred related to prior years" claims may
be offset as we re-establish the "incurred related to current year". Our
reserving practice is to consistently recognize the actuarial best
estimate of our ultimate liability for our claims within a level of
confidence required to meet actuarial standards. Thus, only when the
release of a prior year reserve is not offset with the same level of
conservatism in estimating the current year reserve will the redundancy
reduce medical expense. We have consistently applied this methodology in
determining our best estimate for unpaid claims liability in each period.
(1) The $35.0 million increase in non-TRICARE favorable development from
$33.4 million to $68.4 million related primarily to better than
expected utilization in the latter half of 2003 for our Medicare line
of business.
(2) Changes in estimates of TRICARE incurred claims for prior years
recognized during 2003 and 2004 resulted primarily from claim costs
and utilization levels developing favorably from the levels originally
estimated for the second half of the prior year. As a result of
substantial risk-sharing provisions with the Department of Defense and
with subcontractors, any resulting impact on operations from the
change in estimates of incurred related to prior years is
substantially reduced, whether positive or negative.
Humana Inc.
Dollars in thousands
Medical Claim Reserves - Details and Statistics
Medical and Other Expenses Payable Detail:
December 31 September 30 December 31
2004 2004 2003
A IBNR and other medical
expenses payable $910,525 $945,972 $767,712
B TRICARE IBNR 284,647 238,474 267,146
C TRICARE other medical
expenses payable 6,970 16,923 37,849
D Unprocessed claim
inventories 115,300 122,300 109,700
E Processed claim
inventories 97,801 79,895 74,262
F Payable to pharmacy benefit
administrator 6,767 32,571 15,487
Total medical and other
expenses payable $1,422,010 $1,436,135 $1,272,156
A IBNR represents an estimate of medical expenses payable for claims
incurred but not reported (IBNR) at the balance sheet date. The level of
IBNR is primarily impacted by membership levels, medical claim trends
and the receipt cycle time, which represents the length of time between
when a claim is initially incurred and when the claim form is received
(i.e. a shorter time span results in lower reserves for claims IBNR).
B TRICARE IBNR has increased from higher medical expenses due to the
transition to the new South region contract.
C TRICARE other medical expense payable may include liabilities to
subcontractors and/or risk share payables to the Department of Defense.
The level of these balances may fluctuate from period to period due to
the timing of payment (cutoff) and whether or not the balances are
payables or receivables (receivables from the Department of Defense are
classified as "receivables" in our balance sheet).
D Unprocessed claim inventories represent the estimated valuation of
claims received but not yet fully processed. TRICARE claim inventories
are not included in this amount as an independent third party
administrator processes all TRICARE medical claims on our behalf.
Reserves for TRICARE claims inventory are included in TRICARE IBNR.
E Processed claim inventories represent the estimated valuation of
processed claims that are in the post claim adjudication process, which
consists of administrative functions such as audit and check batching
and handling.
F The balance due to our pharmacy benefit administrator fluctuates due to
bi-weekly payments and the month-end cutoff.
Receipt Cycle Time:
The receipt cycle time measures the average length of time between when a
claim was initially incurred and when the claim form was received. Below
is a summary:
Average Number of Days from Incurred Date to Receipt Date (1)
2004 2003 Change % Change
1st Quarter Average 17.4 17.1 0.3 1.8 %
2nd Quarter Average 16.7 16.7 0.0 0.0 %
3rd Quarter Average 16.9 16.6 0.3 1.8 %
4th Quarter Average 16.4 16.6 (0.2) -1.2 %
Full Year Average 16.9 16.7 0.2 1.2 %
(1) Receipt cycle time data for our 3 largest claim processing platforms
representing approximately 90% of our claims volume.
Humana Inc.
Medical Claim Reserves - Details and Statistics
Unprocessed Claim Inventories:
The estimated valuation and number of claims on hand that are yet to be
processed are as follows:
Estimated Number
Valuation Claim Item of Days
Date (000) Counts On Hand
12/31/2002 $92,300 424,200 4.5
3/31/2003 $99,000 421,700 4.4
6/30/2003 $92,100 446,600 4.7
9/30/2003 $106,800 528,400 5.8
12/31/2003 $109,700 443,000 4.9
3/31/2004 $94,800 400,900 3.9
6/30/2004 $98,100 387,000 3.7
9/30/2004 $122,300 453,300 4.4
12/31/2004 $115,300 394,400 3.7
Days in Claims Payable (Quarterly):
A common metric for monitoring medical claim reserve levels relative to
the medical claim expenses is days in claims payable, or DCP, which
represents the medical claim liabilities at the end of the period divided
by average medical expenses per day in the quarterly period. Since we have
some providers under capitation payment arrangements (which do not require
a medical claim IBNR reserve), we have also summarized this metric
excluding capitation expenses.
Days
in Claims DCP
Quarter Payable Annual Excluding Annual
Ended (DCP) Change % Change Capitation Change % Change
12/31/2002 45.2 (2.2) -4.6 % 53.3 (3.8) -6.7 %
3/31/2003 46.5 (0.7) -1.5 % 54.7 (1.5) -2.7 %
6/30/2003 47.9 1.1 2.4 % 56.2 0.9 1.6 %
9/30/2003 47.2 0.6 1.3 % 54.5 (0.8) -1.4 %
12/31/2003 46.2 1.0 2.2 % 53.2 (0.1) -0.2 %
3/31/2004 47.4 0.9 1.9 % 54.3 (0.4) -0.7 %
6/30/2004 47.4 (0.5) -1.0 % 54.1 (2.1) -3.7 %
9/30/2004 51.8 4.6 9.7 % 59.1 4.6 8.4 %
12/31/2004 49.5 3.3 7.1 % 54.8 1.6 3.0 %
This metric fluctuates due to all of the issues reviewed above, including
the change in the receipt cycle time, the change in medical claim
inventories, the change in TRICARE liability balances, and the timing of
our bi-weekly payment to our pharmacy benefits administrator. An annual
recap follows:
2004 2003
4th quarter-prior year 46.2 45.2
Impact of change in claim receipt
cycle time (0.2) (0.5)
Impact of change in unprocessed
claim inventories 0.2 0.6
Impact of change in processed
claim inventories 0.9 (1.1)
Impact of changing TRICARE
reserve balances 1.6 2.0
Impact of change in pharmacy
payment cutoff (0.4) (1.0)
All other 1.2 1.0
Year to date-current year 49.5 46.2
SOURCE Humana Inc.
Regina Nethery, Investor Relations, +1-502-580-3644, or Rnethery@humana.com , or Tom Noland, Corporate Communications, +1-502-580-3674, or Tnoland@humana.com , both of Humana Inc.
http://www.prnewswire.com