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Account
Humana
HUM
#1113
Rank
$21.50 B
Marketcap
๐บ๐ธ
United States
Country
$178.83
Share price
1.96%
Change (1 day)
-30.75%
Change (1 year)
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Annual Reports (10-K)
Humana
Quarterly Reports (10-Q)
Financial Year FY2015 Q2
Humana - 10-Q quarterly report FY2015 Q2
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Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
ý
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended
June 30, 2015
OR
¨
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934
For the transition period from
to
Commission file number 1-5975
HUMANA INC.
(Exact name of registrant as specified in its charter)
Delaware
61-0647538
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification Number)
500 West Main Street
Louisville, Kentucky 40202
(Address of principal executive offices, including zip code)
(502) 580-1000
(Registrant’s telephone number, including area code)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes
ý
No
¨
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes
ý
No
¨
Indicate by checkmark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act. (Check one):
Large accelerated filer
ý
Accelerated filer
¨
Non-accelerated filer
¨
Smaller reporting company
¨
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes
¨
No
ý
Indicate the number of shares outstanding of each of the issuer’s classes of common stock as of the latest practicable date.
Class of Common Stock
Outstanding at
June 30, 2015
$0.16 2/3 par value
148,143,674 shares
Table of Contents
Humana Inc.
FORM 10-Q
JUNE 30, 2015
INDEX
Page
Part I: Financial Information
Item 1.
Financial Statements (Unaudited)
Condensed Consolidated Balance Sheets at June 30, 2015
and December 31, 2014
3
Condensed Consolidated Statements of Income for the three and six months ended
June 30, 2015 and 2014
4
Condensed Consolidated Statements of Comprehensive Income for the three and six
months ended June 30, 2015 and 2014
5
Condensed Consolidated Statements of Cash Flows for the three and six months ended
June 30, 2015 and 2014
6
Notes to Condensed Consolidated Financial Statements
7
Item 2.
Management’s Discussion and Analysis of Financial Condition and Results
of Operations
32
Item 3.
Quantitative and Qualitative Disclosures about Market Risk
58
Item 4.
Controls and Procedures
58
Part II: Other Information
Item 1.
Legal Proceedings
59
Item 1A.
Risk Factors
59
Item 2.
Unregistered Sales of Equity Securities and Use of Proceeds
61
Item 3.
Defaults Upon Senior Securities
62
Item 4.
Mine Safety Disclosures
62
Item 5.
Other Information
62
Item 6.
Exhibits
62
Signatures
64
Certifications
Humana Inc.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)
June 30,
2015
December 31,
2014
(in millions, except share amounts)
A
SSETS
Current assets:
Cash and cash equivalents
$
2,250
$
1,935
Investment securities
7,041
7,598
Receivables, less allowance for doubtful accounts of $104 in 2015
and $98 in 2014:
2,129
1,053
Other current assets
5,555
4,007
Assets held-for-sale
—
943
Total current assets
16,975
15,536
Property and equipment, net
1,299
1,228
Long-term investment securities
1,839
1,949
Goodwill
3,266
3,231
Other long-term assets
2,005
1,583
Total assets
$
25,384
$
23,527
L
IABILITIES
AND
S
TOCKHOLDERS
’ E
QUITY
Current liabilities:
Benefits payable
$
4,781
$
4,475
Trade accounts payable and accrued expenses
3,292
2,095
Book overdraft
309
334
Unearned revenues
291
361
Short-term borrowings
300
—
Liabilities held-for-sale
—
206
Total current liabilities
8,973
7,471
Long-term debt
3,823
3,825
Future policy benefits payable
2,148
2,349
Other long-term liabilities
357
236
Total liabilities
15,301
13,881
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;
198,272,668 shares issued at June 30, 2015 and 197,951,551 shares
issued at December 31, 2014
33
33
Capital in excess of par value
2,495
2,330
Retained earnings
10,689
9,916
Accumulated other comprehensive income
153
223
Treasury stock, at cost, 50,128,994 shares at June 30, 2015 and
48,347,541 shares at December 31, 2014
(3,287
)
(2,856
)
Total stockholders’ equity
10,083
9,646
Total liabilities and stockholders’ equity
$
25,384
$
23,527
See accompanying notes to condensed consolidated financial statements.
3
Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(Unaudited)
Three months ended
June 30,
Six months ended
June 30,
2015
2014
2015
2014
(in millions, except per share results)
Revenues:
Premiums
$
13,212
$
11,584
$
26,460
$
22,667
Services
407
546
897
1,084
Investment income
113
92
208
183
Total revenues
13,732
12,222
27,565
23,934
Operating expenses:
Benefits
11,252
9,627
22,257
18,751
Operating costs
1,817
1,835
3,762
3,620
Depreciation and amortization
90
79
183
161
Total operating expenses
13,159
11,541
26,202
22,532
Income from operations
573
681
1,363
1,402
Gain on sale of business
267
—
267
—
Interest expense
47
35
93
70
Income before income taxes
793
646
1,537
1,332
Provision for income taxes
362
302
676
620
Net income
$
431
$
344
$
861
$
712
Basic earnings per common share
$
2.88
$
2.22
$
5.74
$
4.59
Diluted earnings per common share
$
2.85
$
2.19
$
5.67
$
4.54
Dividends declared per common share
$
0.29
$
0.28
$
0.57
$
0.55
See accompanying notes to condensed consolidated financial statements.
4
Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(Unaudited)
Three months ended
June 30,
Six months ended
June 30,
2015
2014
2015
2014
(in millions)
Net income
$
431
$
344
$
861
$
712
Other comprehensive (loss) income:
Change in gross unrealized investment
gains/losses
(87
)
56
(73
)
164
Effect of income taxes
32
(21
)
27
(60
)
Total change in unrealized
investment gains/losses, net of tax
(55
)
35
(46
)
104
Reclassification adjustment for net
realized gains included in
investment income
(28
)
(2
)
(37
)
(3
)
Effect of income taxes
9
1
13
1
Total reclassification adjustment, net
of tax
(19
)
(1
)
(24
)
(2
)
Other comprehensive (loss) income, net
of tax
(74
)
34
(70
)
102
Comprehensive income
$
357
$
378
$
791
$
814
See accompanying notes to condensed consolidated financial statements.
5
Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
For the six months ended
June 30,
2015
2014
(in millions)
Cash flows from operating activities
Net income
$
861
$
712
Adjustments to reconcile net income to net cash (used in) provided by
operating activities:
Gain on sale of business
(267
)
—
Net realized capital gains
(37
)
(3
)
Stock-based compensation
69
55
Depreciation
178
157
Other intangible amortization
50
56
Benefit for deferred income taxes
(28
)
(39
)
Changes in operating assets and liabilities, net of effect of
businesses acquired and dispositions:
Receivables
(1,087
)
(1,137
)
Other assets
(1,437
)
(914
)
Benefits payable
306
885
Other liabilities
923
641
Unearned revenues
(70
)
42
Other, net
38
16
Net cash (used in) provided by operating activities
(501
)
471
Cash flows from investing activities
Proceeds from sale of business
1,055
72
Acquisitions, net of cash acquired
(38
)
(3
)
Purchases of property and equipment
(259
)
(216
)
Purchases of investment securities
(1,721
)
(968
)
Maturities of investment securities
615
512
Proceeds from sales of investment securities
1,570
1,007
Net cash provided by investing activities
1,222
404
Cash flows from financing activities
Receipts (withdrawals) from contract deposits, net
(259
)
(127
)
Proceeds from issuance of commercial paper, net
300
—
Change in book overdraft
(25
)
(109
)
Common stock repurchases
(371
)
(152
)
Dividends paid
(86
)
(86
)
Excess tax benefit from stock-based compensation
14
9
Proceeds from stock option exercises and other
21
45
Net cash used in financing activities
(406
)
(420
)
Increase in cash and cash equivalents
315
455
Cash and cash equivalents at beginning of period
1,935
1,138
Cash and cash equivalents at end of period
$
2,250
$
1,593
Supplemental cash flow disclosures:
Interest payments
$
95
$
73
Income tax payments, net
$
736
$
601
See accompanying notes to condensed consolidated financial statements.
6
Table of Contents
Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
Unaudited
1. BASIS OF PRESENTATION AND SIGNIFICANT EVENTS
The accompanying condensed consolidated financial statements are presented in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the disclosures normally required by accounting principles generally accepted in the United States of America, or GAAP, or those normally made in an Annual Report on Form 10-K. The year-end condensed consolidated balance sheet data was derived from audited financial statements, but does not include all disclosures required by GAAP. For further information, the reader of this Form 10-Q should refer to our Form 10-K for the year ended
December 31, 2014
, that was filed with the Securities and Exchange Commission, or the SEC, on February 18, 2015. We refer to the Form 10-K as the “2014 Form 10-K” in this document. References throughout this document to “we,” “us,” “our,” “Company,” and “Humana” mean Humana Inc. and its subsidiaries.
The preparation of our condensed consolidated financial statements in accordance with GAAP requires us to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. The areas involving the most significant use of estimates are the estimation of benefits payable, future policy benefits payable, the impact of risk adjustment provisions related to our Medicare contracts, the valuation and related impairment recognition of investment securities, and the valuation and related impairment recognition of long-lived assets, including goodwill. These estimates are based on knowledge of current events and anticipated future events, and accordingly, actual results may ultimately differ materially from those estimates. Refer to Note 2 to the consolidated financial statements included in our 2014 Form 10-K for information on accounting policies that we consider in preparing our consolidated financial statements.
The financial information has been prepared in accordance with our customary accounting practices and has not been audited. In our opinion, the information presented reflects all adjustments necessary for a fair statement of interim results. All such adjustments are of a normal and recurring nature.
Proposed Merger
On July 2, 2015, we entered into an Agreement and Plan of Merger, which we refer to in this report as the Merger Agreement, with Aetna Inc. and certain wholly owned subsidiaries of Aetna Inc., which we refer to collectively as Aetna, which sets forth the terms and conditions under which we will merge with, and become a wholly owned subsidiary of Aetna, a transaction we refer to in this report as the Merger. In the Merger, each outstanding share of our common stock will be converted into the right to receive (i)
0.8375
of a share of Aetna common stock and (ii)
$125
in cash. The total transaction was estimated at approximately
$37 billion
including the assumption of Humana debt, based on the closing price of Aetna common shares on July 2, 2015. The Merger Agreement includes customary restrictions on the conduct of our business prior to the completion of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of customary specified limitations absent Aetna’s prior written consent, including, for example, limitations on dividends and repurchases of our securities, restrictions on our ability to enter into material contracts, and negotiated thresholds for capital expenditures, capital contributions, acquisitions and divestitures of businesses.
The transaction is subject to customary closing conditions, including, among other things, (i) approval of the holders of our outstanding shares of common stock entitled to vote on the Merger, (ii) approval of the holders of Aetna outstanding shares to the issuance of Aetna common stock in the Merger, (iii) the expiration or termination of the applicable waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, and the receipt of necessary approvals under state insurance and healthcare laws and regulations and pursuant to certain licenses of certain of Humana’s subsidiaries, (iv) the absence of legal restraints and prohibitions on the consummation of the Merger, (v) the effectiveness of the registration statement in respect of the Aetna common stock to be issued in the Merger, (vi) listing of the Aetna common stock to be issued in the Merger on the New York Stock Exchange, (vii) subject to the relevant standards set forth in the Merger Agreement, the accuracy of the representations and warranties made by each party, (viii) material compliance by each party with its covenants in the Merger Agreement, and (ix) no “Company Material Adverse Effect” with respect to us and no “Parent Material Adverse Effect” with respect to Aetna, in each case since the execution of and as defined in the Merger Agreement. In addition, Aetna’s obligation to consummate the Merger is subject to (a) the condition that the required regulatory approvals do not impose any condition that, individually or
7
Table of Contents
Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
in the aggregate, would reasonably be expected to have a “Regulatory Material Adverse Effect” (as such term is defined in the Merger Agreement), and (b) the Centers for Medicare and Medicaid Services, or CMS, has not imposed any sanctions with respect to our Medicare Advantage, or MA, business that, individually or in the aggregate, is or would reasonably be expected to be material and adverse to us and our subsidiaries, taken as a whole. The Merger is expected to close in the second half of 2016.
Business Segment Reclassifications
On January 1, 2015, we realigned certain of our businesses among our reportable segments to correspond with internal management reporting changes and renamed our Employer Group segment to the Group segment. Our three reportable segments remain Retail, Group, and Healthcare Services. The more significant realignments included reclassifying Medicare benefits offered to groups to the Retail segment from the Group segment, bringing all of our Medicare offerings, which are now managed collectively, together in one segment, recognizing that in some instances we market directly to individuals that are part of a group Medicare account. In addition, we realigned our military services business, primarily consisting of our TRICARE South Region contract previously included in the Other Businesses category, to our Group segment as we consider this contract with the government to be a group account. Prior period segment financial information has been recast to conform to the 2015 presentation.
See Note 14 for segment financial information.
2. RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS
In May 2015, the Financial Accounting Standards Board, or FASB, issued new guidance requiring insurance entities to provide additional disclosures about claim liabilities including paid claims development information by accident year and claim frequency data and related methodologies. The guidance is effective for us beginning with the 2016 annual reporting period and interim periods beginning in 2017. We are currently evaluating the impact the new guidance will have on our disclosures.
In April 2015, the FASB issued new guidance to help entities determine whether a cloud computing arrangement contains a software license that should be accounted for as internal-use software or as a service contract. The guidance is effective for us beginning with interim and annual reporting periods in 2016, with early adoption permitted. Upon adoption, an entity has the option to apply the provisions either prospectively to all arrangements entered into or materially modified, or retrospectively. We are currently evaluating the impact, if any, on our results of operations, financial position, and cash flows.
In March 2015, the FASB issued new guidance which changes the presentation of debt issuance costs from an asset to a direct reduction of the related debt liability. The new guidance is effective for us beginning with annual and interim periods in 2016 with early adoption permitted. The adoption of the new guidance will not have a material impact on our results of operations, financial condition, or cash flows.
In February 2015, the FASB issued an amendment to current consolidation guidance that modifies the evaluation of whether limited partnerships and similar legal entities are variable interest entities or voting interest entities, eliminating the presumption that a general partner should consolidate a limited partnership, and affects the consolidation analysis of reporting entities that are involved with variable interest entities. The new guidance is effective for us beginning with interim and annual reporting periods in 2016, with early adoption permitted. All legal entities are subject to reevaluation under the revised consolidation model. We are currently evaluating the impact, if any, on our results of operations, financial position, and cash flows.
In May 2014, the FASB issued new guidance that amends the accounting for revenue recognition. The amendments are intended to provide a more robust framework for addressing revenue issues, improve comparability of revenue recognition practices, and improve disclosure requirements. Insurance contracts are not included in the scope of this new guidance. In July 2015, the FASB decided to defer the effective date provided in the new revenue guidance by one year. Giving effect to this deferral, the new guidance is effective for us beginning with annual and interim periods in 2018. We are currently evaluating the impact on our results of operations, financial condition, and cash flows.
There are no other recently issued accounting standards that apply to us or that are expected to have a material impact on our results of operations, financial condition, or cash flows.
8
Table of Contents
Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
3. ACQUISITIONS AND DIVESTITURES
On June 1, 2015, we completed the sale of our wholly owned subsidiary, Concentra Inc., or Concentra, to MJ Acquisition Corporation, a joint venture between Select Medical Holdings Corporation and Welsh, Carson, Anderson & Stowe XII, L.P., a private equity fund, for approximately
$1,055 million
in cash, excluding approximately
$25 million
of transaction costs.
In connection with the sale, we recognized a pre-tax gain, net of transaction costs, of
$267 million
which is reported as gain on sale of business in the accompanying condensed consolidated statements of income for the
three and six months ended June 30, 2015
.
In March 2015, we classified Concentra as held-for-sale and aggregated Concentra's assets and liabilities separately on the balance sheet, including a reclassification of the December 31, 2014 balance sheet for comparative purposes. The assets and liabilities of Concentra that were disposed of on June 1, 2015 and classified as held-for-sale as of December 31, 2014 were as follows:
June 1, 2015
December 31, 2014
Assets
(in millions)
Receivables, net
$
130
$
115
Property and equipment, net
197
191
Goodwill
480
480
Other intangible assets, net
124
131
Other assets
27
26
Total assets disposed/held-for-sale
$
958
$
943
Liabilities
Trade accounts payable and accrued expenses
$
81
$
90
Other liabilities
114
116
Total liabilities disposed/held-for-sale
$
195
$
206
Net assets disposed
$
763
$
737
The accompanying condensed consolidated statements of income include revenues related to Concentra of
$166 million
and
$411 million
for the
three and six months ended June 30, 2015
, respectively, and income before income taxes of
$8 million
and
$15 million
, respectively.
During
2015
and
2014
, we acquired health and wellness related businesses which, individually or in the aggregate, have not had a material impact on our results of operations, financial condition, or cash flows. The results of operations and financial condition of these businesses have been included in our condensed consolidated statements of income and condensed consolidated balance sheets from the acquisition dates. Acquisition-related costs recognized in
2015
and
2014
were not material to our results of operations. The pro forma financial information assuming the acquisitions had occurred as of the beginning of the calendar year prior to the year of acquisition, as well as the revenues and earnings generated during the year of acquisition, were not material for disclosure purposes.
9
Table of Contents
Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
4. INVESTMENT SECURITIES
Investment securities classified as current and long-term were as follows at
June 30, 2015
and
December 31, 2014
, respectively:
Amortized
Cost
Gross
Unrealized
Gains
Gross
Unrealized
Losses
Fair
Value
(in millions)
June 30, 2015
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations
$
336
$
1
$
—
$
337
Mortgage-backed securities
1,345
34
(17
)
1,362
Tax-exempt municipal securities
2,563
92
(14
)
2,641
Mortgage-backed securities:
Residential
14
—
—
14
Commercial
965
9
(30
)
944
Asset-backed securities
162
1
—
163
Corporate debt securities
3,239
211
(31
)
3,419
Total debt securities
$
8,624
$
348
$
(92
)
$
8,880
December 31, 2014
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations
$
365
$
10
$
(1
)
$
374
Mortgage-backed securities
1,453
50
(5
)
1,498
Tax-exempt municipal securities
2,931
140
(3
)
3,068
Mortgage-backed securities:
Residential
17
—
—
17
Commercial
846
16
(19
)
843
Asset-backed securities
28
1
—
29
Corporate debt securities
3,432
299
(13
)
3,718
Total debt securities
$
9,072
$
516
$
(41
)
$
9,547
10
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
Gross unrealized losses and fair values aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position were as follows at
June 30, 2015
and
December 31, 2014
, respectively:
Less than 12 months
12 months or more
Total
Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
(in millions)
June 30, 2015
U.S. Treasury and other U.S.
government corporations
and agencies:
U.S. Treasury and agency
obligations
$
86
$
—
$
19
$
—
$
105
$
—
Mortgage-backed
securities
710
(14
)
91
(3
)
801
(17
)
Tax-exempt municipal
securities
685
(12
)
38
(2
)
723
(14
)
Mortgage-backed securities:
Residential
—
—
5
—
5
—
Commercial
383
(8
)
271
(22
)
654
(30
)
Asset-backed securities
149
—
—
—
149
—
Corporate debt securities
708
(28
)
38
(3
)
746
(31
)
Total debt securities
$
2,721
$
(62
)
$
462
$
(30
)
$
3,183
$
(92
)
December 31, 2014
U.S. Treasury and other U.S.
government corporations
and agencies:
U.S. Treasury and agency
obligations
$
79
$
—
$
80
$
(1
)
$
159
$
(1
)
Mortgage-backed
securities
22
—
320
(5
)
342
(5
)
Tax-exempt municipal
securities
131
(1
)
118
(2
)
249
(3
)
Mortgage-backed securities:
Residential
1
—
4
—
5
—
Commercial
31
(1
)
267
(18
)
298
(19
)
Asset-backed securities
13
—
—
—
13
—
Corporate debt securities
219
(6
)
128
(7
)
347
(13
)
Total debt securities
$
496
$
(8
)
$
917
$
(33
)
$
1,413
$
(41
)
Approximately
97%
of our debt securities were investment-grade quality, with a weighted average credit rating of
AA-
by S&P at
June 30, 2015
. Most of the debt securities that were below investment-grade were rated
BB
, the higher end of the below investment-grade rating scale. At
June 30, 2015
,
7%
of our tax-exempt municipal securities were pre-refunded, generally with U.S. government and agency securities. Tax-exempt municipal securities that were not pre-refunded were diversified among general obligation bonds of U.S. states and local municipalities as well as special revenue bonds. General obligation bonds, which are backed by the taxing power and full faith of the issuer, accounted for
35%
of the tax-exempt municipals that were not pre-refunded in the portfolio. Special revenue bonds,
11
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
issued by a municipality to finance a specific public works project such as utilities, water and sewer, transportation, or education, and supported by the revenues of that project, accounted for the remaining
65%
of these municipals. Our general obligation bonds are diversified across the United States with no individual state exceeding
11%
. In addition,
17%
of our tax-exempt securities were insured by bond insurers and had an equivalent weighted average S&P credit rating of
AA
exclusive of the bond insurers’ guarantee. Our investment policy limits investments in a single issuer and requires diversification among various asset types.
The recoverability of our non-agency commercial mortgage-backed securities is supported by factors such as seniority, underlying collateral characteristics and credit enhancements. At
June 30, 2015
, these commercial mortgage-backed securities primarily were composed of senior tranches having high credit support. The weighted average credit rating of all commercial mortgage-backed securities was
AA+
at
June 30, 2015
.
The percentage of corporate securities associated with the financial services industry was
23%
at
June 30, 2015
and
21%
at
December 31, 2014
.
All issuers of securities we own that were trading at an unrealized loss at
June 30, 2015
remain current on all contractual payments. After taking into account these and other factors previously described, we believe these unrealized losses primarily were caused by an increase in market interest rates in the current markets since the time the securities were purchased. At
June 30, 2015
, we did not intend to sell the securities with an unrealized loss position in accumulated other comprehensive income, and it is not likely that we will be required to sell these securities before recovery of their amortized cost basis. As a result, we believe that the securities with an unrealized loss were not other-than-temporarily impaired at
June 30, 2015
.
The detail of realized gains (losses) related to investment securities and included within investment income was as follows for the
three and six months ended June 30, 2015
and
2014
:
Three months ended
June 30,
Six months ended
June 30,
2015
2014
2015
2014
(in millions)
Gross realized gains
$
30
$
6
$
47
$
7
Gross realized losses
(2
)
(4
)
(10
)
(4
)
Net realized capital gains
$
28
$
2
$
37
$
3
There were
no
material other-than-temporary impairments for the
three months ended June 30, 2015
or
2014
.
The contractual maturities of debt securities available for sale at
June 30, 2015
, regardless of their balance sheet classification, are shown below. Expected maturities may differ from contractual maturities because borrowers may have the right to call or prepay obligations with or without call or prepayment penalties.
Amortized
Cost
Fair
Value
(in millions)
Due within one year
$
454
$
456
Due after one year through five years
1,859
1,953
Due after five years through ten years
1,805
1,861
Due after ten years
2,020
2,127
Mortgage and asset-backed securities
2,486
2,483
Total debt securities
$
8,624
$
8,880
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
5. FAIR VALUE
Financial Assets
The following table summarizes our fair value measurements at
June 30, 2015
and
December 31, 2014
, respectively, for financial assets measured at fair value on a recurring basis:
Fair Value Measurements Using
Fair
Value
Quoted Prices
in Active
Markets
(Level 1)
Other
Observable
Inputs
(Level 2)
Unobservable
Inputs
(Level 3)
(in millions)
June 30, 2015
Cash equivalents
$
1,619
$
1,619
$
—
$
—
Debt securities:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations
337
—
337
—
Mortgage-backed securities
1,362
—
1,362
—
Tax-exempt municipal securities
2,641
—
2,636
5
Mortgage-backed securities:
Residential
14
—
14
—
Commercial
944
—
944
—
Asset-backed securities
163
—
162
1
Corporate debt securities
3,419
—
3,414
5
Total debt securities
8,880
—
8,869
11
Total invested assets
$
10,499
$
1,619
$
8,869
$
11
December 31, 2014
Cash equivalents
$
1,712
$
1,712
$
—
$
—
Debt securities:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations
374
—
374
—
Mortgage-backed securities
1,498
—
1,498
—
Tax-exempt municipal securities
3,068
—
3,060
8
Mortgage-backed securities:
Residential
17
—
17
—
Commercial
843
—
843
—
Asset-backed securities
29
—
28
1
Corporate debt securities
3,718
—
3,695
23
Total debt securities
9,547
—
9,515
32
Total invested assets
$
11,259
$
1,712
$
9,515
$
32
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
There were
no
material transfers between Level 1 and Level 2 during the
three and six months ended June 30, 2015
or
June 30, 2014
.
Our Level 3 assets had a fair value of
$11 million
at
June 30, 2015
, or
0.1%
of our total invested assets. During the
three and six months ended June 30, 2015
and
2014
, the changes in the fair value of the assets measured using significant unobservable inputs (Level 3) were comprised of the following:
For the three months ended June 30,
2015
2014
Private
Placements
Auction
Rate
Securities
Total
Private
Placements
Auction
Rate
Securities
Total
(in millions)
Beginning balance at April 1
$
6
$
6
$
12
$
24
$
13
$
37
Total gains or losses:
Realized in earnings
—
—
—
—
—
—
Unrealized in other
comprehensive income
—
—
—
—
—
—
Purchases
—
—
—
—
—
—
Sales
—
(1
)
(1
)
—
—
—
Settlements
—
—
—
—
—
—
Balance at June 30
$
6
$
5
$
11
$
24
$
13
$
37
For the six months ended June 30,
2015
2014
Private
Placements
Auction
Rate
Securities
Total
Private
Placements
Auction
Rate
Securities
Total
(in millions)
Beginning balance at January 1
$
24
$
8
$
32
$
24
$
13
$
37
Total gains or losses:
Realized in earnings
(1
)
—
(1
)
—
—
—
Unrealized in other
comprehensive income
—
—
—
—
—
—
Purchases
—
—
—
—
—
—
Sales
(17
)
(3
)
(20
)
—
—
—
Settlements
—
—
—
—
—
—
Balance at June 30
$
6
$
5
$
11
$
24
$
13
$
37
Financial Liabilities
Our long-term debt is recorded at carrying value in our consolidated balance sheets. The carrying value of our long-term debt outstanding was
$3,823 million
at
June 30, 2015
and
$3,825 million
at
December 31, 2014
. The fair value of our long-term debt was
$3,967 million
at
June 30, 2015
and
$4,102 million
at
December 31, 2014
. The fair value of our long-term debt is determined based on Level 2 inputs, including quoted market prices for the same or similar debt, or if no quoted market prices are available, on the current prices estimated to be available to us for debt with similar terms and remaining maturities.
14
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
Assets and Liabilities Measured at Fair Value on a Nonrecurring Basis
As disclosed in Note 3, we completed the acquisition of certain health and wellness related businesses during 2015 and 2014. The values of net tangible assets acquired and the resulting goodwill and other intangible assets were recorded at fair value using Level 3 inputs. The majority of the tangible assets acquired and liabilities assumed were recorded at their carrying values as of the respective dates of acquisition, as their carrying values approximated their fair values due to their short-term nature. The fair values of goodwill and other intangible assets acquired in these acquisitions were internally estimated primarily based on the income approach. The income approach estimates fair value based on the present value of the cash flows that the assets are expected to generate in the future. We developed internal estimates for the expected cash flows and discount rates used in the present value calculations. Other than assets acquired and liabilities assumed in these acquisitions, there were no material assets or liabilities measured at fair value on a nonrecurring basis during the
three and six months ended June 30, 2015
or
2014
.
6. MEDICARE PART D
We cover prescription drug benefits in accordance with Medicare Part D under multiple contracts with the Centers for Medicare and Medicaid Services, or CMS, as described in Note 2 to the consolidated financial statements included in our 2014 Form 10-K. The accompanying condensed consolidated balance sheets include the following amounts associated with Medicare Part D at
June 30, 2015
and
December 31, 2014
. CMS subsidies/discounts in the table below include the reinsurance and low-income cost subsidies funded by CMS for which we assume no risk as well as brand name prescription drug discounts for Part D plan participants in the coverage gap funded by CMS and pharmaceutical manufacturers. The risk corridor settlement includes amounts classified as long-term because settlement associated with the
2015
provision will exceed 12 months at
June 30, 2015
.
June 30, 2015
December 31, 2014
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
(in millions)
Other current assets
$
105
$
2,104
$
105
$
1,690
Trade accounts payable and accrued expenses
(23
)
(176
)
(36
)
(32
)
Net current asset
82
1,928
69
1,658
Other long-term assets
121
—
—
—
Other long-term liabilities
(18
)
—
—
—
Net long-term asset
103
—
—
—
Total net asset
$
185
$
1,928
$
69
$
1,658
7. HEALTH CARE REFORM
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (which we collectively refer to as the Health Care Reform Law) established risk spreading premium stabilization programs including a permanent risk adjustment program and temporary risk corridor and reinsurance programs, which we collectively refer to as the 3Rs, effective January 1, 2014. The 3Rs are applicable to certain of our commercial medical insurance products as further discussed in Note 2 to our 2014 Form 10-K. On June 30, 2015 we received notification from CMS of risk adjustment and reinsurance settlement amounts for 2014. We were also notified that settlement of receivables and payables under the risk adjustment and risk corridor programs will be aggregated by legal entity as opposed to by state and legal entity. We revised our 2014 estimates to reflect actual amounts and also made a corresponding adjustment to our risk corridor estimate based on these results. As expected, the change in estimate for risk adjustment was substantially offset by the corresponding change in estimate for risk corridor, both of which are reflected as changes in premiums revenue in our condensed consolidated statements of income. The change in estimate related to the 3Rs for the 2014 coverage year was a decline in the estimated net receivable of approximately
$29 million
for the
three months ended June 30, 2015
and
$40 million
for the
six months ended June 30, 2015
, primarily
15
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
reflecting impact of the June 30, 2015 notification. In addition, we revised our 3Rs estimates for the 2015 coverage year based on the data from CMS for 2014. The accompanying condensed consolidated balance sheets include the following amounts associated with the 3Rs at
June 30, 2015
and
December 31, 2014
. Amounts related to the 2015 coverage year are classified as long-term because settlement will exceed 12 months at
June 30, 2015
.
June 30, 2015
December 31, 2014
Risk Adjustment
Settlement
Reinsurance
Recoverables
Risk
Corridor
Settlement
Risk Adjustment
Settlement
Reinsurance
Recoverables
Risk
Corridor
Settlement
(in millions)
Premiums receivable
$
44
$
—
$
—
$
131
$
—
$
—
Other current assets
—
521
243
—
586
55
Trade accounts payable and
accrued expenses
(169
)
—
—
(89
)
—
(4
)
Net current (liability) asset
(125
)
521
243
42
586
51
Other long-term assets
65
168
133
—
—
—
Other long-term liabilities
(106
)
—
—
—
—
—
Net long-term (liability) asset
(41
)
168
133
—
—
—
Total net asset
$
(166
)
$
689
$
376
$
42
$
586
$
51
In September 2015, we expect to pay the federal government approximately
$866 million
for the annual non-deductible health insurance industry fee attributed to calendar year
2015
in accordance with the Health Care Reform Law. We have recorded a liability for this fee in other current liabilities with a corresponding deferred cost in other current assets in our condensed consolidated financial statements. Amortization of the deferred cost resulted in operating cost expense of approximately
$213 million
for the
three months ended June 30, 2015
and
$433 million
for the
six months ended June 30, 2015
. For the
three and six months ended June 30, 2014
there was approximately
$143 million
and
$280 million
, respectively, of operating cost expense resulting from the amortization of the 2014 annual health insurance fee. The remaining deferred cost asset balance was approximately
$433 million
at
June 30, 2015
.
8. GOODWILL AND OTHER INTANGIBLE ASSETS
The carrying amount of goodwill for our reportable segments has been retrospectively adjusted to conform to the 2015 presentation as discussed in Note 1. Changes in the carrying amount of goodwill for our reportable segments for the
six months ended June 30, 2015
were as follows:
Retail
Group
Healthcare
Services
Other
Businesses
Total
(in millions)
Balance at January 1, 2015
$
1,069
$
385
$
1,777
$
—
$
3,231
Acquisitions
—
—
35
—
35
Balance at June 30, 2015
$
1,069
$
385
$
1,812
$
—
$
3,266
Healthcare Services segment goodwill of
$480 million
associated with the sale of Concentra was reclassified to assets held-for-sale as of January 1, 2015 and excluded from the table above. This
$480 million
of goodwill was disposed of on June 1, 2015 with the completion of the sale of Concentra.
16
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
The following table presents details of our other intangible assets included in other long-term assets in the accompanying condensed consolidated balance sheets at
June 30, 2015
and
December 31, 2014
and excludes Concentra amounts classified as held-for-sale as of
December 31, 2014
:
June 30, 2015
December 31, 2014
Weighted
Average
Life
Cost
Accumulated
Amortization
Net
Cost
Accumulated
Amortization
Net
(in millions)
Other intangible assets:
Customer contracts/
relationships
9.9 yrs
$
567
$
263
$
304
$
657
$
326
$
331
Trade names and
technology
8.2 yrs
105
47
58
115
50
65
Provider contracts
14.9 yrs
52
23
29
52
21
31
Noncompetes and
other
8.0 yrs
33
23
10
41
28
13
Total other intangible
assets
9.9 yrs
$
757
$
356
$
401
$
865
$
425
$
440
Amortization expense for other intangible assets was approximately
$24 million
for the
three months ended June 30, 2015
and
$28 million
for the
three months ended June 30, 2014
. For the
six months ended June 30, 2015
and
2014
, amortization expense for other intangible assets was approximately
$50 million
and
$56 million
, respectively. The following table presents our estimate of amortization expense for
2015
and each of the five next succeeding years:
(in millions)
For the years ending December 31,:
2015
$
92
2016
78
2017
72
2018
62
2019
51
2020
47
17
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
9. EARNINGS PER COMMON SHARE COMPUTATION
Detail supporting the computation of basic and diluted earnings per common share was as follows for the
three and six months ended June 30, 2015
and
2014
:
Three months ended June 30,
Six months ended June 30,
2015
2014
2015
2014
(dollars in millions, except per common share results; number of shares in thousands)
Net income available for common stockholders
$
431
$
344
$
861
$
712
Weighted average outstanding shares of common stock
used to compute basic earnings per common share
149,473
155,423
149,982
155,257
Dilutive effect of:
Employee stock options
193
227
205
248
Restricted stock
1,482
1,396
1,561
1,341
Shares used to compute diluted earnings per common share
151,148
157,046
151,748
156,846
Basic earnings per common share
$
2.88
$
2.22
$
5.74
$
4.59
Diluted earnings per common share
$
2.85
$
2.19
$
5.67
$
4.54
Number of antidilutive stock options and restricted stock
excluded from computation
314
245
516
609
10. STOCKHOLDERS’ EQUITY
Dividends
The following table provides details of dividend payments, excluding dividend equivalent rights, in
2014
and
2015
under our Board approved quarterly cash dividend policy:
Record
Date
Payment
Date
Amount
per Share
Total
Amount
(in millions)
2014 payments
12/31/2013
1/31/2014
$
0.27
$
42
3/31/2014
4/25/2014
$
0.27
$
42
6/30/2014
7/25/2014
$
0.28
$
43
9/30/2014
10/31/2014
$
0.28
$
43
2015 payments
12/31/2014
1/30/2015
$
0.28
$
42
3/31/2015
4/24/2015
$
0.28
$
42
6/30/2015
7/31/2015
$
0.29
$
43
The Merger
discussed in Note 1
does not impact our ability and intent to continue quarterly dividend payments prior to the closing of the Merger, including the cash dividend of
$0.29
per share payable on
July 31, 2015
to stockholders of record on
June 30, 2015
. Under the terms of the Merger Agreement we have agreed with Aetna that our quarterly dividend will not exceed $0.29 per share prior to the closing of the Merger.
Declaration and payment of future quarterly dividends is at the discretion of our Board and may be adjusted as business needs or market conditions change. In addition, under the terms of the Merger Agreement, we have agreed with Aetna to coordinate the declaration and
18
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
payment of dividends so that our stockholders do not fail to receive a quarterly dividend around the time of the closing of the Merger.
Stock Repurchases
In September
2014
, our Board of Directors replaced a previous share repurchase authorization of up to
$1 billion
(of which
$816 million
remained unused) with a new authorization for repurchases of up to
$2 billion
of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on
December 31, 2016
. Under the new share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, or in privately-negotiated transactions (including pursuant to accelerated share repurchase agreements with investment banks), subject to certain regulatory restrictions on volume, pricing, and timing.
Pursuant to the Merger Agreement with Aetna discussed
in Note 1
, after July 2, 2015, we are prohibited from repurchasing any of our outstanding securities without the prior written consent of Aetna, other than repurchases of shares of our common stock in connection with the exercise of outstanding stock options or the vesting or settlement of outstanding restricted stock awards. Accordingly, as announced on July 3, 2015, we have suspended our share repurchase program due to the Merger.
Our remaining repurchase authorization was
$1.04 billion
as of July 3, 2015.
On
November 7, 2014
, we announced that we had entered into an accelerated share repurchase agreement, or ASR Agreement, with Goldman, Sachs & Co., or Goldman Sachs, to repurchase
$500 million
of our common stock as part of the
$2 billion
share repurchase program authorized in September 2014. Under the ASR Agreement, on
November 10, 2014
, we made a payment of
$500 million
to Goldman Sachs from available cash on hand and received an initial delivery of
3.06 million
shares of our common stock from Goldman Sachs based on the then current market price of Humana common stock. The payment to Goldman Sachs was recorded as a reduction to stockholders’ equity, consisting of a
$400 million
increase in treasury stock, which reflected the value of the initial
3.06 million
shares received upon initial settlement, and a
$100 million
decrease in capital in excess of par value, which reflected the value of stock held back by Goldman Sachs pending final settlement of the ASR Agreement. Upon settlement of the ASR on
March 13, 2015
, we received an additional
0.36 million
shares as determined by the average daily volume weighted-average share price of our common stock during the term of the ASR Agreement of
$146.21
, bringing the total shares received under this program to
3.42 million
. In addition, upon settlement we reclassified the
$100 million
value of stock initially held back by Goldman Sachs from capital in excess of par value to treasury stock.
Excluding the
0.36 million
shares received in March 2015 upon final settlement of our ASR Agreement for which no cash was paid during the period, share repurchases were as follows during the
six months ended June 30, 2015
and
2014
:
Six months ended June 30,
2015
2014
Authorization Date
Purchase Not to Exceed
Shares
Cost
Shares
Cost
(in millions)
September 2014
$
2,000
1.85
$
329
—
$
—
April 2014
1,000
—
—
0.81
101
April 2013
1,000
—
—
0.10
11
Total repurchases
1.85
$
329
0.91
$
112
In connection with employee stock plans, we acquired
0.3 million
common shares for
$42 million
and
0.4 million
common shares for
$40 million
during the
six months ended June 30, 2015
and
2014
, respectively, which amounts are not included in the table above.
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Unaudited
Treasury Stock Reissuance
We reissued
0.7 million
shares of treasury stock during the
six months ended June 30, 2015
at a cost of
$40 million
associated with restricted stock unit vestings and option exercises.
Accumulated Other Comprehensive Income
Accumulated other comprehensive income included, net of tax, net unrealized gains on our investment securities of
$162 million
at
June 30, 2015
and
$301 million
at
December 31, 2014
. In addition, accumulated other comprehensive income included, net of tax,
$9 million
at
June 30, 2015
and
$78 million
at
December 31, 2014
for an additional liability that would exist on our closed block of long-term care insurance policies if unrealized gains on the sale of the investments backing such products had been realized and the proceeds reinvested at then current yields. Refer to Note 18 to the consolidated financial statements in our 2014 Form 10-K for further discussion of our long-term care insurance policies.
11. INCOME TAXES
The effective income tax rate was
45.6%
for the
three months ended June 30, 2015
, compared to
46.7%
for the
three months ended June 30, 2014
. For the
six months ended June 30, 2015
, the effective tax rate was
44.0%
compared to
46.5%
for the
six months ended June 30, 2014
.
The tax effect of the sale of Concentra reduced our effective tax rate by approximately
6.5
percentage points for each of the
three and six months ended June 30, 2015
, partially offset by an increase in the non-deductible health insurance industry fee from 2014.
Humana Inc., our parent company, recognized the deferred tax asset for the excess of the tax basis over the book basis of its Concentra subsidiary of approximately
$53 million
during the first quarter of 2015 because realization of the asset in the foreseeable future was apparent with the classification of the assets and liabilities of Concentra as held-for-sale.
12. DEBT
The carrying value of long-term debt outstanding was as follows at
June 30, 2015
and
December 31, 2014
:
June 30, 2015
December 31, 2014
(in millions)
Senior notes:
$500 million, 7.20% due June 15, 2018
$
504
$
504
$300 million, 6.30% due August 1, 2018
310
312
$400 million, 2.625% due October 1, 2019
400
400
$600 million, 3.15% due December 1, 2022
598
598
$600 million, 3.85% due October 1, 2024
599
599
$250 million, 8.15% due June 15, 2038
266
266
$400 million, 4.625% due December 1, 2042
400
400
$750 million, 4.95% due October 1, 2044
746
746
Total long-term debt
$
3,823
$
3,825
Senior Notes
In September 2014, we issued $400 million of 2.625% senior notes due October 1, 2019, $600 million of 3.85% senior notes due October 1, 2024 and $750 million of 4.95% senior notes due October 1, 2044. Our net proceeds, reduced for the underwriters' discount and commission and offering expenses, were
$1.73 billion
.
We used a portion of the net proceeds to redeem the 6.45% senior unsecured notes as discussed below.
In October 2014, we redeemed the $500 million 6.45% senior unsecured notes due June 1, 2016, at
100%
of the principal amount plus applicable premium for early redemption and accrued and unpaid interest to the redemption date,
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Unaudited
for cash totaling approximately
$560 million
. We recognized a loss on extinguishment of debt of approximately
$37 million
in October 2014 for the redemption of these notes.
Our senior notes, which are unsecured, may be redeemed at our option at any time at
100%
of the principal amount plus accrued interest and a specified make-whole amount. The 7.20% and 8.15% senior notes are subject to an interest rate adjustment if the debt ratings assigned to the notes are downgraded (or subsequently upgraded). In addition, each series of our senior notes (other than the 6.30% senior notes) contain a change of control provision that may require us to purchase the notes under certain circumstances. On July 2, 2015 we entered into a Merger Agreement with Aetna that, when closed, may require redemption of the notes if the notes are downgraded below investment grade by both Standard & Poor’s Rating Services, or S&P and Moody’s Investors Services, Inc., or Moody’s.
Prior to 2009, we were parties to interest-rate swap agreements that exchanged the fixed interest rate under our senior notes for a variable interest rate based on LIBOR. As a result, the carrying value of the senior notes was adjusted to reflect changes in value caused by an increase or decrease in interest rates. During 2008, we terminated all of our swap agreements. The cumulative adjustment to the carrying value of our senior notes was
$103 million
as of the termination date which is being amortized as a reduction to interest expense over the remaining term of the senior notes. In October 2014, the redemption of our 6.45% senior notes reduced the unamortized carrying value adjustment by
$12 million
. The unamortized carrying value adjustment was
$30 million
as of
June 30, 2015
and
$32 million
as of
December 31, 2014
.
Credit Agreement
Our
5
-year
$1.0 billion
unsecured revolving credit agreement expires July 2018. Under the credit agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion bears interest at either LIBOR plus a spread or the base rate plus a spread. The LIBOR spread, currently
110
basis points, varies depending on our credit ratings ranging from 90.0 to 150.0 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently
15
basis points, may fluctuate between 10.0 and 25.0 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate based on LIBOR, at our option.
The terms of the credit agreement include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow additional funds. In addition, the credit agreement contains customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of a minimum level of net worth of
$8.3 billion
at
June 30, 2015
and a maximum leverage ratio of
3.0
. We are in compliance with the financial covenants, with actual net worth of
$10.1 billion
and an actual leverage ratio of
1.3
, as measured in accordance with the credit agreement as of
June 30, 2015
. In addition, the credit agreement includes an uncommitted
$250 million
incremental loan facility.
At
June 30, 2015
, we had
no
borrowings outstanding under the credit agreement and we had outstanding letters of credit of
$1 million
secured under the credit agreement. No amounts have been drawn on these letters of credit. Accordingly, as of
June 30, 2015
, we had
$999 million
of remaining borrowing capacity under the credit agreement, none of which would be restricted by our financial covenant compliance requirement. We have other customary, arms-length relationships, including financial advisory and banking, with some parties to the credit agreement.
Commercial Paper
In October 2014, we entered into a commercial paper program pursuant to which we may issue short-term, unsecured commercial paper notes privately placed on a discount basis through certain broker dealers. Amounts available under the program may be borrowed, repaid and re-borrowed from time to time, with the aggregate face or principal amount outstanding under the program at any time not to exceed
$1 billion
. The net proceeds of issuances have been and are expected to be used for general corporate purposes. The maximum principal amount outstanding at any one time during the
six months ended June 30, 2015
was
$300 million
. There were outstanding borrowings of
$300 million
at
June 30, 2015
. There were
no
outstanding borrowings at
December 31, 2014
.
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Unaudited
13. GUARANTEES AND CONTINGENCIES
Government Contracts
Our Medicare products, which accounted for approximately
72%
of our total premiums and services revenue for the
six months ended June 30, 2015
, primarily consisted of products covered under the Medicare Advantage and Medicare Part D Prescription Drug Plan contracts with the federal government. These contracts are renewed generally for a calendar year term unless CMS notifies us of its decision not to renew by May 1 of the calendar year in which the contract would end, or we notify CMS of our decision not to renew by the first Monday in June of the calendar year in which the contract would end. All material contracts between Humana and CMS relating to our Medicare products have been renewed for 2016. However, our offerings of products under those contracts are subject to approval by CMS, which we expect to receive in the fall of 2015.
CMS uses a risk-adjustment model which apportions premiums paid to Medicare Advantage, or MA, plans according to health severity of covered members. The risk-adjustment model pays more for enrollees with predictably higher costs. Under this model, rates paid to MA plans are based on actuarially determined bids, which include a process whereby our prospective payments are based on a comparison of our beneficiaries’ risk scores, derived from medical diagnoses, to those enrolled in the government’s traditional fee-for-service Medicare program (referred to as "Medicare FFS"). Under the risk-adjustment methodology, all MA plans must collect and submit the necessary diagnosis code information from hospital inpatient, hospital outpatient, and physician providers to CMS within prescribed deadlines. The CMS risk-adjustment model uses the diagnosis data to calculate the risk-adjusted premium payment to MA plans, which CMS adjusts for coding pattern differences between the health plans and the government fee-for-service program. We generally rely on providers, including certain providers in our network who are our employees, to code their claim submissions with appropriate diagnoses, which we send to CMS as the basis for our payment received from CMS under the actuarial risk-adjustment model. We also rely on these providers to document appropriately all medical data, including the diagnosis data submitted with claims. In addition, we conduct medical record reviews as part of our data and payment accuracy compliance efforts, to more accurately reflect diagnosis conditions under the risk adjustment model. These compliance efforts include the internal contract level audits described in more detail below.
CMS is continuing to perform audits of various companies’ selected MA contracts related to this risk adjustment diagnosis data. We refer to these audits as Risk-Adjustment Data Validation Audits, or RADV audits. RADV audits review medical records in an attempt to validate provider medical record documentation and coding practices which influence the calculation of premium payments to MA plans.
In 2012, CMS released a “Notice of Final Payment Error Calculation Methodology for Part C Medicare Advantage Risk Adjustment Data Validation (RADV) Contract-Level Audits.” The payment error calculation methodology provides that, in calculating the economic impact of audit results for an MA contract, if any, the results of the audit sample will be extrapolated to the entire MA contract based upon a comparison to “benchmark” audit data in Medicare FFS (which we refer to as the "FFS Adjuster"). This comparison to the FFS Adjuster is necessary to determine the economic impact, if any, of audit results because the government program data set, including any attendant errors that are present in that data set, provides the basis for MA plans’ risk adjustment to payment rates. CMS already makes other adjustments to payment rates based on a comparison of coding pattern differences between MA plans and Medicare FFS data (such as for frequency of coding for certain diagnoses in MA plan data versus the government program data set).
The final methodology, including the first application of extrapolated audit results to determine audit settlements, is expected to be applied to the current round of RADV contract level audits being conducted on 2011 premium payments. Selected MA contracts will be notified of an audit at some point after the close of the final reconciliation for the payment year being audited. The final reconciliation occurs in August of the calendar year following the payment year. We have been notified that certain of our Medicare Advantage contracts have been selected for audit for contract year 2011.
Estimated audit settlements are recorded as a reduction of premiums revenue in our consolidated statements of income, based upon available information. We perform internal contract level audits based on the RADV audit methodology prescribed by CMS. Included in these internal contract level audits is an audit of our Private Fee-For-
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Unaudited
Service business which we used to represent a proxy of the FFS Adjuster which has not yet been released. We based our accrual of estimated audit settlements for contract years 2011 (the first year that application of extrapolated audit results is applicable) through 2015 on the results of these internal contract level audits and update our estimates as each audit is completed. Estimates derived from these results were not material to our results of operations, financial position, or cash flows. However, as indicated, we are awaiting additional guidance from CMS regarding the FFS Adjuster. Accordingly, we cannot determine whether such RADV audits will have a material adverse effect on our results of operations, financial position, or cash flows.
In addition, CMS' comments in formalized guidance regarding “overpayments” to MA plans appear to be inconsistent with CMS' prior RADV audit guidance. These statements, contained in the preamble to CMS’ final rule release regarding Medicare Advantage and Part D prescription drug benefit program regulations for Contract Year 2015, appear to equate each Medicare Advantage risk adjustment data error with an “overpayment” without reconciliation to the principles underlying the FFS Adjuster referenced above. We will continue to work with CMS to ensure that MA plans are paid accurately and that payment model principles are in accordance with the requirements of the Social Security Act, which, if not implemented correctly could have a material adverse effect on our results of operations, financial position, or cash flows.
At
June 30, 2015
, our military services business, which accounted for approximately
1%
of our total premiums and services revenue for the
six months ended June 30, 2015
, primarily consisted of the TRICARE South Region contract. The current
5
-year South Region contract, which expires
March 31, 2017
, is subject to annual renewals on April 1 of each year during its term at the government’s option. On March 31, 2015, the Defense Health Agency, or DHA, exercised its option to extend the TRICARE South Region contract through March 31, 2016. On April 24, 2015, a request for proposal was issued for the next generation of TRICARE contracts for the period beginning April 1, 2017. The proposal provides for the consolidation of
three
regions into
two
- East and West. The current North Region and South Region are to be combined to form the East Region. We responded to the request for proposal on July 22, 2015.
Our state-based Medicaid business accounted for approximately
4%
of our total premiums and services revenue for the
six months ended June 30, 2015
. In addition to our state-based Temporary Assistance for Needy Families, or TANF, Medicaid contracts in Florida and Kentucky, we have contracts in Illinois and Virginia for stand-alone dual eligible demonstration programs serving individuals dually eligible for both the federal Medicare program and the applicable state-based Medicaid program as well as an Integrated Care Program, or ICP, Medicaid contract in Illinois. We began serving members in Illinois in the first quarter of 2014 and in Virginia in the second quarter of 2014. In addition, we began serving members in Long-Term Support Services (LTSS) regions in Florida at various effective dates ranging from the second half of 2013 through the first quarter of 2014.
The loss of any of the contracts above or significant changes in these programs as a result of legislative or regulatory action, including reductions in premium payments to us, regulatory restrictions on profitability, including by comparison of our Medicare Advantage profitability to our non-Medicare Advantage business profitability and a requirement that they remain within certain ranges of each other, or increases in member benefits without corresponding increases in premium payments to us, may have a material adverse effect on our results of operations, financial position, and cash flows.
Legal Proceedings and Certain Regulatory Matters
Florida Matters
On January 6, 2012, the Civil Division of the United States Attorney’s Office for the Southern District of Florida advised us that it is seeking documents and information from us and several of our affiliates relating to several matters including the coding of medical claims by one or more South Florida medical providers, and loans to physician practices. On May 1, 2014, the U.S. Attorney's Office filed a Notice of Non-Intervention in connection with a civil qui tam suit related to one of these matters captioned United States of America ex rel. Olivia Graves v. Plaza Medical Centers, et al., and the Court ordered the complaint unsealed. Subsequently, the individual plaintiff amended the complaint and served the Company, opting to continue to pursue the action. After the Court dismissed her complaint, the individual
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Unaudited
plaintiff filed a second amended complaint on October 23, 2014, which all defendants answered and moved to dismiss. A Magistrate Judge recommended on March 26, 2015, that the Court deny the defendants' motions to dismiss, and the defendants filed objections to that recommendation. On July 6, 2015, the District Judge adopted the Magistrate Judge's report and recommendation and denied the defendants’ motions to dismiss. We continue to cooperate with and respond to information requests from the U.S. Attorney’s office. These matters could result in additional qui tam litigation.
As previously disclosed, the Civil Division of the United States Department of Justice had provided us with an information request, separate from but related to the Plaza Medical matter, concerning our Medicare Part C risk adjustment practices. The request relates to our oversight and submission of risk adjustment data generated by providers in our Medicare Advantage network, including the providers identified in the Plaza Medical matter, as well as to our business and compliance practices related to risk adjustment data generated by our providers and by us, including medical record reviews conducted as part of our data and payment accuracy compliance efforts, the use of health and well-being assessments, and our fraud detection efforts. We believe that this request for information is in connection with a wider review of Medicare Risk Adjustment generally that includes a number of Medicare Advantage plans, providers, and vendors. We continue to cooperate with and voluntarily respond to the information requests from the Department of Justice and the U.S. Attorney’s Office.
Litigation Related to the Merger
In connection with the Merger, certain litigations were filed by putative stockholders of Humana. On July 9, 2015, a putative class action lawsuit was commenced against our Board, Aetna, and subsidiaries of Aetna that are parties to the Merger Agreement (which subsidiaries are referred to as the “Merger Subs”) in the Commonwealth of Kentucky, Jefferson Circuit Court (referred to as the “Kentucky Action”). On July 22, 2015, a putative class action lawsuit was commenced against the Company, the Board, Aetna, and the Merger Subs in the Delaware Court of Chancery (referred to as the “Delaware Action”).
In both the Kentucky Action and the Delaware Action, plaintiffs allege that the Board breached their fiduciary duties in connection with the Merger by, among other things, carrying out a process that allegedly did not ensure adequate and fair consideration to the Company’s stockholders, entering into the Merger Agreement containing allegedly preclusive deal protection devices, and allegedly putting their personal interests ahead of the interest of the Company’s stockholders. Both plaintiffs further allege that Aetna and the Merger Subs aided and abetted the Board in their alleged breaches of fiduciary duties, and the plaintiff in the Delaware Action also alleges that the Company aided and abetted the Board in their alleged breaches of fiduciary duties. Both the Kentucky Action and the Delaware Action seek equitable relief to enjoin consummation of the Merger, rescission of the Merger, and fees and costs, among other relief, while the Delaware Action also seeks additional unspecified damages.
Other Lawsuits and Regulatory Matters
Our current and past business practices are subject to review or other investigations by various state insurance and health care regulatory authorities and other state and federal regulatory authorities. These authorities regularly scrutinize the business practices of health insurance, health care delivery and benefits companies. These reviews focus on numerous facets of our business, including claims payment practices, provider contracting, risk adjustment, competitive practices, commission payments, privacy issues, utilization management practices, pharmacy benefits, access to care, and sales practices, among others. Some of these reviews have historically resulted in fines imposed on us and some have required changes to some of our practices. We continue to be subject to these reviews, which could result in additional fines or other sanctions being imposed on us or additional changes in some of our practices.
We also are involved in various other lawsuits that arise, for the most part, in the ordinary course of our business operations, certain of which may be styled as class-action lawsuits. Among other matters, this litigation may include employment matters, claims of medical malpractice, bad faith, nonacceptance or termination of providers, anticompetitive practices, improper rate setting, provider contract rate disputes, non-contracted provider rate disputes for out-of-network services, failure to disclose network discounts and various other provider arrangements, general contractual matters, intellectual property matters, and challenges to subrogation practices. For example, a number of hospitals and other providers have asserted that, under their network provider contracts, we are not entitled to reduce Medicare Advantage payments to these providers in connection with changes in Medicare payment systems and in
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Unaudited
accordance with the Balanced Budget and Emergency Deficit Control Act of 1985, as amended (commonly referred to as “sequestration”). Those challenges have led to arbitration demands and litigation and could lead to additional arbitration or other alternative dispute resolution demands or litigation or other legal proceedings. Also, under state guaranty assessment laws, we may be assessed (up to prescribed limits) for certain obligations to the policyholders and claimants of insolvent insurance companies that write the same line or lines of business as we do.
As a government contractor, we may also be subject to qui tam litigation brought by individuals who seek to sue on behalf of the government, alleging that the government contractor submitted false claims to the government including, among other allegations, those resulting from coding and review practices under the Medicare risk adjustment model. Qui tam litigation is filed under seal to allow the government an opportunity to investigate and to decide if it wishes to intervene and assume control of the litigation. If the government does not intervene, the lawsuit is unsealed, and the individual may continue to prosecute the action on his or her own, on behalf of the government. We also are subject to other allegations of non-performance of contractual obligations to providers, members, and others, including failure to properly pay claims, improper policy terminations, challenges to our implementation of the Medicare Part D prescription drug program and other litigation.
A limited number of the claims asserted against us are subject to insurance coverage. Personal injury claims, claims for extracontractual damages, care delivery malpractice, and claims arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future.
We record accruals for the contingencies discussed in both sections above to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters specifically described above because of the inherently unpredictable nature of legal proceedings, which also may be exacerbated by various factors, including: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the proceeding is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties (including where it is uncertain how liability, if any, will be shared among multiple defendants); or (vii) there is a wide range of potential outcomes.
The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting judgments, penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities or as a result of actions by third parties. Nevertheless, it is reasonably possible that any such outcome of litigation, judgments, penalties, fines or other sanctions could be substantial, and the outcome of these matters may have a material adverse effect on our results of operations, financial position, and cash flows, and may also affect our reputation.
14. SEGMENT INFORMATION
On January 1, 2015, we realigned certain of our businesses among our reportable segments to correspond with internal management reporting changes and renamed our Employer Group segment to the Group segment. Our three reportable segments remain Retail, Group, and Healthcare Services. The more significant realignments included reclassifying Medicare benefits offered to groups to the Retail segment from the Group segment, bringing all of our Medicare offerings, which are now managed collectively, together in one segment, recognizing that in some instances we market directly to individuals that are part of a group Medicare account. In addition, we realigned our military services business, primarily consisting of our TRICARE South Region contract previously included in the Other Businesses category, to our Group segment as we consider this contract with the government to be a group account. Prior period segment financial information has been recast to conform to the 2015 presentation.
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Unaudited
We manage our business with
three
reportable segments:
Retail, Group, and Healthcare Services. In addition, the Other Businesses category includes businesses that are not individually reportable because they do not meet the quantitative thresholds required by generally accepted accounting principles. These segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer to assess performance and allocate resources.
The Retail segment consists of Medicare benefits, marketed to individuals or directly via group accounts, as well as individual commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products. In addition, the Retail segment also includes our contract with CMS to administer the LI-NET prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, collectively our state-based contracts. The Group segment consists of employer group commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and voluntary insurance benefits, as well as administrative services only, or ASO products. In addition, our Group segment includes our health and wellness products (primarily marketed to employer groups) and military services business, primarily our TRICARE South Region contract. The Healthcare Services segment includes services offered to our health plan members as well as to third parties, including pharmacy solutions, provider services, home based services, and clinical programs, as well as services and capabilities to advance population health. We will continue to report under the category of Other Businesses those businesses which do not align with the reportable segments described above, primarily our closed-block long-term care insurance policies.
Our Healthcare Services intersegment revenues primarily relate to managing prescription drug coverage for members of our other segments through Humana Pharmacy Solutions
®
, or HPS, and includes the operations of Humana Pharmacy, Inc., our mail order pharmacy business. These revenues consist of the prescription price (ingredient cost plus dispensing fee), including the portion to be settled with the member (co-share) or with the government (subsidies), plus any associated administrative fees. Services revenues related to the distribution of prescriptions by third party retail pharmacies in our networks are recognized when the claim is processed and product revenues from dispensing prescriptions from our mail order pharmacies are recorded when the prescription or product is shipped. Our pharmacy operations, which are responsible for designing pharmacy benefits, including defining member co-share responsibilities, determining formulary listings, contracting with retail pharmacies, confirming member eligibility, reviewing drug utilization, and processing claims, act as a principal in the arrangement on behalf of members in our other segments. As principal, our Healthcare Services segment reports revenues on a gross basis including co-share amounts from members collected by third party retail pharmacies at the point of service.
In addition, our Healthcare Services intersegment revenues include revenues earned by certain owned providers derived from risk-based managed care agreements with our health plans. Under these agreements, the provider receives a monthly capitated fee that varies depending on the demographics and health status of the member, for each member assigned to these owned providers by our health plans. The owned provider assumes the economic risk of funding the assigned members’ healthcare services and related administrative costs. Accordingly, our Healthcare Services segment reports provider services related revenues on a gross basis. Capitation fee revenue is recognized in the period in which the assigned members are entitled to receive healthcare services.
We present our consolidated results of operations from the perspective of the health plans. As a result, the cost of providing benefits to our members, whether provided via a third party provider or internally through a stand-alone subsidiary, is classified as benefits expense and excludes the portion of the cost for which the health plans do not bear responsibility, including member co-share amounts and government subsidies of
$3.0 billion
and
$2.3 billion
for the
three months ended June 30, 2015
and
2014
, respectively. For the
six months ended June 30, 2015
and
2014
these amounts were
$5.5 billion
and
$4.1 billion
, respectively. In addition, depreciation and amortization expense associated with certain businesses in our Healthcare Services segment delivering benefits to our members, primarily associated with our provider services and pharmacy operations, are included with benefits expense. The amount of this expense was
$24 million
and
$27 million
for the
three months ended June 30, 2015
and
2014
, respectively. For the
six months ended June 30, 2015
and
2014
, the amount of this expense was
$45 million
and
$52 million
, respectively.
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Unaudited
Other than those described previously, the accounting policies of each segment are the same and are described in Note 2 to the consolidated financial statements included in our
2014
Form 10-K.
Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and home based services as well as clinical programs, to our Retail and Group customers
.
Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations
in the tables presenting segment results below.
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Unaudited
Our segment results were as follows for the
three and six months ended June 30, 2015
and
2014
:
Retail
Group
Healthcare
Services
Other
Businesses
Eliminations/
Corporate
Consolidated
(in millions)
Three months ended June 30, 2015
Revenues - external customers
Premiums:
Individual Medicare Advantage
$
7,434
$
—
$
—
$
—
$
—
$
7,434
Group Medicare Advantage
1,398
—
—
—
—
1,398
Medicare stand-alone PDP
985
—
—
—
—
985
Total Medicare
9,817
—
—
—
—
9,817
Fully-insured
1,113
1,379
—
—
—
2,492
Specialty
66
265
—
—
—
331
Medicaid and other
559
4
—
9
—
572
Total premiums
11,555
1,648
—
9
—
13,212
Services revenue:
Provider
—
11
221
—
—
232
ASO and other
2
163
—
3
—
168
Pharmacy
—
—
7
—
—
7
Total services revenue
2
174
228
3
—
407
Total revenues - external customers
11,557
1,822
228
12
—
13,619
Intersegment revenues
Services
—
22
4,515
—
(4,537
)
—
Products
—
—
1,233
—
(1,233
)
—
Total intersegment revenues
—
22
5,748
—
(5,770
)
—
Investment income
31
6
—
22
54
113
Total revenues
11,588
1,850
5,976
34
(5,716
)
13,732
Operating expenses:
Benefits
10,068
1,341
—
21
(178
)
11,252
Operating costs
1,213
444
5,713
4
(5,557
)
1,817
Depreciation and amortization
47
22
40
—
(19
)
90
Total operating expenses
11,328
1,807
5,753
25
(5,754
)
13,159
Income from operations
260
43
223
9
38
573
Gain on sale of business
—
—
—
—
267
267
Interest expense
—
—
—
—
47
47
Income before income taxes
$
260
$
43
$
223
$
9
$
258
$
793
28
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
Retail
Group
Healthcare
Services
Other
Businesses
Eliminations/
Corporate
Consolidated
(in millions)
Three months ended June 30, 2014
Revenues - external customers
Premiums:
Individual Medicare Advantage
$
6,467
$
—
$
—
$
—
$
—
$
6,467
Group Medicare Advantage
1,366
—
—
—
—
1,366
Medicare stand-alone PDP
941
—
—
—
—
941
Total Medicare
8,774
—
—
—
—
8,774
Fully-insured
912
1,321
—
—
—
2,233
Specialty
66
275
—
—
—
341
Medicaid and other
214
4
—
18
—
236
Total premiums
9,966
1,600
—
18
—
11,584
Services revenue:
Provider
—
6
324
—
—
330
ASO and other
13
175
—
3
—
191
Pharmacy
—
—
25
—
—
25
Total services revenue
13
181
349
3
—
546
Total revenues - external customers
9,979
1,781
349
21
—
12,130
Intersegment revenues
Services
—
16
3,724
—
(3,740
)
—
Products
—
—
938
—
(938
)
—
Total intersegment revenues
—
16
4,662
—
(4,678
)
—
Investment income
24
5
—
15
48
92
Total revenues
10,003
1,802
5,011
36
(4,630
)
12,222
Operating expenses:
Benefits
8,495
1,262
—
25
(155
)
9,627
Operating costs
1,071
484
4,770
5
(4,495
)
1,835
Depreciation and amortization
37
26
35
1
(20
)
79
Total operating expenses
9,603
1,772
4,805
31
(4,670
)
11,541
Income from operations
400
30
206
5
40
681
Interest expense
—
—
—
—
35
35
Income before income taxes
$
400
$
30
$
206
$
5
$
5
$
646
29
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
Retail
Group
Healthcare
Services
Other
Businesses
Eliminations/
Corporate
Consolidated
(in millions)
Six months ended June 30, 2015
Revenues - external customers
Premiums:
Individual Medicare Advantage
$
14,867
$
—
$
—
$
—
$
—
$
14,867
Group Medicare Advantage
2,792
—
—
—
—
2,792
Medicare stand-alone PDP
1,988
—
—
—
—
1,988
Total Medicare
19,647
—
—
—
—
19,647
Fully-insured
2,207
2,763
—
—
—
4,970
Specialty
129
535
—
—
—
664
Medicaid and other
1,150
10
—
19
—
1,179
Total premiums
23,133
3,308
—
19
—
26,460
Services revenue:
Provider
—
20
529
—
—
549
ASO and other
6
323
—
5
—
334
Pharmacy
—
—
14
—
—
14
Total services revenue
6
343
543
5
—
897
Total revenues - external customers
23,139
3,651
543
24
—
27,357
Intersegment revenues
Services
—
44
8,928
—
(8,972
)
—
Products
—
—
2,383
—
(2,383
)
—
Total intersegment revenues
—
44
11,311
—
(11,355
)
—
Investment income
58
11
—
37
102
208
Total revenues
23,197
3,706
11,854
61
(11,253
)
27,565
Operating expenses:
Benefits
20,004
2,567
—
44
(358
)
22,257
Operating costs
2,467
897
11,319
7
(10,928
)
3,762
Depreciation and amortization
91
45
82
—
(35
)
183
Total operating expenses
22,562
3,509
11,401
51
(11,321
)
26,202
Income from operations
635
197
453
10
68
1,363
Gain on sale of business
—
—
—
—
267
267
Interest expense
—
—
—
—
93
93
Income before income taxes
$
635
$
197
$
453
$
10
$
242
$
1,537
30
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
Unaudited
Retail
Group
Healthcare
Services
Other
Businesses
Eliminations/
Corporate
Consolidated
(in millions)
Six months ended June 30, 2014
Revenues - external customers
Premiums:
Individual Medicare Advantage
$
12,927
$
—
$
—
$
—
$
—
$
12,927
Group Medicare Advantage
2,750
—
—
—
—
2,750
Medicare stand-alone PDP
1,806
—
—
—
—
1,806
Total Medicare
17,483
—
—
—
—
17,483
Fully-insured
1,437
2,650
—
—
—
4,087
Specialty
125
550
—
—
—
675
Medicaid and other
383
10
—
29
—
422
Total premiums
19,428
3,210
—
29
—
22,667
Services revenue:
Provider
—
11
631
—
—
642
ASO and other
27
363
—
6
—
396
Pharmacy
—
—
46
—
—
46
Total services revenue
27
374
677
6
—
1,084
Total revenues - external customers
19,455
3,584
677
35
—
23,751
Intersegment revenues
Services
—
35
7,205
—
(7,240
)
—
Products
—
—
1,784
—
(1,784
)
—
Total intersegment revenues
—
35
8,989
—
(9,024
)
—
Investment income
47
11
—
30
95
183
Total revenues
19,502
3,630
9,666
65
(8,929
)
23,934
Operating expenses:
Benefits
16,575
2,429
—
49
(302
)
18,751
Operating costs
2,081
977
9,204
9
(8,651
)
3,620
Depreciation and amortization
77
50
71
2
(39
)
161
Total operating expenses
18,733
3,456
9,275
60
(8,992
)
22,532
Income from operations
769
174
391
5
63
1,402
Interest expense
—
—
—
—
70
70
Income (loss) before income taxes
$
769
$
174
$
391
$
5
$
(7
)
$
1,332
31
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Humana Inc.
ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The condensed consolidated financial statements of Humana Inc. in this document present the Company’s financial position, results of operations and cash flows, and should be read in conjunction with the following discussion and analysis. References to “we,” “us,” “our,” “Company,” and “Humana” mean Humana Inc. and its subsidiaries. This discussion includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in filings with the SEC, in our press releases, investor presentations, and in oral statements made by or with the approval of one of our executive officers, the words or phrases like “believes,” “expects,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward–looking statements. These forward–looking statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions, including, among other things, information set forth in Item 1A. – Risk Factors in our 2014 Form 10-K, as modified by any changes to those risk factors included in this document and in other reports we filed subsequent to February 18, 2015, in each case incorporated by reference herein. In making these statements, we are not undertaking to address or update such forward-looking statements in future filings or communications regarding our business or results. In light of these risks, uncertainties and assumptions, the forward–looking events discussed in this document might not occur. There may also be other risks that we are unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward–looking statements.
Executive Overview
General
Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Our strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.
Our industry relies on two key statistics to measure performance. The benefit ratio, which is computed by taking total benefits expense as a percentage of premiums revenue, represents a statistic used to measure underwriting profitability. The operating cost ratio, which is computed by taking total operating costs, excluding depreciation and amortization, as a percentage of total revenue less investment income, represents a statistic used to measure administrative spending efficiency.
Proposed Merger
On July 2, 2015, we entered into an Agreement and Plan of Merger, which we refer to in this report as the Merger Agreement, with Aetna Inc. and certain wholly owned subsidiaries of Aetna Inc., which we refer to collectively as Aetna, which sets forth the terms and conditions under which we will merge with, and become a wholly owned subsidiary of Aetna, a transaction we refer to in this report as the Merger. In the Merger, each outstanding share of our common stock will be converted into the right to receive (i)
0.8375
of a share of Aetna common stock and (ii)
$125
in cash. The total transaction was estimated at approximately
$37 billion
including the assumption of Humana debt, based on the closing price of Aetna common shares on July 2, 2015. The Merger Agreement includes customary restrictions on the conduct of our business prior to the completion of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of customary specified limitations absent Aetna’s prior written consent, including, for example, limitations on dividends and repurchases of our securities, restrictions on our ability to enter into material contracts, and negotiated thresholds for capital expenditures, capital contributions, acquisitions and divestitures of businesses.
The transaction is subject to customary closing conditions, including, among other things, (i) approval of the holders of our outstanding shares of common stock entitled to vote on the Merger, (ii) approval of the holders of Aetna outstanding shares to the issuance of Aetna common stock in the Merger, (iii) the expiration or termination of the applicable waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, and the receipt of necessary approvals under state insurance and healthcare laws and regulations and pursuant to certain licenses of certain of Humana’s subsidiaries, (iv) the absence of legal restraints and prohibitions on the consummation of the Merger, (v) the effectiveness of the registration statement in respect of the Aetna common stock to be issued in the Merger, (vi) listing of the Aetna common stock to be issued in the Merger on the New York Stock Exchange, (vii) subject to the relevant
32
Table of Contents
standards set forth in the Merger Agreement, the accuracy of the representations and warranties made by each party, (viii) material compliance by each party with its covenants in the Merger Agreement, and (ix) no “Company Material Adverse Effect” with respect to us and no “Parent Material Adverse Effect” with respect to Aetna, in each case since the execution of and as defined in the Merger Agreement. In addition, Aetna’s obligation to consummate the Merger is subject to (a) the condition that the required regulatory approvals do not impose any condition that, individually or in the aggregate, would reasonably be expected to have a “Regulatory Material Adverse Effect” (as such term is defined in the Merger Agreement), and (b) the Centers for Medicare and Medicaid Services, or CMS, has not imposed any sanctions with respect to our Medicare Advantage, or MA, business that, individually or in the aggregate, is or would reasonably be expected to be material and adverse to us and our subsidiaries, taken as a whole. The Merger is expected to close in the second half of 2016.
A copy of the Merger Agreement is filed as an exhibit to our Current Report on Form 8-K filed with the SEC on July 7, 2015.
Business Segments
On January 1, 2015, we realigned certain of our businesses among our reportable segments to correspond with internal management reporting changes and renamed our Employer Group segment to the Group segment. Our three reportable segments remain Retail, Group, and Healthcare Services. The more significant realignments included reclassifying Medicare benefits offered to groups to the Retail segment from the Group segment, bringing all of our Medicare offerings, which are now managed collectively, together in one segment, recognizing that in some instances we market directly to individuals that are part of a group Medicare account. In addition, we realigned our military services business, primarily consisting of our TRICARE South Region contract previously included in the Other Businesses category, to our Group segment as we consider this contract with the government to be a group account. Prior period segment financial information has been recast to conform to the 2015 presentation.
We manage our business with
three
reportable segments:
Retail, Group, and Healthcare Services. In addition, the Other Businesses category includes businesses that are not individually reportable because they do not meet the quantitative thresholds required by generally accepted accounting principles. These segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer to assess performance and allocate resources.
The Retail segment consists of Medicare benefits, marketed to individuals or directly via group accounts, as well as individual commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products. In addition, the Retail segment also includes our contract with CMS to administer the LI-NET prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, collectively our state-based contracts. The Group segment consists of employer group commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and voluntary insurance benefits, as well as administrative services only, or ASO products. In addition, our Group segment includes our health and wellness products (primarily marketed to employer groups) and military services business, primarily our TRICARE South Region contract. The Healthcare Services segment includes services offered to our health plan members as well as to third parties, including pharmacy solutions, provider services, home based services, and clinical programs, as well as services and capabilities to advance population health. We will continue to report under the category of Other Businesses those businesses which do not align with the reportable segments described above, primarily our closed-block long-term care insurance policies.
The results of each segment are measured by income before income taxes.
Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and home based services as well as clinical programs, to our Retail and Group customers
.
Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate
33
Table of Contents
debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations
.
Seasonality
One of the product offerings of our Retail segment is Medicare stand-alone prescription drug plans, or PDPs, under the Medicare Part D program. Our quarterly Retail segment earnings and operating cash flows are impacted by the Medicare Part D benefit design and changes in the composition of our membership. The Medicare Part D benefit design results in coverage that varies as a member’s cumulative out-of-pocket costs pass through successive stages of a member’s plan period, which begins annually on January 1 for renewals. These plan designs generally result in us sharing a greater portion of the responsibility for total prescription drug costs in the early stages and less in the latter stages. As a result, the PDP benefit ratio generally decreases as the year progresses. In addition, the number of low-income senior members as well as year-over-year changes in the mix of membership in our stand-alone PDP products affects the quarterly benefit ratio pattern.
Our Group segment also experiences seasonality in the benefit ratio pattern. However, the effect is opposite of Medicare stand-alone PDP in the Retail segment, with the Group segment’s benefit ratio increasing as fully-insured members progress through their annual deductible and maximum out-of-pocket expenses. Similarly, certain of our fully-insured individual commercial medical products in our Retail segment experience seasonality in the benefit ratio akin to the Group segment, including the effect of existing previously underwritten members transitioning to policies compliant with the Health Care Reform Law with us and other carriers. As previously underwritten members transition, it results in policy lapses and the release of reserves for future policy benefits and recognition of previously deferred acquisition costs. These policy lapses generally occur during the first quarter of the new coverage year following the open enrollment period.
In addition, the Retail segment also experiences seasonality in the operating cost ratio as a result of costs incurred in the second half of the year associated with the Medicare and individual health care exchange marketing seasons.
2015 Highlights
Consolidated
•
Our 2015 results through
June 30, 2015
reflect the continued implementation of our strategy to offer our members affordable health care combined with a positive consumer experience in growing markets. At the core of this strategy is our integrated care delivery model, which unites quality care, high member engagement, and sophisticated data analytics. Our approach to primary, physician-directed care for our members aims to provide quality care that is consistent, integrated, cost-effective, and member-focused, provided by both employed physicians and physicians with network contract arrangements. The model is designed to improve health outcomes and affordability for individuals and for the health system as a whole, while offering our members a simple, seamless healthcare experience. We believe this strategy is positioning us for long-term growth in both membership and earnings. At
June 30, 2015
, approximately
1,510,400
members, or
55.7%
, of our individual Medicare Advantage members were in value-based relationships under our integrated care delivery model, as compared to
1,301,000
members, or
53.6%
, at
December 31, 2014
and
1,246,700
members, or
52.8%
, at
June 30, 2014
.
•
On June 1, 2015, we completed the sale of our wholly owned subsidiary, Concentra Inc., or Concentra, to MJ Acquisition Corporation, a joint venture between Select Medical Holdings Corporation and Welsh, Carson, Anderson & Stowe XII, L.P., a private equity fund, for approximately
$1,055 million
in cash, excluding approximately
$25 million
of transaction costs.
In connection with the sale,
we recognized a pretax gain, net of transaction costs, of
$267 million
, or
$1.53
per diluted common share, consisting of a
$0.35
per diluted common share gain recognized in the first quarter of
2015
associated with a tax benefit recorded in connection with the held-for-sale classification of Concentra and a
$1.18
per diluted common share gain recognized upon completion of the sale during
three months ended June 30, 2015
.
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•
Excluding the impact of the sale of Concentra, our pretax results for the
three and six months ended June 30, 2015
as compared to the
three and six months ended June 30, 2014
reflect a year-over-year decline in Retail segment pretax results partially offset by year-over-year improvement in the Group and Healthcare Services segment pretax results as discussed in the detailed segment results discussion that follows.
•
Year-over-year comparisons of the operating cost ratio are impacted by an increase in
2015
of the non-deductible health insurance industry fee mandated by the Health Care Reform Law. Likewise, year-over-year comparisons of the benefit ratio reflect the increase in this fee in the pricing of our products for 2015.
•
Year-over-year comparisons of diluted earnings per common share are favorably impacted by a lower number of shares used to compute diluted earnings per common share reflecting the impact of share repurchases.
•
During the
six months ended June 30, 2015
, operating cash flow used in operations was
$501 million
as compared to operating cash flow provided by operations of
$471 million
for the
six months ended June 30, 2014
. The decrease in our operating cash flows for the
six months ended June 30, 2015
primarily reflects the effect of significant growth in individual commercial medical and group Medicare Advantage membership in the prior year, lower earnings exclusive of the gain on the sale of Concentra, and changes in the timing of other working capital items related to the growth in our pharmacy business and the timing of receipts for premiums. Prior year cash flows were favorably impacted from the typical pattern of claim payments that lagged premium receipts related to new membership. Individual commercial medical added
644,200
new members in the
2014 period
compared to
42,600
in the
2015 period
. Likewise group Medicare Advantage added
50,600
new members in the
2014 period
compared to a decline of
16,600
members in the
2015 period
.
•
In September 2015, we expect to pay the federal government
$866 million
for the annual non-deductible health insurance industry fee compared to our payment of
$562 million
in 2014. This fee is not deductible for tax purposes, which significantly increased our effective income tax rate beginning in 2014. The health insurance industry fee is further described below under the section titled “Health Care Reform.”
•
During the
six months ended June 30, 2015
, we repurchased
1.85 million
shares in open market transactions for
$329 million
and paid dividends to stockholders of
$86 million
.
Pursuant to the Merger Agreement with Aetna discussed
previously
, after July 2, 2015, we are prohibited from repurchasing any of our outstanding securities without the prior written consent of Aetna, other than repurchases of shares of our common stock in connection with the exercise of outstanding stock options or the vesting or settlement of outstanding restricted stock awards. Accordingly, as announced on July 3, 2015, we have suspended our share repurchase program due to the Merger.
Our remaining repurchase authorization was
$1.04 billion
as of July 3, 2015.
The Merger
does not impact our ability and intent to continue quarterly dividend payments prior to the closing of the Merger, including the cash dividend of
$0.29
per share payable on
July 31, 2015
to stockholders of record on
June 30, 2015
. Under the terms of the Merger Agreement we have agreed with Aetna that our quarterly dividend will not exceed $0.29 per share prior to the closing of the Merger.
Retail
•
On April 6, 2015, CMS announced final 2016 Medicare benchmark payment rates and related technical factors impacting the bid benchmark premiums, which we refer to as the Final Rate Notice. We believe the Final Rate Notice, together with the impact of payment cuts associated with the Health Care Reform Law, quality bonuses, sunset of the Star quality CMS demonstration in 2015, risk coding modifications, and other funding formula changes, indicate 2016 Medicare Advantage funding increases for us of approximately 0.8% on average. Although the overall rate adjustment is positive, geographic-specific impacts may vary from this average. Accordingly, while we believe in some markets that our members’ benefits may be adversely impacted, we believe we have effectively designed Medicare Advantage products based upon the applicable level of rate changes while continuing to remain competitive compared to both the combination of original Medicare with a supplement policy and Medicare Advantage products offered by our competitors. Failure to execute these strategies may result in a material adverse effect on our results of operations, financial position, and cash flows.
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Table of Contents
•
For the
three months ended June 30, 2015
, our Retail segment pretax income
decrease
d by
$140 million
, or
35.0%
, as compared to the
three months ended June 30, 2014
. Retail segment pretax income
decrease
d
$134 million
, or
17.4%
, for the
six months ended June 30, 2015
, as compared to the
six months ended June 30, 2014
. These declines were primarily due to higher Medicare Advantage and individual commercial medical benefit ratios year-over-year as described further in the results of operations discussion that follows, the impact of changes in estimates for the net reinsurance, risk adjustment and risk corridor, which we collectively refer to as the 3Rs, receivables, as well as a higher mix of members from state-based contracts. These items were partially offset by membership growth in our Medicare Advantage, Medicare stand-alone PDP, and individual commercial medical on-exchange and off-exchange offerings in plans compliant with the Health Care Reform Law.
•
Medicare Advantage operating results were negatively impacted by certain pricing assumptions in our plan designs for 2015. This primarily was related to lower-than-expected 2015 financial claim recovery levels and lower-than-anticipated reductions in inpatient admissions from our clinical programs. Overall, year-over-year hospital admissions are down. We believe we have appropriately reflected the recent medical cost experience in our plan designs for 2016 submitted to CMS.
•
Operating results for our individual commercial medical business continue to be challenged primarily due to the volatility and morbidity associated with new membership related to the start of the Health Care Reform Law. Medical claims associated with certain products, in particular Health Care Reform Law compliant off-exchange offerings, continue to exceed prior expectations for fiscal year 2015. Additionally, on June 30, 2015, CMS issued data with respect to the reinsurance and risk adjustment premium stabilization programs for the 2014 plan year which indicated a meaningfully different risk profile comparison for our membership relative to state averages than had been previously anticipated. This resulted in adjustments to certain of the 3Rs during the
three months ended June 30, 2015
. We are in the process of evaluating our pricing and continued participation in certain products for 2016.
•
Individual Medicare Advantage membership of
2,709,300
at
June 30, 2015
increased
281,400
, or
11.6%
, from
2,427,900
at
December 31, 2014
and increased
350,300
members, or
14.8%
, from
2,359,000
at
June 30, 2014
reflecting net membership additions, particularly for our Health Maintenance Organization, or HMO, offerings for the 2015 plan year.
•
Group Medicare Advantage membership of
473,100
at
June 30, 2015
decreased
16,600
members, or
3.4%
, from
489,700
at
December 31, 2014
and
decreased
6,600
members, or
1.4%
, from
479,700
at
June 30, 2014
. The decline from
December 31, 2014
primarily reflects the loss of a large group account.
•
Medicare stand-alone PDP membership of
4,442,500
at
June 30, 2015
increased
448,500
members, or
11.2%
, from
3,994,000
at
December 31, 2014
and increased
557,000
members, or
14.3%
, from
3,885,500
at
June 30, 2014
reflecting net membership additions, primarily for our Humana-Walmart plan offering, for the 2015 plan year
.
•
Our state-based Medicaid membership of
352,000
as of
June 30, 2015
increased
35,200
members, or
11.1%
, from
316,800
at
December 31, 2014
and
increased
185,000
members, or
110.8%
, from
167,000
at
June 30, 2014
, in each case primarily due to
the addition of members under our Florida Medicaid contract.
•
Individual commercial medical membership of
1,190,700
at
June 30, 2015
increased
42,600
members, or
3.7%
, from
1,148,100
at
December 31, 2014
primarily reflecting new sales and better retention for plans compliant with the Health Care Reform Law, both on-exchange and off-exchange. Individual commercial medical membership
decreased
53,600
members, or
4.3%
, from
1,244,300
at
June 30, 2014
primarily reflecting the loss of members subscribing to plans that are not compliant with the Health Care Reform Law partially offset by an increase in membership in plans that are compliant with the Health Care Reform Law, both on-exchange and off-exchange
. At
June 30, 2015
, individual commercial medical membership in plans compliant with the Health Care Reform Law, both on-exchange and off-exchange, was
879,600
members, an increase of
193,300
members, or
28.2%
, from
December 31, 2014
and an increase of
138,400
members, or
18.7%
, from
June 30, 2014
.
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Table of Contents
Group Segment
•
For the
three and six months ended June 30, 2015
, our Group segment pretax income
increased
$13 million
, or
43.3%
, and
$23 million
, or
13.2%
, respectively, as compared to the
three and six months ended June 30, 2014
, respectively, primarily due to
improvement in the operating cost ratios partially offset by increases in the benefit ratios
as discussed in the results of operations discussion that follows.
•
Membership in HumanaVitality
®
, our wellness and loyalty rewards program, rose
0.7%
to
3,885,200
at
June 30, 2015
from
3,856,800
at
December 31, 2014
and rose
3.0%
from
3,772,000
at
June 30, 2014
, primarily due to individual Medicare Advantage growth as well as growth in stand-alone sales.
Healthcare Services Segment
•
Year-over-year comparisons of results of operations are impacted by the completion of the sale of Concentra on June 1, 2015.
•
As discussed in the detailed Healthcare Services segment results of operations discussion that follows, our Healthcare Services segment pretax income increased
$17 million
, or
8.3%
, and
$62 million
, or
15.9%
, for the
three and six months ended June 30, 2015
, respectively, as compared to the
three and six months ended June 30, 2014
, respectively. This increase was primarily due to
revenue growth from our pharmacy solutions and home based services businesses as they serve our growing Medicare membership
.
•
Programs to enhance the quality of care for members are key elements of our integrated care delivery model. We have accelerated our process for identifying and reaching out to members in need of clinical intervention. At
June 30, 2015
, we had approximately
512,000
Medicare Advantage members with complex chronic conditions in the Humana Chronic Care Program, a
21.7%
increase
compared with approximately
420,700
Medicare Advantage members at
December 31, 2014
, and an
increase
of
48.6%
compared with approximately
344,500
Medicare Advantage members at
June 30, 2014
. These increases reflect enhanced predictive modeling capabilities and focus on proactive clinical outreach and member engagement. We believe these initiatives lead to better health outcomes for our members and lower health care costs.
Health Care Reform
The Health Care Reform Law enacted significant reforms to various aspects of the U.S. health insurance industry. Implementation dates of the Health Care Reform Law began in September 2010 and will continue through 2018, and many aspects of the Health Care Reform Law are already effective and have been implemented by us. Certain significant provisions of the Health Care Reform Law include, among others, mandated coverage requirements, mandated benefits and guarantee issuance associated with commercial medical insurance, rebates to policyholders based on minimum benefit ratios, adjustments to Medicare Advantage premiums, the establishment of federally-facilitated or state-based exchanges coupled with programs designed to spread risk among insurers, and the introduction of plan designs based on set actuarial values. In addition, the Health Care Reform Law established insurance industry assessments, including an annual health insurance industry fee and a three-year $25 billion industry wide commercial reinsurance fee. The annual health insurance industry fee levied on the insurance industry was $8 billion in 2014 with increasing annual amounts thereafter, growing to $14 billion by 2017, and is not deductible for income tax purposes, which significantly increased our effective income tax rate. Our effective tax rate for the full year 2015 is expected to be approximately
46%
to
47%
, including the favorable impact of the sale of Concentra on June 1, 2015. In 2014, we paid the federal government
$562 million
for the annual health insurance industry fee. We expect to pay the federal government
$866 million
for the annual health insurance industry fee in 2015, a
54.1%
increase from 2014, primarily reflecting an increase in the total industry fee.
In addition, the Health Care Reform Law has increased and will continue to increase federal oversight of health plan premium rates and could adversely affect our ability to appropriately adjust health plan premiums on a timely basis. Financing for these reforms comes, in part, from material additional fees and taxes on us (as discussed above) and other health plans and individuals which began in 2014, as well as reductions in certain levels of payments to us and other health plans under Medicare as described in this report.
37
Table of Contents
As noted above, the Health Care Reform Law required the establishment of health insurance exchanges for individuals and small employers to purchase health insurance that became effective January 1, 2014, with an annual open enrollment period. Insurers participating on the health insurance exchanges must offer a minimum level of benefits and are subject to guidelines on setting premium rates and coverage limitations. We may be adversely selected by individuals who have a higher acuity level than the anticipated pool of participants in this market. In addition, the risk corridor, reinsurance, and risk adjustment provisions of the Health Care Reform Law, established to apportion risk for insurers, may not be effective in appropriately mitigating the financial risks related to our products. In addition, regulatory changes to the implementation of the Health Care Reform Law that allowed individuals to remain in plans that are not compliant with the Health Care Reform Law may have an adverse effect on our pool of participants in the health insurance exchange. In addition, states may impose restrictions on our ability to increase rates. All of these factors may have a material adverse effect on our results of operations, financial position, or cash flows if our premiums are not adequate or do not appropriately reflect the acuity of these individuals. Any variation from our expectations regarding acuity, enrollment levels, adverse selection, or other assumptions used in setting premium rates could have a material adverse effect on our results of operations, financial position, and cash flows and could impact our decision to participate or continue in the program in certain states.
As discussed above, it is reasonably possible that the Health Care Reform Law and related regulations, as well as future legislative changes, including legislative restrictions on our ability to manage our provider network or otherwise operate our business, or regulatory restrictions on profitability, including by comparison of our Medicare Advantage profitability to our non-Medicare Advantage business profitability and a requirement that they remain within certain ranges of each other, in the aggregate may have a material adverse effect on our results of operations (including restricting revenue, enrollment and premium growth in certain products and market segments, restricting our ability to expand into new markets, increasing our medical and operating costs, further lowering our Medicare payment rates and increasing our expenses associated with the non-deductible health insurance industry fee and other assessments); our financial position (including our ability to maintain the value of our goodwill); and our cash flows (including the receipt of amounts due under the commercial risk adjustment, risk corridor, and reinsurance provisions of the Health Care Reform Law in 2015 related to claims paid in 2014, which payments may be subject to federal administrative action).
We intend for the discussion of our financial condition and results of operations that follows to assist in the understanding of our financial statements and related changes in certain key items in those financial statements from year to year, including the primary factors that accounted for those changes.
Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and home based services as well as clinical programs, to our Retail and Group customers
and are described in Note 14 to the condensed consolidated financial statements.
38
Table of Contents
Comparison of Results of Operations for
2015
and
2014
The following discussion primarily deals with our results of operations for the
three months ended June 30, 2015
, or the
2015 quarter
, the
three months ended June 30, 2014
, or the
2014 quarter
, the
six months ended June 30, 2015
, or the
2015 period
, and the
six months ended June 30, 2014
, or the
2014 period
.
Consolidated
For the three months ended
June 30,
Change
2015
2014
Dollars
Percentage
(dollars in millions, except per common share results)
Revenues:
Premiums:
Retail
$
11,555
$
9,966
$
1,589
15.9
%
Group
1,648
1,600
48
3.0
%
Other Businesses
9
18
(9
)
(50.0
)%
Total premiums
13,212
11,584
1,628
14.1
%
Services:
Retail
2
13
(11
)
(84.6
)%
Group
174
181
(7
)
(3.9
)%
Healthcare Services
228
349
(121
)
(34.7
)%
Other Businesses
3
3
—
—
%
Total services
407
546
(139
)
(25.5
)%
Investment income
113
92
21
22.8
%
Total revenues
13,732
12,222
1,510
12.4
%
Operating expenses:
Benefits
11,252
9,627
1,625
16.9
%
Operating costs
1,817
1,835
(18
)
(1.0
)%
Depreciation and amortization
90
79
11
13.9
%
Total operating expenses
13,159
11,541
1,618
14.0
%
Income from operations
573
681
(108
)
(15.9
)%
Gain on sale of business
267
—
267
100.0
%
Interest expense
47
35
12
34.3
%
Income before income taxes
793
646
147
22.8
%
Provision for income taxes
362
302
60
19.9
%
Net income
$
431
$
344
$
87
25.3
%
Diluted earnings per common share
$
2.85
$
2.19
$
0.66
30.1
%
Benefit ratio
(a)
85.2
%
83.1
%
2.1
%
Operating cost ratio
(b)
13.3
%
15.1
%
(1.8
)%
Effective tax rate
45.6
%
46.7
%
(1.1
)%
(a)
Represents total benefits expense as a percentage of premiums revenue.
(b)
Represents total operating costs, excluding depreciation and amortization, as a percentage of total revenues less investment income.
39
Table of Contents
For the six months ended
June 30,
Change
2015
2014
Dollars
Percentage
(dollars in millions, except per common share results)
Revenues:
Premiums:
Retail
$
23,133
$
19,428
$
3,705
19.1
%
Group
3,308
3,210
98
3.1
%
Other Businesses
19
29
(10
)
(34.5
)%
Total premiums
26,460
22,667
3,793
16.7
%
Services:
Retail
6
27
(21
)
(77.8
)%
Group
343
374
(31
)
(8.3
)%
Healthcare Services
543
677
(134
)
(19.8
)%
Other Businesses
5
6
(1
)
(16.7
)%
Total services
897
1,084
(187
)
(17.3
)%
Investment income
208
183
25
13.7
%
Total revenues
27,565
23,934
3,631
15.2
%
Operating expenses:
Benefits
22,257
18,751
3,506
18.7
%
Operating costs
3,762
3,620
142
3.9
%
Depreciation and amortization
183
161
22
13.7
%
Total operating expenses
26,202
22,532
3,670
16.3
%
Income from operations
1,363
1,402
(39
)
(2.8
)%
Gain on sale of business
267
—
267
100.0
%
Interest expense
93
70
23
32.9
%
Income before income taxes
1,537
1,332
205
15.4
%
Provision for income taxes
676
620
56
9.0
%
Net income
$
861
$
712
$
149
20.9
%
Diluted earnings per common share
$
5.67
$
4.54
$
1.13
24.9
%
Benefit ratio
(a)
84.1
%
82.7
%
1.4
%
Operating cost ratio
(b)
13.8
%
15.2
%
(1.4
)%
Effective tax rate
44.0
%
46.5
%
(2.5
)%
(a)
Represents total benefits expense as a percentage of premiums revenue.
(b)
Represents total operating costs, excluding depreciation and amortization, as a percentage of total revenues less investment income.
40
Table of Contents
Summary
Net income was
$431 million
, or
$2.85
per diluted common share, in the
2015 quarter
compared to
$344 million
, or
$2.19
per diluted common share, in the
2014 quarter
. Net income was
$861 million
, or
$5.67
per diluted common share, in the
2015 period
compared to
$712 million
, or
$4.54
per diluted common share, in the
2014 period
. The completion of the sale of Concentra on June 1, 2015 resulted in an after-tax gain of
$1.53
per diluted common share, consisting of a
$0.35
per diluted common share gain recognized in the first quarter of
2015
associated with a tax benefit recorded in connection with the held-for-sale classification of Concentra and a
$1.18
per diluted common share gain recognized upon completion of the sale during
the
2015 quarter
. Excluding the impact of the sale of Concentra, the decrease in the
2015 quarter
and
2015 period
were primarily due to a year-over-year decline in Retail segment pretax results partially offset by year-over-year improvement in the Group and Healthcare Services segment pretax results as discussed in the detailed segment results discussion that follows. Year-over-year comparisons of diluted earnings per common share are also favorably impacted by a lower number of shares used to compute diluted earnings per common share in the
2015 quarter
and
2015 period
reflecting the impact of share repurchases.
Premiums
Consolidated premiums
increased
$1.6 billion
, or
14.1%
, from the
2014 quarter
to
$13.2 billion
for the
2015 quarter
and
increased
$3.8 billion
, or
16.7%
, from the
2014 period
to
$26.5 billion
for the
2015 period
reflecting higher premiums in both the Retail and Group segments. These increases are primarily due to average membership growth in the Retail segment and an increase in fully-insured group commercial medical per member premiums in the Group segment. Average membership is calculated by summing the ending membership for each month in a period and dividing the result by the number of months in a period. Premiums revenue reflects changes in membership and average per member premiums. Items impacting average per member premiums include changes in premium rates as well as changes in the geographic mix of membership, the mix of product offerings, and the mix of benefit plans selected by our membership.
Services revenue
Consolidated services revenue
decreased
$139 million
, or
25.5%
, from the
2014 quarter
to
$407 million
for the
2015 quarter
and
decreased
$187 million
, or
17.3%
, from the
2014 period
to
$897 million
for the
2015 period
. These decreases are primarily due to the loss of certain large group ASO accounts as a result of continued discipline in pricing of services for self-funded accounts amid a highly competitive environment as well as the completion of the sale of Concentra on June 1, 2015.
Investment income
Investment income totaled
$113 million
for the
2015 quarter
,
increasing
$21 million
from
$92 million
for the
2014 quarter
. For the
2015 period
, investment income totaled
$208 million
,
increasing
$25 million
from
$183 million
for the
2014 period
. These increases were primarily due to higher realized capital gains in the
2015 quarter
and
2015 period
, with higher average invested balances being substantially offset by lower interest rates.
Benefits expense
Consolidated benefits expense was
$11.3 billion
for the
2015 quarter
, an
increase
of
$1.6 billion
, or
16.9%
, from the
2014 quarter
. For the
2015 period
, benefits expense was
$22.3 billion
, an
increase
of
$3.5 billion
, or
18.7%
, from the
2014 period
. These increases are primarily due to an increase in the Retail segment mainly driven by higher average Medicare Advantage membership and individual commercial medical on-exchange and off-exchange membership in plans compliant with the Health Care Reform Law. We experienced unfavorable medical claims reserve development related to prior fiscal years of
$16 million
in the
2015 quarter
as compared to favorable medical claims reserve development of
$49 million
in the
2014 quarter
. In the
2015 period
, we experienced favorable medical claims reserve development related to prior fiscal years of
$178 million
as compared to
$346 million
in the
2014 period
. The declines in prior-period medical claims reserve development year-over-year primarily were due to Medicare Advantage and individual commercial medical claims development in the Retail segment as discussed further in the segment results of operations discussion that follows.
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Table of Contents
The consolidated benefit ratio
increased
210
basis points to
85.2%
for the
2015 quarter
compared to
83.1%
for the
2014
quarter. The consolidated benefit ratio for the
2015 period
was
84.1%
, a
140
basis point
increase
from
82.7%
for the
2014 period
. These increases are primarily due to increases in the Retail and Group segment ratios as discussed in the segment results of operations discussion that follows. Prior-period medical claims reserve development increased the consolidated benefit ratio by approximately
10
basis points in the
2015 quarter
and decreased the consolidated benefit ratio by approximately
40
basis points in the
2014 quarter
. Favorable prior-period medical claims reserve development decreased the consolidated benefit ratio by approximately
70
basis points in the
2015 period
versus approximately
150
basis points in the
2014 period
.
Operating costs
Our segments incur both direct and shared indirect operating costs. We allocate the indirect costs shared by the segments primarily as a function of revenues. As a result, the profitability of each segment is interdependent.
Consolidated operating costs
decreased
$18 million
, or
1.0%
, during the
2015 quarter
compared to the
2014 quarter
and
increased
$142 million
, or
3.9%
, during the
2015 period
compared to the
2014 period
. The increase in the
2015 period
is primarily due to increases in costs mandated by the Health Care Reform Law, including the non-deductible health insurance industry fee, partially offset by operating cost efficiencies.
The consolidated operating cost ratio for the
2015 quarter
was
13.3%
,
decreasing
180
basis points from the
2014 quarter
primarily due to decreases in the operating cost ratios in our Group and Retail segments. The consolidated operating cost ratio for the
2015 period
was
13.8%
,
decreasing
140
basis points from the
2014 period
primarily due to a decrease in the operating cost ratio in our Group segment with no change in the ratio for the Retail segment.
Depreciation and amortization
Depreciation and amortization for the
2015 quarter
totaled
$90 million
, compared to
$79 million
for the
2014 quarter
. For the
2015 period
, depreciation and amortization totaled
$183 million
compared to
$161 million
for the
2014 period
. These increases reflect increased capital expenditures.
Interest expense
Interest expense for the
2015 quarter
totaled
$47 million
, compared to
$35 million
for the
2014 quarter
and totaled
$93 million
for the
2015 period
compared to
$70 million
for the
2014 period
, primarily reflecting a higher average long-term debt balance due to the issuance of senior notes in September 2014.
Income Taxes
Our effective tax rate during the
2015 quarter
was
45.6%
compared to the effective tax rate of
46.7%
in the
2014 quarter
. For the
2015 period
our effective tax rate was
44.0%
compared to the effective tax rate of
46.5%
for the
2014 period
.
The tax effect of the sale of Concentra reduced our effective tax rate by approximately
6.5
percentage points for each of the
2015 quarter
and the
2015 period
, partially offset by an increase in the non-deductible health insurance industry fee from 2014.
42
Table of Contents
Retail Segment
June 30,
Change
2015
2014
Members
Percentage
Membership:
Medical membership:
Individual Medicare Advantage
2,709,300
2,359,000
350,300
14.8
%
Group Medicare Advantage
473,100
479,700
(6,600
)
(1.4
)%
Medicare stand-alone PDP
4,442,500
3,885,500
557,000
14.3
%
Total Retail Medicare
7,624,900
6,724,200
900,700
13.4
%
Individual commercial (a)
1,190,700
1,244,300
(53,600
)
(4.3
)%
State-based Medicaid
352,000
167,000
185,000
110.8
%
Total Retail medical members
9,167,600
8,135,500
1,032,100
12.7
%
Individual specialty membership (b)
1,203,600
1,229,500
(25,900
)
(2.1
)%
(a)
Individual commercial medical membership includes Medicare Supplement members.
(b)
Specialty products include dental, vision, and other supplemental health and financial protection products. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products.
For the three months ended
June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Premiums and Services Revenue:
Premiums:
Individual Medicare Advantage
$
7,434
$
6,467
$
967
15.0
%
Group Medicare Advantage
1,398
1,366
32
2.3
%
Medicare stand-alone PDP
985
941
44
4.7
%
Total Retail Medicare
9,817
8,774
1,043
11.9
%
Individual commercial
1,113
912
201
22.0
%
State-based Medicaid
559
214
345
161.2
%
Individual specialty
66
66
—
—
%
Total premiums
11,555
9,966
1,589
15.9
%
Services
2
13
(11
)
(84.6
)%
Total premiums and services revenue
$
11,557
$
9,979
$
1,578
15.8
%
Income before income taxes
$
260
$
400
$
(140
)
(35.0
)%
Benefit ratio
87.1
%
85.2
%
1.9
%
Operating cost ratio
10.5
%
10.7
%
(0.2
)%
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Table of Contents
For the six months ended
June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Premiums and Services Revenue:
Premiums:
Individual Medicare Advantage
$
14,867
$
12,927
$
1,940
15.0
%
Group Medicare Advantage
2,792
2,750
42
1.5
%
Medicare stand-alone PDP
1,988
1,806
182
10.1
%
Total Retail Medicare
19,647
17,483
2,164
12.4
%
Individual commercial
2,207
1,437
770
53.6
%
State-based Medicaid
1,150
383
767
200.3
%
Individual specialty
129
125
4
3.2
%
Total premiums
23,133
19,428
3,705
19.1
%
Services
6
27
(21
)
(77.8
)%
Total premiums and services revenue
$
23,139
$
19,455
$
3,684
18.9
%
Income before income taxes
$
635
$
769
$
(134
)
(17.4
)%
Benefit ratio
86.5
%
85.3
%
1.2
%
Operating cost ratio
10.7
%
10.7
%
—
%
Pretax Results
•
Retail segment pretax income was
$260 million
in the
2015 quarter
, a
decrease
of
$140 million
, or
35.0%
, compared to
$400 million
in the
2014 quarter
. Retail segment pretax income was
$635 million
in the
2015 period
, a
decrease
of
$134 million
, or
17.4%
, compared to
$769 million
in the
2014 period
. These declines were primarily driven by an increase in the benefit ratios in the
2015 quarter
and the
2015 period
partially offset by Medicare Advantage membership growth.
Enrollment
•
Individual Medicare Advantage membership
increased
350,300
members, or
14.8%
, from
June 30, 2014
to
June 30, 2015
reflecting net membership additions, particularly for our HMO offerings, for the 2015 plan year.
•
Group Medicare Advantage membership
decreased
6,600
, or
1.4%
, from
June 30, 2014
to
June 30, 2015
.
•
Medicare stand-alone PDP membership
increased
557,000
members, or
14.3%
, from
June 30, 2014
to
June 30, 2015
reflecting net membership additions, primarily for our Humana-Walmart plan offering, for the 2015 plan year
.
•
Individual commercial medical membership
decreased
53,600
members, or
4.3%
, from
June 30, 2014
to
June 30, 2015
primarily reflecting the loss of members subscribing to plans that are not compliant with the Health Care Reform Law partially offset by an increase in membership in plans that are compliant with the Health Care Reform Law, both on-exchange and off-exchange
.
•
State-based Medicaid membership
increased
185,000
members, or
110.8%
, from
June 30, 2014
to
June 30, 2015
, primarily driven by
the addition of members under our Florida Medicaid contract.
State-based Medicaid membership at
June 30, 2015
includes
16,400
dual-eligible demonstration members from state-based contracts compared to
4,000
members at
June 30, 2014
.
•
Individual specialty membership
decreased
25,900
members, or
2.1%
, from
June 30, 2014
to
June 30, 2015
, primarily driven by a membership decline in supplemental health and financial protection products.
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Table of Contents
Premiums
•
Retail segment premiums increased
$1.6 billion
, or
15.9%
, from the
2014 quarter
to the
2015 quarter
and increased
$3.7 billion
, or
19.1%
from the
2014 period
to the
2015 period
. These increases are primarily due to membership growth across our individual Medicare Advantage, state-based Medicaid, and Medicare stand-alone PDP lines of business, as well as a higher percentage of individual commercial medical business in higher premium plans compliant with the Health Care Reform Law (both on-exchange and off-exchange). Average Medicare Advantage membership increased
12.2%
for the
2015 quarter
and
12.4%
for the
2015 period
.
Benefits expense
•
The Retail segment benefit ratio
increased
190
basis points from
85.2%
in the
2014 quarter
to
87.1%
in the
2015 quarter
and
increased
120
basis points from
85.3%
in the
2014 period
to
86.5%
in the
2015 period
. These increases primarily reflect higher than expected medical costs as compared to the assumptions used in our pricing, unfavorable year-over-year comparisons of prior-period medical claims reserve development as discussed below, the impact of the change in estimate for the net 3Rs receivables, and higher benefit ratios associated with members from state-based contracts. We experienced higher than expected medical costs as compared to the assumptions used in our pricing for 2015 primarily due to lower-than-expected 2015 Medicare Advantage claim recoveries and lower-than-anticipated reductions in inpatient admissions from our clinical programs. In addition, medical claims associated with certain individual commercial medical products, in particular off-exchange products compliant with the Health Care Reform Law, exceeded the assumptions used when we set pricing for 2015. These items were partially offset by the impact of the increase in the health insurance industry fee included in the pricing of our products. In addition, the
2015 period
was favorably impacted by the release of reserves for future policy benefits as individual commercial medical members transitioned to plans compliant with the Health Care Reform Law.
•
The Retail segment’s benefits expense for the
2015 quarter
included
$11 million
in unfavorable prior-period medical claims reserve development versus favorable prior-period medical claims reserve development of
$58 million
in the
2014 quarter
. For the
2015 period
, the Retail segment's benefits expense included the beneficial effect of
$177 million
in favorable prior-period medical claims reserve development versus
$335 million
in the
2014 period
. Prior-period medical claims reserve development increased the Retail segment benefit ratio by approximately
10
basis points in the
2015 quarter
and decreased the Retail segment benefit ratio by approximately
60
basis points in the
2014 quarter
. Favorable prior-period medical claims reserve development decreased the Retail segment benefit ratio by approximately
80
basis points in the
2015 period
versus approximately
170
basis points in the
2014 period
.
•
The year-over-year declines in prior-period medical claims reserve development primarily were due to claim payment processing changes, such as our gradual implementation during 2014 of inpatient authorization review prior to admission as opposed to post adjudication, as well as higher than expected flu associated claims from the fourth quarter of 2014 and continued volatility in claims associated with individual commercial medical products.
Operating costs
•
The Retail segment operating cost ratio of
10.5%
for the
2015 quarter
decreased
20
basis points from
10.7%
for the
2014 quarter
primarily due to scale efficiencies associated with medical membership growth in the segment partially offset by the increase in the non-deductible health insurance industry fee. The Retail segment operating cost ratio of
10.7%
for the
2015 period
was unchanged from the
2014 period
reflecting the same factors as those for the quarter as well as the recognition of previously deferred acquisition costs as individual commercial medical members transitioned to plans compliant with the Health Care Reform Law primarily in the first quarter of 2015. The non-deductible health insurance industry fee impacted the operating cost ratio by
160
basis points in both the
2015 quarter
and
2015 period
and by
120
basis points in each of the
2014 quarter
and
2014 period
.
45
Table of Contents
Group Segment
June 30,
Change
2015
2014
Members
Percentage
Membership:
Medical membership:
Fully-insured commercial group
1,179,100
1,210,100
(31,000
)
(2.6
)%
ASO
736,600
1,120,100
(383,500
)
(34.2
)%
Military services
3,071,300
3,111,300
(40,000
)
(1.3
)%
Total group medical members
4,987,000
5,441,500
(454,500
)
(8.4
)%
Group specialty membership (a)
6,179,700
6,576,000
(396,300
)
(6.0
)%
(a)
Specialty products include dental, vision, and voluntary benefit products. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products.
For the three months ended
June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Premiums and Services Revenue:
Premiums:
Fully-insured commercial group
$
1,379
$
1,321
$
58
4.4
%
Group specialty
265
275
(10
)
(3.6
)%
Military services
4
4
—
—
%
Total premiums
1,648
1,600
48
3.0
%
Services
174
181
(7
)
(3.9
)%
Total premiums and services revenue
$
1,822
$
1,781
$
41
2.3
%
Income before income taxes
$
43
$
30
$
13
43.3
%
Benefit ratio
81.4
%
78.9
%
2.5
%
Operating cost ratio
24.1
%
26.9
%
(2.8
)%
46
Table of Contents
For the six months ended
June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Premiums and Services Revenue:
Premiums:
Fully-insured commercial group
$
2,763
$
2,650
$
113
4.3
%
Group specialty
535
550
(15
)
(2.7
)%
Military services
10
10
—
0.0
%
Total premiums
3,308
3,210
98
3.1
%
Services
343
374
(31
)
(8.3
)%
Total premiums and services revenue
$
3,651
$
3,584
$
67
1.9
%
Income before income taxes
$
197
$
174
$
23
13.2
%
Benefit ratio
77.6
%
75.7
%
1.9
%
Operating cost ratio
24.3
%
27.0
%
(2.7
)%
Pretax Results
•
Group segment pretax income
increased
$13 million
, or
43.3%
, to
$43 million
for the
2015 quarter
from the
2014 quarter
, and
increased
$23 million
, or
13.2%
, to
$197 million
for the
2015 period
from the
2014 period
primarily reflecting
improvement in the operating cost ratios partially offset by increases in the benefit ratios
as discussed below.
Enrollment
•
Fully-insured commercial group medical membership
decreased
31,000
members, or
2.6%
, from
June 30, 2014
to
June 30, 2015
as an increase in small group business membership was more than offset by lower membership in large group accounts.
•
Group ASO commercial medical membership
decreased
383,500
members, or
34.2%
, from
June 30, 2014
to
June 30, 2015
primarily due to the loss of certain large group accounts as a result of continued discipline in pricing of services for self-funded accounts amid a highly competitive environment.
•
Group specialty membership
decreased
396,300
members, or
6.0%
, from
June 30, 2014
to
June 30, 2015
primarily due to the loss of certain fully-insured group accounts.
Premiums
•
Group segment premiums
increased
$48 million
, or
3.0%
, to
$1.6 billion
for the
2015 quarter
from the
2014 quarter
and
increased
$98 million
, or
3.1%
, to
$3.3 billion
for the
2015 period
from the
2014 period
primarily due to an increase in fully-insured commercial medical per member premiums partially offset by a net decline in fully-insured commercial medical membership.
Services
•
Group segment services revenue
decreased
$7 million
, or
3.9%
, to
$174 million
for the
2015 quarter
from the
2014 quarter
and decreased $
31 million
, or
8.3%
, to
$343 million
for the
2015 period
from the
2014 period
primarily due to a decline in group ASO commercial medical membership.
47
Table of Contents
Benefits expense
•
The Group segment benefit ratio
increased
250
basis points from
78.9%
in the
2014 quarter
to
81.4%
in the
2015 quarter
and
increased
190
basis points from
75.7%
in the
2014 period
to
77.6%
in the
2015 period
. The increases primarily reflect the impact of higher specialty drug costs, net of rebates, partially offset by an increase in the non-deductible health insurance industry fee included in the pricing of our products.
•
The Group segment’s benefits expense included unfavorable prior-period medical claims reserve development of
$6 million
in the
2015 quarter
versus
$7 million
in the
2014 quarter
. This unfavorable prior-period medical claims reserve development increased the Group segment benefit ratio by approximately
40
basis points in each of the
2015 quarter
and the
2014 quarter
. The Group segment’s benefits expense included unfavorable prior-period medical claims reserve development of
$1 million
in the
2015 period
versus favorable prior-period medical claims reserve development of
$13 million
in the
2014 period
. The favorable prior-period medical claims reserve development had no impact on the Group segment benefit ratio in the
2015 period
and decreased the Group segment benefit ratio by approximately
40
basis points in the
2014 period
. The year-over-year decline in favorable prior-period medical claims reserve development primarily was due to a relatively small number of higher severity claims in the 2015 period associated with prior periods.
Operating costs
•
The Group segment operating cost ratio of
24.1%
for the
2015 quarter
decreased
280
basis points from
26.9%
for the
2014 quarter
. For the
2015 period
, the Group segment operating cost ratio of
24.3%
decreased
270
basis points from
27.0%
for the
2014 period
. The declines primarily reflect a decline in our group ASO commercial medical membership which carries a higher operating cost ratio than our fully-insured commercial medical membership, as well as operating cost efficiencies associated with our fully-insured business as a result of our cost reduction initiatives. These decreases were partially offset by the impact of an increase in the non-deductible health insurance industry fee. The non-deductible health insurance industry fee impacted the operating cost ratio by
140
basis points in each of the
2015 quarter
and
2015 period
and
100
basis points in each of the
2014 quarter
and
2014 period
.
48
Table of Contents
Healthcare Services Segment
For the three months ended June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Revenues:
Services:
Provider services
$
185
$
299
$
(114
)
(38.1
)%
Home based services
36
25
11
44.0
%
Pharmacy solutions
7
25
(18
)
(72.0
)%
Total services revenues
228
349
(121
)
(34.7
)%
Intersegment revenues:
Pharmacy solutions
5,077
4,204
873
20.8
%
Provider services
403
269
134
49.8
%
Home based services
218
138
80
58.0
%
Clinical programs
50
51
(1
)
(2.0
)%
Total intersegment revenues
5,748
4,662
1,086
23.3
%
Total services and intersegment revenues
$
5,976
$
5,011
$
965
19.3
%
Income before income taxes
$
223
$
206
$
17
8.3
%
Operating cost ratio
95.6
%
95.2
%
0.4
%
For the six months ended June 30,
Change
2015
2014
Dollars
Percentage
(in millions)
Revenues:
Services:
Provider services
$
464
$
583
$
(119
)
(20.4
)%
Home based services
65
48
17
35.4
%
Pharmacy solutions
14
46
(32
)
(69.6
)%
Total services revenues
543
677
(134
)
(19.8
)%
Intersegment revenues:
Pharmacy solutions
10,037
8,061
1,976
24.5
%
Provider services
767
571
196
34.3
%
Home based services
408
256
152
59.4
%
Clinical Programs
99
101
(2
)
(2.0
)%
Total intersegment revenues
11,311
8,989
2,322
25.8
%
Total services and intersegment
revenues
$
11,854
$
9,666
$
2,188
22.6
%
Income before income taxes
$
453
$
391
$
62
15.9
%
Operating cost ratio
95.5
%
95.2
%
0.3
%
49
Table of Contents
Pretax results
•
Healthcare Services segment pretax income of
$223 million
for the
2015 quarter
increased
$17 million
, or
8.3%
, from the
2014 quarter
. For the
2015 period
, the Healthcare Services segment pretax income of
$453 million
increased
$62 million
, or
15.9%
, from
$391 million
for the
2014 period
. These increases are primarily due to
revenue growth from our pharmacy solutions and home based services businesses as they serve our growing Medicare membership
.
Script Volume
•
Humana Pharmacy Solutions
®
script volumes for Retail and Group segment membership increased to approximately
98.4 million
in the
2015 quarter
, up
20.6%
versus scripts of approximately
81.6 million
in the
2014 quarter
. For the
2015 period
, script volumes for Retail and Group segment membership increased to approximately
194.5 million
, up
21.4%
versus scripts of approximately
160.2 million
in the
2014 period
. These increases primarily reflect growth associated with higher average medical membership for the
2015 quarter
and
2015 period
than in the
2014 quarter
and
2014 period
.
Services revenues
•
Services revenues
decreased
$121 million
, or
34.7%
, from the
2014 quarter
to
$228 million
for the
2015 quarter
and
decreased
$134 million
, or
19.8%
, from the
2014 period
to
$543 million
for the
2015 period
primarily due to the completion of the sale of Concentra on June 1, 2015.
Intersegment revenues
•
Intersegment revenues
increased
$1.1 billion
, or
23.3%
, from the
2014 quarter
to
$5.7 billion
for the
2015 quarter
and
increased
$2.3 billion
, or
25.8%
, from the
2014 period
to
$11.3 billion
for the
2015 period
primarily due to growth in our Medicare membership which resulted in higher utilization of our Healthcare Services segment businesses.
Operating costs
•
The Healthcare Services segment operating cost ratios for the
2015 quarter
and
2015 period
were relatively unchanged from the
2014 quarter
and
2014 period
,
increasing
40
basis points for the
2015 quarter
to
95.6%
and
30
basis points to
95.5%
for the
2015 period
.
50
Table of Contents
Liquidity
The Merger Agreement includes customary restrictions on the conduct of our business prior to the completion of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of specified limitations absent Aetna’s prior written consent. Historically, our primary sources of cash have included receipts of premiums, services revenue, and investment and other income, as well as proceeds from the sale or maturity of our investment securities, borrowings, and proceeds from sales of businesses. Our primary uses of cash historically have included disbursements for claims payments, operating costs, interest on borrowings, taxes, purchases of investment securities, acquisitions, capital expenditures, repayments on borrowings, dividends, and share repurchases. Because premiums generally are collected in advance of claim payments by a period of up to several months, our business normally should produce positive cash flows during periods of increasing premiums and enrollment. Conversely, cash flows would be negatively impacted during periods of decreasing premiums and enrollment. From period to period, our cash flows may also be affected by the timing of working capital items including premiums receivable, benefits payable, and other receivables and payables. The use of operating cash flows may be limited by regulatory requirements of state departments of insurance (or comparable state regulators) which require, among other items, that our regulated subsidiaries maintain minimum levels of capital and seek approval before paying dividends from the subsidiaries to the parent. Our use of operating cash flows derived from our non-insurance subsidiaries, such as in our Healthcare Services segment, is generally not restricted by state departments of insurance (or comparable state regulators).
The effect of the commercial risk adjustment, risk corridor, and reinsurance provisions of the Health Care Reform Law are impacting the timing of our operating cash flows, as we built receivables for the 2014 coverage year that we expect to collect in the second half of 2015 and we are building receivables for the 2015 coverage year that we expect to collect in the second half of 2016. The net receivable balance associated with the 3Rs was approximately
$899 million
at
June 30, 2015
, including
$639 million
related to the 2014 coverage year, and
$679 million
at
December 31, 2014
. On June 30, 2015 we received notification from CMS of risk adjustment and reinsurance settlement amounts for 2014. These settlement amounts as well as the corresponding change in estimate for risk corridor are reflected in the 2014 coverage year net 3Rs receivable above. Any amounts receivable or payable associated with these risk limiting programs may have an impact on subsidiary liquidity, with any temporary shortfalls funded by the parent company.
For additional information on our liquidity risk, please refer to the section entitled “Risk Factors” in our 2014 Form 10-K.
Cash and cash equivalents increased to approximately
$2.3 billion
at
June 30, 2015
from
$1.9 billion
at
December 31, 2014
. The change in cash and cash equivalents for the
six months ended June 30, 2015
and
2014
is summarized as follows:
2015
2014
(in millions)
Net cash (used in) provided by operating activities
$
(501
)
$
471
Net cash provided by investing activities
1,222
404
Net cash used in financing activities
(406
)
(420
)
Increase in cash and cash equivalents
$
315
$
455
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Table of Contents
Cash Flow from Operating Activities
The
decrease
in operating cash flows from the
2014 period
to the
2015 period
primarily reflects the effect of significant growth in individual commercial medical and group Medicare Advantage membership in the prior year, lower earnings exclusive of the gain on the sale of Concentra, and changes in the timing of other working capital items related to the growth in our pharmacy business and the timing of receipts for premiums. Prior year cash flows were favorably impacted from the typical pattern of claim payments that lagged premium receipts related to new membership. Individual commercial medical added
644,200
new members in the
2014 period
compared to
42,600
in the
2015 period
. Likewise group Medicare Advantage added
50,600
new members in the
2014 period
compared to a decline of
16,600
members in the
2015 period
.
The most significant drivers of changes in our working capital are typically the timing of payments of benefits expense and receipts for premiums. We illustrate these changes with the following summaries of benefits payable and receivables.
The detail of benefits payable was as follows at
June 30, 2015
and
December 31, 2014
:
June 30, 2015
December 31, 2014
2015
Period
Change
2014
Period
Change
(in millions)
IBNR (1)
$
3,376
$
3,254
$
122
$
656
Reported claims in process (2)
522
475
47
254
Other benefits payable (3)
883
746
137
(25
)
Total benefits payable
$
4,781
$
4,475
$
306
$
885
(1)
IBNR represents an estimate of benefits payable for claims incurred but not reported (IBNR) at the balance sheet date and includes unprocessed claim inventories. 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 and processed (i.e. a shorter time span results in a lower IBNR).
(2)
Reported claims in process represents 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, as well as amounts owed to our pharmacy benefit administrator which fluctuate due to bi-weekly payments and the month-end cutoff.
(3)
Other benefits payable primarily include amounts owed to providers under capitated and risk sharing arrangements.
The
increase
in benefits payable from
December 31, 2014
to
June 30, 2015
and from
December 31, 2013
to
June 30, 2014
largely was due to an increase in IBNR. IBNR increased during the
2015 period
primarily as a result of individual Medicare Advantage membership growth while the
2014 period
also saw, in addition to individual Medicare Advantage membership growth, significant growth in individual commercial medical and group Medicare Advantage membership. An increase in the amount of processed but unpaid claims, including amounts due to our pharmacy benefit administrator, which fluctuate due to month-end cutoff, also contributed to the benefits payable increase in both periods. In addition, benefits payable increased in the
2015 period
from an increase in amounts owed to providers under capitated and risk sharing arrangements. As discussed previously, our cash flows are impacted by changes in enrollment. In the
2014 period
(the first period plans compliant with the Health Care Reform Law were effective), membership growth in new fully-insured individual commercial medical plans compliant with the Health Care Reform Law outpaced membership growth in these plans in the
2015 period
. In addition, growth in group Medicare Advantage membership in the
2014 period
favorably impacted the
2014 period
change while a decline in group Medicare Advantage membership in the
2015 period
negatively impacted the
2015 period
change.
52
Table of Contents
The detail of total net receivables was as follows at
June 30, 2015
and
December 31, 2014
:
June 30, 2015
December 31, 2014
2015
Period
Change
2014
Period
Change
(in millions)
Medicare
$
1,792
$
664
$
1,128
$
1,105
Commercial and other
358
381
(23
)
13
Military services
83
106
(23
)
9
Allowance for doubtful accounts
(104
)
(98
)
(6
)
(3
)
Total net receivables
$
2,129
$
1,053
1,076
1,124
Reconciliation to cash flow statement:
Change in receivables held-for-sale and
disposition of receivables from sale of business
11
13
Change in receivables per cash flow
statement resulting in cash from operations
$
1,087
$
1,137
The changes in Medicare receivables for both the
2015 period
and the
2014 period
reflect the typical pattern caused by the timing of accruals and related collections associated with the CMS risk-adjustment model. Significant collections occur with the final and mid-year settlements with CMS in July and August, respectively. In connection with our July 2015 payment from CMS, we collected
$495 million
associated with the final Medicare risk-adjustment payment for the 2014 plan year. In addition, in connection with our August 2015 payment from CMS, we expect to collect approximately
$800 million
associated with the mid-year Medicare risk-adjustment payment for the 2015 plan year.
Many provisions of the Health Care Reform Law became effective in 2014, including the commercial risk adjustment, risk corridor, and reinsurance provisions as well as the non-deductible health insurance industry fee. As discussed previously, the timing of payments and receipts associated with these provisions are impacting our operating cash flows as we built a receivable for the 2014 coverage year that we expect to collect in the second half of 2015 and as we build a receivable for the 2015 coverage year that we expect to collect in the second half of 2016. The net receivable balance associated with the 3Rs was approximately
$899 million
at
June 30, 2015
and
$679 million
at
December 31, 2014
, including certain amounts recorded in receivables above. In September 2015, we expect to pay the federal government
$866 million
for the annual health insurance industry fee.
Cash Flow from Investing Activities
Proceeds from sales and maturities of investment securities exceeded purchases by
$464 million
in the
2015 period
and
$551 million
in the
2014 period
. These proceeds were used to fund normal working capital needs due to an increase in receivables associated with the 3Rs in addition to the timing of payments to and receipts from CMS associated with Medicare Part D reinsurance subsidies, as discussed below.
Our ongoing capital expenditures primarily relate to our information technology initiatives, support of services in our provider services operations including medical and administrative facility improvements necessary for activities such as the provision of care to members, claims processing, billing and collections, wellness solutions, care coordination, regulatory compliance and customer service. Total capital expenditures, excluding acquisitions, were
$259 million
in the
2015 period
and
$216 million
in the
2014 period
reflecting increased spending associated with growth in our provider services and pharmacy businesses in our Healthcare Services segment. Excluding acquisitions, we expect total capital expenditures in
2015
in a range of approximately
$475 million
to
$525 million
compared to total capital expenditures of
$528 million
for full year
2014
.
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Table of Contents
Cash Flow from Financing Activities
Claims payments were
higher than receipts from CMS associated with Medicare Part D claim subsidies for which we do not assume risk
by
$270 million
during the
2015 period
and
$122 million
during the
2014 period
. Our net receivable for CMS subsidies and brand name prescription drug discounts was
$1.9 billion
at
June 30, 2015
compared to
$835 million
at
June 30, 2014
and
$1.7 billion
at
December 31, 2014
. Refer to Note 6 to the condensed consolidated financial statements.
Under our administrative services only TRICARE South Region contract,
health care cost payments for which we do not assume risk exceeded reimbursements from the federal government
by
$22 million
during the
2015 period
compared to
$29 million
during the
2014 period
.
Receipts from the Department of Health and Humana Services, or HHS, associated with cost sharing provisions of the Health Care Reform Law for which we do not assume risk were
$33 million
higher than claims payments
during the
2015 period
and
$24 million
higher than claims payments
during the
2014 period
.
We repurchased
1.9 million
shares for
$329 million
in the
2015 period
and
0.9 million
shares for
$112 million
in the
2014 period
under share repurchase plans authorized by the Board of Directors. We also acquired common shares in connection with employee stock plans for an aggregate cost of
$42 million
in the
2015 period
and
$40 million
in the
2014 period
.
Proceeds from the issuance of commercial paper were
$300 million
in the
2015 period
and the maximum principal amount outstanding at any one time during the
six months ended June 30, 2015
was
$300 million
. We entered into the commercial paper program in October 2014. Accordingly, there were no commercial paper borrowings during the
2014 period
.
We paid dividends to stockholders of
$86 million
during both the
2015 period
and the
2014 period
, as discussed further below.
Future Sources and Uses of Liquidity
Dividends
The following table provides details of dividend payments, excluding dividend equivalent rights, in
2014
and
2015
under our Board approved quarterly cash dividend policy:
Record
Date
Payment
Date
Amount
per Share
Total
Amount
(in millions)
2014 payments
12/31/2013
1/31/2014
$
0.27
$
42
3/31/2014
4/25/2014
$
0.27
$
42
6/30/2014
7/25/2014
$
0.28
$
43
9/30/2014
10/31/2014
$
0.28
$
43
2015 payments
12/31/2014
1/30/2015
$
0.28
$
42
3/31/2015
4/24/2015
$
0.28
$
42
6/30/2015
7/31/2015
$
0.29
$
43
The Merger
discussed in Note 1 to the condensed consolidated financial statements
does not impact our ability and intent to continue quarterly dividend payments prior to the closing of the Merger, including the cash dividend of
$0.29
per share payable on
July 31, 2015
to stockholders of record on
June 30, 2015
. Under the terms of the Merger Agreement we have agreed with Aetna that our quarterly dividend will not exceed $0.29 per share prior to the closing of the Merger.
Declaration and payment of future quarterly dividends is at the discretion of our Board and may be
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Table of Contents
adjusted as business needs or market conditions change. In addition, under the terms of the Merger Agreement, we have agreed with Aetna to coordinate the declaration and payment of dividends so that our stockholders do not fail to receive a quarterly dividend around the time of the closing of the Merger.
Stock Repurchases
In September
2014
, our Board of Directors replaced a previous share repurchase authorization of up to
$1 billion
(of which
$816 million
remained unused) with a new authorization for repurchases of up to
$2 billion
of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on
December 31, 2016
. Under the new share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, or in privately-negotiated transactions (including pursuant to accelerated share repurchase agreements with investment banks), subject to certain regulatory restrictions on volume, pricing, and timing.
Pursuant to the Merger Agreement with Aetna discussed
previously
, after July 2, 2015, we are prohibited from repurchasing any of our outstanding securities without the prior written consent of Aetna, other than repurchases of shares of our common stock in connection with the exercise of outstanding stock options or the vesting or settlement of outstanding restricted stock awards. Accordingly, as announced on July 3, 2015, we have suspended our share repurchase program due to the Merger.
Our remaining repurchase authorization was
$1.04 billion
as of July 3, 2015.
On November 7, 2014, we announced that we had entered into an accelerated share repurchase agreement, or ASR Agreement, with Goldman, Sachs & Co., or Goldman Sachs, to repurchase $500 million of our common stock as part of the $2 billion share repurchase program authorized in September 2014. Under the ASR Agreement, on November 10, 2014, we made a payment of $500 million to Goldman Sachs from available cash on hand and received an initial delivery of 3.06 million shares of our common stock from Goldman Sachs based on the then current market price of Humana common stock. The payment to Goldman Sachs was recorded as a reduction to stockholders’ equity, consisting of a $400 million increase in treasury stock, which reflected the value of the initial 3.06 million shares received upon initial settlement, and a $100 million decrease in capital in excess of par value, which reflected the value of stock held back by Goldman Sachs pending final settlement of the ASR Agreement. Upon settlement of the ASR on
March 13, 2015
, we received an additional
0.36 million
shares as determined by the average daily volume weighted-average share price of our common stock during the term of the ASR Agreement of
$146.21
, bringing the total shares received under this program to
3.42 million
. In addition, upon settlement we reclassified the $100 million value of stock initially held back by Goldman Sachs from capital in excess of par value to treasury stock.
Excluding the
0.36 million
shares received in March 2015 upon settlement of our ASR Agreement for which no cash was paid during the period, share repurchases were as follows during the
2015 quarter
and the
2014 quarter
:
Three months ended June 30,
2015
2014
Authorization Date
Purchase Not to Exceed
Shares
Cost
Shares
Cost
(in millions)
September 2014
$
2,000
1.85
$
329
—
$
—
April 2014
1,000
—
—
0.81
101
April 2013
1,000
—
—
0.10
11
Total repurchases
1.85
$
329
0.91
$
112
In connection with employee stock plans, we acquired
0.3 million
common shares for
$42 million
and
0.4 million
common shares for
$40 million
during the
2015 period
and
2014 period
, respectively, which amounts are not included in the table above.
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Table of Contents
Senior Notes
In September 2014, we issued $400 million of 2.625% senior notes due October 1, 2019, $600 million of 3.85% senior notes due October 1, 2024 and $750 million of 4.95% senior notes due October 1, 2044. Our net proceeds, reduced for the underwriters' discount and commission and offering expenses, were
$1.73 billion
.
We used a portion of the net proceeds to redeem the 6.45% senior unsecured notes as discussed below.
We previously issued $500 million of 6.45% senior notes due June 1, 2016, $500 million of 7.20% senior notes due June 15, 2018, $300 million of 6.30% senior notes due August 1, 2018, $600 million of 3.15% senior notes due December 1, 2022, $250 million of 8.15% senior notes due June 15, 2038, and $400 million of 4.625% senior notes due December 1, 2042.
In October 2014, we redeemed the $500 million 6.45% senior unsecured notes due June 1, 2016, at
100%
of the principal amount plus applicable premium for early redemption and accrued and unpaid interest to the redemption date, for cash totaling approximately
$560 million
. We recognized a loss on extinguishment of debt of approximately
$37 million
in October 2014 for the redemption of these notes.
Our senior notes, which are unsecured, may be redeemed at our option at any time at
100%
of the principal amount plus accrued interest and a specified make-whole amount. The 7.20% and 8.15% senior notes are subject to an interest rate adjustment if the debt ratings assigned to the notes are downgraded (or subsequently upgraded). In addition, each series of our senior notes (other than the 6.30% senior notes) contain a change of control provision that may require us to purchase the notes under certain circumstances. On July 2, 2015 we entered into a Merger Agreement with Aetna that, when closed, may require redemption of the notes if the notes are downgraded below investment grade by both Standard & Poor’s Rating Services, or S&P and Moody’s Investors Services, Inc., or Moody’s.
Credit Agreement
Our 5-year $1.0 billion unsecured revolving credit agreement expires July 2018. Under the credit agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion bears interest at either LIBOR plus a spread or the base rate plus a spread. The LIBOR spread, currently
110
basis points, varies depending on our credit ratings ranging from 90.0 to 150.0 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently
15
basis points, may fluctuate between 10.0 and 25.0 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate based on LIBOR, at our option.
The terms of the credit agreement include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow additional funds. In addition, the credit agreement contains customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of a minimum level of net worth of
$8.3 billion
at
June 30, 2015
and a maximum leverage ratio of
3.0
. We are in compliance with the financial covenants, with actual net worth of
$10.1 billion
and an actual leverage ratio of
1.3
, as measured in accordance with the credit agreement as of
June 30, 2015
. In addition, the credit agreement includes an uncommitted
$250 million
incremental loan facility.
At
June 30, 2015
, we had no borrowings outstanding under the credit agreement and we had outstanding letters of credit of
$1 million
secured under the credit agreement. No amounts have been drawn on these letters of credit. Accordingly, as of
June 30, 2015
, we had
$999 million
of remaining borrowing capacity under the credit agreement, none of which would be restricted by our financial covenant compliance requirement. We have other customary, arms-length relationships, including financial advisory and banking, with some parties to the credit agreement.
Commercial Paper
In October 2014, we entered into a commercial paper program pursuant to which we may issue short-term, unsecured commercial paper notes privately placed on a discount basis through certain broker dealers. Amounts available under the program may be borrowed, repaid and re-borrowed from time to time, with the aggregate face or principal amount outstanding under the program at any time not to exceed
$1 billion
. The net proceeds of issuances have been and are expected to be used for general corporate purposes. The maximum principal amount outstanding at any one time during
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the
six months ended June 30, 2015
was
$300 million
. As of
June 30, 2015
we had
$300 million
outstanding in our commercial paper program. There were no outstanding borrowings at
December 31, 2014
.
Liquidity Requirements
We believe our cash balances, investment securities, operating cash flows, and funds available under our credit agreement and our commercial paper program or from other public or private financing sources, taken together, provide adequate resources to fund ongoing operating and regulatory requirements, acquisitions, future expansion opportunities, and capital expenditures for at least the next twelve months, as well as to refinance or repay debt, and repurchase shares.
Adverse changes in our credit rating may increase the rate of interest we pay and may impact the amount of credit available to us in the future. Our investment-grade credit rating at
June 30, 2015
was
BBB+
according to Standard & Poor’s Rating Services, or S&P, and
Baa3
according to Moody’s Investors Services, Inc., or Moody’s. A downgrade by S&P to BB+ or by Moody’s to Ba1 triggers an interest rate increase of 25 basis points with respect to $750 million of our senior notes. Successive one notch downgrades increase the interest rate an additional 25 basis points, or annual interest expense by $2 million, up to a maximum 100 basis points, or annual interest expense by $8 million.
In addition, we operate as a holding company in a highly regulated industry. Humana Inc., our parent company, is dependent upon dividends and administrative expense reimbursements from our subsidiaries, most of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated operating subsidiaries. Cash, cash equivalents, and short-term investments at the parent company were
$1.9 billion
at
June 30, 2015
compared to
$1.4 billion
at
December 31, 2014
. This increase primarily reflects proceeds from the sale of Concentra on June 1, 2015, subsidiary dividends to the parent company, and proceeds from the issuance of commercial paper partially offset by funding of subsidiary working capital requirements, common stock repurchases, capital expenditures, and payment of stockholder dividends. Statutory accounting for the health insurance industry fee requires us to restrict surplus in the year preceding payment. Therefore, in addition to recording the full-year 2015 assessment in the first quarter of 2015, we are required to restrict surplus for the 2016 assessment ratably in 2015. In September 2015, we expect to pay the federal government
$866 million
for the annual health insurance industry fee.
Regulatory Requirements
Certain of our subsidiaries operate in states that regulate the payment of dividends, loans, or other cash transfers to Humana Inc., our parent company, and require minimum levels of equity as well as limit investments to approved securities. The amount of dividends that may be paid to Humana Inc. by these subsidiaries, without prior approval by state regulatory authorities, or ordinary dividends, is limited based on the entity’s level of statutory income and statutory capital and surplus. In most states, prior notification is provided before paying a dividend even if approval is not required. Actual dividends paid may vary due to consideration of excess statutory capital and surplus and expected future surplus requirements related to, for example, premium volume and product mix.
Although minimum required levels of equity are largely based on premium volume, product mix, and the quality of assets held, minimum requirements vary significantly at the state level. Based on the most recently filed statutory financial statements as of
March 31, 2015
, our state regulated subsidiaries had aggregate statutory capital and surplus of approximately
$5.4 billion
, which exceeded aggregate minimum regulatory requirements of
$4.2 billion
. The amount of dividends paid to our parent company was approximately
$457 million
during the
six months ended June 30, 2015
compared to
$695 million
during the
six months ended June 30, 2014
. The year-over-year decline in dividends to the parent company from the subsidiaries is primarily driven by lower operating results in health plan subsidiaries, including the impact of recording the significantly higher full-year
2015
annual health insurance industry fee in the first quarter of
2015
, as required by state regulators. As discussed previously, we expect to pay the federal government
$866 million
for the annual health insurance industry fee in
2015
, a
54.1%
increase from
$562 million
in
2014
. Subsidiary dividends are subject to state regulatory approval, the amount and timing of which could be reduced or delayed.
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Table of Contents
Item 3. Quantitative and Qualitative Disclosures about Market Risk
Our earnings and financial position are exposed to financial market risk, including those resulting from changes in interest rates.
Interest rate risk also represents a market risk factor affecting our consolidated financial position due to our significant investment portfolio, consisting primarily of fixed maturity securities of investment-grade quality with a weighted average S&P credit rating of
AA-
at
June 30, 2015
. Our net unrealized position
decreased
$219 million
from a net unrealized gain position of
$475 million
at
December 31, 2014
to a net unrealized gain position of
$256 million
at
June 30, 2015
. At
June 30, 2015
, we had gross unrealized losses of
$92 million
on our investment portfolio primarily due to an increase in market interest rates since the time the securities were purchased. There were no material other-than-temporary impairments during the
three months ended June 30, 2015
. While we believe that these impairments are temporary and we currently do not have the intent to sell such securities, given the current market conditions and the significant judgments involved, there is a continuing risk that future declines in fair value may occur and material realized losses from sales or other-than-temporary impairments may be recorded in future periods.
Duration is the time-weighted average of the present value of the bond portfolio’s cash flow. Duration is indicative of the relationship between changes in fair value and changes in interest rates, providing a general indication of the sensitivity of the fair values of our fixed maturity securities to changes in interest rates. However, actual fair values may differ significantly from estimates based on duration. The average duration of our investment portfolio, including cash and cash equivalents, was approximately
4.2
years as of
June 30, 2015
and
4.1
years as of
December 31, 2014
. Based on the duration, including cash equivalents, a 1% increase in interest rates would generally decrease the fair value of our securities by approximately
$440 million
.
Item 4. Controls and Procedures
Under the supervision and with the participation of our Chief Executive Officer, or CEO, our Chief Financial Officer, or CFO, and our Principal Accounting Officer, we carried out an evaluation of the effectiveness of the design and operation of our disclosure controls and procedures for the quarter ended
June 30, 2015
.
Based on our evaluation, our CEO, CFO, and our Principal Accounting Officer concluded that our disclosure controls and procedures are effective to provide reasonable assurance that information the Company is required to disclose in its reports under the Securities Exchange Act of 1934, as amended, is recorded, processed, summarized and reported within the time periods specified in SEC rules and forms, including, without limitation, ensuring that such information is accumulated and communicated to the Company’s management, including its principal executive and principal financial officers, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.
There have been no changes in the Company’s internal control over financial reporting during the quarter ended
June 30, 2015
that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.
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Part II. Other Information
Item 1. Legal Proceedings
For a description of the legal proceedings pending against us and certain other pending or threatened litigation, investigations, or other matters, see “Legal Proceedings and Certain Regulatory Matters” in Note 13 to the condensed consolidated financial statements beginning on page 23 of this Form 10-Q.
Item 1A. Risk Factors
Except as set forth below, there have been no changes to the risk factors included in our 2014 Form 10-K:
Risks Relating to the Proposed Merger with Aetna
The merger with Aetna is subject to various closing conditions, including governmental, regulatory and stockholder approvals as well as other uncertainties and there can be no assurances as to whether and when it may be completed.
On July 2, 2015, we entered into an Agreement and Plan of Merger (which we refer to as the “Merger Agreement”), with Aetna Inc. (or “Aetna”), Echo Merger Sub, Inc. (or “Sub 1”) and Echo Merger Sub, LLC (or “Sub 2”), each a wholly owned subsidiary of Aetna. Under the terms and subject to the conditions set forth in the Merger Agreement, Sub 1 will merge with and into us (the “Merger”). In the Merger, each outstanding share of our common stock will be converted into the right to receive (i) 0.8375 of a share of Aetna common stock and (ii) $125 in cash without interest, subject to any required withholding taxes. Immediately after the Merger, we (as the surviving corporation in the Merger) will be merged with and into Sub 2, with Sub 2 remaining as the surviving entity of that merger and as a wholly owned subsidiary of Aetna, to be renamed Humana LLC. The Merger is expected to close in the second half of 2016.
Consummation of the Merger is subject to customary closing conditions, a number of which are not within our or Aetna’s control, and it is possible that such conditions may prevent, delay or otherwise materially adversely affect the completion of the Merger. These conditions include, among other things, (i) approval of the holders of our outstanding shares of common stock entitled to vote on the Merger, (ii) approval of the holders of Aetna outstanding shares to the issuance of Aetna common stock in the Merger, (iii) the expiration or termination of the applicable waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, and the receipt of necessary approvals under state insurance and healthcare laws and regulations and pursuant to certain licenses of certain of Humana’s subsidiaries, (iv) the absence of legal restraints and prohibitions on the consummation of the Merger, (v) the effectiveness of the registration statement in respect of the Aetna common stock to be issued in the Merger, (vi) listing of the Aetna common stock to be issued in the Merger on the New York Stock Exchange, (vii) subject to the relevant standards set forth in the Merger Agreement, the accuracy of the representations and warranties made by each party, (viii) material compliance by each party with its covenants in the Merger Agreement, and (viii) no “Company Material Adverse Effect” with respect to us and no “Parent Material Adverse Effect” with respect to Aetna, in each case since the execution of and as defined in the Merger Agreement. In addition, Aetna’s obligation to consummate the Merger is subject to (x) the condition that the required regulatory approvals do not impose any condition that, individually or in the aggregate, would reasonably be expected to have a “Regulatory Material Adverse Effect” (as such term is defined in the Merger Agreement), and (b) the Centers for Medicare and Medicaid Services, or CMS, has not imposed any sanctions with respect to our Medicare Advantage business that, individually or in the aggregate, is or would reasonably be expected to be material and adverse to us and its subsidiaries, taken as a whole. We cannot predict with certainty whether and when any of the required closing conditions will be satisfied or if another uncertainty may arise.
If the Merger does not receive, or timely receive, the required regulatory approvals and clearances, or if any regulatory agencies impose certain conditions relating to the required regulatory approvals that would reasonably be expected to have a "Regulatory Material Adverse Effect", or if an event occurs that delays or prevents the Merger, such failure or delay to complete the Merger may cause uncertainty or other negative consequences that may materially and adversely affect our results of operations, financial position, cash flows and the price per share for our common stock.
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The Merger Agreement limits our ability to pursue alternative transactions to the proposed Merger.
The Merger Agreement prohibits us from initiating, soliciting, knowingly encouraging, knowingly facilitating or entering into discussions or negotiations with any third party regarding alternative acquisition proposals. This prohibition limits our ability to affirmatively seek offers from other possible acquirers that may be superior to the pending Merger, although we are permitted, subject to compliance with certain procedures specified in the Merger Agreement, to respond to certain unsolicited proposals from third parties to allow our Board of Directors to comply with its fiduciary duties. If we receive an unsolicited proposal from a third party that our Board of Directors determines is a superior proposal (as defined in the Merger Agreement), our Board of Directors may withdraw or otherwise change its recommendation of the Merger. However, we do not have the ability to terminate the Merger Agreement in order to accept a superior proposal. If our Board of Directors withdraws or otherwise changes its recommendation of the Merger, or if we materially breach our obligation not to solicit alternative acquisition proposals, Aetna may terminate the Merger Agreement and we would be contractually obligated to pay a termination fee of $1.314 billion to Aetna. This termination fee may make it less likely that a third party will make an alternative acquisition proposal for us.
The number of shares of Aetna common stock that our stockholders will receive in the Merger is based on a fixed exchange ratio. Because the market price of Aetna’s common stock will fluctuate, our stockholders cannot be certain of the value of the portion of the merger consideration to be paid in Aetna common stock.
Upon completion of the Merger, each outstanding share of our common stock will be converted into the right to receive (i) 0.8375 of a share of Aetna common stock and (ii) $125 in cash without interest, subject to any required withholding taxes. The exchange ratio for determining the number of shares of Aetna common stock that our stockholders will receive in the Merger is fixed and will not be adjusted for changes in the market price of Aetna’s common stock, which will likely fluctuate before and after the completion of the Merger. Fluctuations in the value of Aetna’s common stock could result from changes in the business, operations or prospects of Aetna prior to or following the closing of the Merger, regulatory considerations, general market and economic conditions and other factors both within and beyond the control of us or Aetna. In addition, the Merger is expected to be completed a considerable amount of time after the date of our special meeting of stockholders to consider and vote on the Merger. As such, at the time of our special meeting of stockholders to consider and vote on the Merger, our stockholders will not have known the value of the Aetna share consideration that they will receive in the Merger for each of our common shares.
While the Merger is pending, we are subject to business uncertainties and contractual restrictions that could materially adversely affect our results of operations, financial position and cash flows or result in a loss of employees, customers, members or suppliers.
The Merger Agreement includes restrictions on the conduct of our business prior to the completion or termination of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of specified limitations absent Aetna’s prior written consent. We may find that these and other contractual restrictions in the Merger Agreement may delay or prevent us from responding, or limit our ability to respond, effectively to competitive pressures, industry developments and future business opportunities that may arise during such period, even if our management believes they may be advisable. The pendency of the proposed Merger may also divert management’s attention and our resources from ongoing business and operations.
Our employees, customers, members and suppliers may experience uncertainties about the effects of the Merger. In connection with the pending Merger, it is possible that some customers, members, suppliers and other parties with whom we have a business relationship may delay or defer certain business decisions or might decide to seek to terminate, change or renegotiate their relationship with us as a result of the Merger. Similarly, current and prospective employees may experience uncertainty about their future roles with us following completion of the Merger, which may materially adversely affect our ability to attract and retain key employees. If any of these effects were to occur, it could materially and adversely impact our results of operations, financial position, cash flows and the price per share for our common stock.
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If the Merger Agreement is terminated, we may, under certain circumstances, be obligated to pay a termination fee to Aetna.
If the Merger Agreement is terminated, in certain circumstances, we would be required to pay a termination fee of $1.314 billion to Aetna. If the Merger Agreement is terminated under such circumstances, the termination fee we may be required to pay under the Merger Agreement may require us to use available cash that would have otherwise been available for general corporate purposes and other matters.
Failure to consummate the Merger could negatively impact our results of operations, financial position and cash flows.
If the Merger is not consummated, our ongoing businesses may be materially and adversely affected and, we will not have realized any of the potential benefits of having consummated the transaction, and we will be subject to a number of risks, including the following:
•
matters relating to the proposed Merger (including integration planning) may require substantial commitments of time and resources by our management, which could otherwise have been devoted to other opportunities that may have been beneficial to us;
•
the Merger Agreement includes restrictions on the conduct of our business prior to the completion or termination of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of specified limitations absent Aetna's prior written consent. We may find that these and other contractual restrictions in the Merger Agreement may delay or prevent us from responding, or limit our ability to respond, effectively to competitive pressures, industry developments and future business opportunities that may arise during such period, even if our management believes they may be advisable. The pendency of the proposed Merger may also divert management’s attention and our resources from ongoing business and operations;
•
we may be required to pay a termination fee to Aetna and would have incurred expenses relating to the Merger; and
•
we also could be subject to litigation related to our failure to consummate the Merger or to perform our obligations under the Merger Agreement.
If the Merger is not consummated, these risks may materially and adversely affect our results of operations, financial position, cash flows and the price per share for our common stock.
Item 2:
Unregistered Sales of Equity Securities and Use of Proceeds
(a)
None.
(b)
N/A
(c)
The following table provides information about our purchases of equity securities that are registered by us pursuant to Section 12 of the Securities Exchange Act of 1934, as amended, during the
three months ended June 30, 2015
:
Period
Total Number
of Shares
Purchased (1)(2)
Average
Price Paid
per Share
Total Number of
Shares Purchased
as Part of Publicly
Announced Plans
or Programs (1)(2)
Dollar Value of
Shares that May
Yet Be Purchased
Under the Plans
or Programs (1)
April 2015
694,163
$
178.81
694,163
$
1,215,353,536
May 2015
704,005
171.61
704,005
1,094,555,924
June 2015
306,644
189.79
306,644
1,036,364,862
Total
1,704,812
$
177.81
1,704,812
(1)
In September 2014, the Board of Directors replaced a previous share repurchase authorization of up to $1 billion with a current authorization for repurchases of up to $2 billion of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on December 31, 2016. Under the current share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended,
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or in privately-negotiated transactions (including pursuant to accelerated share repurchase agreements with investment bankers), subject to certain regulatory restrictions on volume, pricing, and timing. Our remaining repurchase authorization was
$1.04 billion
as of July 3, 2015.
Pursuant to the Merger Agreement with Aetna discussed
in Note 1 to our condensed consolidated financial statements
, after July 2, 2015, we are prohibited from repurchasing any of our outstanding securities without the prior written consent of Aetna, other than repurchases of shares of our common stock in connection with the exercise of outstanding stock options or the vesting or settlement of outstanding restricted stock awards. Accordingly, as announced on July 3, 2015, we have suspended our share repurchase program due to the Merger.
(2)
Excludes
0.3 million
shares repurchased in connection with employee stock plans.
The Merger Agreement with Aetna includes customary restrictions on the conduct of our business prior to the completion of the Merger, generally requiring us to conduct our business in the ordinary course and subjecting us to a variety of customary specified limitations absent Aetna’s prior written consent, including, for example, limitations on dividends (we have agreed that our quarterly dividend will not exceed $0.29 per share prior to the closing of the Merger) and repurchases of our securities (we have agreed to suspend our share repurchase program), restrictions on our ability to enter into material contracts, and negotiated thresholds for capital expenditures, capital contributions, acquisitions and divestitures of businesses.
Item 3:
Defaults Upon Senior Securities
None.
Item 4:
Mine Safety Disclosures
Not applicable.
Item 5:
Other Information
None.
Item 6:
Exhibits
2.1
Agreement and Plan of Merger, dated as of July 2, 2015 among Aetna Inc., Echo Merger Sub, Inc., Echo Merger Sub, LLC and Humana Inc. (incorporated here by reference to Exhibit 2.1 to Humana Inc.’s Current Report on Form 8-K filed on July 7, 2015).
3(i)
Restated Certificate of Incorporation of Humana Inc. filed with the Secretary of State of Delaware on November 9, 1989, as restated to incorporate the amendment of January 9, 1992, and the correction of March 23, 1992 (incorporated herein by reference to Exhibit 4(i) to Humana Inc.’s Post-Effective Amendment No. 1 to the Registration Statement on Form S-8 (Reg. No. 33-49305) filed February 2, 1994).
3(ii)
By-Laws of Humana Inc., as amended on January 4, 2007 (incorporated herein by reference to Exhibit 3 to Humana Inc.’s Annual Report on Form 10-K for the year ended December 31, 2006).
10.1*
Amendment to the Amended and Restated Employment Agreement between Humana Inc. and Bruce D. Broussard, dated July 2, 2015 (incorporated herein by reference to Exhibit 10.1 to Humana Inc.’s Current Report on Form 8-K filed on July 9, 2015).
12
Computation of ratio of earnings to fixed charges.
31.1
Principal Executive Officer certification pursuant to Section 302 of Sarbanes–Oxley Act of 2002.
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31.2
Principal Financial Officer certification pursuant to Section 302 of Sarbanes–Oxley Act of 2002.
32
Principal Executive Officer and Principal Financial Officer certification pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101
The following materials from Humana Inc.'s Quarterly Report of Form 10-Q formatted in XBRL (Extensible Business Reporting Language): (i) the Condensed Consolidated Balance Sheets at
June 30, 2015
and
December 31, 2014
; (ii) the Condensed Consolidated Statements of Income for the
three and six
months ended
June 30, 2015
and
2014
; (iii) the Condensed Consolidated Statements of Comprehensive Income for the
three and six
months ended
June 30, 2015
and
2014
; (iv) the Condensed Consolidated Statements of Cash Flows for the
six
months ended
June 30, 2015
and
2014
; and (v) Notes to Condensed Consolidated Financial Statements.
* Exhibit 10.1 is a compensatory plan or management contract.
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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 thereunto duly authorized.
HUMANA INC.
(Registrant)
Date:
July 29, 2015
By:
/s/ CYNTHIA H. ZIPPERLE
Cynthia H. Zipperle
Vice President, Chief Accounting Officer and Controller (Principal Accounting Officer)
64