- 1Q05 pretax earnings up 18 percent
- 1Q05 EPS exceeds upper end of guided range
- Medicare membership up 19 percent year to date
- Commercial pretax margin increases 70 basis points
- 2005 EPS guidance raised
LOUISVILLE, Ky., May 2 /PRNewswire-FirstCall/ -- Humana Inc. (NYSE: HUM)
today reported $0.67 diluted earnings per common share (EPS) for the quarter
ended March 31, 2005 (1Q05) compared to $0.41 EPS for the quarter ended March
31, 2004 (1Q04). First quarter results exceeded the upper end of company
expectations primarily due to quicker than anticipated response to the
company's new Medicare products and markets.
Pretax income rose 18 percent to $121.7 million in 1Q05 due to significant
growth in Humana's Medicare programs and improved Commercial segment margins.
After-tax income for 1Q05 included a $0.14 per share benefit from the
realization of a federal income tax gain contingency.
"Our Medicare team continually optimizes the performance of this business
through the application of industry-leading capabilities, strategic planning,
and expertise built over 20 years as a successful CMS contractor," said
Michael B. McCallister, Humana's president and chief executive officer. "This
quarter's results reflect senior consumers' early acceptance of both our new
products and our entrance into new markets. Our 1Q05 results also reflect the
continuation of our targeted shift to a mix of members in higher-margin
individual, ASO, and consumer-choice products. More importantly, our progress
this quarter positions Humana to achieve substantial earnings growth
throughout 2005 and longer term."
The company now anticipates EPS for the year ending December 31, 2005 (FY
2005) of $2.23 to $2.25, up from the company's prior guidance of approximately
$2.20 per share.
Commercial Segment Results
Commercial segment pretax earnings rose to $49.5 million in 1Q05 from
$39.1 million in 1Q04, an increase of 27 percent, reflecting a more profitable
business mix with significant increases in administrative services only (ASO),
individual, and consumer-choice product members. Pretax margin for the
Commercial segment increased 70 basis points year over year to 2.9 percent in
1Q05.
The company continues to expect FY 2005 Commercial segment pretax earnings
to increase between 10 and 15 percent over those for the year ended December
31, 2004 (FY 2004).
Commercial Segment Enrollment
Commercial segment medical membership of 3,219,400 at March 31, 2005
decreased 3 percent from December 31, 2004, driven by the January 1
relinquishment of an 89,000-member unprofitable account. The company's ASO
and individual membership grew sequentially by 16 percent and 6 percent,
respectively, as the company continued to improve the risk profile of its
commercial book.
The company's leadership in product innovation continues to be shown
through growth in its consumer-choice plans. At March 31, 2005, 12 percent of
the company's commercial medical membership was in these plans, up from 9
percent at December 31, 2004.
Commercial Segment Premiums and Medical Costs
Premiums and administrative services fees for the Commercial segment
decreased 5 percent to $1.7 billion in 1Q05 compared to the prior year's
quarter, driven by a 7 percent reduction in average organic membership for
1Q05 versus 1Q04 and a shift to a higher percentage of ASO business.
Commercial segment medical premiums for fully insured group membership
increased approximately 8 percent on a per-member basis during 1Q05 compared
to the same period in the prior year, including an approximately 50 basis
point lowering effect from a higher mix of fully insured consumer-choice
members. FY 2005 commercial premiums for fully insured group membership are
projected to increase in the range of 8 to 10 percent on a per-member basis.
In 1Q05, the Commercial segment medical expense ratio (medical expenses
divided by premium revenues) of 82.2 percent was 130 basis points lower than
in 1Q04, reflecting the company's improving risk profile in its commercial
portfolio.
Per-member medical costs for the commercial fully insured group business
are forecast to rise in the range of 8 to 10 percent for FY 2005.
Government Segment Results
Government segment pretax earnings were $72.2 million in 1Q05 compared to
$63.7 million in 1Q04, an increase of 13 percent, the result of significant
growth in the company's Medicare membership along with an improved Medicare
medical expense ratio.
For FY 2005, the company expects another year-over-year increase in
earnings in its Government segment, driven by improvements in results from
both Medicare and TRICARE operations.
Government Segment Enrollment
Organic growth in Medicare Advantage membership accelerated during 1Q05
due primarily to expanded participation in various Medicare programs combined
with marketing and other investment spending in these programs by the company.
Medicare membership of 449,900 at March 31, 2005 increased 72,700 members or
19 percent from the December 31, 2004 level of 377,200, including 50,400
members acquired through the company's acquisition of CarePlus Health Plans of
Florida in mid-February 2005.
Medicare Advantage membership is anticipated to experience continued
growth throughout FY 2005, with projected membership in the range of 480,000
to 500,000 by the end of the year.
As expected, TRICARE membership of 2,871,800 at March 31, 2005 was
unchanged from December 31, 2004.
Government Segment Premiums and Medical Costs
Medicare Advantage premiums per member increased in the range of 10 to 12
percent year over year during 1Q05, including the partial-quarter impact of
higher reimbursement associated with the acquired CarePlus membership.
For FY2005, the company anticipates Medicare per-member premiums to
increase in the range of 11 to 13 percent. Medicare Advantage medical costs
per member are projected to experience a corresponding increase of 11 to 13
percent for FY 2005.
TRICARE premiums and administrative services fees during 1Q05 of $574.0
million reflect the implementation of the new South Region contract with the
Department of Defense, which included a reduction in the benefits and services
provided under previous contracts, and thus, lower revenues. This accounted
for the expected year-over-year decline in TRICARE premiums and administrative
services fees of approximately 16 percent in 1Q05.
For 2005, the company anticipates TRICARE premiums and administrative
services fees to approximate $2.5 billion as the company experiences a full
year under the new South Region contract.
Selling, General & Administrative Expenses
The company's consolidated Selling, General, & Administrative (SG&A)
expense ratio (SG&A expenses as a percent of premiums plus administrative
services fees) was 14.1 percent for 1Q05, a 30 basis point improvement versus
the prior year. The Commercial segment's SG&A expense ratio was 17.6 percent
in 1Q05 versus 16.4 percent in 1Q04, primarily the result of a higher
percentage of ASO business in 1Q05. The Government segment's SG&A expense
ratio for 1Q05 of 10.8 percent was 130 basis points lower than that for 1Q04,
as higher Medicare and TRICARE revenues outpaced the increases in related SG&A
expenses during the quarter.
The company's 2005 consolidated SG&A expense ratio is projected to be in
the range of 13.5 to 14.5 percent. The expected lower SG&A expense ratio
should result from the beneficial effect of both growth in membership and
revenues leveraging fixed costs and management's continued focus on
streamlining administrative costs through process design and technology
adoption.
Cash Flows from Operations
Cash flows provided by operations for 1Q05 of $99.2 million were in line
with the company's expectations, and compared favorably to $40.1 million cash
flows used in operations in 1Q04. The substantial increase in cash flows
resulted from a difference in the timing of the January CMS premium payment
receipt for 2005 versus 2004. The company also evaluates operating cash flows
on a non-GAAP basis, as described below.
The company anticipates that cash flows from operations for FY 2005 will
be in the range of $625 million to $675 million driven by expected higher
earnings.
Non-GAAP Cash Flows from Operations
The following is a reconciliation of the most directly comparable
historical and projected cash flows from operations prepared in accordance
with Generally Accepted Accounting Principles (GAAP), to the historical and
projected non-GAAP financial measures. When reviewing and analyzing Humana's
operating cash flows, company management applies the CMS premium payment in
each month to match the corresponding disbursements. To do otherwise distorts
meaningful analysis of the company's operating cash flow. Therefore,
decisions such as management's forecasting and business plans regarding cash
flow use this non-GAAP financial measure.
($ in millions)
1Q04 1Q05 FY 2005
Actual Actual Expected
GAAP cash flows (used in)
provided by operations $(40.1) $99.2 $625 to $675
Timing of premium payment
receipt from CMS 211.9 19.8 19.8
Non-GAAP cash flows provided
by operations $171.8 $119.0 $625 to $675
Non-GAAP cash flows provided by operations during 1Q05 declined versus
1Q04 primarily as a result of the change in the company's commercial portfolio
to a heavier mix of ASO customers on January 1, 2005 and the corresponding
payment of runoff claims on fully-insured customers that either migrated to
its ASO products or terminated their coverage with the company, including the
large unprofitable, fully-insured account discussed during 2004.
Balance Sheet
At March 31, 2005, cash and investment securities comprised 49 percent of
the company's total assets compared to 54 percent at December 31, 2004. Debt
as a percent of total capitalization (debt plus stockholders' equity)
increased to 28.7 percent from 23.3 percent at December 31, 2004. Changes in
both of these metrics reflect the February 2005 closing of the accretive
CarePlus transaction.
Acquisition of CarePlus
On February 16, 2005, the company completed its acquisition of CarePlus as
well as its affiliated ten CAC-Florida Medical Centers, and PrescibIT Rx
pharmacy company, adding 50,400 Medicare Advantage members in Miami-Dade,
Broward and Palm Beach counties.
Conference Call & Virtual Slide Presentation
Humana will host a conference call, as well as a virtual slide
presentation, at 9:00 a.m. eastern time today to discuss its financial results
for the quarter and the company's expectations for future earnings.
A live virtual presentation (audio with slides) may be accessed via
Humana's Investor Relations page at http://www.humana.com . The company suggests web
participants sign on approximately 15 minutes in advance of the call. The
company also suggests web participants visit the site well in advance of the
call to run a system test and to download any free software needed to view the
presentation.
All parties interested in the audio-only portion of the conference call
are invited to dial 888-625-7430. No password is required. The company
suggests participants dial in approximately ten minutes in advance of the
call.
For those unable to participate in the live event, the virtual
presentation archive will be available in the Presentations section of the
Investor Relations page at http://www.humana.com , approximately two hours following
the live web cast.
Cautionary Statement
This news release contains forward-looking statements. The forward-
looking statements herein are made pursuant to the safe harbor provisions of
the Private Securities Litigation Reform Act of 1995. Forward-looking
statements may be significantly impacted by certain risks and uncertainties
described in the company's Form 10-K for the year ended December 31, 2004, as
filed by Humana with the Securities and Exchange Commission.
About Humana
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's
largest publicly traded health benefits companies, with approximately 7
million medical members located primarily in 15 states and Puerto Rico.
Humana offers a diversified portfolio of health insurance products and related
services - through traditional and consumer-choice plans - to employer groups,
government-sponsored plans, and individuals.
Over its 44-year history, Humana has consistently seized opportunities to
meet changing customer needs. Today, the company is a leader in consumer
engagement, providing guidance that leads to lower costs and a better health
plan experience throughout its diversified customer portfolio.
More information regarding Humana is available to investors via the
Investor Relations page of the company's web site at http://www.humana.com ,
including copies of:
- Annual report to stockholders;
- Securities and Exchange Commission filings;
- Most recent investor conference presentation;
- Quarterly earnings press releases;
- Audio archive of most recent earnings release conference call;
- Calendar of events (includes upcoming earnings conference call dates,
times, and access number, as well as planned interaction with
institutional investors);
- Corporate Governance Information.
Summary of Earnings Guidance Points
2005 Guidance Points
FY 2005 EPS $2.23 to $2.25
2Q05 EPS $0.47 to $0.50
Consolidated revenues Approximately $14.5 billion
Commercial segment pretax income Increase of 10% to 15%
Commercial medical membership Slightly higher excluding loss
of 89K member account on
January 1, 2005
Increase in Commercial segment fully 6% to 8% overall;
insured medical premiums on a per- 8% to 10% group only
member basis
Increase in Commercial segment fully 6% to 8% overall;
insured medical costs on a per- 8% to 10% group only
member basis
TRICARE pretax margin Approximately 3%
Medicare medical membership 480,000 to 500,000 by year end
TRICARE medical membership No material change from 2004
ending membership
Increase in Medicare medical 11% to 13%
premiums on a per-member basis
Increase in Medicare medical costs 11% to 13%
on a per-member basis
TRICARE revenues Approximately $2.5 billion
Consolidated SG&A expense ratio 13.5% to 14.5%
Cash flows from operations for full $625 million to $675 million
year - GAAP and non-GAAP
Capital expenditures Approximately $115 million
Effective tax rate FY 2005 approximately 30
percent; 34% to 36% remainder
of FY 2005
Shares used in computation of EPS FY 2005 approximately 166
million; 2Q05 approximately
165 million
Humana Inc.
In thousands
March 31, Percent
Ending Medical Membership 2005 2004 Difference Change
Commercial:
Fully insured 2,039.3 2,298.6 (259.3) (11.3)
ASO 1,180.1 997.0 183.1 18.4
Total Commercial 3,219.4 3,295.6 (76.2) (2.3)
Government:
Medicare Advantage 449.9 333.2 116.7 35.0
Medicaid 477.2 468.2 9.0 1.9
TRICARE 1,723.4 1,860.1 (136.7) (7.3)
TRICARE ASO 1,148.4 1,057.9 90.5 8.6
Total TRICARE 2,871.8 2,918.0 (46.2) (1.6)
Total Government 3,798.9 3,719.4 79.5 2.1
Total ending
medical membership 7,018.3 7,015.0 3.3 0.0
March 31, Percent
Ending Specialty Membership 2005 2004 Difference Change
Commercial:
Dental-fully insured 874.6 781.6 93.0 11.9
Dental-ASO 488.0 408.2 79.8 19.5
Total Dental 1,362.6 1,189.8 172.8 14.5
Group life 444.9 495.7 (50.8) (10.2)
Short-term disability 16.6 17.7 (1.1) (6.2)
Total ending
specialty membership 1,824.1 1,703.2 120.9 7.1
Three months ended
March 31,
Premiums 2005 2004
Commercial:
Fully insured medical $1,517,394 $1,617,120
Specialty 93,538 85,971
Total Commercial 1,610,932 1,703,091
Government:
Medicare Advantage 983,141 706,318
TRICARE 562,328 648,993
Medicaid 134,414 120,779
Total Government 1,679,883 1,476,090
Total premiums $3,290,815 $3,179,181
Three months ended
March 31,
Administrative services fees 2005 2004
Commercial $50,111 $41,696
Government 11,624 36,541
Total administrative services fees $61,735 $78,237
Humana Inc.
Dollars in thousands, except per share results
Three months ended
March 31,
Consolidated Statements of Income 2005 2004
Revenues:
Premiums $3,290,815 $3,179,181
Administrative services fees 61,735 78,237
Investment income 30,211 27,454
Other income 4,464 2,077
Total revenues 3,387,225 3,286,949
Operating expenses:
Medical 2,753,733 2,683,516
Selling, general and administrative 474,033 469,629
Depreciation 24,806 23,923
Other intangible amortization 4,443 2,389
Total operating expenses 3,257,015 3,179,457
Income from operations 130,210 107,492
Interest expense 8,523 4,719
Income before income taxes 121,687 102,773
Provision for income taxes 11,892 34,943
Net income $109,795 $67,830
Basic earnings per common share $0.68 $0.42
Diluted earnings per common share $0.67 $0.41
Shares used in computing basic earnings
per common share (000's) 160,911 161,966
Shares used in computing diluted earnings
per common share (000's) 164,179 164,357
Operating Results by Segment
Pretax income
Commercial $49,463 $39,086
Government 72,224 63,687
Consolidated $121,687 $102,773
Key Ratios
Medical expense ratio
Commercial 82.2% 83.5%
Government 85.1% 85.4%
Consolidated 83.7% 84.4%
Selling, general, and administrative expense ratio
Commercial 17.6% 16.4%
Government 10.8% 12.1%
Consolidated 14.1% 14.4%
Humana Inc.
Dollars in thousands, except per share results
March 31, December 31,
Consolidated Balance Sheets 2005 2004
Assets
Current assets:
Cash and cash equivalents $560,264 $580,079
Investment securities 2,136,841 2,145,645
Receivables, net:
Premiums 568,184 554,661
Administrative services fees 20,145 24,954
Securities lending collateral 126,678 77,840
Other 226,339 212,958
Total current assets 3,638,451 3,596,137
Property and equipment, net 428,890 399,506
Other assets:
Long-term investment securities 345,692 348,465
Goodwill 1,244,370 885,572
Other 492,190 427,937
Total other assets 2,082,252 1,661,974
Total assets $6,149,593 $5,657,617
Liabilities and Stockholders' Equity
Current liabilities:
Medical and other expenses payable $1,546,050 $1,422,010
Trade accounts payable and accrued expenses 395,498 488,332
Book overdraft 192,741 192,060
Securities lending payable 126,678 77,840
Unearned revenues 143,683 146,326
Total current liabilities 2,404,650 2,326,568
Long-term debt 885,271 636,696
Other long-term liabilities 659,867 604,229
Total liabilities 3,949,788 3,567,493
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; 177,556,156 shares
issued at March 31, 2005 29,592 29,340
Capital in excess of par value 1,055,491 1,017,156
Retained earnings 1,339,618 1,229,823
Accumulated other comprehensive income (5,648) 16,526
Unearned stock compensation (16,872) (1,721)
Treasury stock, at cost, 15,824,092
shares at March 31, 2005 (202,376) (201,000)
Total stockholders' equity 2,199,805 2,090,124
Total liabilities and stockholders' equity $6,149,593 $5,657,617
Debt to total capitalization ratio 28.7% 23.3%
Humana Inc.
Dollars in thousands
Three months ended
March 31,
Consolidated Statements of Cash Flows 2005 2004
Cash flows from operating activities
Net income $109,795 $67,830
Adjustments to reconcile net income to net
cash provided by (used in) operating activities:
Depreciation and amortization 29,249 26,312
Provision for deferred income taxes 7,255 12,223
Changes in operating assets and liabilities
excluding the effects of acquisitions:
Receivables (6,425) (20,546)
Other assets (8,360) (15,472)
Medical and other expenses payable 86,665 124,628
Other liabilities (97,548) (32,431)
Unearned revenues (22,416) (201,699)
Other 1,013 (900)
Net cash provided by (used in) operating
activities 99,228 (40,055)
Cash flows from investing activities
Acquisitions, net of cash acquired (348,099) -
Purchases of property and equipment (36,193) (22,732)
Proceeds from sales of property and equipment 8 19,385
Purchases of investment securities (714,371) (1,491,272)
Proceeds from maturities of
investment securities 261,665 246,845
Proceeds from sales of investment securities 434,506 786,868
Change in securities lending collateral (48,838) (15,222)
Net cash used in investing activities (451,322) (476,128)
Cash flows from financing activities
Borrowings under credit agreement 294,000 -
Repayments under credit agreement (25,000) -
Change in book overdraft 681 (8,617)
Change in securities lending payable 48,838 15,222
Common stock repurchases (1,376) (12,836)
Proceeds from stock option exercises and other 15,136 8,657
Net cash provided by financing activities 332,279 2,426
Decrease in cash and cash equivalents (19,815) (513,757)
Cash and cash equivalents at
beginning of period 580,079 931,404
Cash and cash equivalents at end of period $560,264 $417,647
Humana Inc.
Percentage of Ending Membership Under Capitation Arrangements
Commercial Segment
Fully Total
Insured ASO Segment
March 31, 2005
Capitated HMO hospital system based A 2.7% - 1.7%
Capitated HMO physician group based A 2.5% - 1.6%
Risk-sharing B 2.6% - 1.6%
All other membership 92.2% 100.0% 95.1%
Total 100.0% 100.0% 100.0%
March 31, 2004
Capitated HMO hospital system based A 4.5% - 3.2%
Capitated HMO physician group based A 3.4% - 2.4%
Risk-sharing B 2.1% - 1.5%
All other membership 90.0% 100.0% 92.9%
Total 100.0% 100.0% 100.0%
Government Segment Consol.
Medicare TRICARE Total Total
Advantage Medicaid TRICARE ASO Segment Medical
March 31, 2005
Capitated HMO hospital
system based A 8.1% 3.3% - - 1.4% 1.5%
Capitated HMO physician
group based A 0.9% 35.2% - - 4.5% 3.2%
Risk-sharing B 52.5% 53.0% - - 12.9% 7.7%
All other membership 38.5% 8.5% 100.0% 100.0% 81.2% 87.6%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
March 31, 2004
Capitated HMO hospital
system based A 11.8% 3.3% - - 1.5% 2.3%
Capitated HMO physician
group based A 1.3% 43.9% - - 5.7% 4.1%
Risk-sharing B 53.9% 45.5% - - 10.6% 6.3%
All other membership 33.0% 7.3% 100.0% 100.0% 82.2% 87.3%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
A - In a limited number of circumstances, we contract with hospitals and
physicians to accept financial risk for a defined set of HMO membership.
In transferring this risk, we prepay these providers a monthly fixed-fee
per member to coordinate substantially all of the medical care for their
capitated HMO membership, including some health benefit administrative
functions and claims processing. For these capitated HMO arrangements, we
generally agree to reimbursement rates that target a medical expense ratio
ranging from 82% to 89%. Providers participating in hospital-based
capitated HMO arrangements generally receive a monthly payment for all of
the services within their system for their HMO membership. Providers
participating in physician-based capitated HMO arrangements generally have
subcontracted specialist physicians and are responsible for reimbursing
such hospitals and physicians for services rendered to their HMO
membership.
B - In some circumstances, we contract with physicians under risk-sharing
arrangements whereby physicians have assumed some level of risk for all or
a portion of the medical costs of their HMO membership. Although these
arrangements do include capitation payments for services rendered, we
process substantially all of the claims under these arrangements.
Humana Inc.
Dollars in thousands
Medical Claim Reserves - Details and Statistics
Change in medical and other expenses payable:
The change in medical and other expenses payable is summarized as follows:
For the Three For the Twelve
Months Ended Months Ended
March 31, 2005 December 31, 2004
Balances at January 1 $1,422,010 $1,272,156
Acquisition 37,375 71,063
Incurred related to:
Current year 2,828,027 10,763,105
Prior years - non-TRICARE (62,800) (68,448)
Prior years - TRICARE (1) (11,494) (25,010)
Total incurred 2,753,733 10,669,647
Paid related to:
Current year (1,660,838) (9,504,331)
Prior years (1,006,230) (1,086,525)
Total paid (2,667,068) (10,590,856)
Balances at end of period $1,546,050 $1,422,010
The impact of any change in "incurred related to prior years" claims may
be offset as we re-establish the "incurred related to current year". Our
reserving practice is to consistently recognize the actuarial best estimate of
our ultimate liability for our claims within a level of confidence required to
meet actuarial standards. Thus, only when the release of a prior year reserve
is not offset with the same level of conservatism in estimating the current
year reserve will the redundancy reduce medical expense. We have consistently
applied this methodology in determining our best estimate for unpaid claims
liability in each period.
(1) Changes in estimates of TRICARE incurred claims for prior years
recognized during 2004 and 2005 resulted primarily from claim costs and
utilization levels developing favorably from the levels originally estimated
for the second half of the prior year. As a result of substantial risk-
sharing provisions with the Department of Defense and with subcontractors, any
resulting impact on operations from the change in estimates of incurred
related to prior years is substantially reduced, whether positive or negative.
Humana Inc.
Dollars in thousands
Medical Claim Reserves - Details and Statistics
Medical and Other Expenses Payable Detail:
March 31, December 31,
2005 2004
A IBNR and other medical expenses payable $962,681 $910,525
B TRICARE IBNR 328,920 284,647
C TRICARE other medical expenses payable 20,395 6,970
D Unprocessed claim inventories 111,200 115,300
E Processed claim inventories 92,030 97,801
F Payable to pharmacy benefit administrator 30,824 6,767
Total medical and other expenses
payable $1,546,050 $1,422,010
A IBNR represents an estimate of medical expenses payable for claims
incurred but not reported (IBNR) at the balance sheet date. The level
of IBNR is primarily impacted by membership levels, medical claim
trends and the receipt cycle time, which represents the length of time
between when a claim is initially incurred and when the claim form is
received (i.e. a shorter time span results in lower reserves for claims
IBNR).
B TRICARE IBNR has increased from higher medical expenses due to the
transition to the new South region contract.
C TRICARE other medical expense payable may include liabilities to
subcontractors and/or risk share payables to the Department of Defense.
The level of these balances may fluctuate from period to period due to
the timing of payment (cutoff) and whether or not the balances are
payables or receivables (receivables from the Department of Defense are
classified as "receivables" in our balance sheet).
D Unprocessed claim inventories represent the estimated valuation of
claims received but not yet fully processed. TRICARE claim inventories
are not included in this amount as an independent third party
administrator processes all TRICARE medical claims on our behalf.
Reserves for TRICARE claims inventory are included in TRICARE IBNR.
E Processed claim inventories represent the estimated valuation of
processed claims that are in the post claim adjudication process, which
consists of administrative functions such as audit and check batching
and handling.
F The balance due to our pharmacy benefit administrator fluctuates due to
bi-weekly payments and the month-end cutoff.
Receipt Cycle Time:
The receipt cycle time measures the average length of time between when a
claim was initially incurred and when the claim form was received. Below is a
summary:
Average Number of Days from Incurred
Date to Receipt Date (1)
2005 2004 Change % Change
1st Quarter Average 16.6 17.4 (0.8) -4.6%
2nd Quarter Average - 16.7 N/A N/A
3rd Quarter Average - 16.9 N/A N/A
4th Quarter Average - 16.4 N/A N/A
Full Year Average 16.6 16.9 (0.3) -1.8%
(1) Receipt cycle time data for our 3 largest claim processing platforms
representing approximately 92% of our fully insured claims volume.
Humana Inc.
Medical Claim Reserves - Details and Statistics
Unprocessed Claim Inventories:
The estimated valuation and number of claims on hand that are yet to be
processed are as follows:
Estimated Number
Valuation Claim Item of Days
Date (000) Counts On Hand
3/31/2003 $99,000 421,700 4.4
6/30/2003 $92,100 446,600 4.7
9/30/2003 $106,800 528,400 5.8
12/31/2003 $109,700 443,000 4.9
3/31/2004 $94,800 400,900 3.9
6/30/2004 $98,100 387,000 3.7
9/30/2004 $122,300 453,300 4.4
12/31/2004 $115,300 394,400 3.7
3/31/2005 $111,200 393,200 3.6
Days in Claims Payable (Quarterly):
A common metric for monitoring medical claim reserve levels relative to
the medical claim expenses is days in claims payable, or DCP, which represents
the medical claim liabilities at the end of the period divided by average
medical expenses per day in the quarterly period. Since we have some providers
under capitation payment arrangements (which do not require a medical claim
IBNR reserve), we have also summarized this metric excluding capitation
expenses.
Days
in Claims DCP
Payable Annual Excluding Annual
Quarter Ended (DCP) Change % Change Capitation Change % Change
3/31/2003 46.5 (0.7) -1.5% 54.7 (1.5) -2.7%
6/30/2003 47.9 1.1 2.4% 56.2 0.9 1.6%
9/30/2003 47.2 0.6 1.3% 54.5 (0.8) -1.4%
12/31/2003 46.2 1.0 2.2% 53.2 (0.1) -0.2%
3/31/2004 47.4 0.9 1.9% 54.3 (0.4) -0.7%
6/30/2004 47.4 (0.5) -1.0% 54.1 (2.1) -3.7%
9/30/2004 51.8 4.6 9.7% 59.1 4.6 8.4%
12/31/2004 49.5 3.3 7.1% 54.8 1.6 3.0%
3/31/2005 50.5 3.1 6.5% 56.1 1.8 3.3%
This metric fluctuates due to all of the issues reviewed above, including
the change in the receipt cycle time, the change in medical claim inventories,
the change in TRICARE liability balances, and the timing of our bi-weekly
payment to our pharmacy benefits administrator. An annual recap follows:
2005 2004
4th quarter-prior year 49.5 46.2
Impact of change in claim receipt cycle time (0.3) (0.2)
Impact of change in unprocessed claim inventories (0.1) 0.2
Impact of change in processed claim inventories (0.2) 0.9
Impact of changing TRICARE reserve balances 0.2 1.6
Impact of change in pharmacy payment cutoff 0.8 (0.4)
All other 0.6 1.2
Year to date-current year 50.5 49.5
SOURCE Humana Inc.
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Related links:
http://www.humana.com
Photo Notes:
NewsCom:
http://www.newscom.com/cgi-bin/prnh/20030425/HUMANALOGO
AP Archive: http://photoarchive.ap.org
PRN Photo Desk, photodesk@prnewswire.com
Company News On-Call:
http://www.prnewswire.com/comp/423125.html
CONTACT:
Regina Nethery, Investor Relations,
+1-502-580-3644, or Rnethery@humana.com , or Tom Noland,
Corporate Communications, +1-502-580-3674, or Tnoland@humana.com
, both of Humana Inc.
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