Form 10-Q
Table of Contents

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

 

x QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended June 30, 2011

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  x    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  x    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   x    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  x

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, 2011

$0.16 2/3 par value   166,829,524 shares

 

 

 


Table of Contents

Humana Inc.

FORM 10-Q

JUNE 30, 2011

INDEX

 

Part I: Financial Information    Page  

Item 1.

  Financial Statements   
  Condensed Consolidated Balance Sheets at June 30, 2011 and December 31, 2010      3   
  Condensed Consolidated Statements of Income for the three and six months ended June 30, 2011 and 2010      4   
  Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2011 and 2010      5   
  Notes to Condensed Consolidated Financial Statements      6   

Item 2.

  Management’s Discussion and Analysis of Financial Condition and Results of Operations      25   

Item 3.

  Quantitative and Qualitative Disclosures about Market Risk      43   

Item 4.

  Controls and Procedures      43   
Part II: Other Information   

Item 1.

  Legal Proceedings      44   

Item 1A.

  Risk Factors      44   

Item 2.

  Unregistered Sales of Equity Securities and Use of Proceeds      45   

Item 3.

  Defaults Upon Senior Securities      45   

Item 4.

  Removed and Reserved      45   

Item 5.

  Other Information      45   

Item 6.

  Exhibits      46   
  Signatures      47   
  Certifications   


Table of Contents

Humana Inc.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

 

     June 30,
2011
    December 31,
2010
 
     (in thousands, except share amounts)  
ASSETS     

Current assets:

    

Cash and cash equivalents

   $ 1,567,824      $ 1,673,137   

Investment securities

     7,609,737        6,872,767   

Receivables, less allowance for doubtful accounts of $80,195 in 2011 and $51,470 in 2010:

     1,546,392        959,018   

Securities lending invested collateral

     29,737        49,636   

Other current assets

     721,537        583,141   
                

Total current assets

     11,475,227        10,137,699   
                

Property and equipment, net

     822,611        815,337   

Long-term investment securities

     1,592,919        1,499,672   

Goodwill

     2,577,511        2,567,809   

Other long-term assets

     1,126,637        1,082,736   
                

Total assets

   $ 17,594,905      $ 16,103,253   
                
LIABILITIES AND STOCKHOLDERS’ EQUITY     

Current liabilities:

    

Benefits payable

   $ 3,953,185      $ 3,469,306   

Trade accounts payable and accrued expenses

     1,944,897        1,624,832   

Book overdraft

     217,287        409,385   

Securities lending payable

     35,536        55,693   

Unearned revenues

     204,859        185,410   
                

Total current liabilities

     6,355,764        5,744,626   

Long-term debt

     1,664,015        1,668,849   

Future policy benefits payable

     1,560,668        1,492,855   

Other long-term liabilities

     427,741        272,867   
                

Total liabilities

     10,008,188        9,179,197   
                

Commitments and contingencies

    

Stockholders’ equity:

    

Preferred stock, $1 par; 10,000,000 shares authorized; none issued

     0        0   

Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 192,739,787 shares issued at June 30, 2011 and 190,244,741 shares issued at December 31, 2010

     32,123        31,707   

Capital in excess of par value

     1,897,852        1,737,207   

Retained earnings

     6,262,943        5,529,001   

Accumulated other comprehensive income

     189,030        120,584   

Treasury stock, at cost, 25,910,263 shares at June 30, 2011 and 21,795,051 shares at December 31, 2010

     (795,231     (494,443
                

Total stockholders’ equity

     7,586,717        6,924,056   
                

Total liabilities and stockholders’ equity

   $ 17,594,905      $ 16,103,253   
                

See accompanying notes to condensed consolidated financial statements.

 

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Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(Unaudited)

 

     Three months ended
June 30,
     Six months ended
June 30,
 
     2011      2010      2011      2010  
     (in thousands, except per share results)  

Revenues:

           

Premiums

   $ 8,849,376       $ 8,376,751       $ 17,615,667       $ 16,538,614   

Services

     343,509         132,702         678,451         265,722   

Investment income

     91,246         79,790         180,731         165,245   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total revenues

     9,284,131         8,589,243         18,474,849         16,969,581   
  

 

 

    

 

 

    

 

 

    

 

 

 

Operating expenses:

           

Benefits

     7,269,768         6,869,096         14,614,522         13,686,478   

Operating costs

     1,192,405         1,093,690         2,448,248         2,154,547   

Depreciation and amortization

     67,781         64,381         133,890         123,240   
  

 

 

    

 

 

    

 

 

    

 

 

 

Total operating expenses

     8,529,954         8,027,167         17,196,660         15,964,265   
  

 

 

    

 

 

    

 

 

    

 

 

 

Income from operations

     754,177         562,076         1,278,189         1,005,316   

Interest expense

     27,663         26,222         54,891         52,536   
  

 

 

    

 

 

    

 

 

    

 

 

 

Income before income taxes

     726,514         535,854         1,223,298         952,780   

Provision for income taxes

     266,227         195,778         447,835         353,936   
  

 

 

    

 

 

    

 

 

    

 

 

 

Net income

   $ 460,287       $ 340,076       $ 775,463       $ 598,844   
  

 

 

    

 

 

    

 

 

    

 

 

 

Basic earnings per common share

   $ 2.76       $ 2.02       $ 4.64       $ 3.56   
  

 

 

    

 

 

    

 

 

    

 

 

 

Diluted earnings per common share

   $ 2.71       $ 2.00       $ 4.57       $ 3.52   
  

 

 

    

 

 

    

 

 

    

 

 

 

Dividends declared per common share

   $ 0.25       $ 0.00       $ 0.25       $ 0.00   
  

 

 

    

 

 

    

 

 

    

 

 

 

See accompanying notes to condensed consolidated financial statements.

 

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Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

 

     For the six months  ended
June 30,
 
     2011     2010  
     (in thousands)  

Cash flows from operating activities

    

Net income

   $ 775,463      $ 598,844   

Adjustments to reconcile net income to net cash provided by operating activities:

    

Net realized capital gains

     (5,109     (7,976

Stock-based compensation

     40,978        39,627   

Depreciation and amortization

     150,583        132,046   

Provision (benefit) for deferred income taxes

     21,418        (81,267

Changes in operating assets and liabilities, net of effect of businesses acquired:

    

Receivables

     (587,374     (501,482

Other assets

     (174,800     73,683   

Benefits payable

     483,879        607,149   

Other liabilities

     202,069        219,163   

Unearned revenues

     19,449        (19,471

Other, net

     30,109        19,646   
                

Net cash provided by operating activities

     956,665        1,079,962   
                

Cash flows from investing activities

    

Acquisitions, net of cash acquired

     (10,952     (1,669

Purchases of property and equipment

     (129,181     (91,427

Purchases of investment securities

     (1,902,083     (2,759,168

Maturities of investment securities

     731,204        1,014,032   

Proceeds from sales of investment securities

     432,006        1,091,282   

Change in securities lending collateral

     20,157        74,809   
                

Net cash used in investing activities

     (858,849     (672,141
                

Cash flows from financing activities

    

Receipts from CMS contract deposits

     1,254,847        880,252   

Withdrawals from CMS contract deposits

     (1,066,478     (643,976

Change in securities lending payable

     (20,157     (74,809

Change in book overdraft

     (192,098     (134,548

Common stock repurchases

     (300,788     (57,869

Excess tax benefit from stock-based compensation

     11,287        1,264   

Proceeds from stock option exercises and other

     110,258        7,259   
                

Net cash used in financing activities

     (203,129     (22,427
                

(Decrease) increase in cash and cash equivalents

     (105,313     385,394   

Cash and cash equivalents at beginning of period

     1,673,137        1,613,588   
                

Cash and cash equivalents at end of period

   $ 1,567,824      $ 1,998,982   
                

Supplemental cash flow disclosures:

    

Interest payments

   $ 56,958      $ 55,855   

Income tax payments, net

   $ 407,416      $ 356,390   

See accompanying notes to condensed consolidated financial statements.

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

Unaudited

1. BASIS OF PRESENTATION

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 those normally made in an Annual Report on Form 10-K. For further information, the reader of this Form 10-Q should refer to our Form 10-K for the year ended December 31, 2010, that was filed with the Securities and Exchange Commission, or the SEC, on February 17, 2011. 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 accounting principles generally accepted in the United States of America 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, the impact of risk sharing provisions related to our Medicare and TRICARE 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 Form 10-K for the year ended December 31, 2010 for information on accounting policies that the Company considers in preparing its 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.

Realignment of Business Segments

During the first quarter of 2011, we realigned our business segments to reflect our evolving business model. We manage and report our operating results using the following segments: Retail, Employer Group, and Health and Well-Being Services. We also disclose results for Other Businesses. Historical segment information has been retrospectively adjusted to reflect the effect of this change. Our segment information is more fully described in Note 13.

As a result of changing our reportable segments, we also changed the classification of certain revenues and costs. Beginning January 1, 2011, costs of certain health and well-being services were reclassified as benefits expense including costs incurred by our wholly-owned home delivery pharmacy from transactions with our members that were historically classified as selling, general and administrative (and now titled operating costs), as well as depreciation and amortization expenses. The effect of this reclassification is to account for the cost of providing these benefits to our members similarly whether the services are provided via a third party provider or internally through a stand-alone subsidiary. Likewise, co-share amounts from our members associated with our wholly-owned home delivery pharmacy operations, historically classified as other revenue, are now classified as a reduction of benefits expense. The remaining items previously classified as other revenue, primarily consisting of patient service revenue associated with our recently acquired Concentra Inc. subsidiary, were combined with our previous administrative services fee revenue and are now classified as services revenue. Prior period amounts have been reclassified to conform to the new presentation. These adjustments had no impact on net income, cash flows or equity. Further, none of these adjustments impacted our regulated subsidiaries.

Depreciation and amortization expense associated with certain businesses in our Health and Well-Being Services segment delivering benefits to our members, primarily associated with our pharmacy operations, are now included with benefits expense. The amount of this expense was $7.3 million and $4.9 million for the three months ended June 30, 2011 and 2010, respectively. For the six months ended June 30, 2011 and 2010, the amount of this expense was $16.7 million and $8.8 million, respectively.

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

2. RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS

In July 2011, the Financial Accounting Standards Board, or FASB, issued new guidance regarding how health insurers should recognize and classify fees mandated by 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 Insurance Reform Legislation). The Health Insurance Reform Legislation imposes a non-deductible annual fee on health insurers for each calendar year beginning on or after January 1, 2014. The guidance requires that the liability for the fee should be estimated and recorded in full once we provide qualifying insurance coverage in the applicable calendar year in which the fee is payable with a corresponding deferred cost that is amortized to expense over the calendar year that it is payable. The new guidance is effective for us for calendar year 2014, when the fee initially becomes effective.

In June 2011, the FASB issued new guidance requiring the presentation of other comprehensive income in a statement presented with equal prominence to the other primary financial statements. The new guidance eliminates the current option to report other comprehensive income and its components in the statement of stockholders’ equity and requires one of two alternatives for the presentation of items of net income and other comprehensive income: (1) in a single continuous statement referred to as the statement of comprehensive income, or (2) in two separate, but consecutive statements. Under either alternative, each component of net income and each component of other comprehensive income, together with totals for each, as well as total comprehensive income would need to be displayed. The new guidance is effective for us, beginning with the filing of our Form 10-Q for the three months ending March 31, 2012, with retrospective application required. As the new guidance only affects the presentation of other comprehensive income, it will not have a material impact on our results of operations, financial condition, or cash flows.

In May 2011, the FASB issued new guidance intended to improve the comparability of fair value measurements presented and disclosed in financial statements prepared in accordance with accounting principles generally accepted in the United States of America and those prepared in accordance with international financial reporting standards. While the new guidance is largely consistent with existing fair value measurement principles, it expands existing disclosure requirements for fair value measurements and makes other amendments which could change how existing fair value measurement guidance is applied. The new guidance will be effective for us beginning with the filing of our Form 10-Q for the three months ending March 31, 2012. We are currently evaluating the impact of the adoption of this new guidance on our results of operations, financial condition, or cash flows.

In January 2010, the FASB issued new guidance that expanded and clarified existing disclosures about fair value measurements. Under the new guidance, we are required to disclose additional information about movements of assets among the three-tier fair value hierarchy, present separately (that is, on a gross basis) information about purchases, sales, issuances, and settlements of financial instruments in the reconciliation of fair value measurements using significant unobservable inputs (Level 3), and expand disclosures regarding the determination of fair value measurements. We adopted the new disclosure provisions during the year ended December 31, 2010, except for the gross disclosures regarding purchases, sales, issuances and settlements in the roll forward of activity in Level 3 fair value measurements which we adopted with the filing of our Form 10-Q for the three months ended March 31, 2011 as provided in Note 5.

There are no other recently issued accounting standards that apply to us or that will have a material impact on our condensed consolidated financial statements.

3. ACQUISITION

On December 21, 2010, we acquired Concentra Inc., or Concentra, a health care company based in Addison, Texas, for cash consideration of $804.7 million. During the first half of 2011, we accrued and paid $3.7 million related to the final determination of working capital that existed at the acquisition date and recorded immaterial adjustments to the acquisition date fair value of Concentra’s net tangible assets acquired with a corresponding adjustment to goodwill. Through its affiliated clinicians, Concentra delivers occupational medicine, urgent care, physical therapy, and wellness services to workers and the general public through its operation of medical centers and worksite medical facilities. The Concentra acquisition provides us entry into the primary care space on a national scale, offering additional means for achieving health and wellness solutions and providing an expandable platform for growth with a management team experienced in physician asset management and alternate site care. The total consideration of $808.4 million exceeded our estimated fair value of the net tangible assets acquired by approximately $724.5 million, of which we allocated $188.0 million to other intangible assets and $536.5 million to goodwill. The goodwill was assigned to the Health and Well-Being Services segment. The other intangible assets, which primarily consist of customer

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

relationships and trade name, have a weighted average useful life of 13.7 years. Approximately $57.9 million of the acquired goodwill is deductible for tax purposes. The purchase price allocation is preliminary, subject to completion of valuation analyses, including, for example, refining assumptions used to calculate the fair value of other intangible assets.

The results of operations and financial condition of Concentra have been included in our consolidated statements of income and consolidated balance sheets from the acquisition date. In connection with the acquisition, we recognized approximately $14.9 million of acquisition-related costs, primarily banker and other professional fees, as operating costs in the fourth quarter of 2010. The pro forma financial information assuming the acquisition had occurred as of January 1, 2009 was not material to our results of operations.

4. INVESTMENT SECURITIES

Investment securities classified as current and long-term were as follows at June 30, 2011 and December 31, 2010, respectively:

 

     Amortized
Cost
     Gross
Unrealized
Gains
     Gross
Unrealized
Losses
    Fair Value  
     (in thousands)  

June 30, 2011

          

U.S. Treasury and other U.S. government corporations and agencies:

          

U.S. Treasury and agency obligations

   $ 808,985       $ 14,242       $ (440   $ 822,787   

Mortgage-backed securities

     1,761,438         63,358         (760     1,824,036   

Tax-exempt municipal securities

     2,437,115         63,506         (10,738     2,489,883   

Mortgage-backed securities:

          

Residential

     50,858         425         (1,534     49,749   

Commercial

     397,262         18,618         (917     414,963   

Asset-backed securities

     115,928         1,486         (29     117,385   

Corporate debt securities

     3,321,621         165,184         (8,285     3,478,520   

Redeemable preferred stock

     5,333         0         0        5,333   
  

 

 

    

 

 

    

 

 

   

 

 

 

Total debt securities

   $ 8,898,540       $ 326,819       $ (22,703   $ 9,202,656   
  

 

 

    

 

 

    

 

 

   

 

 

 

December 31, 2010

          

U.S. Treasury and other U.S. government corporations and agencies:

          

U.S. Treasury and agency obligations

   $ 697,816       $ 14,412       $ (615   $ 711,613   

Mortgage-backed securities

     1,614,569         49,783         (1,173     1,663,179   

Tax-exempt municipal securities

     2,439,659         37,294         (43,619     2,433,334   

Mortgage-backed securities:

          

Residential

     58,017         545         (2,675     55,887   

Commercial

     306,291         14,911         (171     321,031   

Asset-backed securities

     148,068         1,727         (44     149,751   

Corporate debt securities

     2,906,228         139,793         (13,710     3,032,311   

Redeemable preferred stock

     5,333         0         0        5,333   
  

 

 

    

 

 

    

 

 

   

 

 

 

Total debt securities

   $ 8,175,981       $ 258,465       $ (62,007   $ 8,372,439   
  

 

 

    

 

 

    

 

 

   

 

 

 

We participate in a securities lending program where we loan certain investment securities for short periods of time in exchange for collateral, consisting of cash or U.S. Government securities, initially equal to at least 102% of the fair value of the investment securities on loan. Investment securities with a fair value of $34.1 million at June 30, 2011 and $54.0 million at December 31, 2010 were on loan as of those respective dates. At June 30, 2011, all collateral from lending our investment securities was in the form of cash which has been reinvested in money market funds.

 

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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, 2011 and December 31, 2010, respectively:

 

     Less than 12 months     12 months or more     Total  
            Gross            Gross            Gross  
     Fair      Unrealized     Fair      Unrealized     Fair      Unrealized  
     Value      Losses     Value      Losses     Value      Losses  
     (in thousands)  

June 30, 2011

               

U.S. Treasury and other U.S. government corporations and agencies:

               

U.S. Treasury and agency obligations

   $ 74,009       $ (440   $ 0       $ 0      $ 74,009       $ (440

Mortgage-backed securities

     40,023         (422     21,650         (338     61,673         (760

Tax-exempt municipal securities

     480,854         (6,930     63,336         (3,808     544,190         (10,738

Mortgage-backed securities:

               

Residential

     3,605         (59     26,807         (1,475     30,412         (1,534

Commercial

     96,425         (905     156         (12     96,581         (917

Asset-backed securities

     4,860         (9     5,059         (20     9,919         (29

Corporate debt securities

     398,311         (6,499     14,548         (1,786     412,859         (8,285
                                                   

Total debt securities

   $ 1,098,087       $ (15,264   $ 131,556       $ (7,439   $ 1,229,643       $ (22,703
                                                   

December 31, 2010

               

U.S. Treasury and other U.S. government corporations and agencies:

               

U.S. Treasury and agency obligations

   $ 141,766       $ (615   $ 0       $ 0      $ 141,766       $ (615

Mortgage-backed securities

     110,358         (1,054     5,557         (119     115,915         (1,173

Tax-exempt municipal securities

     1,168,221         (33,218     97,809         (10,401     1,266,030         (43,619

Mortgage-backed securities:

               

Residential

     0         0        32,671         (2,675     32,671         (2,675

Commercial

     0         0        2,752         (171     2,752         (171

Asset-backed securities

     17,069         (42     283         (2     17,352         (44

Corporate debt securities

     383,677         (9,572     31,464         (4,138     415,141         (13,710
                                                   

Total debt securities

   $ 1,821,091       $ (44,501   $ 170,536       $ (17,506   $ 1,991,627       $ (62,007
                                                   

Approximately 95% of our debt securities were investment-grade quality at June 30, 2011, with an average credit rating of AA- by S&P. 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, 2011, 13% of our tax-exempt municipal securities were pre-refunded, generally with U.S. government and agency securities, and 25% of our tax-exempt securities were insured by bond insurers and had an equivalent 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 residential and commercial mortgage-backed securities is supported by factors such as seniority, underlying collateral characteristics and credit enhancements. Our residential and commercial mortgage-backed securities at June 30, 2011 primarily were composed of senior tranches having high credit support, with 99% of the collateral consisting of prime loans. The average credit rating of all commercial mortgage-backed securities was AA at June 30, 2011.

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

All issuers of securities we own that were trading at an unrealized loss at June 30, 2011 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 and tighter liquidity conditions in the current markets than when the securities were purchased. At June 30, 2011, 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, 2011.

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, 2011 and 2010:

 

     For the three months ended
June 30,
    For the six months ended
June 30,
 
     2011     2010     2011     2010  
     (in thousands)  

Gross realized gains

   $ 6,272      $ 3,840      $ 10,848      $ 23,753   

Gross realized losses

     (5,089     (4,558     (5,739     (15,777
  

 

 

   

 

 

   

 

 

   

 

 

 

Net realized capital gains (losses)

   $ 1,183      $ (718   $ 5,109      $ 7,976   
  

 

 

   

 

 

   

 

 

   

 

 

 

There were no material other-than-temporary impairments for the three and six months ended June 30, 2011 or 2010.

The contractual maturities of debt securities available for sale at June 30, 2011, 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      Fair  
     Cost      Value  
     (in thousands)  

Due within one year

   $ 410,307       $ 412,900   

Due after one year through five years

     1,993,459         2,066,110   

Due after five years through ten years

     2,450,596         2,547,202   

Due after ten years

     1,718,692         1,770,311   

Mortgage and asset-backed securities

     2,325,486         2,406,133   
  

 

 

    

 

 

 

Total debt securities

   $ 8,898,540       $ 9,202,656   
  

 

 

    

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

5. FAIR VALUE

Financial Assets

The following table summarizes our fair value measurements at June 30, 2011 and December 31, 2010, respectively, for financial assets measured at fair value on a recurring basis:

 

            Fair Value Measurements Using  
     Fair Value      Quoted Prices in
Active Markets
for Identical
Assets

(Level 1)
     Significant Other
Observable Inputs

(Level 2)
     Significant
Unobservable
Inputs

(Level 3)
 
     (in thousands)  

June 30, 2011

           

Cash equivalents

   $ 1,470,957       $ 1,470,957       $ 0       $ 0   

Debt securities:

           

U.S. Treasury and other U.S. government corporations and agencies:

           

U.S. Treasury and agency obligations

     822,787         0         822,787         0   

Mortgage-backed securities

     1,824,036         0         1,824,036         0   

Tax-exempt municipal securities

     2,489,883         0         2,468,830         21,053   

Mortgage-backed securities:

           

Residential

     49,749         0         49,749         0   

Commercial

     414,963         0         414,963         0   

Asset-backed securities

     117,385         0         116,286         1,099   

Corporate debt securities

     3,478,520         0         3,454,422         24,098   

Redeemable preferred stock

     5,333         0         0         5,333   
                                   

Total debt securities

     9,202,656         0         9,151,073         51,583   

Securities lending invested collateral

     29,737         29,737         0         0   
                                   

Total invested assets

   $ 10,703,350       $ 1,500,694       $ 9,151,073       $ 51,583   
                                   

December 31, 2010

           

Cash equivalents

   $ 1,606,592       $ 1,606,592       $ 0       $ 0   

Debt securities:

           

U.S. Treasury and other U.S. government corporations and agencies:

           

U.S. Treasury and agency obligations

     711,613         0         711,613         0   

Mortgage-backed securities

     1,663,179         0         1,663,179         0   

Tax-exempt municipal securities

     2,433,334         0         2,381,528         51,806   

Mortgage-backed securities:

           

Residential

     55,887         0         55,887         0   

Commercial

     321,031         0         321,031         0   

Asset-backed securities

     149,751         0         148,545         1,206   

Corporate debt securities

     3,032,311         0         3,025,097         7,214   

Redeemable preferred stock

     5,333         0         0         5,333   
                                   

Total debt securities

     8,372,439         0         8,306,880         65,559   

Securities lending invested collateral

     49,636         24,639         24,997         0   
                                   

Total invested assets

   $ 10,028,667       $ 1,631,231       $ 8,331,877       $ 65,559   
                                   

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Our Level 3 assets had a fair value of $51.6 million at June 30, 2011, or less than 0.5% of our total invested assets. During the three and six months ended June 30, 2011 and 2010, 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,  
     2011     2010  
     Auction
Rate
Securities
    Private
Placements/
Venture
Capital
    Total     Auction
Rate
Securities
    Private
Placements/
Venture
Capital
    Total  
     (in thousands)  

Beginning balance at April 1

   $ 51,323      $ 13,492      $ 64,815      $ 63,902      $ 11,920      $ 75,822   

Total gains or losses:

            

Realized in earnings

     0        (380     (380     0        17        17   

Unrealized in other comprehensive income

     1,831        696        2,527        821        570        1,391   

Purchases

     0        17,000        17,000        0        3,000        3,000   

Sales/calls

     (32,525     (373     (32,898     (2,500     (500     (3,000

Settlements

     425        94        519        (10,750     (466     (11,216
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Balance at June 30

   $ 21,054      $ 30,529      $ 51,583      $ 51,473      $ 14,541      $ 66,014   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     For the six months ended June 30,  
     2011     2010  
     Auction
Rate
Securities
    Private
Placements/
Venture
Capital
    Total     Auction
Rate
Securities
    Private
Placements/
Venture
Capital
    Total  
     (in thousands)  

Beginning balance at January 1

   $ 51,806      $ 13,753      $ 65,559      $ 68,814      $ 23,909      $ 92,723   

Total gains or losses:

            

Realized in earnings

     16        (213     (197     16        6,195        6,211   

Unrealized in other comprehensive income

     1,757        615        2,372        1,368        (4,205     (2,837

Purchases

     0        17,000        17,000        0        3,167        3,167   

Sales/calls

     (32,525     (626     (33,151     (2,500     (13,220     (15,720

Settlements

     0        0        0        (16,225     (1,305     (17,530
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Balance at June 30

   $ 21,054      $ 30,529      $ 51,583      $ 51,473      $ 14,541      $ 66,014   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

There were no material transfers between Level 1 and Level 2 during the three and six months ended June 30, 2011 or June 30, 2010.

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 $1,664.0 million at June 30, 2011 and $1,668.8 million at December 31, 2010. The fair value of our long-term debt was $1,824.3 million at June 30, 2011 and $1,746.5 million at December 31, 2010. The fair value of our long-term debt is determined based on 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.

 

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Unaudited

 

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. The condensed consolidated balance sheets include the following amounts associated with Medicare Part D as of June 30, 2011 and December 31, 2010. The risk corridor settlement includes amounts classified as long-term because settlement associated with the 2011 provision will exceed 12 months as of June 30, 2011.

 

     June 30, 2011     December 31, 2010  
   Risk
Corridor
Settlement
    CMS
Subsidies
    Risk
Corridor
Settlement
    CMS
Subsidies
 
     (in thousands)  

Other current assets

   $ 1,507      $ 77,686      $ 1,563      $ 16,211   

Trade accounts payable and accrued expenses

     (400,806     (420,075     (389,203     (170,231
  

 

 

   

 

 

   

 

 

   

 

 

 

Net current liability

     (399,299     (342,389     (387,640     (154,020
  

 

 

   

 

 

   

 

 

   

 

 

 

Other long-term assets

     4,349        0        0        0   

Other long-term liabilities

     (147,235     0        0        0   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net long-term liability

     (142,886     0        0        0   
  

 

 

   

 

 

   

 

 

   

 

 

 

Total net liability

   $ (542,185   $ (342,389   $ (387,640   $ (154,020
  

 

 

   

 

 

   

 

 

   

 

 

 

7. GOODWILL AND OTHER INTANGIBLE ASSETS

The realignment of our business segments and corresponding change in our reportable segments, more fully described herein in Note 13, resulted in a change in the composition of our reporting units, the unit of accounting for goodwill. Accordingly, we reassigned goodwill to our reporting units as of January 1, 2011 using the relative fair value approach. Changes in the carrying amount of goodwill, by our new reportable segments, for the six months ended June 30, 2011 were as follows:

 

     Retail      Employer
Group
     Health &
Well-Being
Services
     Other
Businesses
     Total  
     (in thousands)  

Balance at January 1, 2011

   $ 592,844       $ 61,990       $ 1,855,522       $ 57,453       $ 2,567,809   

Acquisitions

     0         0         4,022         0         4,022   

Subsequent adjustments

     0         0         5,680         0         5,680   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Balance at June 30, 2011

   $ 592,844       $ 61,990       $ 1,865,224       $ 57,453       $ 2,577,511   
  

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

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, 2011 and December 31, 2010:

 

     Weighted      June 30, 2011      December 31, 2010  
     Average             Accumulated                    Accumulated         
     Life      Cost      Amortization      Net      Cost      Amortization      Net  
     (in thousands)  

Other intangible assets:

                    

Customer contracts/relationships

     10.7 yrs       $ 417,285       $ 165,807       $ 251,478       $ 413,855       $ 145,997       $ 267,858   

Trade names

     19.6 yrs         87,400         4,565         82,835         87,400         2,268         85,132   

Provider contracts

     16.0 yrs         42,753         13,347         29,406         42,753         11,659         31,094   

Noncompetes and other

     7.4 yrs         36,937         6,331         30,606         19,475         4,085         15,390   
     

 

 

    

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

Total other intangible assets

     12.2 yrs       $ 584,375       $ 190,050       $ 394,325       $ 563,483       $ 164,009       $ 399,474   
     

 

 

    

 

 

    

 

 

    

 

 

    

 

 

    

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Amortization expense for other intangible assets was approximately $26.0 million for the six months ended June 30, 2011 and $18.1 million for the six months ended June 30, 2010. The following table presents our estimate of amortization expense for 2011 and each of the five next succeeding years:

 

     (in thousands)  

For the years ending December 31,:

  

2011

   $ 53,280   

2012

     53,102   

2013

     49,847   

2014

     45,349   

2015

     40,017   

2016

     34,342   

8. COMPREHENSIVE INCOME

The following table presents details supporting the computation of comprehensive income, net of tax, for the three and six months ended June 30, 2011 and 2010:

 

     Three months ended
June 30,
     Six months ended
June 30,
 
     2011      2010      2011      2010  
     (in thousands)  

Net income

   $ 460,287       $ 340,076       $ 775,463       $ 598,844   

Net unrealized investment gains and other, net of tax

     80,222         88,434         68,446         116,293   
                                   

Comprehensive income, net of tax

   $ 540,509       $ 428,510       $ 843,909       $ 715,137   
                                   

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, 2011 and 2010:

 

     Three months ended
June 30,
     Six months ended
June 30,
 
     2011      2010      2011      2010  
     (in thousands, except per common share results)  

Net income available for common stockholders

   $ 460,287       $ 340,076       $ 775,463       $ 598,844   
                                   

Weighted average outstanding shares of common stock used to compute basic earnings per common share

     167,021         168,472         167,146         168,336   

Dilutive effect of:

           

Employee stock options

     1,073         533         996         566   

Restricted stock

     1,466         1,224         1,405         1,252   
                                   

Shares used to compute diluted earnings per common share

     169,560         170,229         169,547         170,154   
                                   

Basic earnings per common share

   $ 2.76       $ 2.02       $ 4.64       $ 3.56   
                                   

Diluted earnings per common share

   $ 2.71       $ 2.00       $ 4.57       $ 3.52   
                                   

Number of antidilutive stock options and restricted stock excluded from computation

     139         4,770         1,441         4,904   

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

10. STOCKHOLDERS’ EQUITY

In April 2011, our Board of Directors approved a quarterly cash dividend policy and declared a cash dividend to stockholders of $0.25 per share payable on July 28, 2011 to stockholders of record on June 30, 2011. Accordingly, on July 28, 2011, we paid dividends aggregating $41.5 million. Declaration and payment of future quarterly dividends is at the discretion of the Board and may be adjusted as business needs or market conditions change.

In addition, in April 2011, the Board of Directors replaced its previously approved share repurchase authorization of up to $250 million with a new authorization for repurchases of up to $1 billion of our common shares exclusive of shares repurchased in connection with employee stock plans. The new authorization will expire June 30, 2013. Under this share repurchase authorization, shares could be purchased from time to time at prevailing prices in the open market, by block purchases, or in privately-negotiated transactions, subject to certain regulatory restrictions on volume, pricing, and timing. During the six months ended June 30, 2010, we repurchased 1.03 million shares in open market transactions for $50.0 million at an average price of $48.76 under the previously approved share repurchase authorization. During the six months ended June 30, 2011, we repurchased 0.8 million shares in open market transactions for $52.6 million at an average price of $63.73 under the previously approved share repurchase authorization and we repurchased 2.5 million shares in open market transactions for $200.1 million at an average price of $78.51 under the new authorization. As of August 1, 2011, the remaining authorized amount under the new authorization totaled $799.9 million.

In connection with employee stock plans, we acquired 0.7 million common shares for $48.1 million and 0.2 million common shares for $7.9 million during the six months ended June 30, 2011 and 2010, respectively.

11. INCOME TAXES

The effective income tax rate was 36.6% for the three months ended June 30, 2011 compared to 36.5% for the three months ended June 30, 2010. For the six months ended June 30, 2011, the effective tax rate was 36.6% compared to 37.1% for the six months ended June 30, 2010. The higher tax rate for the six months ended June 30, 2010 primarily was due to the cumulative adjustment associated with estimating the retrospective aspect of new limitations on the deductibility of annual compensation in excess of $500,000 per employee as mandated by the March 2010 health insurance reforms.

12. GUARANTEES AND CONTINGENCIES

Government Contracts

Our Medicare business, which accounted for approximately 65% of our total premiums and services revenue for the six months ended June 30, 2011, 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 August 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 business have been renewed for 2012 and we expect to learn in the Fall of 2011 the status of our product offerings filed with CMS for 2012.

CMS uses a risk-adjustment model which apportions premiums paid to Medicare Advantage plans according to health severity. The risk-adjustment model pays more for enrollees with predictably higher costs. Under this model, rates paid to Medicare Advantage 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 original Medicare program. Under the risk-adjustment methodology, all Medicare Advantage 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-

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

adjustment model uses this diagnosis data to calculate the risk adjusted premium payment to Medicare Advantage plans. We generally rely on providers 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 providers to appropriately document all medical data, including the diagnosis data submitted with claims.

CMS is continuing to perform audits of various companies’ selected Medicare Advantage contracts related to this risk adjustment diagnosis data. These audits are referred to herein as Risk-Adjustment Data Validation Audits, or RADV audits. RADV audits review medical record documentation in an attempt to validate provider coding practices and the presence of risk adjustment conditions which influence the calculation of premium payments to Medicare Advantage plans.

On December 21, 2010, CMS posted a description of the agency’s proposed RADV sampling and payment adjustment calculation methodology to its website, and invited public comment, noting that CMS may revise its sampling and payment error calculation methodology based upon the comments received. We believe the audit and payment adjustment methodology proposed by CMS is fundamentally flawed and actuarially unsound. In essence, in making the comparison referred to above, CMS relies on two interdependent sets of data to set payment rates for Medicare Advantage (MA) plans: (1) fee for service (FFS) data from the government’s original Medicare program; and (2) MA data. The proposed methodology would review medical records for only one set of data (MA data), while not performing the same exercise on the other set (FFS data). However, because these two sets of data are inextricably linked, we believe CMS must audit and validate both of them before determining the financial implications of any potential RADV audit results, in order to ensure that any resulting payment adjustment is accurate. We believe that the Social Security Act, under which the payment model was established, requires the consistent use of these data sets in determining risk-adjusted payments to MA plans. Furthermore, our payment received from CMS, as well as benefits offered and premiums charged to members, is based on bids that did not, by CMS design, include any assumption of retroactive audit payment adjustments. We believe that applying a retroactive audit adjustment after CMS acceptance of bids would improperly alter this process of establishing member benefits and premiums.

CMS has received public comments, including our comments and comments from other industry participants and the American Academy of Actuaries, which expressed concerns about the failure to appropriately compare the two sets of data. On February 3, 2011, CMS issued a statement that it was closely evaluating the comments it has received on this matter and anticipates making changes to the proposed methodology based on input it has received, although we are unable to predict the extent of changes that they may make.

To date, six Humana contracts have been selected by CMS for RADV audits for the 2007 contract year, consisting of one “pilot” audit and five “targeted” audits for Humana plans. We believe that the proposed methodology for these audits is actuarially unsound and in violation of the Social Security Act. We intend to defend that position vigorously. However, if CMS moves forward with implementation of the proposed methodology without changes to adequately address the data inconsistency issues described above, it would have a material adverse effect on our revenues derived from the Medicare Advantage program and, therefore, our results of operations, financial position, and cash flows.

Our Medicaid business, which accounted for approximately 2% of our total premiums and services revenue for the six months ended June 30, 2011, consists of contracts in Puerto Rico and Florida, with the vast majority in Puerto Rico. Effective October 1, 2010, as amended in May 2011, the Puerto Rico Health Insurance Administration, or PRHIA, awarded us three contracts for the East, Southeast, and Southwest regions for a three year term through June 30, 2013.

The loss of any of the contracts above or significant changes in these programs as a result of legislative action, including reductions in premium payments to us, 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.

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Our military services business, which accounted for approximately 10% of our total premiums and services revenue for the six months ended June 30, 2011, primarily consists of the TRICARE South Region contract. The original 5-year South Region contract expired on March 31, 2009 and was extended through March 31, 2011. On October 5, 2010, we were notified that the Department of Defense, or DoD, TRICARE Management Activity, or TMA, intended to negotiate with us for an extension of our administration of the TRICARE South Region contract, and on January 6, 2011, an Amendment of Solicitation/Modification of Contract to the TRICARE South Region contract became effective. The Amendment added one additional one-year option period, Option Period IX (which runs from April 1, 2011 through March 31, 2012). The TMA exercised Option Period IX on March 17, 2011.

As required under the current contract, the target underwritten health care cost and underwriting fee amounts are negotiated separately. Any variance from the target health care cost is shared with the federal government. Accordingly, events and circumstances not contemplated in the negotiated target health care cost amount may have a material adverse effect on us. These changes may include an increase or reduction in the number of persons enrolled or eligible to enroll due to the federal government’s decision to increase or decrease U.S. military deployments. In the event government reimbursements were to decline from projected amounts, any failure to reduce the health care costs associated with these programs may have a material adverse effect on our results of operations, financial position, and cash flows.

In July 2009, we were notified by the DoD that we were not awarded the third generation TRICARE program contract for the South Region which had been subject to competing bids. We filed a protest with the Government Accountability Office, or GAO, in connection with the award to another bidder citing discrepancies between the award criteria and procedures prescribed in the request for proposals issued by the DoD and those that appear to have been used by the DoD in making its contractor selection. In October 2009, we learned that the GAO had upheld our protest, determining that the TMA evaluation of our proposal had unreasonably failed to fully recognize and reasonably account for the likely cost savings associated with our record of obtaining network provider discounts from our established network in the South Region. On February 25, 2011, TMA awarded the South Region contract to us. On March 7, 2011, the competing bidder filed a protest of the award with the GAO. Also on March 7, 2011, as provided in the Federal Acquisition Regulations, TMA issued a stop work order to us in connection with the award. On June 14, 2011, the GAO upheld the award of the contract to us and TMA subsequently lifted the stop work order. On June 21, 2011, the competing bidder filed a complaint in the United States Court of Federal Claims objecting to the award of the contract to us. That case is currently pending before the Court. Ultimate disposition of the contract award is subject to the resolution of the complaint filed by the unsuccessful bidder.

Legal Proceedings and Certain Regulatory Matters

Provider Litigation

Humana Military Healthcare Services, Inc. (“Humana Military”) was named as a defendant in Sacred Heart Health System, Inc., et al. v. Humana Military Healthcare Services Inc., Case No. 3:07-cv-00062 MCR/EMT (the “Sacred Heart” Complaint), a purported class action lawsuit filed on February 5, 2007 in the U.S. District Court for the Northern District of Florida asserting contract and fraud claims against Humana Military. The Sacred Heart Complaint alleged, among other things, that, Humana Military breached its network agreements with a class of hospitals in six states, including the seven named plaintiffs, that contracted for reimbursement of outpatient services provided to beneficiaries of the DoD’s TRICARE health benefits program (“TRICARE”). The Complaint alleged that Humana Military breached its network agreements when it failed to reimburse the hospitals based on negotiated discounts for non-surgical outpatient services performed on or after October 1, 1999, and instead reimbursed them based on published CHAMPUS Maximum Allowable Charges (so-called “CMAC rates”). Humana Military denied that it breached the network agreements with the hospitals and asserted a number of defenses to these claims. The Complaint sought, among other things, the following relief for the purported class members: (i) damages as a result of the alleged breach of contract by Humana Military, (ii) taxable costs of the litigation, (iii) attorneys fees, and (iv) any other relief the court deems just and proper. Separate and apart from the class relief, named plaintiff Sacred Heart Health System Inc. requested damages and other relief for its individual claim against

 

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Humana Military for fraud in the inducement to contract. On September 25, 2008, the district court certified a class consisting of all institutional healthcare service providers in TRICARE former Regions 3 and 4 which had network agreements with Humana Military to provide outpatient non-surgical services to CHAMPUS/TRICARE beneficiaries as of November 18, 1999, excluding those network providers who contractually agreed with Humana Military to submit any such disputes with Humana Military to arbitration. On March 3, 2010, the Court of Appeals reversed the district court’s class certification order and remanded the case to the district court for further proceeding. On June 28, 2010, the plaintiffs sought leave of the district court to amend their complaint to join additional hospital plaintiffs. Humana Military filed its response to the motion on July 28, 2010. The district court granted the plaintiffs’ motion to join 33 additional hospitals on September 24, 2010. On October 27, 2010, the plaintiffs filed their Fourth Amended Complaint claiming the U.S. District Court for the Northern District of Florida has subject matter jurisdiction over the case because the allegations in the complaint raise a substantial question under federal law. The amended complaint asserts no other material changes to the allegations or relief sought by the plaintiffs. Humana Military’s Answer to the Fourth Amended Complaint was filed on November 30, 2010.

On March 2, 2009, in a case styled Southeast Georgia Regional Medical Center, et al. v. Humana Military Healthcare Services, Inc., the named plaintiffs filed an arbitration demand, seeking relief on the same grounds as the plaintiffs in the Sacred Heart litigation. The arbitration plaintiffs originally sought certification of a class consisting of all institutional healthcare service providers that had contracts with Humana Military to provide outpatient non-surgical services and whose agreements provided for dispute resolution through arbitration. Humana Military submitted its response to the demand for arbitration on May 1, 2009. The plaintiffs have subsequently withdrawn their motion for class certification. On June 18, 2010, plaintiffs submitted their amended arbitration complaint. Humana Military’s answer to the complaint was submitted on July 9, 2010. On November 12, 2010, the arbitrators issued a revised case management and scheduling order and scheduled a hearing to begin on September 26, 2011.

Humana intends to defend each of these actions vigorously.

Internal Investigation

With the assistance of outside counsel, we are conducting an ongoing internal investigation related to certain aspects of our Florida subsidiary operations, and have voluntarily self-reported the existence of this investigation to CMS, the U.S. Department of Justice and the Florida Agency for Health Care Administration. Matters under review include, without limitation, the relationships between certain of our Florida-based employees and providers in our Medicaid and/or Medicare networks, practices related to the financial support of non-profit or provider access centers for Medicaid enrollment and related enrollment processes, and loans to or other financial support of physician practices. We have reported to the regulatory authorities noted above on the progress of our investigation to date, and intend to continue to discuss with these authorities our factual findings as well as any remedial actions we have taken or may take.

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 and benefits companies. These reviews focus on numerous facets of our business, including claims payment practices, provider contracting, competitive practices, commission payments, privacy issues, utilization management practices, 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.

On September 10, 2009, the Office of Inspector General, or OIG, of the United States Department of Health and Human Services issued subpoenas to us and our subsidiary, Humana Pharmacy, Inc., seeking documents related to

 

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our Medicare Part D prescription plans and the operation of RightSourceRx®, our home delivery pharmacy in Phoenix, Arizona. In July 2010, the government informed us that no additional materials will be sought pursuant to the subpoenas.

We also are involved in various other lawsuits that arise, for the most part, in the ordinary course of our business operations, including employment litigation, claims of medical malpractice, bad faith, nonacceptance or termination of providers, anticompetitive practices, improper rate setting, failure to disclose network discounts and various other provider arrangements, general contractual matters, intellectual property matters, and challenges to subrogation practices, certain of which may be styled as class-action lawsuits. We also are subject to claims relating to 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.

Personal injury claims and claims for extracontractual damages 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 such contingencies 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 the inherently unpredictable nature of legal proceedings 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 penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. Nevertheless, it is reasonably possible that any such 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 affect our reputation.

13. SEGMENT INFORMATION

During the first quarter of 2011, we realigned our business segments to reflect our evolving business model. As a result, we reassessed and changed our operating and reportable segments in the first quarter of 2011 to reflect managements’ new view of the business and to align our external financial reporting with our new operating and internal financial reporting model. Historical segment information has been retrospectively adjusted to reflect the effect of this change. Our new reportable segments and the basis for determining those segments are discussed below.

We manage our business with three reportable segments: Retail, Employer Group, and Health and Well-Being Services. In addition, we include businesses that are not individually reportable because they do not meet the quantitative thresholds in an Other Businesses category. 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 and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, marketed directly to individuals. The Employer Group segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection

 

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products, as well as administrative services only products marketed to employer groups. The Health and Well-Being Services segment includes services offered to our health plan members as well as to third parties that promote health and wellness, including primary care, pharmacy, integrated wellness, and home care services. The Other Businesses category consists of our Military services, primarily our TRICARE South region contract, Medicaid, and closed-block long-term care businesses as well as our contract with CMS to administer the Limited Income Newly Eligible Transition (LI-NET) program.

Our Health and Well-Being 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 RightSourceRx®, our home delivery 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. Service revenues related to the distribution of prescriptions by third party retail pharmacies in our networks are recognized when the claim is processed. Product revenues from dispensing prescriptions from our home delivery 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, selecting and establishing prices charged by 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 Health and Well-Being 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.

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 $1.0 billion and $0.9 billion for the three months ended June 30, 2011 and 2010, respectively. For the six months ended June 30, 2011 and 2010, these amounts were $2.0 billion and $1.7 billion, respectively.

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 Form 10-K for the year ended December 31, 2010. Transactions between reportable segments consist of sales of services rendered by our Health and Well-Being Services segment, primarily pharmacy and behavioral health services, to our Retail and Employer Group customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often utilize 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 do not report total assets by segment since this is not a metric used to assess performance and allocate resources. We allocate most operating expenses to our segments. Certain corporate income and expenses are not allocated to the segments, including investment income not supporting segment operations, interest expense on corporate debt, and certain corporate expenses. These items are managed at the corporate level and are not the responsibility of segment management. These corporate amounts are reported separately from our reportable segments and included with intersegment eliminations in the tables presenting segment results below.

 

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Our segment results were as follows for the three and six months ended June 30, 2011 and 2010, respectively:

 

     Retail      Employer
Group
     Health and
Well-Being
Services
     Other
Businesses
     Eliminations/
Corporate
    Consolidated  
     (in thousands)  

Three months ended June 30, 2011

                

Revenues - external customers

                

Premiums:

                

Medicare Advantage

   $ 4,555,163       $ 764,595       $ 0       $ 0       $ 0      $ 5,319,758   

Medicare stand-alone PDP

     601,345         1,911         0         77,184         0        680,440   
                                                    

Total Medicare

     5,156,508         766,506         0         77,184         0        6,000,198   
                                                    

Fully-insured

     206,291         1,216,601         0         0         0        1,422,892   

Specialty

     29,580         233,233         0         0         0        262,813   

Military services

     0         0         0         934,738         0        934,738   

Medicaid and other

     0         0         0         228,735         0        228,735   
                                                    

Total premiums

     5,392,379         2,216,340         0         1,240,657         0        8,849,376   
                                                    

Services revenue:

                

Provider

     0         0         222,401         0         0        222,401   

ASO and other

     3,894         86,657         0         27,945         0        118,496   

Pharmacy

     0         0         2,612         0         0        2,612   
                                                    

Total services revenue

     3,894         86,657         225,013         27,945         0        343,509   
                                                    

Total revenues - external customers

     5,396,273         2,302,997         225,013         1,268,602         0        9,192,885   
                                                    

Intersegment revenues

                

Services

     0         3,317         2,073,686         0         (2,077,003     0   

Products

     0         0         433,869         0         (433,869     0   
                                                    

Total intersegment revenues

     0         3,317         2,507,555         0         (2,510,872     0   
                                                    

Investment income

     18,949         11,793         0         13,371         47,133        91,246   
                                                    

Total revenues

     5,415,222         2,318,107         2,732,568         1,281,973         (2,463,739     9,284,131   
                                                    

Operating expenses:

                

Benefits

     4,390,146         1,799,711         0         1,149,320         (69,409     7,269,768   

Operating costs

     490,133         386,925         2,625,168         110,617         (2,420,438     1,192,405   

Depreciation and amortization

     31,875         23,062         19,597         2,644         (9,397     67,781   
                                                    

Total operating expenses

     4,912,154         2,209,698         2,644,765         1,262,581         (2,499,244     8,529,954   
                                                    

Income from operations

     503,068         108,409         87,803         19,392         35,505        754,177   

Interest expense

     0         0         0         0         27,663        27,663   
                                                    

Income before income taxes

   $ 503,068       $ 108,409       $ 87,803       $ 19,392       $ 7,842      $ 726,514   
                                                    

 

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     Retail      Employer
Group
     Health and
Well-Being
Services
     Other
Businesses
     Eliminations/
Corporate
    Consolidated  
     (in thousands)  

Three months ended June 30, 2010

                

Revenues - external customers

                

Premiums:

                

Medicare Advantage

   $ 4,106,667       $ 778,542       $ 0       $ 0       $ 0      $ 4,885,209   

Medicare stand-alone PDP

     504,296         1,154         0         194,772         0        700,222   
                                                    

Total Medicare

     4,610,963         779,696         0         194,772         0        5,585,431   
                                                    

Fully-insured

     183,261         1,300,759         0         0         0        1,484,020   

Specialty

     19,668         224,093         0         0         0        243,761   

Military services

     0         0         0         885,368         0        885,368   

Medicaid and other

     0         0         0         178,171         0        178,171   
                                                    

Total premiums

     4,813,892         2,304,548         0         1,258,311         0        8,376,751   
                                                    

Services revenue:

                

Provider

     0         0         2,891         0         0        2,891   

ASO and other

     2,540         100,234         0         27,037         0        129,811   

Pharmacy

     0         0         0         0         0        0   
                                                    

Total services revenue

     2,540         100,234         2,891         27,037         0        132,702   
                                                    

Total revenues - external customers

     4,816,432         2,404,782         2,891         1,285,348         0        8,509,453   
                                                    

Intersegment revenues

                

Services

     0         3,279         1,923,802         0         (1,927,081     0   

Products

     0         0         306,983         0         (306,983     0   
                                                    

Total intersegment revenues

     0         3,279         2,230,785         0         (2,234,064     0   
                                                    

Investment income

     19,529         10,207         0         10,027         40,027        79,790   
                                                    

Total revenues

     4,835,961         2,418,268         2,233,676         1,295,375         (2,194,037     8,589,243   
                                                    

Operating expenses:

                

Benefits

     3,923,278         1,870,910         0         1,127,876         (52,968     6,869,096   

Operating costs

     555,035         414,505         2,176,392         115,248         (2,167,490     1,093,690   

Depreciation and amortization

     31,710         25,097         6,411         3,129         (1,966     64,381   
                                                    

Total operating expenses

     4,510,023         2,310,512         2,182,803         1,246,253         (2,222,424     8,027,167   
                                                    

Income from operations

     325,938         107,756         50,873         49,122         28,387        562,076   

Interest expense

     0         0         0         0         26,222        26,222   
                                                    

Income before income taxes

   $ 325,938       $ 107,756       $ 50,873       $ 49,122       $ 2,165      $ 535,854   
                                                    

 

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Unaudited

 

     Retail      Employer
Group
     Health and
Well-Being
Services
     Other
Businesses
     Eliminations/
Corporate
    Consolidated  
     (in thousands)  

Six months ended June 30, 2011

                

Revenues - external customers

                

Premiums:

                

Medicare Advantage

   $ 9,079,789       $ 1,561,349       $ 0       $ 0       $ 0      $ 10,641,138   

Medicare stand-alone PDP

     1,158,817         3,728         0         153,080         0        1,315,625   
                                                    

Total Medicare

     10,238,606         1,565,077         0         153,080         0        11,956,763   
                                                    

Fully-insured

     407,179         2,415,191         0         0         0        2,822,370   

Specialty

     55,355         462,884         0         0         0        518,239   

Military services

     0         0         0         1,858,015         0        1,858,015   

Medicaid and other

     0         0         0         460,280         0        460,280   
                                                    

Total premiums

     10,701,140         4,443,152         0         2,471,375         0        17,615,667   
                                                    

Services revenue:

                

Provider

     0         0         437,447         0         0        437,447   

ASO and other

     6,767         179,203         0         50,215         0        236,185   

Pharmacy

     0         0         4,819         0         0        4,819   
                                                    

Total services revenue

     6,767         179,203         442,266         50,215         0        678,451   
                                                    

Total revenues - external customers

     10,707,907         4,622,355         442,266         2,521,590         0        18,294,118   
                                                    

Intersegment revenues

                

Services

     0         6,598         4,195,077         0         (4,201,675     0   

Products

     0         0         868,509         0         (868,509     0   
                                                    

Total intersegment revenues

     0         6,598         5,063,586         0         (5,070,184     0   
                                                    

Investment income

     37,945         23,408         0         25,675         93,703        180,731   
                                                    

Total revenues

     10,745,852         4,652,361         5,505,852         2,547,265         (4,976,481     18,474,849   
                                                    

Operating expenses:

                

Benefits

     8,944,389         3,551,115         0         2,258,759         (139,741     14,614,522   

Operating costs

     1,022,545         810,832         5,281,450         229,571         (4,896,150     2,448,248   

Depreciation and amortization

     58,860         43,250         40,226         4,352         (12,798     133,890   
                                                    

Total operating expenses

     10,025,794         4,405,197         5,321,676         2,492,682         (5,048,689     17,196,660   
                                                    

Income from operations

     720,058         247,164         184,176         54,583         72,208        1,278,189   

Interest expense

     0         0         0         0         54,891        54,891   
                                                    

Income before income taxes

   $ 720,058       $ 247,164       $ 184,176       $ 54,583       $ 17,317      $ 1,223,298   
                                                    

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

     Retail      Employer
Group
     Health and
Well-Being
Services
     Other
Businesses
     Eliminations/
Corporate
    Consolidated  
     (in thousands)  

Six months ended June 30, 2010

                

Revenues - external customers

                

Premiums:

                

Medicare Advantage

   $ 8,165,834       $ 1,536,355       $ 0       $ 0       $ 0      $ 9,702,189   

Medicare stand-alone PDP

     1,007,809         2,290         0         269,148         0        1,279,247   
                                                    

Total Medicare

     9,173,643         1,538,645         0         269,148         0        10,981,436   
                                                    

Fully-insured

     362,078         2,628,760         0         0         0        2,990,838   

Specialty

     37,190         446,241         0         0         0        483,431   

Military services

     0         0         0         1,730,362         0        1,730,362   

Medicaid and other

     0         0         0         352,547         0        352,547   
                                                    

Total premiums

     9,572,911         4,613,646         0         2,352,057         0        16,538,614   
                                                    

Services revenue:

                

Provider

     0         0         6,054         0         0        6,054   

ASO and other

     5,341         199,357         0         54,970         0        259,668   

Pharmacy

     0         0         0         0         0        0   
                                                    

Total services revenue

     5,341         199,357         6,054         54,970         0        265,722   
                                                    

Total revenues - external customers

     9,578,252         4,813,003         6,054         2,407,027         0        16,804,336   
                                                    

Intersegment revenues

                

Services

     0         6,668         3,831,730         0         (3,838,398     0   

Products

     0         0         593,896         0         (593,896     0   
                                                    

Total intersegment revenues

     0         6,668         4,425,626         0         (4,432,294     0   
                                                    

Investment income

     40,737         21,247         0         19,881         83,380        165,245   
                                                    

Total revenues

     9,618,989         4,840,918         4,431,680         2,426,908         (4,348,914     16,969,581   
                                                    

Operating expenses:

                

Benefits

     7,917,327         3,767,841         0         2,104,482         (103,172     13,686,478   

Operating costs

     1,051,741         843,329         4,321,088         230,060         (4,291,671     2,154,547   

Depreciation and amortization

     59,201         48,515         11,492         6,020         (1,988     123,240   
                                                    

Total operating expenses

     9,028,269         4,659,685         4,332,580         2,340,562         (4,396,831     15,964,265   
                                                    

Income from operations

     590,720         181,233         99,100         86,346         47,917        1,005,316   

Interest expense

     0         0         0         0         52,536        52,536   
                                                    

Income before income taxes

   $ 590,720       $ 181,233       $ 99,100       $ 86,346       $ (4,619   $ 952,780   
                                                    

Retail segment operating costs for the three and six months ended June 30, 2010 include $147.5 million for the write-down of deferred acquisition costs associated with our individual major medical policies as discussed more fully in Note 18 to the consolidated financial statements included in our Form 10-K for the year ended December 31, 2010.

 

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Humana Inc.

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 “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 Form 10-K for the year ended December 31, 2010 that was filed with the SEC on February 17, 2011, as modified by any changes to those risk factors included in this document and in other reports we filed subsequent to February 17, 2011, in each case incorporated by reference herein. In making these statements, we are not undertaking to address or update these factors 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

Headquartered in Louisville, Kentucky, Humana is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of our core businesses, we believe that we can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom we have relationships.

Our industry relies on two key statistics to measure performance. The benefit ratio, which is computed by taking total benefit expenses 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 as a percentage of total revenue less investment income, represents a statistic used to measure administrative spending efficiency.

2011 Business Segment Realignment

During the first quarter of 2011, we realigned our business segments to reflect our evolving business model. As a result, we reassessed and changed our operating and reportable segments in the first quarter of 2011 to reflect managements’ new view of the business and to align our external financial reporting with our new operating and internal financial reporting model. Historical segment information has been retrospectively adjusted to reflect the effect of this change. Our new reportable segments and the basis for determining those segments are discussed below.

Business Segments

We now manage our business with three reportable segments: Retail, Employer Group, and Health and Well-Being Services. In addition, we include other businesses that are not reportable because they do not meet the quantitative thresholds in an Other Businesses category. 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 and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, marketed directly

 

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to individuals. The Employer Group segment consists of Medicare and commercial fully-insured medical and specialty health insurance benefits, including dental, vision, and other supplemental health and financial protection products, as well as administrative services only products marketed to employer groups. The Health and Well-Being Services segment includes services offered to our health plan members as well as to third parties that promote health and wellness, including primary care, pharmacy, integrated wellness, and home care services. The Other Businesses category consists of our Military services, primarily our TRICARE South region contract, Medicaid, and closed-block long-term care businesses as well as our contract with CMS to administer the Limited Income Newly Eligible Transition (LI-NET) program.

The results of each segment are measured by income before income taxes. Transactions between reportable segments consist of sales of services rendered by our Health and Well-Being Services segment, primarily pharmacy and behavioral health services, to our Retail and Employer Group customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often utilize 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 do not report total assets by segment since this is not a metric used to assess performance and allocate resources. We allocate most operating expenses to our segments. Certain corporate income and expenses are not allocated to the segments, including investment income not supporting segment operations, interest expense on corporate debt, and certain corporate expenses. These items are managed at the corporate level and are not the responsibility of segment management. These corporate amounts are reported separately from our reportable segments and included with intersegment eliminations.

Seasonality

Our Retail segment offers Medicare stand-alone prescription drug plans, or PDPs, under the Medicare Part D program. These plans provide varying degrees of coverage. 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 affect the quarterly benefit ratio pattern.

2011 Highlights

Consolidated

 

   

We experienced favorable prior-period medical claims reserve development of approximately $55.1 million, or $0.21 per diluted common share, for the three months ended June 30, 2011 and $117.0 million, or $0.44 per diluted common share, for the three months ended June 30, 2010. For the six months ended June 30, 2011, we experienced favorable prior-period development of approximately $116.8 million, or $0.44 per diluted common share, compared to $137.5 million, or $0.51 per diluted common share, for the six months ended June 30, 2010.

 

   

In April 2011, our Board of Directors approved a quarterly cash dividend policy and declared a cash dividend to stockholders of $0.25 per share. The dividend aggregating $41.5 million was paid on July 28, 2011 to stockholders of record on June 30, 2011.

 

   

In addition, in April 2011, the Board of Directors replaced its previously approved share repurchase authorization of up to $250 million with a new authorization for repurchases of up to $1 billion. The new authorization will expire June 30, 2013. As of August 1, 2011, the remaining authorized amount under the new authorization totaled $799.9 million.

 

   

Our year-over-year quarterly and year-to-date comparisons are impacted by the $147.5 million write-down of deferred acquisition costs associated with our individual major medical policies during the three months

 

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ended June 30, 2010 as discussed more fully in Note 18 to the consolidated financial statements included in our Form 10-K for the year ended December 31, 2010.

Retail

 

   

On April 4, 2011, CMS announced that Medicare Advantage payment rates will increase on average 0.4% sector-wide in 2012. We believe that we can effectively design Medicare Advantage products based upon this level of rate increase while continuing to remain competitive compared to both the combination of original Medicare with a supplement policy as well as other Medicare Advantage competitors within our industry. In addition, we will continue to pursue our cost-reduction and outcome-enhancing strategies, including care coordination and disease management, which we believe will mitigate the adverse effects of the rates on our Medicare Advantage members. Nonetheless, there can be no assurance that we will be able to successfully execute operational and strategic initiatives with respect to changes in the Medicare Advantage program. Failure to execute these strategies may result in a material adverse effect on our results of operations, financial position, and cash flows.

 

   

Individual Medicare Advantage membership of 1,602,500 at June 30, 2011 increased 141,800 members, or 9.7%, from 1,460,700 at December 31, 2010 and increased 139,600, or 9.5%, from 1,462,900 at June 30, 2010 primarily due to a successful enrollment season associated with the 2011 plan year.

 

   

Individual Medicare stand-alone PDP membership of 2,408,700 at June 30, 2011 increased 738,400 members, or 44.2%, from 1,670,300 at December 31, 2010 and increased 700,700, or 41.0%, from 1,708,000 at June 30, 2010, primarily due to sales of our new lowest premium national stand-alone Medicare Part D prescription drug plan co-branded with Wal-Mart Stores, Inc., the Humana Walmart-Preferred Rx Plan, that we began offering for the 2011 plan year.

 

   

Our year-over-year quarterly and year-to-date Retail segment comparisons are impacted by the $147.5 million write-down of deferred acquisition costs associated with our individual major medical policies during the three months ended June 30, 2010 as discussed above.

Other Businesses

 

   

As more fully discussed in Note 12 to the condensed consolidated financial statements, on February 25, 2011, the TMA awarded the TRICARE South Region contract to us. On March 7, 2011, the competing bidder filed a protest of the award with the GAO. Also on March 7, 2011, as provided in the Federal Acquisition Regulations, TMA issued a stop work order to us in connection with the award. On June 14, 2011, the GAO upheld the award of the contract to us and TMA subsequently lifted the stop work order. On June 21, 2011, the competing bidder filed a complaint in the United States Court of Federal Claims objecting to the award of the contract to us. That case is currently pending before the Court. As a result of the award of the TRICARE South Region contract to us, we no longer expect a goodwill impairment to occur during the second half of 2011. Ultimate disposition of the contract award is, however, subject to the resolution of the complaint filed by the unsuccessful bidder.

Health Insurance Reform

In March 2010, the President signed into law 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 Insurance Reform Legislation) which enact significant reforms to various aspects of the U.S. health insurance industry. While regulations and interpretive guidance on some provisions of the Health Insurance Reform Legislation have been issued to date by the Department of Health and Human Services (HHS), the Department of Labor, the Treasury Department, and the National Association of Insurance Commissioners, there are many significant provisions of the legislation that will require additional guidance and clarification in the form of regulations and interpretations in order to fully understand the impacts of the legislation on our overall business, which we expect to occur over the next several years.

Implementation dates of the Health Insurance Reform Legislation vary from as early as six months from the date of enactment, or September 23, 2010, to as late as 2018. The following outlines certain provisions of the Health Insurance Reform Legislation:

 

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Changes effective for plan years beginning on or after September 23, 2010 included: elimination of pre-existing condition limits for enrollees under age 19, elimination of certain annual and lifetime caps on the dollar value of benefits, expansion of dependent coverage to include adult children until age 26, a requirement to provide coverage for preventive services without cost to members, new claim appeal requirements, and the establishment of an interim high risk program for those unable to obtain coverage due to a pre-existing condition or health status.

 

   

Effective January 1, 2011, minimum benefit ratios were mandated for all commercial fully-insured medical plans in the large group (85%), small group (80%), and individual (80%) markets, with annual rebates to policyholders if the actual benefit ratios do not meet these minimums. Initial rebate payments will be made in mid-2012.

 

   

Medicare Advantage payment benchmarks for 2011 were frozen at 2010 levels and beginning in 2012, additional cuts to Medicare Advantage plan payments will begin to take effect (plans will receive a range of 95% in high-cost areas to 115% in low-cost areas of Medicare fee-for-service rates), with changes being phased-in over two to six years, depending on the level of payment reduction in a county. In addition, beginning in 2011, the gap in coverage for Medicare Part D prescription drug coverage has begun to incrementally close.

 

   

Beginning in 2014, the Health Insurance Reform Legislation requires: all individual and group health plans to guarantee issuance and renew coverage without pre-existing condition exclusions or health-status rating adjustments; the elimination of annual limits on coverage on certain plans; the establishment of state-based exchanges for individuals and small employers (with up to 100 employees); the introduction of standardized plan designs based on set actuarial values; the establishment of a minimum benefit ratio of 85% for Medicare Advantage plans; and insurance industry assessments, including an annual premium-based assessment ($8 billion levied on the insurance industry in 2014 with increasing annual amounts thereafter), which is not deductible for income tax purposes.

The Health Insurance Reform Legislation also specifies required benefit designs, limits rating and pricing practices, encourages additional competition (including potential incentives for new market entrants) and expands eligibility for Medicaid programs. In addition, the law will significantly 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 will come, in part, from material additional fees and taxes on us and other health insurers, health plans and individuals beginning in 2014, as well as reductions in certain levels of payments to us and other health plans under Medicare as described above.

As discussed above, implementing regulations and related interpretive guidance continue to be issued on several significant provisions of the Health Insurance Reform Legislation, and certain aspects of the Health Insurance Reform Legislation are also being challenged in federal court, seeking to limit the scope of or have all or portions of the Health Insurance Reform Legislation declared unconstitutional. Judicial proceedings are subject to appeal and could last for an extended period of time, and we cannot predict the results of any of these proceedings. Congress may also withhold the funding necessary to implement the Health Insurance Reform Legislation, or may attempt to replace the legislation with amended provisions or repeal it altogether. Given the breadth of possible changes and the uncertainties of interpretation, implementation, and timing of these changes, which we expect to occur over the next several years, the Health Insurance Reform Legislation could change the way we do business, potentially impacting our pricing, benefit design, product mix, geographic mix, and distribution channels. The response of other companies to the Health Insurance Reform Legislation and adjustments to their offerings, if any, could cause meaningful disruption in the local health care markets. Further, various health insurance reform proposals are also emerging at the state level. It is reasonably possible that the Health Insurance Reform Legislation and related regulations, as well as future legislative changes, 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 administrative costs, lowering our Medicare payment rates and increasing our expenses associated with the non-deductible federal premium tax and other assessments; our financial position, including our ability to maintain the value of our goodwill; and our cash flows. If the new non-deductible federal premium tax is imposed as enacted, and if we are unable to adjust our business model to address this new tax, there can be no assurance that the non-deductible federal premium tax would not have a material adverse effect on our results of operations, financial position, and cash flows.

 

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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.

Comparison of Results of Operations for 2011 and 2010

The following discussion primarily deals with our results of operations for the three months ended June 30, 2011, or the 2011 quarter, the three months ended June 30, 2010, or the 2010 quarter, the six months ended June 30, 2011, or the 2011 period, and the six months ended June 30, 2010, or the 2010 period.

Consolidated

 

     For the three months ended
June 30,
    Change  
     2011     2010     Dollars     Percentage  
     (dollars in thousands)  

Revenues:

        

Premiums:

        

Retail

   $ 5,392,379      $ 4,813,892      $ 578,487        12.0

Employer Group

     2,216,340        2,304,548        (88,208     (3.8 )% 

Other Businesses

     1,240,657        1,258,311        (17,654     (1.4 )% 
  

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     8,849,376        8,376,751        472,625        5.6
  

 

 

   

 

 

   

 

 

   

 

 

 

Services:

        

Retail

     3,894        2,540        1,354        53.3

Employer Group

     86,657        100,234        (13,577     (13.5 )% 

Health and Well-Being Services

     225,013        2,891        222,122        nm   

Other Businesses

     27,945        27,037        908        3.4
  

 

 

   

 

 

   

 

 

   

 

 

 

Total services

     343,509        132,702        210,807        158.9
  

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     91,246        79,790        11,456        14.4
  

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     9,284,131        8,589,243        694,888        8.1
  

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

        

Benefits

     7,269,768        6,869,096        400,672        5.8

Operating costs

     1,192,405        1,093,690        98,715        9.0

Depreciation and amortization

     67,781        64,381        3,400        5.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     8,529,954        8,027,167        502,787        6.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     754,177        562,076        192,101        34.2

Interest expense

     27,663        26,222        1,441        5.5
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     726,514        535,854        190,660        35.6

Provision for income taxes

     266,227        195,778        70,449        36.0
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

   $ 460,287      $ 340,076      $ 120,211        35.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Diluted earnings per common share

   $ 2.71      $ 2.00      $ 0.71        35.5

Benefit ratio(a)

     82.2     82.0       0.2

Operating cost ratio(b)

     13.0     12.9       0.1

Effective tax rate

     36.6     36.5       0.1

 

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     For the six months ended
June 30,
    Change  
     2011     2010     Dollars     Percentage  
     (dollars in thousands)  

Revenues:

        

Premiums:

        

Retail

   $ 10,701,140      $ 9,572,911      $ 1,128,229        11.8

Employer Group

     4,443,152        4,613,646        (170,494     (3.7 )% 

Other Businesses

     2,471,375        2,352,057        119,318        5.1
  

 

 

   

 

 

   

 

 

   

 

 

 

Total premiums

     17,615,667        16,538,614        1,077,053        6.5
  

 

 

   

 

 

   

 

 

   

 

 

 

Services:

        

Retail

     6,767        5,341        1,426        26.7

Employer Group

     179,203        199,357        (20,154     (10.1 )% 

Health and Well-Being Services

     442,266        6,054        436,212        nm   

Other Businesses

     50,215        54,970        (4,755     (8.7 )% 
  

 

 

   

 

 

   

 

 

   

 

 

 

Total services

     678,451        265,722        412,729        155.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Investment income

     180,731        165,245        15,486        9.4
  

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

     18,474,849        16,969,581        1,505,268        8.9
  

 

 

   

 

 

   

 

 

   

 

 

 

Operating expenses:

        

Benefits

     14,614,522        13,686,478        928,044        6.8

Operating costs

     2,448,248        2,154,547        293,701        13.6

Depreciation and amortization

     133,890        123,240        10,650        8.6
  

 

 

   

 

 

   

 

 

   

 

 

 

Total operating expenses

     17,196,660        15,964,265        1,232,395        7.7
  

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     1,278,189        1,005,316        272,873        27.1

Interest expense

     54,891        52,536        2,355        4.5
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     1,223,298        952,780        270,518        28.4

Provision for income taxes

     447,835        353,936        93,899        26.5
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

   $ 775,463      $ 598,844      $ 176,619        29.5
  

 

 

   

 

 

   

 

 

   

 

 

 

Diluted earnings per common share

   $ 4.57      $ 3.52      $ 1.05        29.8

Benefit ratio(a)

     83.0     82.8       0.2

Operating cost ratio(b)

     13.4     12.8       0.6

Effective tax rate

     36.6     37.1       (0.5 )% 

 

(a) Represents total benefit expenses as a percentage of premium revenues.
(b) Represents total operating costs as a percentage of total revenues less investment income.

nm – not meaningful

 

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Summary

Net income was $460.3 million, or $2.71 per diluted common share, in the 2011 quarter compared to $340.1 million, or $2.00 per diluted common share, in the 2010 quarter. Net income was $775.5 million, or $4.57 per diluted common share, in the 2011 period compared to $598.8 million, or $3.52 per diluted common share, in the 2010 period. The increases during the 2011 quarter and period primarily were due to improved operating performance in the Retail, Health and Well-Being Services, and Employer Group Segments. Our diluted earnings per common share include the beneficial impact of favorable prior-period medical claims reserve development of approximately $0.21 per diluted common share for the 2011 quarter compared to $0.44 per diluted common share for the 2010 quarter and $0.44 per diluted common share for the 2011 period compared to $0.51 per diluted common share for the 2010 period. Net income for the 2010 quarter and period also included the negative impact of a $147.5 million ($0.55 per diluted common share) write-down of deferred acquisition costs associated with our individual major medical policies in our Retail Segment.

Premiums

Consolidated premiums increased $472.6 million, or 5.6%, from the 2010 quarter to $8.8 billion for the 2011 quarter, and increased $1.1 billion, or 6.5%, from 2010 period to $17.6 billion for the 2011 period. The increases primarily were due to a $578.5 million, or 12.0%, and $1.1 billion, or 11.8%, year-over-year increase in Retail segment premiums for the 2011 quarter and period, respectively, partially offset by a decline in Employer Group segment premiums. The increase in Retail segment premiums primarily resulted from higher average individual Medicare Advantage membership. The decrease in Employer Group segment premiums primarily resulted from lower average fully-insured commercial group medical membership. 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.

Services Revenue

Consolidated services revenue increased $210.8 million from the 2010 quarter to $343.5 million for the 2011 quarter. For the 2011 period, services revenue was $678.5 million, an increase of $412.7 million, or 155.3%, compared to the 2010 period. The increases during the 2011 quarter and period were primarily the result of the increase in primary care services revenue in our Health and Well-Being Services segment primarily as a result of the acquisition of Concentra on December 21, 2010.

Investment Income

Investment income totaled $91.2 million for the 2011 quarter, an increase of $11.5 million from the 2010 quarter. For the 2011 period, investment income totaled $180.7 million, an increase of $15.5 million from the 2010 period. These increases primarily reflect higher average invested balances as a result of the reinvestment of operating cash flow.

Benefit Expenses

Consolidated benefit expenses were $7.3 billion for the 2011 quarter, an increase of $400.7 million, or 5.8%, from the 2010 quarter. For the 2011 period, consolidated benefit expenses increased by $928.0 million, or 6.8%, from the 2010 period to $14.6 billion. The increases were primarily due to a $466.9 million, or 11.9%, and $1.0 billion, or 13.0%, year-over-year increase in Retail segment benefit expenses in the 2011 quarter and period, respectively, primarily driven by an increase in the average number of Medicare members.

The consolidated benefit ratio was 82.2% for the 2011 quarter and 83.0% for the 2011 period, each representing a 20 basis point increase from the comparable 2010 quarter and period primarily driven by lower favorable prior-period medical claims reserve development in the 2011 quarter and period than in the 2010 quarter and 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 increased $98.7 million, or 9.0%, during the 2011 quarter compared to the 2010 quarter. For the 2011 period, consolidated operating costs increased $293.7 million, or 13.6%, compared to the 2010 period. The increases primarily were due to an increase in operating costs in our Health and Well-Being Segment as

 

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a result of the acquisition of Concentra on December 21, 2010. The 2010 quarter and period include $147.5 million of operating costs for the write-down of deferred acquisition costs associated with our individual major medical policies in our Retail Segment.

The consolidated operating cost ratio for the 2011 quarter was 13.0%, an increase of 10 basis points from the 2010 quarter. For the 2011 period, the consolidated operating cost ratio was 13.4%, a 60 basis point increase from the 2010 period. The $147.5 million write-down of deferred acquisition costs in the 2010 quarter and period increased the operating cost ratio 180 basis points for the 2010 quarter and 90 basis points for the 2010 period. Excluding the impact of the write-down of deferred acquisition costs in 2010, the increases primarily reflect the greater percentage of our revenues derived from our Health and Well-Being Services segment, which carries a higher operating cost ratio than our other business segments.

Depreciation and Amortization

Depreciation and amortization for the 2011 quarter totaled $67.8 million, an increase of $3.4 million, or 5.3%, from the 2010 quarter. Depreciation and amortization for the 2011 period totaled $133.9 million, an increase of $10.7 million or 8.6% from the 2010 period. The increases primarily reflect depreciation and amortization expense associated with our Concentra operations, acquired on December 21, 2010.

Interest Expense

Interest expense was $27.7 million for the 2011 quarter, increasing $1.4 million, or 5.5% from the 2010 quarter, and $54.9 million for the 2011 period, increasing $2.4 million, or 4.5%, from the 2010 period.

Income Taxes

Our effective tax rate during the 2011 quarter was 36.6% compared to the effective tax rate of 36.5% in the 2010 quarter. The effective tax rate for the 2011 period of 36.6% declined from 37.1% for the 2010 period. The higher tax rate for the 2010 period primarily was due to the cumulative adjustment associated with estimating the retrospective aspect of new limitations on the deductibility of annual compensation in excess of $500,000 per employee as mandated by the Health Insurance Reform Legislation.

 

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Retail Segment

 

     June 30,     Change  
     2011     2010     Members      Percentage  

Membership:

         

Medical membership:

         

Medicare Advantage

     1,602,500        1,462,900        139,600         9.5

Medicare stand-alone PDP

     2,408,700        1,708,000        700,700         41.0
  

 

 

   

 

 

   

 

 

    

 

 

 

Total Medicare

     4,011,200        3,170,900        840,300         26.5

Individual

     456,600        407,100        49,500         12.2
  

 

 

   

 

 

   

 

 

    

 

 

 

Total medical members

     4,467,800        3,578,000        889,800         24.9
  

 

 

   

 

 

   

 

 

    

 

 

 

Specialty membership(a)

     680,500        440,400        240,100         54.5
  

 

 

   

 

 

   

 

 

    

 

 

 

 

(a)    Specialty products include dental, vision, and other supplemental 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  
     2011     2010     Dollars      Percentage  
     (in thousands)         

Premiums and Services Revenue:

         

Premiums:

         

Medicare Advantage

   $ 4,555,163      $ 4,106,667      $ 448,496         10.9

Medicare stand-alone PDP

     601,345        504,296        97,049         19.2
  

 

 

   

 

 

   

 

 

    

 

 

 

Total Medicare

     5,156,508        4,610,963        545,545         11.8

Individual

     206,291        183,261        23,030         12.6

Specialty

     29,580        19,668        9,912         50.4
  

 

 

   

 

 

   

 

 

    

 

 

 

Total premiums

     5,392,379        4,813,892        578,487         12.0
  

 

 

   

 

 

   

 

 

    

 

 

 

Services

     3,894        2,540        1,354         53.3
  

 

 

   

 

 

   

 

 

    

 

 

 

Total premiums and services revenue

   $ 5,396,273      $ 4,816,432      $ 579,841         12.0
  

 

 

   

 

 

   

 

 

    

 

 

 

Income before income taxes

   $ 503,068      $ 325,938      $ 177,130         54.3

Benefit ratio

     81.4     81.5        (0.1 )% 

Operating cost ratio

     9.1     11.5        (2.4 )% 
     For the six months ended
June 30,
    Change  
     2011     2010     Dollars      Percentage  
     (in thousands)         

Premiums and Services Revenue:

         

Premiums:

         

Medicare Advantage

   $ 9,079,789      $ 8,165,834      $ 913,955         11.2

Medicare stand-alone PDP

     1,158,817        1,007,809        151,008         15.0
  

 

 

   

 

 

   

 

 

    

 

 

 

Total Medicare

     10,238,606        9,173,643        1,064,963