hum-2020 q4 8k-ex99-2
TRANSCRIPT
newsrelease
HumanaInc.500WestMainStreetP.O.Box1438Louisville,KY40202http://www.humana.com
FORMOREINFORMATIONCONTACT:
AmySmithHumanaInvestorRelations(502)580-2811e-mail:[email protected]
KelleyMurphyHumanaCorporateCommunications(502)224-1755e-mail:[email protected]
HumanaReportsFourthQuarter2020FinancialResults;ProvidesFullYear2021FinancialGuidance
• Reports4Q20losspercommonshareof$2.07onaGAAPbasis,$2.30onanAdjustedbasis;reportsfullyear(FY)2020earningsperdilutedcommonshare(EPS)of$25.31onaGAAPbasis,$18.75onanAdjustedbasis(in-linewiththecompany'sinitialFY2020AdjustedEPSguidanceascommunicatedthroughouttheyear)
• AnnouncesFY2021EPSguidanceinarangeof$20.82to$21.32onaGAAPbasis,$21.25to$21.75onAdjustedbasis;whileacknowledgingtheheighteneduncertaintysurroundingtheongoingpandemic
• ReaffirmsFY2021expectedindividualMedicareAdvantagemembershipgrowthrangeofapproximately425,000to475,000members,representingexpectedyear-over-yeargrowthofapproximately11to12percent
• Ongoingassistancetomembers,providers,employergroups,employees,andcommunitiesduring4Q20includingthecontinuedwaiverofMedicareAdvantagecostsharing(includingforprimarycare,COVID-19treatment,andmore),deliveryofmeals,masks,andpreventivescreeningtestkits,programsinunderservedcommunities,andproviderreliefefforts,whilecontinuingtoadvancethecompany'sstrategy
LOUISVILLE,KY(February3,2021)–HumanaInc.(NYSE:HUM)todayreportedconsolidatedpretaxresultsandresultspercommonshareforthequarterendedDecember31,2020(4Q20)versusthequarterendedDecember31,2019(4Q19)andfortheyearendedDecember31,2020(FY2020)versustheyearendedDecember31,2019(FY2019)asnotedinthetablesbelow.
Consolidated(loss)incomebeforeincometaxesandequityinearnings(pretax(loss)income)Inmillions 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
GenerallyAcceptedAccountingPrinciples(GAAP) ($458) $593 $4,600 $3,456
Amortizationassociatedwithidentifiableintangibles 22 17 88 70
Put/callvaluationadjustmentsassociatedwithcompany'snon-consolidatingminorityinterestinvestments 40 (289) 103 (506)
Changeinfairmarketvalueofpublicly-tradedequitysecurities (102) — (745) —
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff,net — — (578) —
Chargesassociatedwithworkforceoptimization — 1 — 47
Adjusted(non-GAAP) ($498) $322 $3,468 $3,067
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(Losspercommonshare)ordilutedearningspercommonshare(EPS) 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
GAAP ($2.07) $3.84 $25.31 $20.10
Amortizationassociatedwithidentifiableintangibles 0.13 0.10 0.51 0.40Put/callvaluationadjustmentsassociatedwithcompany'snon-consolidatingminorityinterestinvestments 0.24 (1.67) 0.60 (2.89)
Changeinfairmarketvalueofpublicly-tradedequitysecurities (0.60) — (4.32) —
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff,net — — (3.35) —
Chargesassociatedwithworkforceoptimization — 0.01 — 0.26
Adjusted(non-GAAP) ($2.30) $2.28 $18.75 $17.87
Thecompanyhas includedfinancialmeasuresthroughoutthisearningsreleasethatarenot inaccordancewithGAAP.Managementbelievesthatthesemeasures,whenpresentedinconjunctionwiththecomparableGAAPmeasures,areusefultobothmanagementanditsinvestorsinanalyzingthecompany’songoingbusinessandoperatingperformance.Consequently,managementusesthesenon-GAAP(Adjusted)financialmeasuresasindicatorsofthecompany’sbusinessperformance,aswellasforoperationalplanninganddecisionmakingpurposes.Non-GAAP(Adjusted)financialmeasuresshouldbeconsideredinadditionto,butnotasasubstitutefor,orsuperiorto,financialmeasurespreparedinaccordancewithGAAP.AllfinancialmeasuresinthispressreleaseareinaccordancewithGAAPunlessotherwiseindicated.PleaserefertothefootnotesforadetaileddescriptionofeachitemadjustedoutofGAAPfinancialmeasurestoarriveatanon-GAAP(Adjusted)financialmeasure.
“Despite the pandemic, Humana has continued to accelerate on all fronts, including our short-term operating andfinancialperformance,ourability toadvanceour long-termstrategicobjectives, andour customer centricityefforts,”saidBruceD.Broussard,Humana’sPresidentandChiefExecutiveOfficer.“OurresponsetothepandemichighlightedthevalueofourMedicareAdvantage(MA)program,mostnotablyitsfocusonsupportingunderservedpopulationsandonaddressinghealthdisparities, criticalareasof importance forourcompany,and forourcountry.To thatend,wehadstrongMAmembershipgrowthin2020of11percent,includingDualSpecialNeedsPlan(D-SNP)membershipgrowthof41percent,andMedicaidfootprintexpansionfromthreestatestosix.Wealsocontinuedtoinvestinourprimarycareand home assets to expand access to care, particularly for underserved populations. Given the strength of ourunderlyingcorebusiness,combinedwithourcontinuedstrategic investments,weanticipatesolidgrowth in2021andbeyond.”
SummaryofQuarterlyandFullYearResults
Resultsfor4Q20andFY2020reflectcontinuedstrongcoreperformanceacrossthecompany,combinedwiththeimpactof the ongoing COVID-19 pandemic, including the company’s relentless efforts to ease the burdens for all of itsstakeholders by proactively addressing the physical, mental, and financial well-being of its members, communitiesincludingtheunderserved,providers,andemployergroups.
Beginning in the latter half of November and accelerating throughout the month of December, the companyexperienced a significant increase inCOVID-19 admissions in nearly all of themarkets inwhich it operates across itsMedicare Advantage, Medicaid, and group commercial insurance business lines. Humana also experienced acorrespondingdeclineinnon-COVIDutilizationinallservicecategories,withMedicareAdvantagenon-COVIDutilizationrunningapproximately15percentbelownormallevelsatthecloseofthequarter,wellbelowthenearbaselinelevelsofutilizationwitnessedaslateastheendofOctober2020.
Resultsofoperationsinthequarterwereaffectedbythefollowingfactors:• meaningfulCOVID-19treatmentandtestingcostsrelatedtotheuptickincasesinthelasttwomonthsof4Q20,
morethanoffsetbythedeclininglevelsofnon-COVIDutilizationaspreviouslydiscussed,• ongoingcrisisreliefeffortsandstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,bothof
whichwereheavilyweightedtothefinalmonthsof2020,and• increasedmarketingexpensesassociatedwiththeMedicareAdvantageAnnualElectionPeriod(AEP).
Inaddition,Humana’s4Q20andFY2020GAAPresultsofoperationswereimpactedbymarketgainsresultingfromtheinitial conversionof the company'spriorownership interest in certainprivately-held companies (primarilyOakStreetHealth, Inc.) into publicly-traded common stock upon such companies' initial public offering (IPO) during the thirdquarterof2020andthesubsequentchangesinthemarketvalueofsuchsecuritiesfromtheirIPO.FY2020resultswerefurtherimpactedbythereceiptofunpaidriskcorridorpayments(thatwerepreviouslywrittenoff)inthethirdquarter.ThereceiptoftheriskcorridorpaymentswasassociatedwithlossesincurredbythecompanyundertheAffordableCare
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Act(ACA)businessfrom2014to2016.Thereceiptoftheseriskcorridorpaymentsaccountedforlessthan50percentofthecompany’saccumulatedpretaxlossesfromitsACAbusinessesduringthattimeperiod.
The impact of both the fair market value changes and the receipt of the unpaid risk corridor payments have beenexcludedinthecompany’sAdjusted(non-GAAP)consolidatedresultsofoperationsasdetailedinthetablesabove.
Pleaserefertothetablesabove,aswellastheconsolidatedandsegmenthighlightsectionsthat followforadditionaldiscussionofthefactorsimpactingtheyear-over-yearcomparisons.
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Inaddition,belowisasummaryofkeyconsolidatedandsegmentstatisticscomparing4Q20to4Q19andFY2020toFY2019.
HumanaInc.SummaryofQuarterlyResults(dollarsinmillions,exceptpershareamounts) 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
Consolidatedresults:
Revenues-GAAP $19,062 $16,295 $77,155 $64,888
Revenues-Adjusted $18,960 $16,295 $75,801 $64,888
Pretax(loss)income-GAAP ($458) $593 $4,600 $3,456
Pretax(loss)income-Adjusted ($498) $322 $3,468 $3,067
(Losspercommonshare)dilutedEPS-GAAP ($2.07) $3.84 $25.31 $20.10
(Losspercommonshare)dilutedEPS-Adjusted ($2.30) $2.28 $18.75 $17.87
Benefitsexpenseratio-GAAP 88.3% 86.6% 83.1% 85.6%
Benefitsexpenseratio-Adjusted 88.3% 86.6% 83.8% 85.6%
Operatingcostratio-GAAP 16.3% 13.2% 13.2% 11.5%
Operatingcostratio-Adjusted 16.3% 13.2% 13.3% 11.4%
Operatingcashflows-GAAP $283 $512 $5,639 $5,284
Parentcompanycashandshortterminvestments $772 $1,361
Debt-to-totalcapitalization 32.7% 32.0%
Retailsegmentresults:
Revenues-GAAP $16,834 $14,207 $67,298 $56,466
Benefitsexpenseratio-GAAP 87.0% 86.3% 84.2% 86.4%
Operatingcostratio-GAAP 14.0% 11.6% 11.0% 9.4%
Segment(loss)earnings-GAAP ($210) $275 $3,017 $2,235
Segment(loss)earnings-Adjusted ($207) $279 $3,032 $2,251
GroupandSpecialtysegmentresults:
Revenues-GAAP $1,791 $1,875 $7,285 $7,525
Benefitsexpenseratio-GAAP 104.3% 95.2% 85.6% 86.0%
Operatingcostratio-GAAP 28.1% 22.4% 25.0% 22.0%
Segment(loss)earnings-GAAP ($375) ($146) ($143) $28
Segment(loss)earnings-Adjusted ($374) ($145) ($139) $32
HealthcareServicessegmentresults:
Revenues-GAAP $7,291 $6,696 $28,448 $25,783
Operatingcostratio-GAAP 97.8% 96.8% 96.3% 96.4%
Segmentearnings-GAAP $128 $178 $944 $789
Adjustedearningsbeforeinterest,taxes,depreciationandamortization(AdjustedEBITDA)(e) $196 $241 $1,232 $1,056
2021EarningsGuidance
Whileacknowledgingtheheighteneduncertaintysurroundingtheongoingpandemic,thecompanyprovided itsGAAPandAdjustedEPSguidance for theyearendingDecember31,2021 (FY2021)asdetailedbelow. GAAPandAdjustedresults for FY 2020 are also shown for comparison. Additional FY 2021 guidance points are included in the tablebeginningonpage24ofthisearningsrelease.
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DilutedearningspercommonshareFY2021
Guidance(f) FY2020(c)
GAAP $20.82to$21.32 $25.31
Amortizationofidentifiableintangibles ~$0.43 0.51
Put/callvaluationadjustmentsassociatedwithcompany'snon-consolidatingminorityinterestinvestments — 0.60
Changeinfairmarketvalueofpublicly-tradedequitysecurities — (4.32)
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff,net — (3.35)
Adjusted(non-GAAP)–FY2021projected;FY2020reported $21.25to$21.75 $18.75
2022FinalRateNotice
On January15,2021,Centers forMedicare&MedicaidServices (CMS)published itsAnnouncementofCalendarYear2022MedicareAdvantageCapitationRatesandPartCandPartDPaymentPolicies(theFinalRateNotice).ThecompanyexpectstheFinalRateNoticetoresultina3.7percent(g)rateincreasefornonendstagerenaldisease(ESRD)MedicareAdvantagebusiness,excludingtheimpactofEmployerGroupWaiverPlan(EGWP)fundingchanges.Thecompany’s3.7percentrateincreasecomparestoCMS’estimateforthesectorof4.08percentonacomparablebasis,withthevarianceprimarily driven by county rebasing and the company's geographic footprint. CMS also establishes separate rates ofpayment forESRDbeneficiariesenrolled inMedicareAdvantageplans.Thecompanyexpects theFinalRateNotice toresultina5.0percentrateincreasein2021forESRDbeneficiaries.Thecompany’sestimateof5.0percentisequivalenttoCMS’estimate.
The2022benchmarkincreaseof3.7percentincludesroughly0.8percentfortheprojectedcostofCOVID-19vaccines.
HumanaConsolidatedHighlights
Consolidatedrevenues
Consolidatedrevenues 4Q20(a) 4Q19 FY2020(c) FY2019
GAAP $ 19,062 $ 16,295 $ 77,155 $ 64,888
Changeinfairmarketvalueofpublicly-tradedequitysecurities (102) — (745) —
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff — — (609) —
Adjusted(non-GAAP) $ 18,960 $ 16,295 $ 75,801 $ 64,888
GAAPconsolidatedrevenuesfor4Q20were$19.06billion,anincreaseof$2.77billion,or17percent,from$16.30billionin4Q19.Totalpremiumsandservices revenuesof$18.85billion in4Q20 increased$2.70billion,or17percent, from$16.15billion in4Q19. The favorable year-over-year comparisonswereprimarilydrivenbyhigherpremium revenuesstemmingfromMedicareAdvantageandstate-basedcontractsmembershipgrowthandhigherpermemberMedicareAdvantagepremiums.Theseincreaseswerepartiallyoffsetbytheimpactofdecliningyear-over-yearstand-alonePDPandfully-insuredgroupcommercialmedicalmembership.
GAAPconsolidatedrevenuesforFY2020increased$12.27billion,or19percent,to$77.16billionfrom$64.89billioninFY2019.TotalFY2020premiumsandservicesrevenuesroseto$76.00billion,increasing$11.61billion,or18percent,from$64.39billionintheprior-yearperiod.TheFY2020increaseswereprimarilydrivenbythesamefactorsimpactingthequarterlyGAAPcomparison,alongwithhigherinvestmentincomeprimarilyresultingfrommarketgainsassociatedwithpublicly-tradedequitysecuritiesheldbythecompanyandthereceiptofpaymentsassociatedwiththecommercialriskcorridorreceivables(previouslywritten-off)inthethirdquarterof2020.
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Adjusted consolidated revenues for both 4Q20 and FY 2020were impacted by the same factors affecting the GAAPcomparisonswhileexcludingtheimpactofthefactorsdetailedinthetableabove.
Consolidatedbenefitsexpense
Consolidatedbenefitratio(benefitsexpenseasapercentofpremiums) 4Q20(a) 4Q19 FY2020(c) FY2019
GAAP 88.3% 86.6% 83.1% 85.6%
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff —% —% 0.7% —%
Adjusted(non-GAAP) 88.3% 86.6% 83.8% 85.6%
The4Q20andFY2020GAAPconsolidatedbenefitratiosof88.3percentand83.1percent,respectively,comparedtothe4Q19andFY2019GAAPconsolidatedbenefitratiosof86.6percentand85.6percent,respectively.
Theyear-over-year increase in theGAAPquarterlycomparisonreflects the impactofmeaningfulCOVID-19treatmentandtestingcostsresultingfromtheincreaseincasenumbersinthelasttwomonthsofthequarter.Thecomparisonwasfurtheraffectedbyongoingpandemicreliefeffortsandstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,bothofwhichwereheavilyweightedtothefinalmonthsof2020.Thesereliefefforts includethewaiverofallcostsharingforin-networkprimarycare,outpatientbehavioralhealth,andtelehealthvisitsforthecompany'sMedicareAdvantagemembers, continueddeliveryofmeals to seniormembers inneed, thedistributionof in-homepreventivescreeningkits tomembers,establishmentofa clinicaloutreach teamtoproactivelyengagewith thecompany'smostvulnerablemembers,andvariousproviderandemployergroupsupportinitiatives.
Thesefactorswerepartiallyoffsetbythefollowingfactors:
• temporarydeferralofnon-COVIDutilization;aspreviouslydiscussed,Humanaexperiencedasignificantdeclinein non-COVID utilization across all lines of business in the last two months of the quarter with MedicareAdvantagenon-COVIDutilizationrunningapproximately15percentbelowhistoricbaselinelevelsattheendof4Q20,
• thereinstatementofthenon-deductiblehealth insurance industryfee(HIF) in2020thatwascontemplated inthepricingandbenefitdesignofthecompany'sproducts;and
• higherfavorablePriorPeriodDevelopmentin4Q20.
The year-over-year decrease in the comparison of FY GAAP consolidated benefit ratios reflects the significantlydepressed non-COVID utilization in the first half of 2020 and in the last two months of 4Q20, along with thereinstatementofthenon-deductibleHIFinFY2020aspreviouslydiscussed,andthereceiptofcommercialriskcorridorreceivables(previouslywrittenoff)inthethirdquarterof2020.Thesedecreaseswerepartiallyoffsetbythefollowingfactors:
• meaningfulCOVID-19treatmentandtestingcosts,
• ongoingpandemicreliefeffortsandstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,and
• lowerfavorablePriorPeriodDevelopmentinFY2020.
TheAdjustedconsolidatedbenefit ratio forboth4Q20andFY2020were impactedby thesame factorsaffecting theGAAPcomparisonswhileexcluding the receiptof commercial risk corridors receivables (previouslywrittenoff) in thethirdquarterof2020.
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PriorPeriodMedicalClaimsReserveDevelopment(PriorPeriodDevelopment)
ConsolidatedPriorPeriodDevelopment(inmillions)Favorable(unfavorable)
FirstQuarter
SecondQuarter
ThirdQuarter
FourthQuarter FY
PriorPeriodDevelopmentfromprioryearsrecognizedin2020 $284 $(49) $43 $35 $313
PriorPeriodDevelopmentfromprioryearsrecognizedin2019 $267 $8 $56 $5 $336
FavorablePriorPeriodDevelopmentdecreased theconsolidatedbenefit ratioby20basispoints in4Q20anddidnotmaterially impact theconsolidatedbenefit ratio in4Q19.FavorablePriorPeriodDevelopmentdecreased theFY2020consolidatedbenefitratioby40basispointswhiledecreasingtheFY2019consolidatedbenefitratioby50basispoints.
Consolidatedoperatingexpenses
Consolidatedoperatingcostratio(operatingcostsasapercentoftotalrevenueslessinvestmentincome) 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
GAAP 16.3% 13.2% 13.2% 11.5%
Receiptofcommercialriskcorridorreceivablespreviouslywrittenoff,net — —% 0.1% —%
Chargesassociatedwithworkforceoptimization — —% —% (0.1)%
Adjusted(non-GAAP) 16.3% 13.2% 13.3% 11.4%
The4Q20GAAPconsolidatedoperatingcostratio(operatingcostsasapercentoftotalrevenueslessinvestmentincome)of16.3percentincreased310basispointsfromthe4Q19ratioof13.2percent.Theincreasewasprimarilyrelatedtothefollowingfactors:
• COVID-19 related administrative costs, including those associated with purchasing personal protectiveequipment for the company's clinicians and the build-out of infrastructure necessary to support employeesworkingremotely,
• continuedsupportforthecompany'sconstituents,includingmembers,providers,employergroups,employees,andcommunities,aswellasstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,
• increasedspendingassociatedwithMedicareAEP,and
• reinstatementofthenon-deductibleHIFin2020,whichincreasedtheconsolidatedGAAPoperatingcostratiobyapproximately160basispointsin4Q20.
Theaboveitemswerepartiallyoffsetbythefollowingitems:
• scaleefficienciesassociatedwithgrowthinthecompany'sMedicareAdvantagemembership;and
• significantoperatingcostefficienciesin4Q20drivenbypreviouslydisclosedproductivityinitiatives.
The170basispointincreaseintheFY2020GAAPconsolidatedoperatingcostratioof13.2percentfrom11.5percentinFY2019wasprimarilyimpactedbythesamefactorsinfluencingthefourthquarterGAAPcomparisoncombinedwiththe$200millionofcontributionstotheHumanaFoundationinthefirsthalfof2020tosupportthecommunitiesservedbythecompany,particularlythosewithsocialandhealthdisparities.
Thenon-deductibleHIFincreasedtheFY2020consolidatedGAAPoperatingcostratiobyapproximately160basispoints.
TheAdjustedconsolidatedoperatingcostratiosforboth4Q20andFY2020wereimpactedbythesamefactorsaffectingtheGAAPcomparisonswhileexcludingtheimpactofthefactorsdetailedinthetableabove.
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Balancesheet
• AtDecember 31, 2020, the company had cash, cash equivalents, and investment securities of$18.44 billion,downapproximately$3.39billion,or16percent,from$21.83billionatSeptember30,2020primarilyresultingfromcommonstock repurchases related to thecompany'saccelerated stock repurchase (ASR)programmorefullydescribedbelow,the$1.00billionrepaymentofatermloan,andrepaymentof$400millionrelatedtothecompany's2.50percentseniornoteswhichcamedueonDecember15,2020.Detailedchangesareoutlinedinthecompany’sconsolidatedstatementofcashflowsonpagesS-6ofthestatisticalsupplementincludedinthisrelease.
• AtDecember31,2020,cashandshort-terminvestmentsheldattheparentcompanyof$772milliondecreasedapproximately $1.65 billion, or 68 percent, from$2.42 billion at September 30, 2020.The sequential changeprimarily reflects common stock repurchases related to the company's ASRmore fully described below, the$1.00billionrepaymentofatermloan,repaymentof$400millionrelatedtothecompany's2.50percentseniornotes, capital expenditures, capital contributions to certain subsidiaries, and cash dividends to shareholders.These decreases were partially offset by dividends from certain regulated subsidiaries and non-regulatedsubsidiaryearnings.
• Days in claims payable (DCP) of 46.2 days at December 31, 2020, decreased by 2.2 days from 48.4 days atSeptember 30, 2020 but increased 5.8 days from 40.4 days at December 31, 2019. The sequential declineprimarilyresultedfromtimingofsurpluspaymentstoprovidersinrisksharingarrangements.
Theyear-over-yearincreaseinDCPprimarilyreflectsthepreviouslydiscussedlowerutilizationlevelsduringFY2020comparedtoFY2019,whichledtohigherprovidersurplusaccrualsrelatedtothecompany'srisksharingarrangements.
ChangesareoutlinedintheDCProllforwardonpageS-19ofthestatisticalsupplementincludedinthisrelease.
• Debt-to-totalcapitalizationatDecember31,2020was32.7percent,down30basispointsfrom33.0percentatSeptember 30, 2020 primarily resulting from a $1.00 billion repayment of a term loan and $400 millionrepaymentofthecompany's2.50percentseniornoteswhichcamedueonDecember15,2020.ThesedecreaseswerepartiallyoffsetbytheimpactofsharerepurchasesresultingfromtheASRprogramasmorefullydescribedbelow,additionalcommercialpaperborrowings,andtheimpactofthe4Q20loss.
Thecompany’slong-termdebt-to-totalcapitalizationtargetofapproximately35percentisexpectedtoallowthecompanytomaintainitsinvestmentgradecreditratingwhileprovidingsignificantfinancialflexibility.Attimes,the company's debt-to-total capitalization will exceed this target due to the timing of share repurchases,acquisitions,anddebtissuance.
Operatingcashflows
• GAAP cash flows provided by operations of$283million in 4Q20 compared toGAAP cash flows provided byoperationsof$512million in4Q19,adecreaseof$229million,or45percent,yearoveryear. Theyear-over-yeardecreasewasprimarilyimpactedbytheearningsdeclinein4Q20comparedto4Q19partiallyoffsetbythepositiveimpactofworkingcapitalitems.
• GAAPcashflowsprovidedbyoperationsforFY2020totaled$5.64billionversus$5.28billionduringFY2019,anincreaseof$355million,or7percent, yearoveryear. Theyear-over-year increaseprimarily reflectedhigherearningsinFY2020comparedtoFY2019andtheimpactofworkingcapitalitems.
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Sharerepurchases
• In July 2019, Humana's Board of Directors approved a $3.00 billion share repurchase authorization with anexpiration date of June 30, 2022. Prior to 2020, Humana repurchased $1.00 billion of shares through apreviouslydisclosedASRagreementunderthisauthorization.
InDecember2020,thecompanyenteredintoseparateagreementswithtwothird-partyfinancialinstitutionstoeffectanaggregate$1.75billionASRprogramunder theauthorization.During4Q20,under the termsof thisprogram,thecompanyrepurchasedapproximately3,829,400shares.TheactualnumberofsharesrepurchasedundertheDecember2020ASRagreementswillbedeterminedbasedonavolume-weightedaveragepriceofthecompany'scommonstockduringthepurchaseperiod.Settlementofapproximately$263millionofrepurchasesunder theASR agreements remains pending, and the company expects final settlement in secondquarter of2021. Aside from the completion of the ASR program, the company did not complete any additional open-marketsharerepurchasetransactionsduring4Q20.
• AsofFebruary2,2021,thecompanyhasaremainingrepurchaseauthorizationofapproximately$250million.
Cashdividends
• Thecompanypaidcashdividends to its stockholdersof$84million in4Q20versus$75million in4Q19.Cashdividendsof$323millionwerepaidtothecompany’sstockholdersduringFY2020comparedto$291millioninFY 2019. The increases reflect growth in the per share dividend amount to $0.625, as approved by thecompany'sBoardofDirectorsinFebruary2020,versusthepreviouspershareamountof$0.55.
Humana’sRetailSegment
This segment consists of the company’s Medicare benefits, marketed to individuals directly or via group Medicareaccounts,aswellasitsMedicareSupplementandstate-basedcontractsbusinesses.State-basedcontractsincludethosewithvariousstatestoprovideservicesundertheMedicaidprogram,includingTemporaryAssistanceforNeedyFamilies(TANF),dualeligible,andLong-TermSupportServicesbenefits. Inaddition, this segmentalso includes thecompany’scontract with Centers for Medicare & Medicaid Services (CMS) to administer the Limited Income Newly EligibleTransitionprescriptiondrugplan(PDP)program.
Retailsegmentrevenues:
• The4Q20revenuesfortheRetailsegmentwere$16.83billion,anincreaseof$2.63billion,or18percent,from$14.21billionin4Q19primarilyreflectinghigherpremiumsasaresultofMedicareAdvantageandstate-basedcontractsmembershipgrowthandhigherpermemberMedicareAdvantagepremiums. Thesefavorableitemswerepartiallyoffsetbythedeclineinmembershipinthecompany'sstand-alonePDPofferings.Theyear-over-yearmembershipchangesarefurtherdiscussedbelow.
• TheFY2020revenuesfortheRetailsegmentwere$67.30billion,up$10.83billion,or19percent,from$56.47billioninFY2019,primarilyreflectingthesamefactorsimpactingtheyear-over-yearfourthquartercomparison.
Retailsegmentenrollment:
• IndividualMedicareAdvantagemembershipwas3,962,700asofDecember31,2020,anetincreaseof375,500or 10 percent, from3,587,200 as of December 31, 2019, andup 27,600, or 1 percent, from3,935,100 as ofSeptember30,2020. Theyear-over-year increasewasprimarilyduetomembershipadditionsassociatedwiththe 2020Annual Election Period (AEP), continued enrollment due to special elections, age-ins, and andDualEligible Special Need Plans (D-SNP) members, as well as the 2020 Open Election Period (OEP) forMedicarebeneficiaries. The2020OEPsalesperiod,whichran fromJanuary1toMarch31,2020,addedapproximately30,000members.
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IndividualMedicareAdvantagemembershipincludes406,100D-SNPmembersasofDecember31,2020,anetincreaseof117,900,or41percent,from288,200asofDecember31,2019,andup15,000,or4percent,from391,100asofSeptember30,2020.
• January2021individualMedicareAdvantagemembershipapproximated4,270,600,upapproximately307,900,or 8 percent, from December 31, 2020, reflecting netmembership additions of 299,700 during the recentlyconcluded 2021 AEP, plus an additional 8,200D-SNPmembers associatedwith the recently completed iCareacquisition.
Includingthe impactoftherecentlycompleted iCareacquisition,January2021 individualMedicareAdvantagemembership includes 475,200 D-SNP members, which represents growth of 69,100, or 17 percent, overDecember31,2020.
• GroupMedicareAdvantagemembershipwas613,200asofDecember31,2020,anetincreaseof87,900,or17percent,from525,300atDecember31,2019,andup1,200from612,000asofSeptember30,2020.Theyear-over-yearincreasereflectstheadditionofalargeaccountinJanuary2020,alongwithnetmembershipadditionsassociatedwiththe2020sellingseason.
• January2021groupMedicareAdvantagemembershipapproximated556,900,downapproximately56,300,or9percent,fromDecember31,2020,reflectingnetmembershipdeclinesduringthe2021sellingseason.
• Membership in the company’s stand-alone PDP offerings was 3,866,700 as of December 31, 2020, a netdecreaseof498,500,or11percent,from4,365,200asofDecember31,2019,anddown25,500,or1percent,from3,892,200asofSeptember30,2020. Theanticipatedyear-over-yeardeclinewasprimarily the resultofterminations driven by premium and benefit adjustments experienced by members that were previouslyenrolled in thecompany's2019HumanaWalmartRxplanand the2019HumanaEnhancedplan,whichwereconsolidatedintothePremierRxplanin2020.TheexpectedPDPlosseswerepartiallyoffsetbygrowthinthenewlow-priceHumanaWalmartValueRxplan,drivenbybothnewsalesandplantoplanchanges.
• January 2021 stand-alone PDP membership approximated 3,663,200, down approximately 203,500, or 5percent, fromDecember31,2020, reflectingnetmembershipdeclinesduring the recently concludedAEP forMedicarebeneficiaries.Aspreviouslydisclosed,theseanticipatedmembershiplosseswereprimarilytheresultofHumana'sWalmartValueplannotbeingthelowcostleaderintheindustryin2021.
• State-based contracts membership (including dual-eligible demonstration members) was 772,400 as ofDecember 31, 2020, a net increase of 303,400, or 65 percent, from 469,000 at December 31, 2019 and up42,300,or6percent,from730,100atSeptember30,2020.Themembershipincreasesin2020primarilyreflecttheimpactofdiscontinuingthereinsuranceagreementwithCareSourceandtheassumptionoffullfinancialriskfortheexistingKentuckyMedicaidcontractasofJanuary1,2020,aswellasadditionalenrollmentresultingfromthecurrenteconomicdownturnduetotheCOVID-19pandemic.
Retailsegmentbenefitsexpense:
• The4Q20benefitratiofortheRetailsegmentwas87.0percent,anincreaseof70basispointsfrom86.3percentfor4Q19.Theyear-over-yearincreaseinthesegmentbenefitratiowasprimarilyduetothefollowingfactors:
◦ meaningfulCOVID-19treatmentandtestingcosts,
◦ ongoingpandemicreliefeffortsandstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,bothofwhichwereheavilyweightedtothefinalmonthsof2020,and
◦ ashiftinMedicaremembershipmixduetothelossofstand-alonePDPmembersandsignificantgrowthinMedicareAdvantagemembers;thebenefitratioforstand-alonePDPmembersgenerallydecreasesastheyearprogress.
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Theaboveitemswerepartiallyoffsetbythefollowingfactors:
◦ thetemporarydeferralofnon-COVIDutilizationinthelatterpartof4Q20aspreviouslydiscussed,
◦ the reinstatement of the non-deductible HIF in 2020 that was contemplated in the pricing and benefitdesignofthecompany'sproducts,and
◦ slightlyhigherfavorablePriorPeriodDevelopmentin4Q20comparedto4Q19.
• TheFY2020benefitratioforthesegmentof84.2percentwas220basispointslowerthantheFY2019ratioof86.4percentprimarilyreflectingthefollowingfactors:
◦ significantlydepressednon-COVIDutilization inthefirsthalfof2020andagain inthe lasttwomonthsof4Q20;and
◦ reinstatementofthenon-deductibleHIFin2020thatwascontemplatedinthepricingandbenefitdesignofthecompany'sproducts.
Thesedecreaseswerepartiallyoffsetbythefollowingfactors:
◦ meaningfulCOVID-19treatmentandtestingcosts,
◦ thecompany'songoingpandemicreliefeffortsandstrategicinvestmentsinthecompany'sintegratedcaredeliverymodel,
◦ theimpactfromashiftinMedicaremembershipmix,and
◦ lowerfavorablePriorPeriodDevelopmentinFY2020.
PriorPeriodDevelopment
Favorable Prior Period Development in the Retail segment decreased the segment benefit ratio by 20 basispointsin4Q20comparedtodecreasingthe4Q19ratioby10basispoints.
FavorablePriorPeriodDevelopmentdecreasedtheFY2020ratioby40basispointsanddecreasedtheFY2019benefitratioby70basispoints.
RetailSegmentPriorPeriodDevelopment(inmillions)Favorable(unfavorable)
FirstQuarter
SecondQuarter
ThirdQuarter
FourthQuarter FY
PriorPeriodDevelopmentfromprioryearsrecognizedin2020 $238 $(33) $30 $31 $266
PriorPeriodDevelopmentfromprioryearsrecognizedin2019 $283 $28 $55 $20 $386
Retailsegmentoperatingcosts:
• TheRetailsegment’soperatingcostratioof14.0percentin4Q20increased240basispointsfrom11.6percentin4Q19.Theyear-over-yearcomparisonwasnegativelyimpactedbythefollowingfactors:
◦ reinstatementofthenon-deductibleHIFin2020,whichincreasedtheRetailsegment'sGAAPoperatingcostratiobyapproximately160basispointsin4Q20,
◦ COVID-19relatedadministrativecostsaspreviouslydiscussed,
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◦ continued support for the company's constituents and strategic investments in the company's integratedcaredeliverymodel,and
◦ increasedspendingassociatedwithMedicareAEP.
Theaboveincreaseswerepartiallyoffsetbythefollowingitems:
◦ scaleefficienciesassociatedwithgrowthinthecompany'sMedicareAdvantagemembership;and
◦ significantoperatingcostefficienciesin4Q20drivenbypreviouslydisclosedproductivityinitiatives.
• TheRetailsegment’sFY2020operatingcostratioof11.0percentincreased160basispointsfrom9.4percentinFY 2019 primarily reflecting the same factors that impacted the year-over-year comparison for the fourthquarter. Thenon-deductibleHIF impacted the segment’s FY 2020operating cost ratio by approximately 160points.
Retailsegmentresults:
Retailsegment(loss)earningsinmillions 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
GAAP ($210) $275 $3,017 $2,235
Amortizationassociatedwithidentifiableintangibles 3 4 15 16
Adjusted(non-GAAP) ($207) $279 $3,032 $2,251
• Theyear-over-yearunfavorablequartercomparisoninGAAPsegmentresultswasimpactedbythesamefactorsthatledtothesegment'shigherbenefitandoperatingcostratiosin4Q20.Theyear-over-yearfavorablecomparisoninFYGAAPsegmentearningsresultedfromthenetfavorableimpactofalowersegmentbenefitratiopartiallyoffsetbyahigheroperatingcostratioaspreviouslydescribed.
Humana’sGroupandSpecialtySegment
This segment consists of the company’s employer group fully-insured commercial medical products and specialtyinsurancebenefitsmarketedtoindividualsandgroups,includingdental,vision,andlifeinsurancebenefits.Inaddition,thesegmentalsoincludesthecompany’sadministrativeservicesonly(ASO)productsanditsmilitaryservicesbusinesses.
GroupandSpecialtysegmentrevenues:
• The4Q20 revenues for theGroupandSpecialty segmentwere$1.79billion, down$84million, or 4percent,yearoveryearfrom$1.88billionin4Q19.Thisdecreasewasprimarilyduetothedeclineinthecompany'sfully-insuredgroupcommercialmembership,partiallyoffsetbyhigherpermemberpremiumsacrossthefully-insuredcommercialbusiness.
• TheFY2020revenuesfortheGroupandSpecialtysegmentwere$7.29billion,down$240million,or3percent,from $7.53 billion in FY 2019 primarily reflecting the same factors that impacted the year-over-year fourthquartercomparison,alongwithhigherstop-lossrevenuesrelatedtothecompany'slevel-fundedASOaccountsresultingfrommembershipgrowthinthisproductasmorefullydescribedbelow.
GroupandSpecialtysegmentenrollment:
• Group fully-insured commercial medical membership was 777,400 at December 31, 2020, a decrease of131,200,or14percent,from908,600atDecember31,2019,anddown22,100,or3percent,from799,500atSeptember30,2020.Theseanticipateddeclinesprimarilyreflectlowermembershipinsmallgroupaccountsdue
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inpart tomoresmallgroupaccountsselecting level-fundedASOproducts,aswellas the lossofcertain largegroup accounts due to disciplined pricing in the competitive environment. Additionally, the declines inmembershipwereimpactedbythecurrenteconomicdownturndrivenbytheCOVID-19pandemicresulting inhigherunemploymentratesand lossofcoveragefor fully-insuredcommercialgroupmembers.Theportionofgroupfully-insuredcommercialmedicalmembershipinsmallgroupaccounts(2-99sizedemployergroups)wasapproximately54percentatDecember31,2020comparedto56percentatSeptember30,2020and59percentatDecember31,2019.
• GroupASOcommercialmedicalmembershipwas504,900atDecember31,2020, adecreaseof24,300,or5percent,from529,200atDecember31,2019,butup2,800,or1percent,from502,100atSeptember30,2020.Thesechangesprimarilyreflectthelossofcertainlargegroupaccountsduetocontinueddisciplineinpricingofservices for self-funded accounts amid a highly competitive environment and the impact of the currenteconomicdownturndrivenby theCOVID-19pandemicaspreviouslydiscussed,partiallyoffsetbymore smallgroupaccountsselecting level-fundedASOproducts.Smallgroupmembershipcomprised45percentofgroupASOmedicalmembershipatDecember31,2020andatSeptember30,2020versus40percentatDecember31,2019.
• Militaryservicesmembershipwas5,998,700atDecember31,2020,anincreaseof14,400, from5,984,300atDecember 31, 2019, but down 17,700 from 6,016,400 at September 30, 2020.Membership includesmilitaryservicemembers,retirees,andtheirfamiliestowhomthecompanyisprovidinghealthcareservicesunderthecurrentTRICAREEastRegioncontract.
• Membershipinspecialtyproducts(h)was5,310,300atDecember31,2020,adecreaseof115,600,or2percent,from 5,425,900, at December 31, 2019, and down 15,300 from 5,325,600 at September 30, 2020. Thesedecreasesresultedfromthelossofcertaingroupaccountsofferingstand-alonedentalandvisionproducts,aswellastheimpactofthecurrenteconomicdownturndrivenbytheCOVID-19pandemicaspreviouslydiscussed.
GroupandSpecialtysegmentbenefitsexpense:
• The4Q20benefitratiofortheGroupandSpecialtysegmentwas104.3percent,anincreaseof910basispointsfrom95.2percentfor4Q19.Theyear-over-yearincreaseinthesegmentbenefitratiowasprimarilyduetothefollowingfactors:
◦ ongoingpandemicreliefeffortsandstrategicinvestmentsinthebusiness,primarilysurroundinginitiativestoeaseadministrativeandfinancialstressforprovidersandemployerswhilepositioningthebusinessforlong-termsuccess.Investmentsinthesegmentweredisproportionaterelativetothereductioninnon-COVIDutilizationlevelsforthecompany'scommercialgroupmedicalandspecialtymembers;and
◦ meaningfulCOVID-19treatmentandtestingcosts.
Theaboveitemswerepartiallyoffsetbythefollowingfactors:
◦ reinstatementofthenon-deductibleHIFin2020thatwascontemplatedinthepricingandbenefitdesignofthecompany'sproducts,
◦ thetemporarydeferralofnon-COVIDutilizationinthelasttwomonthsof4Q20aspreviouslydiscussed,and
◦ higherfavorablePriorPeriodDevelopmentinthesegmentin4Q20.
• TheFY2020benefitratioforthesegmentof85.6percentwas40basispointslowerthantheFY2019ratioof86.0percent.Theyear-over-yearcomparisonwasimpactedbythefollowingfactors:
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◦ significantlydepressednon-COVIDutilizationinthefirsthalfof2020andagaininthelasttwomonthsof4Q20,
◦ reinstatementofthenon-deductibleHIFin2020thatwascontemplatedinthepricingandbenefitdesignofthecompany'sproducts,and
◦ higherfavorablePriorPeriodDevelopmentinthesegmentinFY2020.
Thesefactorswerepartiallyoffsetbythefollowingitems:
◦ meaningfulCOVID-19treatmentandtestingcosts;and
◦ thecompany'songoingpandemicreliefeffortsandstrategicinvestmentsaspreviouslydescribed.
PriorPeriodDevelopment
TheGroupandSpecialtysegment'sfavorablePriorPeriodDevelopmentfor4Q20,asnotedinthetablebelow,decreased the segment benefit ratio by 30 basis points in 4Q20 compared to unfavorable Prior PeriodDevelopmentin4Q19increasingthesegmentratioby90basispoints.
Favorable Prior Period Development decreased the FY 2020 ratio by 70 basis points while unfavorabledevelopmentinFY2019increasedthebenefitratioby70basispoints.
GroupandSpecialtysegmentPriorPeriodDevelopment(inmillions)Favorable(unfavorable)
FirstQuarter
SecondQuarter
ThirdQuarter
FourthQuarter FY
PriorPeriodDevelopmentfromprioryearsrecognizedin2020 $46 $(16) $13 $4 $47
PriorPeriodDevelopmentfromprioryearsrecognizedin2019 $(16) $(20) $1 $(15) $(50)
GroupandSpecialtysegmentoperatingcosts:
• TheGroupandSpecialtysegment’soperatingcostratiowas28.1percentin4Q20,anincreaseof570basispointsfrom22.4percentin4Q19primarilyreflectingthefollowingfactors:
◦ COVID-19relatedadministrativecostsaspreviouslydiscussed,
◦ continuedsupportforthecompany'sconstituentsandstrategicinvestmentsinthesegmenttopositionthebusinessforlong-termsuccess,and
◦ reinstatementofthenon-deductibleHIFin2020,whichincreasedtheGroupandSpecialtysegment'sGAAPoperatingcostratiobyapproximately130basispointsin4Q20.
Theimpactoftheaboveitemswaspartiallyoffsetbysignificantoperatingcostefficienciesin4Q20drivenbypreviouslydisclosedproductivityinitiatives.
• TheGroupandSpecialtysegment’soperatingcostratioof25.0percentforFY2020wasup300basispointscomparedto22.0percentforFY2019.Theyear-over-yearincreasewasprimarilyimpactedbythesamefactorsinfluencingthefourthquartercomparison.
Thenon-deductibleHIFimpactedthesegment’sFY2020operatingcostratiobyapproximately130basispoints.
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GroupandSpecialtysegmentresults:
GroupandSpecialtysegment(loss)earningsInmillions 4Q20(a) 4Q19(b) FY2020(c) FY2019(d)
GAAP ($375) ($146) ($143) $28
Amortizationassociatedwithidentifiableintangibles 1 1 4 4
Adjusted(non-GAAP) ($374) ($145) ($139) $32
• Theunfavorableyear-over-yearquartercomparisoninGAAPsegmentresultswasimpactedbythesamefactorsthatledtothesegment'shigherbenefitandoperatingcostratiosin4Q20.Theunfavorableyear-over-yearFYcomparisonofGAAPsegmentearningsresultedfromthenetnegativeimpactofahigheroperatingcostratio,partiallyoffsetbyaslightlylowerbenefitratioinFY2020.
Humana’sHealthcareServicesSegment
This segment includes services offered to the company’s health planmembers as well as to third parties, includingpharmacysolutions,providerservices,andclinicalprograms,suchashomehealthandotherservicesandcapabilitiestopromote wellness and advance population health, including the company's non-consolidating minority interestinvestmentsinKindredatHomeandthestrategicpartnershipwithWelsh,Carson,Anderson&Stowe(WCAS)todevelopandoperatesenior-focused,payor-agnostic,primarycarecenters.
Servicesofferedbythissegmentaredesignedtoenhancethehealthcareexperienceoverall.Theseservicesmayleadtolowerutilizationassociatedwithimprovedmemberhealthand/orlowerdrugcosts.
HealthcareServicessegmentrevenues:
• Revenuesof$7.29billionin4Q20fortheHealthcareServicessegmentincreasedby$595million,or9percent,from$6.70billionin4Q19.Theyear-over-yearcomparisonwasfavorablyimpactedbythefollowingfactors:
◦ thecompany'sstrongMedicareAdvantagemembershipgrowth;and
◦ additionalpharmacyrevenuesin4Q20associatedwiththeacquisitionofEnclaraHealthcare.
Theseincreaseswerepartiallyoffsetbythelossofintersegmentrevenuesassociatedwiththedeclineinstand-alonePDPmembershipaspreviouslydiscussed.
• FY2020revenues for theHealthcareServicessegmentwere$28.45billion,an increaseof$2.67billion,or10percent, from $25.78 billion in FY 2019 primarily due to the same factors affecting the year-over-yearcomparisonforthefourthquarter,alongwithaslightshiftbymembersto90-daysupply.
HealthcareServicessegmentoperatingcosts:• TheHealthcareServicessegment’soperatingcostratioof97.8percentin4Q20increased100basispointsfrom
96.8percentin4Q19primarilyresultingfromthefollowing:
◦ COVID-19administrativerelatedcosts,includingexpensesassociatedwithadditionalsafetymeasurestakenforthecompany'sproviderandclinicalteamswhohavecontinuedtoprovideservicestomembersduringthecrisis,
◦ highercostsincurredinthepharmacybusinesstoensuretimelydeliveryofprescriptionsamidtheCOVID-19pandemic,and
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◦ additionalinvestmentsinthesegment'sproviderbusinessduring4Q20relatedtomarketingandAEPinitiatives.
ThesecostswerepartiallyoffsetbyoperationalimprovementsandreducedutilizationresultingfromCOVID-19inthecompany'sproviderservicesbusiness,aswellassignificantoperatingcostefficienciesin4Q20drivenbypreviouslydisclosedproductivityinitiatives.
• TheHealthcareServicessegment’sFY2020operatingcostratioof96.3percentdecreased10basispointsfrom96.4percentinFY2019asaresultofthenetfavorableimpactofthesamefactorsaffectingthefourthquartercomparison.
HealthcareServicessegmentoperatingstatistics:
• Primary care providers in value-based (shared risk and path to risk) relationships of67,800 at December 31,2020, increased 10 percent from 61,900 at December 31, 2019, and increased 1 percent from 67,000 atSeptember30,2020.Thepercentageofthecompany’sindividualMedicareAdvantagemembersinvalue-basedrelationships was 67 percent as of December 31, 2020 and as of December 31, 2019, versus 66 percent atSeptember30,2020.
• Medicare Advantage and dual demonstration programmembership enrolled in a Humana caremanagementprogram(i)was 910,600 atDecember 31, 2020, up5 percent from868,800 atDecember 31, 2019 but down1percentfrom917,200atSeptember30,2020.Thesechangesweredrivenbythecompany'simprovedprocessfor identifying and enrollingmembers in the appropriate program at the right time, coupledwith growth inSpecialNeedsPlans(SNP)membership.
• Pharmacy script volume on an adjusted 30-day equivalent basis of122million for 4Q20 increased3 percentcompared to 118million for 4Q19. Pharmacy script volume of 478 million for FY 2020 increased 5 percentcomparedto456millionforFY2019.TheseincreasesprimarilyweredrivenbyhigherMedicareAdvantageandstate-basedcontractsmembership,partiallyoffsetbythedeclineinstand-alonePDPmembership.
HealthcareServicessegmentresults:
HealthcareServicessegmentresults(inmillions) 4Q20 4Q19 FY2020 FY2019
GAAPsegmentearnings $128 $178 $944 $789
Depreciationandamortizationexpense 52 44 203 179
Interestandtaxes 16 19 85 88
AdjustedEBITDA(e) $196 $241 $1,232 $1,056
• TheHealthcareServicessegment’s4Q20GAAPsegmentearningsdecreased$50million,or28percent,to$128millioncomparedtoGAAPsegmentearningsof$178millionin4Q19.Thedecreasewasprimarilyeffectedbythesame factors that resulted in a higher operating cost ratio for the segment in 4Q20 compared to the 4Q19segmentratio.
Adjusted EBITDA in 4Q20 for the Healthcare Services segment of $196million was down $45million, or 19percent,comparedtoAdjustedEBITDAof$241millionin4Q19.Theunfavorableyear-over-yearcomparisonofAdjustedEBITDAprimarily resulted from the same factors that impacted thequarterlyGAAP segment resultscomparisonwhileexcludingtheimpactofthefactorsdetailedinthetableabove.
• TheHealthcareServicessegment’sGAAPsegmentearningsinFY2020increased$155million,or20percent,to$944 million compared to GAAP segment earnings of $789 million in FY 2019 primarily reflecting the samefactorsthatresultedinalowerFY2020operatingcostratio,aswellashigherearningsfromequityinaffiliatesinFY2020.
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AdjustedEBITDAforFY2020of$1.23billionincreased$176million,or17percent,versustheFY2019AdjustedEBITDA for the Healthcare Services segment of $1.06 billion. The favorable year-over-year comparison ofAdjusted EBITDA primarily resulted from the same factors that impacted the FY GAAP segment resultscomparisonwhileexcludingtheimpactofthefactorsdetailedinthetableabove.
ConferenceCall
Humanawillhostaconferencecallat9:00a.m.Easterntimetodaytodiscussitsfinancialresultsforthequarterandthecompany’sexpectationsforfutureearnings.
Allpartiesinterestedinthecompany’s4Q20earningsconferencecallareinvitedtodial888-625-7430.Nopasswordisrequired.Theaudio-onlywebcastof the4Q20earningscallmaybeaccessedviaHumana’s InvestorRelationspageathumana.com.Thecompanysuggestsparticipantsforboththeconferencecallandthoselisteningviathewebdialinorsignonatleast15minutesinadvanceofthecall.
For those unable to participate in the live event, the archive will be available in the Historical Webcasts andPresentations section of the Investor Relations page at humana.com, approximately two hours following the livewebcast.Telephonereplayswillalsobeavailablefromapproximately12:15p.m.EasterntimeonFebruary3,2021until11:59p.m.EasterntimeonApril3,2021andcanbeaccessedbydialing855-859-2056andprovidingtheconferenceID#5899612.
Footnotes
(a)4Q20Adjustedresultsexcludethefollowing:• Amortizationexpenseforidentifiableintangiblesofapproximately$22millionpretax,or$0.13per
commonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andsegmentearnings(forrespectiveamortizationexpensefortheRetailandGroupandSpecialtysegments).
• Put/callvaluationadjustmentsofapproximately$40million,or$0.24percommonshare,associatedwithHumana’snon-consolidatingminorityinterestinvestments.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretaxandEPS.
• Changeinfairmarketvalueofpublicly-tradedequitysecuritiesof$102million,or$0.60percommonshare.Humanaadjustsforthemarketgainsandlossesofitspublicly-tradedequityinvestments(primarilyOakStreetHealth,Inc.)eachperiodbecausewhileinvestmentsarestrategicdecisionsforthecompany,management'smeasureofperformanceisprimarilyfocusedonoperationalresultsratherthanfairvalueofsuchinvestments.Also,managementdoesnotforecastchangesinfairvalueofitsequityinvestments.Accordingly,thecompanybelievesitisusefultoadjustGAAPEPSforthemarketgainsandlossesofpublicly-tradedequitysecurities.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andconsolidatedrevenues.
(b)4Q19Adjustedresultsexcludethefollowing:• Amortizationexpenseforidentifiableintangiblesofapproximately$17millionpretax,or$0.10perdiluted
commonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andsegmentearnings(forrespectiveamortizationexpensefortheRetailandGroupandSpecialtysegments).
• Put/callvaluationadjustmentsofapproximately$289million,or$1.67perdilutedcommonshare,associatedwithHumana’snon-consolidatingminorityinterestinvestments.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretaxandEPS.
• Expenseassociatedwithinvoluntaryworkforcereductionofapproximately$1millionpretax,or$0.01perdilutedcommonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andconsolidatedoperatingcostratio.
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(c)FY2020Adjustedresultsexcludethefollowing:• Amortizationexpenseforidentifiableintangiblesofapproximately$88millionpretax,or$0.51perdiluted
commonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPSandsegmentearnings(forrespectiveamortizationexpensefortheRetailandGroupandSpecialtysegments.)
• Put/callvaluationadjustmentsofapproximately$103million,or$0.60perdilutedcommonshare,associatedwithHumana'snon-consolidatingminorityinterestinvestments.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretaxandEPS.
• Changeinfairmarketvalueofpublicly-tradedequitysecuritiesof$745million,or$4.32perdilutedcommonshare.Humanaadjustsforthemarketgainsandlossesofitspublicly-tradedequityinvestments(primarilyOakStreetHealth,Inc.)eachperiodbecausewhileinvestmentsarestrategicdecisionsforthecompany,management'smeasureofperformanceisprimarilyfocusedonoperationalresultsratherthanfairvalueofsuchinvestments.Also,managementdoesnotforecastchangesinfairvalueofitsequityinvestments.Accordingly,thecompanybelievesitisusefultoadjustGAAPEPSforthemarketgainsandlossesofpublicly-tradedequitysecurities.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andconsolidatedrevenues.
• Netadjustmentof$578million,or$3.35perdilutedcommonshare,relatedtothereceiptofunpaidriskcorridorpaymentsassociatedwiththelossesincurredbythecompanyundertheACAbusinessfrom2014to2016(previouslywrittenoff).GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,consolidatedrevenues,consolidatedbenefitsexpenseratio,andconsolidatedoperatingcostratio.
(d)FY2019Adjustedresultsexcludethefollowing:• Amortizationexpenseforidentifiableintangiblesofapproximately$70millionpretax,or$0.40perdiluted
commonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPSandsegmentearnings(forrespectiveamortizationexpensefortheRetailandGroupandSpecialtysegments.)
• Put/callvaluationadjustmentsofapproximately$506million,or$2.89perdilutedcommonshare,associatedwithHumana'snon-consolidatingminorityinterestinvestments.GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretaxandEPS.
• Expenseassociatedwithinvoluntaryworkforcereductionofapproximately$47millionpretax,or$0.26perdilutedcommonshare;GAAPmeasuresaffectedinthisreleaseincludeconsolidatedpretax,EPS,andconsolidatedoperatingcostratio.
(e)TheHealthcareServicessegmentAdjustedEBITDAincludesGAAPsegmentearningswithadjustmentstoaddbackdepreciationandamortizationexpense,interestexpense,andincometaxes.TheAdjustedEBITDAincludesresultsfromalllinesofbusinesswithinthesegment.TheAdjustedEBITDAalsoincludestheimpactofHumana’s40%minorityinterestinKindredatHomeandthestrategicpartnershipwithWelsh,Carson,Anderson&Stowe(WCAS)todevelopandoperatesenior-focused,payor-agnostic,primarycarecenters.
(f)FY2021AdjustedEPSprojectionsexcludethefollowing:• Amortizationexpenseforidentifiableintangiblesofapproximately~$0.43perdilutedcommonshare.• FY21GAAPEPSguidanceexcludestheimpactoffuturevaluechangesofput/calloptionsrelatedtoHumana’s
non-consolidatingminorityinterestinvestments.Thefuturevaluechangeoftheseput/calloptionscannotbeestimated.
• Thefuturevalueofpublicly-tradedequitysecurities,theirimpactonGAAPEPS,andtherelatednon-GAAPadjustmentwillfluctuateonthepublictradingvalueofthestock.Theguidancesetforthhereinassumesnofurtherchangeinthefairvalueoftheseinvestments.
(g)Excludesestimatesofchangesinrevenuesassociatedwithincreasedaccuracyofriskcoding.
(h)Thecompanyprovidesafullrangeofinsuredspecialtyproductsincludingdental,vision,andlifeinsurancebenefitsmarketedtoindividualsandgroups.Membersincludedintheseproductsmaynotbeuniquetoeachproductsincemembershavetheabilitytoenrollinmultipleproducts.
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(i)IncludesMedicareAdvantage(includingSpecialNeedsPlans(SNP))anddual-eligibledemonstrationprogrammembersenrolledinoneofHumana’scareprograms.ThesemembersmaybeenrolledinHumanaAtHomeChronicCareProgram(HCCP),HumanaAtHomeRemoteMonitoring,oranAdvanceIllnessSupportprogram.Membersincludedintheseprogramsmaynotbeuniquetoeachprogramsincemembershavetheabilitytoenrollinmultipleprograms.Inaddition,themembersintheHCCPprogrammayreceivevaryinglevelsofcaremanagementbasedontheirhealthstatusandneeds,rangingfromactivecaremanagementtoongoingmonitoring.
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CautionaryStatement
Thisnewsreleaseincludesforward-lookingstatementsregardingHumanawithinthemeaningofthePrivateSecuritiesLitigationReformActof1995.Whenusedininvestorpresentations,pressreleases,SecuritiesandExchangeCommission(SEC)filings,andinoralstatementsmadebyorwiththeapprovalofoneofHumana’sexecutiveofficers,thewordsorphraseslike“expects,”“believes,”“anticipates,”“intends,”“likelywillresult,”“estimates,”“projects”orvariationsofsuchwordsandsimilarexpressionsareintendedtoidentifysuchforward-lookingstatements.Theseforward-lookingstatementsarenotguaranteesoffutureperformanceandaresubjecttorisks,uncertainties,andassumptions,including,amongotherthings,informationsetforthinthe“RiskFactors”sectionofthecompany’sSECfilings,asummaryofwhichincludesbutisnotlimitedtothefollowing:
• IfHumanadoesnotdesignandpriceitsproductsproperlyandcompetitively,ifthepremiumsHumanareceivesareinsufficienttocoverthecostofhealthcareservicesdeliveredtoitsmembers,ifthecompanyisunabletoimplementclinicalinitiativestoprovideabetterhealthcareexperienceforitsmembers,lowercostsandappropriatelydocumenttheriskprofileofitsmembers,orifitsestimatesofbenefitsexpenseareinadequate,Humana’sprofitabilitycouldbemateriallyadverselyaffected.Humanaestimatesthecostsofitsbenefitexpensepayments,anddesignsandpricesitsproductsaccordingly,usingactuarialmethodsandassumptionsbasedupon,amongotherrelevantfactors,claimpaymentpatterns,medicalcostinflation,andhistoricaldevelopmentssuchasclaiminventorylevelsandclaimreceiptpatterns.Thecompanycontinuallyreviewsestimatesoffuturepaymentsrelatingtobenefitexpensesforservicesincurredinthecurrentandpriorperiodsandmakesnecessaryadjustmentstoitsreserves,includingpremiumdeficiencyreserves,whereappropriate.Theseestimatesinvolveextensivejudgment,andhaveconsiderableinherentvariabilitybecausetheyareextremelysensitivetochangesinclaimpaymentpatternsandmedicalcosttrends.Accordingly,Humana'sreservesmaybeinsufficient.
• IfHumanafailstoeffectivelyimplementitsoperationalandstrategicinitiatives,particularlyitsMedicareinitiativesandstate-basedcontractstrategy,thecompany’sbusinessmaybemateriallyadverselyaffected,whichisofparticularimportancegiventheconcentrationofthecompany’srevenuesintheseproducts.Inaddition,therecanbenoassurancesthatthecompanywillbesuccessfulinmaintainingorimprovingitsStarratingsinfutureyears.
• IfHumanafailstoproperlymaintaintheintegrityofitsdata,tostrategicallymaintainexistingorimplementnewinformationsystems,toprotectHumana’sproprietaryrightstoitssystems,ortodefendagainstcyber-securityattacksorpreventotherprivacyordatasecurityincidentsthatresultinsecuritybreachesthatdisruptouroperationsorintheunintendeddisseminationofsensitivepersonalinformationorproprietaryorconfidentialinformation,thecompany’sbusinessmaybemateriallyadverselyaffected.
• Humanaisinvolvedinvariouslegalactions,ordisputesthatcouldleadtolegalactions(suchas,amongotherthings,providercontractdisputesandquitamlitigationbroughtbyindividualsonbehalfofthegovernment),governmentalandinternalinvestigations,androutineinternalreviewofbusinessprocessesanyofwhich,ifresolvedunfavorablytothecompany,couldresultinsubstantialmonetarydamagesorchangesinitsbusinesspractices.Increasedlitigationandnegativepublicitycouldalsoincreasethecompany’scostofdoingbusiness.
• Asagovernmentcontractor,Humanaisexposedtorisksthatmaymateriallyadverselyaffectitsbusinessoritswillingnessorabilitytoparticipateingovernmenthealthcareprogramsincluding,amongotherthings,lossofmaterialgovernmentcontracts,governmentalauditsandinvestigations,potentialinadequacyofgovernmentdeterminedpaymentrates,potentialrestrictionsonprofitability,includingbycomparisonofprofitabilityofthecompany’sMedicareAdvantagebusinesstonon-MedicareAdvantagebusiness,orotherchangesinthegovernmentalprogramsinwhichHumanaparticipates.Changestotherisk-adjustmentmodelutilizedbyCMStoadjustpremiumspaidtoMedicareAdvantage,orMA,plansaccordingtothehealthstatusofcoveredmembers,includingproposedchangestothemethodologyusedbyCMSforriskadjustmentdatavalidationauditsthat
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failtoaddressadequatelythestatutoryrequirementofactuarialequivalence,ifimplemented,couldhaveamaterialadverseeffectonouroperatingresults,financialpositionandcashflows.
• Humana'sbusinessactivitiesaresubjecttosubstantialgovernmentregulation.Newlawsorregulations,orlegislative,judicial,orregulatorychangesinexistinglawsorregulationsortheirmannerofapplicationcouldincreasethecompany'scostofdoingbusinessandhaveamaterialadverseeffectonHumana’sresultsofoperations(includingrestrictingrevenue,enrollmentandpremiumgrowthincertainproductsandmarketsegments,restrictingthecompany’sabilitytoexpandintonewmarkets,increasingthecompany’smedicalandoperatingcostsby,amongotherthings,requiringaminimumbenefitratiooninsuredproducts,loweringthecompany’sMedicarepaymentratesandincreasingthecompany’sexpensesassociatedwithanon-deductiblehealthinsuranceindustryfeeandotherassessments);thecompany’sfinancialposition(includingthecompany’sabilitytomaintainthevalueofitsgoodwill);andthecompany’scashflows.
• Humana’sfailuretomanageacquisitions,divestituresandothersignificanttransactionssuccessfullymayhaveamaterialadverseeffectonthecompany’sresultsofoperations,financialposition,andcashflows.
• IfHumanafailstodevelopandmaintainsatisfactoryrelationshipswiththeprovidersofcaretoitsmembers,thecompany’sbusinessmaybeadverselyaffected.
• Humana’spharmacybusinessishighlycompetitiveandsubjectsittoregulationsandsupplychainrisksinadditiontothosethecompanyfaceswithitscorehealthbenefitsbusinesses.
• ChangesintheprescriptiondrugindustrypricingbenchmarksmayadverselyaffectHumana’sfinancialperformance.
• Humana’sabilitytoobtainfundsfromcertainofitslicensedsubsidiariesisrestrictedbystateinsuranceregulations.
• DowngradesinHumana’sdebtratings,shouldtheyoccur,mayadverselyaffectitsbusiness,resultsofoperations,andfinancialcondition.
• Thesecuritiesandcreditmarketsmayexperiencevolatilityanddisruption,whichmayadverselyaffectHumana’sbusiness.
• Thespreadof,andresponseto,thenovelcoronavirus,orCOVID-19,underscorescertainrisksHumanafaces,includingthosediscussedabove,andtheongoing,heighteneduncertaintycreatedbythepandemicprecludesanypredictionastotheultimateadverseimpacttoHumanaofCOVID-19.
TotheextentthatthespreadofCOVID-19isnotcontained,thepremiumsthecompanychargesmayprovetobeinsufficienttocoverthecostofhealthcareservicesdeliveredtoitsmembers,whichmayincreasesignificantlyasaresultofhigherutilizationratesofmedicalfacilitiesandservicesandotherincreases in associated hospital and pharmaceutical costs. Humanamay also experience increasedcostsordecreasedrevenues if,asaresultof thecompany’smembersbeingunableorunwillingtosee theirprovidersdue toactions taken tomitigate the spreadofCOVID-19,Humana isunable toimplementclinicalinitiativestomanagehealthcarecostsandchronicconditionsofitsmembers,andappropriatelydocumenttheirriskprofiles.Inaddition,Humanaisoffering,andhasbeenmandatedbylegislativeandregulatoryaction(includingtheFamiliesFirstActandCARESAct)toprovide,certainexpandedbenefitcoveragetoitsmembers,suchaswaivingoutofpocketcostsforCOVID-19testingandtreatment.Humana isalsotakingactionsdesignedtohelpprovidefinancialandadministrativerelief for the health care provider community. Such measures and any further steps taken byHumana, or governmental action, to continue to respond to and address the ongoing impact ofCOVID-19,includingfurtherexpansionormodificationoftheservicesdeliveredtoitsmembers,theadoptionormodificationofregulatoryrequirementsassociatedwiththoseservicesandthecostsandchallenges associatedwith ensuring timely compliancewith such requirements, to provide furtherreliefforthehealthcareprovidercommunity,or inconnectionwiththerelaxationofstay-at-homeandphysicaldistancingordersandotherrestrictionsonmovementandeconomicactivity, includingthe potential for widespread testing and therapeutic treatments and the distribution andadministrationofCOVID-19vaccines,couldadverselyimpactthecompany’sprofitability.
ThespreadandimpactofCOVID-19,oractionstakentomitigatethisspread,couldhavematerialandadverseeffectsonHumana’sabilitytooperateeffectively,includingasaresultofthecompleteorpartialclosureoffacilitiesorlaborshortages.Disruptionsinpublicandprivateinfrastructure,
21
includingcommunications,availabilityofin-personsalesandmarketingchannels,financialservicesandsupplychains,couldmateriallyandadverselydisruptthecompany’snormalbusinessoperations.HumanahastransitionedasignificantsubsetofitsemployeepopulationtoaremoteworkenvironmentinanefforttomitigatethespreadofCOVID-19,ashaveanumberofthecompany’sthird-partyserviceproviders,whichmayexacerbatecertainriskstoHumana’sbusiness,includinganincreaseddemandforinformationtechnologyresources,increasedriskofphishingandothercybersecurityattacks,andincreasedriskofunauthorizeddisseminationofsensitivepersonalinformationorproprietaryorconfidentialinformationaboutthecompanyoritsmembersorotherthird-parties.TheoutbreakofCOVID-19hasseverelyimpactedglobaleconomicactivity,includingthebusinessesofsomeofHumana’scommercialcustomers,andcausedsignificantvolatilityandnegativepressureinthefinancialmarkets.InadditiontodisruptingHumana’soperations,thesedevelopmentsmayadverselyaffectthetimingofcommercialcustomerpremiumcollectionsandcorrespondingclaimpayments,thevalueofthecompany’sinvestmentportfolio,orfutureliquidityneeds.
Theongoing,heighteneduncertaintycreatedbythepandemicprecludesanypredictionastotheultimateadverseimpacttoHumanaofCOVID-19.HumanaiscontinuingtomonitorthespreadofCOVID-19,changestothecompany’sbenefitcoverages,andtheongoingcostsandbusinessimpactsofdealingwithCOVID-19,includingthepotentialcostsandimpactsassociatedwithliftingorreimposingrestrictionsonmovementandeconomicactivityandrelatedrisks.ThemagnitudeanddurationofthepandemicanditsimpactonHumana’sbusiness,resultsofoperations,financialposition,andcashflowsisuncertain,butsuchimpactscouldbematerialtothecompany’sbusiness,resultsofoperations,financialpositionandcashflows.
Inmakingforward-lookingstatements,Humanaisnotundertakingtoaddressorupdatetheminfuturefilingsorcommunicationsregardingitsbusinessorresults.Inlightoftheserisks,uncertainties,andassumptions,theforward-lookingeventsdiscussedhereinmayormaynotoccur.Therealsomaybeotherrisksthatthecompanyisunabletopredictatthistime.Anyoftheserisksanduncertaintiesmaycauseactualresultstodiffermateriallyfromtheresultsdiscussedintheforward-lookingstatements.
HumanaadvisesinvestorstoreadthefollowingdocumentsasfiledbythecompanywiththeSECforfurtherdiscussionbothoftherisksitfacesanditshistoricalperformance:
• Form10-KfortheyearendedDecember31,2019;
• Form10-QforthequarterendedMarch31,2020;June30,2020;September30,2020;and
• Form8-Ksfiledduring2020and2021.
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AboutHumana
HumanaInc.(NYSE:HUM)iscommittedtohelpingourmillionsofmedicalandspecialtymembersachievetheirbesthealth.Oursuccessfulhistoryincaredeliveryandhealthplanadministrationishelpinguscreateanewkindofintegratedcarewiththepowertoimprovehealthandwell-beingandlowercosts.OureffortsareleadingtoabetterqualityoflifeforpeoplewithMedicare,families,individuals,militaryservicepersonnel,andcommunitiesatlarge.
Toaccomplishthat,wesupportphysiciansandotherhealthcareprofessionalsastheyworktodelivertherightcareintherightplacefortheirpatients,ourmembers.Ourrangeofclinicalcapabilities,resourcesandtools–suchasin-homecare,behavioralhealth,pharmacyservices,dataanalyticsandwellnesssolutions–combinetoproduceasimplifiedexperiencethatmakeshealthcareeasiertonavigateandmoreeffective.
MoreinformationregardingHumanaisavailabletoinvestorsviatheInvestorRelationspageofthecompany’swebsiteathumana.com,includingcopiesof:
• Annualreportstostockholders• SecuritiesandExchangeCommissionfilings• Mostrecentinvestorconferencepresentations• Quarterlyearningsnewsreleasesandconferencecalls• Calendarofevents• CorporateGovernanceinformation
23
InaccordancewithGAAPunless
otherwisenoted
HumanaInc.Full-Year2021ProjectionsAsofFebruary3,2021
Comments
Dilutedearningspercommonshare(EPS)
GAAP $20.82to$21.32
• Non-GAAPadjustmentsnotedinfootnote(f).
Adjustments ~$0.43
Non-GAAP $21.25to$21.75
Totalrevenues
Consolidated $80.3billionto$81.9billion •Consolidatedandsegment-levelrevenueprojectionsincludeexpectedinvestmentincome.
• Segment-levelrevenuesincludeamountsthateliminateinconsolidation.
Retailsegment $72.6billionto$73.7billion
GroupandSpecialtysegment $6.6billionto$7.1billion
HealthcareServicessegment $30.2billionto$30.5billion
Changeinyear-endmedicalmembershipfromprioryearend
• IndividualMedicareAdvantage:Up~425,000to475,000(nochange)
• GroupMedicareAdvantage:Down~50,000(nochange)• Medicarestand-alonePDP:Down~300,000(nochange)• State-basedcontracts:Down~50,000toUp~100,000• Groupcommercialmedical:Down~100,000
• State-basedcontractsincludecurrentmembershipinFlorida,Illinois,Kentucky,andWisconsin.ThelowendoftheguidancerangeassumesthePublicHealthEmergency(PHE)endsonApril20,2021whilethehighendoftherangeassumesthePHEcontinuesthrough2021.
• Groupcommercialmedicalmembershipincludesfully-insuredandASO(self-insured).
BenefitRatioRetailsegment 87.5%to88.5% • Ratiocalculation:benefitsexpenseasa
percentofpremiumsrevenues.GroupandSpecialtysegment 83.2%to83.7%
Consolidatedoperatingcostratio
10.0%to11.0% • Ratiocalculation:operatingcostsexcludingdepreciationandamortizationasapercentofrevenuesexcludinginvestmentincome.
24
InaccordancewithGAAPunless
otherwisenoted
HumanaInc.Full-Year2021ProjectionsAsofFebruary3,2021
Comments
Segmentresults
Retailsegmentearnings $2.1billionto$2.3billion•Nomaterialimpacttosegmentearningsanticipatedfromnon-GAAPadjustments.GroupandSpecialtysegmentearnings $75millionto$125million
HealthcareServicesAdjustedEBITDA $1.45billionto$1.5billion
Effectivetaxrate 22.1%to22.7%
WeightedaveragesharecountfordilutedEPS
128.6millionto129.6million • FY2021guidancereflectsincrementalsharerepurchase.
Cashflowsfromoperations $4.0billionto$4.5billion
Capitalexpenditures $1.1billionto$1.2billion
25
Humana Inc.Statistical Schedules
AndSupplementary Information
4Q20 Earnings Release
S-1
HumanaInc.StatisticalSchedulesandSupplementaryInformation4Q20EarningsRelease
Contents
ConsolidatedFinancialStatements
1. ConsolidatedStatementsofIncome(S-3-S-4)
2. ConsolidatedBalanceSheets(S-5)
3. ConsolidatedStatementsofCashFlows(S-6-S-7)
OperatingResultsDetail
4. ConsolidatingStatementsofIncome-Quarter(S-8-S-9)
5. ConsolidatingStatementsofIncome-FY(S-10-S-11)
6. EndingMembershipDetail(S-12)
7. PremiumsandServicesRevenueDetail(S-13-S-14)
8. HealthcareServicesSegmentMetrics(S-15-S-17)
BalanceSheetDetail
9. BenefitsPayableDetailandStatistics(S-18-S-19)
Footnotes(S-20)
S-2
HumanaInc.ConsolidatedStatementsofIncomeDollarsinmillions,exceptpercommonshareresults
ForthethreemonthsendedDecember31,Dollar Percentage
2020 2019 Change Change
Revenues:Premiums $ 18,364 $ 15,809 $ 2,555 16.2%
Services 484 336 148 44.0%
Investmentincome 214 150 64 42.7%
Totalrevenues 19,062 16,295 2,767 17.0%
Operatingexpenses:Benefits 16,213 13,689 2,524 18.4%
Operatingcosts 3,068 2,129 939 44.1%
Depreciationandamortization 127 115 12 10.4%
Totaloperatingexpenses 19,408 15,933 3,475 21.8%(Loss)incomefromoperations (346) 362 (708) -195.6%Interestexpense 72 58 14 24.1%Otherexpense(income),net(A) 40 (289) 329 113.8%(Loss)incomebeforeincometaxesandequityinnetearnings (458) 593 (1,051) 177.2%(Benefit)provisionforincometaxes (178) 79 (257) -325.3%Equityinnetearnings(losses)(B) 6 (2) 8 -400.0%
Net(loss)income $ (274)$ 512 $ (786) -153.5%
Basic(loss)earningspercommonshare $ (2.07)$ 3.87 $ (5.94) -153.5%
(Losspercommonshare)dilutedearningspercommonshare $ (2.07)$ 3.84 $ (5.91) -153.9%
Sharesusedincomputingbasicearningspercommonshare(000’s) 132,094 132,453Sharesusedincomputingdilutedearningspercommonshare(000’s) 132,094 133,342
S-3
HumanaInc.ConsolidatedStatementsofIncomeDollarsinmillions,exceptpercommonshareresults
FortheyearendedDecember31,Dollar Percentage
2020 2019 Change Change
Revenues:Premiums $ 74,186 $ 62,948 $ 11,238 17.9%
Services 1,815 1,439 376 26.1%
Investmentincome 1,154 501 653 130.3%
Totalrevenues 77,155 64,888 12,267 18.9%
Operatingexpenses:Benefits 61,628 53,857 7,771 14.4%
Operatingcosts 10,052 7,381 2,671 36.2%
Depreciationandamortization 489 458 31 6.8%Totaloperatingexpenses 72,169 61,696 10,473 17.0%
Incomefromoperations 4,986 3,192 1,794 56.2%Interestexpense 283 242 41 16.9%Otherexpense(income),net(A) 103 (506) 609 120.4%Incomebeforeincometaxesandequityinnetearnings 4,600 3,456 1,144 33.1%Provisionforincometaxes 1,307 763 544 71.3%
Equityinnetearnings(B) 74 14 60 428.6%Netincome $ 3,367 $ 2,707 $ 660 24.4%
Basicearningspercommonshare $ 25.47 $ 20.20 $ 5.27 26.1%Dilutedearningspercommonshare $ 25.31 $ 20.10 $ 5.21 25.9%
Sharesusedincomputingbasicearningspercommonshare(000’s) 132,199 134,055
Sharesusedincomputingdilutedearningspercommonshare(000’s) 133,012 134,727
S-4
HumanaInc.ConsolidatedBalanceSheetsDollarsinmillions,exceptshareamounts December31, December31, Year-to-DateChange
2020 2019 Dollar Percent
Assets
Currentassets:
Cashandcashequivalents $ 4,673 $ 4,054
Investmentsecurities 12,554 10,972
Receivables,net 1,138 1,056
Othercurrentassets 5,276 3,806
Totalcurrentassets 23,641 19,888 $ 3,753 18.9%
Propertyandequipment,net 2,371 1,955
Long-terminvestmentsecurities 1,212 406
Goodwill 4,447 3,928
Equitymethodinvestments 1,170 1,063
Otherlong-termassets 2,128 1,834
Totalassets $ 34,969 $ 29,074 $ 5,895 20.3%
LiabilitiesandStockholders’Equity
Currentliabilities:
Benefitspayable $ 8,143 $ 6,004
Tradeaccountspayableandaccruedexpenses 4,013 3,754
Bookoverdraft 320 225
Unearnedrevenues 318 247
Short-termdebt 600 699
Totalcurrentliabilities 13,394 10,929 $ 2,465 22.6%
Long-termdebt 6,060 4,967
Otherlong-termliabilities 1,787 1,141
Totalliabilities 21,241 17,037 $ 4,204 24.7%
Commitmentsandcontingencies
Stockholders’equity:
Preferredstock,$1par;10,000,000sharesauthorized,noneissued — —
Commonstock,$0.162/3par;300,000,000sharesauthorized;198,648,742issuedatDecember31,2020 33 33
Capitalinexcessofparvalue 2,705 2,820
Retainedearnings 20,517 17,483
Accumulatedothercomprehensiveincome 391 156
Treasurystock,atcost,69,787,614sharesatDecember31,2020 (9,918) (8,455)
Totalstockholders’equity 13,728 12,037 $ 1,691 14.0%
Totalliabilitiesandstockholders’equity $ 34,969 $ 29,074 $ 5,895 20.3%
Debt-to-totalcapitalizationratio 32.7% 32.0%
S-5
HumanaInc.ConsolidatedStatementsofCashFlowsDollarsinmillions ForthethreemonthsendedDecember31,
Dollar Percentage 2020 2019 Change Change
Cashflowsfromoperatingactivities
Net(loss)income $ (274) $ 512Adjustmentstoreconcilenetincometonetcashprovidedbyoperatingactivities:
Depreciation 138 123Amortization 22 17Gainsoninvestmentsecurities,net (142) (39)
Equityinnet(earnings)losses (6) 2
Stock-basedcompensation 52 44
Provisionfordeferredincometaxes 198 183
Changesinoperatingassetsandliabilities,netofeffectofbusinessesacquiredanddispositions:Receivables (3) (211)Otherassets 966 (216)Benefitspayable (65) (216)Otherliabilities (658) 303Unearnedrevenues 31 (27)
Other,net 24 37Netcashprovidedbyoperatingactivities 283 512 ($229) -44.7%
Cashflowsfrominvestingactivities
Purchasesofpropertyandequipment,net (296) (230)
Purchasesofinvestmentsecurities (1,895) (2,231)
Maturitiesofinvestmentsecurities 1,486 452
Proceedsfromsalesofinvestmentsecurities 650 1,208Netcashusedininvestingactivities (55) (801) $746 93.1%
Cashflowsfromfinancingactivities
Withdrawalsfromcontractdeposits,net (665) (634)
Proceeds(repayments)fromissuanceofcommercialpaper,net 274 (2)
Repaymentofseniornotes (400) (400)
Repaymentoftermloan (1,000) —
Changeinbookoverdraft 106 (48)
Commonstockrepurchases (1,790) (60)
Dividendspaid (84) (75)
Proceedsfromstockoptionexercisesandother 19 35Netcashusedinfinancingactivities (3,540) (1,184) ($2,356) -199.0%Decreaseincashandcashequivalents (3,312) (1,473)Cashandcashequivalentsatbeginningofperiod 7,985 5,527Cashandcashequivalentsatendofperiod $ 4,673 $ 4,054
S-6
HumanaInc.ConsolidatedStatementsofCashFlowsDollarsinmillions FortheyearendedDecember31,
Dollar Percent
2020 2019 Change Change
Cashflowsfromoperatingactivities
Netincome $ 3,367 $ 2,707
Adjustmentstoreconcilenetincometonetcashprovidedbyoperatingactivities:Depreciation 528 505Amortization 88 70Gainsoninvestmentsecurities,net (838) (62)
Equityinnetearnings (74) (14)
Stock-basedcompensation 181 163
Provisionfordeferredincometaxes 195 162
Changesinoperatingassetsandliabilities,netofeffectofbusinessesacquiredanddispositions:
Receivables (85) (32)Otherassets (581) 118Benefitspayable 2,139 1,142Otherliabilities 599 471Unearnedrevenues 71 (36)
Other,net 49 90Netcashprovidedbyoperatingactivities 5,639 5,284 $355 6.7%
Cashflowsfrominvestingactivities
Acquisitions,netofcashacquired (709) —
Purchasesofpropertyandequipment,net (964) (736)
Purchasesofinvestmentsecurities (9,125) (6,361)
Maturitiesofinvestmentsecurities 4,986 1,733
Proceedsfromsalesofinvestmentsecurities 2,747 4,086Netcashusedininvestingactivities (3,065) (1,278) ($1,787) -139.8%
Cashflowsfromfinancingactivities
Withdrawalsfromcontractdeposits,net (939) (623)
Proceeds(repayment)fromtheissuanceofcommercialpaper,net 295 (360)
Proceedsfromissuanceofseniornotes,net 1,088 987
Repaymentofseniornotes (400) (400)
Proceedsfromissuanceoftermloan 1,000 —
Repaymentoftermloan (1,000) (650)
Changeinbookoverdraft 95 54
Commonstockrepurchases (1,820) (1,070)
Dividendspaid (323) (291)
Proceedsfromstockoptionexercisesandother 49 58Netcashusedinfinancingactivities (1,955) (2,295) $340 -14.8%Increaseincashandcashequivalents 619 1,711Cashandcashequivalentsatbeginningofperiod 4,054 2,343Cashandcashequivalentsatendofperiod $ 4,673 $ 4,054
S-7
HumanaInc.ConsolidatingStatementsofIncome—ForthethreemonthsendedDecember31,2020Inmillions
RetailGroupandSpecialty
HealthcareServices
Eliminations/Corporate Consolidated
Revenues—externalcustomersPremiums:
IndividualMedicareAdvantage $ 12,949 $ — $ — $ — $ 12,949
GroupMedicareAdvantage 1,907 — — — 1,907
Medicarestand-alonePDP 634 — — — 634
TotalMedicare 15,490 — — — 15,490
Fully-insured 179 1,155 — — 1,334
Specialty — 421 — — 421
Medicaidandother(C) 1,119 — — — 1,119
Totalpremiums 16,788 1,576 — — 18,364
Servicesrevenue:
Provider — — 119 — 119
ASOandother(D) 5 204 — — 209
Pharmacy — — 156 — 156
Totalservicesrevenue 5 204 275 — 484
Totalrevenues—externalcustomers 16,793 1,780 275 — 18,848
Intersegmentrevenues
Services — 7 4,977 (4,984) —
Products — — 2,028 (2,028) —
Totalintersegmentrevenues — 7 7,005 (7,012) —
Investmentincome 41 4 11 158 214
Totalrevenues 16,834 1,791 7,291 (6,854) 19,062
Operatingexpenses:
Benefits 14,598 1,643 — (28) 16,213
Operatingcosts 2,355 502 7,121 (6,910) 3,068
Depreciationandamortization 91 21 48 (33) 127
Totaloperatingexpenses 17,044 2,166 7,169 (6,971) 19,408
(Loss)incomefromoperations (210) (375) 122 117 (346)
Interestexpense — — — 72 72
Otherexpense,net(A) — — — 40 40
(Loss)incomebeforeincometaxesandequityinnetearnings (210) (375) 122 5 (458)
Equityinnetearnings(B) — — 6 — 6
Segment(loss)earnings $ (210) $ (375) $ 128 $ 5 $ (452)
Benefitratio 87.0% 104.3% 88.3%
Operatingcostratio 14.0% 28.1% 97.8% 16.3%
S-8
HumanaInc.ConsolidatingStatementsofIncome—ForthethreemonthsendedDecember31,2019Inmillions
RetailGroupandSpecialty
HealthcareServices
Eliminations/Corporate Consolidated
Revenues—externalcustomersPremiums:
IndividualMedicareAdvantage $ 10,874 $ — $ — $ — $ 10,874
GroupMedicareAdvantage 1,608 — — — 1,608
Medicarestand-alonePDP 757 — — — 757
TotalMedicare 13,239 — — — 13,239
Fully-insured 154 1,250 — — 1,404
Specialty — 411 — — 411
Medicaidandother(C) 755 — — — 755
Totalpremiums 14,148 1,661 — — 15,809
Servicesrevenue:
Provider — — 79 — 79
ASOandother(D) 3 203 — — 206
Pharmacy — — 51 — 51
Totalservicesrevenue 3 203 130 — 336
Totalrevenues—externalcustomers 14,151 1,864 130 — 16,145
Intersegmentrevenues
Services — 5 4,799 (4,804) —
Products — — 1,766 (1,766) —
Totalintersegmentrevenues — 5 6,565 (6,570) —
Investmentincome 56 6 1 87 150
Totalrevenues 14,207 1,875 6,696 (6,483) 16,295
Operatingexpenses:
Benefits 12,206 1,581 — (98) 13,689
Operatingcosts 1,642 419 6,481 (6,413) 2,129
Depreciationandamortization 84 21 35 (25) 115
Totaloperatingexpenses 13,932 2,021 6,516 (6,536) 15,933
Income(loss)fromoperations 275 (146) 180 53 362
Interestexpense — — — 58 58
Otherincome,net(A) — — — (289) (289)
Income(loss)beforeincometaxesandequityinnetearnings 275 (146) 180 284 593
Equityinnetlosses(B) — — (2) — (2)
Segmentearnings(loss) $ 275 $ (146) $ 178 $ 284 $ 591
Benefitratio 86.3% 95.2% 86.6%
Operatingcostratio 11.6% 22.4% 96.8% 13.2%
S-9
HumanaInc.ConsolidatingStatementsofIncome—FortheyearendedDecember31,2020Inmillions
RetailGroupandSpecialty
HealthcareServices
Eliminations/Corporate Consolidated
Revenues—externalcustomersPremiums:
IndividualMedicareAdvantage $ 51,697 $ — $ — $ — $ 51,697
GroupMedicareAdvantage 7,774 — — — 7,774
Medicarestand-alonePDP 2,742 — — — 2,742
TotalMedicare 62,213 — — — 62,213
Fully-insured 688 4,761 — 602 6,051
Specialty — 1,699 — — 1,699
Medicaidandother(C) 4,223 — — — 4,223
Totalpremiums 67,124 6,460 — 602 74,186
Servicesrevenue:
Provider — — 435 — 435
ASOandother(D) 19 780 — — 799
Pharmacy — — 581 — 581
Totalservicesrevenue 19 780 1,016 — 1,815
Totalrevenues—externalcustomers 67,143 7,240 1,016 602 76,001
Intersegmentrevenues
Services — 29 19,491 (19,520) —
Products — — 7,928 (7,928) —
Totalintersegmentrevenues — 29 27,419 (27,448) —
Investmentincome 155 16 13 970 1,154
Totalrevenues 67,298 7,285 28,448 (25,876) 77,155
Operatingexpenses:
Benefits 56,537 5,529 — (438) 61,628
Operatingcosts 7,402 1,818 27,395 (26,563) 10,052
Depreciationandamortization 342 81 183 (117) 489
Totaloperatingexpenses 64,281 7,428 27,578 (27,118) 72,169
Income(loss)fromoperations 3,017 (143) 870 1,242 4,986
Interestexpense — — — 283 283
Otherexpense,net(A) — — — 103 103
Income(loss)beforeincometaxesandequityinnetearnings 3,017 (143) 870 856 4,600
Equityinnetearnings(B) — — 74 — 74
Segmentearnings(loss) $ 3,017 $ (143) $ 944 $ 856 $ 4,674
Benefitratio 84.2% 85.6% 83.1%
Operatingcostratio 11.0% 25.0% 96.3% 13.2%
HumanaInc.
S-10
ConsolidatingStatementsofIncome—FortheyearendedDecember31,2019Inmillions
RetailGroupandSpecialty
HealthcareServices
Eliminations/Corporate Consolidated
Revenues—externalcustomersPremiums:
IndividualMedicareAdvantage $ 43,128 $ — $ — $ — $ 43,128
GroupMedicareAdvantage 6,475 — — — 6,475
Medicarestand-alonePDP 3,165 — — — 3,165
TotalMedicare 52,768 — — — 52,768
Fully-insured 588 5,123 — — 5,711
Specialty — 1,571 — — 1,571
Medicaidandother(C) 2,898 — — — 2,898
Totalpremiums 56,254 6,694 — — 62,948
Servicesrevenue:
Provider — — 446 — 446
ASOandother(D) 17 790 — — 807
Pharmacy — — 186 — 186
Totalservicesrevenue 17 790 632 — 1,439
Totalrevenues—externalcustomers 56,271 7,484 632 — 64,387
Intersegmentrevenues
Services — 18 18,255 (18,273) —
Products — — 6,894 (6,894) —
Totalintersegmentrevenues — 18 25,149 (25,167) —
Investmentincome 195 23 2 281 501
Totalrevenues 56,466 7,525 25,783 (24,886) 64,888
Operatingexpenses:
Benefits 48,602 5,758 — (503) 53,857
Operatingcosts 5,306 1,651 24,852 (24,428) 7,381
Depreciationandamortization 323 88 156 (109) 458
Totaloperatingexpenses 54,231 7,497 25,008 (25,040) 61,696
Incomefromoperations 2,235 28 775 154 3,192
Interestexpense — — — 242 242
Otherincome,net(A) — — — (506) (506)
Incomebeforeincometaxesandequityinnetearnings 2,235 28 775 418 3,456
Equityinnetearnings(B) — — 14 — 14
Segmentearnings $ 2,235 $ 28 $ 789 $ 418 $ 3,470
Benefitratio 86.4% 86.0% 85.6%
Operatingcostratio 9.4% 22.0% 96.4% 11.5%
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HumanaInc.EndingMembershipDetailInthousands
Year-over-YearChange SequentialChange
December31,2020 Average4Q20 December31,2019 Amount PercentSeptember30,
2020 Amount Percent
MedicalMembership:
Retail
IndividualMedicareAdvantage 3,962.7 3,958.8 3,587.2 375.5 10.5% 3,935.1 27.6 0.7%
GroupMedicareAdvantage 613.2 613.1 525.3 87.9 16.7% 612.0 1.2 0.2%
Medicarestand-alonePDP 3,866.7 3,876.7 4,365.2 (498.5) -11.4% 3,892.2 (25.5) -0.7%
TotalMedicare 8,442.6 8,448.6 8,477.7 (35.1) -0.4% 8,439.3 3.3 —%
State-basedcontracts(E) 772.4 758.1 469.0 303.4 64.7% 730.1 42.3 5.8%
MedicareSupplement 335.6 334.2 298.4 37.2 12.5% 331.3 4.3 1.3%
TotalRetail 9,550.6 9,540.9 9,245.1 305.5 3.3% 9,500.7 49.9 0.5%
GroupandSpecialty
Fully-insuredcommercialmedical 777.4 787.0 908.6 (131.2) -14.4% 799.5 (22.1) -2.8%
ASOcommercial 504.9 502.6 529.2 (24.3) -4.6% 502.1 2.8 0.6%
Militaryservices 5,998.7 6,022.5 5,984.3 14.4 0.2% 6,016.4 (17.7) -0.3%
TotalGroupandSpecialty 7,281.0 7,312.1 7,422.1 (141.1) -1.9% 7,318.0 (37.0) -0.5%
TotalMedicalMembership 16,831.6 16,853.0 16,667.2 164.4 1.0% 16,818.7 12.9 0.1%
SpecialtyMembership(includedinGroupandSpecialtysegment):
Dental—fully-insured(F) 2,617.6 2,620.9 2,646.4 (28.8) -1.1% 2,627.4 (9.8) -0.4%
Dental—ASO 284.9 283.6 278.9 6.0 2.2% 282.4 2.5 0.9%
Vision 2,005.5 2,003.1 2,082.5 (77.0) -3.7% 2,013.8 (8.3) -0.4%
Othersupplementalbenefits(G) 402.3 402.2 418.1 (15.8) -3.8% 402.0 0.3 0.1%
TotalSpecialtyMembership 5,310.3 5,309.8 5,425.9 (115.6) -2.1% 5,325.6 (15.3) -0.3%
December31,2020MemberMix
December31,2020 December31,2019MemberMix
December31,2019
IndividualMedicareAdvantageMembership
HMO 2,352.5 59% 2,129.9 59%
PPO 1,610.2 41% 1,457.3 41%
TotalIndividualMedicareAdvantage 3,962.7 100% 3,587.2 100%
IndividualMedicareAdvantageMembership
SharedRisk(H) 1,231.9 31% 1,116.1 31%
PathtoRisk(I) 1,418.2 36% 1,290.9 36%
TotalValue-based 2,650.1 67% 2,407.0 67%
Other 1,312.6 33% 1,180.2 33%
TotalIndividualMedicareAdvantage 3,962.7 100% 3,587.2 100%
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HumanaInc.PremiumsandServicesRevenueDetailDollarsinmillions,exceptpermemberpermonth
ForthethreemonthsendedDecember31,PerMemberperMonth(L)
ForthethreemonthsendedDecember31,
Dollar Percentage
2020 2019 Change Change 2020 2019
PremiumsandServicesRevenue
Retail
IndividualMedicareAdvantage $ 12,949 $ 10,874 $ 2,075 19.1% $ 1,090 $ 1,013
GroupMedicareAdvantage 1,907 1,608 299 18.6% 1,037 1,021
Medicarestand-alonePDP 634 757 (123) -16.2% 55 58
State-basedcontracts(E) 1,119 755 364 48.2% 492 537
MedicareSupplement 179 154 25 16.2% 179 175
Otherservices 5 3 2 66.7%
TotalRetail 16,793 14,151 2,642 18.7%
GroupandSpecialty
Fully-insuredcommercialmedical 1,155 1,250 (95) -7.6% 489 454
Specialty(J) 421 411 10 2.4% 28 27
CommercialASO&otherservices(D) 74 88 (14) -15.9%
Militaryservices(K) 137 120 17 14.2%
TotalGroupandSpecialty 1,787 1,869 (82) -4.4%
HealthcareServices
Pharmacysolutions 6,468 5,905 563 9.5%
Providerservices 634 594 40 6.7%
Clinicalprograms 178 196 (18) -9.2%
TotalHealthcareServices 7,280 6,695 585 8.7%
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HumanaInc.PremiumsandServicesRevenueDetailDollarsinmillions,exceptpermemberpermonth
FortheyearendedDecember31,PerMemberperMonth(L)
FortheyearendedDecember31,
Dollar Percentage
2020 2019 Change Change 2020 2019
PremiumsandServicesRevenueRetail
IndividualMedicareAdvantage $ 51,697 $ 43,128 $ 8,569 19.9% $ 1,107 $ 1,027
GroupMedicareAdvantage 7,774 6,475 1,299 20.1% 1,064 1,036
Medicarestand-alonePDP 2,742 3,165 (423) -13.4% 59 60
State-basedcontracts(E) 4,223 2,898 1,325 45.7% 510 525
MedicareSupplement 688 588 100 17.0% 177 176
Otherservices 19 17 2 11.8%
TotalRetail 67,143 56,271 10,872 19.3%
GroupandSpecialtyFully-insuredcommercialmedical 4,761 5,123 (362) -7.1% 483 454
Specialty(J) 1,699 1,571 128 8.1% 28 25
CommercialASO&otherservices(D) 309 326 (17) -5.2%
Militaryservices(K) 500 482 18 3.7%
TotalGroupandSpecialty 7,269 7,502 (233) -3.1%
HealthcareServicesPharmacysolutions 25,168 22,375 2,793 12.5%
Providerservices 2,594 2,650 (56) -2.1%
Clinicalprograms 673 756 (83) -11.0%
TotalHealthcareServices 28,435 25,781 2,654 10.3%
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HumanaInc.HealthcareServicesSegmentMetrics
December31,2020
December31,2019 Difference
September30,2020 Difference
PrimaryCareProviders:
SharedRisk(H)
Proprietary 900 1,200 (300) -25.0% 1,000 (100) -10.0%
Contracted 23,000 18,700 4,300 23.0% 22,100 900 4.1%
PathtoRisk(I) 43,900 42,000 1,900 4.5% 43,900 — —%
TotalValue-based 67,800 61,900 5,900 9.5% 67,000 800 1.2%
CareManagementStatistics:
MembersenrolledinaHumanacaremanagementprogram(M) 910,600 868,800 41,800 4.8% 917,200 (6,600) -0.7%
Numberofhigh-riskdischargesenrolledinapost-dischargecaremanagementprogram(N) 73,600 61,500 12,100 19.7% 68,900 4,700 6.8%
PrimaryCareCenters(O) AsofDecember31,2020
CentersPrimary
CarePhysicians PatientsServed
Humana'sCareDeliverySubsidiaries 156 662 255,400
JointVentureandAllianceProviderPartners 152 274
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HumanaInc.HealthcareServicesSegmentMetrics(Continued)Scriptvolumeinthousands
ForthethreemonthsendedDecember31,2020
ForthethreemonthsendedDecember31,2019
Year-over-Year
DifferenceForthethreemonthsended
September30,2020SequentialDifference
Pharmacy:GenericDispenseRate
Retail 91.8% 91.8% —% 91.5% 0.3%
GroupandSpecialty 88.1% 87.1% 1.0% 88.0% 0.1%
Mail-OrderPenetration
Retail 30.6% 29.2% 1.4% 29.9% 0.7%
GroupandSpecialty 6.4% 6.2% 0.2% 6.3% 0.1%
DifferencePercentageChange Difference
PercentageChange
Scriptvolume(P) 121,800 117,700 4,100 3.5% 119,400 2,400 2.0%
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HumanaInc.HealthcareServicesSegmentMetrics(Continued)Scriptvolumeinthousands
FortheyearendedDecember31,2020
FortheyearendedDecember31,2019
Year-over-YearDifference
Pharmacy:GenericDispenseRate
Retail 91.7% 91.7% —%
GroupandSpecialty 87.9% 87.4% 0.5%
Mail-OrderPenetrationRetail 30.1% 28.8% 1.3%
GroupandSpecialty 6.2% 6.3% -0.1%
DifferencePercentageChange
Scriptvolume(P) 477,600 456,300 21,300 4.7%
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HumanaInc.DetailofBenefitsPayableBalanceandYear-to-DateChangesDollarsinmillions
FortheyearendedDecember31,2020
FortheninemonthsendedSeptember30,2020
FortheyearendedDecember31,2019
Year-to-datechangesinbenefitspayable,excludingmilitaryservices
BalancesatJanuary1 $6,004 $6,004 $4,862
Less:Reinsurancerecoverables(Q) (68) (68) (95)
Beginningbalance,netofreinsurancerecoverable 5,936 5,936 4,767
Incurredrelatedto:
Currentyear 61,941 45,693 54,193
Prioryears(R) (313) (278) (336)
Totalincurred 61,628 45,415 53,857
Paidrelatedto:
Currentyear (54,003) (37,810) (48,421)
Prioryears (5,418) (5,334) (4,267)
Totalpaid (59,421) (43,144) (52,688)
Reinsurancerecoverables(Q) — 1 68
Endingbalance $8,143 $8,208 $6,004
S-18
HumanaInc.BenefitsPayableStatistics(Continued)(S)
DaysinClaimsPayable
QuarterEnded
DaysinClaims
Payable(DCP)
ChangeLast4
QuartersPercentageChange
12/31/2019 40.4 1.3 3.3%
3/31/2020 41.3 1.1 2.7%
6/30/2020 51.2 11.3 28.3%
9/30/2020 48.4 5.6 13.1%12/31/2020 46.2 5.8 14.4%
ChangeinDaysinClaimsPayable(T)1Q2020
2Q2020
3Q2020
4Q2020
FY2020
4Q2019
FY2019
DCP—beginningofperiod 40.4 41.3 51.2 48.4 40.4 42.8 39.1
ComponentsofchangeinDCP:
Provideraccruals(U) 0.2 7.0 (2.8) (1.0) 3.4 (0.6) 1.4
Medicalfee-for-service(V) 0.6 2.4 (0.6) (0.4) 2.0 0.3 0.7
Pharmacy(W) 0.3 (0.2) — (0.4) (0.3) (0.3) (0.5)
Processedclaimsinventory(X) (0.1) 0.6 0.7 (0.4) 0.8 (2.0) (0.5)
Other(Y) (0.1) 0.1 (0.1) — (0.1) 0.2 0.2
DCP—endofperiod 41.3 51.2 48.4 46.2 46.2 40.4 40.4
Totalchangefrombeginningofperiod 0.9 9.9 (2.8) (2.2) 5.8 (2.4) 1.3
S-19
HumanaInc.FootnotestoStatisticalSchedulesandSupplementaryInformation4Q20EarningsRelease
(A) Put/callvaluationadjustmentsassociatedwiththecompany'snon-consolidatingminorityinterestinvestments.(B) Netearningsassociatedwiththecompany'snon-consolidatingminorityinterestinvestments.(C) TheMedicaidandothercategoryincludespremiumsassociatedwiththecompany’sMedicaidbusiness.(D) TheASOandothercategoryisprimarilycomprisedofAdministrativeServicesOnly(ASO)feesandotherancillaryservicesfees,includingmilitaryservicesunlessseparatelydisclosed.(E) IncludesMedicaidTemporaryAssistanceforNeedyFamilies(TANF),dual-eligibledemonstration,andLong-TermSupportServices(LTSS)fromstate-basedcontracts.(F) Fully-insureddentalmembershipasreporteddoesnotincludeHumanamembersthathaveaMedicareAdvantageplanthatincludesanembeddeddentalbenefit.Costsassociatedwiththesedentalbenefits,
however,arerecordedintheGroupandSpecialtysegmentearningsresults.(G) Othersupplementalbenefitsincludegrouplifepolicies.(H) Incertaincircumstances,thecompanycontractswithproviderstoacceptfinancialriskforadefinedsetofMedicareAdvantagemembership.Intransferringthisrisk,thecompanyprepaystheseprovidersa
monthlyfixed-feepermembertocoordinatesubstantiallyallofthemedicalcarefortheirMedicareAdvantagemembersassignedorattributedtotheirproviderpanel,includingsomehealthbenefitadministrativefunctionsandclaimsprocessing.ForthesecapitatedSharedRiskarrangements,thecompanygenerallyagreestopaymentratesthattargetabenefitexpenseratio.Theresultisahighlevelofengagementonthepartoftheprovider.
(I) APathtoRiskproviderisonewhohasahighlevelofengagementandparticipatesinoneofHumana’spay-for-performanceprograms(ModelPracticeorMedicalHome)orhasariskcontractinplacewithatrigger(futuredateormembershipthreshold)whichhasnotyetbeenmet.Inadditiontoearningincentives,theseprovidersmayalsohaveasharedsavingscomponentbywhichtheycanshareinachievedsurpluseswhentheactualcostofthemedicalservicesprovidedtopatientsassignedorattributedtotheirpanelislessthantheagreeduponmedicalexpensetarget.
(J) Specialtypermemberpermonthiscomputedbasedonreportedspecialtypremiumsandaveragefully-insuredspecialtymembershipfortheperiod.Includedwithspecialtypremiumsarestop-lossASOpremiums.
(K) TheamountsprimarilyreflectservicesrevenuesundertheTRICAREEastRegioncontractthatgenerallyarecontractedonaper-memberbasis.(L) Computedbasedonaveragemembershipfortheperiod(i.e.,monthlyendingmembershipduringtheperioddividedbythenumberofmonthsintheperiod).(M) IncludesMedicareAdvantage(includingSpecialNeedsPlans(SNP))anddual-eligibledemonstrationprogrammembersenrolledinoneofHumana’scareprograms.ThesemembersmaybeenrolledinHumana
AtHomeChronicCareProgram(HCCP),HumanaAtHomeRemoteMonitoring,oranAdvanceIllnessSupportprogram.Membersincludedintheseprogramsmaynotbeuniquetoeachprogramsincemembershavetheabilitytoenrollinmultipleprograms.Inaddition,themembersintheHCCPprogrammayreceivevaryinglevelsofcaremanagementbasedontheirhealthstatusandneeds,rangingfromactivecaremanagementtoongoingmonitoring.
(N) ReflectsdischargesenrolledinHumana’s30-daycaremanagementservices,whichsupportsmembersaftertheyaredischargedhomefromahospitalorotherfacility.Theprogramisaimedatindividualsathigh-riskforre-hospitalization.Caremanagersvisitandcallmembersathometoensuretheyhaveandunderstandcorrectprescriptions,theirdoctorsareinformedaboutmembers’changedstatus,andthatmembersareeitherself-managingadequatelyorarereferredtoappropriateongoingservices.
(O) Humana'scaredeliverysubsidiariesincludeConviva,PartnersinPrimaryCare,andFamilyPhysiciansGroup.Thecenter,primarycarephysician,andpatientsservedcountsinclude(i)theoperationsofourmedicalcenterbusinessthroughbothemployedphysiciansandcareproviders,andthroughthirdpartymanagementserviceorganizationsandprofessionalgroupswithwhomwecontracttoarrangeforandmanagecertainclinicalservices,(ii)clinicsandoperationsmanagedbyPartnersinPrimaryCareinconnectionwithastrategicpartnershipwithWelsh,Carson,Anderson&Stowe,and(iii)thoseassociatedwithMSO/IPArelationshipswithConviva.
(P) Scriptvolumeispresentedonanadjusted30-dayequivalentbasis.ThisincludesallscriptsprocessedbytheHumanapharmacybenefitmanager(PBM).(Q) Representsreinsurancerecoverablesassociatedwiththecompany’sstate-basedMedicaidcontractinKentucky.(R) Amountsincurredrelatedtoprioryearsvaryfrompreviouslyestimatedliabilitiesastheclaimsultimatelyaresettled.Negativeamountsreportedforincurredrelatedtoprioryearsresultfromclaimsbeing
ultimatelysettledforamountslessthanoriginallyestimated(favorabledevelopment).Therewerenochangesintheapproachusedtodeterminethecompany’sestimateofmedicalclaimreservesduringthequarter.
(S) Acommonmetricformonitoringbenefitspayablelevelsrelativetobenefitsexpenseisdaysinclaimspayable(DCP).ThecompanycalculatesDCPusingthequarterlyreportedbenefitsexpenseandbenefitspayablebalancesaspresentedwithinthecompany’sconsolidatedfinancialstatements.
(T) DCPfluctuatesduetoanumberoffactors,themoresignificantofwhicharedetailedinthisrollforward.GrowthincertainproductlinescanalsoimpactDCPforthequartersinceaprovisionforclaimswouldnothavebeenrecordedformembersthathadnotyetenrolledearlierinthequarter,yetthosememberswouldhaveaprovisionandcorrespondingmedicalclaimsreserverecordeduponenrollmentlaterinthequarter.
(U) Provideraccrualsrepresentportionsofcapitationpaymentssetasidetopayfuturesettlementsforcapitatedproviders.Relatedsettlementsgenerallyhappenovera12-monthperiod.(V) Representsmedicalandspecialtyclaimsincurredbutnotreported(IBNR)fornon-pharmacyfully-insuredproducts.(W) Representspharmacyclaimsexpenseincludingpaymentstothecompany’spharmacybenefitmanagerforprescriptiondrugsfilledonbehalfofHumana’smembers,aswellasgovernmentsubsidized
programsfromMedicarePartDsuchaslowincomecostandreinsurancesubsidies,aswellascoveragegapdiscountprograms.(X) Includesprocessedclaimsthatareinthepostclaimadjudicationprocess,whichconsistsofoperatingfunctionssuchasaudit,checkbatchingandcheckhandling.TheseclaimsareincludedinIBNRlags,but
havenotyetbeenmailedorreleasedfromHumana.(Y) Includesnon-laggedreservessuchasASOstoploss,lifereserves,andaccidentaldeathanddismemberment/accidentandhealth.Alsoincludesanexplicitprovisionforuncertainty(alsocalledaprovisionfor
adversedeviation)intendedtoensuretheunpaidclaimliabilitiesareadequateundermoderatelyadverseconditions.
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