UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

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

For the quarterly period ended September 30, 2001

OR

[ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934

For the transition period from _____ to _____

Commission file number 1-5975


HUMANA INC.
(Exact name of registrant as specified in its charter)

Delaware
(State or other jurisdiction of
incorporation or organization)

61-0647538
(I.R.S. Employer
Identification Number)

500 West Main Street
Louisville, Kentucky 40202
(Address of principal executive offices, including zip code)

(502) 580-1000
(Registrant's telephone number, including area code)

     Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15 (d) of the Securities
Exchange Act of 1934 during the preceding 12 months, and (2) has been subject to such filing requirements for the past 90 days.
Yes X No ______

     
Indicate the number of shares outstanding of each of the issuer's classes of common stock as of the latest practicable date.

Class of Common Stock
$0.16 2/3 par value

Outstanding at
October 31, 2001
168,696,631 shares


Humana Inc.
FORM 10-Q
SEPTEMBER 30, 2001

INDEX

Part I: Financial Information

Page

Item 1.

Financial Statements

Condensed Consolidated Balance Sheets at September 30, 2001 and
    December 31, 2000 Balance Sheet

3

Condensed Consolidated Statements of Income for the three and nine
    months ended September 30, 2001 and 2000

4

Condensed Consolidated Statements of Cash Flows for the nine months ended
    September 30, 2001 and 2000

5

Notes to Condensed Consolidated Financial Statements

6

Item 2.

Management's Discussion and Analysis of Financial Condition and
    Results of Operations

14

Item 3.

Quantitative and Qualitative Disclosures about Market Risk

30

Part II: Other Information

Item 1.

Legal Proceedings

31

Item 6.

Exhibits and Reports on Form 8-K

34

Signatures

35

 

 

 

2


Humana Inc.
CONDENSED CONSOLIDATED BALANCE SHEETS

 

 

 

 

 

September 30,
2001


 

 

December 31,
2000


 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Unaudited)

 

 

(Audited)

 

 

 

 

 

 

(in millions, except share amounts)

 

Assets

Current assets:

   Cash and cash equivalents

 

$

592

 

 

$

658

 

   Investment securities

 

 

1,392

 

 

 

1,409

 

   Premiums receivable, less allowance for doubtful accounts
      of $41 at September 30, 2001 and $42 at December 31, 2000

 

 

282

 

 

 

205

 

   Other

185

227

 



Total current assets

 

 

2,451

 

 

 

2,499

 

Long-term investment securities

 

 

274

 

 

 

240

 

Property and equipment, net

 

 

453

 

 

 

435

 

Goodwill

 

 

793

 

 

 

790

 

Other

 

 

203

 

 

 

203

 

 

 


 

 


 

        Total assets

 

$

4,174

 

 

$

4,167

 

 

 


 

 


 

Liabilities and Stockholders' Equity

Current liabilities:

   Medical and other expenses payable

 

$

1,130

 

 

$

1,181

 

   Trade accounts payable and accrued expenses

 

 

422

 

 

 

402

 

   Book overdraft

 

 

141

 

 

 

149

 

   Unearned premium revenues

 

 

283

 

 

 

333

 

   Short-term debt

 

 

271

 

 

 

600

 

 

 


 

 


 

      Total current liabilities

 

 

2,247

 

 

 

2,665

 

Long-term debt

 

 

318

 

 

 

-

 

Professional liabilities and other obligations

 

 

145

 

 

 

142

 

 

 


 

 


 

      Total liabilities

 

 

2,710

 

 

 

2,807

 

 

 


 

 


 

Commitments and contingencies

Stockholders' equity:

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

 

 

-

 

 

 

-

 

   Common stock, $0.16 2/3 par; 300,000,000 shares authorized;       170,662,634 and 170,889,142 shares issued in 2001 and 2000,       respectively

 

 

28

 

 

 

28

 

   Capital in excess of par value

 

 

923

 

 

 

923

 

   Retained earnings

 

 

543

 

 

 

461

 

   Accumulated other comprehensive income (loss)

 

 

6

 

 

 

(8

)

   Unearned restricted stock compensation

 

 

(21

)

 

 

(30

)

   Treasury stock, at cost, 1,874,004 and 1,823,348 shares in 2001 and       2000, respectively

 

 

(15

)

 

 

(14

)

 

 


 

 


 

      Total stockholders' equity

 

 

1,464

 

 

 

1,360

 

 

 


 

 


 

        Total liabilities and stockholders' equity

 

$

4,174

 

 

$

4,167

 

 

 


 

 


 

See accompanying notes to condensed consolidated financial statements.

3


Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(Unaudited)

For the three months ended
September 30,


For the nine months ended
September 30,


2001


2000


2001


2000


(in millions)

Revenues:

   Premiums

$

2,541

$

2,588

$

7,395

$

7,865

   Administrative services fees

40

19

87

68

   Investment and other income

30

28

90

86





      Total revenues

2,611

2,635

7,572

8,019





Operating expenses:

   Medical

2,118

2,179

6,172

6,664

   Selling, general and administrative

399

382

1,133

1,144

   Depreciation and amortization

41

38

119

109





      Total operating expenses

2,558

2,599

7,424

7,917





Income from operations

53

36

148

102

   Interest expense

6

7

20

22





Income before income taxes

47

29

128

80

   Provision for income taxes

17

6

46

17





Net income

$

30

$

23

$

82

$

63





Basic earnings per common share

$

0.18

$

0.14

$

0.50

$

0.38





Diluted earnings per common share

$

0.18

$

0.14

$

0.49

$

0.38





See accompanying notes to condensed consolidated financial statements.

4


Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)

 

   

For the nine months ended
September 30,


 
   

2001


   

2000


 

 

 

(in millions)

 

Cash flows from operating activities:

 

 

 

 

 

 

 

 

   Net income

 

$

82

 

 

$

63

 

   Adjustments to reconcile net income to net cash provided by
      (used in) operating activities:

 

 

 

 

 

 

 

 

   Depreciation and amortization

 

 

119

 

 

 

109

 

   Provision for deferred income taxes

 

 

40

 

 

 

18

 

   Payment for government audit settlement

 

 

(8

)

 

 

(15

)

   Changes in operating assets and liabilities excluding effects of       acquisitions and divestitures:

         Premiums receivable

 

 

16

 

 

 

8

 

         Other assets

 

 

12

 

 

 

(13

)

         Medical and other expenses payable

 

 

(156

)

 

 

(145

)

         Workers' compensation run-out claims reduction

 

 

-

 

 

 

(30

)

         Other liabilities

 

 

10

 

 

 

27

 

         Unearned premium revenues

 

 

(55

)

 

 

(259

)

   Other

 

 

-

 

 

 

(2

)



         Net cash provided by (used in) operating activities

 

 

60

 

 

 

(239

)

 

 


 

 


 

Cash flows from investing activities:

 

 

 

 

 

 

   Acquisitions, net of cash and cash equivalents acquired

 

 

(32

)

 

 

(12

)

   Dispositions, net of cash and cash equivalents disposed

 

 

-

 

 

 

32

 

   Purchases of investment securities

 

 

(1,359

)

 

 

(744

)

   Maturities of investment securities

 

 

421

 

 

 

365

 

   Proceeds from sales of investment securities

 

 

965

 

 

 

260

 

   Purchases of property and equipment

 

 

(82

)

 

 

(99

)

   Proceeds from sales of property and equipment

 

 

-

 

 

 

14

 



         Net cash used in investing activities

(87

)

(184

)



Cash flows from financing activities:

 

 

 

 

 

 

 

 

   Revolving credit agreement repayments

 

 

(250

)

 

 

-

 

   Net commercial paper repayments

 

 

(80

)

 

 

(77

)

   Proceeds from issuance of senior notes

 

 

296

 

 

 

-

 

   Change in book overdraft

 

 

(8

)

 

 

(86

)

   Common stock repurchases

 

 

(2

)

 

 

(26

)

   Other

 

 

5

 

 

 

(2

)

 

 


 

 


 

         Net cash used in financing activities

 

 

(39

)

 

 

(191

)

 

 


 

 


 

Decrease in cash and cash equivalents

(66

)

(614

)

Cash and cash equivalents at beginning of period

658

978



Cash and cash equivalents at end of period

$

592

$

364



Supplemental cash flow information:

 

 

 

 

 

 

 

 

   Interest payments

$

20

$

23

   Income tax payments (refunds), net

$

3

$

(35

)

See accompanying notes to condensed consolidated financial statements.

5


Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
Unaudited

 

(A)  Basis of Presentation

     The accompanying condensed consolidated financial statements are presented in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the disclosures normally required by accounting principles generally accepted in the United States of America, or those normally made in an Annual Report on Form 10-K. References to "we," "us," "our" and "Humana" mean Humana Inc. and all entities we own or control. For further information, the reader of this Form 10-Q should refer to the Form 10-K of Humana Inc., for the year ended December 31, 2000 that we filed with the Securities and Exchange Commission, or the SEC, on March 30, 2001, as well as the Form S-3 Registration Statement that we filed with the SEC on August 3, 2001.

     The preparation of our condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America, requires us to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Although our estimates are based on knowledge of current events and anticipated future events, actual results may ultimately differ from those estimates.

     The financial information has been prepared in accordance with our customary accounting practices and has not been audited. In our opinion, the information presented reflects all adjustments necessary for a fair statement of interim results. All such adjustments are of a normal and recurring nature. We have reclassified certain items in the prior year's condensed consolidated financial statements to conform with the current year presentation.

(B)  Recent Transaction

     On May 31, 2001, we acquired for $45 million cash, plus transaction costs of approximately $2 million, the outstanding shares of common stock of a newly formed Anthem Health Insurance Company subsidiary responsible for administering TRICARE benefits to approximately 1.2 million eligible members. We provide ASO services for 592,000 of the total 1.2 million eligible members. We accounted for this acquisition under the purchase method of accounting and accordingly, our consolidated results of operations include the results of the acquired TRICARE business from the date of acquisition. We allocated the purchase price to net tangible and identifiable intangible assets based on their fair value. Any remaining value not assigned to net tangible and identifiable intangible assets was then allocated to goodwill. We allocated $12 million to identifiable intangible assets, representing the value assigned to an acquired contract, which is being amortized on a straight-line basis over approximately 2 years. We allocated $35 million to goodwill, amortized on a straight-line basis over 20 years. The purchase price and allocation is subject to adjustment, no later than January 2002, based upon completion of a final balance sheet as of May 31, 2001.

(C)  Debt

     Credit Agreements

     As of September 30, 2001, we maintained an unsecured revolving credit agreement, which provided a line of credit of up to $1.0 billion and was set to expire in August 2002. Principal amounts outstanding under that credit agreement were $270 million at September 30, 2001, and $520 million at December 31, 2000. Under this agreement, at our option, we could borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of the agreement would bear interest at a floating rate, ranging from LIBOR plus 35 basis points to LIBOR plus 80 basis points, depending on our capitalization and credit ratings. The competitive advance portion of the agreement would bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option. In addition, we paid a 15 basis point annual facility fee on the entire $1.0 billion facility amount, regardless of utilization. This facility fee fluctuated between 6.5 and 20 basis points depending on our capitalization and credit ratings. We also paid a 12.5 basis point annual usage fee when borrowings exceed one-third of the facility amount. Our effective interest rate on borrowings outstanding under this credit agreement at September 30, 2001 was 3.94%. Our credit agreement contained customary covenants and events of default. We were in compliance with all covenants at September 30, 2001. The carrying value of our borrowings under this credit agreement approximated fair value as the interest rate on our borrowings varied with market rates.

6


     On October 11, 2001, we replaced our existing credit agreement with two new unsecured revolving credit agreements consisting of a $265 million 4-year revolving credit agreement and a $265 million 364-day revolving credit agreement with a one-year term out option. In addition, the 364-day revolving credit agreement supports a new conduit commercial paper financing program of up to $265 million. Under this program, a third party issues commercial paper and loans the proceeds of those issuances to us so that the interest and principal payments on the loans match those on the underlying commercial paper.

     Under these new agreements, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of both the 4-year and 364-day agreements bear interest at either a fixed rate or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 80 to 125 basis points for our 4-year agreement and 85 to 137.5 basis points for our 364-day agreement. We also pay an annual facility fee regardless of utilization. This facility fee, currently 25 basis points, may fluctuate between 15 and 50 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings under either the 4-year or 364-day revolving credit agreements will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

     Our new credit agreements contain customary restrictive and financial covenants as well as customary events of defaults, including financial covenants regarding minimum consolidated net worth, maximum leverage, and minimum interest coverage amounts substantially similar to those that existed under the agreement in place at September 30, 2001.

     Commercial Paper Program

     We also maintain and issue short-term debt securities under a commercial paper program. The program is backed by our new credit agreements described above. Aggregate borrowings under both the credit agreements and the commercial paper program cannot exceed $530 million. We had no commercial paper borrowings outstanding at September 30, 2001, and $80 million outstanding at December 31, 2000.

     Senior Notes

     On August 7, 2001, we issued $300 million 7 1/4% senior, unsecured notes due August 1, 2006 at 99.759%. Our net proceeds, reduced for costs of the offering, were approximately $296 million. The net proceeds from this offering were used to repay a portion of the amounts outstanding under our existing credit facility.

     In order to hedge the risk of changes in the fair value of our $300 million 7 1/4% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. Our interest rate swap agreements exchange the 7 1/4% fixed interest rate under our senior notes for a variable interest rate, which was 3.91% at September 30, 2001. The $300 million swap agreements mature on August 1, 2006, and have the same critical terms as our senior notes. Changes in the fair value of the 7 1/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness.

     Our swap agreements are recognized in our condensed consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. At September 30, 2001, the $13 million fair value of our swap agreements is included in other long-term assets. Likewise, the carrying value of our senior notes has been increased $13 million to its fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

7


(D)  Earnings Per Common Share

     Basic earnings per common share is computed on the basis of the weighted average number of unrestricted common shares outstanding. Diluted earnings per common share is computed on the basis of the weighted average number of unrestricted common shares outstanding plus the dilutive effect of outstanding employee stock options and restricted shares using the "treasury stock" method.

     There were no adjustments required to be made to net income for purposes of computing basic or diluted earnings per common share. The following table presents reconciliations of the average number of unrestricted common shares outstanding used in the calculation of basic earnings per common share and diluted earnings per common share for the three and nine months ended September 30, 2001 and 2000:

Three months ended
September 30,


Nine months ended
September 30,


2001

2000

2001

2000





Shares used to compute basic earnings per
   common share

164,110,064

165,379,590

164,088,071

166,957,116

Effect of dilutive common stock options
   and restricted shares

2,632,533

310,665

2,775,449

136,637





Shares used to compute diluted earnings
   per common share

166,742,597

165,690,255

166,863,520

167,093,753





Number of antidilutive stock options
   excluded from computation

5,876,220

13,807,697

6,249,637

11,676,093





(E)  Comprehensive Income

     The following table presents details supporting the computation of comprehensive income for the three and nine months ended September 30, 2001 and 2000:

 

Three months ended
September 30,


 

Nine months ended
September 30,


 

2001

 

2000

 

2001

 

2000





(in millions)

Net income

$

30

 

$

23

 

$

82

 

$

63

Net unrealized investment gains, net of tax

 

11

 

 

10

 

 

14

 

 

11

 


 


 


 


Comprehensive income, net of tax

$

41

 

$

33

 

$

96

 

$

74

 


 


 


 



(F)  Contingencies

     Government Contracts

     Our Medicare+Choice contracts with the federal government are renewed for a one-year term each December 31 unless terminated 90 days prior thereto. Increased funding, which began March 1, 2001, under Medicare, Medicaid and the State Children's Health Insurance Benefits Improvement and Protection Act, or BIPA, is being used to provide additional reimbursement under our contracts with providers and lower member premiums in certain markets. Legislative proposals are being considered which may revise the Medicare program's current support of the use of managed health care for Medicare beneficiaries and future reimbursement rates thereunder. Management is unable to predict the outcome of these proposals or the impact they may have on our financial position, results of operations, or cash flows.

8


     Our Medicaid contracts with various states are generally annual contracts. One of our two Puerto Rico Medicaid contracts covering approximately 147,000 members was transitioned to another insurer on October 1, 2001. The loss of this contract, which accounted for approximately 1% of consolidated premium revenues for the nine months ended September 30, 2001, was not material to our financial position, results of operations, or cash flows. The other contract with the Health Insurance Administration in Puerto Rico covering approximately 248,000 members is scheduled to expire on June 30, 2002, unless extended.

     Effective July 1, 2001, our TRICARE contract for regions 3 and 4 was renewed for up to two additional years subject to annual renewal at the option of the Department of Defense. The TRICARE contract for regions 2 and 5 that we recently acquired from Anthem is scheduled to expire on May 1, 2003, subject to the exercise of an option by the Department of Defense to renew the final year of this contract.

     The loss of any of these government contracts or significant changes in these programs as a result of legislative action, including reductions in payments or increases in benefits without corresponding increases in payments, may have a material adverse effect on our revenues, profitability, and business prospects.

     Legal Proceedings

     Securities Litigation

     Six purported class action complaints were filed in 1999 in the United States District Court for the Western District of Kentucky at Louisville by purported stockholders against us and certain of our current and former directors and officers. The complaints contained the same or substantially similar allegations, namely, that we and the individual defendants knowingly or recklessly made false or misleading statements in press releases and public filings concerning our financial condition, primarily with respect to the impact of negotiations over renewal of our contract with HCA-The Healthcare Company, formerly Columbia/HCA Healthcare Corporation, which took effect April 1, 1999. The complaints allege violations of Section 10(b) of the Securities Exchange Act of 1934, or the 1934 Act, Rule 10b-5 and Section 20(a) of the 1934 Act, and seek certification of a class of stockholders who purchased shares of our common stock starting either (in four complaints) in late October 1998 or (in two complaints) on February 9, 1999, and ending (in all complaints) on April 8, 1999. Plaintiffs moved for consolidation of the actions, now styled In re Humana Inc. Securities Litigation, and filed a consolidated complaint. On April 28, 2000, the defendants filed a motion requesting dismissal of the consolidated complaint. On November 7, 2000, the United States District Court for the Western District of Kentucky issued a memorandum opinion and order dismissing the action. On November 30, 2000, the plaintiffs filed a notice of appeal to the United States Court of Appeals for the Sixth Circuit. We believe the above allegations are without merit and intend to continue to pursue defense of the action.

     In late 1997, three purported class action complaints were filed in the United States District Court for the Southern District of Florida by former stockholders of Physician Corporation of America, or PCA, and certain of its former directors and officers. We acquired PCA by a merger that became effective on September 8, 1997. The three actions were consolidated into a single action entitled In re Physician Corporation of America Securities Litigation. The consolidated complaint alleges that PCA and the individual defendants knowingly or recklessly made false and misleading statements in press releases and public filings with respect to the financial and regulatory difficulties of PCA's workers' compensation business. On May 5, 1999, plaintiffs moved for certification of the purported class, and on August 25, 2000, the defendants moved for summary judgment. On January 31, 2001, defendants were granted leave to file a third-party complaint for declaratory judgment on insurance coverage, seeking a determination that the defense costs and liability, if any, resulting from the class action defense are covered by an insurance policy issued by one insurer and, in the alternative, declaring that there is coverage under policies issued by two other insurers. Defendants have moved for summary judgment on the third-party complaint, and the third party defendants have moved to dismiss or stay the third-party complaint.

9


     Managed Care Industry Class Action Litigation

     We are involved in several purported class action lawsuits that are part of a wave of generally similar actions that target the health care payor industry and particularly target managed care companies. As a result of action by the Judicial Panel on Multi District Litigation, most of the cases against us, as well as similar cases against other companies in the industry, have been consolidated in the United States District Court for the Southern District of Florida, and are now styled In re Managed Care Litigation. The cases include separate suits against us and five other managed care companies that purport to have been brought on behalf of members, which are referred to as the subscriber track cases, and a single action against us and seven other companies that purport to have been brought on behalf of providers, which is referred to as the provider track case.

     In the subscriber track cases, the plaintiffs seek a recovery under RICO for all persons who are or were subscribers at any time during the four-year period prior to the filing of the complaints. Plaintiffs also seek to represent a subclass of policyholders who purchased insurance through their employers' health benefit plans governed by ERISA, and who are or were subscribers at any time during the six-year period prior to the filing of the complaints. The complaint alleges, among other things, that we intentionally concealed from members certain information concerning the way in which we conduct business, including the methods by which we pay providers. The plaintiffs do not allege that any of the purported practices resulted in denial of any claim for a particular benefit, but instead, claim that we provided the purported class with health insurance benefits of lesser value than promised. The complaint also alleges an industry-wide conspiracy to engage in the various alleged improper practices. We filed a motion to dismiss the complaint on July 14, 2000. On August 15, 2000, the plaintiffs filed their amended motion for class certification, seeking a class consisting of all members of our medical plans, excluding Medicare and Medicaid plans, for the period from 1990 to 1999. We filed our opposition to the motion for class certification on November 15, 2000. A hearing on the class certification issue was conducted on July 24, 2001. No ruling has been issued.

     On June 12, 2001, the federal district court rendered its decision with respect to the motions to dismiss. The court dismissed the ERISA claims against us and the other defendants on the grounds that the plaintiffs had failed to exhaust administrative remedies, but permitted the plaintiffs to file amended complaints no later than June 29, 2001. The court declined to dismiss all of the RICO fraud claims against Humana. In the subscriber track cases against other companies, the court dismissed all RICO fraud claims against the other defendants for lack of specificity in their allegations but permitted the plaintiffs to refile all dismissed RICO claims. The plaintiffs filed amended complaints against all except one of the other defendants realleging RICO and ERISA claims on June 29, 2001. Following the district court's June 12, 2001 ruling, we and other defendants requested that the court amend its ruling to allow us to ask the United States Court of Appeals for the Eleventh Circuit to review the court's refusal to follow the decision by the Third Circuit in Maio v. Aetna that would have resulted in dismissal of the RICO claims. The district court denied this request, but noted that the defendants could renew it following its ruling on motions to dismiss the amended complaints. The motions to dismiss were filed on August 13, 2001.

     In the provider track case, the plaintiffs assert that we and other defendants improperly (i) paid providers' claims and (ii) "downcoded" their claims by paying lesser amounts than they submitted. The complaint alleges, among other things, multiple violations under RICO as well as various breaches of contract and violations of regulations governing the timeliness of claim payments. We moved to dismiss the provider track complaint on September 8, 2000, and the other defendants filed similar motions thereafter. On March 2, 2001, the court dismissed certain of the plaintiffs' claims, including the RICO claim, pursuant to the defendants' several motions to dismiss. However, the court allowed the plaintiffs to attempt to correct the deficiencies in their complaint with an amended pleading with respect to all of the allegations except the claim under the federal Medicare regulations, which was dismissed with prejudice. The court also left undisturbed the plaintiffs' claims for breach of contract. On March 26, 2001, the plaintiffs filed their amended complaint which, among other things, added four state or county medical associations as additional plaintiffs. Two of those, the Denton County Medical Society and the Texas Medical Association, purport to bring their actions against us, as well as against several other defendant companies. The Medical Association of Georgia and the California Medical Association purport to bring their actions against various other defendant companies. The associations seek injunctive relief only. The Florida Medicaid Association has also announced its intent to join the action. On October 27, 2000, the provider track plaintiffs filed a motion for class certification. We filed our opposition to that motion on November 17, 2000. Oral argument on the motion for class certification was conducted May 7, 2001. No ruling has been issued.

     Some defendants have filed appeals to the United States Court of Appeals for the Eleventh Circuit from a ruling by the district court that refused to enforce several arbitration clauses in the provider agreements with the defendants. On June 25, 2001, the Eleventh Circuit stayed all proceedings in the district court pending these appeals. Oral argument before the Eleventh Circuit is scheduled for January 2002. Other defendants, including us, have filed similar motions to enforce arbitration agreements which have not yet been ruled on by the district court.

     We intend to continue to defend these actions vigorously.

10


    Chipps v. Humana Health Insurance Company of Florida, Inc.

     On January 4, 2000, a jury in Palm Beach County, Florida, rendered an approximately $80 million verdict against us in a case arising from removal of an insured from a special case management program. The award included approximately $78.5 million of punitive damages, $1 million of damages for emotional distress and $29,000 of damages for contractual benefits. On September 19, 2001, the Court of Appeals overturned the verdict, citing numerous errors by the trial court, and remanded for a new trial. The plaintiff filed a Motion for Rehearing EnBanc with the Court of Appeals on October 3, 2001.

     Government Audits and Other Litigation and Proceedings

     In July 2000, the Office of the Florida Attorney General initiated an investigation, apparently relating to some of the same matters that are involved in the purported class action lawsuits described above. While the Attorney General has filed no action against us, he has indicated that he may do so in the future. On September 21, 2001, the Texas Attorney General initiated a similar investigation.

     On May 31, 2000, we entered into a five-year Corporate Integrity Agreement, or CIA, with the Office of Inspector General, or OIG, of the Department of Health and Human Services. Under the CIA, we are obligated to, among other things, provide training, conduct periodic audits and make periodic reports to the OIG.

     In addition, our business practices are subject to review by various state insurance and health care regulatory authorities and federal regulatory authorities. Recently, there has been increased scrutiny by these regulators of the managed health care companies' business practices, including claims payment practices and utilization management. We have been and continue to be subject to such reviews. Some of these could require changes in some of our practices and could also result in fines or other sanctions.

     We also are involved in other lawsuits that arise in the ordinary course of our business operations, including claims of medical malpractice, bad faith, failure to properly pay claims, nonacceptance or termination of providers, failure to disclose network discounts and various provider arrangements, challenges to subrogation practices, and claims relating to performance of contractual obligations to providers and others. Recent court decisions and pending state and federal legislative activity may increase our exposure for any of these types of claims.

     Personal injury claims and claims for extracontractual damages arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In connection with the case of Chipps v. Humana Health Insurance Company of Florida, Inc., our insurance carriers have preliminarily indicated they believe no coverage may be available for a punitive damages award. Other potential liabilities may not be covered by insurance, insurers may dispute coverage, or the amount of insurance may not be enough to cover the damages awarded. In addition, insurance coverage for all or certain forms of liability may become unavailable or prohibitively expensive in the future.

     We do not believe that any pending or threatened legal actions against us or audits by agencies will have a material adverse effect on our financial position, results of operations, or cash flows. However, the likelihood or outcome of current or future suits, like the purported class action lawsuits described above and the appeal of the Chipps case, cannot be accurately predicted with certainty. In addition, the increased litigation which has accompanied the recent negative publicity and public perception of our industry adds to this uncertainty. Therefore, such legal actions could have a material adverse effect on our financial position, results of operations, and cash flows.

11


(G)  Segment Information

     During the first quarter of 2001, we realigned our management to better reflect our focus on the consumer. As part of this management realignment, we redefined our business into two segments, Commercial and Government. The Commercial segment includes three lines of business: fully insured medical, administrative services only, or ASO, and specialty. The Government segment includes three lines of business: Medicare+Choice, Medicaid, and TRICARE. Results of each segment are measured based upon income from operations before income taxes. We allocate administrative expenses, investment and other income, and interest expense, but not assets, to our segments. Members served by the two segments generally utilize the same medical provider networks, enabling us to obtain more favorable contract terms with providers. Our segments also share overhead costs. As a result, the profitability of each segment is interdependent.

     During the third quarter of 2001, we changed our presentation of administrative services fees and the method of allocating investment income and interest expense to our segments. Prior period segment results were reclassified to conform to our current period presentation. Additionally, we reclassified medical and selling, general and administrative expenses in 2000 to better conform prior year's results to our current segment definitions described above. None of these changes impacted consolidated results of operations. See supplemental schedules in Management's Discussion and Analysis for 2001 and 2000 quarterly financial information by segment.

     The following tables present financial information for our Commercial and Government segments for the three and nine months ended September 30, 2001 and 2000:

 

Commercial Segment

 

 


 

 

Three months ended
September 30,

 

Nine months ended
September 30,

 

 


 


 

 

2001

 

2000

 

2001

 

2000

 

 


 


 


 


 

 

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

    Premiums

$

1,307

 

$

1,366

 

$

3,910

 

$

4,211

 

    Administrative services fees

 

21

 

 

19

 

 

62

 

 

68

 

    Investment and other income

 

19

 

 

18

 

 

57

 

 

57

 

 


 


 


 


 

        Total revenues

 

1,347

 

 

1,403

 

 

4,029

 

 

4,336

 

 


 


 


 


 

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

 

    Medical

 

1,088

 

 

1,138

 

 

3,234

 

 

3,543

 

    Selling, general and administrative

 

233

 

 

238

 

 

700

 

 

733

 

    Depreciation and amortization

 

24

 

 

24

 

 

74

 

 

70

 

 


 


 


 


 

        Total operating expenses

 

1,345

 

 

1,400

 

 

4,008

 

 

4,346

 

 


 


 


 


 

Income (loss) from operations

 

2

 

 

3

 

 

21

 

 

(10

)

    Interest expense

 

4

 

 

4

 

 

12

 

 

14

 

 


 


 


 


 

(Loss) income before income taxes

$

(2

)

$

(1

)

$

9

 

$

(24

)

 


 


 


 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Government Segment

 

 


 

 

Three months ended
September 30,

 

Nine months ended
September 30,

 

 


 


 

 

2001

 

2000

 

2001

 

2000

 

 


 


 


 


 

 

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

    Premiums

$

1,234

 

$

1,222

 

$

3,485

 

$

3,654

 

    Administrative services fees

 

19

 

 

-

 

 

25

 

 

-

 

    Investment and other income

 

11

 

 

10

 

 

33

 

 

29

 

 


 


 


 


 

        Total revenues

 

1,264

 

 

1,232

 

 

3,543

 

 

3,683

 

 


 


 


 


 

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

 

    Medical

 

1,030

 

 

1,041

 

 

2,938

 

 

3,121

 

    Selling, general and administrative

 

166

 

 

144

 

 

433

 

 

411

 

    Depreciation and amortization

 

17

 

 

14

 

 

45

 

 

39

 

 


 


 


 


 

        Total operating expenses

 

1,213

 

 

1,199

 

 

3,416

 

 

3,571

 

 


 


 


 


 

Income from operations

 

51

 

 

33

 

 

127

 

 

112

 

    Interest expense

 

2

 

 

3

 

 

8

 

 

8

 

 


 


 


 


 

Income before income taxes

$

49

 

$

30

 

$

119

 

$

104

 

 


 


 


 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Consolidated

 

 


 

 

Three months ended
September 30,

 

Nine months ended
September 30,

 

 


 


 

 

2001

 

2000

 

2001

 

2000

 

 


 


 


 


 

 

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

    Premiums

$

2,541

 

$

2,588

 

$

7,395

 

$

7,865

 

    Administrative services fees

 

40

 

 

19

 

 

87

 

 

68

 

    Investment and other income

 

30

 

 

28

 

 

90

 

 

86

 

 


 


 


 


 

        Total revenues

 

2,611

 

 

2,635

 

 

7,572

 

 

8,019

 

 


 


 


 


 

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

 

    Medical

 

2,118

 

 

2,179

 

 

6,172

 

 

6,664

 

    Selling, general and administrative

 

399

 

 

382

 

 

1,133

 

 

1,144

 

    Depreciation and amortization

 

41

 

 

38

 

 

119

 

 

109

 

 


 


 


 


 

        Total operating expenses

 

2,558

 

 

2,599

 

 

7,424

 

 

7,917

 

 


 


 


 


 

Income from operations

 

53

 

 

36

 

 

148

 

 

102

 

    Interest expense

 

6

 

 

7

 

 

20

 

 

22

 

 


 


 


 


 

Income before income taxes

$

47

 

$

29

 

$

128

 

$

80

 

 


 


 


 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12


 

(H)  Recently Issued Accounting Pronouncements

     In June 2001, the Financial Accounting Standards Board, or FASB, issued Statement No. 141, Business Combinations, and Statement No. 142, Goodwill and Other Intangible Assets.

     Statement 141 requires that all business combinations initiated after June 30, 2001 be accounted for using the purchase method. Use of the pooling-of-interest method is no longer permitted.

     Statement 142 requires that goodwill no longer be amortized to earnings, but instead be reviewed at least annually for impairment. Impairment losses that arise from completing a transitional impairment test during 2002 are to be reported as resulting from a change in accounting principle. The amortization of existing goodwill ceases upon adoption of the Statement, which we will adopt effective January 1, 2002. Goodwill acquired after June 30, 2001 will not be subject to amortization. In the third quarter of 2001, goodwill amortization expense of $13 million decreased earnings per share by $0.08.

     In October 2001, the FASB issued Statement No. 144, Accounting for the Impairment or Disposal of Long-Lived Assets. Statement 144 develops a single accounting model for long-lived assets to be disposed of by sale, and addresses significant implementation issues related to previous guidance. Statement 144 requires long-lived assets to be disposed of by sale be measured at the lower of their carrying amount or fair value less cost to sell, whether reported in continuing operations or in discontinued operations. Statement 144 also broadens the reporting of discontinued operations by potentially qualifying more disposal transactions for discontinued operations reporting. Generally, the provisions of Statement 144 are to be applied prospectively. Our January 1, 2002 adoption of the Statement is not expected to have a material impact on our financial position, results of operations or cash flows.

13


Humana Inc.
MANAGEMENT'S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS

 

     The following discussion of our financial condition and results of operations should be read in conjunction with our condensed consolidated financial statements presented in this quarterly report. This discussion contains forward-looking statements that involve risks and uncertainties. Our actual results could differ materially from those anticipated in the forward-looking statements as a result of certain factors, including but not limited to, those discussed in "Cautionary Statements" in this document.

Introduction

     We are one of the largest publicly traded health benefits companies, based on our 2000 total revenues of $10.5 billion. We offer coordinated health insurance coverage and related services principally through traditional and Internet-based plans to employer groups and government-sponsored plans. As of September 30, 2001, we had approximately 6.4 million members in our medical insurance programs. In addition, we have approximately 2.3 million members in our specialty products programs. We contract directly with more than 400,000 physicians, hospitals, dentists and other providers to provide health care to our members. For the first nine months of 2001, over 70% of our premium revenues were derived from members located in Florida, Illinois, Texas, Kentucky and Ohio.

     During the first quarter of 2001, we realigned our management to better focus on the consumer. As part of this management realignment, we redefined our business into two segments, Commercial and Government. The Commercial segment includes three lines of business: fully insured medical, administrative services only, or ASO, and specialty. The Government segment includes three lines of business: Medicare+Choice, Medicaid, and TRICARE. Results of each segment are measured based upon income from operations before income taxes. We allocate administrative expenses, investment and other income, and interest expense, but not assets, to our segments. Members served by the two segments generally utilize the same medical provider networks, enabling us to obtain more favorable contract terms with providers. Our segments also share overhead costs. As a result, the profitability of each segment is interdependent.

     Throughout 2000 and to date in 2001, we continued to implement a strategy targeted at improving our financial results while simultaneously positioning ourselves for future growth. Part of our strategy involved eliminating non-core businesses and focusing on improving the infrastructure related to our core businesses. Our core businesses are those that are profitable or have the potential to be profitable, have growth potential, have sufficient membership to allow us to contract with an adequate network of medical providers at appropriate rates or have steady performance.

     During 2000 and to date in 2001, we completed transactions to divest our workers' compensation business and portions of our Medicaid businesses in north Florida, Milwaukee, Wisconsin, and Austin, Houston and San Antonio, Texas. We reinsured with third parties substantially all of our Medicare supplement business. We also exited numerous non-core counties in our Medicare+Choice business and discontinued aspects of our product line focusing on small group commercial businesses in 17 states.

Revenue and Medical Cost Recognition

     Premium revenues are recognized as income in the period members are entitled to receive services. Premiums received prior to such period are recorded as unearned premium revenues.

     Administrative services fees are earned as services are performed and consist of fees for administrative services provided to members of self-funded employers, which may include claims processing, access to provider networks and clinical programs, and customer service inquiries. Under administrative services only, or ASO, contracts, self-funded employers and, for TRICARE ASO, the Department of Defense, retain the full risk of financing benefits.

     Medical costs include claim payments, capitation payments, allocations of certain centralized expenses and various other costs incurred to provide health insurance coverage to members, as well as estimates of future payments to hospitals and others for medical care provided prior to the balance sheet date. Capitation payments represent monthly prepaid fees disbursed to participating primary care physicians and other providers who are responsible for providing medical care to members. We estimate the costs of our future medical claims and other expense payments using actuarial methods and assumptions based upon payment patterns, medical inflation, historical developments and other relevant factors, and create medical claims reserves for future payments. We continually review estimates of future payments relating to medical claims costs for services incurred in the current and prior periods and make necessary adjustments to our reserves.

14


     We reassess the profitability of our contracts for providing health insurance coverage to our members when current market operating results or forecasts indicate probable future losses. We record a premium deficiency in current operations to the extent that the sum of expected medical costs, claim adjustment expenses and maintenance costs exceeds related future premiums. Anticipated investment income is not considered for purposes of computing the premium deficiency. Because the majority of our member contracts renew annually, we do not anticipate premium deficiencies, except when unanticipated adverse events or changes in circumstances indicate otherwise.

     We believe our medical and other expenses payable are adequate to cover future claims payments required. However, such estimates are based on knowledge of current events and anticipated future events, and, therefore, the actual liability could differ from amounts provided.

Recent Developments

     The tragic events of September 11, 2001, and their aftermath, including the threats of further terrorism, did not have a material financial impact on our operations through September 30, 2001. An initial analysis for the fourth quarter of 2001, indicates an increase in physician office visits and antibiotic and mental health drug prescriptions, which is not expected to have a material adverse effect on our results of operations. It is uncertain whether or not the costs associated with higher physician and prescription drug utilization will have a material impact on the remainder of the fourth quarter of 2001, or on subsequent periods. We will continue to monitor the potential impact of these events on our business.

On May 31, 2001, we acquired for $45 million cash, plus transaction costs of approximately $2 million, the outstanding shares of common stock of a newly formed Anthem Health Insurance Company subsidiary responsible for administering TRICARE benefits to approximately 1.2 million eligible members. We provide ASO services for 592,000 of the total 1.2 million eligible members.

     Upon becoming Medicare eligible, which is normally at age 65, TRICARE beneficiaries generally stop receiving benefits under the TRICARE program and begin receiving benefits under a Medicare program. However, recent legislation allows TRICARE beneficiaries to receive pharmacy benefits after age 65. Effective April 1, 2001, we provided pharmacy benefits in an administrative capacity under this new program to approximately 555,000 members for our two TRICARE contracts. Effective October 1, 2001, the benefits under this administrative services program for the over age 65 TRICARE population were expanded to include medical benefits comparable to the benefits for the under age 65 beneficiaries.

Comparison of Results of Operations

     The following discussion deals primarily with our results of operations for the three months ended September 30, 2001, or the 2001 quarter, and the three months ended September 30, 2000, or the 2000 quarter, as well as the nine months ended September 30, 2001, or the 2001 period, and the nine months ended September 30, 2000, or the 2000 period.

The following table presents certain consolidated financial data as well as data for our two segments for the three and nine months ended September 30, 2001 and 2000:

Three months ended
September 30,


Nine months ended
September 30,


2001


2000


2001


2000


(in millions, except ratios)

Premium revenues:

    Commercial

$

1,307

$

1,366

$

3,910

$

4,211

    Government

1,234

1,222

3,485

3,654





        Total

$

2,541

$

2,588

$

7,395

$

7,865





Administrative services fees:

    Commercial

$

21

$

19

$

62

$

68

    Government

19

-

25

-





        Total

$

40

$

19

$

87

$

68





Medical expense ratios:

    Commercial

83.2

%

83.3

%

82.7

%

84.1

%

    Government

83.4

%

85.2

%

84.3

%

85.4

%





        Total

83.3

%

84.2

%

83.5

%

84.7

%





SG&A expense ratios:

    Commercial

17.5

%

17.2

%

17.6

%

17.1

%

    Government

13.2

%

11.8

%

12.3

%

11.2

%





        Total

15.4

%

14.7

%

15.1

%

14.4

%





Income (loss) before income taxes:

    Commercial

$

(2

)

$

(1

)

$

9

$

(24

)

    Government

49

30

119

104





        Total

$

47

$

29

$

128

$

80





15


     The following table presents our medical membership at September 30, 2001 and 2000:

 

September 30,


 

Change


 
   

2001


 

2000


 

Members


 

Percentage


 

Commercial segment medical members:

 

 

 

 

 

 

 

 

 

   Fully insured

 

2,332,700

 

2,639,600

 

(306,900

)

(11.6

)%

   ASO

 

577,800

 

647,300

 

(69,500

)

(10.7

)%

 

 


 


 


 


 

      Total Commercial

 

2,910,500

 

3,286,900

 

(376,400

)

(11.5

)%

 

 


 


 


 


 

Government segment medical members

 

 

 

 

 

 

 

 

 

   Medicare+Choice

 

406,100

 

513,100

 

(107,000

)

(20.9

)%

   Medicaid

 

456,600

 

584,400

 

(127,800

)

(21.9

)%

   TRICARE

 

1,712,700

 

1,063,200

 

649,500

 

61.1

%

   TRICARE ASO

 

942,700

 

-

 

942,700

 

100.0

%

 

 


 


 


 


 

      Total Government

 

3,518,100

 

2,160,700

 

1,357,400

 

62.8

%

 

 

 

 

 

 

 

 

 

 





Total medical membership

6,428,600

5,447,600

981,000

18.0

%





 

     Overview

     Our net income was $30 million, or $0.18 per diluted share in the 2001 quarter compared to $23 million, or $0.14 per diluted share in the 2000 quarter and $82 million, or $0.49 per diluted share for the 2001 period compared to $63 million, or $0.38 for the 2000 period. The earnings improvements resulted from our strategy targeted at improving our financial results which includes actions taken to eliminate non-core businesses and focusing on improvement in the infrastructure related to our core businesses, significant Medicare+Choice benefit reductions, and improvements in determining appropriate premiums for our fully insured commercial medical membership, a process we refer to as pricing discipline.

     Premium Revenues and Medical Membership

     Our premium revenues decreased 1.8% to $2.54 billion for the 2001 quarter, compared to $2.59 billion for the 2000 quarter and decreased 6.0% to $7.40 billion for the 2001 period compared to $7.87 billion for the 2000 period. These decreases were due to medical membership reductions from exiting numerous non-core markets and products, partially offset by higher premium revenues from our TRICARE acquisition on May 31, 2001, and premium yields in our commercial and Medicare+Choice products. Premium yield represents the percentage increase in the average premium per member over the comparable period in the prior year. Items impacting premium yield include changes in premium rates, changes in government reimbursement rates, changes in the geographic mix of membership, and changes in the mix of benefit plans selected by our membership.

     Our Commercial segment's premium revenues decreased 4.3% to $1.31 billion for the 2001 quarter, compared to $1.37 billion for the 2000 quarter and decreased 7.1% to $3.91 billion for the 2001 period compared to $4.21 billion for the 2000 period. These decreases were due to membership reductions partially offset by premium yields on our fully insured commercial business. Our fully insured commercial medical membership decreased 11.6% or 306,900 members, to 2,332,700 at September 30, 2001 compared to 2,639,600 at September 30, 2000, as we continued to focus on opportunities that satisfy our pricing criteria and to exit non-core businesses.

     Our Government segment's premium revenues increased 1.0% to $1.23 billion for the 2001 quarter, compared to $1.22 billion for the 2000 quarter but decreased 4.6% to $3.49 billion for the 2001 period, compared to $3.65 billion for the 2000 period. While the increase for the 2001 quarter was due primarily to our TRICARE acquisition on May 31, 2001 and Medicare+Choice premium yield, the decline for the 2001 period was primarily attributable to reductions in our Medicare+Choice and Medicaid membership partially offset by Medicare+Choice premium yield. For the 2001 quarter, TRICARE premiums were $399 million compared to $238 million for the 2000 quarter. Our fully insured TRICARE membership increased by 649,500 members, or 61.1% to 1,712,700 for the 2001 quarter compared to 1,063,200 for the 2000 quarter. Medicare+Choice membership was 406,100 at September 30, 2001 compared to 513,100 at September 30, 2000, a decline of 107,000 members, or 20.9%, primarily attributable to the exits from 45 Medicare counties on January 1, 2001. Our Medicaid membership was 456,600 at September 30, 2001 compared to 584,400 for the 2000 quarter. This decline resulted primarily from the divestiture of the north Florida, Milwaukee, Wisconsin, and Austin, San Antonio and Houston, Texas Medicaid businesses.

     Membership for all other lines of business should remain relatively constant for the remainder of 2001 with the exception of our Medicaid business in Puerto Rico. We were recently notified that we retained the larger of our two contracts in Puerto Rico. The business associated with the smaller of the two contracts that covers approximately 147,000 members, and accounted for approximately 1% of consolidated premium revenues for the 2001 period, was transitioned to another insurer on October 1, 2001. We do not anticipate any significant changes in our Medicare+Choice membership other than the exit of 5 counties on January 1, 2002 affecting approximately 14,000 members.

16


     Administrative Services Fees

     Our administrative services fees for the 2001 quarter were $40 million, an increase of $21 million from $19 million for the 2000 quarter. For the 2001 period, our administrative services fees were $87 million, an increase of $19 million from $68 million for the 2000 period. These increases were primarily due to the TRICARE regions 2 and 5 acquisition, and servicing pharmacy benefits in an administrative capacity under a new TRICARE program for seniors beginning April 1, 2001. Effective October 1, 2001, benefits under this administrative services program for seniors will be expanded to include medical benefits as well.

     Investment and Other Income

     Our investment and other income totaled $30 million for the 2001 quarter, an increase of $2 million from $28 million for the 2000 quarter. For the 2001 period, our investment and other income was $90 million, an increase of $4 million from $86 million for the 2000 period. The increased investment and other income resulted from higher average invested balances partially offset by lower interest rates.

     Medical Expense

     Our medical expense as a percentage of premium revenues, or medical expense ratio, for the 2001 quarter was 83.3%, decreasing 90 basis points from the 2000 quarter of 84.2%, and 83.5% for the 2001 period, decreasing 120 basis points from the 2000 period of 84.7%. The improvements in the medical expense ratios were primarily due to our exiting numerous higher cost, non-core markets and products in 2000, and significant benefit reductions in our Medicare+Choice product effective January 1, 2001.

     Our Commercial segment's medical expense ratio for the 2001 quarter was 83.2%, decreasing 10 basis points from the 2000 quarter of 83.3%, and 82.7% for the 2001 period, decreasing 140 basis points from the 2000 period of 84.1%. Our improving Commercial medical expense ratio results primarily from our pricing discipline and the impact from exiting numerous higher cost, non-core markets and products in 2000.

     Our Government segment's medical expense ratio for the 2001 quarter was 83.4%, decreasing 180 basis points from the 2000 quarter of 85.2%, and 84.3% for the 2001 period, decreasing 110 basis points from the 2000 period of 85.4%. This improvement primarily resulted from exiting 45 non-core counties in our Medicare+Choice business with higher medical expense ratios on January 1, 2001, coupled with significant benefit design changes that also became effective January 1, 2001.

     SG&A Expense

     Our selling, general and administrative, or SG&A, expense as a percentage of premium revenues and administrative services fees, or SG&A expense ratio, for the 2001 quarter was 15.4%, increasing 70 basis points from the 2000 quarter of 14.7%, and 15.1% for the 2001 period, increasing 70 basis points from the 2000 period of 14.4%. Similar increases occurred in the SG&A expense ratios of our segments as indicated in the preceding table. These increases resulted from an increase in the mix of ASO membership, primarily from the TRICARE acquisition and planned spending on infrastructure and technology initiatives. We expect an increase in the SG&A ratio from the third quarter of 2001 to the fourth quarter of 2001, as the TRICARE ASO program currently administering pharmacy benefits to eligible seniors expands to include medical benefits effective October 1, 2001.

     Depreciation and amortization increased $3 million to $41 million in the 2001 quarter and $10 million to $119 million in the 2001 period. These increases were the result of increased capital expenditures primarily related to our technology initiatives and the TRICARE acquisition on May 31, 2001.

17


     Interest Expense

     Our interest expense was $6 million for the 2001 quarter, a decrease of $1 million from the 2000 quarter. For the 2001 period, our interest expense was $20 million, a decrease of $2 million from the 2000 period. During these periods, the impact from higher daily average outstanding borrowings was offset by lower interest rates. A greater proportion of total debt outstanding during 2001 resulted from borrowings under our credit agreement in effect at September 30, 2001. These borrowings have longer maturities than borrowings under our commercial paper program, resulting in higher daily average outstanding borrowings in 2001 compared to 2000. As a result of this changing debt mix, our daily cash in excess of our funding requirements was invested, causing higher average invested balances discussed above.

     Income Taxes

     On an interim basis, the provision for income taxes is provided for at the anticipated effective tax rate for the year. Our effective tax rate for the three and nine months ended September 30, 2001 was approximately 36% compared to 21% for the comparable periods of 2000. The lower effective tax rate in 2000 includes the benefit recognized for available capital loss carryforwards resulting from the sale of our workers' compensation business.

     Membership

     The following table presents our medical and specialty membership at the end of each quarter ended in 2001 and 2000:

 

2001


 

2000


   

March 31


 

June 30


 

Sept. 30


 

March 31


 

June 30


 

Sept. 30


 

Dec. 31


Medical Membership:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial segment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Fully insured

 

2,387,900

 

2,343,300

 

2,332,700

 

2,977,500

 

2,844,500

 

2,639,600

 

2,545,800

   ASO

 

547,200

 

548,100

 

577,800

 

657,000

 

655,700

 

647,300

 

612,800

   Medicare supplement

 

-

 

-

 

-

 

40,800

 

38,800

 

-

 

-

 

 


 


 


 


 


 


 


     Total Commercial

 

2,935,100

 

2,891,400

 

2,910,500

 

3,675,300

 

3,539,000

 

3,286,900

 

3,158,600

 

 


 


 


 


 


 


 


Government segment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Medicare+Choice

 

428,100

 

418,000

 

406,100

 

518,000

 

522,100

 

513,100

 

494,200

   Medicaid

 

493,200

 

488,400

 

456,600

 

656,600

 

675,100

 

584,400

 

575,500

   TRICARE

 

1,070,900

 

1,725,800

 

1,712,700

 

1,060,000

 

1,049,100

 

1,063,200

 

1,070,400

   TRICARE ASO

 

-

 

939,400

 

942,700

 

-

 

-

 

-

 

-

 

 


 


 


 


 


 


 


     Total Government

 

1,992,200

 

3,571,600

 

3,518,100

 

2,234,600

 

2,246,300

 

2,160,700

 

2,140,100

 

 


 


 


 


 


 


 


Total medical members

 

4,927,300

 

6,463,000

 

6,428,600

 

5,909,900

 

5,785,300

 

5,447,600

 

5,298,700

 

 


 


 


 


 


 


 


Specialty Membership:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial segment

 

2,266,600

 

2,240,700

 

2,267,700

 

2,980,100

 

2,491,500

 

2,394,500

 

2,344,800

 

 


 


 


 


 


 


 


18


Liquidity

     The following table presents cash flows for the nine months ended September 30, 2001 and 2000, excluding the effects of the timing of the Medicare+Choice premium receipts and the previously funded workers' compensation claim payments:

 

 

Nine months ended
September 30


 

 

 

2001


   

2000


 

 

 

(in millions)

 

Cash flows provided by (used in) operating activities

$

60

$

(239

)

Timing of Medicare+Choice premium receipts

 

 

5

 

 

 

251

 

Funded workers' compensation claim payments

 

 

-

 

 

 

30

 

 

 


 

 


 

    Pro forma cash flows provided by operating activities

 

$

65

 

 

$

42

 

 

 


 

 


 

 

     The increase in pro forma cash flows provided by operating activities was primarily due to higher net income. Pro forma operating cash flow for both periods was negatively impacted by a reduction in claims inventories from a higher percentage of claims both received and paid electronically, and from run-off payments for terminated members.

     On March 31, 2000, we received $125 million from the disposition of our workers' compensation business ($60 million, net of cash and cash equivalents included in the disposed operating subsidiary). We used the proceeds from this transaction to reduce debt and fund infrastructure and information technology spending.

     In 2000, our Board of Directors authorized the repurchase of up to five million of our common shares. During the third quarter of 2001, we repurchased 187,500 shares of our common stock for approximately $1.87 million. In total, we have repurchased approximately 3.6 million common shares for an aggregate purchase price of $28 million at an average cost of $7.82 per share as of September 30, 2001.

     Our HMO and PPO subsidiaries, other than those dealing with TRICARE, operate in states that require minimum levels of equity, regulate the payment of distributions to Humana Inc., our parent company, and limit investments to approved securities. Although the minimum required levels of equity are largely based on product mix and premium volume, as well as the quality of assets held, minimum requirements can vary significantly at the state level. Therefore, mergers of any two subsidiaries, or a change in the state of domicile of any subsidiary, can have an impact on the required levels of equity. Based on the most recently stated requirements and the impact of mergers that have happened or will happen by December 31, 2001, each of our subsidiaries is in substantial compliance with applicable statutory capital requirements totaling $564 million in the aggregate. As of September 30, 2001, our regulated subsidiaries maintained aggregate statutory capital and surplus of approximately $991 million. This excess over required levels of $427 million compares favorably to June 30, 2001 of $336 million and December 31, 2000 of $208 million. The amount of distributions that may be paid by these subsidiaries, without prior approval by state regulatory authorities, is limited based on the entity's level of statutory net income and statutory capital and surplus, and in some states, prior approval is required before any distribution can be made. In addition, we normally notify these authorities prior to making payments that do not require approval.

     Our HMO and PPO subsidiaries, other than those dealing with TRICARE, are impacted by the implementation of risk-based capital requirements, or RBC, recommended by the National Association of Insurance Commissioners, or NAIC. RBC is a model developed by the NAIC to monitor regulated entity solvency. The outcome of this calculation provides for minimum levels of capital and surplus for each regulated entity and determines regulatory measures should actual reported surplus fall below these recommended levels. Several states are currently in the process of phasing in these requirements for HMOs over a number of years. If RBC were fully implemented as of September 30, 2001, we would be required to fund additional capital into specific entities aggregating approximately $39 million. After this capital infusion, we would have $339 million of aggregate statutory capital and surplus above the minimum level required under RBC.

     We file statutory-basis financial statements with state regulatory authorities in all states in which we conduct business. On January 1, 2001, changes to the statutory basis of accounting became effective. The cumulative effect of these changes was recorded as a direct adjustment to January 1, 2001 statutory surplus and did not materially impact our compliance with aggregate minimum statutory capital and surplus requirements.

     As of September 30, 2001, we maintained an unsecured revolving credit agreement, which provided a line of credit of up to $1.0 billion and was set to expire in August 2002. Principal amounts outstanding under that credit agreement were $270 million at September 30, 2001, and $520 million at December 31, 2000. Under this agreement, at our option, we could borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of the agreement would bear interest at a floating rate, ranging from LIBOR plus 35 basis points to LIBOR plus 80 basis points, depending on our capitalization and credit ratings. The competitive advance portion of the agreement would bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option. In addition, we paid a 15 basis point annual facility fee on the entire $1.0 billion facility amount, regardless of utilization. This facility fee fluctuated between 6.5 and 20 basis points depending on our capitalization and credit ratings. We also paid a 12.5 basis point annual usage fee when borrowings exceed one-third of the facility amount. Our effective interest rate on borrowings outstanding under this credit agreement at September 30, 2001 was 3.94%. Our credit agreement contained customary covenants and events of default. We were in compliance with all covenants at September 30, 2001. The carrying value of our borrowings under this credit agreement approximated fair value as the interest rate on our borrowings varied with market rates.

19


     On October 11, 2001, we replaced our existing credit agreement with two new unsecured revolving credit agreements consisting of a $265 million 4-year revolving credit agreement and a $265 million 364-day revolving credit agreement with a one-year term out option. In addition, the 364-day revolving credit agreement supports a new conduit commercial paper financing program of up to $265 million. Under this program, a third party issues commercial paper and loans the proceeds of those issuances to us so that the interest and principal payments on the loans match those on the underlying commercial paper.

     Under these new agreements, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of both the 4-year and 364-day agreements bear interest at either a fixed or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 80 to 125 basis points for our 4-year agreement and 85 to 137.5 basis points for our 364-day agreement. We also pay an annual facility fee regardless of utilization. This facility fee, currently 25 basis points, may fluctuate between 15 and 50 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings under either the 4-year or 364-day revolving credit agreements will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

     Our new credit agreements contain customary restrictive and financial covenants as well as customary events of defaults, including financial covenants regarding minimum consolidated net worth, maximum leverage and minimum interest coverage amounts substantially similar to those that existed under the agreement that existed at September 30, 2001.

     We also maintain and issue short-term debt securities under a commercial paper program. The program is backed by our new credit agreements described above. Aggregate borrowings under both the credit agreements and the commercial paper program cannot exceed $530 million. We had no commercial paper borrowings outstanding at September 30, 2001, and $80 million outstanding at December 31, 2000.

     On August 7, 2001, we issued $300 million 7 1/4% senior, unsecured notes due August 1, 2006 at 99.759%. Our net proceeds, reduced for costs of the offering, were approximately $296 million. The net proceeds from this offering were used to repay a portion of the amounts outstanding under our existing credit facility.

     In order to hedge the risk of changes in the fair value of our $300 million 7 1/4% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. Our interest rate swap agreements exchange the 7 1/4% fixed interest rate under our senior notes for a variable interest rate, which was 3.91% at September 30, 2001. The $300 million swap agreements mature on August 1, 2006, and have the same critical terms as our senior notes. Changes in the fair value of the 7 1/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness.

     Our swap agreements are recognized in our condensed consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. At September 30, 2001, the $13 million fair value of our swap agreements is included in other long-term assets. Likewise, the carrying value of our senior notes has been increased $13 million to its fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

     We believe that funds from future operating cash flows and funds available under our new credit agreements and commercial paper program are sufficient to meet future liquidity needs. We also believe the aforementioned sources of funds are adequate to allow us to fund selected expansion opportunities, as well as to fund capital requirements.

     Capital Expenditures

     Our ongoing capital expenditures relate primarily to our technology initiatives and administrative facilities necessary for activities such as claims processing, billing and collections, and customer service. Our capital expenditures were $82 million for the nine months ended September 30, 2001 compared to $99 million for the nine months ended September 30, 2000. Excluding acquisitions, we expect our total capital expenditures in 2001 will be approximately $110 million compared to $135 million for 2000, most of which will be used to fund our technology initiatives and expansion and improvement of administrative facilities.

20


Recently Issued Accounting Pronouncements

     In June 2001, the Financial Accounting Standards Board, or FASB, issued Statement No. 141, Business Combinations, and Statement No. 142, Goodwill and Other Intangible Assets.

     Statement 141 requires that all business combinations initiated after June 30, 2001 be accounted for using the purchase method. Use of the pooling-of-interest method is no longer permitted.

     Statement 142 requires that goodwill no longer be amortized to earnings, but instead be reviewed at least annually for impairment. Impairment losses that arise from completing a transitional impairment test during 2002 are to be reported as resulting from a change in accounting principle. The amortization of existing goodwill ceases upon adoption of the Statement, which we will adopt effective January 1, 2002. Goodwill acquired after June 30, 2001 will not be subject to amortization. In the third quarter of 2001, goodwill amortization expense of $13 million decreased earnings per share by $0.08.

     In October 2001, the FASB issued Statement No. 144, Accounting for the Impairment or Disposal of Long-Lived Assets. Statement 144 develops a single accounting model for long-lived assets to be disposed of by sale, and addresses significant implementation issues related to previous guidance. Statement 144 requires long-lived assets to be disposed of by sale be measured at the lower of their carrying amount or fair value less cost to sell, whether reported in continuing operations or in discontinued operations. Statement 144 also broadens the reporting of discontinued operations by potentially qualifying more disposal transactions for discontinued operations reporting. Generally, the provisions of Statement 144 are to be applied prospectively. Our January 1, 2002 adoption of the Statement is not expected to have a material impact on our financial position, results of operations or cash flows.

21


     Supplemental 2001 Statements of Quarterly Operations (unaudited)

 

2001


 

First


Second


Third


Total


Commercial Segment:

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

1,311

 

$

1,292

 

$

1,307

 

$

3,910

 

   Administrative services fees

 

21

 

 

20

 

 

21

 

 

62

 

   Investment and other income

 

19

 

 

19

 

 

19

 

 

57

 

 


 


 


 


 

      Total revenues

 

1,351

 

 

1,331

 

 

1,347

 

 

4,029

 





Operating expenses:

   Medical

 

1,070

 

 

1,076

 

 

1,088

 

 

3,234

 

   Selling, general and administrative

 

237

 

 

230

 

 

233

 

 

700

 

   Depreciation and amortization

 

25

 

 

25

 

 

24

 

 

74

 





      Total operating expenses

1,332

1,331

1,345

4,008





Income from operations

19

-

2

21

   Interest expense

 

4

 

 

4

 

 

4

 

 

12

 





Income (loss) before income taxes

$

15

$

(4

)

$

(2

)

$

9





 

2001


 

First


Second


Third


Total


Government Segment:

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

1,102

 

$

1,149

 

$

1,234

 

$

3,485

 

   Administrative services fees

 

-

 

 

6

 

 

19

 

 

25

 

   Investment and other income

 

11

 

 

11

 

 

11

 

 

33

 

 


 


 


 


 

      Total revenues

 

1,113

 

 

1,166

 

 

1,264

 

 

3,543

 





Operating expenses:

   Medical

 

937

 

 

971

 

 

1,030

 

 

2,938

 

   Selling, general and administrative

 

132

 

 

135

 

 

166

 

 

433

 

   Depreciation and amortization

 

14

 

 

14

 

 

17

 

 

45

 





      Total operating expenses

1,083

1,120

1,213

3,416





Income from operations

30

46

51

127

   Interest expense

 

3

 

 

3

 

 

2

 

 

8

 





Income before income taxes

$

27

$

43

$

49

$

119

 


 


 


 


 

 

2001


 

First


Second


Third


Total


Consolidated:

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

2,413

 

$

2,441

 

$

2,541

 

$

7,395

 

   Administrative services fees

 

21

 

 

26

 

 

40

 

 

87

 

   Investment and other income

 

30

 

 

30

 

 

30

 

 

90

 

 


 


 


 


 

      Total revenues

 

2,464

 

 

2,497

 

 

2,611

 

 

7,572

 





Operating expenses:

   Medical

 

2,007

 

 

2,047

 

 

2,118

 

 

6,172

 

   Selling, general and administrative

 

369

 

 

365

 

 

399

 

 

1,133

 

   Depreciation and amortization

 

39

 

 

39

 

 

41

 

 

119

 





      Total operating expenses

2,415

2,451

2,558

7,424





Income from operations

49

46

53

148

   Interest expense

 

7

 

 

7

 

 

6

 

 

20

 





Income before income taxes

$

42

$

39

$

47

$

128

 


 


 


 


 

22


     Supplemental 2000 Statements of Quarterly Operations (unaudited)

 

2000


 

 

First


 

Second


 

Third


 

Fourth


 

Total


 

Commercial Segment:

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

1,431

 

$

1,414

 

$

1,366

 

$

1,344

 

$

5,555

 

   Administrative services fees

 

28

 

 

21

 

 

19

 

 

19

 

 

87

 

   Investment and other income

 

22

 

 

17

 

 

18

 

 

18

 

 

75

 






      Total revenues

 

1,481

 

 

1,452

 

 

1,403

 

 

1,381

 

 

5,717

 






Operating expenses:

   Medical

 

1,214

 

 

1,191

 

 

1,138

 

 

1,101

 

 

4,644

 

   Selling, general and administrative

 

249

 

 

246

 

 

238

 

 

237

 

 

970

 

   Depreciation and amortization

 

22

 

 

24

 

 

24

 

 

23

 

 

93

 






      Total operating expenses

1,485

1,461

1,400

1,361

5,707






(Loss) income from operations

(4

)

(9

)

3

20

10

   Interest expense

 

6

 

 

4

 

 

4

 

 

4

 

 

18

 






(Loss) income before income taxes

$

(10

)

$

(13

)

$

(1

)

$

16

$

(8

)






2000


 

First


 

Second


 

Third


 

Fourth


 

Total


 

Government Segment:

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

1,180

 

$

1,252

 

$

1,222

 

$

1,186

 

$

4,840

 

   Investment and other income

 

8

 

 

11

 

 

10

 

 

11

 

 

40

 






      Total revenues

 

1,188

 

 

1,263

 

 

1,232

 

 

1,197

 

 

4,880

 






Operating expenses:

   Medical

 

1,006

 

 

1,074

 

 

1,041

 

 

1,017

 

 

4,138

 

   Selling, general and administrative

 

131

 

 

136

 

 

144

 

 

144

 

 

555

 

   Depreciation and amortization

 

12

 

 

13

 

 

14

 

 

15

 

 

54

 






      Total operating expenses

1,149

1,223

1,199

1,176

4,747






Income from operations

39

40

33

21

133

   Interest expense

 

2

 

 

3

 

 

3

 

 

3

 

 

11

 






Income before income taxes

$

37

$

37

$

30

$

18

$

122






2000


 

First


 

Second


 

Third


 

Fourth


 

Total


 

Consolidated

(in millions)

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Premiums

$

2,611

 

$

2,666

 

$

2,588

 

$

2,530

 

$

10,395

 

   Administrative services fees

 

28

 

 

21

 

 

19

 

 

19

 

 

87

 

   Investment and other income

 

30

 

 

28

 

 

28

 

 

29

 

 

115

 

 


 


 


 


 


 

      Total revenues

 

2,669

 

 

2,715

 

 

2,635

 

 

2,578

 

 

10,597

 






Operating expenses:

   Medical

 

2,220

 

 

2,265

 

 

2,179

 

 

2,118

 

 

8,782

 

   Selling, general and administrative

 

380

 

 

382

 

 

382

 

 

381

 

 

1,525

 

   Depreciation and amortization

 

34

 

 

37

 

 

38

 

 

38

 

 

147

 






      Total operating expenses

2,634

2,684

2,599

2,537

10,454






Income from operations

35

31

36

41

143

   Interest expense

 

8

 

 

7

 

 

7

 

 

7

 

 

29

 






Income before income taxes

$

27

$

24

$

29

$

34

$

114






23


Cautionary Statements

     This document includes both historical and forward-looking statements. The forward-looking statements are made within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. We intend such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995, and we are including this statement for purposes of complying with these safe harbor provisions. We have based these forward-looking statements on our current expectations and projections about future events. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions, including, among other things, the information discussed below. In making these statements, we are not undertaking to address or update each factor in future filings or communications regarding our business or results and are not undertaking to address how any of these factors may have caused results to differ from discussions or information contained in previous filings or communications. Our business is complicated, highly regulated and competitive with many different factors affecting results.

     If the premiums we charge are insufficient to cover the cost of health care services delivered to our members, or if our reserves are inadequate, our profitability could decline.

     We use a significant portion of our revenues to pay the costs of health care services delivered to our members. These costs include claims payments, capitation payments, allocations of certain centralized expenses and various other costs incurred to provide health insurance coverage to our members, as well as estimates of future payments to hospitals and others for medical care provided to our members. Generally, premiums in the health care business are fixed for one-year periods. Accordingly, costs we incur in excess of our medical cost projections generally are not recovered in the contract year through higher premiums. We estimate the costs of our future medical claims and other expenses using actuarial methods and assumptions based upon payment patterns, medical inflation, historical developments and other relevant factors, and create medical claims reserves for future payments. We continually review estimates of future payments relating to medical claims costs for services incurred in the current and prior periods and make necessary adjustments to our reserves. However, competition, government regulations and other factors may and often do cause actual health care costs to exceed what was estimated and reflected in premiums. These factors may include:

     Failure to adequately price our products or develop sufficient reserves may result in a material adverse effect on our financial position, results of operations and cash flows.

     If we fail to manage prescription drug costs successfully, our financial results could suffer.

     In general, prescription drug costs have been rising over the past few years. These increases are due to the introduction of new drugs costing significantly more than existing drugs, direct consumer advertising by the pharmaceutical industry that creates consumer demand for particular brand-name drugs, and members seeking medications to address lifestyle changes. In order to control prescription drug costs, we introduced Rx3, our three-tiered copayment pricing formula for prescription drugs, as well as a new formula with four coverage levels that we have recently implemented. We cannot assure that these efforts will be successful in controlling costs. Failure to control these costs could have a material adverse effect on our financial position, results of operations and cash flows.

24


     If competitive pressures restrict or lower the premiums we receive, our financial results could suffer.

     In addition to the challenge of controlling health care costs, we face competitive pressure to contain premium prices. The managed health care industry is highly competitive and contracts for the sale of commercial products are generally bid upon or renewed annually. Many of our competitors are more established in the health care industry and have a larger market share and greater financial resources than we do in certain markets. In addition, other companies may enter our markets in the future. While health plans compete on the basis of many factors, including service and the quality and depth of provider networks, we expect that price will continue to be a significant basis of competition. Failure to compete effectively in our markets could have a material adverse effect on our financial position, results of operations and cash flows.

     We are involved in various legal actions, which, if resolved unfavorably to us, could result in substantial monetary damages.

     We are a party to a variety of legal actions that affect our business, such as employment and employment discrimination-related suits, employee benefit claims, breach of contract actions, tort claims, and shareholder suits, including securities fraud.

     A number of purported class action lawsuits have been filed against us and some of our competitors in the health benefits business. The suits are purported class actions on behalf of all of our managed care members and network providers for alleged breaches of federal statutes, including Employee Retirement Income Security Act, as amended, or ERISA, and Racketeer Influenced and Corrupt Organizations Act, or RICO.

     In addition, because of the nature of the health care business, we are subject to a variety of legal actions relating to our business operations, including the design, management and offering of products and services. These include and could include in the future:

     In some cases, substantial non-economic or punitive damages, or treble damages, may be sought. While we currently have insurance coverage for some of these potential liabilities, other potential liabilities may not be covered by insurance, insurers may dispute coverage, or the amount of insurance may not be enough to cover the damages awarded.

     In addition, certain types of damages, such as punitive damages, may not be covered by insurance, particularly in those jurisdictions in which coverage of punitive damages is prohibited. In connection with one ongoing lawsuit in which one of our subsidiaries is a defendant, Chipps v. Humana Health Insurance Company of Florida, Inc., our liability carriers have preliminarily indicated they believe no coverage is available for punitive damages. Insurance coverage for all or some forms of liability may become unavailable or prohibitively expensive in the future.

     A description of material legal actions in which we are currently involved is included under "Legal Proceedings" in Part 2 of this document. We cannot predict the outcome of these suits with certainty, and we are incurring expenses in the defense of these matters. In addition, recent court decisions and legislative activity may increase our exposure for any of these types of claims. Therefore, these legal actions could have a material adverse effect on our financial position, results of operations and cash flows.

25


     Increased litigation and negative publicity could increase our cost of doing business.

     The managed care industry continues to receive significant negative publicity and has been the subject of large jury awards that have affected or reflected public perception of the industry. This publicity and perception have been accompanied by increased litigation, legislative activity, regulation and governmental review of industry practices. These factors may adversely affect our ability to market our products or services, may require us to change our products or services, and may increase the regulatory burdens under which we operate. Any combination of these factors could further increase our cost of doing business and adversely affect our financial position, results of operations and cash flows.

     If we fail to effectively implement our operational and strategic initiatives, our business could be materially adversely affected.

     Our future performance depends in large part upon our management team's ability to execute our strategy to position the company for the future. This strategy involves, among other things, the introduction of new products and benefit designs, the successful implementation of our e-business initiatives and the selection and adoption of new technologies. We believe we have experienced, capable management and technical staff who are capable of implementing this strategy. However, the market for management and technical staff in the health care industry is competitive. Loss of key employees could adversely affect the implementation of our initiatives. There can be no assurance that we will be able to successfully implement our operational and strategic initiatives that are intended to position the company for future growth. Failure to implement this strategy may result in a material adverse effect on our financial position, results of operations and cash flows.

     Our industry is currently subject to substantial government regulation, which, along with possible increased governmental regulation or legislative reform, increases our costs of doing business and could adversely affect our profitability.

     The health care industry in general, and HMOs and PPOs in particular, are subject to substantial federal and state government regulation, including:

     State regulations require our HMO and insurance subsidiaries to maintain minimum net worth requirements and restrict certain investment activities. Additionally, those regulations restrict the ability of our subsidiaries to make dividend payments, loans, loan repayments or other payments to us.

     In recent years, significant federal and state legislation affecting our business has been enacted. State and federal governmental authorities are continually considering changes to laws and regulations applicable to us and are currently considering regulations relating to:

     All of these proposals could apply to us.

26


     There can be no assurance that we will be able to continue to obtain or maintain required governmental approvals or licenses or that legislative or regulatory changes will not have a material adverse effect on our business. Delays in obtaining or failure to obtain or maintain required approvals, or moratoria imposed by regulatory authorities, could adversely affect our revenue or the number of our members, increase costs or adversely affect our ability to bring new products to market as forecasted.

     The National Association of Insurance Commissioners, or NAIC, has adopted risk-based capital requirements, also know as RBC, which is subject to state-by-state adoption and to the extent implemented, sets minimum capitalization requirements for insurance and HMO companies. The NAIC recommendations for life insurance companies were adopted in all states and the prescribed calculation for HMOs has been adopted in most states in which we operate. The HMO rules may increase the minimum capital required for some of our subsidiaries. See "Management's Discussion and Analysis of Financial Condition and Results of Operations-Liquidity."

     Congress is considering significant changes to Medicare, including a pharmacy benefit requirement. President Bush announced a prescription drug discount plan for Medicare-eligible seniors in July 2001; however, this discount plan is currently being challenged in federal court. We expect that this discount plan will be revised in the future by the Centers for Medicare and Medicaid Services, or CMS (formerly known as the Health Care Financing Administration). We are unable to determine what effect, if any, the prescription drug discount plan will have on our products or our operating results.

     Congress is also considering proposals relating to health care reform, including a comprehensive package of requirements for managed care plans called the Patient Bill of Rights, or PBOR, legislation. During the summer of 2001, the House and Senate both passed versions of PBOR legislation that must now be reconciled. Due to the tragic events of September 11, 2001, enactment of PBOR legislation is being delayed. If PBOR legislation becomes law, it could expose us to significant increased costs and additional litigation risks. Although we could attempt to mitigate our ultimate exposure from these costs through increases in premiums or changes in benefits, there can be no assurance that we will be able to mitigate or cover the costs stemming from any PBOR legislation or the other costs incurred in connection with complying with any PBOR or similar legislation.

     The Health Insurance Portability and Accountability Act of 1996, or HIPAA, includes administrative provisions directed at simplifying electronic data interchange through standardizing transactions, establishing uniform health care provider, payor and employer identifiers and seeking protections for confidentiality and security of patient data. Under the new HIPAA privacy rules, we must comply with a variety of requirements concerning the use and disclosure of individuals' protected health information, establish rigorous internal procedures to protect health information and enter into business associate contracts with those companies to whom protected health information is disclosed. Violations of these rules will subject us to significant penalties. Compliance with HIPAA regulations requires significant systems enhancements, training and administrative effort. The final rules do not provide for complete federal preemption of state laws, but rather preempt all inconsistent state laws unless the state law is more stringent. HIPAA could also expose us to additional liability for violations by our business associates.

     We are also subject to various governmental audits and investigations. These can include audits and investigations by state attorneys general, CMS, the Office of the Inspector General of Health and Human Services, the Office of Personnel Management, the Department of Justice and state Departments of Insurance and Departments of Health. These activities could result in the loss of licensure or the right to participate in various programs, or the imposition of fines, penalties and other sanctions. In addition, disclosure of any adverse investigation or audit results or sanctions could negatively affect our reputation in various markets and make it more difficult for us to sell our products and services.

27


     As a government contractor, we are exposed to additional risks that could adversely affect our business or our willingness to participate in government health care programs.

     A significant portion of our revenues relates to federal, state and local government health care coverage programs, including the Medicare+Choice, Medicaid and TRICARE programs. These programs involve various risks, including:

     If we fail to maintain satisfactory relationships with the providers of care to our members, our business could be adversely affected.

     We contract with physicians, hospitals and other providers to deliver health care to our members. Our products encourage or require our customers to use these contracted providers. These providers may share medical cost risk with us or have financial incentives to deliver quality medical services in a cost-effective manner.

     In any particular market, providers could refuse to contract with us, demand higher payments, or take other actions that could result in higher health care costs for us, less desirable products for customers and members, or difficulty meeting regulatory or accreditation requirements. In some markets, certain providers, particularly hospitals, physician/hospital organizations or multi-specialty physician groups, may have significant market positions and negotiating power. In addition, physician or practice management companies, which aggregate physician practices for administrative efficiency and marketing leverage, may, in some cases, compete directly with us. If these providers refuse to contract with us, use their market position to negotiate favorable contracts, or place us at a competitive disadvantage, our ability to market products or to be profitable in those areas could be adversely affected.

28


     In some situations, we have contracts with individual or groups of primary care physicians for an actuarially determined, fixed, per-member-per-month fee under which physicians are paid a fixed amount to provide all required medical services to our members. The inability of providers to properly manage costs under these arrangements can result in the financial instability of such providers and the termination of their relationship with us. In addition, payment or other disputes between the primary care provider and specialists with whom it contracts can result in a disruption in the provision of services to our members or a reduction in the services available. A primary care provider's financial instability or failure to pay other providers for services rendered could lead that provider to demand payment from us, even though we have made our regular fixed payments to the primary provider. There can be no assurance that providers with whom we contract will properly manage the costs of services, maintain financial solvency or avoid disputes with other providers, the failure of any of which could have an adverse effect on the provision of services to our members and our operations.

29


Item 3. Quantitative and Qualitative Disclosure about Market Risk
Humana Inc.


     We are exposed to market risks, such as changes in interest rates. To manage the volatility relating to these exposures, we net the exposures on a consolidated basis to take advantage of natural offsets. A portion of our natural offsets changed when we issued $300 million 7 1/4% senior notes during the third quarter of 2001. This change was mitigated when we entered into interest rate swap agreements as discussed in Note C to our condensed consolidated financial statements. Changes in the fair value of the 7 1/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness.

     Other than the change describe above, no other material changes have occurred in our exposures to market risk since the date of our Annual Report on Form 10-K for the fiscal year ended December 31, 2000.

30


Part 2. Other Information
Humana Inc.

Item 1: Legal Proceedings

     Securities Litigation

     In late 1997, three purported class action complaints were filed in the United States District Court for the Southern District of Florida by former stockholders of Physician Corporation of America, or PCA, and certain of its former directors and officers. We acquired PCA by a merger that became effective on September 8, 1997. The three actions were consolidated into a single action entitled In re Physician Corporation of America Securities Litigation. The consolidated complaint alleges that PCA and the individual defendants knowingly or recklessly made false and misleading statements in press releases and public filings with respect to the financial and regulatory difficulties of PCA's workers' compensation business. On May 5, 1999, plaintiffs moved for certification of the purported class, and on August 25, 2000, the defendants moved for summary judgment. On January 31, 2001, defendants were granted leave to file a third-party complaint for declaratory judgment on insurance coverage, seeking a determination that the defense costs and liability, if any, resulting from the class action defense are covered by an insurance policy issued by one insurer and, in the alternative, declaring that there is coverage under policies issued by two other insurers. Defendants have moved for summary judgment on the third-party complaint, and the third party defendants have moved to dismiss or stay the third-party complaint.

     Managed Care Industry Class Action Litigation

     We are involved in several purported class action lawsuits that are part of a wave of generally similar actions that target the health care payor industry and particularly target managed care companies. As a result of action by the Judicial Panel on Multi District Litigation, most of the cases against us, as well as similar cases against other companies in the industry, have been consolidated in the United States District Court for the Southern District of Florida, and are now styled In re Managed Care Litigation. The cases include separate suits against us and five other managed care companies that purport to have been brought on behalf of members, which are referred to as the subscriber track cases, and a single action against us and seven other companies that purport to have been brought on behalf of providers, which is referred to as the provider track case.

     In the subscriber track cases, the plaintiffs seek a recovery under RICO for all persons who are or were subscribers at any time during the four-year period prior to the filing of the complaints. Plaintiffs also seek to represent a subclass of policyholders who purchased insurance through their employers' health benefit plans governed by ERISA, and who are or were subscribers at any time during the six-year period prior to the filing of the complaints. The complaint alleges, among other things, that we intentionally concealed from members certain information concerning the way in which we conduct business, including the methods by which we pay providers. The plaintiffs do not allege that any of the purported practices resulted in denial of any claim for a particular benefit, but instead, claim that we provided the purported class with health insurance benefits of lesser value than promised. The complaint also alleges an industry-wide conspiracy to engage in the various alleged improper practices. We filed a motion to dismiss the complaint on July 14, 2000. On August 15, 2000, the plaintiffs filed their amended motion for class certification, seeking a class consisting of all members of our medical plans, excluding Medicare and Medicaid plans, for the period from 1990 to 1999. We filed our opposition to the motion for class certification on November 15, 2000. A hearing on the class certification issue was conducted on July 24, 2001. No ruling has been issued.

31


     On June 12, 2001, the federal district court rendered its decision with respect to the motions to dismiss. The court dismissed the ERISA claims against us and the other defendants on the grounds that the plaintiffs had failed to exhaust administrative remedies, but permitted the plaintiffs to file amended complaints no later than June 29, 2001. The court declined to dismiss all of the RICO fraud claims against Humana. In the subscriber track cases against other companies, the court dismissed all RICO fraud claims against the other defendants for lack of specificity in their allegations but permitted the plaintiffs to refile all dismissed RICO claims. The plaintiffs filed amended complaints against all except one of the other defendants realleging RICO and ERISA claims on June 29, 2001. Following the district court's June 12, 2001 ruling, we and other defendants requested that the court amend its ruling to allow us to ask the United States Court of Appeals for the Eleventh Circuit to review the court's refusal to follow the decision by the Third Circuit in Maio v. Aetna that would have resulted in dismissal of the RICO claims. The district court denied this request, but noted that the defendants could renew it following its ruling on motions to dismiss the amended complaints. The motions to dismiss were filed on August 13, 2001.

     In the provider track case, the plaintiffs assert that we and other defendants improperly (i) paid providers' claims and (ii) "downcoded" their claims by paying lesser amounts than they submitted. The complaint alleges, among other things, multiple violations under RICO as well as various breaches of contract and violations of regulations governing the timeliness of claim payments. We moved to dismiss the provider track complaint on September 8, 2000, and the other defendants filed similar motions thereafter. On March 2, 2001, the court dismissed certain of the plaintiffs' claims, including the RICO claim, pursuant to the defendants' several motions to dismiss. However, the court allowed the plaintiffs to attempt to correct the deficiencies in their complaint with an amended pleading with respect to all of the allegations except the claim under the federal Medicare regulations, which was dismissed with prejudice. The court also left undisturbed the plaintiffs' claims for breach of contract. On March 26, 2001, the plaintiffs filed their amended complaint which, among other things, added four state or county medical associations as additional plaintiffs. Two of those, the Denton County Medical Society and the Texas Medical Association, purport to bring their actions against us, as well as against several other defendant companies. The Medical Association of Georgia and the California Medical Association purport to bring their actions against various other defendant companies. The associations seek injunctive relief only. The Florida Medicaid Association has also announced its intent to join the action. On October 27, 2000, the provider track plaintiffs filed a motion for class certification. We filed our opposition to that motion on November 17, 2000. Oral argument on the motion for class certification was conducted May 7, 2001. No ruling has been issued.

     Some defendants have filed appeals to the United States Court of Appeals for the Eleventh Circuit from a ruling by the district court that refused to enforce several arbitration clauses in the provider agreements with the defendants. On June 25, 2001, the Eleventh Circuit stayed all proceedings in the district court pending these appeals. Oral argument before the Eleventh Circuit is scheduled for January 2002. Other defendants, including us, have filed similar motions to enforce arbitration agreements which have not yet been ruled on by the district court.

     We intend to continue to defend these actions vigorously.

     Chipps v. Humana Health Insurance Company of Florida, Inc.

     On January 4, 2000, a jury in Palm Beach County, Florida, rendered an approximately $80 million verdict against us in a case arising from removal of an insured from a special case management program. The award included approximately $78.5 million of punitive damages, $1 million of damages for emotional distress and $29,000 of damages for contractual benefits. On September 19, 2001, the Court of Appeals overturned the verdict, citing numerous errors by the trial court, and remanded for a new trial. The plaintiff filed a Motion for Rehearing EnBanc with the Court of Appeals on October 3, 2001.

32


     Government Audits and Other Litigation and Proceedings

     In July 2000, the Office of the Florida Attorney General initiated an investigation, apparently relating to some of the same matters that are involved in the purported class action lawsuits described above. While the Attorney General has filed no action against us, he has indicated that he may do so in the future. On September 21, 2001, the Texas Attorney General initiated a similar investigation.

     In addition, our business practices are subject to review by various state insurance and health care regulatory authorities and federal regulatory authorities. Recently, there has been increased scrutiny by these regulators of the managed health care companies' business practices, including claims payment practices and utilization management. We have been and continue to be subject to such reviews. Some of these could require changes in some of our practices and could also result in fines or other sanctions.

     We also are involved in other lawsuits that arise in the ordinary course of our business operations, including claims of medical malpractice, bad faith, failure to properly pay claims, nonacceptance or termination of providers, failure to disclose network discounts and various provider arrangements, challenges to subrogation practices, and claims relating to performance of contractual obligations to providers and others. Recent court decisions and pending state and federal legislative activity may increase our exposure for any of these types of claims.

     Personal injury claims and claims for extracontractual damages arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In connection with the case of Chipps v. Humana Health Insurance Company of Florida, Inc., our insurance carriers have preliminarily indicated they believe no coverage would be available for a punitive damages award. Other potential liabilities may not be covered by insurance, insurers may dispute coverage, or the amount of insurance may not be enough to cover the damages awarded. In addition, insurance coverage for all or certain forms of liability may become unavailable or prohibitively expensive in the future.

     We do not believe that any pending or threatened legal actions against us or audits by agencies will have a material adverse effect on our financial position, results of operations, or cash flows. However, the likelihood or outcome of current or future suits, like the purported class action lawsuits described above and the appeal of the Chipps case, cannot be accurately predicted with certainty. In addition, the increased litigation which has accompanied the recent negative publicity and public perception of our industry adds to this uncertainty. Therefore, such legal actions could have a material adverse effect on our financial position, results of operations and cash flows.

33


Item 2:

 

Changes in securities

None.

Item 3:

Defaults Upon Senior Securities

None.

Item 4:

Submission of Matters to a Vote of Security Holders

None.

Item 5:

 

Other Information

None.

Item 6:

 

Exhibits and Reports on Form 8-K

(a)

Exhibit Index

 

 

 

Exhibit 10:

 

10(a)

364-Day Credit Agreement

10(b)

Four-Year Credit Agreement

10(c)

RFC Loan Agreement

 

 

(b)

Other than the Form 8-K filed on July 30, 2001 and a Form 8-KA filed on July 31, 2001, and referenced in the June 30, 2001 Form 10-Q, there were no other reports filed on Form 8-K.

34


SIGNATURES

     Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

Humana Inc.

 

(Registrant)

Date:

November 14, 2001


By:

/s/ James H. Bloem


 

 

 

James H. Bloem
Senior Vice President
And Chief Financial Officer
(Principal Accounting Officer)

 

 

 

 

 

 

 

 

 

Date:

November 14, 2001


By:

/s/ Arthur P. Hipwell


 

 

 

Arthur P. Hipwell
Senior Vice President and
General Counsel

 

 

 

 

 

 

35