ý
|
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
|
o
|
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
|
Delaware
|
|
47-0937650
|
(State or other jurisdiction of
|
|
(I.R.S. Employer
|
incorporation or organization)
|
|
Identification No.)
|
|
For the Three Months Ended
September 30, |
|
For the Nine Months Ended
September 30, |
||||||||||||
|
2018
|
|
2017
|
|
2018
|
|
2017
|
||||||||
Revenues:
|
|
|
|
|
|
|
|
||||||||
Premium
|
4,988.8
|
|
|
4,390.9
|
|
|
14,227.7
|
|
|
12,631.5
|
|
||||
Products and services
|
34.6
|
|
|
—
|
|
|
34.6
|
|
|
—
|
|
||||
Investment and other income
|
34.7
|
|
|
12.0
|
|
|
81.0
|
|
|
30.6
|
|
||||
Total revenues
|
5,058.1
|
|
|
4,402.9
|
|
|
14,343.3
|
|
|
12,662.1
|
|
||||
|
|
|
|
|
|
|
|
||||||||
Expenses:
|
|
|
|
|
|
|
|
||||||||
Medical benefits
|
4,195.0
|
|
|
3,740.7
|
|
|
12,023.0
|
|
|
10,938.3
|
|
||||
Costs of products and services
|
33.5
|
|
|
—
|
|
|
33.5
|
|
|
—
|
|
||||
Selling, general and administrative
|
433.2
|
|
|
372.3
|
|
|
1,167.0
|
|
|
1,040.2
|
|
||||
ACA industry fee
|
86.5
|
|
|
—
|
|
|
247.0
|
|
|
—
|
|
||||
Medicaid premium taxes
|
31.5
|
|
|
29.5
|
|
|
94.2
|
|
|
90.6
|
|
||||
Depreciation and amortization
|
46.2
|
|
|
31.4
|
|
|
117.1
|
|
|
84.6
|
|
||||
Interest
|
23.6
|
|
|
17.1
|
|
|
57.8
|
|
|
51.4
|
|
||||
Total expenses
|
4,849.5
|
|
|
4,191.0
|
|
|
13,739.6
|
|
|
12,205.1
|
|
||||
Income from operations
|
208.6
|
|
|
211.9
|
|
|
603.7
|
|
|
457.0
|
|
||||
Loss on extinguishment of debt
|
—
|
|
|
—
|
|
|
—
|
|
|
26.1
|
|
||||
Income before income taxes and equity in losses of unconsolidated subsidiaries
|
208.6
|
|
|
211.9
|
|
|
603.7
|
|
|
430.9
|
|
||||
Equity in earnings (losses) of unconsolidated subsidiaries
|
6.6
|
|
|
23.2
|
|
|
(0.1
|
)
|
|
22.1
|
|
||||
Income before income taxes
|
215.2
|
|
|
235.1
|
|
|
603.6
|
|
|
453.0
|
|
||||
Income tax expense
|
84.6
|
|
|
63.5
|
|
|
219.7
|
|
|
140.0
|
|
||||
Net income
|
$
|
130.6
|
|
|
$
|
171.6
|
|
|
$
|
383.9
|
|
|
$
|
313.0
|
|
|
|
|
|
|
|
|
|
||||||||
Other comprehensive income (loss):
|
|
|
|
|
|
|
|
||||||||
Change in net unrealized gains and losses on
available-for-sale securities, before tax
|
(1.1
|
)
|
|
0.4
|
|
|
(11.4
|
)
|
|
1.7
|
|
||||
Income tax expense (benefit) related to other
comprehensive income
|
(0.3
|
)
|
|
0.2
|
|
|
(2.7
|
)
|
|
0.6
|
|
||||
Other comprehensive (loss) income, net of tax
|
(0.8
|
)
|
|
0.2
|
|
|
(8.7
|
)
|
|
1.1
|
|
||||
Comprehensive income
|
$
|
129.8
|
|
|
$
|
171.8
|
|
|
$
|
375.2
|
|
|
$
|
314.1
|
|
|
|
|
|
|
|
|
|
||||||||
Earnings per common share:
|
|
|
|
|
|
|
|
||||||||
Basic
|
$
|
2.74
|
|
|
$
|
3.86
|
|
|
$
|
8.40
|
|
|
$
|
7.04
|
|
Diluted
|
$
|
2.70
|
|
|
$
|
3.82
|
|
|
$
|
8.29
|
|
|
$
|
6.97
|
|
|
|
|
|
|
|
|
|
||||||||
Weighted average common shares outstanding:
|
|
|
|
|
|
|
|
||||||||
Basic
|
47,712,712
|
|
|
44,509,692
|
|
|
45,692,804
|
|
|
44,458,096
|
|
||||
Diluted
|
48,384,427
|
|
|
44,969,033
|
|
|
46,287,616
|
|
|
44,909,916
|
|
|
|||||||
|
September 30,
2018 |
|
December 31,
2017 |
||||
Assets
|
|
|
|
||||
Current Assets:
|
|
|
|
||||
Cash and cash equivalents
|
$
|
4,306.6
|
|
|
$
|
4,198.6
|
|
Short-term investments
|
1,034.4
|
|
|
469.5
|
|
||
Premiums receivable, net
|
969.6
|
|
|
453.4
|
|
||
Pharmacy rebates receivable, net
|
494.6
|
|
|
335.0
|
|
||
Funds receivable for the benefit of members
|
268.1
|
|
|
27.5
|
|
||
Prepaid expenses and other current assets, net
|
608.9
|
|
|
335.2
|
|
||
Total current assets
|
7,682.2
|
|
|
5,819.2
|
|
||
|
|
|
|
||||
Property, equipment and capitalized software, net
|
384.1
|
|
|
319.5
|
|
||
Goodwill
|
1,753.5
|
|
|
660.7
|
|
||
Other intangible assets, net
|
1,326.6
|
|
|
367.9
|
|
||
Long-term investments
|
844.4
|
|
|
766.2
|
|
||
Restricted cash, cash equivalents and investments
|
234.8
|
|
|
211.0
|
|
||
Other assets
|
17.8
|
|
|
4.9
|
|
||
Assets of discontinued operations
|
215.1
|
|
|
215.2
|
|
||
Total Assets
|
$
|
12,458.5
|
|
|
$
|
8,364.6
|
|
|
|
|
|
||||
Liabilities and Stockholders' Equity
|
|
|
|
|
|
||
Current Liabilities:
|
|
|
|
|
|
||
Medical benefits payable
|
$
|
2,901.4
|
|
|
$
|
2,146.3
|
|
Unearned premiums
|
20.8
|
|
|
65.9
|
|
||
Accounts payable and accrued expenses
|
868.8
|
|
|
788.1
|
|
||
Funds payable for the benefit of members
|
1,569.2
|
|
|
1,075.9
|
|
||
Other payables to government partners
|
444.2
|
|
|
367.0
|
|
||
Total current liabilities
|
5,804.4
|
|
|
4,443.2
|
|
||
|
|
|
|
||||
Deferred income tax liability, net
|
117.2
|
|
|
93.4
|
|
||
Long-term debt, net
|
2,125.4
|
|
|
1,182.4
|
|
||
Other liabilities
|
34.0
|
|
|
13.7
|
|
||
Liabilities of discontinued operations
|
215.1
|
|
|
215.2
|
|
||
Total Liabilities
|
8,296.1
|
|
|
5,947.9
|
|
||
Commitments and contingencies (see Note 13)
|
—
|
|
|
—
|
|
||
Stockholders' Equity:
|
|
|
|
||||
Preferred stock, $0.01 par value (20,000,000 authorized, no shares
issued or outstanding)
|
—
|
|
|
—
|
|
||
Common stock, $0.01 par value (100,000,000 authorized, 49,979,666 and 44,522,988 shares issued and outstanding at September 30, 2018 and December 31, 2017, respectively)
|
0.5
|
|
|
0.4
|
|
||
Paid-in capital
|
1,961.9
|
|
|
591.5
|
|
||
Retained earnings
|
2,211.4
|
|
|
1,827.5
|
|
||
Accumulated other comprehensive loss
|
(11.4
|
)
|
|
(2.7
|
)
|
||
Total Stockholders' Equity
|
4,162.4
|
|
|
2,416.7
|
|
||
Total Liabilities and Stockholders' Equity
|
$
|
12,458.5
|
|
|
$
|
8,364.6
|
|
See notes to unaudited condensed consolidated financial statements.
|
|
Common Stock
|
|
Paid in Capital
|
|
Retained Earnings
|
|
Accumulated
Other
Comprehensive Income (Loss)
|
|
Total
Stockholders' Equity |
|||||||||||||
Shares
|
|
Amount
|
||||||||||||||||||||
Balance at January 1, 2018
|
44,522,988
|
|
|
$
|
0.4
|
|
|
$
|
591.5
|
|
|
$
|
1,827.5
|
|
|
$
|
(2.7
|
)
|
|
$
|
2,416.7
|
|
Issuance of common stock, net of issuance costs
|
5,207,547
|
|
|
0.1
|
|
|
1,342.2
|
|
|
—
|
|
|
—
|
|
|
1,342.3
|
|
|||||
Common stock issued for vested
stock-based compensation awards
|
356,491
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
Repurchase and retirement of shares to
satisfy tax withholding requirements
|
(107,360
|
)
|
|
—
|
|
|
(23.3
|
)
|
|
—
|
|
|
—
|
|
|
(23.3
|
)
|
|||||
Stock-based compensation expense, net
of forfeitures
|
—
|
|
|
—
|
|
|
51.5
|
|
|
—
|
|
|
—
|
|
|
51.5
|
|
|||||
Comprehensive income
|
—
|
|
|
—
|
|
|
—
|
|
|
383.9
|
|
|
(8.7
|
)
|
|
375.2
|
|
|||||
Balance at September 30, 2018
|
49,979,666
|
|
|
$
|
0.5
|
|
|
$
|
1,961.9
|
|
|
$
|
2,211.4
|
|
|
$
|
(11.4
|
)
|
|
$
|
4,162.4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||
Balance at January 1, 2017
|
44,293,881
|
|
|
$
|
0.4
|
|
|
$
|
546.9
|
|
|
$
|
1,453.8
|
|
|
$
|
(1.0
|
)
|
|
$
|
2,000.1
|
|
Common stock issued for vested
stock-based compensation awards
|
315,391
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
Repurchase and retirement of shares to
satisfy tax withholding requirements
|
(96,795
|
)
|
|
—
|
|
|
(13.6
|
)
|
|
—
|
|
|
—
|
|
|
(13.6
|
)
|
|||||
Stock-based compensation expense, net
of forfeitures
|
—
|
|
|
—
|
|
|
32.8
|
|
|
—
|
|
|
—
|
|
|
32.8
|
|
|||||
Comprehensive income
|
—
|
|
|
—
|
|
|
—
|
|
|
313.0
|
|
|
1.1
|
|
|
314.1
|
|
|||||
Balance at September 30, 2017
|
44,512,477
|
|
|
$
|
0.4
|
|
|
$
|
566.1
|
|
|
$
|
1,766.8
|
|
|
$
|
0.1
|
|
|
$
|
2,333.4
|
|
|
|||||||
|
For the Nine Months Ended
September 30, |
||||||
|
2018
|
|
2017
|
||||
Cash flows from operating activities:
|
|
|
|
||||
Net income
|
$
|
383.9
|
|
|
$
|
313.0
|
|
Adjustments to reconcile net income to cash flows from operating activities:
|
|
|
|
|
|
||
Depreciation and amortization
|
117.1
|
|
|
84.6
|
|
||
Loss on extinguishment of debt
|
—
|
|
|
26.1
|
|
||
Stock-based compensation expense
|
51.5
|
|
|
32.8
|
|
||
Deferred taxes, net
|
(9.8
|
)
|
|
(39.0
|
)
|
||
Other, net
|
13.1
|
|
|
13.4
|
|
||
Changes in operating accounts, net of effects from acquisitions:
|
|
|
|
|
|
||
Premiums receivable, net
|
(144.1
|
)
|
|
58.4
|
|
||
Pharmacy rebates receivable, net
|
(138.7
|
)
|
|
(52.7
|
)
|
||
Medical benefits payable
|
227.1
|
|
|
258.8
|
|
||
Unearned premiums
|
(74.7
|
)
|
|
574.4
|
|
||
Other payables to government partners
|
64.8
|
|
|
36.6
|
|
||
Accrued liabilities and other, net
|
(292.2
|
)
|
|
(60.9
|
)
|
||
Net cash provided by operating activities
|
198.0
|
|
|
1,245.5
|
|
||
|
|
|
|
||||
Cash flows from investing activities:
|
|
|
|
|
|
||
Acquisitions and acquisition-related settlements, net of cash acquired
|
(2,035.7
|
)
|
|
(728.5
|
)
|
||
Purchases of investments
|
(1,322.6
|
)
|
|
(1,062.2
|
)
|
||
Proceeds from sales and maturities of investments
|
822.8
|
|
|
324.1
|
|
||
Additions to property, equipment and capitalized software, net
|
(87.5
|
)
|
|
(92.6
|
)
|
||
Net cash used in investing activities
|
(2,623.0
|
)
|
|
(1,559.2
|
)
|
||
|
|
|
|
||||
Cash flows from financing activities:
|
|
|
|
|
|
||
Proceeds from issuance of debt, net of financing costs paid
|
739.0
|
|
|
1,182.2
|
|
||
Borrowings on Revolving Credit Facility, net of financing costs paid
|
221.3
|
|
|
—
|
|
||
Payments on debt
|
(25.0
|
)
|
|
(1,026.1
|
)
|
||
Proceeds from issuance of common stock, net of issuance fees paid
|
1,342.3
|
|
|
—
|
|
||
Repurchase and retirement of shares to satisfy employee tax withholding requirements
|
(23.3
|
)
|
|
(13.6
|
)
|
||
Funds received for the benefit of members, net
|
250.8
|
|
|
978.0
|
|
||
Other, net
|
29.5
|
|
|
13.4
|
|
||
Net cash provided by financing activities
|
2,534.6
|
|
|
1,133.9
|
|
||
|
|
|
|
||||
Increase in cash, cash equivalents and restricted cash and cash equivalents
|
109.6
|
|
|
820.2
|
|
||
Balance at beginning of period
(1)
|
4,263.0
|
|
|
4,121.3
|
|
||
Balance at end of period
(1)
|
$
|
4,372.6
|
|
|
$
|
4,941.5
|
|
|
|
|
|
||||
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION:
|
|
|
|
|
|
||
Cash paid for taxes, net of refunds
|
$
|
174.6
|
|
|
$
|
149.5
|
|
Cash paid for interest
|
$
|
65.5
|
|
|
$
|
56.3
|
|
SUPPLEMENTAL DISCLOSURES OF NON-CASH TRANSACTIONS:
|
|
|
|
|
|
||
Non-cash additions to property, equipment, and capitalized software
|
$
|
3.7
|
|
|
$
|
11.3
|
|
Assets
|
(in millions)
|
||
Cash, cash equivalents and restricted cash
|
$
|
484.4
|
|
Investments, including restricted investments
|
180.4
|
|
|
Premiums receivable, net
|
379.6
|
|
|
Other current assets
|
196.5
|
|
|
Property, equipment and capitalized software, net
|
49.3
|
|
|
Goodwill
|
1,086.5
|
|
|
Other intangible assets, net
|
1,000.0
|
|
|
Fair value of total assets acquired
|
$
|
3,376.7
|
|
|
|
||
Liabilities
|
|
||
Medical benefits payable
|
$
|
528.0
|
|
ACA Fee liability
|
66.5
|
|
|
Other liabilities
|
262.1
|
|
|
Fair value of liabilities assumed
|
856.6
|
|
|
Fair value of net assets acquired
|
$
|
2,520.1
|
|
|
|
|
Medicaid Health Plans
|
|
Medicare Health Plans
|
|
Not assigned
(1)
|
|
Total
|
||||||||
Balance as of December 31, 2017
|
$
|
274.7
|
|
|
$
|
386.0
|
|
|
$
|
—
|
|
|
$
|
660.7
|
|
Acquisitions
(1)
|
—
|
|
|
—
|
|
|
1,086.5
|
|
|
1,086.5
|
|
||||
Acquisition related adjustments
|
—
|
|
|
6.3
|
|
|
—
|
|
|
6.3
|
|
||||
Balance as of September 30, 2018
(1)
|
$
|
274.7
|
|
|
$
|
392.3
|
|
|
$
|
1,086.5
|
|
|
$
|
1,753.5
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma - Unaudited
|
||||||||||||||
|
|
Three Months ended
September 30,
|
|
Nine Months Ended
September 30,
|
||||||||||||
(in millions, except per share data)
|
|
2018
|
|
2017
|
|
2018
|
|
2017
|
||||||||
Total revenues
|
|
$
|
5,869.8
|
|
|
$
|
5,284.6
|
|
|
$
|
17,337.8
|
|
|
$
|
15,399.8
|
|
Net income
|
|
$
|
106.9
|
|
|
$
|
164.2
|
|
|
$
|
355.2
|
|
|
$
|
305.8
|
|
|
|
|
|
|
|
|
|
|
||||||||
Earnings per common share:
|
|
|
|
|
|
|
|
|
||||||||
Basic
|
|
$
|
2.14
|
|
|
$
|
3.30
|
|
|
$
|
7.12
|
|
|
$
|
6.16
|
|
Diluted
|
|
$
|
2.11
|
|
|
$
|
3.27
|
|
|
$
|
7.03
|
|
|
$
|
6.10
|
|
|
|
|
|
|
|
|
|
|
||||||||
Weighted average common shares outstanding:
|
|
|
|
|
|
|
|
|
||||||||
Basic
|
|
49,976,863
|
|
|
49,717,239
|
|
|
49,949,219
|
|
|
47,665,643
|
|
||||
Diluted
|
|
50,648,578
|
|
|
50,176,580
|
|
|
50,514,031
|
|
|
50,117,463
|
|
||||
|
|
|
|
|
|
|
|
|
•
|
Elimination of historical intangible asset amortization expense and addition of amortization expense based on the current preliminary values of identified intangible assets;
|
•
|
Elimination of interest expense associated with retired obligations and addition of interest expense based on debt incurred to finance the Meridian transaction;
|
•
|
Elimination of results for Meridian operations not acquired;
|
•
|
Elimination of transaction and integration-related costs;
|
•
|
Elimination of Universal American discontinued operations;
|
•
|
Include
5,207,547
shares of our common stock issued to finance the Meridian transaction;
|
•
|
Adjustments to align the acquisitions to our accounting policies; and
|
•
|
Tax effects of the adjustments noted above.
|
|
For the Three Months Ended
September 30, |
|
For the Nine Months Ended
September 30, |
||||
|
2018
|
|
2017
|
|
2018
|
|
2017
|
Kentucky
|
13%
|
|
15%
|
|
14%
|
|
15%
|
Florida
|
13%
|
|
15%
|
|
13%
|
|
15%
|
|
Medicaid Health Plan
|
Medicare Health Plan
|
Medicare PDP
|
Corporate & Other
|
Consolidated
|
||||||||||
For the Three Months Ended September 30, 2018
|
(in millions)
|
||||||||||||||
Premium
|
$
|
3,223.3
|
|
$
|
1,582.0
|
|
$
|
182.3
|
|
$
|
1.2
|
|
$
|
4,988.8
|
|
Products and services
|
—
|
|
—
|
|
—
|
|
34.6
|
|
34.6
|
|
|||||
Total premium and products and services revenues
|
3,223.3
|
|
1,582.0
|
|
182.3
|
|
35.8
|
|
5,023.4
|
|
|||||
|
|
|
|
|
|
||||||||||
Medical benefits
|
2,738.1
|
|
1,340.8
|
|
115.1
|
|
1.0
|
|
4,195.0
|
|
|||||
Costs of products and services
|
—
|
|
—
|
|
—
|
|
33.5
|
|
33.5
|
|
|||||
ACA industry fee
|
54.4
|
|
27.5
|
|
4.6
|
|
—
|
|
86.5
|
|
|||||
Medicaid premium taxes
|
31.5
|
|
—
|
|
—
|
|
—
|
|
31.5
|
|
|||||
Total gross margin expenses
|
2,824.0
|
|
1,368.3
|
|
119.7
|
|
34.5
|
|
4,346.5
|
|
|||||
|
|
|
|
|
|
||||||||||
Gross margin
(1)
|
399.3
|
|
213.7
|
|
62.6
|
|
1.3
|
|
676.9
|
|
|||||
|
|
|
|
|
|
||||||||||
Investment and other income
|
—
|
|
—
|
|
—
|
|
34.7
|
|
34.7
|
|
|||||
Other expenses
(2)
|
—
|
|
—
|
|
—
|
|
(503.0
|
)
|
(503.0
|
)
|
|||||
Income from operations
|
$
|
399.3
|
|
$
|
213.7
|
|
$
|
62.6
|
|
$
|
(467.0
|
)
|
$
|
208.6
|
|
|
|
|
|
|
|
||||||||||
For the Three Months Ended September 30, 2017
|
|
|
|
|
|
||||||||||
Premium
|
$
|
2,722.7
|
|
$
|
1,466.3
|
|
$
|
201.9
|
|
$
|
—
|
|
$
|
4,390.9
|
|
Products and services
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
Total premium and products and services revenues
|
2,722.7
|
|
1,466.3
|
|
201.9
|
|
—
|
|
4,390.9
|
|
|||||
|
|
|
|
|
|
||||||||||
Medical benefits
|
2,341.7
|
|
1,256.3
|
|
142.7
|
|
—
|
|
3,740.7
|
|
|||||
Costs of products and services
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
ACA industry fee
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
Medicaid premium taxes
|
29.5
|
|
—
|
|
—
|
|
—
|
|
29.5
|
|
|||||
Total gross margin expenses
|
2,371.2
|
|
1,256.3
|
|
142.7
|
|
—
|
|
3,770.2
|
|
|||||
|
|
|
|
|
|
||||||||||
Gross margin
(1)
|
351.5
|
|
210.0
|
|
59.2
|
|
—
|
|
620.7
|
|
|||||
|
|
|
|
|
|
||||||||||
Investment and other income
|
—
|
|
—
|
|
—
|
|
12.0
|
|
12.0
|
|
|||||
Other expenses
(2)
|
—
|
|
—
|
|
—
|
|
(420.8
|
)
|
(420.8
|
)
|
|||||
Income from operations
|
$
|
351.5
|
|
$
|
210.0
|
|
$
|
59.2
|
|
$
|
(408.8
|
)
|
$
|
211.9
|
|
|
Medicaid Health Plan
|
Medicare Health Plan
|
Medicare PDP
|
Corporate & Other
|
Consolidated
|
||||||||||
For the Nine Months Ended September 30, 2018
|
(in millions)
|
||||||||||||||
Premium
|
$
|
8,899.4
|
|
$
|
4,684.9
|
|
$
|
642.2
|
|
$
|
1.2
|
|
$
|
14,227.7
|
|
Products and services
|
—
|
|
—
|
|
—
|
|
34.6
|
|
34.6
|
|
|||||
Total premium and products and services revenues
|
8,899.4
|
|
4,684.9
|
|
642.2
|
|
35.8
|
|
14,262.3
|
|
|||||
|
|
|
|
|
|
||||||||||
Medical benefits
|
7,601.1
|
|
3,929.8
|
|
491.1
|
|
1.0
|
|
12,023.0
|
|
|||||
Costs of products and services
|
—
|
|
—
|
|
—
|
|
33.5
|
|
33.5
|
|
|||||
ACA industry fee
|
151.5
|
|
81.8
|
|
13.7
|
|
—
|
|
247.0
|
|
|||||
Medicaid premium taxes
|
94.2
|
|
—
|
|
—
|
|
—
|
|
94.2
|
|
|||||
Total gross margin expenses
|
7,846.8
|
|
4,011.6
|
|
504.8
|
|
34.5
|
|
12,397.7
|
|
|||||
|
|
|
|
|
|
||||||||||
Gross margin
(1)
|
1,052.6
|
|
673.3
|
|
137.4
|
|
1.3
|
|
1,864.6
|
|
|||||
|
|
|
|
|
|
||||||||||
Investment and other income
|
—
|
|
—
|
|
—
|
|
81.0
|
|
81.0
|
|
|||||
Other expenses
(2)
|
—
|
|
—
|
|
—
|
|
(1,341.9
|
)
|
(1,341.9
|
)
|
|||||
Income from operations
|
$
|
1,052.6
|
|
$
|
673.3
|
|
$
|
137.4
|
|
$
|
(1,259.6
|
)
|
$
|
603.7
|
|
|
|
|
|
|
|
||||||||||
For the Nine Months Ended September 30, 2017
|
|
|
|
|
|
||||||||||
Premium
|
$
|
8,058.3
|
|
$
|
3,877.6
|
|
$
|
695.6
|
|
$
|
—
|
|
$
|
12,631.5
|
|
Products and services
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
Total premium and products and services revenues
|
8,058.3
|
|
3,877.6
|
|
695.6
|
|
—
|
|
12,631.5
|
|
|||||
|
|
|
|
|
|
||||||||||
Medical benefits
|
7,039.2
|
|
3,301.4
|
|
597.7
|
|
—
|
|
10,938.3
|
|
|||||
Costs of products and services
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
ACA industry fee
|
—
|
|
—
|
|
—
|
|
—
|
|
—
|
|
|||||
Medicaid premium taxes
|
90.6
|
|
—
|
|
—
|
|
—
|
|
90.6
|
|
|||||
Total gross margin expenses
|
7,129.8
|
|
3,301.4
|
|
597.7
|
|
—
|
|
11,028.9
|
|
|||||
|
|
|
|
|
|
||||||||||
Gross margin
(1)
|
928.5
|
|
576.2
|
|
97.9
|
|
—
|
|
1,602.6
|
|
|||||
|
|
|
|
|
|
||||||||||
Investment and other income
|
—
|
|
—
|
|
—
|
|
30.6
|
|
30.6
|
|
|||||
Other expenses
(2)
|
—
|
|
—
|
|
—
|
|
(1,176.2
|
)
|
(1,176.2
|
)
|
|||||
Income from operations
|
$
|
928.5
|
|
$
|
576.2
|
|
$
|
97.9
|
|
$
|
(1,145.6
|
)
|
$
|
457.0
|
|
(1)
|
Effective July 1, 2018, the Company redefined gross margin as total revenues less investment and other income, medical expenses, cost of products and services, the ACA industry fee expense, and Medicaid premium tax expense. Accordingly, results for the three and nine months ended September 30, 2017 were adjusted to include Medicaid premium taxes, which decreased gross margin by $
29.5 million
and $
90.6 million
, respectively.
|
(2)
|
Effective July 1, 2018, other expenses include SG&A expenses, depreciation, amortization and interest. Accordingly, results for the three and nine months ended September 30, 2017 were adjusted to exclude Medicaid premium taxes, which decreased other expenses by $
29.5 million
and $
90.6 million
, respectively.
|
|
For the Three Months Ended
September 30, |
|
For the Nine Months Ended
September 30, |
||||||||
|
2018
|
|
2017
|
|
2018
|
|
2017
|
||||
|
|
|
|
|
|
|
|
||||
Weighted-average common shares outstanding — basic
|
47,712,712
|
|
|
44,509,692
|
|
|
45,692,804
|
|
|
44,458,096
|
|
Dilutive effect of outstanding stock-based compensation awards
|
671,715
|
|
|
459,341
|
|
|
594,812
|
|
|
451,820
|
|
Weighted-average common shares outstanding — diluted
|
48,384,427
|
|
|
44,969,033
|
|
|
46,287,616
|
|
|
44,909,916
|
|
Anti-dilutive stock-based compensation awards excluded from computation
|
136,428
|
|
|
147,141
|
|
|
184,964
|
|
|
51,475
|
|
|
|
|
|
|
|
|
|
|
Amortized
Cost
|
|
Gross
Unrealized
Gains
|
|
Gross
Unrealized
Losses
|
|
Estimated
Fair Value
|
||||||||
September 30, 2018
|
|
|
|
|
|
|
|
||||||||
Asset-backed securities
|
$
|
127.3
|
|
|
$
|
—
|
|
|
$
|
(0.6
|
)
|
|
$
|
126.7
|
|
Corporate debt securities
|
941.0
|
|
|
0.3
|
|
|
(9.4
|
)
|
|
931.9
|
|
||||
Municipal securities
|
266.0
|
|
|
0.1
|
|
|
(3.2
|
)
|
|
262.9
|
|
||||
Residential mortgage-backed securities
|
36.7
|
|
|
—
|
|
|
(0.5
|
)
|
|
36.2
|
|
||||
Short-term time deposits
|
341.6
|
|
|
—
|
|
|
—
|
|
|
341.6
|
|
||||
Government and agency obligations
|
98.3
|
|
|
—
|
|
|
(1.0
|
)
|
|
97.3
|
|
||||
Other securities
|
82.3
|
|
|
—
|
|
|
(0.1
|
)
|
|
82.2
|
|
||||
Total
|
$
|
1,893.2
|
|
|
$
|
0.4
|
|
|
$
|
(14.9
|
)
|
|
$
|
1,878.8
|
|
December 31, 2017
|
|
|
|
|
|
|
|
|
|
|
|
||||
Asset-backed securities
|
$
|
88.9
|
|
|
$
|
—
|
|
|
$
|
(0.2
|
)
|
|
$
|
88.7
|
|
Corporate debt securities
|
400.6
|
|
|
0.7
|
|
|
(1.2
|
)
|
|
400.1
|
|
||||
Municipal securities
|
223.7
|
|
|
1.0
|
|
|
(1.9
|
)
|
|
222.8
|
|
||||
Residential mortgage-backed securities
|
11.2
|
|
|
—
|
|
|
—
|
|
|
11.2
|
|
||||
Short-term time deposits
|
300.4
|
|
|
—
|
|
|
—
|
|
|
300.4
|
|
||||
Government and agency obligations
|
148.7
|
|
|
—
|
|
|
(1.2
|
)
|
|
147.5
|
|
||||
Other securities
|
65.2
|
|
|
—
|
|
|
(0.2
|
)
|
|
65.0
|
|
||||
Total
|
$
|
1,238.7
|
|
|
$
|
1.7
|
|
|
$
|
(4.7
|
)
|
|
$
|
1,235.7
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
Within
1 Year
|
|
1 Through 5
Years
|
|
5 Through 10
Years
|
|
Thereafter
|
||||||||||
Asset-backed securities
|
$
|
126.7
|
|
|
$
|
51.1
|
|
|
$
|
71.6
|
|
|
$
|
1.2
|
|
|
$
|
2.8
|
|
Corporate debt securities
|
931.9
|
|
|
525.6
|
|
|
319.8
|
|
|
75.8
|
|
|
10.7
|
|
|||||
Municipal securities
|
262.9
|
|
|
12.6
|
|
|
146.4
|
|
|
79.5
|
|
|
24.4
|
|
|||||
Residential mortgage-backed securities
|
36.2
|
|
|
—
|
|
|
0.4
|
|
|
0.3
|
|
|
35.5
|
|
|||||
Short-term time deposits
|
341.6
|
|
|
341.6
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||
Government and agency obligations
|
97.3
|
|
|
53.7
|
|
|
39.3
|
|
|
4.3
|
|
|
—
|
|
|||||
Other securities
|
82.2
|
|
|
49.8
|
|
|
—
|
|
|
3.0
|
|
|
29.4
|
|
|||||
Total
|
$
|
1,878.8
|
|
|
$
|
1,034.4
|
|
|
$
|
577.5
|
|
|
$
|
164.1
|
|
|
$
|
102.8
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortized
Cost
|
|
Gross
Unrealized
Gains
|
|
Gross
Unrealized
Losses
|
|
Estimated
Fair Value
|
||||||||
September 30, 2018
|
|
|
|
|
|
|
|
||||||||
Cash
|
$
|
4.9
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
4.9
|
|
Money market funds
|
61.1
|
|
|
—
|
|
|
—
|
|
|
61.1
|
|
||||
U.S. government securities and other
|
169.6
|
|
|
—
|
|
|
(0.8
|
)
|
|
168.8
|
|
||||
Total
|
$
|
235.6
|
|
|
$
|
—
|
|
|
$
|
(0.8
|
)
|
|
$
|
234.8
|
|
December 31, 2017
|
|
|
|
|
|
|
|
|
|
|
|
||||
Cash
|
$
|
5.7
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
5.7
|
|
Money market funds
|
58.7
|
|
|
—
|
|
|
—
|
|
|
58.7
|
|
||||
U.S. government securities and other
|
147.4
|
|
|
—
|
|
|
(0.8
|
)
|
|
146.6
|
|
||||
Total
|
$
|
211.8
|
|
|
$
|
—
|
|
|
$
|
(0.8
|
)
|
|
$
|
211.0
|
|
|
|
|
|
|
|
|
|
|
RSUs
|
|
PSUs
|
|
MSUs
|
|
Total
|
||||
Outstanding as of January 1, 2018
|
274,643
|
|
|
552,618
|
|
|
45,230
|
|
|
872,491
|
|
Granted
|
121,902
|
|
|
256,679
|
|
|
45,075
|
|
|
423,656
|
|
Vested
|
(128,210
|
)
|
|
(154,055
|
)
|
|
(90,150
|
)
|
|
(372,415
|
)
|
Forfeited
|
(15,251
|
)
|
|
(33,361
|
)
|
|
(155
|
)
|
|
(48,767
|
)
|
Outstanding as of September 30, 2018
|
253,084
|
|
|
621,881
|
|
|
—
|
|
|
874,965
|
|
|
|
|
|
|
|
|
|
|
September 30, 2018
|
|
December 31, 2017
|
||||
Long-term debt, net:
|
|
|
|
||||
5.25% Senior Notes, due April 1, 2025
|
$
|
1,200.0
|
|
|
$
|
1,200.0
|
|
5.375% Senior Notes, due August 15, 2026
|
750.0
|
|
|
—
|
|
||
Revolving Credit Facility
|
200.0
|
|
|
—
|
|
||
Debt issuance costs
|
(24.6
|
)
|
|
(17.6
|
)
|
||
Total long-term debt, net
|
$
|
2,125.4
|
|
|
$
|
1,182.4
|
|
|
|
|
|
•
|
incur additional indebtedness and issue preferred stock;
|
•
|
pay dividends or make other distributions;
|
•
|
make other restricted payments and investments;
|
•
|
sell assets, including capital stock of restricted subsidiaries;
|
•
|
create certain liens;
|
•
|
incur restrictions on the ability of restricted subsidiaries to pay dividends or make other payments, and in the case of our subsidiaries, guarantee indebtedness;
|
•
|
engage in transactions with affiliates; and
|
•
|
create unrestricted subsidiaries.
|
(1)
|
at least
50%
of the aggregate principal amount of the 2026 Notes issued under the Indenture (including any additional 2026 Notes, but excluding 2026 Notes held by the Company or its subsidiaries) remains outstanding immediately after the occurrence of such redemption, unless all such 2026 Notes are redeemed substantially concurrently with the redemption of 2026 Notes; and
|
(2)
|
the redemption occurs within
180 days
of the date of the closing of such equity offering.
|
|
|
|
Fair Value Measurements Using
|
||||||||||||
|
Carrying Value
|
|
Quoted Prices in
Active Markets
for Identical
Assets
(Level 1)
|
|
Significant Other
Observable
Inputs
(Level 2)
|
|
Significant
Unobservable
Inputs
(Level 3)
|
||||||||
Investments:
|
|
|
|
|
|
|
|
||||||||
Asset-backed securities
|
$
|
126.7
|
|
|
$
|
—
|
|
|
$
|
126.7
|
|
|
$
|
—
|
|
Corporate debt securities
|
931.9
|
|
|
—
|
|
|
931.9
|
|
|
—
|
|
||||
Municipal securities
|
262.9
|
|
|
—
|
|
|
262.9
|
|
|
—
|
|
||||
Residential mortgage-backed securities
|
36.2
|
|
|
—
|
|
|
36.2
|
|
|
—
|
|
||||
Short-term time deposits
|
341.6
|
|
|
—
|
|
|
341.6
|
|
|
—
|
|
||||
Government and agency obligations
|
97.3
|
|
|
97.3
|
|
|
—
|
|
|
—
|
|
||||
Other securities
|
82.2
|
|
|
49.8
|
|
|
32.4
|
|
|
—
|
|
||||
Total investments
|
$
|
1,878.8
|
|
|
$
|
147.1
|
|
|
$
|
1,731.7
|
|
|
$
|
—
|
|
Restricted cash, cash equivalents and investments:
|
|
|
|
|
|
|
|
|
|
|
|
||||
Cash
|
$
|
4.9
|
|
|
$
|
4.9
|
|
|
$
|
—
|
|
|
$
|
—
|
|
Money market funds
|
61.1
|
|
|
61.1
|
|
|
—
|
|
|
—
|
|
||||
U.S. government securities and other
|
168.8
|
|
|
168.6
|
|
|
0.2
|
|
|
—
|
|
||||
Total restricted cash, cash equivalents and investments
|
$
|
234.8
|
|
|
$
|
234.6
|
|
|
$
|
0.2
|
|
|
$
|
—
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value Measurements Using
|
||||||||||||
|
Carrying Value
|
|
Quoted Prices in Active Markets for Identical Assets
(Level 1)
|
|
Significant Other Observable Inputs
(Level 2)
|
|
Significant Unobservable Inputs
(Level 3)
|
||||||||
Investments:
|
|
|
|
|
|
|
|
||||||||
Asset-backed securities
|
$
|
88.7
|
|
|
$
|
—
|
|
|
$
|
88.7
|
|
|
$
|
—
|
|
Corporate debt securities
|
400.1
|
|
|
—
|
|
|
400.1
|
|
|
—
|
|
||||
Municipal securities
|
222.8
|
|
|
—
|
|
|
210.5
|
|
|
12.3
|
|
||||
Residential mortgage-backed securities
|
11.2
|
|
|
—
|
|
|
11.2
|
|
|
—
|
|
||||
Short-term time deposits
|
300.4
|
|
|
—
|
|
|
300.4
|
|
|
—
|
|
||||
Government and agency obligations
|
147.5
|
|
|
147.5
|
|
|
—
|
|
|
—
|
|
||||
Other securities
|
65.0
|
|
|
52.8
|
|
|
12.2
|
|
|
—
|
|
||||
Total Investments
|
$
|
1,235.7
|
|
|
$
|
200.3
|
|
|
$
|
1,023.1
|
|
|
$
|
12.3
|
|
Restricted cash, cash equivalents and investments:
|
|
|
|
|
|
|
|
|
|
|
|
||||
Cash
|
$
|
5.7
|
|
|
$
|
5.7
|
|
|
$
|
—
|
|
|
$
|
—
|
|
Money market funds
|
58.7
|
|
|
58.7
|
|
|
—
|
|
|
—
|
|
||||
U.S. government securities and other
|
146.6
|
|
|
146.4
|
|
|
0.2
|
|
|
—
|
|
||||
Total restricted cash, cash equivalents and investments
|
$
|
211.0
|
|
|
$
|
210.8
|
|
|
$
|
0.2
|
|
|
$
|
—
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value Measurements Using
|
||||||||
|
Carrying Value
|
|
Quoted Prices in Active Markets for Identical Assets
(Level 1) |
|
Significant Other Observable Inputs
(Level 2) |
|
Significant Unobservable Inputs
(Level 3) |
||||
Long-term debt - September 30, 2018
|
2,125.4
|
|
|
1,985.8
|
|
|
200.0
|
|
|
—
|
|
Long-term debt - December 31, 2017
|
1,182.4
|
|
|
1,274.3
|
|
|
—
|
|
|
—
|
|
|
|
For the Three Months Ended
September 30,
|
|
For the Nine Months Ended
September 30, |
||||||||
|
|
2017
|
|
2018
|
|
2017
|
||||||
Balance at beginning of period
|
|
$
|
12.3
|
|
|
$
|
12.3
|
|
|
$
|
12.4
|
|
Realized gains (losses) in earnings
|
|
—
|
|
|
(1.2
|
)
|
|
—
|
|
|||
Changes in unrealized gains (losses) in other comprehensive income
|
|
—
|
|
|
1.4
|
|
|
|
|
|||
Purchases, sales and redemptions
|
|
—
|
|
|
(12.5
|
)
|
|
(0.1
|
)
|
|||
Net transfers in or (out) of Level 3
|
|
—
|
|
|
—
|
|
|
—
|
|
|||
Balance at end of period
|
|
$
|
12.3
|
|
|
$
|
—
|
|
|
$
|
12.3
|
|
|
|
|
|
|
|
|
|
|
For the nine months ended September 30, 2018
|
||||||||||||||||||
|
|
Medicaid Health Plans
|
|
Medicare Health Plans
|
|
Medicare PDPs
|
|
Corporate and other
(2)
|
|
Consolidated
|
||||||||||
Beginning balance
(1)
|
|
$
|
1,373.2
|
|
|
$
|
722.5
|
|
|
$
|
50.6
|
|
|
$
|
—
|
|
|
$
|
2,146.3
|
|
Acquisitions
|
|
478.2
|
|
|
47.1
|
|
|
—
|
|
|
2.7
|
|
|
528.0
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medical benefits incurred related to:
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Current year
|
|
7,803.2
|
|
|
4,051.6
|
|
|
560.4
|
|
|
1.0
|
|
|
12,416.2
|
|
|||||
Prior years
|
|
(202.1
|
)
|
|
(121.8
|
)
|
|
(69.3
|
)
|
|
—
|
|
|
(393.2
|
)
|
|||||
Total
|
|
7,601.1
|
|
|
3,929.8
|
|
|
491.1
|
|
|
1.0
|
|
|
12,023.0
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medical benefits paid related to:
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Current year
|
|
(6,562.2
|
)
|
|
(3,382.3
|
)
|
|
(502.9
|
)
|
|
(0.8
|
)
|
|
(10,448.2
|
)
|
|||||
Prior years
|
|
(889.3
|
)
|
|
(488.3
|
)
|
|
30.0
|
|
|
(0.1
|
)
|
|
(1,347.7
|
)
|
|||||
Total
|
|
(7,451.5
|
)
|
|
(3,870.6
|
)
|
|
(472.9
|
)
|
|
(0.9
|
)
|
|
(11,795.9
|
)
|
|||||
Ending balance
(1)
|
|
$
|
2,001.0
|
|
|
$
|
828.8
|
|
|
$
|
68.8
|
|
|
$
|
2.8
|
|
|
$
|
2,901.4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the nine months ended September 30, 2017
|
||||||||||||||||||
|
|
Medicaid Health Plans
|
|
Medicare Health Plans
|
|
Medicare PDPs
|
|
Corporate and other
(2)
|
|
Consolidated
|
||||||||||
Beginning balance
|
|
$
|
1,135.8
|
|
|
$
|
510.0
|
|
|
$
|
44.7
|
|
|
$
|
—
|
|
|
$
|
1,690.5
|
|
Acquisitions
|
|
—
|
|
|
128.1
|
|
|
—
|
|
|
—
|
|
|
128.1
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medical benefits incurred related to:
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Current year
|
|
7,229.9
|
|
|
3,397.4
|
|
|
662.7
|
|
|
—
|
|
|
11,290.0
|
|
|||||
Prior years
|
|
(190.7
|
)
|
|
(96.0
|
)
|
|
(65.0
|
)
|
|
—
|
|
|
(351.7
|
)
|
|||||
Total
|
|
7,039.2
|
|
|
3,301.4
|
|
|
597.7
|
|
|
—
|
|
|
10,938.3
|
|
|||||
|
|
|
|
|
|
|
|
|
|
—
|
|
|||||||||
Medical benefits paid related to:
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Current year
|
|
(6,104.3
|
)
|
|
(2,905.4
|
)
|
|
(633.7
|
)
|
|
—
|
|
|
(9,643.4
|
)
|
|||||
Prior years
|
|
(749.6
|
)
|
|
(308.6
|
)
|
|
21.5
|
|
|
—
|
|
|
(1,036.7
|
)
|
|||||
Total
|
|
(6,853.9
|
)
|
|
(3,214.0
|
)
|
|
(612.2
|
)
|
|
—
|
|
|
(10,680.1
|
)
|
|||||
Ending balance
|
|
$
|
1,321.1
|
|
|
$
|
725.5
|
|
|
$
|
30.2
|
|
|
$
|
—
|
|
|
$
|
2,076.8
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
September 30, 2018
|
|
December 31, 2017
|
||||
|
|
(in millions)
|
||||||
Assets
|
|
|
|
|
||||
Cash and cash equivalents
|
|
$
|
1.9
|
|
|
$
|
1.3
|
|
Investments
|
|
43.3
|
|
|
46.5
|
|
||
Reinsurance recoverables
|
|
169.4
|
|
|
166.9
|
|
||
Other assets
|
|
0.5
|
|
|
0.5
|
|
||
Total Assets
|
|
$
|
215.1
|
|
|
$
|
215.2
|
|
|
|
|
|
|
||||
Liabilities
|
|
|
|
|
||||
Reserves and other policy liabilities
|
|
$
|
149.4
|
|
|
$
|
148.6
|
|
Other liabilities
|
|
65.7
|
|
|
66.6
|
|
||
Total liabilities
|
|
$
|
215.1
|
|
|
$
|
215.2
|
|
|
|
|
|
|
▪
|
Membership
at
September 30, 2018
increased by
1.2 million
, or
26.6%
, compared with
September 30, 2017
. The increase was primarily driven by our September 2018 acquisition of Meridian as well as organic growth in our Medicare Health Plans segment, partially offset by decreased membership in our PDP segment resulting from our 2018 bid positioning.
|
▪
|
Premiums
increased
13.6%
for the three months ended
September 30, 2018
compared with the same period in 2017, reflecting our September 2018 acquisition of Meridian, the assignment of additional members in our Illinois Medicaid health plan, organic growth in our Medicare Health Plans segment and the expiration of the 2017 ACA industry fee moratorium (discussed in
Key Development and Accomplishments
below), which reestablished the associated Medicaid ACA industry fee reimbursements from our state government partners for 2018. Premiums increased
12.6%
for the nine months ended
September 30, 2018
compared with the same period in 2017, as a result of the items noted above as well as the acquisition of Universal American in April 2017 and our participation in the Missouri Medicaid program expansion, effective May 1, 2017. These increases were partially offset by the previously discussed membership declines in our PDP segment.
|
▪
|
Net Income
decreased
$41.0 million
for the three months ended
September 30, 2018
compared with the same period in 2017, primarily reflecting the effect of the recognition of certain previously unrecognized tax benefits during the three months ended September 30, 2017, the expiration of the 2017 ACA industry fee moratorium and reestablishment of the ACA industry fee for 2018, which is nondeductible for tax purposes, and incremental retroactive revenue related to Florida. These decreases were partially offset by continued improvement in operational execution across all three of our segments and the effect of the
Tax Cuts and Jobs Act of 2017
("TCJA")
w
hich reduced the U.S. federal statutory corporate income tax rate for 2018 (discussed in Note 11 -
Income Taxes
to the condensed consolidated financial statements of this 2018 Form 10-Q). Net income increased
$70.9 million
for the nine months ended
September 30, 2018
compared with the same period in 2017, reflecting continued improvement in operational execution, and increased investment income.
|
•
|
In September 2018, we entered into an asset purchase agreement with Aetna Inc. ("Aetna") to acquire Aetna's entire standalone Medicare Part D prescription drug plan business ("Aetna Part D business"), which Aetna plans to divest as part of CVS Health Corporation's proposed acquisition of Aetna ("CVS Health Transaction"). The closing of the acquisition is subject to the closing of the CVS Health Transaction and other customary closing conditions. The Aetna Part D business had an aggregate of approximately
2.2 million
members as of June 30, 2018. Per the terms of the agreements, Aetna will provide administrative services to, and retain financial risk of, the Aetna Part D business through 2019.
|
•
|
In September 2018, we completed the acquisition of Meridian for approximately
$2.5 billion
in cash. As a result of this transaction, we expanded our Medicaid portfolio through the addition of Michigan, where Meridian has the leading market position; expanded our Medicaid presence in Illinois; and acquired an integrated PBM platform. Meridian also serves MA members in Illinois, Indiana, Michigan and Ohio, as well as Health Insurance Marketplace members in Michigan.
|
•
|
In August 2018, we completed a public offering and issuance of
5,207,547
shares of our common stock, at an offering price of $265.00 per share. The net proceeds from the offering were approximately
$1.3 billion
, after deducting underwriting discounts and offering costs of
$37.7 million
. We used the net proceeds to fund the acquisition of Meridian.
|
•
|
In August 2018, we completed the offering and sale of
5.375%
unsecured senior notes due 2026 in the aggregate principal amount of $
750.0 million
(the “2026 Notes"). The aggregate net proceeds from the issuance of the 2026 Notes were
$739.0 million
, which were used to fund a portion of the cash consideration for our acquisition of Meridian.
|
•
|
In July 2018, we entered into an amended and restated Credit Agreement (“Amended and Restated Credit Agreement”) which increased the aggregate principle amount available under our Revolving Credit Facility from
$1.0 billion
to
$1.3 billion
. Additionally, we extended the maturity date under the Revolving Credit Facility from January 2021 to July 2023.
|
•
|
In July 2018, we received a Notice of Intent to Award a contract from the Florida Department of Health to provide statewide-managed care services to more than 60,000 children with medically complex conditions through the Children's Medical Services Managed Care Plan ("CMS Plan") and the proposed five-year contract award is intended to begin on January 1, 2019. Additionally, in April 2018, we received a Notice of Agency Decision from the Florida
|
•
|
In March 2018, we announced that our Arizona subsidiary, Care1st Health Plan Arizona, Inc., was selected to enter into a contract with the Arizona Health Care Cost Containment System ("AHCCCS") to coordinate the provision of physical and behavioral healthcare services in the Central and North geographic service areas ("GSAs"). Under the new program, health plans were eligible to be awarded two of the three GSAs. Services under the new contract began on October 1, 2018. The initial term of the contract with AHCCCS is three years. The parties may extend the term upon mutual consent for up to two additional two-year terms.
|
•
|
Effective January 1, 2017, the Consolidated Appropriations Act, 2016 provided for a one-year moratorium on the ACA industry fee, which also eliminated the associated Medicaid ACA industry fee reimbursements from our state government partners. This 2017 moratorium expired effective January 1, 2018. Accordingly, we incurred
$86.5 million
and
$247.0 million
of ACA industry fee expense for the
three and nine
months ended
September 30, 2018
, respectively, compared with no expense for the same periods in 2017. Additionally, we recognized
$71.5 million
and
$199.0 million
in Medicaid ACA industry fee reimbursement revenue during the
three and nine
months ended
September 30, 2018
, respectively, compared with no reimbursement recognized for the same periods in 2017.
|
|
For the Three Months Ended
September 30, |
|
Percentage
|
|
For the Nine Months Ended
September 30, |
|
Percentage
|
||||||||||||
|
2018
|
|
2017
|
|
Change
|
|
2018
|
|
2017
|
|
Change
|
||||||||
Revenues:
|
(Dollars in millions)
|
|
|
|
(Dollars in millions)
|
|
|
||||||||||||
Premium
|
$
|
4,988.8
|
|
|
$
|
4,390.9
|
|
|
13.6%
|
|
$
|
14,227.7
|
|
|
$
|
12,631.5
|
|
|
12.6%
|
Products and services
|
34.6
|
|
|
—
|
|
|
100.0%
|
|
34.6
|
|
|
—
|
|
|
100.0%
|
||||
Investment and other income
|
34.7
|
|
|
12.0
|
|
|
189.2%
|
|
81.0
|
|
|
30.6
|
|
|
164.7%
|
||||
Total revenues
|
5,058.1
|
|
|
4,402.9
|
|
|
14.9%
|
|
14,343.3
|
|
|
12,662.1
|
|
|
13.3%
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
Expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
Medical benefits
|
4,195.0
|
|
|
3,740.7
|
|
|
12.1%
|
|
12,023.0
|
|
|
10,938.3
|
|
|
9.9%
|
||||
Costs of products and services
|
33.5
|
|
|
—
|
|
|
100.0%
|
|
33.5
|
|
|
—
|
|
|
100.0%
|
||||
Selling, general and administrative
|
433.2
|
|
|
372.3
|
|
|
16.4%
|
|
1,167.0
|
|
|
1,040.2
|
|
|
12.2%
|
||||
ACA industry fee
|
86.5
|
|
|
—
|
|
|
100.0%
|
|
247.0
|
|
|
—
|
|
|
100.0%
|
||||
Medicaid premium taxes
|
31.5
|
|
|
29.5
|
|
|
6.8%
|
|
94.2
|
|
|
90.6
|
|
|
4.0%
|
||||
Depreciation and amortization
|
46.2
|
|
|
31.4
|
|
|
47.1%
|
|
117.1
|
|
|
84.6
|
|
|
38.4%
|
||||
Interest
|
23.6
|
|
|
17.1
|
|
|
38.0%
|
|
57.8
|
|
|
51.4
|
|
|
12.5%
|
||||
Total expenses
|
4,849.5
|
|
|
4,191.0
|
|
|
15.7%
|
|
13,739.6
|
|
|
12,205.1
|
|
|
12.6%
|
||||
Income from operations
|
208.6
|
|
|
211.9
|
|
|
(1.6)%
|
|
603.7
|
|
|
457.0
|
|
|
32.1%
|
||||
Loss on extinguishment of debt
|
—
|
|
|
—
|
|
|
—%
|
|
—
|
|
|
26.1
|
|
|
(100.0)%
|
||||
Income before income taxes and equity in losses of unconsolidated subsidiaries
|
208.6
|
|
|
211.9
|
|
|
(1.6)%
|
|
603.7
|
|
|
430.9
|
|
|
40.1%
|
||||
Equity in earnings (losses) of unconsolidated subsidiaries
|
6.6
|
|
|
23.2
|
|
|
(71.6)%
|
|
(0.1
|
)
|
|
22.1
|
|
|
NM
|
||||
Income before income taxes
|
215.2
|
|
|
235.1
|
|
|
(8.5)%
|
|
603.6
|
|
|
453.0
|
|
|
33.2%
|
||||
Income tax expense
|
84.6
|
|
|
63.5
|
|
|
33.2%
|
|
219.7
|
|
|
140.0
|
|
|
56.9%
|
||||
Net income
|
$
|
130.6
|
|
|
$
|
171.6
|
|
|
(23.9)%
|
|
$
|
383.9
|
|
|
$
|
313.0
|
|
|
22.7%
|
Effective tax rate
|
39.3
|
%
|
|
27.0
|
%
|
|
12.3%
|
|
36.4
|
%
|
|
30.9
|
%
|
|
5.5%
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30, 2018
|
||||||||||||
State
|
|
Medicaid Health Plans
(1)
|
|
Medicare Health Plans
(1)
|
|
Medicare PDPs
|
|
Total Membership
|
|
Percentage of
Total
|
||||
Illinois
|
|
862,000
|
|
|
27,000
|
|
|
34,000
|
|
|
923,000
|
|
|
16.8%
|
Florida
|
|
735,000
|
|
|
96,000
|
|
|
29,000
|
|
|
860,000
|
|
|
15.6%
|
Michigan
|
|
512,000
|
|
|
19,000
|
|
|
44,000
|
|
|
575,000
|
|
|
10.4%
|
Georgia
|
|
502,000
|
|
|
50,000
|
|
|
15,000
|
|
|
567,000
|
|
|
10.3%
|
Kentucky
|
|
448,000
|
|
|
13,000
|
|
|
22,000
|
|
|
483,000
|
|
|
8.8%
|
New York
|
|
152,000
|
|
|
89,000
|
|
|
52,000
|
|
|
293,000
|
|
|
5.3%
|
Missouri
|
|
265,000
|
|
|
—
|
|
|
16,000
|
|
|
281,000
|
|
|
5.1%
|
Other states
|
|
427,000
|
|
|
250,000
|
|
|
844,000
|
|
|
1,521,000
|
|
|
27.6%
|
Health Insurance Marketplace
(2)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
5,000
|
|
|
0.1%
|
Total
|
|
3,903,000
|
|
|
544,000
|
|
|
1,056,000
|
|
|
5,508,000
|
|
|
100.0%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30, 2017
|
||||||||||||
State
|
|
Medicaid Health Plans
(1)
|
|
Medicare Health Plans
(1)
|
|
Medicare PDPs
|
|
Total Membership
|
|
Percentage of
Total
|
||||
Illinois
|
|
139,000
|
|
|
18,000
|
|
|
36,000
|
|
|
193,000
|
|
|
4.4%
|
Florida
|
|
757,000
|
|
|
101,000
|
|
|
30,000
|
|
|
888,000
|
|
|
20.4%
|
Georgia
|
|
498,000
|
|
|
46,000
|
|
|
20,000
|
|
|
564,000
|
|
|
13.0%
|
Kentucky
|
|
446,000
|
|
|
9,000
|
|
|
23,000
|
|
|
478,000
|
|
|
11.0%
|
New York
|
|
144,000
|
|
|
89,000
|
|
|
57,000
|
|
|
290,000
|
|
|
6.7%
|
Missouri
|
|
291,000
|
|
|
—
|
|
|
17,000
|
|
|
308,000
|
|
|
7.1%
|
Other states
|
|
441,000
|
|
|
229,000
|
|
|
958,000
|
|
|
1,628,000
|
|
|
37.4%
|
Total
|
|
2,716,000
|
|
|
492,000
|
|
|
1,141,000
|
|
|
4,349,000
|
|
|
100.0%
|
|
|
|
|
|
|
|
|
|
|
|
•
|
Medicaid Health Plans.
Membership increased by
1.2 million
or
43.7%
year-over-year to
3.9 million
members as of
September 30, 2018
. The increase was primarily driven by the acquisition of Meridian, as well as organic membership growth primarily in our Illinois Medicaid health plan as a result of a new contract with HFS to administer the Health Choice Illinois Medicaid managed care program statewide, effective January 1, 2018. These increases were partially offset by net eligibility decreases in certain of our Medicaid markets.
|
•
|
Medicare Health Plans.
Membership as of
September 30, 2018
increased by
52,000
year-over-year, or
10.6%
, to
544,000
members. The increase is partially a result of the acquisition of Meridian which expanded our membership through the addition of Michigan, Indiana and Ohio, as well as deepened our presence in Illinois. Additionally, the increase reflects our 2018 bid positioning and organic growth.
|
•
|
Medicare PDPs.
Membership as of
September 30, 2018
decreased
85,000
year-over-year, or
7.4%
, to
1.1 million
members. The decrease was primarily the result of our 2018 bid positioning. Our 2018 PDP bids resulted in one of our basic plans being below CMS benchmarks in 25 of the 34 CMS regions, and within the
de minimis
range in five other regions, compared with our 2017 bids, in which we were below the benchmarks in 30 of the 34 CMS regions, and within the
de minimis
range in three other regions.
|
|
For the Three Months Ended
September 30, |
|
For the Nine Months Ended
September 30, |
||||||||||||
|
2018
|
|
2017
|
|
2018
|
|
2017
|
||||||||
|
(Dollars in millions)
|
||||||||||||||
SG&A expense (GAAP)
|
$
|
433.2
|
|
|
$
|
372.3
|
|
|
$
|
1,167.0
|
|
|
$
|
1,040.2
|
|
Adjustments:
|
|
|
|
|
|
|
|
|
|||||||
Investigation costs
|
(0.1
|
)
|
|
(0.9
|
)
|
|
(0.3
|
)
|
|
(7.2
|
)
|
||||
Transaction and integration costs
|
(13.1
|
)
|
|
(6.6
|
)
|
|
(25.5
|
)
|
|
(33.3
|
)
|
||||
Adjusted SG&A expense (non-GAAP)
|
$
|
420.0
|
|
|
$
|
364.8
|
|
|
$
|
1,141.2
|
|
|
$
|
999.7
|
|
SG&A ratio (GAAP)
(1) (3)
|
8.6
|
%
|
|
8.5
|
%
|
|
8.1
|
%
|
|
8.2
|
%
|
||||
Adjusted SG&A ratio (non-GAAP)
(2) (3)
|
8.5
|
%
|
|
8.3
|
%
|
|
8.1
|
%
|
|
8.0
|
%
|
|
For the Three Months Ended
September 30, |
|
Percentage
|
|
For the Nine Months Ended
September 30, |
|
Percentage
|
||||||||||||||
|
2018
|
|
2017
|
|
Change
|
|
2018
|
|
2017
|
|
Change
|
||||||||||
|
(Dollars in millions)
|
|
|
|
(Dollars in millions)
|
|
|
||||||||||||||
Gross Margin
(1)
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medicaid Health Plans
|
$
|
399.3
|
|
|
$
|
351.5
|
|
|
13.6
|
%
|
|
$
|
1,052.6
|
|
|
$
|
928.5
|
|
|
13.4
|
%
|
Medicare Health Plans
|
213.7
|
|
|
210.0
|
|
|
1.8
|
%
|
|
673.3
|
|
|
576.2
|
|
|
16.9
|
%
|
||||
Medicare PDPs
|
62.6
|
|
|
59.2
|
|
|
5.7
|
%
|
|
137.4
|
|
|
97.9
|
|
|
40.3
|
%
|
||||
Corporate and Other
(2)
|
1.3
|
|
|
—
|
|
|
100.0
|
%
|
|
1.3
|
|
|
—
|
|
|
100.0
|
%
|
||||
Total gross margin
|
676.9
|
|
|
620.7
|
|
|
9.1
|
%
|
|
1,864.6
|
|
|
1,602.6
|
|
|
16.3
|
%
|
||||
Investment and other income
|
34.7
|
|
|
12.0
|
|
|
189.2
|
%
|
|
81.0
|
|
|
30.6
|
|
|
164.7
|
%
|
||||
Other expenses
(3)
|
(503.0
|
)
|
|
(420.8
|
)
|
|
19.5
|
%
|
|
(1,341.9
|
)
|
|
(1,176.2
|
)
|
|
14.1
|
%
|
||||
Income from operations
|
$
|
208.6
|
|
|
$
|
211.9
|
|
|
(1.6
|
)%
|
|
$
|
603.7
|
|
|
$
|
457.0
|
|
|
32.1
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the Three Months Ended
September 30, |
|
Percentage
|
|
For the Nine Months Ended
September 30, |
|
Percentage
|
||||||||||||||
|
2018
|
|
2017
|
|
Change
|
|
2018
|
|
2017
|
|
Change
|
||||||||||
|
(Dollars in millions)
|
|
|
|
(Dollars in millions)
|
|
|
||||||||||||||
Premium revenue
(1)
|
$
|
3,120.3
|
|
|
$
|
2,693.2
|
|
|
15.9
|
%
|
|
$
|
8,606.2
|
|
|
$
|
7,967.7
|
|
|
8.0
|
%
|
Medicaid premium tax reimbursement
(1)
|
31.5
|
|
|
29.5
|
|
|
6.8
|
%
|
|
94.2
|
|
|
90.6
|
|
|
4.0
|
%
|
||||
Medicaid ACA industry fee reimbursement
(1)
|
71.5
|
|
|
—
|
|
|
100.0
|
%
|
|
199.0
|
|
|
—
|
|
|
100.0
|
%
|
||||
Total premiums
|
3,223.3
|
|
|
2,722.7
|
|
|
18.4
|
%
|
|
8,899.4
|
|
|
8,058.3
|
|
|
10.4
|
%
|
||||
Medical benefits expense
|
2,738.1
|
|
|
2,341.7
|
|
|
16.9
|
%
|
|
7,601.1
|
|
|
7,039.2
|
|
|
8.0
|
%
|
||||
ACA industry fee
|
54.4
|
|
|
—
|
|
|
100.0
|
%
|
|
151.5
|
|
|
—
|
|
|
100.0
|
%
|
||||
Medicaid premium tax
|
31.5
|
|
|
29.5
|
|
|
6.8
|
%
|
|
94.2
|
|
|
90.6
|
|
|
4.0
|
%
|
||||
Gross margin
(2)
|
$
|
399.3
|
|
|
$
|
351.5
|
|
|
13.6
|
%
|
|
$
|
1,052.6
|
|
|
$
|
928.5
|
|
|
13.4
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medicaid Health Plans MBR
(1)
|
84.9
|
%
|
|
86.0
|
%
|
|
(1.1
|
)%
|
|
85.4
|
%
|
|
87.4
|
%
|
|
(2.0
|
)%
|
||||
Effect of:
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medicaid premium taxes
|
0.9
|
%
|
|
0.9
|
%
|
|
|
|
|
0.9
|
%
|
|
0.9
|
%
|
|
|
|||||
Medicaid ACA industry fee reimbursement
|
2.0
|
%
|
|
—
|
%
|
|
|
|
|
2.0
|
%
|
|
—
|
%
|
|
|
|||||
Medicaid Health Plans Adjusted MBR
(1)
|
87.8
|
%
|
|
86.9
|
%
|
|
0.9
|
%
|
|
88.3
|
%
|
|
88.3
|
%
|
|
—
|
%
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Medicaid membership at end of period:
|
3,903,000
|
|
|
2,716,000
|
|
|
43.7
|
%
|
|
|
|
|
|
|
|
For the Three Months Ended
September 30, |
|
Percentage
|
|
For the Nine Months Ended
September 30, |
|
Percentage
|
||||||||||||||
|
2018
|
|
2017
|
|
Change
|
|
2018
|
|
2017
|
|
Change
|
||||||||||
Medicare Health Plans:
|
(Dollars in millions)
|
|
|
|
(Dollars in millions)
|
|
|
||||||||||||||
Premium revenue
|
$
|
1,582.0
|
|
|
$
|
1,466.3
|
|
|
7.9
|
%
|
|
$
|
4,684.9
|
|
|
$
|
3,877.6
|
|
|
20.8
|
%
|
Medical benefits expense
|
1,340.8
|
|
|
1,256.3
|
|
|
6.7
|
%
|
|
3,929.8
|
|
|
3,301.4
|
|
|
19.0
|
%
|
||||
ACA industry fee
|
27.5
|
|
|
—
|
|
|
—
|
%
|
|
81.8
|
|
|
—
|
|
|
—
|
%
|
||||
Gross margin
|
$
|
213.7
|
|
|
$
|
210.0
|
|
|
1.8
|
%
|
|
$
|
673.3
|
|
|
$
|
576.2
|
|
|
16.9
|
%
|
MBR
|
84.8
|
%
|
|
85.7
|
%
|
|
(0.9
|
)%
|
|
83.9
|
%
|
|
85.1
|
%
|
|
(1.2
|
)%
|
||||
Membership
|
544,000
|
|
|
492,000
|
|
|
10.6
|
%
|
|
|
|
|
|
|
|
For the Three Months Ended
September 30, |
|
Percentage
|
|
For the Nine Months Ended
September 30, |
|
Percentage
|
||||||||||||||
|
2018
|
|
2017
|
|
Change
|
|
2018
|
|
2017
|
|
Change
|
||||||||||
Medicare PDPs:
|
(Dollars in millions)
|
|
|
|
(Dollars in millions)
|
|
|
||||||||||||||
Premium revenue
|
$
|
182.3
|
|
|
$
|
201.9
|
|
|
(9.7
|
)%
|
|
$
|
642.2
|
|
|
$
|
695.6
|
|
|
(7.7
|
)%
|
Medical benefits expense
|
115.1
|
|
|
142.7
|
|
|
(19.3
|
)%
|
|
491.1
|
|
|
597.7
|
|
|
(17.8
|
)%
|
||||
ACA industry fee
|
4.6
|
|
|
—
|
|
|
100.0
|
%
|
|
13.7
|
|
|
—
|
|
|
100.0
|
%
|
||||
Gross margin
|
$
|
62.6
|
|
|
$
|
59.2
|
|
|
5.7
|
%
|
|
$
|
137.4
|
|
|
$
|
97.9
|
|
|
40.3
|
%
|
MBR
|
63.1
|
%
|
|
70.7
|
%
|
|
(7.6
|
)%
|
|
76.5
|
%
|
|
85.9
|
%
|
|
(9.4
|
)%
|
||||
Membership
|
1,056,000
|
|
|
1,141,000
|
|
|
(7.4
|
)%
|
|
|
|
|
|
|
•
|
payment of medical claims and other health care services;
|
•
|
payment of certain Part D benefits paid for members on behalf of CMS;
|
•
|
SG&A costs directly incurred or paid through a management services agreement to one of our non-regulated administrative and management services subsidiaries; and
|
•
|
federal tax payments to the parent company under an intercompany tax sharing agreement.
|
•
|
generating cash flows from operating activities, mainly from premium revenue;
|
•
|
receipts of prospective subsidy payments and related final settlements from CMS to reimburse us for certain Part D benefits paid for members on behalf of CMS;
|
•
|
cash flows from investing activities, including investment income and sales of investments; and
|
•
|
capital contributions received from our non-regulated subsidiaries.
|
•
|
payment of administrative costs not directly incurred by our regulated operations, including, but not limited to, staffing costs, business development, rent, branding and certain information technology services;
|
•
|
capital contributions paid to our regulated subsidiaries;
|
•
|
capital expenditures;
|
•
|
debt service; and
|
•
|
federal and state tax payments.
|
•
|
management fees earned by our non-regulated administrator subsidiary under management services agreements;
|
•
|
dividends received from our regulated subsidiaries;
|
•
|
collecting federal and state tax payments from the regulated subsidiaries;
|
•
|
proceeds from issuance of debt and equity securities; and
|
•
|
cash flows from investing activities, including investment income and sales of investments.
|
|
For the Nine Months Ended
September 30, |
||||||
|
2018
|
|
2017
|
||||
|
(In millions)
|
||||||
Net cash provided by operating activities
|
$
|
198.0
|
|
|
$
|
1,245.5
|
|
Net cash used in investing activities
|
(2,623.0
|
)
|
|
(1,559.2
|
)
|
||
Net cash provided by financing activities
|
2,534.6
|
|
|
1,133.9
|
|
||
Increase in cash, cash equivalents and restricted cash and cash equivalents
|
$
|
109.6
|
|
|
$
|
820.2
|
|
|
|
|
|
•
|
Net proceeds of approximately
$1.3 billion
from an issuance of
5,207,547
shares of our common stock, after deducting underwriting discounts and offering costs;
|
•
|
Net proceeds of
$935.3 million
resulting from debt transactions executed during the
nine
months ended September 30, 2018, including net proceeds of
$739.0 million
from the issuance of our 2026 Notes in August 2018 and net borrowings on our Revolving Credit Facility of
$196.3 million
during the third quarter of 2018, both transactions are net of issuance costs.
|
•
|
Net funds received for the benefit of members was approximately
$250.8 million
for the
nine
months ended
September 30, 2018
, compared with
$978.0 million
during the same period in 2017. These funds represent the net amounts of subsidies we received from CMS in connection with the low-income cost sharing, catastrophic reinsurance and coverage gap discount components of the Medicare Part D program related to the government's portion of financial responsibility, net of the amounts we paid for related prescription drug benefits, described above in "Medicare Part D Funding and Settlements." The decrease was primarily the result of our 2018 bid positioning, resulting in lower payments received for 2018 net subsidies, as well as the advance receipt of October 2017 CMS Medicare subsidy payments in September 2017.
|
•
|
incur additional indebtedness and issue preferred stock;
|
•
|
pay dividends or make other distributions;
|
•
|
make other restricted payments and investments;
|
•
|
sell assets, including capital stock of restricted subsidiaries;
|
•
|
create certain liens;
|
•
|
incur restrictions on the ability of restricted subsidiaries to pay dividends or make other payments, and in the case of our subsidiaries, guarantee indebtedness;
|
•
|
engage in transactions with affiliates; and
|
•
|
create unrestricted subsidiaries.
|
•
|
incur additional indebtedness and issue preferred stock;
|
•
|
pay dividends or make other distributions;
|
•
|
make other restricted payments and investments;
|
•
|
sell assets, including capital stock of restricted subsidiaries;
|
•
|
create certain liens;
|
•
|
incur restrictions on the ability of restricted subsidiaries to pay dividends or make other payments, and in the case of our subsidiaries, guarantee indebtedness;
|
•
|
engage in transactions with affiliates; and
|
•
|
create unrestricted subsidiaries.
|
•
|
reducing the federal matching payments to state Medicaid programs;
|
•
|
restricting revenue, enrollment and premium growth in certain products and market segments;
|
•
|
restricting our ability to expand into new markets;
|
•
|
increasing our medical and administrative costs;
|
•
|
lowering our Medicare payment rates and/or increasing our expenses associated with the non-deductible federal premium tax and other assessments;
|
•
|
encouraging states to contract with organizations that are not subject to the annual premium-based health insurance industry assessment imposed by the ACA (the "ACA industry fee") for their Medicaid programs; and
|
•
|
encouraging states to integrate Medicare and Medicaid using a limited number of health plans or a fee for service model.
|
•
|
the market price of our common stock could decline;
|
•
|
time and resources committed by our management to matters relating to the acquisition could otherwise have been devoted to pursuing other beneficial opportunities;
|
•
|
we may experience negative reactions from the financial markets or from our customers or employees;
|
•
|
we will be required to pay our costs relating to the acquisition, such as termination fees and legal, accounting and financial advisory expenses; and
|
•
|
we could be subject to litigation related to any failure to complete the acquisition or related to any enforcement proceeding commenced against us to perform our obligations under the transaction agreement.
|
•
|
|
•
|
difficulty retaining legacy employees and/or attracting new employees because of potential uncertainty in our business relating to the business combination;
|
•
|
acquired provider networks that operate on different terms than our existing networks and whose contracts may need to be renegotiated;
|
•
|
existing members who decide to switch to another health care plan;
|
•
|
separate administrative and information technology systems; and
|
•
|
difficulties implementing our operations strategy to operate the acquired businesses profitably
|
•
|
the time and costs associated with obtaining the necessary licenses and approvals to operate;
|
•
|
lower quality scores compared to our competitors;
|
•
|
participation in fewer lines of business compared to our competitors;
|
•
|
our inability to develop a network of physicians, hospitals and other health care providers that meets our requirements and those of government regulators;
|
•
|
delays in the procurement, renewal or implementation of Medicaid or similar programs in new or existing states;
|
•
|
CMS or state contract provisions regarding quality measures, such as CMS Star Ratings;
|
•
|
competition, which increases the cost of recruiting members;
|
•
|
the cost of providing health care services in those areas;
|
•
|
demographics and population density; and
|
•
|
applicable state regulations that, among other things, require the maintenance of minimum levels of capital and surplus.
|
•
|
the addition of new members, whether by acquisition, new enrollment, program startup or expansion (including geographic expansion), whose risk profiles are uncertain or unknown and for whom initiatives to manage their care take longer than expected;
|
•
|
an increase in the cost of health care services and supplies, including pharmaceuticals, whether as a result of the introduction of new products or technologies, inflation or otherwise;
|
•
|
the performance of our pharmaceutical benefit managers in managing pharmaceutical costs;
|
•
|
higher-than-expected utilization of health care services;
|
•
|
contractual provisions related to continuity of care for new members;
|
•
|
contractual provisions or regulatory requirements restricting the use and design of quality and affordability initiatives, including the ability to control the pharmaceutical formulary in Medicaid programs;
|
•
|
periodic renegotiation of hospital, physician and/or other provider contracts;
|
•
|
the occurrence of catastrophes, natural disasters, epidemics, pandemics, terrorism or bio-terrorism;
|
•
|
changes in the demographics of our members and medical trends affecting them;
|
•
|
challenges in implementing medical expense cost control initiatives, especially during the first year of a new Medicaid program;
|
•
|
new mandated benefits, increased mandated provider reimbursement rates or other changes in health care laws, regulations, public policy and/or practices;
|
•
|
emerging changes in the economy;
|
•
|
changes in members' behavior and health care utilization patterns;
|
•
|
provider billing practices; and
|
•
|
changes in the fee schedules, rate design, and reimbursement structure for health care services.
|
•
|
imposing additional license, accreditation, registration and/or capital requirements;
|
•
|
increasing our administrative and other costs;
|
•
|
requiring us to change our operating structure;
|
•
|
requiring significant additional reporting and technological capabilities;
|
•
|
imposing additional fees and taxes, which cannot be offset by increased premium revenue;
|
•
|
increasing mandated benefits, such as the proposed mental health parity regulation;
|
•
|
further limiting our ability to engage in intra-company transactions with our affiliates and subsidiaries;
|
•
|
restricting our revenue and enrollment growth;
|
•
|
requiring us to restructure our relationships with providers; and
|
•
|
requiring us to implement additional or different programs and systems.
|
•
|
claims by government agencies relating to compliance with laws and regulations;
|
•
|
claims relating to sales practices;
|
•
|
claims relating to the methodologies for calculating premiums;
|
•
|
claims relating to the denial or delay of health care benefit payments;
|
•
|
claims relating to claims payments and procedures;
|
•
|
claims relating to provider marketing;
|
•
|
claims by providers for network termination or exclusion;
|
•
|
anti-kickback claims;
|
•
|
medical malpractice or negligence actions based on our medical necessity decisions or brought against us on the theory that we are liable for our providers’ malpractice or negligence;
|
•
|
allegations of anti-competitive and unfair business activities;
|
•
|
provider disputes over compensation and termination of provider contracts or defamation claims;
|
•
|
allegations of discrimination;
|
•
|
allegations of breaches of duties;
|
•
|
claims relating to inadequate or incorrect disclosure or accounting in our public filings and other statements;
|
•
|
allegations of agent misconduct;
|
•
|
claims related to deceptive trade practices;
|
•
|
claims relating to audits and contract performance;
|
•
|
protests related to Medicaid awards; and
|
•
|
violations of state procurement laws and policies.
|
•
|
loss of our right to participate in government-sponsored programs, including Medicaid and Medicare;
|
•
|
forfeiture or recoupment of amounts we have been paid pursuant to our government contracts;
|
•
|
imposition of significant civil or criminal penalties, fines or other sanctions on us and/or our key associates;
|
•
|
reduction or limitation of our membership;
|
•
|
damage to our reputation in various markets;
|
•
|
increased difficulty in marketing our products and services;
|
•
|
inability to obtain approval for future acquisitions or service or geographic expansion;
|
•
|
suspension or loss of one or more of our licenses to act as an insurer, HMO, third party administrator, or pharmaceutical benefit manager or to otherwise provide a service; and
|
•
|
an event of default under our debt agreements.
|
•
|
limit our ability to borrow additional funds for working capital, capital expenditures, acquisitions and general corporate or other purposes; and
|
•
|
expose us to greater interest rate risk since the interest rate on borrowings under our Amended and Restated Credit Agreement is variable.
|
•
|
variations in our operating results;
|
•
|
changes in our or the market's expectations about our future operating results;
|
•
|
changes in financial estimates and recommendations by securities analysts concerning our Company or the health care industry generally;
|
•
|
operating and stock price performance of other companies that investors may deem comparable;
|
•
|
news reports relating to trends in our markets;
|
•
|
changes or proposed changes in the laws, regulations and policies affecting our business;
|
•
|
acquisitions and financings by us or others in our industry;
|
•
|
changes in our senior management;
|
•
|
sales of substantial amounts of our common stock by our directors and executive officers or principal stockholders, or the perception that such sales could occur; and
|
•
|
the risks described in “Risks Related to Our Business” above.
|
|
INCORPORATED BY REFERENCE
|
|||
Exhibit
Number
|
Description
|
Form
|
Filing Date
with SEC
|
Exhibit
Number
|
10.1
|
|
|
|
|
31.1
|
|
|
|
|
31.2
|
|
|
|
|
32.1
|
|
|
|
|
32.2
|
|
|
|
|
101.INS
|
XBRL Instance Document ††
|
|
|
|
101.SCH
|
XBRL Taxonomy Extension Schema Document ††
|
|
|
|
101.CAL
|
XBRL Taxonomy Extension Calculation Linkbase Document ††
|
|
|
|
101.LAB
|
XBRL Taxonomy Extension Label Linkbase Document ††
|
|
|
|
101.PRE
|
XBRL Taxonomy Extension Presentation Linkbase Document ††
|
|
|
|
101.DEF
|
XBRL Taxonomy Extension Definition Linkbase Document ††
|
|
|
|
|
† Filed herewith.
|
|
|
|
|
†† Furnished herewith and not filed for purposes of Section 11 and Section 12 of the Securities Act of 1933 and Section 18 of the Securities Exchange Act of 1934.
|
|
|
|
|
WELLCARE HEALTH PLANS, INC.
|
|
|
By:
|
/s/ Andrew L. Asher
|
|
|
Andrew L. Asher
|
|
|
Executive Vice President and Chief Financial Officer (Principal Financial Officer)
|
|
|
|
|
By:
|
/s/ Michael Troy Meyer
|
|
|
Michael Troy Meyer
|
|
|
Vice President and Chief Accounting Officer (Principal Accounting Officer)
|
1.
|
Purpose of the Plan
|
2.
|
Effective Date
|
3.
|
Administration
|
4.
|
Participation
|
5.
|
Severance Benefits
|
Tier as of Termination Date
|
Cash Severance
|
Health Benefit Continuation
|
Tier I Participant
|
1.5 x Base Salary
plus
1.5 x Bonus
|
18 months
|
Tier II Participant
|
1 x Base Salary
plus
1 x Bonus
|
12 months
|
Tier III Participant
|
1 x Base Salary
plus
1 x Bonus
|
12 months
|
Tier as of Termination Date
|
Cash Severance
|
Health Benefit Continuation
|
Tier I Participant
|
3 x Base Salary
plus
3 x Bonus
plus
1x Prorated Target Bonus
|
18 months
|
Tier II Participant
|
2 x Base Salary
plus
2 x Bonus
plus
1x Prorated Target Bonus
|
18 months
|
Tier III Participant
|
1.5 x Base Salary
plus
1.5 x Bonus
plus
1x Prorated Target Bonus
|
18 months
|
6.
|
Other Terms and Conditions of Eligibility
|
7.
|
Benefit Claims
|
8.
|
Recoupment
|
9.
|
General
|
10.
|
Definitions
|
1.
|
I have reviewed this Quarterly Report on Form 10-Q of WellCare Health Plans, Inc.;
|
2.
|
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
|
3.
|
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
|
4.
|
The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
|
a.
|
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
|
b.
|
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
|
c.
|
Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
|
d.
|
Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and
|
5.
|
The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):
|
a.
|
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and
|
b.
|
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.
|
Date:
|
October 30, 2018
|
|
/s/ Kenneth A. Burdick
|
|
|
|
Kenneth A. Burdick
|
|
|
|
Chief Executive Officer
|
|
|
|
(Principal Executive Officer)
|
1.
|
I have reviewed this Quarterly Report on Form 10-Q of WellCare Health Plans, Inc.;
|
2.
|
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
|
3.
|
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
|
4.
|
The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
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a.
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Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
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b.
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Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
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c.
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Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
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d.
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Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and
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5.
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The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):
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a.
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All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and
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b.
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Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.
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Date:
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October 30, 2018
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/s/ Andrew L. Asher
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Andrew L. Asher
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Executive Vice President and Chief Financial Officer
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|
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(Principal Financial Officer)
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|
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EXHIBIT 32.1
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(1)
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The Form 10-Q fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
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(2)
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The information contained in the Form 10-Q fairly presents, in all material respects, the financial condition and results of operations of the Company.
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Date:
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October 30, 2018
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/s/ Kenneth A. Burdick
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|
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Kenneth A. Burdick
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|
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Chief Executive Officer
|
|
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(Principal Executive Officer)
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|
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EXHIBIT 32.2
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(1)
|
The Form 10-Q fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
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(2)
|
The information contained in the Form 10-Q fairly presents, in all material respects, the financial condition and results of operations of the Company.
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Date:
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October 30, 2018
|
|
/s/ Andrew L. Asher
|
|
|
|
Andrew L. Asher
|
|
|
|
Executive Vice President and Chief Financial Officer
|
|
|
|
(Principal Financial Officer)
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