Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended SeptemberJune 30, 20202021
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)
Delaware61-0647538
(State or other jurisdiction of incorporation or organization)(I.R.S. Employer Identification No.)
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)

Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading SymbolName of each exchange on which registered
Common stock, $0.16 2/3 par valueHUMNew York Stock Exchange
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes      No  
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    Yes      No  
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company” and "emerging growth company" in Rule 12b-2 of the Exchange Act.
Large accelerated filerAccelerated filer
Non-accelerated filerSmaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).    Yes      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 StockOutstanding at SeptemberJune 30, 20202021
$0.16 2/3 par value132,341,451128,504,664 shares


Table of Contents
Humana Inc.
FORM 10-Q
SEPTEMBERJUNE 30, 20202021
INDEX
 Page
Part I: Financial Information
Item 1.Financial Statements (Unaudited)
Item 2.
Item 3.
Item 4.
Item 1.
Item 1A.
Item 2.
Item 3.
Item 4.
Item 5.
Item 6.
Certifications




Humana Inc.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)
September 30,
2020
December 31, 2019June 30,
2021
December 31, 2020
(in millions, except share amounts)(in millions, except share amounts)
ASSETS
ASSETS
ASSETS
Current assets:Current assets:Current assets:
Cash and cash equivalentsCash and cash equivalents$7,985 $4,054 Cash and cash equivalents$3,378 $4,673 
Investment securitiesInvestment securities12,741 10,972 Investment securities13,471 12,554 
Receivables, less allowance for doubtful accounts of $78 in 2020
and $69 in 2019
1,135 1,056 
Receivables, less allowance for doubtful accounts of $78 in 2021
and $72 in 2020
Receivables, less allowance for doubtful accounts of $78 in 2021
and $72 in 2020
2,438 1,138 
Other current assetsOther current assets5,170 3,806 Other current assets6,503 5,276 
Total current assetsTotal current assets27,031 19,888 Total current assets25,790 23,641 
Property and equipment, netProperty and equipment, net2,228 1,955 Property and equipment, net2,690 2,371 
Long-term investment securitiesLong-term investment securities1,105 406 Long-term investment securities1,182 1,212 
Equity method investmentsEquity method investments1,160 1,063 Equity method investments1,240 1,170 
GoodwillGoodwill4,443 3,928 Goodwill4,914 4,447 
Other long-term assetsOther long-term assets2,510 1,834 Other long-term assets2,254 2,128 
Total assetsTotal assets$38,477 $29,074 Total assets$38,070 $34,969 
LIABILITIES AND STOCKHOLDERS’ EQUITY
LIABILITIES AND STOCKHOLDERS’ EQUITY
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:Current liabilities:Current liabilities:
Benefits payableBenefits payable$8,208 $6,004 Benefits payable$8,485 $8,143 
Trade accounts payable and accrued expensesTrade accounts payable and accrued expenses4,472 3,754 Trade accounts payable and accrued expenses4,898 4,013 
Book overdraftBook overdraft214 225 Book overdraft236 320 
Unearned revenuesUnearned revenues287 247 Unearned revenues323 318 
Short-term debtShort-term debt1,724 699 Short-term debt1,109 600 
Total current liabilitiesTotal current liabilities14,905 10,929 Total current liabilities15,051 13,394 
Long-term debtLong-term debt6,059 4,967 Long-term debt6,063 6,060 
Future policy benefits payable202 206 
Other long-term liabilitiesOther long-term liabilities1,543 935 Other long-term liabilities2,113 1,787 
Total liabilitiesTotal liabilities22,709 17,037 Total liabilities23,227 21,241 
Stockholders’ equity:Stockholders’ equity:Stockholders’ equity:
Preferred stock, $1 par; 10,000,000 shares authorized; NaN issuedPreferred stock, $1 par; 10,000,000 shares authorized; NaN issuedPreferred stock, $1 par; 10,000,000 shares authorized; NaN issued
Common stock, $0.16 2/3 par; 300,000,000 shares authorized;
198,648,742 shares issued at September 30, 2020 and 198,629,992 shares issued at December 31, 2019
33 33 
Common stock, $0.16 2/3 par; 300,000,000 shares authorized;
198,648,742 shares issued at June 30, 2021 and December 31, 2020
Common stock, $0.16 2/3 par; 300,000,000 shares authorized;
198,648,742 shares issued at June 30, 2021 and December 31, 2020
33 33 
Capital in excess of par valueCapital in excess of par value2,940 2,820 Capital in excess of par value3,018 2,705 
Retained earningsRetained earnings20,872 17,483 Retained earnings21,751 20,517 
Accumulated other comprehensive incomeAccumulated other comprehensive income370 156 Accumulated other comprehensive income216 391 
Treasury stock, at cost, 66,307,291 shares at September 30, 2020 and
66,524,771 shares at December 31, 2019
(8,447)(8,455)
Treasury stock, at cost, 70,144,078 shares at June 30, 2021 and
69,787,614 shares at December 31, 2020
Treasury stock, at cost, 70,144,078 shares at June 30, 2021 and
69,787,614 shares at December 31, 2020
(10,175)(9,918)
Total stockholders’ equityTotal stockholders’ equity15,768 12,037 Total stockholders’ equity14,843 13,728 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$38,477 $29,074 Total liabilities and stockholders’ equity$38,070 $34,969 
See accompanying notes to condensed consolidated financial statements.
3


Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(Unaudited)
 
Three months ended
September 30,
Nine months ended
September 30,
Three months ended
June 30,
Six months ended
June 30,
2020201920202019 2021202020212020
(in millions, except per share results) (in millions, except per share results)
Revenues:Revenues:Revenues:
PremiumsPremiums$18,904 $15,712 $55,822 $47,139 Premiums$19,978 $18,556 $40,102 $36,918 
ServicesServices457 393 1,331 1,103 Services491 450 957 874 
Investment incomeInvestment income714 136 940 351 Investment income176 77 254 226 
Total revenuesTotal revenues20,075 16,241 58,093 48,593 Total revenues20,645 19,083 41,313 38,018 
Operating expenses:Operating expenses:Operating expenses:
BenefitsBenefits15,611 13,357 45,415 40,168 Benefits17,149 14,175 34,445 29,804 
Operating costsOperating costs2,513 1,889 6,984 5,252 Operating costs2,116 2,354 4,123 4,471 
Depreciation and amortizationDepreciation and amortization128 127 362 343 Depreciation and amortization144 119 286 234 
Total operating expensesTotal operating expenses18,252 15,373 52,761 45,763 Total operating expenses19,409 16,648 38,854 34,509 
Income from operationsIncome from operations1,823 868 5,332 2,830 Income from operations1,236 2,435 2,459 3,509 
Interest expenseInterest expense75 62 211 184 Interest expense79 76 147 136 
Other (income) expense, net(7)(82)63 (217)
Other expense (income), netOther expense (income), net419 (227)534 70 
Income before income taxes and equity in net earningsIncome before income taxes and equity in net earnings1,755 888 5,058 2,863 Income before income taxes and equity in net earnings738 2,586 1,778 3,303 
Provision for income taxesProvision for income taxes450 200 1,485 684 Provision for income taxes183 783 416 1,035 
Equity in net earningsEquity in net earnings35 68 16 Equity in net earnings33 25 54 33 
Net incomeNet income$1,340 $689 $3,641 $2,195 Net income$588 $1,828 $1,416 $2,301 
Basic earnings per common shareBasic earnings per common share$10.12 $5.16 $27.53 $16.31 Basic earnings per common share$4.57 $13.83 $11.00 $17.41 
Diluted earnings per common shareDiluted earnings per common share$10.05 $5.14 $27.37 $16.24 Diluted earnings per common share$4.55 $13.75 $10.94 $17.31 
See accompanying notes to condensed consolidated financial statements.
4


Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(Unaudited)
Three months ended
September 30,
Nine months ended
September 30,
Three months ended
June 30,
Six months ended
June 30,
2020201920202019 2021202020212020
(in millions) (in millions)
Net incomeNet income$1,340 $689 $3,641 $2,195 Net income$588 $1,828 $1,416 $2,301 
Other comprehensive income:Other comprehensive income:Other comprehensive income:
Change in gross unrealized investment
gains/losses
Change in gross unrealized investment
gains/losses
66 87 332 452 Change in gross unrealized investment gains/losses136 358 (184)266 
Effect of income taxesEffect of income taxes(15)(20)(78)(105)Effect of income taxes(31)(85)42 (63)
Total change in unrealized
investment gains/losses, net of tax
Total change in unrealized
investment gains/losses, net of tax
51 67 254 347 Total change in unrealized investment gains/losses, net of tax105 273 (142)203 
Reclassification adjustment for net
realized gains
Reclassification adjustment for net
realized gains
(1)(1)(48)(7)Reclassification adjustment for net realized gains(9)(2)(64)(47)
Effect of income taxesEffect of income taxes10 Effect of income taxes15 10 
Total reclassification adjustment, net
of tax
Total reclassification adjustment, net
of tax
(1)(1)(38)(5)Total reclassification adjustment, net of tax(7)(2)(49)(37)
Other comprehensive income, net of tax50 66 216 342 
Other comprehensive gain (loss), net of taxOther comprehensive gain (loss), net of tax98 271 (191)166 
Comprehensive income (loss) attributable to equity method investmentsComprehensive income (loss) attributable to equity method investments(1)(2)(6)Comprehensive income (loss) attributable to equity method investments10 (2)16 (5)
Comprehensive incomeComprehensive income$1,393 $754 $3,855 $2,531 Comprehensive income$696 $2,097 $1,241 $2,462 
See accompanying notes to condensed consolidated financial statements.
5



Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
(Unaudited)
Common StockCapital In
Excess of
Par Value
Retained
Earnings
Accumulated
Other
Comprehensive
Income (Loss)
Treasury
Stock
Total
Stockholders’
Equity
Common StockCapital In
Excess of
Par Value
Retained
Earnings
Accumulated
Other
Comprehensive
Income (loss)
Treasury
Stock
Total
Stockholders’
Equity
Issued
Shares
Amount Issued
Shares
Amount
(dollars in millions, share amounts in thousands)(dollars in millions, share amounts in thousands)
Three months ended September 30, 2020
Balances, June 30, 2020198,630 $33 $2,898 $19,616 $317 $(8,448)$14,416 
Three months ended June 30, 2021Three months ended June 30, 2021
Balances, March 31, 2021Balances, March 31, 2021198,649 $33 $2,712 $21,252 $108 $(9,915)$14,190 
Net incomeNet income1,340 1,340 Net income588 588 
Other comprehensive loss53 53 
Other comprehensive incomeOther comprehensive income108 108 
Common stock repurchasesCommon stock repurchases19 (5)(5)Common stock repurchases263 (265)(2)
Dividends and dividend
equivalents
Dividends and dividend
equivalents
(84)(84)Dividends and dividend
equivalents
(89)(89)
Stock-based compensationStock-based compensation47 47 Stock-based compensation45 45 
Restricted stock unit vestingRestricted stock unit vesting(6)Restricted stock unit vesting(3)
Stock option exercisesStock option exercisesStock option exercises
Balances, September 30, 2020198,649 $33 $2,940 $20,872 $370 $(8,447)$15,768 
Balances, June 30, 2021Balances, June 30, 2021198,649 $33 $3,018 $21,751 $216 $(10,175)$14,843 
Three months ended September 30, 2019
Balances, June 30, 2019198,628 $33 $2,763 $16,429 $112 $(7,465)$11,872 
Three months ended June 30, 2020Three months ended June 30, 2020
Balances, March 31, 2020Balances, March 31, 2020198,630 $33 $2,857 $17,871 $48 $(8,454)$12,355 
Net incomeNet income689 689 Net income1,828 1,828 
Other comprehensive incomeOther comprehensive income65 65 Other comprehensive income269 269 
Common stock repurchasesCommon stock repurchases(200)(800)(1,000)Common stock repurchases(8)(8)
Dividends and dividend
equivalents
Dividends and dividend
equivalents
(73)(73)Dividends and dividend
equivalents
(83)(83)
Stock-based compensationStock-based compensation43 43 Stock-based compensation46 46 
Restricted stock unit vestingRestricted stock unit vestingRestricted stock unit vesting(9)
Stock option exercisesStock option exercisesStock option exercises
Balances, September 30, 2019198,629 $33 $2,608 $17,045 $177 $(8,262)$11,601 
Balances, June 30, 2020Balances, June 30, 2020198,630 $33 $2,898 $19,616 $317 $(8,448)$14,416 
See accompanying notes to condensed consolidated financial statements.


















6


Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY — (Continued)
(Unaudited)
 Common StockCapital In
Excess of
Par Value
Retained
Earnings
Accumulated
Other
Comprehensive
Income (Loss)
Treasury
Stock
Total
Stockholders’
Equity
 Issued
Shares
Amount
(dollars in millions, share amounts in thousands)
Nine months ended September 30, 2020
Balances, December 31, 2019198,630 $33 $2,820 $17,483 $156 $(8,455)$12,037 
Net income3,641 3,641 
Impact of adopting ASC 326 -
Current expected credit loss
standard (CECL)
(2)(2)
Other comprehensive income214 214 
Common stock repurchases19 (30)(30)
Dividends and dividend
equivalents
(250)(250)
Stock-based compensation129 129 
Restricted stock unit vesting(21)21 
Stock option exercises12 17 29 
Balances, September 30, 2020198,649 $33 $2,940 $20,872 $370 $(8,447)$15,768 
Nine months ended September 30, 2019
Balances, December 31, 2018198,595 $33 $2,535 $15,072 $(159)$(7,320)$10,161 
Net income2,195 2,195 
Other comprehensive loss336 336 
Common stock repurchases— (50)(960)(1,010)
Dividends and dividend
equivalents
(222)(222)
Stock-based compensation119 119 
Restricted stock unit vesting32 (3)
Stock option exercises15 22 
Balances, September 30, 2019198,629 $33 $2,608 $17,045 $177 $(8,262)$11,601 
 Common StockCapital In
Excess of
Par Value
Retained
Earnings
Accumulated
Other
Comprehensive
Income
Treasury
Stock
Total
Stockholders’
Equity
 Issued
Shares
Amount
(dollars in millions, share amounts in thousands)
Six months ended June 30, 2021
Balances, December 31, 2020198,649 $33 $2,705 $20,517 $391 $(9,918)$13,728 
Net income1,416 1,416 
Other comprehensive loss(175)(175)
Common stock repurchases263 (296)(33)
Dividends and dividend
   equivalents
(182)(182)
Stock-based compensation84 84 
Restricted stock unit vesting(36)36 
Stock option exercises
Balances, June 30, 2021198,649 $33 $3,018 $21,751 $216 $(10,175)$14,843 
Six months ended June 30, 2020
Balances, December 31, 2019198,630 $33 $2,820 $17,483 $156 $(8,455)$12,037 
Net income2,301 2,301 
Impact of adopting ASC 326 -
   Current expected credit loss
   standard (CECL)
(2)(2)
Other comprehensive income161 161 
Common stock repurchases(25)(25)
Dividends and dividend
   equivalents
(166)(166)
Stock-based compensation82 82 
Restricted stock unit vesting(15)15 
Stock option exercises11 17 28 
Balances, June 30, 2020198,630 $33 $2,898 $19,616 $317 $(8,448)$14,416 
See accompanying notes to condensed consolidated financial statements.
7



Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
For the nine months ended
September 30,
For the six months ended
June 30,
20202019 20212020
(in millions) (in millions)
Cash flows from operating activitiesCash flows from operating activitiesCash flows from operating activities
Net incomeNet income$3,641 $2,195 Net income$1,416 $2,301 
Adjustments to reconcile net income to net cash provided by
operating activities:
Adjustments to reconcile net income to net cash (used in) provided by
operating activities:
Adjustments to reconcile net income to net cash (used in) provided by
operating activities:
Gains on investment securities, netGains on investment securities, net(696)(23)Gains on investment securities, net(86)(51)
Equity in net earningsEquity in net earnings(68)(16)Equity in net earnings(54)(33)
Stock-based compensationStock-based compensation129 119 Stock-based compensation84 82 
DepreciationDepreciation390 382 Depreciation308 252 
AmortizationAmortization66 53 Amortization30 43 
Benefit for deferred income taxesBenefit for deferred income taxes(3)(21)Benefit for deferred income taxes(3)
Changes in operating assets and liabilities, net of effect of
businesses acquired and dispositions:
Changes in operating assets and liabilities, net of effect of
businesses acquired and dispositions:
Changes in operating assets and liabilities, net of effect of
businesses acquired and dispositions:
ReceivablesReceivables(82)179 Receivables(1,285)(1,185)
Other assetsOther assets(1,547)334 Other assets(879)(2,124)
Benefits payableBenefits payable2,204 1,358 Benefits payable300 1,976 
Other liabilitiesOther liabilities1,257 168 Other liabilities(301)2,267 
Unearned revenuesUnearned revenues40 (9)Unearned revenues19 
OtherOther25 53 Other(15)(3)
Net cash provided by operating activities5,356 4,772 
Net cash (used in) provided by operating activitiesNet cash (used in) provided by operating activities(477)3,541 
Cash flows from investing activitiesCash flows from investing activitiesCash flows from investing activities
Acquisitions, net of cash acquiredAcquisitions, net of cash acquired(709)Acquisitions, net of cash acquired(325)(709)
Purchases of property and equipmentPurchases of property and equipment(668)(506)Purchases of property and equipment(619)(418)
Purchases of investment securitiesPurchases of investment securities(7,230)(4,130)Purchases of investment securities(5,307)(5,464)
Maturities of investment securitiesMaturities of investment securities3,500 1,281 Maturities of investment securities1,627 1,645 
Proceeds from sales of investment securitiesProceeds from sales of investment securities2,097 2,878 Proceeds from sales of investment securities2,421 2,084 
Net cash used in investing activitiesNet cash used in investing activities(3,010)(477)Net cash used in investing activities(2,203)(2,862)
Cash flows from financing activitiesCash flows from financing activitiesCash flows from financing activities
(Withdrawals) receipts from contract deposits, net(274)11 
Receipts from contract deposits, netReceipts from contract deposits, net1,183 389 
Proceeds from issuance of senior notes, netProceeds from issuance of senior notes, net1,088 987 Proceeds from issuance of senior notes, net1,088 
Proceeds (repayments) from issuance of commercial paper, net21 (358)
Proceeds from issuance of commercial paper, netProceeds from issuance of commercial paper, net508 21 
Proceeds from term loanProceeds from term loan1,000 Proceeds from term loan1,000 
Repayment of term loan(650)
Debt issue costsDebt issue costs(21)
Change in book overdraftChange in book overdraft(11)102 Change in book overdraft(84)85 
Common stock repurchasesCommon stock repurchases(30)(1,010)Common stock repurchases(33)(25)
Dividends paidDividends paid(239)(216)Dividends paid(173)(156)
Proceeds from stock option exercises and other, netProceeds from stock option exercises and other, net30 23 Proceeds from stock option exercises and other, net28 
Net cash provided by (used in) financing activities1,585 (1,111)
Increase in cash and cash equivalents3,931 3,184 
Net cash provided by financing activitiesNet cash provided by financing activities1,385 2,430 
(Decrease) increase in cash and cash equivalents(Decrease) increase in cash and cash equivalents(1,295)3,109 
Cash and cash equivalents at beginning of periodCash and cash equivalents at beginning of period4,054 2,343 Cash and cash equivalents at beginning of period4,673 4,054 
Cash and cash equivalents at end of periodCash and cash equivalents at end of period$7,985 $5,527 Cash and cash equivalents at end of period$3,378 $7,163 
Supplemental cash flow disclosures:Supplemental cash flow disclosures:Supplemental cash flow disclosures:
Interest paymentsInterest payments$159 $136 Interest payments$132 $115 
Income tax payments, netIncome tax payments, net$778 $578 Income tax payments, net$386 $36 
See accompanying notes to condensed consolidated financial statements.
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

1. BASIS OF PRESENTATION AND SIGNIFICANT EVENTS
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 GAAP, or those normally made in an Annual Report on Form 10-K. The year-end condensed consolidated balance sheet data was derived from audited financial statements, but does not include all disclosures required by GAAP. For further information, the reader of this Form 10-Q should refer to our Form 10-K for the year ended December 31, 2019,2020, that was filed with the Securities and Exchange Commission, or the SEC, on February 20, 2020.18, 2021. We refer to the Form 10-K as the “2019“2020 Form 10-K” in this document. References throughout this document to “we,” “us,” “our,” “Company,” and “Humana” mean Humana Inc. and its subsidiaries.
The preparation of our condensed consolidated financial statements in accordance with GAAP requires us to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. The areas involving the most significant use of estimates are the estimation of benefits payable, the impact of risk adjustment provisions related to our Medicare contracts, the valuation and related impairment recognition of investment securities, and the valuation and related impairment recognition of long-lived assets, including goodwill. These estimates are based on knowledge of current events and anticipated future events, and accordingly, actual results may ultimately differ materially from those estimates. Refer to Note 2 to the consolidated financial statements included in our 20192020 Form 10-K for information on accounting policies that we consider in preparing our consolidated financial statements. Since the filing of our 2019 Form 10-K we have received common stock, primarily in Oak Street Health, Inc., or OSH, as part of their initial public offering during the third quarter of 2020. We have updated our accounting policy for investment securities below.
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.
Investment SecuritiesKindred at Home Acquisition
Investment securities,On April 27, 2021, we entered into a definitive agreement to acquire the remaining 60% interest in Kindred at Home, or KAH, the nation’s largest home health and hospice provider, from TPG Capital, the private equity platform of global alternative asset firm, or TPG, and Welsh, Carson, Anderson & Stowe, or WCAS, two private equity funds, or the Sponsors, for an enterprise value of $8.1 billion, which consistincludes our existing equity value of debt and equity securities, are stated at fair value. Our debt securities have been categorized as available for sale. Debt securities available for current operations are classified as current assets and debt securities available for$2.4 billion associated with our long-term insurance products and professional liability funding requirements, as well as restricted statutory deposits and equity securities, are classified as long-term assets. For the purpose of determining realized gross gains and losses for debt securities sold,40% minority ownership interest. KAH has locations in 40 states, providing extensive geographic coverage with approximately 65% overlap with our individual Medicare Advantage membership. The acquisition, which are included as a component of investment incomeis expected to close in the consolidated statementsthird quarter of income,2021, is subject to customary state and federal regulatory approvals. We expect to fund the costapproximate $5.7 billion transaction (net of investment securities sold is based upon specific identification. Unrealized holding gainsour existing equity stake) through a combination of parent company cash, debt financing, and losses for debt securities, netthe assumption of applicable deferred taxes, are included as a component of stockholders’ equity and comprehensive income until realized from a sale or other-than-temporary impairment. For the purpose of determining gross gains and losses for equity securities, changes in fair value at the reporting date are included as a component of investment income in the consolidated statements of income.existing KAH indebtedness.
COVID-19
The temporary deferral of non-essential care resulting from stay-at-homeemergence and physical distancing orders and other restrictions on movement and economic activity implemented throughout the country beginning in the second half of March 2020 to reduce the spread of the novel coronavirus, or COVID-19, beginning in the first quarter of 2020 has impacted our business. HospitalDuring periods of increased incidences of COVID-19, non-essential care from a reduction in non-COVID-19 hospital admissions and lower overall healthcare system consumption decreased utilization. Likewise COVID-19 treatment and testing cost increased utilization. The significant disruption in utilization were significantly depressed in Aprilduring 2020 also impacted our ability to implement clinical initiatives to manage health care costs and increased throughout Maychronic conditions of our members, and June. Utilization continued to rebound throughoutappropriately document their risk profiles, and, as such, affecting our 2021 revenue under the third quarter of 2020, reaching approximately 95% of historic baseline levels at the close of the third quarter. The impact of the deferral of non-essential care was partially offset by COVID-19 testing and treatment costs, as well as our ongoing pandemic relief efforts.risk adjustment payment model for Medicare Advantage plans.


9

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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Revenue Recognition

Our revenues include premium and service revenues. Service revenues include administrative service fees that are recorded based upon established per member per month rates and the number of members for the month and are
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
recognized as services are provided for the month. Additionally, service revenues include net patient service revenues that are recorded based upon established billing rates, less allowances for contractual adjustments, and are recognized as services are provided. For more information about our revenues, refer to Note 2 to the consolidated financial statements included in our 20192020 Form 10-K for information on accounting policies that we consider in preparing our consolidated financial statements. See Note 14 for disaggregation of revenue by segment and type.
At SeptemberJune 30, 2020,2021, accounts receivable related to services were $155$192 million. For the three and ninesix months ended SeptemberJune 30, 2020,2021, we had no material bad-debt expense and there were no material contract assets, contract liabilities or deferred contract costs recorded on the condensed consolidated balance sheet at SeptemberJune 30, 2020.2021.
For the three and ninesix months ended SeptemberJune 30, 2020,2021, services revenue recognized from performance obligations related to prior periods (for example, due to changes in transaction price), was not material. Further, services revenue expected to be recognized in any future year related to remaining performance obligations was not material.
Health Care Reform
The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010 (which we collectively refer to as the Health Care Reform Law) enacted significant reforms to various aspects of the U.S. health insurance industry. Certain of these reforms became effective January 1, 2014, including an annual insurance industry premium-based fee. The Continuing Resolution bill, H.R. 195, enacted on January 22, 2018, included a one year suspension in 2019 of the health insurance industry fee, but the fee resumed in calendar year 2020. The Further Consolidated Appropriations Act, 2020, enacted on December 20, 2019, permanently repealed the health insurance industry fee beginning in calendar year 2021.
In September 2020, we paid the federal government $1.2 billion for the annual health insurance industry fee attributed to calendar year 2020. This fee, fixed in amount by law and apportioned to insurance carriers based on market share, is not deductible for tax purposes. On January 1 we recorded a liability for this fee in trade accounts payable and accrued expenses which we carried until the fee was paid. We also recorded a corresponding deferred cost in other current assets in our condensed consolidated financial statements which is amortized ratably to expense over the calendar year. Amortization of the deferred cost was recorded in operating cost expense of approximately $292 million and $884 million for the three and nine months ended September 30, 2020, respectively, resulting from the amortization of the 2020 annual health insurance industry fee.
On November 2, 2017, we filed suit against the United States of America in the United States Court of Federal Claims, on behalf of our health plans seeking recovery from the federal government of approximately $611 million in payments under the risk corridor premium stabilization program established under Health Care Reform, for years 2014, 2015 and 2016. On April 27, 2020, the U.S. Supreme Court ruled that the government is obligated to pay the losses under this risk corridor program, and that Congress did not impliedly repeal the obligation under its appropriations riders. In September 2020, we received a $609 million payment from the U.S Government pursuant to the judgement issued by the Court of Federal Claims on July 7, 2020. The $609 million payment received from the U.S Government and approximately $31 million in related fees and expenses are reflected in "Premiums" revenue and "Operating costs", respectively, in our condensed consolidated statements of income for the three and nine months ended September 30, 2020 and reported in the Corporate segment.

2. RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS
In June 2016, the FASB issued guidance introducing a new model for recognizing credit losses on financial instruments based on an estimate of current expected credit losses. The guidance was effective for us beginning January 1, 2020. The new current expected credit losses (CECL) model generally calls for the immediate recognition
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
of all expected credit losses and applies to loans, accounts and trade receivables as well as other financial assets measured at amortized cost, loan commitments and off-balance sheet credit exposures, debt securities and other financial assets measured at fair value through other comprehensive income, and beneficial interests in securitized financial assets. The new guidance replaces the current incurred loss model for measuring expected credit losses, requires expected losses on available for sale debt securities to be recognized through an allowance for credit losses rather than as reductions in the amortized cost of the securities, and provides for additional disclosure requirements. Our investment portfolio consists primarily of available for sale debt securities. We adopted the new standard effective January 1, 2020. Due to the high concentration of our financial assets measured at amortized cost being with the federal government resulting in zero nonpayment risk as well as our available for sale debt securities primarily being in an unrealized gain position, the adoption of the new standard did not have a material impact on our results of operations, financial condition, or cash flows.
In September 2018, the FASB issued new guidance related to accounting for long-duration contracts of insurers which revises key elements of the measurement models and disclosure requirements for long-duration contracts issued by insurers and reinsurers. The new guidance is effective for us beginning with annual and interim periods in 2023, with earlier adoption permitted, and requires retrospective application to previously issued annual and interim financial statements. We are currently evaluating the impact on our results of operations, financial position and cash flows.

There are no other recently issued accounting standards that apply to us or that are expected to have a material impact on our results of operations, financial condition, or cash flows.

3. ACQUISITIONS AND DIVESTITURES
On January 31,During 2021 and 2020, we purchased privately held Enclara Healthcare, or Enclara, one of the nation’s largest hospice pharmacy and benefit management providers for cash consideration of approximately $709 million, net of cash received. This resulted in a preliminary purchase price allocation to goodwill of $515 million, other intangible assets of $240 million, and net tangible liabilities assumed of $11 million. The goodwill was assigned to the Healthcare Services segment. The other intangible assets, which primarily consist of customer contracts, have an estimated weighted average useful life of 11.4 years. The purchase price allocation is preliminary, subject to completion of valuation analysis, including for example, refining assumptions used to calculate the fair value of intangible assets.
On February 1, 2020, our Partners in Primary Care wholly-owned subsidiary entered into a strategic partnership with Welsh, Carson, Anderson & Stowe, or WCAS, to accelerate the expansion of our primary care model. The WCAS partnership is expected to open approximately 50 payor-agnostic, senior-focused primary care centers over 3 years beginning in 2020. Partners in Primary Care committed to the acquisition of a non-controlling interest in the approximately $600 million entity accounted for under the equity method of accounting. In addition, the agreement includes a series of put and call options through which WCAS may require us to purchase their interest in the entity, and through which we may acquire WCAS’s interest, over the next 5 to 10 years.
During 2020 and 2019, we acquired othervarious health and wellness related businesses which, individually or in the aggregate, have not had a material impact on our results of operations, financial condition, or cash flows. The results of operations and financial condition of these businesses acquired in 20202021 and 20192020 have been included in our condensed consolidated statements of income and condensed consolidated balance sheets from the respective acquisition dates. Acquisition-related costs recognized in 20202021 and 20192020 were not material to our results of operations. The pro forma financial information assuming the acquisitions had occurred as of the beginning of the calendar year prior to the year of acquisition, as well as the revenues and earnings generated during the year of acquisition, were not material for disclosure purposes.


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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
4. INVESTMENT SECURITIES
Investment securities classified as current and long-term were as follows at SeptemberJune 30, 20202021 and December 31, 2019,2020, respectively:
Amortized
Cost
Gross
Unrealized
Gains
Gross
Unrealized
Losses
Fair
Value
Amortized
Cost
Gross
Unrealized
Gains
Gross
Unrealized
Losses
Fair
Value
(in millions) (in millions)
September 30, 2020
June 30, 2021June 30, 2021
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligationsU.S. Treasury and agency obligations$1,195 $$(1)$1,196 U.S. Treasury and agency obligations$646 $$(7)$641 
Mortgage-backed securitiesMortgage-backed securities3,511 183 (2)3,692 Mortgage-backed securities3,493 79 (42)3,530 
Tax-exempt municipal securitiesTax-exempt municipal securities1,439 40 (3)1,476 Tax-exempt municipal securities1,052 43 (1)1,094 
Commercial mortgage-backed securities1,020 54 (1)1,073 
Mortgage-backed securities:Mortgage-backed securities:
ResidentialResidential257 (1)256 
CommercialCommercial1,415 43 (5)1,453 
Asset-backed securitiesAsset-backed securities1,278 (5)1,281 Asset-backed securities1,450 1,458 
Corporate debt securitiesCorporate debt securities4,199 218 (2)4,415 Corporate debt securities5,280 179 (31)5,428 
Total debt securitiesTotal debt securities$12,642 $505 $(14)13,133 Total debt securities$13,593 $354 $(87)13,860 
Common stockCommon stock713 Common stock793 
Total investment securitiesTotal investment securities$13,846 Total investment securities$14,653 
December 31, 2019
December 31, 2020December 31, 2020
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligationsU.S. Treasury and agency obligations$353 $$$354 U.S. Treasury and agency obligations$616 $$(1)$616 
Mortgage-backed securitiesMortgage-backed securities3,628 85 (3)3,710 Mortgage-backed securities3,115 140 (1)3,254 
Tax-exempt municipal securitiesTax-exempt municipal securities1,433 30 1,463 Tax-exempt municipal securities1,393 54 1,447 
Commercial mortgage-backed securities786 18 804 
Mortgage-backed securities:Mortgage-backed securities:
ResidentialResidential17 17 
CommercialCommercial1,260 59 (1)1,318 
Asset-backed securitiesAsset-backed securities1,093 (3)1,093 Asset-backed securities1,364 10 (2)1,372 
Corporate debt securitiesCorporate debt securities3,867 82 (2)3,947 Corporate debt securities4,672 256 (1)4,927 
Total debt securitiesTotal debt securities$11,160 $219 $(8)11,371 Total debt securities$12,437 $520 $(6)12,951 
Common stockCommon stockCommon stock815 
Total investment securitiesTotal investment securities$11,378 Total investment securities$13,766 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Gross unrealized losses and fair values aggregated by investment category and length of time of individual debt securities that have been in a continuous unrealized loss position for which no allowances for credit loss has been recorded were as follows at SeptemberJune 30, 20202021 and December 31, 2019,2020, respectively:
 Less than 12 months12 months or moreTotal
 Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
 (in millions)
September 30, 2020
U.S. Treasury and other U.S.
government corporations
and agencies:
U.S. Treasury and agency
obligations
$662 $(1)$$$662 $(1)
Mortgage-backed
securities
450 (2)450 (2)
Tax-exempt municipal
securities
127 (3)12 139 (3)
Commercial mortgage-backed securities181 36 (1)217 (1)
Asset-backed securities121 (1)537 (4)658 (5)
Corporate debt securities275 (1)98 (1)373 (2)
Total debt securities$1,816 $(8)$683 $(6)$2,499 $(14)
December 31, 2019
U.S. Treasury and other U.S.
government corporations
and agencies:
U.S. Treasury and agency
obligations
$48 $$23 $$71 $
Mortgage-backed
securities
315 (1)204 (2)519 (3)
Tax-exempt municipal
securities
58 75 133 
Commercial mortgage-backed securities118 36 154 
Asset-backed securities20 607 (3)627 (3)
Corporate debt securities589 (2)155 744 (2)
Total debt securities$1,148 $(3)$1,100 $(5)$2,248 $(8)
 Less than 12 months12 months or moreTotal
 Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
Fair
Value
Gross
Unrealized
Losses
 (in millions)
June 30, 2021
U.S. Treasury and other U.S.
    government corporations
    and agencies:
U.S. Treasury and agency
    obligations
$373 $(7)$17 $$390 $(7)
Mortgage-backed
    securities
2,336 (39)114 (3)2,450 (42)
Tax-exempt municipal
    securities
81 (1)85 (1)
Mortgage-backed securities:
Residential79 (1)79 (1)
Commercial255 (5)74 329 (5)
Asset-backed securities231 149 380 
Corporate debt securities1,388 (31)19 1,407 (31)
Total debt securities$4,743 $(84)$377 $(3)$5,120 $(87)
December 31, 2020
U.S. Treasury and other U.S.
    government corporations
    and agencies:
U.S. Treasury and agency
    obligations
$225 $(1)$$$225 $(1)
Mortgage-backed
    securities
199 (1)199 (1)
Tax-exempt municipal
    securities
16 19 35 
Mortgage-backed securities:
Residential17 17 
Commercial193 (1)43 236 (1)
Asset-backed securities65 498 (2)563 (2)
Corporate debt securities342 (1)16 358 (1)
Total debt securities$1,057 $(4)$576 $(2)$1,633 $(6)

Approximately 96%95% of our debt securities were investment-grade quality, with a weighted average credit rating of AAAA- by Standard & Poor's Rating Service, or S&P, at SeptemberJune 30, 2020.2021. Most of the debt securities that were below investment-grade were rated BB, the higher end of the below investment-grade rating scale. Tax-exempt municipal securities were diversified among general obligation bonds of states and local municipalities in the United States as well as special revenue bonds issued by municipalities to finance specific public works projects such as utilities, water and sewer, transportation, or education. Our general obligation bonds are diversified across the United States
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
with no individual state exceeding 1% of our total debt securities. Our investment policy limits investments in a single issuer and requires diversification among various asset types.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Our unrealized losses from all debt securities were generated from approximately 155405 positions out of a total of approximately 1,5301,700 positions at SeptemberJune 30, 2020.2021. All issuers of debt securities we own that were trading at an unrealized loss at SeptemberJune 30, 20202021 remain current on all contractual payments. After taking into account these and other factors previously described, we believe these unrealized losses primarily were caused by an increase in market interest rates in the current markets since the time these debt securities were purchased. At SeptemberJune 30, 2020,2021, we did not intend to sell any debt securities with an unrealized loss position in accumulated other comprehensive income, and it is not likely that we will be required to sell these debt securities before recovery of their amortized cost basis. Additionally, we did not record any material credit allowances for debt securities that were in an unrealized loss position for the three and ninesix months ended SeptemberJune 30, 2021 and 2020.
The detail of gains (losses) related to investment securities and included within investment income was as follows for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
Three months ended
September 30,
Nine months ended
September 30,
Three months ended
June 30,
Six months ended
June 30,
2020201920202019 2021202020212020
(in millions) (in millions)(in millions)
Gross gains on investment securitiesGross gains on investment securities$645 $41 $714 $59 Gross gains on investment securities$14 $13 $109 $69 
Gross losses on investment securitiesGross losses on investment securities(23)(18)(36)Gross losses on investment securities(11)(18)
Net gains (losses) on equity securitiesNet gains (losses) on equity securities62 (23)
Net gains on investment securitiesNet gains on investment securities$645 $18 $696 $23 Net gains on investment securities$76 $$86 $51 

Gross gain on investment securities includes both the gain resulting from the initial conversion of our prior ownership interest in certain privately held companies into common stock upon such companies' initial public offering, or IPO, during the three months ended September 30, 2020, and subsequent changes in the market value of such securities from the IPO through the end of the period, which combined to total $643 million for the three and nine months ended September 30, 2020.
All purchasesPurchases of and proceeds from investment securities for the three and ninesix months ended SeptemberJune 30, 20202021 and 20192020 relate to debt securities.
There were no material other-than-temporary impairments for the three and nine months ended September 30, 2019.
The contractual maturities of debt securities available for sale at SeptemberJune 30, 2020,2021, regardless of their balance sheet classification, are shown below. Expected maturities may differ from contractual maturities because borrowers may have the right to call or prepay obligations with or without call or prepayment penalties.
Amortized
Cost
Fair
Value
Amortized
Cost
Fair
Value
(in millions) (in millions)
Due within one yearDue within one year$1,487 $1,490 Due within one year$461 $465 
Due after one year through five yearsDue after one year through five years2,176 2,259 Due after one year through five years2,061 2,134 
Due after five years through ten yearsDue after five years through ten years1,999 2,128 Due after five years through ten years2,958 3,035 
Due after ten yearsDue after ten years1,171 1,210 Due after ten years1,498 1,529 
Mortgage and asset-backed securitiesMortgage and asset-backed securities5,809 6,046 Mortgage and asset-backed securities6,615 6,697 
Total debt securitiesTotal debt securities$12,642 $13,133 Total debt securities$13,593 $13,860 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
5. FAIR VALUE
Financial Assets
The following table summarizes our fair value measurements at SeptemberJune 30, 20202021 and December 31, 2019,2020, respectively, for financial assets measured at fair value on a recurring basis:
 Fair Value Measurements Using
 Fair
Value
Quoted Prices
in Active
Markets
(Level 1)
Other
Observable
Inputs
(Level 2)
Unobservable
Inputs
(Level 3)
 (in millions)
September 30, 2020
Cash equivalents$7,722 $7,722 $$
Debt securities:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations1,196 1,196 
Mortgage-backed securities3,692 3,692 
Tax-exempt municipal securities1,476 1,476 
Commercial mortgage-backed securities1,073 1,073 
Asset-backed securities1,281 1,281 
Corporate debt securities4,415 4,415 
Total debt securities13,133 13,133 
Common stock713 713 
Total investment securities$21,568 $8,435 $13,133 $
December 31, 2019
Cash equivalents$3,660 $3,660 $$
Debt securities:
U.S. Treasury and other U.S. government
corporations and agencies:
U.S. Treasury and agency obligations354 354 
Mortgage-backed securities3,710 3,710 
Tax-exempt municipal securities1,463 1,463 
Commercial mortgage-backed securities804 804 
Asset-backed securities1,093 1,093 
Corporate debt securities3,947 3,947 
Total debt securities11,371 11,371 
Common stock
Total investment securities$15,038 $3,667 $11,371 $

 Fair Value Measurements Using
 Fair
Value
Quoted Prices
in Active
Markets
(Level 1)
Other
Observable
Inputs
(Level 2)
Unobservable
Inputs
(Level 3)
 (in millions)
June 30, 2021
Cash equivalents$3,191 $3,191 $$
Debt securities:
U.S. Treasury and other U.S. government
    corporations and agencies:
U.S. Treasury and agency obligations641 641 
Mortgage-backed securities3,530 3,530 
Tax-exempt municipal securities1,094 1,094 
Mortgage-backed securities:
Residential256 256 
Commercial1,453 1,453 
Asset-backed securities1,458 1,458 
Corporate debt securities5,428 5,428 
Total debt securities13,860 13,860 
Common stock793 793 
Total invested assets$17,844 $3,984 $13,860 $
December 31, 2020
Cash equivalents$4,548 $4,548 $$
Debt securities:
U.S. Treasury and other U.S. government
    corporations and agencies:
U.S. Treasury and agency obligations616 616 
Mortgage-backed securities3,254 3,254 
Tax-exempt municipal securities1,447 1,447 
Mortgage-backed securities:
Residential17 17 
Commercial1,318 1,318 
Asset-backed securities1,372 1,372 
Corporate debt securities4,927 4,927 
Total debt securities12,951 12,951 
Common stock815 815 
Total invested assets$18,314 $5,363 $12,951 $
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Financial Liabilities
Our debt is recorded at carrying value in our consolidated balance sheets. The carrying value of our senior notes debt outstanding, net of unamortized debt issuance costs, was $6,458 million$6.1 billion at SeptemberJune 30, 20202021 and $5,366 million at December 31, 2019.2020. The fair value of our senior notes debt was $7,674 million$7.1 billion at SeptemberJune 30, 20202021 and $5,916 million$7.4 billion at December 31, 2019.2020. The fair value of our senior notenotes debt is determined based on Level 2 inputs, including quoted market prices for the same or similar debt, or if no quoted market prices are available, on the current prices estimated to be available to us for debt with similar terms and remaining maturities. Due to the short-term nature, carrying value approximates fair value for our term note and commercial paper borrowings. The term loan outstanding and commercial paper borrowings were $1,325 million$1.1 billion and $0.6 billion as of SeptemberJune 30, 2020. The commercial paper borrowings were $300 million as of2021 and December 31, 2019.2020, respectively.
Put and Call Options Measured at Fair Value
As part of our investment in Kindred at Home, we entered into a shareholders agreement with TPG Capital, or TPG, and Welsh, Carson, Anderson & Stowe, or WCAS, the Sponsors, that provides for certain rights and obligations of each party. The shareholders agreementEffective April 27, 2021, with the Sponsors includes a put option under which they havesigning of the rightdefinitive agreement to require us to purchase theiracquire the remaining 60% interest inof KAH, the joint venture beginning on July 2, 2021 and ending on July 1, 2022. Likewise, we have a call option under which we have the right to require the Sponsors to sell their interest in the joint venture to Humana beginning on July 2, 2022 and ending on July 1, 2023. The put and call options which are exercisable at a fixed EBITDA multiplewere terminated. As such, the $63 million put and provide a minimum return on$440 million call fair values as of the Sponsor's investment if exercised, are measured at fair value each period using a Monte Carlo simulation.first quarter of 2021 were reduced to 0, resulting in $377 million in "Other (income) expense, net" in our condensed consolidated statements of income during the three months ended June 30, 2021.
The put and call options were measured at fair value using a Monte Carlo simulation which resulted in fair values were $151of $45 million and $634 million, respectively, at September 30, 2020, and $28 million and $557$503 million, respectively, at December 31, 2019.2020. The put option is included within other long-term liabilities and the call option is included within other long-term assets.assets at December 31, 2020. The change in fair value of the put and call options is reflected as "Other (income) expense, net" in our condensed consolidated statements of income.

The significant unobservable inputs utilized in these Level 3 fair value measurements (and selected values) include the enterprise value of Kindred at Home, annualized volatility and secured credit rate. Enterprise value was derived from a discounted cash flow model, which utilized significant unobservable inputs for long-term net operating profit after tax margin, or NOPAT, to measure underlying cash flows, weighted average cost of capital and long term growth rate. The table below presents the assumptions used for each reporting period.
September 30, 2020December 31, 2019
Annualized volatility44.9 %19.8 %
Secured credit rate0.4 %2.2 %
NOPAT12.0 %12.0 %
Weighted average cost of capital10.0 %10.0 %
Long term growth rate3.0 %3.0 %

The calculation of NOPAT utilized net income plus after tax interest expense. We regularly evaluate each of the assumptions used in establishing these assets and liabilities. Significant changes in assumptions for weighted average cost of capital, long term growth rates, NOPAT, volatility, credit spreads, risk free rate, and underlying cash flow estimates, could result in significantly lower or higher fair value measurements. A change in one of these assumptions is not necessarily accompanied by a change in another assumption.

Other Assets and Liabilities Measured at Fair Value

As disclosed in Note 3, we acquired Enclara during 2020. The values of net tangible assets acquired andOther than the resulting goodwill and other intangible assets were recorded at fair value using Level 3 inputs. The majority of the net tangible liabilities assumed were recorded at their carrying values as of the date of acquisition, as their carrying values approximated their fair values due to their short-term nature. The fair values of goodwill and other intangible
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
assets acquired in this acquisition were internally estimated primarily based on the income approach. The income approach estimates fair value based on the present value of the cash flows that the assets are expected to generate in the future. We developed internal estimates for the expected future cash flows and discount rates used in the present value calculations. Other thanimmaterial assets acquired and liabilities assumed in this acquisition,the acquisitions in Note 3, there were no other material assets or liabilities measured at fair value on a recurring or nonrecurring basis during 2020.2021.
6. MEDICARE PART D
We cover prescription drug benefits in accordance with Medicare Part D under multiple contracts with the Centers for Medicare and Medicaid Services, or CMS, as described further in Note 2 to the consolidated financial statements included in our 20192020 Form 10-K. The accompanying condensed consolidated balance sheets include the following amounts associated with Medicare Part D at SeptemberJune 30, 20202021 and December 31, 2019.2020. CMS subsidies/discounts in the table below include the reinsurance and low-income cost subsidies funded by CMS for which we assume no risk as well as brand name prescription drug discounts for Part D plan participants in the coverage gap funded by CMS and pharmaceutical manufacturers.
September 30, 2020December 31, 2019 June 30, 2021December 31, 2020
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
Risk
Corridor
Settlement
CMS
Subsidies/
Discounts
(in millions) (in millions)
Other current assetsOther current assets$25 $1,226 $$585 Other current assets$169 $1,635 $216 $1,420 
Trade accounts payable and accrued expensesTrade accounts payable and accrued expenses(101)(714)(120)(356)Trade accounts payable and accrued expenses(13)(1,653)(39)(253)
Net current (liability) asset(76)512 (115)229 
Net current asset (liability)Net current asset (liability)156 (18)177 1,167 
Other long-term assetsOther long-term assets273 Other long-term assets317 
Other long-term liabilitiesOther long-term liabilities(176)(61)Other long-term liabilities(198)(90)
Net long-term asset (liability)Net long-term asset (liability)97 (55)Net long-term asset (liability)119 (82)
Total net asset (liability)Total net asset (liability)$21 $512 $(170)$229 Total net asset (liability)$275 $(18)$95 $1,167 

15
7. GOODWILL AND OTHER INTANGIBLE ASSETS
Changes in the carrying amount of goodwill for our reportable segments for the nine months ended September 30, 2020 were as follows:
RetailGroup and SpecialtyHealthcare
Services
Total
 (in millions)
Balance at January 1, 2020$1,535 $261 $2,132 $3,928 
Acquisitions515 515 
Balance at September 30, 2020$1,535 $261 $2,647 $4,443 
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
7. GOODWILL AND OTHER INTANGIBLE ASSETS
Changes in the carrying amount of goodwill for our reportable segments for the six months ended June 30, 2021 were as follows:
RetailGroup and SpecialtyHealthcare
Services
Total
 (in millions)
Balance at January 1, 2021$1,535 $261 $2,651 $4,447 
Acquisitions112 355 467 
Balance at June 30, 2021$1,647 $261 $3,006 $4,914 
    The following table presents details of our other intangible assets included in other long-term assets in the accompanying condensed consolidated balance sheets at SeptemberJune 30, 20202021 and December 31, 2019.2020.
 September 30, 2020December 31, 2019
Weighted
Average
Life
CostAccumulated
Amortization
NetCostAccumulated
Amortization
Net
 ($ in millions)
Other intangible assets:
Customer contracts/
relationships
9.5 years$849 $553 $296 $646 $496 $150 
Trade names and
technology
7.0 years122 87 35 84 84 
Provider contracts11.8 years70 49 21 70 44 26 
Noncompetes and
other
7.3 years29 29 29 28 
Total other intangible
assets
9.3 years$1,070 $718 $352 $829 $652 $177 
 June 30, 2021December 31, 2020
Weighted
Average
Life
CostAccumulated
Amortization
NetCostAccumulated
Amortization
Net
 ($ in millions)
Other intangible assets:
Customer contracts/
    relationships
9.4 years$875 $596 $279 $849 $572 $277 
Trade names and
    technology
6.7 years136 92 44 122 89 33 
Provider contracts11.8 years69 53 16 69 50 19 
Noncompetes and
    other
7.1 years32 29 29 29 
Total other intangible
    assets
9.1 years$1,112 $770 $342 $1,069 $740 $329 
    For the three months ended SeptemberJune 30, 20202021 and 2019,2020, amortization expense for other intangible assets was approximately $23$15 million and $17$22 million, respectively. For the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, amortization expense for other intangible assets was approximately $66$30 million and $53$43 million, respectively. The following table presents our estimate of amortization expense remaining for 20202021 and each of the five next succeeding years:
(in millions) (in millions)
For the years ending December 31,For the years ending December 31,For the years ending December 31,
2020$22 
2021202156 2021$33 
2022202253 202262 
2023202340 202348 
2024202433 202440 
2025202533 202539 
2026202627 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
8. BENEFITS PAYABLE
On a consolidated basis, activity in benefits payable, was as follows for the ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
For the nine months ended September 30,For the six months ended June 30,
2020201920212020
(in millions) (in millions)
Balances, beginning of periodBalances, beginning of period$6,004 $4,862 Balances, beginning of period$8,143 $6,004 
Less: Reinsurance recoverablesLess: Reinsurance recoverables(68)(95)Less: Reinsurance recoverables(68)
Balances, beginning of period, netBalances, beginning of period, net5,936 4,767 Balances, beginning of period, net8,143 5,936 
AcquisitionsAcquisitions42 
Incurred related to:Incurred related to:Incurred related to:
Current yearCurrent year45,693 40,499 Current year35,164 30,039 
Prior yearsPrior years(278)(331)Prior years(719)(235)
Total incurredTotal incurred45,415 40,168 Total incurred34,445 29,804 
Paid related to:Paid related to:Paid related to:
Current yearCurrent year(37,810)(34,625)Current year(27,556)(22,665)
Prior yearsPrior years(5,334)(4,158)Prior years(6,589)(5,098)
Total paidTotal paid(43,144)(38,783)Total paid(34,145)(27,763)
Reinsurance recoverableReinsurance recoverable68 Reinsurance recoverable
Balances, end of periodBalances, end of period$8,208 $6,220 Balances, end of period$8,485 $7,980 
Amounts incurred related to prior periods vary from previously estimated liabilities as the claims ultimately are settled. Negative amounts reported for incurred related to prior years result from claims being ultimately settled for amounts less than originally estimated (favorable development).
Our reserving practice is to consistently recognize the actuarial best estimate of our ultimate liability for claims. Actuarial standards require the use of assumptions based on moderately adverse experience, which generally results in favorable reserve development, or reserves that are considered redundant.
The higher prior year favorable development for the six months ended June 20, 2021 was primarily attributable to the reversal of actions taken in 2020, including the suspension of certain financial recovery programs for a period of time. The suspension during 2020 was intended to provide financial and administrative relief for providers facing unprecedented strain as a result of the COVID-19 pandemic.

Incurred and Paid Claims Development
The following discussion provides information about incurred and paid claims development for our Retail and Group and Specialty segments as of SeptemberJune 30, 20202021 and 2019,2020, net of reinsurance, and the total estimate of benefits payable for claims incurred but not reported, or IBNR, included within the net incurred claims amounts.








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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Retail Segment
Activity in benefits payable for our Retail segment was as follows for the ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
For the nine months ended September 30,For the six months ended June 30,
2020201920212020
(in millions) (in millions)
Balances, beginning of periodBalances, beginning of period$5,363 $4,338 Balances, beginning of period$7,428 $5,363 
Less: Reinsurance recoverablesLess: Reinsurance recoverables(68)(95)Less: Reinsurance recoverables(68)
Balances, beginning of period, netBalances, beginning of period, net5,295 4,243 Balances, beginning of period, net7,428 5,295 
AcquisitionsAcquisitions42 
Incurred related to:Incurred related to:Incurred related to:
Current yearCurrent year42,186 36,762 Current year32,986 27,921 
Prior yearsPrior years(235)(366)Prior years(619)(205)
Total incurredTotal incurred41,951 36,396 Total incurred32,367 27,716 
Paid related to:Paid related to:Paid related to:
Current yearCurrent year(34,946)(31,476)Current year(25,953)(21,063)
Prior yearsPrior years(4,759)(3,634)Prior years(5,990)(4,528)
Total paidTotal paid(39,705)(35,110)Total paid(31,943)(25,591)
Reinsurance recoverableReinsurance recoverable68 Reinsurance recoverable
Balances, end of periodBalances, end of period$7,542 $5,597 Balances, end of period$7,894 $7,423 
At SeptemberJune 30, 2020,2021, benefits payable for our Retail segment included IBNR of approximately $4.6$4.9 billion, primarily associated with claims incurred in 2020.2021.
Group and Specialty Segment
Activity in benefits payable for our Group and Specialty segment was as follows for the ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
For the nine months ended September 30,For the six months ended June 30,
2020201920212020
(in millions) (in millions)
Balances, beginning of periodBalances, beginning of period$641 $517 Balances, beginning of period$715 $641 
Incurred related to:Incurred related to:Incurred related to:
Current yearCurrent year3,929 4,142 Current year2,492 2,434 
Prior yearsPrior years(43)35 Prior years(100)(30)
Total incurredTotal incurred3,886 4,177 Total incurred2,392 2,404 
Paid related to:Paid related to:Paid related to:
Current yearCurrent year(3,286)(3,547)Current year(1,917)(1,918)
Prior yearsPrior years(575)(524)Prior years(599)(570)
Total paidTotal paid(3,861)(4,071)Total paid(2,516)(2,488)
Balances, end of periodBalances, end of period$666 $623 Balances, end of period$591 $557 
At SeptemberJune 30, 2020,2021, benefits payable for our Group and Specialty segment included IBNR of approximately $576$514 million, primarily associated with claims incurred in 2020.2021.
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Reconciliation to Consolidated

The reconciliation of the net incurred and paid claims development tables to benefits payable in the consolidated statement of financial position is as follows:
Reconciliation of the Disclosure of Incurred and Paid Claims Development to Benefits Payable, net of reinsurance
September 30,
2020
Net outstanding liabilities(in millions)
Retail$7,541 
Group and Specialty666 
    Benefits payable, net of reinsurance8,207 
Reinsurance recoverable on unpaid claims
Retail
     Total benefits payable, gross$8,208 

9. EARNINGS PER COMMON SHARE COMPUTATION
Detail supporting the computation of basic and diluted earnings per common share was as follows for the three and ninesix months ended SeptemberJune 30, 2021 and 2020:
Three months ended June 30,Six months ended June 30,
2021202020212020
(dollars in millions, except per common share results; number of shares in thousands)
Net income available for common stockholders$588 $1,828 $1,416 $2,301 
Weighted average outstanding shares of common stock
    used to compute basic earnings per common share
128,692 132,248 128,811 132,192 
Dilutive effect of:
Employee stock options74 89 63 90 
Restricted stock621 686 595 635 
Shares used to compute diluted earnings per common share129,387 133,023 129,469 132,917 
Basic earnings per common share$4.57 $13.83 $11.00 $17.41 
Diluted earnings per common share$4.55 $13.75 $10.94 $17.31 
Number of antidilutive stock options and restricted stock
    excluded from computation
103 130 317 395 

10. STOCKHOLDERS’ EQUITY
Dividends
The following table provides details of dividend payments, excluding dividend equivalent rights for unvested stock awards, in 2020 and 2019:2021 under our Board approved quarterly cash dividend policy:
Three months ended September 30,Nine months ended September 30,
2020201920202019
(dollars in millions, except per common share results; number of shares in thousands)
Net income available for common stockholders$1,340 $689 $3,641 $2,195 
Weighted average outstanding shares of common stock
used to compute basic earnings per common share
132,318 133,321 132,234 134,589 
Dilutive effect of:
Employee stock options105 101 95 99 
Restricted stock773 603 681 501 
Shares used to compute diluted earnings per common share133,196 134,025 133,010 135,189 
Basic earnings per common share$10.12 $5.16 $27.53 $16.31 
Diluted earnings per common share$10.05 $5.14 $27.37 $16.24 
Number of antidilutive stock options and restricted stock
excluded from computation
143 302 311 589 
Record
Date
Payment
Date
Amount
per Share
Total
Amount
(in millions)
2020 payments
12/31/20191/31/2020$0.550 $73 
3/31/20204/24/20200.625 83 
6/30/20207/31/20200.625 83 
9/30/202010/30/20200.625 83 
2021 payments
12/31/20201/29/2021$0.625 $81 
3/31/20204/30/20210.700 90 
In April 2021, the Board declared a cash dividend of $0.70 per share payable on July 30, 2021 to stockholders of record on June 30, 2021.



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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
10. STOCKHOLDERS’ EQUITY
Dividends
The following table provides details of dividend payments, excluding dividend equivalent rights for unvested stock awards, in 2019 and 2020 under our Board approved quarterly cash dividend policy:
Record
Date
Payment
Date
Amount
per Share
Total
Amount
(in millions)
2019 payments
12/31/20181/25/2019$0.50 $68 
3/29/20194/26/2019$0.55 $74 
6/28/20197/26/2019$0.55 $74 
9/30/201910/25/2019$0.55 $73 
2020 payments
12/31/20191/31/2020$0.55 $73 
3/31/20204/24/2020$0.625 $83 
6/30/20207/31/2020$0.625 $83 
9/30/202010/30/2020$0.625 $83 

In November 2020, the Board declared a cash dividend of $0.625 per share payable on January 29, 2021 to stockholders of record on December 31, 2020.
Stock Repurchases
Our Board of Directors may authorize the purchase of our common stock shares. Under the share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, or in privately-negotiated transactions, including pursuant to accelerated share repurchase agreements with investment banks, subject to certain regulatory restrictions on volume, pricing, and timing.
On July 30, 2019, the Board of Directors replaced a previous share repurchase authorization of up to $3 billion (of which approximately $1.03 billion remained unused) with a new authorization for repurchases of up to $3 billion of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on June 30, 2022.
On July 31, 2019, we entered into an accelerated stock repurchase agreement, the July 2019 ASR, with Citibank, N.A., or Citi, to repurchase $1 billion of our common stock. On August 2, 2019, we made a payment of $1 billion to Citi and received an initial delivery of 2.7 million shares of our common stock. We recorded the payment to Citi as a reduction to stockholders’ equity, consisting of an $800 million increase in treasury stock, which reflects the value of the initial 2.7 million shares received upon initial settlement, and a $200 million decrease in capital in excess of par value, which reflects the value of stock held back by Citi pending final settlement of the July 2019 ASR. Upon final settlement of the July 2019 ASR on December 26, 2019, we received an additional 0.7 million shares as determined by the average daily volume weighted-averages share price of our common stock during the term of the agreement, less a discount, of $296.19, bringing the total shares received under the July 2019 ASR to 3.4 million. In addition, upon settlement we reclassified the $200 million value of stock initially held back by Citi from capital in excess of par value to treasury stock.
On December 22, 2020, we entered into separate accelerated stock repurchase agreements, ("the December 2020 ASR Agreements"), with Citibank, N.A., or Citi, and JPMorgan Chase Bank, or JPM, to repurchase $1.75 billion of our common stock as part of the $3 billion repurchase program authorized by the Board of Directors on July 30, 2019. On December 23, 2020, in accordance with the December 2020 ASR Agreements, we made a payment of $1.75 billion ($875 million to Citi and $875 million to JPM) and received an initial delivery of 3.8 million shares of our common stock (1.9 million shares each from Citi and JPM). We recorded the payments to Citi and JPM as a reduction to stockholders’ equity, consisting of an $1.5 billion increase in treasury stock, which reflects the value of the initial 3.8 million shares received upon initial settlement, and a $262.5 million decrease in capital in excess of par value, which reflects the value of stock held back by Citi and JPM pending final settlement of the December 2020 ASR Agreements. Upon final settlement of the December 2020 ASR agreements with Citi and JPM on May 4, 2021 and May 5, 2021, respectively, we received an additional 0.3 million shares and 0.3 million shares, respectively, as determined by the average daily volume weighted-averages share price of our common stock during the term of the agreement, less a discount, of $400.07 and 401.49, respectively, bringing the total shares received under the December 2020 ASR agreements to 4.4 million. In addition, upon settlement we reclassified the $262.5 million value of stock initially held back by Citi and JPM from capital in excess of par value to treasury stock.
On February 18, 2021, the Board of Directors replaced the previous share repurchase authorization of up to $3 billion (of which approximately $250 million remained unused) with a new authorization for repurchases of up to $3 billion of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring as of February 18, 2024. Our remaining repurchase authorization was approximately $2$3 billion as of July 27, 2021.
In connection with employee stock plans, we acquired 0.09 million common shares for $33 million and 0.08 million common shares for $25 million during the six months ended June 30, 2021 and 2020, respectively.

11. INCOME TAXES
The effective income tax rate was 23.7% and 22.7% for the three and six months ended June 30, 2021, respectively, compared to 30.0% and 31.0% for the three and six months ended June 30, 2020, respectively, primarily due to the termination of the $3 billion share repurchase program as of November 2, 2020.non-deductible health insurance industry fee in 2021.

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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
In connection with employee stock plans, we acquired 0.08 million common shares for $30 million and 0.03 million common shares for $10 million during the nine months ended September 30, 2020 and 2019, respectively.

11. INCOME TAXES
The effective income tax rate was 25.2% and 29.0% for the three and nine months ended September 30, 2020, respectively, compared to 22.5% and 23.8% for the three and nine months ended September 30, 2019, respectively, primarily due to the reinstatement of the non-deductible health insurance industry fee in 2020.

12.  DEBT
The carrying value of debt outstanding, net of unamortized debt issuance costs, was as follows at SeptemberJune 30, 20202021 and December 31, 2019:2020:
September 30, 2020December 31, 2019June 30, 2021December 31, 2020
(in millions)(in millions)
Short-term debt:Short-term debt:Short-term debt:
Commercial paperCommercial paper$325 $300 Commercial paper$1,109 $600 
Term note1,000 
Senior notes:
$400 million, 2.50% due December 15, 2020399 399 
Total short-term debtTotal short-term debt$1,724 $699 Total short-term debt$1,109 $600 
Long-term debt:Long-term debt:Long-term debt:
Senior notes:Senior notes:Senior notes:
$600 million, 3.15% due December 1, 2022$600 million, 3.15% due December 1, 2022$598 $598 $600 million, 3.15% due December 1, 2022$598 $598 
$400 million, 2.90% due December 15, 2022$400 million, 2.90% due December 15, 2022398 397 $400 million, 2.90% due December 15, 2022398 398 
$600 million, 3.85% due October 1, 2024$600 million, 3.85% due October 1, 2024597 597 $600 million, 3.85% due October 1, 2024598 598 
$600 million, 4.50% due April 1, 2025$600 million, 4.50% due April 1, 2025595 $600 million, 4.50% due April 1, 2025595 595 
$600 million, 3.95% due March 15, 2027$600 million, 3.95% due March 15, 2027596 595 $600 million, 3.95% due March 15, 2027596 596 
$500 million, 3.125% due August 15, 2029$500 million, 3.125% due August 15, 2029495 495 $500 million, 3.125% due August 15, 2029496 495 
$500 million, 4.875% due April 1, 2030$500 million, 4.875% due April 1, 2030494 $500 million, 4.875% due April 1, 2030495 494 
$250 million, 8.15% due June 15, 2038$250 million, 8.15% due June 15, 2038262 262 $250 million, 8.15% due June 15, 2038262 262 
$400 million, 4.625% due December 1, 2042$400 million, 4.625% due December 1, 2042396 396 $400 million, 4.625% due December 1, 2042396 396 
$750 million, 4.95% due October 1, 2044$750 million, 4.95% due October 1, 2044739 739 $750 million, 4.95% due October 1, 2044740 739 
$400 million, 4.80% due March 15, 2047$400 million, 4.80% due March 15, 2047396 396 $400 million, 4.80% due March 15, 2047396 396 
$500 million, 3.95% due August 15, 2049$500 million, 3.95% due August 15, 2049493 492 $500 million, 3.95% due August 15, 2049493 493 
Total long-term debt Total long-term debt$6,059 $4,967  Total long-term debt$6,063 $6,060 
Senior Notes    
In March 2020, we issued $600 million of 4.500% senior notes due April 1, 2025 and $500 million of 4.875% senior notes due April 1, 2030. Our net proceeds, reduced for the underwriters' discount and commission and offering expenses paid, were approximately $1,088 million as of September 30, 2020. We intend to use the net proceeds for general corporate purposes, which may include the repayment of existing indebtedness.
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Our senior notes, which are unsecured, may be redeemed at our option at any time at 100% of the principal amount plus accrued interest and a specified make-whole amount. The 8.15% senior notes are subject to an interest rate adjustment if the debt ratings assigned to the notes are downgraded (or subsequently upgraded). In addition, our senior notes contain a change of control provision that may require us to purchase the notes under certain circumstances.
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Revolving Credit AgreementAgreements
OurIn June 2021, we entered into two separate revolving credit agreements: (i) a 5-year, $2.0$2.5 billion unsecured revolving credit agreement expires May 2022.and (ii) a 364-day $1.5 billion unsecured revolving credit agreement. Under the revolving credit agreement,agreements, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion bears interest at either LIBOR plus a spread or the base rate plus a spread. If drawn upon, the revolving credit would revert to using the alternative base rate once LIBOR is discontinued. The LIBOR spread, currently 110.0 basis points, varies depending on our credit ratings ranging from 91.0 to 150.0 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently 15.0 basis points, may fluctuate between 9.0 and 25.0 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate based on LIBOR, at our option. The revolving credit agreements provide for the transition from LIBOR and do not require amendment in connection with such transition.

The LIBOR spread, currently 110.0 basis points under the 5-year revolving credit agreements and 115.0 basis points under the 364-day revolving credit agreement, varies depending on our credit ratings ranging from 91.0 to 140.0 basis points under the 5-year revolving credit agreement and from 93.0 to 145.0 basis points under the 364-day revolving credit agreement. We also pay an annual facility fee regardless of utilization. This facility fee, currently 15.0 basis points, under the 5-year revolving credit agreement and 10.0 basis points under the 364-day revolving agreement, various depending on our credit ratings ranging from 9.0 to 22.5 basis points under the 5-year revolving credit agreement and from 7.0 to 17.5 basis points under the 364-day revolving credit agreement.
The terms of the revolving credit agreementagreements include standard provisions related to conditions of borrowing which could limit our ability to borrow additional funds. In addition, the credit agreement containsagreements contain customary restrictive covenants and a financial covenant regarding maximum debt to capitalization of 50%60%, as well as customary events of default. We are in compliance with this financial covenant, with actual debt to capitalization of 33% as measured in accordance with the revolving credit agreementagreements as of SeptemberJune 30, 2020.2021. Upon our agreement with one or more financial institutions, we may expand the aggregate commitments under the revolving credit agreementagreements by up to $750 million in the aggregate, to a maximum of $2.5$4.75 billion, through a $500 million incremental loan facility.across the 5-year and 364-day revolving credit agreements.
At SeptemberJune 30, 2020,2021, we had 0 borrowings and 0less than $1 million of letters of credit outstanding under the revolving credit agreement.agreements. Accordingly, as of SeptemberJune 30, 2020,2021, we had $2.0$2.5 billion of remaining borrowing capacity under the 5-year revolving credit agreement and $1.5 billion of remaining borrowing capacity under the 364-day revolving credit agreement (which excludes the uncommitted $500$750 million of incremental loan facility under the credit agreement)facilities), none of which would be restricted by our financial covenant compliance requirement.
We have other customary, arms-length relationships, including financial advisory and banking, with some parties to the revolving credit agreements.
Delayed Draw Term Loan Credit Agreement
In May 2021, we entered into a $500 million unsecured delayed draw term loan credit agreement. Under the term loan credit agreement, loans bear interest at either LIBOR plus a spread or the base rate plus a spread. The loans under the term loan credit agreement mature on the third anniversary of the funding date. The LIBOR spread, currently 125 basis points, varies depending on our credit ratings ranging from 100.0 to 162.5 basis points. The term loan credit agreement provides for the transition from LIBOR and does not require amendment in connection with such transition.

The term loan credit agreement contains customary restrictive covenants and a financial covenant regarding maximum debt to capitalization of 60%, as well as customary events of default. We are in compliance with this financial covenant, with actual debt to capitalization of 33% as measured in accordance with the term loan credit agreement as of June 30, 2021. At June 30, 2021, we had 0 borrowings under the delayed term loan credit agreement. 

We have other customary, arms-length relationships, including financial advisory and banking, with some parties to the term loan agreement.

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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
Commercial Paper

Under our commercial paper program we may issue short-term, unsecured commercial paper notes privately placed on a discount basis through certain broker dealers at any time not to exceed $2 billion. Amounts available under the program may be borrowed, repaid and re-borrowed from time to time. The net proceeds of issuances have been and are expected to be used for general corporate purposes. The maximum principal amount outstanding at any one time during the ninesix months ended SeptemberJune 30, 20202021 was $600 million,$1.3 billion, with $325 million$1.1 billion outstanding at SeptemberJune 30, 20202021 compared to $300$600 million outstanding at December 31, 2019.2020. The outstanding commercial paper at SeptemberJune 30, 20202021 had a weighted average annual interest rate of 0.35%0.32%.
Term NoteOther Short-term Borrowings
We are a member, through one subsidiary, of the Federal Home Loan Bank of Cincinnati, or FHLB. As a member we have the ability to obtain short-term cash advances, subject to certain minimum collateral requirements. At June 30, 2021 we had 0 outstanding short-term FHLB borrowings.

Bridge Loan Financing

In February 2020,April 2021, we entered into a commitment letter with Goldman Sachs Bank USA, or Goldman Sachs, pursuant to which, and subject to the terms and conditions set forth therein, Goldman Sachs committed to lend us up to $3.5 billion under a new $1senior unsecured 364-day bridge loan facility, or Bridge Loan. If we enter into the Bridge Loan, the proceeds of the Bridge Loan will be used to finance a portion of the cash consideration payable for the KAH transaction. The outstanding Bridge Loan commitments under the commitment letter were reduced to $3.0 billion in connection with the effectiveness of the delayed draw term loan commitment with a bank that matures 1 year after the first draw, subject to a 1 year extension. In March 2020, we made a draw on the entire term loan commitment of $1 billion. The facility fee, interest rate and financial covenants are consistent with those of our revolving credit agreement. There is no prepayment penalty.agreement in May 2021.




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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
13. COMMITMENTS, GUARANTEES AND CONTINGENCIES
Government Contracts
Our Medicare products, which accounted for approximately 82%83% of our total premiums and services revenue for the ninesix months ended SeptemberJune 30, 2020,2021, primarily consistedconsisted of products covered under the Medicare Advantage and Medicare Part D Prescription Drug Plan contracts with the federal government. These contracts are renewed generally for a calendar year term unless CMS notifies us of its decision not to renew by May 1 of the calendar year in which the contract would end, or we notify CMS of our decision not to renew by the first Monday in June of the calendar year in which the contract would end. All material contracts between Humana and CMS relating to our Medicare products have been renewed for 2021 and all of our2022. Our product offerings have been approved.under those contracts are subject to approval by CMS in the third quarter of 2021.
CMS uses a risk-adjustment model which adjusts premiums paid to Medicare Advantage, or MA, plans according to health status of covered members. The risk-adjustment model, which CMS implemented pursuant to the Balanced Budget Act of 1997 (BBA) and the Benefits Improvement and Protection Act of 2000 (BIPA), generally pays more where a plan's membership has higher expected costs. Under this model, rates paid to MA plans are based on actuarially determined bids, which include a process whereby our prospective payments are based on our estimated cost of providing standard Medicare-covered benefits to an enrollee with a "national average risk profile." That baseline payment amount is adjusted to reflect the health status of our enrolled membership. Under the risk-adjustment methodology, all MA plans must collect from providers and submit the necessary diagnosis code information from hospital inpatient, hospital outpatient, and physician providers to CMS within prescribed deadlines. The CMS risk-adjustment model uses the diagnosis data to calculate the risk-adjusted premium payment to MA plans, which CMS adjusts for coding pattern differences between the health plans and the government fee-for-service program. We generally rely on providers, including certain providers in our network who are our employees, to code their claim submissions with appropriate diagnoses, which we send to CMS as the basis for our payment received from CMS under the actuarial risk-adjustment model. We also rely on these providers to document appropriately all medical data, including the diagnosis data submitted with claims. In addition, we conduct medical record reviews as part of our data and payment accuracy compliance efforts, to more accurately reflect diagnosis conditions under the risk adjustment model. These compliance efforts
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include the internal contract level audits described in more detail below, as well as ordinary course reviews of our internal business processes.
CMS is phasing-in the process of calculating risk scores using diagnoses data from the Risk Adjustment Processing System, or RAPS, to diagnoses data from the Encounter Data System, or EDS. The RAPS process requires MA plans to apply a filter logic based on CMS guidelines and only submit diagnoses that satisfy those guidelines. For submissions through EDS, CMS requires MA plans to submit all the encounter data and CMS will apply the risk adjustment filtering logic to determine the risk scores. For 2019, 25%2020, 50% of the risk score was calculated from claims data submitted through EDS. CMS increased that percentage to 50% in 202075% for 2021 and will increase that percentage to 75% in 2021. For 2022, CMS has proposed to calculate risk scores for payment to MA organizations using only risk adjustment eligible diagnoses identified from EDS data completingcomplete the phased-in transition from RAPS to EDS.EDS by using only EDS data to calculate risk scores in 2022. The phase-in from RAPS to EDS could result in different risk scores from each dataset as a result of plan processing issues, CMS processing issues, or filtering logic differences between RAPS and EDS, and could have a material adverse effect on our results of operations, financial position, or cash flows.
CMS and the Office of the Inspector General of Health and Human Services, or HHS-OIG, are continuing to perform audits of various companies’ selected MA contracts related to this risk adjustment diagnosis data. We refer to these audits as Risk-Adjustment Data Validation Audits, or RADV audits. RADV audits review medical records in an attempt to validate provider medical record documentation and coding practices which influence the calculation of premium payments to MA plans.
In 2012, CMS released a “Notice of Final Payment Error Calculation Methodology for Part C Medicare Advantage Risk Adjustment Data Validation (RADV) Contract-Level Audits.” The payment error calculation methodology provided that, in calculating the economic impact of audit results for an MA contract, if any, the results of the RADV audit sample would be extrapolated to the entire MA contract after a comparison of the audit results to a similar audit of the government’s traditional fee-for-service Medicare program, or Medicare FFS. We
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refer to the process of accounting for errors in FFS claims as the "FFS Adjuster." This comparison of RADV audit results to the FFS error rate is necessary to determine the economic impact, if any, of RADV audit results because the government used the Medicare FFS program data set, including any attendant errors that are present in that data set, to estimate the costs of various health status conditions and to set the resulting adjustments to MA plans’ payment rates in order to establish actuarial equivalence in payment rates as required under the Medicare statute. CMS already makes other adjustments to payment rates based on a comparison of coding pattern differences between MA plans and Medicare FFS data (such as for frequency of coding for certain diagnoses in MA plan data versus the Medicare FFS program dataset).
The final RADV extrapolation methodology, including the first application of extrapolated audit results to determine audit settlements, is expected to be applied to CMS RADV contract level audits conducted for contract year 2011 and subsequent years. CMS is currently conducting RADV contract level audits for certain of our Medicare Advantage plans.
Estimated audit settlements are recorded as a reduction of premiums revenue in our consolidated statements of income, based upon available information. We perform internal contract level audits based on the RADV audit methodology prescribed by CMS. Included in these internal contract level audits is an audit of our Private Fee-For Service business which we used to represent a proxy of the FFS Adjuster which has not yet been finalized. We based our accrual of estimated audit settlements for each contract year on the results of these internal contract level audits and update our estimates as each audit is completed. Estimates derived from these results were not material to our results of operations, financial position, or cash flows. We report the results of these internal contract level audits to CMS, including identified overpayments, if any.
On October 26, 2018, CMS issued a proposed rule and accompanying materials (which we refer to as the “Proposed Rule”) related to, among other things, the RADV audit methodology described above. If implemented, the Proposed Rule would use extrapolation in RADV audits applicable to payment year 2011 contract-level audits and all subsequent audits, without the application of a FFS Adjuster to audit findings. We believe that the Proposed Rule fails to address adequately the statutory requirement of actuarial equivalence, and have provided substantive
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comments to CMS on the Proposed Rule as part of the notice-and-comment rulemaking process. Whether, and to what extent, CMS finalizes the Proposed Rule, and any related regulatory, industry or company reactions, could have a material adverse effect on our results of operations, financial position, or cash flows.
In addition, as part of our internal compliance efforts, we routinely perform ordinary course reviews of our internal business processes related to, among other things, our risk coding and data submissions in connection with the risk adjustment model. These reviews may also result in the identification of errors and the submission of corrections to CMS, that may, either individually or in the aggregate, be material. As such, the result of these reviews may have a material adverse effect on our results of operations, financial position, or cash flows.

We believe that CMS'CMS's statements and policies regarding the requirement to report and return identified overpayments received by MA plans are inconsistent with CMS'CMS's 2012 RADV audit methodology, and the Medicare statute's requirements. These statements and policies, such as certain statements contained in the preamble to CMS’CMS’s final rule release regarding Medicare Advantage and Part D prescription drug benefit program regulations for Contract Year 2015 (which we refer to as the "Overpayment Rule"), and the Proposed Rule, appear to equate each Medicare Advantage risk adjustment data error with an “overpayment” without addressing the principles underlying the FFS Adjuster referenced above. On September 7, 2018, the Federal District Court for the District of Columbia vacated CMS's Overpayment Rule, concluding that it violated the Medicare statute, including the requirement for actuarial equivalence, and that the Overpayment Rule was also arbitrary and capricious in departing from CMS's RADV methodology without adequate explanation (among other reasons). CMS has appealed the decision to the Circuit Court of Appeals.
We will continue to work with CMS to ensure that MA plans are paid accurately and that payment model principles are in accordance with the requirements of the Social Security Act, which, if not implemented correctly could have a material adverse effect on our results of operations, financial position, or cash flows.
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(Unaudited)
our total premiums and services revenue for the six months ended June 30, 2021 primarily consisted of serving members enrolled in Medicaid, and in certain circumstances members who qualify for both Medicaid and Medicare, under contracts with various states.
At SeptemberJune 30, 2020,2021, our military services business, which accounted for approximately 1% of our total premiums and services revenue for the ninesix months ended SeptemberJune 30, 2020,2021, primarily consisted of the TRICARE T2017 East Region contract. The T2017 East Region contract is a consolidation of the former T3 North and South Regions, comprising NaN32 states and approximately 6 million TRICARE beneficiaries, under which delivery of health care services commenced on January 1, 2018. The T2017 East Region contract is a 5-year contract set to expire on December 31, 2022 and is subject to renewals on January 1 of each year during its term at the government's option.
Our state-based Medicaid business accounted for approximately 5% of our total premiums and services revenue for the nine months ended September 30, 2020. In addition to our state-based Temporary Assistance for Needy Families, or TANF, Medicaid contracts in Florida and Kentucky, we have contracts in Florida for Long Term Support Services (LTSS), and in Illinois for stand-alone dual eligible demonstration programs serving individuals dually eligible for both the federal Medicare program and the applicable state-based Medicaid program.
The loss of any of the contracts above or significant changes in these programs as a result of legislative or regulatory action, including reductions in premium payments to us, regulatory restrictions on profitability, including reviews by regulatory bodies that may compare our Medicare Advantage profitability to our non-Medicare Advantage business profitability, or compare the profitability of various products within our Medicare Advantage business, and require that they remain within certain ranges of each other, or increases in member benefits or member eligibility criteria without corresponding increases in premium payments to us, may have a material adverse effect on our results of operations, financial position, and cash flows.

Legal Proceedings and Certain Regulatory Matters
As previously disclosed, the Civil Division of the United States Department of Justice provided us with an information request in December 2014, concerning our Medicare Part C risk adjustment practices. The request relates to our oversight and submission of risk adjustment data generated by providers in our Medicare Advantage network, as well as to our business and compliance practices related to risk adjustment data generated by our providers and by us, including medical record reviews conducted as part of our data and payment accuracy compliance efforts, the use of health and well-being assessments, and our fraud detection efforts. We believe that this request for information is in connection with a wider review of Medicare Risk Adjustment generally that
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includes a number of Medicare Advantage plans, providers and vendors. We continue to cooperate with the Department of Justice. These matters are expected to result in additional qui tam litigation.
As previously disclosed, on January 19, 2016, an individual filed a qui tam suit captioned United States of America ex rel. Steven Scott v. Humana, Inc., in United States District Court, Central District of California, Western Division. The complaint alleges certain civil violations by us in connection with the actuarial equivalence of the plan benefits under Humana’s Basic PDP plan, a prescription drug plan offered by us under Medicare Part D. The action seeks damages and penalties on behalf of the United States under the False Claims Act. The court ordered the qui tam action unsealed on September 13, 2017, so that the relator could proceed, following notice from the U.S. Government that it was not intervening at that time. On January 29, 2018, the suit was transferred to the United States District Court, Western District of Kentucky, Louisville Division. We take seriously our obligations to comply with applicable CMS requirements and actuarial standards of practice, and continue to vigorously defend against these allegations since the transfer to the Western District of Kentucky. We have substantially completed discovery with the relator who has pursued the matter on behalf of the United States following its unsealing, and expect the Court to consider our motion for summary judgment.
On November 2, 2017, we filed suit against the United States of America in the United States Court of Federal Claims, on behalf of our health plans seeking recovery from the federal government of approximately $611 million in payments under the risk corridor premium stabilization program established under Health Care Reform, for years 2014, 2015 and 2016. On April 27, 2020, the U.S. Supreme Court ruled that the government is obligated to pay the losses under this risk corridor program, and that Congress did not impliedly repeal the obligation under its appropriations riders. In September 2020, we received a $609 million payment from the U.S Government pursuant to the judgement issued by the Court of Federal Claims on July 7, 2020. The $609 million payment received from
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the U.S Government and approximately $31 million in related fees and expenses are reflected in "Premiums" revenue and "Operating costs", respectively, in our condensed consolidated statements of income for the three and nine months ended September 30, 2020.

Other Lawsuits and Regulatory Matters
    Our current and past business practices are subject to review or other investigations by various state insurance and health care regulatory authorities and other state and federal regulatory authorities. These authorities regularly scrutinize the business practices of health insurance, health care delivery and benefits companies. These reviews focus on numerous facets of our business, including claims payment practices, statutory capital requirements, provider contracting, risk adjustment, competitive practices, commission payments, privacy issues, utilization management practices, pharmacy benefits, access to care, and sales practices, among others. Some of these reviews have historically resulted in fines imposed on us and some have required changes to some of our practices. We continue to be subject to these reviews, which could result in additional fines or other sanctions being imposed on us or additional changes in some of our practices.
We also are involved in various other lawsuits that arise, for the most part, in the ordinary course of our business operations, certain of which may be styled as class-action lawsuits. Among other matters, this litigation may include employment matters, claims of medical malpractice, bad faith, nonacceptance or termination of providers, anticompetitive practices, improper rate setting, provider contract rate and payment disputes, including disputes over reimbursement rates required by statute, disputes arising from competitive procurement process, general contractual matters, intellectual property matters, and challenges to subrogation practices. Under state guaranty assessment laws, including those related to state cooperative failures in the industry, we may be assessed (up to prescribed limits) for certain obligations to the policyholders and claimants of insolvent insurance companies that write the same line or lines of business as we do.
As a government contractor, we may also be subject to qui tam litigation brought by individuals who seek to sue on behalf of the government, alleging that the government contractor submitted false claims to the government including, among other allegations, those resulting from coding and review practices under the Medicare risk adjustment model. Qui tam litigation is filed under seal to allow the government an opportunity to investigate and to decide if it wishes to intervene and assume control of the litigation. If the government does not intervene, the individual may continue to prosecute the action on his or her own, on behalf of the government. We also are subject to other allegations of nonperformance of contractual obligations to providers, members, and others, including failure to properly pay claims, improper policy terminations, challenges to our implementation of the Medicare Part D prescription drug program and other litigation.

A limited number of the claims asserted against us are subject to insurance coverage. Personal injury claims, claims for extra contractual damages, care delivery malpractice, and claims arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future.
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We record accruals for the contingencies discussed in the sections above to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters specifically described above because of the inherently unpredictable nature of legal proceedings, which also may be exacerbated by various factors, including: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the proceeding is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties (including where it is uncertain how liability, if any, will be shared among multiple defendants); or (vii) there is a wide range of potential outcomes.
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The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting judgments, penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities or as a result of actions by third parties. Nevertheless, it is reasonably possible that any such outcome of litigation, judgments, penalties, fines or other sanctions could be substantial, and the outcome of these matters may have a material adverse effect on our results of operations, financial position, and cash flows, and may also affect our reputation.

14. SEGMENT INFORMATION
We manage our business with 3 reportable segments: Retail, Group and Specialty, and Healthcare Services. The reportable segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer, the Chief Operating Decision Maker, to assess performance and allocate resources.
The Retail segment consists of Medicare benefits, marketed to individuals or directly via group Medicare accounts. In addition, the Retail segment also includes our contract with CMS to administer the Limited Income Newly Eligible Transition, or LI-NET, prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, which we refer to collectively as our state-based contracts. The Group and Specialty segment consists of employer group commercial fully-insured medical and specialty health insurance benefits marketed to individuals and employer groups, including dental, vision, and other supplemental health benefits, as well as administrative services only, or ASO products. In addition, our Group and Specialty segment includes our military services business, primarily our TRICARE T2017 East Region contract. The Healthcare Services segment includes our services offered to our health plan members as well as to third parties, including pharmacy solutions, provider services, and clinical care service, such as home health and other services and capabilities to promote wellness and advance population health, including our non-consolidating minority investment in Kindred at Home and the strategic partnership with WCAS to develop and operate senior-focused, payor-agnostic, primary care centers.
Our Healthcare Services intersegment revenues primarily relate to managing prescription drug coverage for members of our other segments through Humana Pharmacy Solutions®, or HPS, and includes the operations of Humana Pharmacy, Inc., our mail order pharmacy business. These revenues consist of the prescription price (ingredient cost plus dispensing fee), including the portion to be settled with the member (co-share) or with the government (subsidies), plus any associated administrative fees. Services revenues related to the distribution of prescriptions by third party retail pharmacies in our networks are recognized when the claim is processed and product revenues from dispensing prescriptions from our mail order pharmacies are recorded when the prescription or product is shipped. Our pharmacy operations, which are responsible for designing pharmacy benefits, including defining member co-share responsibilities, determining formulary listings, contracting with retail pharmacies, confirming member eligibility, reviewing drug utilization, and processing claims, act as a principal in the arrangement on behalf of members in our other segments. As principal, our Healthcare Services segment reports revenues on a gross basis, including co-share amounts from members collected by third party retail pharmacies at the point of service.
In addition, our Healthcare Services intersegment revenues include revenues earned by certain owned providers derived from risk-based and non-risk-based managed care agreements with our health plans. Under risk-based risk based
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agreements, the provider receives a monthly capitated fee that varies depending on the demographics and health status of the member, for each member assigned to these owned providers by our health plans. The owned provider assumes the economic risk of funding the assigned members’ healthcare services. Under non risk-based agreements, our health plans retain the economic risk of funding the assigned members' healthcare services. Our Healthcare Services segment reports provider services revenues associated with risk-based agreements on a gross basis, whereby capitation fee revenue is recognized in the period in which the assigned members are entitled to receive healthcare services. Provider services revenues associated with non-risk-based agreements are presented net of associated healthcare costs.
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We present our condensed consolidated results of operations from the perspective of the health plans. As a result, the cost of providing benefits to our members, whether provided via a third party provider or internally through a stand-alone subsidiary, is classified as benefits expense and excludes the portion of the cost for which the health plans do not bear responsibility, including member co-share amounts and government subsidies of $4.4 billion and $4.0 billion for the three months ended SeptemberJune 30, 20202021 and 2019,2020, respectively. For the ninesix months ended SeptemberJune 30, 20202021 and 20192020 these amounts were $11.9$8.0 billion and $10.7$7.4 billion, respectively. In addition, depreciation and amortization expense associated with certain businesses in our Healthcare Services segment delivering benefits to our members, primarily associated with our provider services and pharmacy operations, are included with benefits expense. The amount of this expense was $33$26 million and $32$31 million for the three months ended SeptemberJune 30, 20202021 and 2019,2020, respectively. For the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, the amount of this expense was $94$52 million and $92$61 million, respectively.
Other than those described previously, the accounting policies of each segment are the same and are described in Note 2 to the consolidated financial statements included in our 20192020 Form 10-K. Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and clinical care services, to our Retail and Group and Specialty segment customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations in the tables presenting segment results below.




















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Our segment results were as follows for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
ConsolidatedRetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Three months ended September 30, 2020(in millions)
Three months ended June 30, 2021Three months ended June 30, 2021(in millions)
External revenuesExternal revenuesExternal revenues
Premiums:Premiums:Premiums:
Individual Medicare AdvantageIndividual Medicare Advantage$12,949 $$$$12,949 Individual Medicare Advantage$14,585 $$$$14,585 
Group Medicare AdvantageGroup Medicare Advantage1,880 1,880 Group Medicare Advantage1,775 1,775 
Medicare stand-alone PDPMedicare stand-alone PDP622 622 Medicare stand-alone PDP662 662 
Total MedicareTotal Medicare15,451 15,451 Total Medicare17,022 17,022 
Fully-insuredFully-insured177 1,169 602 1,948 Fully-insured182 1,078 1,260 
SpecialtySpecialty424 424 Specialty432 432 
Medicaid and otherMedicaid and other1,081 1,081 Medicaid and other1,264 1,264 
Total premiumsTotal premiums16,709 1,593 602 18,904 Total premiums18,468 1,510 19,978 
Services revenue:Services revenue:Services revenue:
ProviderProvider107 107 Provider122 122 
ASO and otherASO and other189 193 ASO and other12 194 206 
PharmacyPharmacy157 157 Pharmacy163 163 
Total services revenueTotal services revenue189 264 457 Total services revenue12 194 285 491 
Total external revenuesTotal external revenues16,713 1,782 264 602 19,361 Total external revenues18,480 1,704 285 20,469 
Intersegment revenuesIntersegment revenuesIntersegment revenues
ServicesServices4,852 (4,861)Services10 4,977 (4,987)
ProductsProducts2,013 (2,013)Products2,261 (2,261)
Total intersegment revenuesTotal intersegment revenues6,865 (6,874)Total intersegment revenues10 7,238 (7,248)
Investment incomeInvestment income28 681 714 Investment income65 106 176 
Total revenuesTotal revenues16,741 1,794 7,131 (5,591)20,075 Total revenues18,545 1,718 7,524 (7,142)20,645 
Operating expenses:Operating expenses:Operating expenses:
BenefitsBenefits14,224 1,481 (94)15,611 Benefits16,068 1,247 (166)17,149 
Operating costsOperating costs1,877 452 6,871 (6,687)2,513 Operating costs1,533 409 7,205 (7,031)2,116 
Depreciation and amortizationDepreciation and amortization87 21 46 (26)128 Depreciation and amortization108 22 41 (27)144 
Total operating expensesTotal operating expenses16,188 1,954 6,917 (6,807)18,252 Total operating expenses17,709 1,678 7,246 (7,224)19,409 
Income (loss) from operations553 (160)214 1,216 1,823 
Income from operationsIncome from operations836 40 278 82 1,236 
Interest expenseInterest expense75 75 Interest expense79 79 
Other income, net(7)(7)
Other expense, netOther expense, net419 419 
Income (loss) before income taxes and equity in net earningsIncome (loss) before income taxes and equity in net earnings553 (160)214 1,148 1,755 Income (loss) before income taxes and equity in net earnings836 40 278 (416)738 
Equity in net earningsEquity in net earnings35 35 Equity in net earnings33 33 
Segment earnings (loss)Segment earnings (loss)$553 $(160)$249 $1,148 $1,790 Segment earnings (loss)$836 $40 $311 $(416)$771 
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(Unaudited)
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Three months ended June 30, 2020(in millions)
External revenues
Premiums:
Individual Medicare Advantage$13,005 $$$$13,005 
Group Medicare Advantage1,976 1,976 
Medicare stand-alone PDP731 731 
Total Medicare15,712 15,712 
Fully-insured169 1,208 1,377 
Specialty425 425 
Medicaid and other1,042 1,042 
Total premiums16,923 1,633 18,556 
Services revenue:
Provider105 105 
ASO and other192 198 
Pharmacy147 147 
Total services revenue192 252 450 
Total external revenues16,929 1,825 252 19,006 
Intersegment revenues
Services4,712 (4,718)
Products1,977 (1,977)
Total intersegment revenues6,689 (6,695)
Investment income32 41 77 
Total revenues16,961 1,835 6,941 (6,654)19,083 
Operating expenses:
Benefits13,251 1,094 (170)14,175 
Operating costs1,638 435 6,603 (6,322)2,354 
Depreciation and amortization83 19 46 (29)119 
Total operating expenses14,972 1,548 6,649 (6,521)16,648 
Income (loss) from operations1,989 287 292 (133)2,435 
Interest expense76 76 
Other income, net(227)(227)
Income before income taxes and equity in net earnings1,989 287 292 18 2,586 
Equity in net earnings25 25 
Segment earnings$1,989 $287 $317 $18 $2,611 
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(Unaudited)
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Six months ended June 30, 2021(in millions)
External revenues
Premiums:
Individual Medicare Advantage$29,400 $$$$29,400 
Group Medicare Advantage3,530 3,530 
Medicare stand-alone PDP1,326 1,326 
Total Medicare34,256 34,256 
Fully-insured360 2,177 2,537 
Specialty866 866 
Medicaid and other2,443 2,443 
Total premiums37,059 3,043 40,102 
Services revenue:
Provider237 237 
ASO and other17 384 401 
Pharmacy319 319 
Total services revenue17 384 556 957 
Total external revenues37,076 3,427 556 41,059 
Intersegment revenues
Services20 9,751 (9,771)
Products4,413 (4,413)
Total intersegment revenues20 14,164 (14,184)
Investment income117 127 254 
Total revenues37,193 3,455 14,722 (14,057)41,313 
Operating expenses:
Benefits32,367 2,392 (314)34,445 
Operating costs2,984 806 14,115 (13,782)4,123 
Depreciation and amortization212 43 81 (50)286 
Total operating expenses35,563 3,241 14,196 (14,146)38,854 
Income from operations1,630 214 526 89 2,459 
Interest expense147 147 
Other expense, net534 534 
Income (loss) before income taxes and equity in net earnings1,630 214 526 (592)1,778 
Equity in net earnings54 54 
Segment earnings (loss)$1,630 $214 $580 $(592)$1,832 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Three months ended September 30, 2019(in millions)
External revenues
Premiums:
Individual Medicare Advantage$10,752 $$$$10,752 
Group Medicare Advantage1,609 1,609 
Medicare stand-alone PDP781 781 
Total Medicare13,142 13,142 
Fully-insured150 1,278 1,428 
Specialty400 400 
Medicaid and other742 742 
Total premiums14,034 1,678 15,712 
Services revenue:
Provider136 136 
ASO and other200 204 
Pharmacy53 53 
Total services revenue200 189 393 
Total external revenues14,038 1,878 189 16,105 
Intersegment revenues
Services4,654 (4,658)
Products1,759 (1,759)
Total intersegment revenues6,413 (6,417)
Investment income50 79 136 
Total revenues14,088 1,889 6,602 (6,338)16,241 
Operating expenses:
Benefits12,050 1,448 (141)13,357 
Operating costs1,310 413 6,348 (6,182)1,889 
Depreciation and amortization89 24 43 (29)127 
Total operating expenses13,449 1,885 6,391 (6,352)15,373 
Income from operations639 211 14 868 
Interest expense62 62 
Other income, net(82)(82)
Income before income taxes and equity in net earnings639 211 34 888 
Equity in net earnings
Segment earnings$639 $$212 $34 $889 
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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
ConsolidatedRetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Nine months ended September 30, 2020(in millions)
External revenues
Six months ended June 30, 2020Six months ended June 30, 2020(in millions)
External RevenuesExternal Revenues
Premiums:Premiums:Premiums:
Individual Medicare AdvantageIndividual Medicare Advantage$38,748 $$$$38,748 Individual Medicare Advantage$25,799 $$$$25,799 
Group Medicare AdvantageGroup Medicare Advantage5,867 5,867 Group Medicare Advantage3,987 3,987 
Medicare stand-alone PDPMedicare stand-alone PDP2,108 2,108 Medicare stand-alone PDP1,486 1,486 
Total MedicareTotal Medicare46,723 46,723 Total Medicare31,272 31,272 
Fully-insuredFully-insured509 3,606 602 4,717 Fully-insured332 2,437 2,769 
SpecialtySpecialty1,278 1,278 Specialty854 854 
Medicaid and otherMedicaid and other3,104 3,104 Medicaid and other2,023 2,023 
Total premiumsTotal premiums50,336 4,884 602 55,822 Total premiums33,627 3,291 36,918 
Services revenue:Services revenue:Services revenue:
ProviderProvider316 316 Provider209 209 
ASO and otherASO and other14 576 590 ASO and other10 387 397 
PharmacyPharmacy425 425 Pharmacy268 268 
Total services revenueTotal services revenue14 576 741 1,331 Total services revenue10 387 477 874 
Total external revenuesTotal external revenues50,350 5,460 741 602 57,153 Total external revenues33,637 3,678 477 37,792 
Intersegment revenuesIntersegment revenuesIntersegment revenues
ServicesServices22 14,514 (14,536)Services13 9,662 (9,675)
ProductsProducts5,900 (5,900)Products3,887 (3,887)
Total intersegment revenuesTotal intersegment revenues22 20,414 (20,436)Total intersegment revenues13 13,549 (13,562)
Investment incomeInvestment income114 12 812 940 Investment income86 131 226 
Total revenuesTotal revenues50,464 5,494 21,157 (19,022)58,093 Total revenues33,723 3,700 14,026 (13,431)38,018 
Operating expenses:Operating expenses:Operating expenses:
BenefitsBenefits41,939 3,886 (410)45,415 Benefits27,715 2,405 (316)29,804 
Operating costsOperating costs5,047 1,316 20,274 (19,653)6,984 Operating costs3,170 864 13,403 (12,966)4,471 
Depreciation and amortizationDepreciation and amortization251 60 135 (84)362 Depreciation and amortization164 39 89 (58)234 
Total operating expensesTotal operating expenses47,237 5,262 20,409 (20,147)52,761 Total operating expenses31,049 3,308 13,492 (13,340)34,509 
Income from operations3,227 232 748 1,125 5,332 
Income (loss) from operationsIncome (loss) from operations2,674 392 534 (91)3,509 
Interest expenseInterest expense211 211 Interest expense136 136 
Other expense, netOther expense, net63 63 Other expense, net70 70 
Income before income taxes and equity in net earnings3,227 232 748 851 5,058 
Income (loss) before income taxes and equity in net earningsIncome (loss) before income taxes and equity in net earnings2,674 392 534 (297)3,303 
Equity in net earningsEquity in net earnings68 68 Equity in net earnings33 33 
Segment earnings$3,227 $232 $816 $851 $5,126 
Segment earnings (loss)Segment earnings (loss)$2,674 $392 $567 $(297)$3,336 

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Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)
(Unaudited)
RetailGroup and SpecialtyHealthcare
Services
Eliminations/
Corporate
Consolidated
Nine months ended September 30, 2019(in millions)
External Revenues
Premiums:
Individual Medicare Advantage$32,254 $$$$32,254 
Group Medicare Advantage4,867 4,867 
Medicare stand-alone PDP2,408 2,408 
Total Medicare39,529 39,529 
Fully-insured434 3,873 4,307 
Specialty1,160 1,160 
Medicaid and other2,143 2,143 
Total premiums42,106 5,033 47,139 
Services revenue:
Provider367 367 
ASO and other14 587 601 
Pharmacy135 135 
Total services revenue14 587 502 1,103 
Total external revenues42,120 5,620 502 48,242 
Intersegment revenues
Services13 13,456 (13,469)
Products5,128 (5,128)
Total intersegment revenues13 18,584 (18,597)
Investment income139 17 194 351 
Total revenues42,259 5,650 19,087 (18,403)48,593 
Operating expenses:
Benefits36,396 4,177 (405)40,168 
Operating costs3,664 1,232 18,371 (18,015)5,252 
Depreciation and amortization239 67 121 (84)343 
Total operating expenses40,299 5,476 18,492 (18,504)45,763 
Income from operations1,960 174 595 101 2,830 
Interest expense184 184 
Other income, net(217)(217)
Income before income taxes and equity in net earnings1,960 174 595 134 2,863 
Equity in net earnings16 16 
Segment earnings$1,960 $174 $611 $134 $2,879 

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Humana Inc.
ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The condensed consolidated financial statements of Humana Inc. in this document present the Company’s financial position, results of operations and cash flows, and should be read in conjunction with the following discussion and analysis. References to “we,” “us,” “our,” “Company,” and “Humana” mean Humana Inc. and its subsidiaries. This discussion includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in filings with the Securities and Exchange Commission, or SEC, in our press releases, investor presentations, and in oral statements made by or with the approval of one of our executive officers, the words or phrases like “believes,” “expects,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward–looking statements. These forward–looking statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions, including, among other things, information set forth in Item 1A. – Risk Factors in our 20192020 Form 10-K, as modified by any changes to those risk factors included in this document including the potential impacts of risks related to the spread of, and response to, the COVID-19 pandemic as further discussed in Part II of this report and in other reports we filed subsequent to February 20, 2020,18, 2021, in each case incorporated by reference herein. In making these statements, we are not undertaking to address or update such forward-looking statements in future filings or communications regarding our business or results. In light of these risks, uncertainties and assumptions, the forward–looking events discussed in this document might not occur. There may also be other risks that we are unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward–looking statements.
Executive Overview
General
Humana Inc., headquartered in Louisville, Kentucky, is a leading health and well-being company committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large. To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools, such as in home care, behavioral health, pharmacy services, data analytics and wellness solutions, combine to produce a simplified experience that makes health care easier to navigate and more effective.
Our industry relies on two key statistics to measure performance. The benefit ratio, which is computed by taking
total benefits expense as a percentage of premiums revenue, represents a statistic used to measure underwriting profitability. The operating cost ratio, which is computed by taking total operating costs, excluding depreciation and amortization, as a percentage of total revenue less investment income, represents a statistic used to measure administrative spending efficiency.
COVID-19Kindred at Home Acquisition
We have continuedOn April 27, 2021, we entered into a definitive agreement to take actions to protect, inform,acquire the remaining 60% interest in Kindred at Home, or KAH, the nation’s largest home health and carehospice provider, from TPG Capital, the private equity platform of global alternative asset firm, or TPG, and Welsh, Carson, Anderson & Stowe, or WCAS, two private equity funds, or the Sponsors, for an enterprise value of $8.1 billion, which includes our members, providers, employees, and other stakeholdersexisting equity value of $2.4 billion associated with our 40% minority ownership interest. KAH has locations in 40 states, providing extensive geographic coverage with approximately 65% overlap with our individual Medicare Advantage membership. The acquisition, which is expected to close in the outbreakthird quarter of 2021, is subject to customary state and federal regulatory approvals. We expect to fund the approximate $5.7 billion transaction (net of our existing equity stake) through a combination of parent company cash, debt financing, and the assumption of existing KAH indebtedness. A mark to market gain on our existing 40% ownership interest, currently expected to approximate $1 billion, will be recorded upon closing of the transaction.
COVID-19
The emergence and spread of the novel coronavirus, or COVID-19. Specifically, we have takenCOVID-19, beginning in the following actions to support our members:

waiving all cost sharing for in-network primary care, outpatient behavioral health, and telehealth visits for the remainderfirst quarter of 2020 forhas impacted our Medicare Advantage members, to reduce financial barriers to members seeking to re-engage with their providers, while continuing to encourage the usebusiness. During periods of telehealth;

delivering meals to our senior membersincreased incidences of COVID-19, non-essential care from a reduction in need;

making it easier for members to be tested for COVID-19 by offering at-home testing, as well as collaborating with other providers to deploy drive-thru testing at hundreds of sites throughout the country;
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mailing in-home screening kitsnon-COVID-19 hospital admissions and lower overall healthcare system consumption decreased utilization. Likewise COVID-19 treatment and testing cost increased utilization. The significant disruption in utilization during 2020 also impacted our ability to implement clinical initiatives to manage health care costs and chronic conditions of our members, to encourage members to seek preventative care that may have been delayed duringand appropriately document their risk profiles, and, as such, affecting our 2021 revenue under the pandemic;risk adjustment payment model for Medicare Advantage plans.

proactively delivering safety kits, including face masks, to members and employee homes to facilitate access to care and support visits to providers safely;

continuing to extend grace periods for premium payments for our fully-insured commercial group members, to ensure continuity of coverage during times of financial stress; and

establishing a clinical outreach team to proactively engage with our most vulnerable members.

In addition, we took steps to support our provider partners and boost system viability:
increasing provider funding, simplifying and expanding claims processing and releasing advanced funding to providers, to get reimbursement payments to providers as quickly as possible and ease financial concerns so that members are able to continue to access the care and information they need; and
expanding modifications to certain utilization management processes, to ease administrative stress and make sure providers are able to most efficiently care for their patients.
Finally, we continued to support the communities we serve by donating $200 million during the first half of 2020 to the Humana Foundation to address social determinants of health in an effort to promote more health days and encourage greater health equity.
The temporary deferral of non-essential care resulting from stay-at-home and physical distancing orders and other restrictions on movement and economic activity implemented throughout the country beginning in the second half of March 2020 to reduce the spread of the novel coronavirus, or COVID-19, has impacted our business. Hospital admissions and utilization were significantly depressed in April and increased throughout May and June. Utilization continued to rebound throughout the third quarter of 2020, reaching approximately 95% of historic baseline levels at the close of the third quarter. The impact of the deferral of non-essential care was partially offset by COVID-19 testing and treatment costs, as well as our ongoing pandemic relief efforts.

We significantly increased our liquidity position during March 2020 with the issuance of $1.1 billion in senior notes and a $1 billion draw under the prior one-year term loan bank commitment. At September 30, 2020, we held $2.4 billion of cash and short-term investments at our parent company and access to an additional $2.0 billion under our credit agreement.
For the remainder of 2020, we expect our year to date 2020 performance will be further offset by the impact of increasing utilization, COVID-19 testing and treatment costs and the continued support for our constituents. A number of significant variables and uncertainties will impact these trends including, among others, the severity and duration of the pandemic, continued actions taken to mitigate the spread of COVID-19 and in turn, relax those restrictions, the timing and degree in resumption of demand for deferred health care services, the ability of our commercial members to pay their premium, the nature, level and cost of diagnostic testing, the cost and timing of new therapeutic treatments and vaccines, all of which are difficult to predict.As such, our response to this global health crisis and the subsequent recovery will continue to evolve over the coming months to support the needs of our stakeholders.

Recent Transactions
In the first quarter of 2020, we purchased privately held Enclara, one of the nation’s largest hospice pharmacy and benefit management providers, for cash consideration of approximately $709 million, net of cash received.
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We have entered into a strategic partnership with WCAS to accelerate the expansion of our primary care model. The WCAS partnership is expected to open approximately 50 payor-agnostic, senior-focused primary care centers over 3 years beginning in 2020.
These transactions are more fully discussed in Note 3 to the condensed consolidated financial statements.
Business Segments
We manage our business with three reportable segments: Retail, Group and Specialty, and Healthcare Services. The reportable segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer, the Chief Operating Decision Maker, to assess performance and allocate resources.
The Retail segment consists of Medicare benefits, marketed to individuals or directly via group Medicare accounts. In addition, the Retail segment also includes our contract with CMS to administer the Limited Income Newly Eligible Transition, or LI-NET, prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, which we refer to collectively as our state-based contracts. The Group and Specialty segment consists of employer group commercial fully-insured medical and specialty health insurance benefits marketed to individuals and employer groups, including dental, vision, and other supplemental health benefits, as well as administrative services only, or ASO products. In addition, our Group and Specialty segment includes our military services business, primarily our TRICARE T2017 East Region contract. The Healthcare Services segment includes our services offered to our health plan members as well as to third parties, including pharmacy solutions, provider services, and clinical care service, such as home health and other services and capabilities to promote wellness and advance population health, including our non-consolidating minority investment in Kindred at Home and the strategic partnership with WCAS to develop and operate senior-focused, payor-agnostic, primary care centers.
The results of each segment are measured by segment earnings, and for our Healthcare Services Segment, also include equity in net earnings from our equity method investees. Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and clinical care services, to our Retail and Group and Specialty segment customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations.
Seasonality
COVID-19 disrupted the pattern of our quarterly earnings and operating cash flows largely due to the temporary deferral of non-essential care which resulted in reductions in non-COVID-19 hospital admissions and lower overall healthcare system utilization during higher levels of COVID-19 hospital admissions. Likewise, during periods of increased incidences of COVID-19, COVID-19 treatment and testing costs increase. Similar impacts and seasonal disruptions from either higher or lower utilization are expected to persist as we respond to and recover from the COVID-19 global health crisis.
One of the product offerings of our Retail segment is Medicare stand-alone prescription drug plans, or PDPs, under the Medicare Part D program. Our quarterly Retail segment earnings and operating cash flows are impacted by the Medicare Part D benefit design and changes in the composition of our membership. The Medicare Part D benefit design results in coverage that varies as a member’s cumulative out-of-pocket costs pass through successive
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stages of a member’s plan period, which begins annually on January 1 for renewals. These plan designs generally result in us sharing a greater portion of the responsibility for total prescription drug costs in the early stages and less in the latter stages. As a result, the PDP benefit ratio generally decreases as the year progresses. In addition, the number of low income senior members as well as year-over-year changes in the mix of membership in our stand-alonestandalone PDP products affects the quarterly benefit ratio pattern.
In addition, the Retail segment also experiences seasonality in the operating cost ratio as a result of costs incurred in the second half of the year associated with the Medicare marketing season.
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Our Group and Specialty segment also experiences seasonality in the benefit ratio pattern. However, the effect is opposite of Medicare stand-alone PDP in the Retail segment, with the Group and Specialty segment’s benefit ratio increasing as fully-insured members progress through their annual deductible and maximum out-of-pocket expenses.
20202021 Highlights
Our strategy offers our members affordable health care combined with a positive consumer experience in growing markets. At the core of this strategy is our integrated care delivery model, which unites quality care, high member engagement, and sophisticated data analytics. Our approach to primary, physician-directed care for our members aims to provide quality care that is consistent, integrated, cost-effective, and member-focused, provided by both employed physicians and physicians with network contract arrangements. The model is designed to improve health outcomes and affordability for individuals and for the health system as a whole, while offering our members a simple, seamless healthcare experience. We believe this strategy is positioning us for long-term growth in both membership and earnings. We offer providers a continuum of opportunities to increase the integration of care and offer assistance to providers in transitioning from a fee-for-service to a value-based arrangement. These include performance bonuses, shared savings and shared risk relationships. At SeptemberJune 30, 2020,2021, approximately 2,605,9002,914,300 members, or 66%67%, of our individual Medicare Advantage members were in value-based relationships under our integrated care delivery model, as compared to 2,340,6002,552,300 members, or 66%, at SeptemberJune 30, 2019.2020. Medicare Advantage and dual demonstration program membership enrolled in a Humana chronic care management program was 917,200947,400 at SeptemberJune 30, 2020,2021, an increase of 4%5.1% from 882,800901,000 at SeptemberJune 30, 2019.2020. These members may not be unique to each program since members have the ability to enroll in multiple programs. The increase is primarily driven by our improved process for identifying and enrolling members in the appropriate program at the right time, coupled with growth in Special Needs Plans, or SNP, membership.
In October, 2020, the Centers for Medicare and Medicaid Services, or CMS, issued its preliminary 2022 Medicare Advantage and Part D payment rates and proposed policy changes, collectively, the Advance Notice. CMS has invited public comment on the Advance Notice before publishing final rates on or before April 5, 2021, or the Final Notice, and indicated that the Final Notice may be published earlymembership, partially offset by improved predictive modeling leading to a reduction in light of the challenges posedmembers being managed by the uncertainty associated with the COVID-19 pandemic. In the Advance Notice, CMS estimates Medicare Advantage plans across the sector will, on average, experience a 2.82 percent increase in benchmark funding based on proposals included therein. As indicated by CMS, its estimate excludes the impact of fee-for-service county rebasing/re-pricing since the related impact is dependent upon finalization of certain data, which will be available with the publication of the Final Notice. Based on our preliminary analysis using the same factors CMS included in its estimate, the components of which are detailed on CMS’ website, we anticipate the proposals in the Advance Notice would result in a change generally in line with CMS’ estimate, with the exception of our Medicare Star Ratings for bonus year 2022, as more fully described below, that led our peers. We will be drawing upon our program expertise to provide CMS formal commentary on the impact of the Advance Notice and the related impact upon Medicare beneficiaries’ quality oflegacy care and service to our members through the Medicare Advantage program.
In October 2020, CMS published its updated Medicare Star Ratings for bonus year 2022.We have 4.1 million members, or approximately 92 percent of our Medicare Advantage membership as of September 2020, enrolled in 15 contracts that received a 4-star rating or above. In addition, we received a 5 out of 5-star rating for our CarePlus Health Plans, Inc. contract in Florida for the third consecutive year and received a 4.5-star rating for three Medicare Advantage contracts offered in 7 states, which cover approximately 796,000 members. Additionally, over 99 percent of retirees in our group Medicare Advantage plans remain in 4-star or above contracts for bonus year 2022. Our Star Ratings continue to reflect our focus on quality in both member experience and clinical outcomes.    management programs.
Net income was $1.3$588 million, or $4.55 per diluted common share, and $1.8 billion, or $10.05$13.75, for the three months ended June 30, 2021, and 2020, respectively. Net income was $1.4 billion, or $10.94 per diluted common share, and $2.3 billion, or $17.31 per diluted common share for the threesix months ended SeptemberJune 30, 2021, and 2020, or the 2020 quarter, compared to $689 million, or $5.14 per diluted common share, for the three months ended September 30, 2019, or the 2019 quarter, andrespectively. This comparison was $3.6 billion, or $27.37 per diluted
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common share, for the nine months ended September 30, 2020, or the 2020 period, compared to $2.2 billion, or $16.24 per diluted common share, for the nine months ended September 30, 2019, or the 2019 period. These comparisons were significantly impacted by the put/call valuation adjustments associated with certain equity method investments, the change in the fair value of publicly-traded equity securities, and transaction and integration costs associated with the net receipt of commercial risk corridor receivables previously written off, and thepending Kindred at Home acquisition. The put/call valuation adjustments associated with certain equity method investments. The change inincluded the fair value of our publicly-traded equity securities relates primarily to our common stock holdings, including both the gain resulting from the initial conversion of our prior ownership interest in certain privately held companies, primarily in Oak Street Health, Inc., or OSH, into common stock upon such companies' initial public offering, or IPO, during the third quarter of 2020, and the subsequent changes in the market value of such securities from their IPO through the endimpact of the period. In September 2020, we received $578 million, net of related fees and expenses pursuant to the U.S. Supreme Court ruling that the government is obligated to pay the losses under the risk corridor program. The receipttermination of the risk corridor payments was associated with losses incurred underput/call agreement related to Kindred at Home as a result of the Health Care Reform business in 2014 to 2016. The receipt of these risk corridor payments accounted for less than half of our accumulated losses before income taxes from this business during that time period.transaction announced on April 27, 2021. The impact of these adjustments to our consolidated income before income taxes and equity in net earnings and diluted earnings per common share was as follows for the 20202021 quarter and period.

For the three months ended September 30,For the nine months ended September 30,
2020201920202019
Consolidated income before income taxes and equity in net earnings:
Change in the fair value of publicly-traded equity securities$643 $— $643 $— 
Receipt of commercial risk corridor receivables previously written off, net578— 578— 
Put/call valuation adjustments782(63)217
Total$1,228 $82 $1,158 $217 
For the three months ended September 30,For the nine months ended September 30,
2020201920202019
Diluted earnings per common share:
Change in the fair value of publicly-traded equity securities$3.72 $— $3.73 $— 
Receipt of commercial risk corridor receivables previously written off, net3.35 — 3.35 — 
Put/call valuation adjustments0.03 0.47 (0.37)1.23 
Total$7.10 $0.47 $6.71 $1.23 

Excluding these adjustments, our results of operations reflect the impact of the ongoing COVID-19 pandemic. Utilization continued to rebound throughout the 2020 quarter, reaching approximately 95% of historic baseline levels by end of the third quarter. As such, our 2020 quarter results of operations comparisons were impacted by increasing utilization, COVID-19 testing and treatment costs, as well as the financial impact of our ongoing crisis relief efforts. Our 2020 period results reflect historically low utilization levels in the first six months of the year from the temporary deferral of non-essential care amid the COVID-19 pandemic.
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For the three months ended June 30,For the six months ended June 30,
2021202020212020
Consolidated income before income taxes and equity in net earnings:
Change in the fair value of publicly-traded equity securities$63 $— $(22)$— 
Transaction and integration costs associated with pending KAH acquisition(22)— (22)— 
Put/call valuation adjustments(419)227 (534)(70)
Total$(378)$227 $(578)$(70)
For the three months ended June 30,For the six months ended June 30,
2021202020212020
Diluted earnings per common share:
Change in the fair value of publicly-traded equity securities$0.37 $— $(0.13)$— 
Transaction and integration costs associated with pending KAH acquisition(0.13)— (0.13)— 
Put/call valuation adjustments(2.49)1.32 (3.18)(0.40)
Total$(2.25)$1.32 $(3.44)$(0.40)

These changesExcluding these adjustments, comparisons of our results of operations were materially impacted by the significant, temporary deferral of care in 2020 resulting from stay-at-home orders, physical distancing measures, and other restrictions implemented to reduce the spread of COVID-19, as well as the impact of COVID-19 testing and treatment costs, which on a net basis significantly and favorably impacted the 2020 quarter and period results when compared to the 2021 quarter and period results.

In addition, our results of operations for 2021 were favorably impacted by individual Medicare Advantage and state-based contract membership growth and improved operating performance in the Group and Specialty and Healthcare Services segments. Further, 2021 was also favorably impacted by the lower tax rate resulting from the termination of the non-deductible health insurance industry fee in 2021, as well as a lower number of shares used to compute dilutive earnings per common share, primarily reflecting share repurchases completed during 2019, partially offset by a higher tax rate resulting from the return of the non-deductible health insurance industry free in 2020.repurchases.

Contributing to our Retail segment revenue growth was our individual Medicare Advantage membership, which increased 382,600 members, or 10.8%, from September 30, 2019 to September 30, 2020.
Our operating cash flows for the 2020 period of $5.4 billion increased from the 2019 period of $4.8 billion primarily due primarily to higher income from operations.
Health Care Reform
The Health Care Reform Law enacted significant reforms to various aspects of the U.S. health insurance industry. Certain significant provisions of the Health Care Reform Law include, among others, mandated coverage requirements, mandated benefits and guarantee issuance associated with commercial medical insurance, rebates to policyholders based on minimum benefit ratios, adjustments to Medicare Advantage premiums, the establishment of federally facilitated or state-based exchanges coupled with programs designed to spread risk among insurers, and the introduction of plan designs based on set actuarial values. In addition, the Health Care Reform Law established insurance industry assessments, including an annual health insurance industry fee. The annual health insurance industry fee, which was suspended in 2019, but has resumed for calendar year 2020, is not deductible for income tax purposes and significantly increasesincreased our effective tax rate. We paid the federal government $1.2 billionrate, was in Septembereffect for 2020, for this fee. Under current law, the health industry fee will bebut was permanently repealed beginning in calendar year 2021.
It is reasonably possible that the Health Care Reform Law and related regulations, as well as other current or future legislative, judicial or regulatory changes such as the Families First Coronavirus Response Act (the "Families First Act"), the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") and other legislative andor regulatory changes associated withaction taken in response to COVID-19 including restrictions on our ability to manage our provider
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network or otherwise operate our business, or restrictions on profitability, including reviews by regulatory bodies that may compare our Medicare Advantage profitability to our non-Medicare Advantage business profitability, or compare the profitability of various products within our Medicare Advantage business, and require that they remain within certain ranges of each other, increases in member benefits or changes to member eligibility criteria without corresponding increases in premium payments to us, or increases in regulation of our prescription drug benefit businesses, in the aggregate may have a material adverse effect on our results of operations (including restricting revenue, enrollment and premium growth in certain products and market segments, restricting our ability to expand into new markets, increasing our medical and operating costs, further lowering our Medicare payment rates and increasing our expenses associated with assessments); our financial position (including our ability to maintain the value of our goodwill); and our cash flows.
We intend for the discussion of our financial condition and results of operations that follows to assist in the understanding of our financial statements and related changes in certain key items in those financial statements from year to year, including the primary factors that accounted for those changes. Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and clinical care services, to our Retail and Group and Specialty segment customers and are described in Note 14 to the condensed consolidated financial statements included in this report.





















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Comparison of Results of Operations for 20202021 and 20192020
The following discussion primarily deals with our results of operations for the three months ended SeptemberJune 30, 2021, or the 2021 quarter, and the three months ended June 30, 2020, or the 2020 quarter, the six months ended June 30, 2021, or the 2021 period, and the threesix months ended September 30, 2019, or the 2019 quarter, the nine months ended SeptemberJune 30, 2020, or the 2020 period, and the nine months ended September 30, 2019, or the 2019 period.
Consolidated
For the three months ended September 30,ChangeFor the three months ended June 30,Change
20202019DollarsPercentage20212020DollarsPercentage
(dollars in millions, except per common share results)(dollars in millions, except per common share results)
Revenues:Revenues:Revenues:
Premiums:Premiums:Premiums:
RetailRetail$16,709 $14,034 $2,675 19.1 %Retail$18,468 $16,923 $1,545 9.1 %
Group and SpecialtyGroup and Specialty1,593 1,678 (85)(5.1)%Group and Specialty1,510 1,633 (123)(7.5)%
Corporate602 — 602 100.0 %
Total premiumsTotal premiums18,904 15,712 3,192 20.3 %Total premiums19,978 18,556 1,422 7.7 %
Services:Services:Services:
RetailRetail— — %Retail12 100.0 %
Group and SpecialtyGroup and Specialty189 200 (11)(5.5)%Group and Specialty194 192 1.0 %
Healthcare ServicesHealthcare Services264 189 75 39.7 %Healthcare Services285 252 33 13.1 %
Total servicesTotal services457 393 64 16.3 %Total services491 450 41 9.1 %
Investment incomeInvestment income714 136 578 425.0 %Investment income176 77 99 128.6 %
Total revenuesTotal revenues20,075 16,241 3,834 23.6 %Total revenues20,645 19,083 1,562 8.2 %
Operating expenses:Operating expenses:Operating expenses:
BenefitsBenefits15,611 13,357 2,254 16.9 %Benefits17,149 14,175 2,974 21.0 %
Operating costsOperating costs2,513 1,889 624 33.0 %Operating costs2,116 2,354 (238)(10.1)%
Depreciation and amortizationDepreciation and amortization128 127 0.8 %Depreciation and amortization144 119 25 21.0 %
Total operating expensesTotal operating expenses18,252 15,373 2,879 18.7 %Total operating expenses19,409 16,648 2,761 16.6 %
Income from operationsIncome from operations1,823 868 955 110.0 %Income from operations1,236 2,435 (1,199)(49.2)%
Interest expenseInterest expense75 62 13 21.0 %Interest expense79 76 3.9 %
Other income, net(7)(82)(75)(91.5)%
Other expense (income), netOther expense (income), net419 (227)646 284.6 %
Income before income taxes and equity in net earningsIncome before income taxes and equity in net earnings1,755 888 867 97.6 %Income before income taxes and equity in net earnings738 2,586 (1,848)(71.5)%
Provision for income taxesProvision for income taxes450 200 250 125.0 %Provision for income taxes183 783 (600)(76.6)%
Equity in net earningsEquity in net earnings35 34 3,400.0 %Equity in net earnings33 25 32.0 %
Net incomeNet income$1,340 $689 $651 94.5 %Net income$588 $1,828 $(1,240)(67.8)%
Diluted earnings per common shareDiluted earnings per common share$10.05 $5.14 $4.91 95.5 %Diluted earnings per common share$4.55 $13.75 $(9.20)(66.9)%
Benefit ratio (a)
Benefit ratio (a)
82.6 %85.0 %(2.4)%
Benefit ratio (a)
85.8 %76.4 %9.4 %
Operating cost ratio (b)
Operating cost ratio (b)
13.0 %11.7 %1.3 %
Operating cost ratio (b)
10.3 %12.4 %(2.1)%
Effective tax rateEffective tax rate25.2 %22.5 %2.7 %Effective tax rate23.7 %30.0 %(6.3)%
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For the nine months ended
September 30,
ChangeFor the six months ended
June 30,
Change
20202019DollarsPercentage20212020DollarsPercentage
(dollars in millions, except per common share results)(dollars in millions, except per common share results)
Revenues:Revenues:Revenues:
Premiums:Premiums:Premiums:
RetailRetail$50,336 $42,106 $8,230 19.5 %Retail$37,059 $33,627 $3,432 10.2 %
Group and SpecialtyGroup and Specialty4,884 5,033 (149)(3.0)%Group and Specialty3,043 3,291 (248)(7.5)%
Corporate602 — 602 100.0 %
Total premiumsTotal premiums55,822 47,139 8,683 18.4 %Total premiums40,102 36,918 3,184 8.6 %
Services:Services:Services:
RetailRetail14 14 — — %Retail17 10 70.0 %
Group and SpecialtyGroup and Specialty576 587 (11)(1.9)%Group and Specialty384 387 (3)(0.8)%
Healthcare ServicesHealthcare Services741 502 239 47.6 %Healthcare Services556 477 79 16.6 %
Total servicesTotal services1,331 1,103 228 20.7 %Total services957 874 83 9.5 %
Investment incomeInvestment income940 351 589 167.8 %Investment income254 226 28 12.4 %
Total revenuesTotal revenues58,093 48,593 9,500 19.6 %Total revenues41,313 38,018 3,295 8.7 %
Operating expenses:Operating expenses:Operating expenses:
BenefitsBenefits45,415 40,168 5,247 13.1 %Benefits34,445 29,804 4,641 15.6 %
Operating costsOperating costs6,984 5,252 1,732 33.0 %Operating costs4,123 4,471 (348)(7.8)%
Depreciation and amortizationDepreciation and amortization362 343 19 5.5 %Depreciation and amortization286 234 52 22.2 %
Total operating expensesTotal operating expenses52,761 45,763 6,998 15.3 %Total operating expenses38,854 34,509 4,345 12.6 %
Income from operationsIncome from operations5,332 2,830 2,502 88.4 %Income from operations2,459 3,509 (1,050)(29.9)%
Interest expenseInterest expense211 184 27 14.7 %Interest expense147 136 11 8.1 %
Other expense (income), net63 (217)280 129.0 %
Other expense, netOther expense, net534 70 464 662.9 %
Income before income taxes and equity in net earningsIncome before income taxes and equity in net earnings5,058 2,863 2,195 76.7 %Income before income taxes and equity in net earnings1,778 3,303 (1,525)(46.2)%
Provision for income taxesProvision for income taxes1,485 684 801 117.1 %Provision for income taxes416 1,035 (619)(59.8)%
Equity in net earningsEquity in net earnings68 16 52 325.0 %Equity in net earnings54 33 21 63.6 %
Net incomeNet income$3,641 $2,195 $1,446 65.9 %Net income$1,416 $2,301 $(885)(38.5)%
Diluted earnings per common shareDiluted earnings per common share$27.37 $16.24 $11.13 68.5 %Diluted earnings per common share$10.94 $17.31 $(6.37)(36.8)%
Benefit ratio (a)
Benefit ratio (a)
81.4 %85.2 %(3.8)%
Benefit ratio (a)
85.9 %80.7 %5.2 %
Operating cost ratio (b)
Operating cost ratio (b)
12.2 %10.9 %1.3 %
Operating cost ratio (b)
10.0 %11.8 %(1.8)%
Effective tax rateEffective tax rate29.0 %23.8 %5.2 %Effective tax rate22.7 %31.0 %(8.3)%
(a)Represents benefits expense as a percentage of premiums revenue.
(b)Represents operating costs as a percentage of total revenues less investment income.







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Premiums Revenue
Consolidated premiums increased $3.2$1.4 billion, or 20.3%7.7%, from $15.7 billion in the 2019 quarter to $18.9$18.6 billion in the 2020 quarter and increased $8.7 billion, or 18.4%, from $47.1to $20.0 billion in the 2019 period to $55.82021 quarter and increased $3.2 billion, or 8.6%, from $36.9 billion in the 2020 period to $40.1 billion in the 2021 period. These increases were primarily due to higher premiums in the Retail segment, mainly resulting fromindividual Medicare Advantage and state-based contracts membership growth, as well as higher per member individual Medicare Advantage premiums andas a result of the receiptimproving CMS benchmark rate for 2021, net of commercial risk corridor receivables previously written off,Medicare Risk Adjustment, or MRA, headwinds resulting from COVID-19 related utilization disruption in 2020. These increases were partially offset by the impact of declining stand-alone PDP, membership as more fully describedgroup commercial medical, and group Medicare Advantage membership. The 2021 period was further impacted by the Medicare sequestration relief in the detailed segment results discussionfirst quarter of 2021 that follows.was not enacted until the second quarter of 2020.
Consolidated services revenue increased $64$41 million, or 16.3%9.1%, from $393 million in the 2019 quarter to $457$450 million in the 2020 quarter to $491 million in the 2021 quarter and increased $228$83 million, or 20.7%9.5%, from $1.1 billion in the 2019 period to $1.3 billion$874 million in the 2020 period to $957 million in the 2021 period. These increases were were primarily due to an increase in services revenue in the Healthcare Services segmenthigher revenues associated with higher externalour pharmacy and provider businesses. The 2021 period further reflects additional pharmacy revenues resulting fromassociated with the acquisition of Enclara acquisition inwhich was closed during the first quarter of 2020.
Investment Income
Investment income increased $578$99 million, or 425.0%128.6%, from $136 million in the 2019 quarter to $714$77 million in the 2020 quarter and increased $589 million, or 167.8%, from $351to $176 million in the 2019 period to $9402021 quarter primarily reflecting changes in the fair value of our common stock investments and higher realized capital gains, partially offset by lower average invested balances. Investment income increased $28 million, or 12.4%, from $226 million in the 2020 period. These increases were primarily dueperiod to $254 million in the $643 million change2021 period primarily reflecting higher realized capital gains, partially offset by changes inthe fair value of publicly-traded equity securities during the 2020 quarter.our common stock investments and lower average invested balances.
Benefit Expense
Consolidated benefits expense increased $2.3$3.0 billion, or 16.9%21.0%, from $13.4 billion in the 2019 quarter to $15.6$14.2 billion in the 2020 quarter and increased $5.2 billion, or 13.1%, from $40.2to $17.1 billion in the 2019 period to $45.42021 quarter and increased $4.6 billion, or 15.6%, from $29.8 billion in the 2020 period to $34.4 billion in the 2021 period. The consolidated benefit ratio decreased 240increased 940 basis points from 85.0% for the 2019 quarter to 82.6%76.4% for the 2020 quarter to 85.8% for the 2021 quarter and decreased 380increased 520 basis points from 85.2% for the 2019 period to 81.4%80.7% for the 2020 period to 85.9% for the 2021 period. These comparisonsincreases reflect the receiptsignificant impact of the commercial risk corridor receivables previously written off, the changedeferral of non-essential care, net of COVID-19 treatment and testing costs and our pandemic relief efforts in quarterly utilization patterns from2020, amid the COVID-19 pandemic, and the reinstatementtermination in 2021 of the non-deductible health insurance industry fee in 2020 thatwhich, along with a portion of the related tax benefit, was contemplated in the pricing and benefit design of our products.Tproducts. The increases were also due to the impact in 2021 ahesessociated with the competitive nature of the group Medicare Advantage business, particularly in large group accounts that were recently procured, as well as in the stand-alone PDP business. These factors were were partially offset by COVID-19 testing and treatment costs along with our ongoing pandemic relief efforts.higher favorable prior-period medical claims reserve development in 2021.

The higher favorable prior-period medical claims reserve development was primarily attributable to the reversal of actions taken in 2020, including the suspension of certain financial recovery programs for a period of time. The suspension during 2020 was intended to provide financial and administrative relief for provider facing unprecedented strain as a result of the COVID-19 pandemic. The favorable prior-period medical claims reserve development decreased the consolidated benefit ratio by approximately 2080 basis points in the 20202021 quarter versuswhereas the unfavorable prior-period medical claims reserve development increased the consolidated benefit ratio by approximately 4030 basis points in the 20192020 quarter. The favorable prior-period medical claims reserve development decreased the consolidated benefit ratio by approximately 50180 basis points in the 2021 period versus approximately 60 basis points in the 2020 period versus approximately 70 basis points in the 2019 period.

Operating Costs
Our segments incur both direct and shared indirect operating costs. We allocate the indirect costs shared by the segments primarily as a function of revenues. As a result, the profitability of each segment is interdependent.
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Consolidated operating costs increased $624decreased $238 million, or 33.0%10.1%, from $1.9 billion in the 2019 quarter to $2.5$2.4 billion in the 2020 quarter and increased $1.7 billion, or 33.0% from $5.3to $2.1 billion in the 2019 period to $7.02021 quarter and decreased $348 million, or 7.8%, from $4.5 billion in the 2020 period.
to $4.1 billion in the 2021 period. The consolidated operating cost ratio increased 130decreased 210 basis points from 11.7% for the 2019 quarter to 13.0%12.4% for the 2020 quarter to 10.3% for the 2021 quarter and increased 130decreased 180 basis points from 10.9% for the 2019 period to 12.2%11.8% for the 2020 period to 10.0% for the 2021 period. These increasesdecreases were primarily due to the reinstatementtermination of the non-deductible health insurance industry fee in 2021, the impact of a $150 million contribution in the 2020 quarter to the Humana Foundation to support communities served by us particularly those with social and health disparities, as well as the impact of lower COVID-19 related administrative costs including thosein 2021 compared to 2020. Administrative costs in 2020 included costs associated with purchasing personal protective equipment, for our clinicians, member response efforts, and the build-out of infrastructure necessary to support employees working remotely. These increasesdecreases were partially offsetfurther impacted by scale efficiencies associated with growth in our Medicare Advantage membership significantand operating cost efficiencies in the 2020 quarter driven2021 from previously implemented productivity initiatives. These factors were partially offset by previously disclosed
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productivity initiatives, charges associated with workforce optimization in the 2019 quarter that did not recur in the 2020 quarter, and the net impact of the receipt of the commercial risk corridor receivables previously written off. The 2020 period was further impacted by a $200 million contribution during the first half of 2020continued strategic investments made to the Humana Foundation to support the communities served byposition us particularly those with social and health disparities.for long-term success. The non-deductible health insurance industry fee impacted the operating cost ratio by 150 basis points in the 2020 quarter and period.      by 160 basis points in the 2020 period.
Depreciation and Amortization
Depreciation and amortization increased $1$25 million, or 0.8%21.0%, from $127 million in the 2019 quarter to $128$119 million in the 2020 quarter and increased $19 million, or 5.5%, from $343to $144 million in the 2019 period to $3622021 quarter and increased $52 million, or 22.2%, from $234 million in the 2020 period.period to $286 million in the 2021 period primarily due to capital expenditures.
Interest Expense
Interest expense increased $13$3 million, or 21.0%3.9%, from $62 million in the 2019 quarter to $75$76 million in the 2020 quarter and increased $27 million, or 14.7%, from $184to $79 million in the 2019 period to $2112021 quarter and increased $11 million, or 8.1%, from $136 million in the 2020 period to $147 million in the 2021 period.
Income Taxes
The effective income tax rate was 25.2%23.7% and 29.0%30.0% for the three and nine months ended SeptemberJune 30, 2021, and 2020, respectively compared to 22.5% and 23.8%was 22.7% and 31.0% for the three and ninesix months ended SeptemberJune 30, 2019,2021, and 2020, respectively. These increasesThe decreases were primarily due to the reinstatementtermination of the non-deductible health insurance industry fee in 2020.2021.
Retail Segment
September 30,Change June 30,Change
20202019MembersPercentage 20212020MembersPercentage
Membership:Membership:Membership:
Medical membership:Medical membership:Medical membership:
Individual Medicare AdvantageIndividual Medicare Advantage3,935,100 3,552,500 382,600 10.8 %Individual Medicare Advantage4,341,600 3,877,200 464,400 12.0 %
Group Medicare AdvantageGroup Medicare Advantage612,000 523,900 88,100 16.8 %Group Medicare Advantage557,300 608,300 (51,000)(8.4)%
Medicare stand-alone PDPMedicare stand-alone PDP3,892,200 4,379,800 (487,600)(11.1)%Medicare stand-alone PDP3,653,100 3,888,400 (235,300)(6.1)%
Total Retail MedicareTotal Retail Medicare8,439,300 8,456,200 (16,900)(0.2)%Total Retail Medicare8,552,000 8,373,900 178,100 2.1 %
State-based Medicaid730,100 469,000 261,100 55.7 %
State-based Medicaid and otherState-based Medicaid and other877,300 689,200 188,100 27.3 %
Medicare SupplementMedicare Supplement331,300 286,600 44,700 15.6 %Medicare Supplement330,400 324,600 5,800 1.8 %
Total Retail medical membersTotal Retail medical members9,500,700 9,211,800 288,900 3.1 %Total Retail medical members9,759,700 9,387,700 372,000 4.0 %
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For the three months ended September 30,ChangeFor the three months ended June 30,Change
20202019DollarsPercentage20212020DollarsPercentage
(in millions)(in millions)
Premiums and Services Revenue:Premiums and Services Revenue:Premiums and Services Revenue:
Premiums:Premiums:Premiums:
Individual Medicare AdvantageIndividual Medicare Advantage$12,949 $10,752 $2,197 20.4 %Individual Medicare Advantage$14,585 $13,005 $1,580 12.1 %
Group Medicare AdvantageGroup Medicare Advantage1,880 1,609 271 16.8 %Group Medicare Advantage1,775 1,976 (201)(10.2)%
Medicare stand-alone PDPMedicare stand-alone PDP622 781 (159)(20.4)%Medicare stand-alone PDP662 731 (69)(9.4)%
Total Retail MedicareTotal Retail Medicare15,451 13,142 2,309 17.6 %Total Retail Medicare17,022 15,712 1,310 8.3 %
State-based Medicaid1,081 742 339 45.7 %
State-based Medicaid and otherState-based Medicaid and other1,264 1,042 222 21.3 %
Medicare SupplementMedicare Supplement177 150 27 18.0 %Medicare Supplement182 169 13 7.7 %
Total premiumsTotal premiums16,709 14,034 2,675 19.1 %Total premiums18,468 16,923 1,545 9.1 %
ServicesServices— — %Services12 100.0 %
Total premiums and services revenueTotal premiums and services revenue16,713 $14,038 $2,675 19.1 %Total premiums and services revenue18,480 $16,929 $1,551 9.2 %
Segment earningsSegment earnings$553 $639 $(86)(13.5)%Segment earnings$836 $1,989 $(1,153)(58.0)%
Benefit ratioBenefit ratio85.1 %85.9 %(0.8)%Benefit ratio87.0 %78.3 %8.7 %
Operating cost ratioOperating cost ratio11.2 %9.3 %1.9 %Operating cost ratio8.3 %9.7 %(1.4)%

For the nine months ended
September 30,
Change
20202019DollarsPercentage
(in millions)
Premiums and Services Revenue:
Premiums:
Individual Medicare Advantage$38,748 $32,254 $6,494 20.1 %
Group Medicare Advantage5,867 4,867 1,000 20.5 %
Medicare stand-alone PDP2,108 2,408 (300)(12.5)%
Total Retail Medicare46,723 39,529 7,194 18.2 %
State-based Medicaid3,104 2,143 961 44.8 %
Medicare Supplement509 434 75 17.3 %
Total premiums50,336 42,106 8,230 19.5 %
Services14 14 — — %
Total premiums and services revenue$50,350 $42,120 $8,230 19.5 %
Segment earnings$3,227 $1,960 $1,267 64.6 %
Benefit ratio83.3 %86.4 %(3.1)%
Operating cost ratio10.0 %8.7 %1.3 %

For the six months ended
June 30,
Change
20212020DollarsPercentage
(in millions)
Premiums and Services Revenue:
Premiums:
Individual Medicare Advantage$29,400 $25,799 $3,601 14.0 %
Group Medicare Advantage3,530 3,987 (457)(11.5)%
Medicare stand-alone PDP1,326 1,486 (160)(10.8)%
Total Retail Medicare34,256 31,272 2,984 9.5 %
State-based Medicaid and other2,443 2,023 420 20.8 %
Medicare Supplement360 332 28 8.4 %
Total premiums37,059 33,627 3,432 10.2 %
Services17 10 70.0 %
Total premiums and services revenue$37,076 $33,637 $3,439 10.2 %
Segment earnings$1,630 $2,674 $(1,044)(39.0)%
Benefit ratio87.3 %82.4 %4.9 %
Operating cost ratio8.0 %9.4 %(1.4)%
Segment Earnings
Retail segment earnings decreased $86 million, or 13.5%, from $639 million in the 2019 quarter to $553 million in the 2020 quarter primarily due to a higher operating cost ratio, partially offset by a lower benefit ratio as more fully described below. Retail segment earnings increased $1.3$1.2 billion, or 64.6%58.0%, from $2.0 billion in the 2019 period2020 quarter to $3.2$836 million in the 2021 quarter and decreased $1.0 billion, or 39.0%, from $2.7 billion in the 2020 period to $1.6 billion in the 2021 period. These decreases primarily dueresulted from the same factors that led to the net favorable impact of a lowersegment's higher benefit ratio, partially offset by a higherthe segment's lower operating cost ratio as more fully described below.
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Enrollment
Individual Medicare Advantage membership increased 382,600464,400 members, or 10.8%12.0%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 2020,2021, primarily due to membership additions associated with the previousmost recent Annual Election Period, or AEP, and Open Election Period, or OEP, for Medicare beneficiaries. The OEP sales period, which ranmembership growth was further impacted by continued enrollment resulting from January 1 to March 31, 2020 added approximately 30,000 members. Since the conclusion of the 2020 OEP, enrollment continued to increase due to special elections, age-ins, and Dual Eligible Special Need Plans, or D-SNP, members. The OEP sales period, which ran from January 1 to March 31, 2021 added approximately 36,000 members compared to the 2020 OEP that added approximately 30,000 members. Individual Medicare Advantage membership includes 391,100532,900 D-SNP members as of SeptemberJune 30, 2020,2021, a net increase of 110,400,167,600, or 39.3%45.9%, from 280,700365,300 as of SeptemberJune 30, 2019.2020.
Group Medicare Advantage membership increased 88,100,decreased 51,000, or 16.8%8.4%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 2020,2021, primarily due to the additionnet loss of acertain large accountaccounts in January 2020, along with net membership additions associated with the previous AEP for Medicare beneficiaries.January 2021, partially offset by continued growth in small group accounts.
Medicare stand-alone PDP membership decreased 487,600235,300 members, or 11.1%6.1%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 20202021, primarily reflecting netdue to anticipated declines duringas a result of the previous AEP for Medicare beneficiaries. The anticipated decline primarily resulted from terminations driven by premium and benefit adjustments experienced by members that were previously enrolled in our 2019 Humana Walmart Rx plan and the 2019 Humana Enhanced plan, which were consolidated into the Premier Rx plan in 2020. The expected PDP losses were partially offset by growth in the new low-price Humana Walmart Value Rx plan driven by both new sales and plan to plan changes.no longer being the low cost leader in 2021.
State-based Medicaid membership increased 261,100188,100 members, or 55.7%27.3%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 2020. This increase2021, primarily reflects the impact of discontinuing the reinsurance agreement with CareSource and the assumption of full financial risk for the existing Kentucky Medicaid contract as of January 1, 2020, as well asreflecting additional enrollment particularly in Florida, resulting from the current economic downturn due to the COVID-19 pandemic.pandemic, as well as the recently completed acquisition in Wisconsin.
Premiums Revenue
Retail segment premiums increased $2.7$1.5 billion, or 19.1%9.1%, from $14.0 billion in the 2019 quarter to $16.7$16.9 billion in the 2020 quarter and increased $8.2 billion, or 19.5%, from $42.1to $18.5 billion in the 2019 period to $50.32021 quarter and increased $3.4 billion, or 10.2%, from $33.6 billion in the 2020 period to $37.1 billion in the 2021 period. These increases were primarily reflectdue to higher premiums as a result of individual Medicare Advantage and state-based contracts membership growth and higher per member individual Medicare Advantage premiums.premiums as a result of the improving CMS benchmark rate for 2021, net of MRA headwinds resulting from COVID-19 related utilization disruption in 2020. These favorable items were partially offset by the decline in membership in our stand-alone PDP and group Medicare Advantage offerings. The 2021 period was further impacted by the Medicare sequestration relief in the first quarter of 2021 that was not enacted until the second quarter of 2020.
Benefits Expense
The Retail segment benefit ratio decreased 80increased 870 basis points from 85.9% for the 2019 quarter to 85.1%78.3% for the 2020 quarter to 87.0% for the 2021 quarter and increased 490 basis points from 82.4% for the 2020 period to 87.3% for the 2021 period. These increases were primarily due to the significant impact of the temporary deferral of non-essential care, net of COVID-19 treatment and testing costs and our pandemic relief efforts in the 2020 quarter, amid the COVID-19 pandemic, andpandemic. These comparisons were further impacted by the reinstatementtermination in 2021 of the non-deductible health insurance industry fee in 2020 which, along with a portion of the related tax benefit, was contemplated in the pricing and benefit design of our products. products, as well as the impact in 2021 associated with the competitive nature of the group Medicare Advantage business, particularly in large group accounts that were recently procured, as well as in the stand-alone PDP business. These factors were partially offset by COVID-19 testing and treatment costs, as well as our ongoing pandemic relief efforts, including the waiver of all cost sharing for in-network primary care, outpatient behavioral health, and telehealth visits for our Medicare Advantage members, continued delivery of meals to senior members in need, the distribution of in-home preventative screening kits to members, establishment of a clinical outreach team to proactively engage with our most vulnerable members, and various provider initiatives. The 2020 quarter was further impacted by a shift in Medicare membership mix due to the loss of stand-alone PDP members and significant growth in the Medicare Advantage membership as well as lowerhigher favorable prior-period medical claims reserve development. The benefit ratio for stand-alone PDP members generally decreases as the year progresses. The Retail segment benefit ratio decreased 310 basis points from 86.4% for the 2019 period to 83.3% for the 2020 period primarily reflecting significantly depressed utilization experienced in the first
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half of 2020 as well as the same factors as discussed above with the exception of the impact from a shift in Medicare membership mix.
The Retail segment's benefits expense for the 20202021 quarter included $30includes $156 million in favorable prior-period medical claims reserve development versus $55$33 million in unfavorable prior-period medical claims development in the 20192020 quarter. For the 20202021 period, the Retail segment’s benefit expense includedincludes the beneficialbeneficial effect of $235$619 million in favorable prior-period medical claims reserve development versus $366$205 million in the 2019 period.2020 period. Prior-period medical claims reserve development decreased the Retail segmentsegment's benefit ratio by approximately 80 basis points in the 2021 quarter but increased the Retail segment's benefit ratio by approximately 20 basis points in the 2020 quarter versus approximately 40 basis points in the 2019 quarter. Favorable prior-period medical claims reserve
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development decreased the Retail segment benefit ratio by approximately 50170 basis points in the 2021 period versus approximately 60 basis points in the 2020 period versus approximately 90 basis points in the 2019 period.
Operating Costs
The Retail segment operating cost ratio increased 190decreased 140 basis points from 9.3% for the 2019 quarter to 11.2%9.7% for the 2020 quarter to 8.3% for the 2021 quarter and increased 130decreased 140 basis points from 8.7% for the 2019 period to 10.0%9.4% for the 2020 period to 8.0% for the 2021 period. These increasesdecreases were primarily due to the reinstatementtermination of the non-deductible health insurance industry fee in 2020 and2021, lower COVID-19 related administrative costs in the 2021 quarter, as previously discussed, partially offset by scale efficiencies associated with growth in our individual Medicare Advantage membership, and significant operating cost efficiencies in the 2021 quarter driven by previously disclosedimplemented productivity initiatives. These improvements were partially offset by continued strategic investments made to position us for long-term success. The non-deductible health insurance industry fee impacted the operating cost ratio by 160 basis points in the 2020 quarter and period.
Group and Specialty Segment
September 30,ChangeJune 30,Change
20202019MembersPercentage20212020MembersPercentage
Membership:Membership:Membership:
Medical membership:Medical membership:Medical membership:
Fully-insured commercial groupFully-insured commercial group799,500 927,400 (127,900)(13.8)%Fully-insured commercial group706,100 820,800 (114,700)(14.0)%
ASOASO502,100 516,800 (14,700)(2.8)%ASO497,800 506,200 (8,400)(1.7)%
Military servicesMilitary services6,016,400 5,998,700 17,700 0.3 %Military services6,038,500 6,033,300 5,200 0.1 %
Total group medical membersTotal group medical members7,318,000 7,442,900 (124,900)(1.7)%Total group medical members7,242,400 7,360,300 (117,900)(1.6)%
Specialty membership (a)Specialty membership (a)5,325,600 5,411,400 (85,800)(1.6)%Specialty membership (a)5,327,500 5,344,900 (17,400)(0.3)%
(a)Specialty products include dental, vision, and other supplemental health. Members included in these products may not be unique to each product since members have the ability to enroll in multiple products.
For the three months ended June 30,Change
20212020DollarsPercentage
(in millions) 
Premiums and Services Revenue:
Premiums:
Fully-insured commercial group$1,078 $1,208 $(130)(10.8)%
Group specialty432 425 1.6 %
Total premiums1,510 1,633 (123)(7.5)%
Services194 192 1.0 %
Total premiums and services revenue$1,704 $1,825 $(121)(6.6)%
Segment earnings$40 $287 $(247)(86.1)%
Benefit ratio82.6 %67.0 %15.6 %
Operating cost ratio23.9 %23.8 %0.1 %
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For the three months ended September 30,Change
20202019DollarsPercentage
(in millions) 
Premiums and Services Revenue:
Premiums:
Fully-insured commercial group$1,169 $1,278 $(109)(8.5)%
Group specialty424 400 24 6.0 %
Total premiums1,593 1,678 (85)(5.1)%
Services189 200 (11)(5.5)%
Total premiums and services revenue$1,782 $1,878 $(96)(5.1)%
Segment (losses) earnings$(160)$$(164)(4100.0)%
Benefit ratio93.0 %86.3 %6.7 %
Operating cost ratio25.2 %21.9 %3.3 %
For the nine months ended
September 30,
ChangeFor the six months ended
June 30,
Change
20202019DollarsPercentage20212020DollarsPercentage
(in millions) (in millions) 
Premiums and Services Revenue:Premiums and Services Revenue:Premiums and Services Revenue:
Premiums:Premiums:Premiums:
Fully-insured commercial groupFully-insured commercial group$3,606 $3,873 $(267)(6.9)%Fully-insured commercial group$2,177 $2,437 $(260)(10.7)%
Group specialtyGroup specialty1,278 1,160 118 10.2 %Group specialty866 854 12 1.4 %
Total premiumsTotal premiums4,884 5,033 (149)(3.0)%Total premiums3,043 3,291 (248)(7.5)%
ServicesServices576 587 (11)(1.9)%Services384 387 (3)(0.8)%
Total premiums and services revenueTotal premiums and services revenue$5,460 $5,620 $(160)(2.8)%Total premiums and services revenue$3,427 $3,678 $(251)(6.8)%
Segment earningsSegment earnings$232 $174 $58 33.3 %Segment earnings$214 $392 $(178)(45.4)%
Benefit ratioBenefit ratio79.6 %83.0 %(3.4)%Benefit ratio78.6 %73.1 %5.5 %
Operating cost ratioOperating cost ratio24.0 %21.9 %2.1 %Operating cost ratio23.4 %23.4 %— %
Segment Earnings
Group and Specialty segment earnings decreased $164$247 million, or 86.1%, from $4$287 million segment earnings in the 2019 quarter to $160 million segment loss in the 2020 quarter primarily due to higher benefit and operating cost ratios as more fully described below. Group and Specialty segment earnings increased $58 million, or 33.3%, from $174$40 million in the 2019 period to $2322021 quarter and decreased $178 million, or 45.4%, from $392 million in the 2020 period to $214 million in the 2021 period. These decreases were primarily due the same factors that led to the net favorable impact of a lowersegment's higher benefit ratio, partially offset by a higher operating cost ratio as more fully described below.ratio.
Enrollment
Fully-insured commercial group medical membership decreased 127,900114,700 members, or 13.8%14.0%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 2020. These anticipated declines primarily reflect2021 reflecting lower membership in small group accounts due in partquoting activity and sales attributable to more small group accounts selecting level-funded ASO products, as well as the loss of certain large group accounts due to disciplined pricing in the competitive environment. Additionally, the declines in membership were impacted by the currentdepressed economic downturn driven byactivity from the COVID-19 pandemic, resultingpartially offset by higher retention of existing customers, particularly in higher unemployment rates and loss of coverage for fully-insured commercial group members.larger groups. The portion of group fully-insured commercial medical membership in small group accounts was approximately 56%52% at SeptemberJune 30, 20202021 and 60%57% at SeptemberJune 30, 2019.2020.
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Group ASO commercial medical membershipmembership decreased 14,7008,400 members, or 2.8%1.7%, from September 30, 2019 to SeptemberJune 30, 2020 primarily reflecting to June 30, 2021. Sthe loss of certain large group accounts due to continued discipline in pricing of services for self-funded accounts amid a highly competitive environment and the impact of the current economic downturn driven by the COVID-19 pandemic as previously discussed, partially offset by more small group accounts selecting level-funded ASO products. Smallmall group membership comprised 45% of group ASO medical membership at SeptemberJune 30, 2020 versus 39%2021 and 45% at SeptemberJune 30, 2019.2020. The membership change reflects intensified competition for small group accounts, partially offset by strong retention among large group accounts.
Military services membership increased 17,7005,200 members, or 0.3%0.1%, from SeptemberJune 30, 20192020 to SeptemberJune 30, 2020.2021. Membership includes military service members, retirees, and their families to whom we are providing healthcare services under the current TRICARE East Region contract.
Specialtypecialty membership decreased 85,80017,400 members, or 1.6%0.3%, from September 30, 2019 to SeptemberJune 30, 2020 to June 30, 2021 due primarily dueto the loss of dental and vision groups cross-sold with medical, as reflected in the loss of group fully-insured commercial medical membership described above, as well as the loss of certain group accounts offeringgroups with stand-alone dental and vision products, as well asvision. The decrease also reflects the impact of the current economic downturn driven by the COVID-19 pandemic as previously discussed.pandemic.
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Premiums Revenue
Group and Specialty segment premiums decreased $85$123 million, or 5.1%7.5%, from $1.7 billion in the 2019 quarter to $1.6 billion in the 2020 quarter and decreased $149 million, or 3.0%, from $5.0to $1.5 billion in the 2019 period to $4.92021 quarter and decreased $248 million, or 7.5%, from $3.3 billion in the 2020 period. to $3.0 billion in the 2021 period. These decreases were primarily due to the decline in our fully-insured group commercial membership, partially offset by higher stop-loss revenues related to our level-funded ASO accounts resulting from membership growth in this product and higher per member premiums across the fully-insured commercial business.
Services Revenue
Group and Specialty segment services revenue decreased $11increased $2 million, or 5.5%1.0%, from $200 million in the 2019 quarter to $189$192 million in the 2020 quarter and decreased $11 million, or 1.9%, from $587to $194 million in the 20192021 quarter and decreased $3 million, or 0.8%, from $387 million in the 2020 period to $576$384 million in the 20202021 period. These decreases were primarily due to lower ASO membership described previously.
Benefits Expense
The Group and Specialty segment benefit ratio increased 6701,560 basis points from 86.3% in the 2019 quarter to 93.0%67.0% in the 2020 quarter to 82.6% in the 2021 quarter and increased 550 basis points from 73.1% in the 2020 period to 78.6% in the 2021 period. These increases were primarily due to ongoingthe significant impact of the deferral of non-essential care, net of COVID-19 treatment and testing costs and our pandemic relief efforts primarily surrounding initiatives to ease administrative and financial stress for providers and employers, including premium rate relief for select employer groupsin the 2020 quarter, amid the COVID-19 pandemic, and the payment of monthly stipends to support participating dental providers, and meaningful COVID-19 testing and treatment costs for fully-insured commercial group medical members as several of our key commercial markets were locatedtermination in areas more significantly impacted by COVID-19. These items were partially offset by the reinstatement2021 of the non-deductible health insurance industry fee in 2020 which, along with a portion of the related tax benefit, was contemplated in the pricing and benefit design of our products, the temporary deferral of non-essential care as previously discussed, andproducts. These increases were partially offset by higher favorable prior-period medical claims reserve development. Utilization returned faster for fully-insured commercial group membersdevelopment, as compared to members in the Retail segment, but remained below historic baseline levels at the close of the 2020 quarter.
The Group and Specialty segment benefit ratio decreased 340 basis points from 83.0% in the 2019 period to 79.6% in the 2020 period primarilywell as the result of significantly depressed utilization levels experienced during the first half of 2020 as previously discussed, the reinstatement of the non-deductible health insurance industry fee in 2020 which was contemplated in thedeliberate pricing and benefit design of our products, as well as higher favorable prior-period medical claims development. These items were partially offset by COVID-19 testingefforts to increase profitability and treatments costs, and our ongoing pandemic relief efforts as previously described.position the commercial business for long-term success.
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The Group and Specialty segment's benefits expense included $13$8 million in favorable prior-period medical claims reserve development in the 20202021 quarter versus $1$16 million in unfavorable prior-period medical claims reserve development in the 20192020 quarter. This favorable prior-period medical claims reserve development decreased the Group and Specialty segment benefit ratio by approximately 8050 basis points in the 2021 quarter but increased the Group Specialty segment benefit ratio by approximately 100 basis points in the 2020 quarter and by approximately 10 basis points in the 2019 quarter. The Group and Specialty segment's benefits expense included the effect of a favorable prior-period medical claims reserve development of $43$100 million in the 2021 period versus $30 million in the 2020 period versus an unfavorable prior-period medical claims reserve development of $35 million in the 2019 period. The favorable prior-periodprior period medical claims reserve development for the 20202021 period decreased the Group and Specialty segment benefit ratio by approximately 330 basis points and 90 basis points andin the unfavorable development for the 2019 period increased the Group and Specialty segment benefit ratio 70 basis points.2020 period.
Operating Costs
The Group and Specialty segment operating cost ratio increased 33010 basis points from 21.9% for the 2019 quarter to 25.2%23.8% for the 2020 quarter and increased 210 basis points from 21.9%to 23.9% for the 2019 period2021 quarter primarily reflecting the continued strategic investments made to 24.0%position us for long-term success. The impact of the 2020 period. These increases were primarily due tostrategic investments was partially offset by the reinstatementtermination of the non-deductible health insurance industry fee in 2020 and2021, lower COVID-19 related administrative costs in 2021, as previously discussed.These increases were partially offset by significantdiscussed, and operating cost efficiencies driven by previously disclosedimplemented productivity initiatives. The Group and Specialty segment operating cost ratio was unchanged from 23.4% for the 2020 period. The non-deductible health insurance industry fee impacted the operating cost ratio by 130 basis points in the 2020 quarter and period.
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Healthcare Services Segment
For the three months ended September 30,ChangeFor the three months ended June 30,Change
20202019DollarsPercentage20212020DollarsPercentage
(in millions)(in millions)
Revenues:Revenues:Revenues:
Services:Services:Services:
Pharmacy solutionsPharmacy solutions$163 $147 $16 10.9 %
Provider servicesProvider services$81 $104 $(23)(22.1)%Provider services97 79 18 22.8 %
Pharmacy solutions157 53 104196.2 %
Clinical care servicesClinical care services26 32 (6)(18.8)%Clinical care services25 26 (1)(3.8)%
Total services revenuesTotal services revenues264 189 75 39.7 %Total services revenues285 252 33 13.1 %
Intersegment revenues:Intersegment revenues:Intersegment revenues:
Pharmacy solutionsPharmacy solutions6,158 5,673 485 8.5 %Pharmacy solutions6,458 5,977 481 8.0 %
Provider servicesProvider services573 591 (18)(3.0)%Provider services642 575 67 11.7 %
Clinical care servicesClinical care services134 149 (15)(10.1)%Clinical care services138 137 0.7 %
Total intersegment revenuesTotal intersegment revenues6,865 6,413 452 7.0 %Total intersegment revenues7,238 6,689 549 8.2 %
Total services and intersegment revenuesTotal services and intersegment revenues$7,129 $6,602 $527 8.0 %Total services and intersegment revenues$7,523 $6,941 $582 8.4 %
Segment earningsSegment earnings$249 $212 $37 17.5 %Segment earnings$311 $317 $(6)(1.9)%
Operating cost ratioOperating cost ratio96.4 %96.2 %0.2 %Operating cost ratio95.8 %95.1 %0.7 %
For the nine months ended
September 30,
Change
20202019DollarsPercentage
(in millions)
Revenues:
Services:
Pharmacy solutions$425 $134 $291 217.2 %
Provider services236 265 (29)(10.9)%
Clinical care services80 103 (23)(22.3)%
Total services revenues741 502 239 47.6 %
Intersegment revenues:
Pharmacy solutions18,275 16,335 1,940 11.9 %
Provider services1,724 1,792 (68)(3.8)%
Clinical care services415 457 (42)(9.2)%
Total intersegment revenues20,414 18,584 1,830 9.8 %
Total services and intersegment revenues$21,155 $19,086 $2,069 10.8 %
Segment earnings$816 $611 $205 33.6 %
Operating cost ratio95.8 %96.3 %(0.5)%




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For the six months ended
June 30,
Change
20212020DollarsPercentage
(in millions)
Revenues:
Services:
Pharmacy solutions$319 $268 $51 19.0 %
Provider services188 155 33 21.3 %
Clinical care services49 54 (5)(9.3)%
Total services revenues556 477 79 16.6 %
Intersegment revenues:
Pharmacy solutions12,675 12,117 558 4.6 %
Provider services1,228 1,151 77 6.7 %
Clinical care services261 281 (20)(7.1)%
Total intersegment revenues14,164 13,549 615 4.5 %
Total services and intersegment revenues$14,720 $14,026 $694 4.9 %
Segment earnings$580 $567 $13 2.3 %
Operating cost ratio95.9 %95.6 %0.3 %
Segment Earnings
Healthcare Services segment earnings increased $37decreased $6 million, or 17.5%1.9%, from $212 million in the 2019 quarter to $249$317 million in the 2020 quarter and increased $205 million, or 33.6%, from $611 to $311 million in the 2019 period2021 quarter resulting from the same factors that led to $816the segment's increased operating cost ratio in the 2021 quarter, partially offset by higher earnings from equity method investments. Healthcare Services segment earnings increased $13 million, or 2.3%, from $567 million in the 2020 period. These increases wereperiod
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to $580 million in the 2021 period primarily due to operational improvements and reduced utilization resulting from COVID-19improved operating performance in ourthe provider services business. These improvements were partially offset by COVID-19 administrative related costs, including expenses associated with additional safety measures for our provider and clinical teams who have continued to provide services to members during the COVID-19 pandemic. The 2020 period was further impacted bybusiness, as well as higher earnings from our pharmacy operations.equity method investments.
Script Volume
Humana Pharmacy Solutions script volumes on an adjusted 30-day equivalent basis increased to approximately 119129 million in the 20202021 quarter, up 3%11.2%, versus scripts of approximately 116 million in the 20192020 quarter. For the 20202021 period, script volumes increased to approximately 356approximately 255 million, up 5%7.8%, versus scripts of approximately 339236 million in the 20192020 period. These increases were primarily due to the growth associated with higher individual Medicare Advantage and state-based contracts membership, along withpartially offset by the decline in stand-alone PDP and group Medicare Advantage membership and the impact of early prescription refills in the second quarter of 2020 as members prepared for extended supply needs in response to COVID-19. These increases were partially offset by the decline in stand-alone PDP membership.COVID-19 restrictions.
Services Revenues
Services revenues increased $75$33 million, or 39.7%13.1%, from $189 million in the 2019 quarter to $264$252 million in the 2020 quarter and increased $239 million, or 47.6%, from $502to $285 million in the 2019 period to $7412021 quarter and increased $79 million, or 16.6%, from $477 million in the 2020 period to $556 million in the 2021 period. These increases were primarily due to thehigher revenues associated with our pharmacy and provider businesses. The 2021 period further reflects additional pharmacy revenues associated with the acquisition of Enclara inwhich was closed during the 2020 period.first quarter of 2020.
Intersegment Revenues
Intersegment revenues increased $452$549 million, or 7.0%8.2%, from $6.4 billion in the 2019 quarter to $6.9$6.69 billion in the 2020 quarter and increased $1.8 billion, or 9.8%, from $18.6to $7.24 billion in the 2019 period to $20.42021 quarter and increased $615 million, or 4.5%, from $13.5 billion in the 2020 period to $14.2 billion in the 2021 period. These increases were primarilyprimarily due to strongindividual Medicare Advantage and state-based contracts membership growth, as well as higher revenues associated with our provider business. These increases were partially offset by the loss of intersegment revenues associated with the decline in stand-alone PDP membership. Theand group Medicare Advantage membership as previously discussed and the impact of increased pharmacy revenues in the 2020 period was also impacted by the modest increase in pharmacy revenuesquarter as a result of us allowing early prescription refills to permit our members to prepare for extended supply needs in responsedue to COVID-19 and a slight shift by members to 90-day mail supply.restrictions.
Operating Costs
The Healthcare Services segment operating cost ratio increased 2070 basis points from 96.2% for the 2019 quarter to 96.4%95.1% for the 2020 quarter primarily due to 95.8% for the 2021 quarter and increased 30 basis points from 95.6% for the 2020 period to 95.9% for the 2021 period. These increases reflect increased administrative costs in the pharmacy operations as a result of incremental spend to accelerate growth within the business, additional shipping costs incurred in pharmacy operations to ensure members' timely receipt of prescriptions, and increased utilization levels in our provider business in 2021 compared to depressed levels in 2020 amid the COVID-19 pandemic. These increases were partially offset by the impact on the 2020 ratios associated with COVID-19 administrative related costs, including expenses associated with additional safety measures taken for our pharmacy, provider, and clinical teams who have continued to provide services to members duringthroughout the COVID-19 pandemic. The increase further reflects higher costs incurred in the pharmacy business to ensure timely delivery of prescriptions amid the COVID-19 pandemic. These costs were partially offset bycrisis, as well as operational improvements and reduced utilization resulting from COVID-19improvement in our provider services business, as well as significantlargely related to Conviva, along with operating cost efficiencies in the 2020 quarter driven by previously disclosedimplemented productivity initiatives.initiatives in 2021. The Healthcare Services segment operating cost ratio decreased 50 basis points from 96.3% for2021 period was further impacted by pharmacy labor-related overtime costs due to weather disruptions occurring in the 2019 period to 95.8% for the 2020 period as a resultfirst quarter of the net favorable impact of the same factors affecting the 2020 quarter.2021.



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Liquidity
Historically, our primary sources of cash have included receipts of premiums, services revenue, and investment and other income, as well as proceeds from the sale or maturity of our investment securities, and borrowings. Our primary uses of cash historically have included disbursements for claims payments, operating costs, interest on borrowings, taxes, purchases of investment securities, acquisitions, capital expenditures, repayments on borrowings,
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dividends, and share repurchases. Because premiums generally are collected in advance of claim payments by a period of up to several months, our business normally should produce positive cash flows during periods of increasing premiums and enrollment. Conversely, cash flows would be negatively impacted during periods of decreasing premiums and enrollment. From period to period, our cash flows may also be affected by the timing of working capital items including premiums receivable, benefits payable, and other receivables and payables. Our cash flows are impacted by the timing of payments to and receipts from CMS associated with Medicare Part D subsidies for which we do not assume risk. The use of cash flows may be limited by regulatory requirements of state departments of insurance (or comparable state regulators) which require, among other items, that our regulated subsidiaries maintain minimum levels of capital and seek approval before paying dividends from the subsidiaries to the parent. Our use of cash flows derived from our non-insurance subsidiaries, such as in our Healthcare Services segment, is generally not restricted by state departments of insurance (or comparable state regulators).
For additional information on our liquidity risk, please refer to the section entitled “Risk Factors” in our 20192020 Form 10-K and Item 1A of Part II of this document.     
Cash and cash equivalents increaseddecreased to approximately $8.0$3.4 billion at SeptemberJune 30, 20202021 from $4.1$4.7 billion at December 31, 2019.2020. The change in cash and cash equivalents for the ninesix months ended SeptemberJune 30, 20202021 and 20192020 is summarized as follows:
Nine Months Ended
20202019
 (in millions)
Net cash provided by operating activities$5,356 $4,772 
Net cash used in investing activities(3,010)(477)
Net cash provided by (used in) financing activities1,585 (1,111)
Increase in cash and cash equivalents$3,931 $3,184 
Six Months Ended
20212020
 (in millions)
Net cash (used in) provided by operating activities$(477)$3,541 
Net cash used in investing activities(2,203)(2,862)
Net cash provided by financing activities1,385 2,430 
(Decrease) increase in cash and cash equivalents$(1,295)$3,109 
Cash Flow from Operating Activities
Cash flows used in operations of $477 million in the 2021 period decreased $4.0 billion from cash flows provided by operations of $3.5 billion in the 2020 period primarily due to the negative impact of working capital items and lower earnings in the 2021 period compared to the 2020 period. Our 2021 period operating cash flows were significantly impacted by changes to working capital levels, primarily as a result of prior year disruptions caused by COVID-19. These impacts include paying down claims inventory and capitation for provider surplus amounts earned in 2020 as well as additional provider support. Further, quarterly tax payment estimates typically paid in the 2020 period increased fromwere deferred to the 2019 periodthird quarter of 2020 due primarily to higher income from operations.COVID-19.
The most significant drivers of changes in our working capital are typically the timing of payments of benefits expense and receipts for premiums. We illustrate these changes with the following summaries of benefits payable and receivables.







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The detail of benefits payable was as follows at SeptemberJune 30, 20202021 and December 31, 2019:2020:
September 30, 2020December 31, 20192020
Period
Change
2019
Period
Change
June 30, 2021December 31, 20202021
Period
Change
2020
Period
Change
(in millions) (in millions)
IBNR (1)IBNR (1)$5,149 $4,150 $999 $656 IBNR (1)$5,419 $5,290 $129 $698 
Reported claims in process (2)Reported claims in process (2)1,167 628 539 467 Reported claims in process (2)1,244 816 428 331 
Other benefits payable (3)Other benefits payable (3)1,892 1,226 666 235 Other benefits payable (3)1,822 2,037 (215)947 
Total benefits payableTotal benefits payable$8,208 $6,004 $2,204 $1,358 Total benefits payable$8,485 $8,143 $342 $1,976 
Payables from acquisitionPayables from acquisition(42)— 
Change in benefits payable per cash flow
statement resulting in cash from operations
Change in benefits payable per cash flow
statement resulting in cash from operations
$300 $1,976 
(1)IBNR represents an estimate of benefits payable for claims incurred but not reported (IBNR) at the balance sheet date and includes unprocessed claim inventories. The level of IBNR is primarily impacted by membership levels,
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medical claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received and processed (i.e. a shorter time span results in a lower IBNR).
(2)Reported claims in process represents the estimated valuation of processed claims that are in the post claim adjudication process, which consists of administrative functions such as audit and check batching and handling, as well as amounts owed to our pharmacy benefit administrator which fluctuate due to bi-weekly payments and the month-end cutoff.
(3)Other benefits payable primarily include amounts owed to providers under capitated and risk sharing arrangements.
The increase in benefits payable from December 31, 2019 to September 30, 2020in 2021 was primarily due to an increase in reported claims in process and higher IBNR, partially offset by reduction in capitation accruals. Higher reported claims in process was a function of month-end cutoff. IBNR increased primarily as a result of individual Medicare Advantage membership growth partially offset by paying down claim inventories. The 2020 period was significantly impacted by higher capitation accruals as well as increasessignificantly lower utilization caused by COVID-19 resulted in amounts owedhigher surplus accruals to providers under the capitated and risk sharing arrangements, which were affected by the response to COVID-19 and resulting deferral of care impact on medical claims reserves, and an increase in the amount of processed but unpaid claims which fluctuate due to month-end cutoff. The increases in benefits payable from December 31, 2018 to September 30, 2019 were due to an increase in IBNR primarily as a result of Medicare Advantage membership growth and an increase in the amount of processed but unpaid claims which fluctuate due to month-end cutoff.providers.
The detail of total net receivables was as follows at SeptemberJune 30, 20202021 and December 31, 2019:2020:
September 30, 2020December 31, 20192020
Period
Change
2019
Period
Change
June 30, 2021December 31, 20202021
Period
Change
2020
Period
Change
(in millions) (in millions)
MedicareMedicare$863 $835 $28 $(198)Medicare$2,153 $928 $1,225 $1,179 
Commercial and otherCommercial and other209 162 47 17 Commercial and other200 122 78 13 
Military servicesMilitary services141 128 13 Military services163 160 
Allowance for doubtful accountsAllowance for doubtful accounts(78)(69)(9)Allowance for doubtful accounts(78)(72)(6)(19)
Total net receivablesTotal net receivables$1,135 $1,056 $79 $(167)Total net receivables$2,438 $1,138 $1,300 $1,182 
Reconciliation to cash flow statement:Reconciliation to cash flow statement:Reconciliation to cash flow statement:
Receivables from disposition (acquisition) of
business
(12)
Receivables from acquisitionReceivables from acquisition(15)
Change in receivables per cash flow
statement resulting in cash from operations
Change in receivables per cash flow
statement resulting in cash from operations
$82 $(179)Change in receivables per cash flow
statement resulting in cash from operations
$1,285 $1,185 

The changes in Commercial and other receivables for the 2020 period were primarily as a result of Medicaid membership growth. The changes in Medicare receivables for both the 20202021 period and the 20192020 period reflect the typical pattern caused by the timing of accruals and related collections associated with the CMS risk-adjustment model. Significant collections occur with the mid-year and final settlements with CMS in the second and third quarter. We received the 2021 $1.3 billion mid-year settlement in July 2021.
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Cash Flow from Investing Activities
In the first quarterDuring 2021, we acquired various health and wellness related businesses for cash consideration of approximately $325 million, net of cash received.
During 2020, we acquired privately held Enclara Healthcare for cash consideration of approximately $709 million, net of cash received as discussed in Note 3 to the condensed consolidated financial statements.received.

Our ongoing capital expenditures primarily relate to our information technology initiatives, support of services in our provider services operations including medical and administrative facility improvements necessary for activities such as the provision of care to members, claims processing, billing and collections, wellness solutions,
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care coordination, regulatory compliance and customer service. Total capital expenditures, excluding acquisitions, were $668$619 million in the 20202021 period and $506$418 million in the 20192020 period.

Net purchases of investment securities were $1.3 billion and $1.7 billion in the 2021 and 2020 period, were $1.6 billion as compared to net proceeds from investment securities sales and maturities of $29 million in the 2019 period.respectively.
Cash Flow from Financing Activities
Claims payments were $283 million higher than receipts from CMS associated with Medicare Part D claim subsidies for which we do not assume risk in the 2020 period and receiptsReceipts from CMS associated with Medicare Part D claim subsidies for which we do not assume risk were higher than claimsclaim payments by $113$1.2 billion and $412 million in the 2019 period.2021 and 2020 period, respectively.
Under our administrative services only TRICARE contracts, reimbursements from the federal government exceeded health care cost payments for which we do not assume risk by $9 million in the 2020 period and health care costcosts payments for which we do not assume risk exceeded reimbursements from the federal government by $102$2 million and $23 million in the 20192021 and 2020 period, respectively.
Net proceeds from the issuance of commercial paper were $508 million in the 2021 period and $21 million in the 2020 period. The maximum principal amount outstanding at any one time during the 2021 period was $1.3 billion.
In March 2020, we issued $600 million of 4.500% senior notes due April 1, 2025 and $500 million of 4.875% senior notes due April 1, 2030. Our net proceeds, reduced for the underwriters' discount and commission and offering expenses paid as of SeptemberJune 30, 2020 were $1,088 million.
In August 2019, we issued $500 million of 3.125% senior notes due August 15, 2029 and $500 million of 3.950% senior notes due August 15, 2049. Our net proceeds, reduced for the underwriters' discount and commission and offering expenses paid as of September 30, 2019 were $987 million. We used the net proceeds from this offering, together with available cash, to repay the $650 million outstanding amount due under our term note in August 2019, and the $400 million aggregate principal amount of our 2.625% senior notes due on its maturity date of October 1, 2019.
On July 31, 2019, we entered into an accelerated stock repurchase agreement, the July 2019 ASR, with Citibank, N.A., or Citi, to repurchase $1 billion of our common stock. On August 2, 2019, we made a payment of $1 billion to Citi and received an initial delivery of 2.7 million shares of our common stock. We also acquired common shares in connection with employee stock plans for an aggregate cost of $30$33 million in the 2021 period and $25 million in the 2020 period.
We paid dividends to stockholders of $173 million during the 2021 period and $10$156 million induring the 20192020 period.
In March 2020, we drew $1 billion on our existing term loan commitment.commitment, which was repaid in November 2020.
Net
The remainder of the cash used in or provided by financing activities in 2021 and 2020 primarily resulted from proceeds from stock option exercises and the issuance of commercial paper were $21 millionchange in the 2020 period and net repayments from the issuance of commercial paper were $358 million in the 2019 period. The maximum principal amount outstanding at any one time during the 2020 period was $600 million.
We paid dividends to stockholders of $239 million during the 2020 period and $216 million during the 2019 period.book overdraft.

Future Sources and Uses of Liquidity
Dividends
For a detailed discussion of dividends to stockholders, please refer to Note 10 to the condensed consolidated financial statements.
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Stock Repurchases
For a detailed discussion of stock repurchases, please refer to Note 10 to the condensed consolidated financial statements.
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Debt
For a detailed discussion of our debt, including our senior notes, term loan, credit agreement andagreements, commercial paper program, and other short-term borrowings, please refer to Note 12 to the condensed consolidated financial statements.
Acquisitions and DivestituresKindred at Home Acquisition
DuringOn April 27, 2021, we entered into a definitive agreement to acquire the 2020 period, we completed the acquisition of privately held Enclara, one ofremaining 60% interest in KAH, the nation’s largest home health and hospice pharmacyprovider, from TPG and benefit management providersWCAS, two private equity funds, or the Sponsors, for an enterprise value of $8.1 billion, which includes our existing equity value of $2.4 billion associated with our 40% minority ownership interest. KAH has locations in 40 states, providing extensive geographic coverage with approximately 65% overlap with our individual Medicare Advantage membership. The acquisition, which is expected to close in the third quarter of 2021, is subject to customary state and federal regulatory approvals. We expect to fund the approximate $5.7 billion transaction (net of our existing equity stake) through a combination of parent company cash and debt financing.
In April 2021, we entered into a commitment letter with Goldman Sachs Bank USA, or Goldman Sachs, pursuant to which, and subject to the terms and conditions set forth therein, Goldman Sachs committed to lend us up to $3.5 billion under a new senior unsecured 364-day bridge loan facility, or Bridge Loan. If we enter into the Bridge Loan, the proceeds of the Bridge Loan will be used to finance a portion of the cash consideration payable for the KAH transaction. The outstanding Bridge Loan commitments under the commitment letter were reduced to $3.0 billion in connection with the effectiveness of approximately $709the delayed draw term loan credit agreement described below.

In May 2021, we entered into a $500 million netunsecured delayed draw term loan credit agreement. If we draw on the delayed term loan, the proceeds will be used to finance a portion of the cash received. For a detailed discussion of this transaction, please refer to Note 3 toconsideration payable for the condensed consolidated financial statements.KAH transaction.

Liquidity Requirements
We believe our cash balances, investment securities, operating cash flows, and funds available under our credit agreement and our commercial paper program or from other public or private financing sources, taken together, provide adequate resources to fund ongoing operating and regulatory requirements, acquisitions, future expansion opportunities, and capital expenditures for at least the next twelve months, as well as to refinance or repay debt, and repurchase shares.
Adverse changes in our credit rating may increase the rate of interest we pay and may impact the amount of credit available to us in the future. Our investment-grade credit rating at SeptemberJune 30, 20202021 was BBB+ according to Standard & Poor’s Rating Services, or S&P, and Baa3 according to Moody’s Investors Services, Inc., or Moody’s. A downgrade by S&P to BB+ or by Moody’s to Ba1 triggers an interest rate increase of 25 basis points with respect to $250 million of our senior notes. Successive one notch downgrades increase the interest rate an additional 25 basis points, or annual interest expense by less than $1 million, up to a maximum 100 basis points, or annual interest expense by $3 million.
In addition, we operate as a holding company in a highly regulated industry. Humana Inc., our parent company, is dependent upon dividends and administrative expense reimbursements from our subsidiaries, most of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated operating subsidiaries. Cash, cash equivalents, and short-term investments at the parent company were $2.4$1.3 billion at SeptemberJune 30, 20202021 compared to $1.4 billion$772 million at December 31, 2019.2020. This increase primarily was due to the net proceedsdividends received from regulated subsidiaries, earnings in non-regulated Healthcare Services subsidiaries, and the issuance of senior notes, proceeds from a term loan, and commercial paper, issuance. The increase was further impacted by regulated subsidiary dividends and non-regulated subsidiary earnings in our Healthcare Services segment. These increases were partially offset by the Enclara acquisition,acquisitions, capital expenditures, cash
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dividends to shareholders, and other working capital changes.contributions to certain subsidiaries. Our use of operating cash derived from our non-insurance subsidiaries, such as our Healthcare Services segment, is generally not restricted by departments of insurance (or comparable state regulators).
Regulatory Requirements
Certain of our subsidiaries operate in states that regulate the payment of dividends, loans, or other cash transfers to Humana Inc., our parent company, and require minimum levels of equity as well as limit investments to approved securities. The amount of dividends that may be paid to Humana Inc. by these subsidiaries, without prior approval by state regulatory authorities, or ordinary dividends, is limited based on the entity’s level of statutory income and statutory capital and surplus. If the dividend, together with other dividends paid within the preceding twelve months, exceeds a specified statutory limit or is paid from sources other than earned surplus, it is generally considered an extraordinary dividend requiring prior regulatory approval. In most states, prior notification is provided before paying a dividend even if approval is not required.
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Although minimum required levels of equity are largely based on premium volume, product mix, and the quality of assets held, minimum requirements vary significantly at the state level. Based on the most recently filed statutory financial statements as of June 30, 2020,March 31, 2021, our state regulated subsidiaries had aggregate statutory capital and surplus of approximately $9.3$10.0 billion, which exceeded aggregate minimum regulatory requirements of $6.4$7.2 billion. The amount of ordinary dividends paid to our parent company was approximately $1.3 billion during the six months ended June 30, 2021 compared to $360 million during the ninesix months ended SeptemberJune 30, 2020 compared to $1.4 billion during the nine months ended September 30, 2019. Actual dividends paid may2020. The amount, timing and mix of ordinary and extraordinary dividend payments will vary year over year due to considerationstate regulatory requirements, the level of excess statutory capital and surplus and expected future surplus requirements related to, for example, premium volume and product mix.

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Item 3.    Quantitative and Qualitative Disclosures about Market Risk
Our earnings and financial position are exposed to financial market risk, including those resulting from changes in interest rates.
Interest rate risk also represents a market risk factor affecting our consolidated financial position due to our significant investment portfolio, consisting primarily of fixed maturity securities of investment-grade quality with a weighted average S&P credit rating of AAAA- at SeptemberJune 30, 2020.2021. Our net unrealized position increased $280decreased $247 million from a net unrealized gain position of $211$514 million at December 31, 20192020 to a net unrealized gain position of $491$267 million at SeptemberJune 30, 2020.2021. At SeptemberJune 30, 2020,2021, we had gross unrealized losses of $14$87 million on our investment portfolio primarily due to an increase in market interest rates since the time the securities were purchased. There were no material credit allowances during the ninesix months ended SeptemberJune 30, 2020.2021. While we believe that these securities in an unrealized loss will recover in value over time and we currently do not have the intent to sell such securities, given the current market conditions and the significant judgments involved, there is a continuing risk that future declines in fair value may occur and material realized losses from sales or credit allowances may be recorded in future periods.
Duration is the time-weighted average of the present value of the bond portfolio’s cash flow. Duration is indicative of the relationship between changes in fair value and changes in interest rates, providing a general indication of the sensitivity of the fair values of our fixed maturity securities to changes in interest rates. However, actual fair values may differ significantly from estimates based on duration. The average duration of our investment portfolio, including cash and cash equivalents, was approximately 2.13.6 years as of SeptemberJune 30, 20202021 and approximately 2.53.0 years as of December 31, 2019.2020. The declineincrease in the average duration is reflective of the increaseddecreased holdings of cash and cash equivalents, along with other portfolio management activities. Based on the duration, including cash equivalents, a 1% increase in interest rates would generally decrease the fair value of our securities by approximately $452$619 million at SeptemberJune 30, 2020.2021.

Item 4.    Controls and Procedures
Under the supervision and with the participation of our Chief Executive Officer, or CEO, our Chief Financial Officer, or CFO, and our Principal Accounting Officer, we carried out an evaluation of the effectiveness of the design and operation of our disclosure controls and procedures for the quarter ended SeptemberJune 30, 2020.2021.
Based on our evaluation, our CEO, CFO, and our Principal Accounting Officer concluded that our disclosure controls and procedures are effective to provide reasonable assurance that information the Company is required to disclose in its reports under the Securities Exchange Act of 1934, as amended, is recorded, processed, summarized and reported within the time periods specified in SEC rules and forms, including, without limitation, ensuring that such information is accumulated and communicated to the Company’s management, including its principal executive and principal financial officers, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.
There have been no changes in the Company’s internal control over financial reporting during the quarter ended SeptemberJune 30, 20202021 that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.

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Part II. Other Information

Item 1.     Legal Proceedings
For a description of the legal proceedings pending against us and certain other pending or threatened litigation, investigations, or other matters, see “Legal Proceedings and Certain Regulatory Matters” in Note 13 to the condensed consolidated financial statements beginning on page 2725 of this Form 10-Q.

Item 1A. Risk Factors
In additionThere have been no changes to the other information set forth in this report, you should carefully consider therisk factors discussed in Part I, Item 1A. “Risk factors”included in our Annual Report on2020 Form 10-K for the year ended December 31, 2019, and the risk factor set forth below.

The spread of, and response to, the novel coronavirus, or COVID-19, underscores certain risks we face, including those discussed in our Form 10-K for the fiscal year ended December 31, 2019, and the rapid development and fluidity of this situation precludes any prediction as to the ultimate adverse impact to us of COVID-19.

In December 2019, a novel strain of coronavirus (COVID-19) emerged which was declared a pandemic by the World Health Organization on March 11, 2020, and has now spread globally including throughout the United States. The spread of COVID-19 underscores certain risks we face in our business, including those discussed in our Form 10-K for the fiscal year ended December 31, 2019.

Governmental and non-governmental organizations may not effectively combat the spread and severity of COVID-19, increasing the potential for harm for our members. If the spread of COVID-19 is not contained, the premiums we charge may prove to be insufficient to cover the cost of health care services delivered to our members, which may increase significantly as a result of higher utilization rates of medical facilities and services and other increases in associated hospital and pharmaceutical costs. Over time, we may also experience increased costs or decreased revenues if, as a result of our members being unable to see their providers due to actions taken to mitigate the spread of COVID-19, we are unable to implement clinical initiatives to manage health care costs and chronic conditions of our members, and appropriately document their risk profiles. In addition, we are offering our members expanded benefit coverage, such as waiving out of pocket costs for COVID-19 diagnostic testing and treatment, certain additional coverages have been mandated by governmental action and we are taking actions designed to help provide financial and administrative relief for the health care provider community. Such measures and any further steps taken by us, or governmental action, to continue to respond to and to address the ongoing impact of COVID-19, including further expansion or modification of the services delivered to our members, the adoption or modification of regulatory requirements associated with those services and the costs and challenges associated with ensuring timely compliance with such requirements, to provide further relief for the health care provider community, or in connection with the relaxation of stay-at-home and physical distancing orders and other restrictions on movement and economic activity, including the potential for widespread testing and therapeutic treatments and a vaccine, once available, as a component of lifting these measures, could adversely impact our profitability.
The spread and impact of COVID-19, or actions taken to mitigate this spread, could have material and adverse effects on our ability to operate effectively, including as a result of the complete or partial closure of facilities or labor shortages. Disruptions in public and private infrastructure, including communications, availability of in-person sales and marketing channels, financial services and supply chains, could materially and adversely disrupt our normal business operations. We have transitioned a significant subset of our employee population to a remote work environment in an effort to mitigate the spread of COVID-19, as have a number of our third-party service providers, which may exacerbate
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certain risks to our business, including an increased demand for information technology resources, increased risk of phishing and other cybersecurity attacks, and increased risk of unauthorized dissemination of sensitive personal information or proprietary or confidential information about us or our members or other third-parties. The outbreak of COVID-19 has severely impacted global economic activity, including the businesses of some of our commercial customers, and caused significant volatility and negative pressure in the financial markets. In addition to disrupting our operations, these developments may adversely affect the timing of commercial customer premium collections and corresponding claim payments, the value of our investment portfolio, or future liquidity needs.

The rapid development and fluidity of this situation precludes any prediction as to the ultimate adverse impact to us of COVID-19. We are continuing to monitor the spread of COVID-19, changes to our benefit coverages, the ongoing costs and business impacts of dealing with COVID-19, including the potential costs and impacts associated with lifting, or reimposing restrictions on movement and economic activity and related risks. The magnitude and duration of the pandemic and its ultimate impact on our business, results of operations, financial position, and cash flows is uncertain as this continues to evolve globally, but such impacts could be material to our business, results of operations, financial position and cash flows.10-K.


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Item 2:2.     Unregistered Sales of Equity Securities and Use of Proceeds
(a)None.
(b)N/A
(c)The following table provides information about our purchases of equity securities that are registered by us pursuant to Section 12 of the Securities Exchange Act of 1934, as amended, during the three months ended SeptemberJune 30, 2020:2021:
PeriodTotal Number
of Shares
Purchased (1)(2)
Average
Price Paid
per Share
Total Number of
Shares Purchased
as Part of Publicly
Announced Plans
or Programs (1)(2)
Dollar Value of
Shares that May
Yet Be Purchased
Under the Plans
or Programs (1)
July 2020April 2021— $— — $— 
August 2020May 2021— — — — 
September 2020June 2021— — — — 
Total— $— — 
(1)On December 22, 2020, we entered into separate accelerated stock repurchase agreements, ("the December 2020 ASR Agreements"), with Citibank, N.A., or Citi, and JPMorgan Chase Bank, or JPM, to repurchase $1.75 billion of our common stock as part of the $3 billion repurchase program authorized by the Board of Directors on July 30, 2019,2019. On December 23, 2020, in accordance with the December 2020 ASR Agreements, we made a payment of $1.75 billion ($875 million to Citi and $875 million to JPM) and received an initial delivery of 3.8 million shares of our common stock (1.9 million shares each from Citi and JPM). We recorded the payments to Citi and JPM as a reduction to stockholders’ equity, consisting of an $1.5 billion increase in treasury stock, which reflects the value of the initial 3.8 million shares received upon initial settlement, and a $262.5 million decrease in capital in excess of par value, which reflects the value of stock held back by Citi and JPM pending final settlement of the December 2020 ASR Agreements. Upon final settlement of the December 2020 ASR agreements with Citi and JPM on May 4, 2021 and May 5, 2021, respectively, we received an additional 0.3 million shares and 0.3 million shares, respectively, as determined by the average daily volume weighted-averages share price of our common stock during the term of the agreement, less a discount, of $400.07 and 401.49, respectively, bringing the total shares received under the December 2020 ASR agreements to 4.4 million. In addition, upon settlement we reclassified the $262.5 million value of stock initially held back by Citi and JPM from capital in excess of par value to treasury stock. On February 18, 2021, the Board of Directors replaced athe previous share repurchase authorization of up to $3 billion (of which approximately $250 million remained unused) with a new authorization for repurchases of up to $3 billion of our common shares exclusive of shares repurchased in connection with employee stock plans, expiring on June 30, 2022.as of February 18, 2024. Under our share repurchase authorization, shares may be purchased from time to time at prevailing prices in the open market, by block purchases, through plans designed to comply with Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, or in privately-negotiated transactions (including pursuant to accelerated share repurchase agreements with investment banks), subject to certain regulatory restrictions on volume, pricing, and timing. Our remaining repurchase authorization was approximately $23 billion as of November 2, 2020July 27, 2021.
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(2)Excludes 80,00090,000 shares repurchased in connection with employee stock plans.

Item 3:3.     Defaults Upon Senior Securities
None.

Item 4:4.     Mine Safety Disclosures
Not applicable.

Item 5:5.     Other Information
None.
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Item 6:     Exhibits
3(i)Restated Certificate of Incorporation of Humana Inc. filed with the Secretary of State of Delaware on November 9, 1989, as restated to incorporate the amendment of January 9, 1992, and the correction of March 23, 1992 (incorporated herein by reference to Exhibit 4(i) to Humana Inc.’s Post-Effective Amendment No. 1 to the Registration Statement on Form S-8 (Reg. No. 33-49305) filed February 2, 1994).
By-Laws of Humana Inc., as amended on December 14, 2017 (incorporated herein by reference to Exhibit 3(b) to Humana Inc.’s Current Report on Form 8-K, filed December 14, 2017).
Five-Year $2.5 Billion Amended and Restated Credit Agreement, dated as of June 4, 2021, among Humana Inc., and JPMorgan Chase Bank, N.A. as Agent and as CAF Loan Agent, Bank of America, N.A. and Goldman Sachs Bank USA as Syndication Agents, Citibank, N.A., PNC Bank, National Association, U.S. Bank National Association and Wells Fargo Securities, LLC, as Documentation Agents, and JPMorgan Chase Bank, N.A., BofA Securities, Inc., Goldman Sachs Bank USA, Citigroup Global Markets, Inc., PNC Capital Markets LLC, U.S. Bank National Association and Wells Fargo Securities, LLC, as Joint-Lead Arrangers and Joint Bookrunners (incorporated herein by reference to Exhibit 10 to Humana Inc.’s Current Report on Form 8-K filed on June 4, 2021).
364-Day $1.5 Billion Revolving Credit Agreement, dated as of June 4, 2021, among Humana Inc., and JPMorgan Chase Bank, N.A. as Agent and as CAF Loan Agent, Bank of America, N.A. and Goldman Sachs Bank USA as Syndication Agents, Citibank, N.A., PNC Bank, National Association, U.S. Bank National Association and Wells Fargo Securities, LLC, as Documentation Agents, and JPMorgan Chase Bank, N.A., BofA Securities, Inc., Goldman Sachs Bank USA, Citigroup Global Markets, Inc., PNC Capital Markets LLC, U.S. Bank National Association and Wells Fargo Securities, LLC, as Joint-Lead Arrangers and Joint Bookrunners (incorporated herein by reference to Exhibit 10 to Humana Inc.’s Current Report on Form 8-K filed on June 4, 2021).
$500 Million Delayed Draw Term Loan Credit Agreement, dated as of May 28, 2021, among Humana Inc., and JPMorgan Chase Bank, N.A. as Agent, Bank of America, N.A. and Goldman Sachs Bank USA as Syndication Agents, Citibank, N.A., PNC Capital Markets LLC, Trust Bank, U.S. Bank, National Association and Wells Fargo Securities, LLC, as Documentation Agents, and Goldman Sachs Bank USA, BofA Securities, Inc., JPMorgan Chase Bank, N.A., Citibank, N.A., PNC Capital Markets LLC, Trust Securities, Inc., U.S. Bank National Association and Wells Fargo Securities, LLC, as Joint-Lead Arrangers and Joint Bookrunners (incorporated herein by reference to Exhibit 10 to Humana Inc.’s Current Report on Form 8-K filed on June 4, 2021).
Principal Executive Officer certification pursuant to Section 302 of Sarbanes–Oxley Act of 2002.
Principal Financial Officer certification pursuant to Section 302 of Sarbanes–Oxley Act of 2002.
Principal Executive Officer and Principal Financial Officer certification pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
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101The following materials from Humana Inc.'s Quarterly Report on Form 10-Q formatted in iXBRL (Inline Extensible Business Reporting Language): (i) the Condensed Consolidated Balance Sheets at SeptemberJune 30, 20202021 and December 31, 2019;2020; (ii) the Condensed Consolidated Statements of Income for the three months and ninesix months ended SeptemberJune 30, 20202021 and 2019;2020; (iii) the Condensed Consolidated Statements of Comprehensive Income for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019;2020; (iv) the Consolidated Statements of Equity for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019;2020; (v) the Condensed Consolidated Statements of Cash Flows for the ninesix months ended SeptemberJune 30, 20202021 and 2019;2020; and (vi) Notes to Condensed Consolidated Financial Statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
104Cover Page Interactive Data File formatted in Inline XBRL and contained in Exhibit 101.
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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 3, 2020July 28, 2021By:/s/ CYNTHIA H. ZIPPERLE
Cynthia H. Zipperle
Senior Vice President, Chief Accounting Officer and Controller (Principal Accounting Officer)
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