Which states they will exit..... is unknown. The retooling of plans means the PPO off market option is gone, and any open referral networks......changed to referral required.
Forbes Welcome
Humana Reports First Quarter 2016 Financial Results; Reaffirms 2016 Financial Guidance | Humana Healthcare
Forbes Welcome
Humana Reports First Quarter 2016 Financial Results; Reaffirms 2016 Financial Guidance | Humana Healthcare
Individual commercial business
As previously disclosed, in the fourth quarter of 2015 the company recorded a PDR associated with its 2016 individual commercial ACA-compliant offerings. Historically, this business has reported a profit in the first quarter of the year due to the related benefit designs. Because the company continues to anticipate a loss associated with this business for the full year 2016, the seasonal earnings generated in 1Q 2016 are offset by an increase in the PDR, resulting in a higher benefit ratio year over year. This first quarter seasonality was anticipated as the company developed its estimate of the full-year PDR recorded in the fourth quarter of 2015.
Financial results associated with the wind-down of the non-ACA compliant (legacy) business, including the related release of policy reserves, as well as indirect administrative costs associated with ACA-compliant offerings are included in the company’s 1Q 2016 financial results.
Consistent with data evaluated as the company established the PDR in the fourth quarter of 2015, early indications for ACA-compliant business effective in 1Q 2016 include:
New members enrolling in off-exchange plans had higher admissions per thousand members (APT) than renewing members.
Renewing members in both on and off exchange plans from 2015 to 2016 were higher utilizers based on APT and pharmacy statistics than those terminating coverage.
The company will continue to evaluate the performance of this business for 2016 as it further develops and the corresponding impact on the PDR, if any, over the coming quarters.
Humana is in the process of finalizing plans for its ACA-compliant individual commercial medical market offerings in 2017. Humana anticipates proposing a number of changes to retain a viable product for individual consumers, where feasible, and address persistent risk selection challenges. Such changes may include certain statewide market and product exits both on and off exchange, service area reductions and pricing commensurate with anticipated levels of risk by state.
Individual commercial membership of 875,700 as of March 31, 2016, was down 233,200, or 21 percent, from 1,108,900 at March 31, 2015, and down 23,400, or 3 percent, from 899,100 at December 31, 2015 The year-over-year change primarily reflected the loss of approximately 150,000 members due to termination by CMS for lack of eligibility documentation, lower membership in legacy plans and the loss of membership associated with non-payment of premiums during the last three quarters of 2015. The sequential change in individual commercial membership primarily reflected lower membership in legacy plans and the loss of membership associated with 1Q 2016 ACA-compliant plan discontinuances.
