Humana 2005 Annual Report Download - page 14

Our Products
The following table presents our segment membership, premiums and ASO fees by product for the year
ended December 31, 2005:
Medical
Membership*
Specialty
Membership* Premiums ASO Fees
Total
Premiums and
ASO Fees
Percent of
Total
Premiums
and ASO
Fees
(dollars in thousands)
Government:
Medicare Advantage:
HMO................. 427,900 — $ 4,092,166 $ — $ 4,092,166 28.7%
PFFS ................. 121,300 — 459,474 — 459,474 3.2%
PPO.................. 8,600 — 38,722 — 38,722 0.3%
Total Medicare
Advantage ......... 557,800 — 4,590,362 — 4,590,362 32.2%
Medicaid ................ 457,900 — 548,714 — 548,714 3.8%
TRICARE ............... 1,750,900 — 2,407,653 — 2,407,653 16.9%
TRICARE ASO .......... 1,138,200 — — 50,059 50,059 0.4%
Total Government .... 3,904,800 — 7,546,729 50,059 7,596,788 53.3%
Commercial:
Fully insured:
PPO.................. 1,295,200 — 3,635,347 — 3,635,347 25.5%
HMO................. 704,600 — 2,432,768 — 2,432,768 17.1%
Total fully insured .... 1,999,800 — 6,068,115 — 6,068,115 42.6%
ASO ................... 1,171,000 — — 209,378 209,378 1.4%
Specialty ................ — 1,902,100 386,747 — 386,747 2.7%
Total Commercial ..... 3,170,800 1,902,100 6,454,862 209,378 6,664,240 46.7%
Total ............... 7,075,600 1,902,100 $14,001,591 $259,437 $14,261,028 100.0%
* As of December 31, 2005.
Our Products Marketed to Government Segment Members and Beneficiaries
Medicare Advantage Products
Medicare is a federal program that provides persons age 65 and over and some disabled persons under the
age of 65 certain hospital and medical insurance benefits. Hospitalization benefits are provided under Part A,
without the payment of any premium, for up to 90 days per incident of illness plus a lifetime reserve aggregating
60 days. Eligible beneficiaries are required to pay an annually adjusted premium to the federal government to be
eligible for physician care and other services under Part B. Beneficiaries eligible for Part A and Part B coverage
under traditional Medicare are still required to pay out-of-pocket deductibles and coinsurance. CMS, an agency
of the United States Department of Health and Human Services, administers the Medicare program.
We contract with CMS under the Medicare Advantage program to provide health insurance benefits to
Medicare eligible persons under health maintenance organization, or HMO, preferred provider organization, or
PPO, and Private Fee-For-Service, or PFFS, plans in exchange for contractual payments received from CMS,
usually a fixed payment per member per month. With each of these products, the beneficiary generally receives
benefits in excess of traditional Medicare, typically including a prescription drug benefit, a reduced monthly Part
B premium, or reduced cost sharing. Beginning in 2006, Medicare beneficiaries have more health plan options,
including a prescription drug benefit option and greater access to a PPO offering with the roll-out of Regional
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