Humana 2012 Annual Report Download - page 18

Our Employer Group Segment Products
This segment is comprised of products sold to employer groups including medical and supplemental benefit
plans described in the discussion that follows. The following table presents our premiums and services revenue
for the Employer Group segment by product for the year ended December 31, 2012:
Employer Group
Segment
Premiums and
Services Revenue
Percent of
Consolidated
Premiums and
Services Revenue
(dollars in millions)
Premiums:
Fully-insured commercial group ............... $ 4,996 12.9 %
Group Medicare Advantage ................... 4,064 10.5 %
Group Medicare stand-alone PDP .............. 8 0.0%
Total group Medicare .................... 4,072 10.5 %
Group specialty ............................ 1,070 2.8 %
Total premiums ........................ 10,138 26.2 %
Services ...................................... 358 0.9%
Total premiums and services revenue ....... $10,496 27.1 %
Employer Group Commercial Coverage
Our commercial products sold to employer groups include a broad spectrum of major medical benefits with
multiple in-network coinsurance levels and annual deductible choices that employers of all sizes can offer to their
employees on either a fully-insured, through HMO, PPO, or POS plans, or self-funded basis. Our plans integrate
clinical programs, plan designs, communication tools, and spending accounts. We participate in the Federal
Employee Health Benefits Program, or FEHBP, primarily with our HMO offering in certain markets. FEHBP is
the government’s health insurance program for Federal employees, retirees, former employees, family members,
and spouses. As with our individual commercial products, the employer group offerings include
HumanaVitality®, our wellness and loyalty reward program.
Our administrative services only, or ASO, products are offered to employers who self-insure their employee
health plans. We receive fees to provide administrative services which generally include the processing of
claims, offering access to our provider networks and clinical programs, and responding to customer service
inquiries from members of self-funded employers. These products may include all of the same benefit and
product design characteristics of our fully-insured HMO, PPO, or POS products described previously. Under
ASO contracts, self-funded employers generally retain the risk of financing substantially all of the cost of health
benefits. However, more than half of our ASO customers purchase stop loss insurance coverage from us to cover
catastrophic claims or to limit aggregate annual costs.
As with individual commercial policies, employers can customize their offerings with optional benefits such
as dental, vision, life, and a broad portfolio of financial protection products.
Group Medicare Advantage and Medicare stand-alone PDP
We offer products that enable employers that provide post-retirement health care benefits to replace
Medicare wrap or Medicare supplement products with Medicare Advantage or stand-alone PDPs from Humana.
These products offer the same types of benefits and services available to members in our individual Medicare
plans discussed previously and can be tailored to closely match an employer’s post-retirement benefit structure.
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