cigna10k.htm
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
FORM
10-K
___________________
(Mark
One)
[X] ANNUAL
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF
1934
For
the fiscal year ended December 31, 2007
OR
[ ] TRANSITION
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF
1934
Commission
file number 1-8323
CIGNA
Corporation
(Exact
name of registrant as specified in its charter)
Delaware
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06-1059331
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(State
or other jurisdiction of
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(I.R.S.
Employer
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incorporation
or organization)
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Identification
No.)
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Two
Liberty Place, Philadelphia, Pennsylvania
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19192
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(Address
of principal executive offices)
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(Zip
Code)
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Registrant’s
telephone number, including area code (215) 761-1000
Securities registered pursuant to
section 12(b) of the Act:
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Name
of each exchange on
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Title of each
class
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which
registered
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Common
Stock, Par Value $0.25
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New
York Stock Exchange, Inc.
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Securities
registered pursuant to section 12(g) of the Act:
None
Indicate
by check mark if the registrant is a well-known seasoned issuer, as defined in
Rule 405 of the Securities Act. Yes X No
__
Indicate
by check mark if the registrant is not required to file reports pursuant to
Section 13 or Section 15(d) of the Act. Yes __ No
X
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 X No
__
Indicate
by check mark if disclosure of delinquent filers pursuant to Item 405 of
Regulation S-K is not contained herein, and will not be contained, to the best
of registrant’s knowledge, in definitive proxy or information statements
incorporated by reference in Part III of this Form 10-K or any amendment to this
Form
10-K. [ ]
Indicate
by check mark whether the registrant is a large accelerated filer, an
accelerated filer, a non-accelerated filer, or a smaller reporting
company. See definitions of “large accelerated filer”, “accelerated
filer”, and “smaller reporting company” in Rule 12b-2 of the Exchange
Act.
Large
accelerated filer [X]
|
Accelerated
filer [ ]
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Non-accelerated
filer [ ]
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Smaller
Reporting Company
[ ]
|
Indicate
by check mark whether the registrant is a shell company (as defined in Rule
12b-2 of the Exchange Act). Yes _ No X
The
aggregate market value of the voting stock held by non-affiliates of the
registrant as of June 30, 2007 was approximately $13.5 billion.
As of
January 31, 2008, 280,085,645 shares of the registrant’s Common Stock were
outstanding.
Part III
of this Form 10-K incorporates by reference information from the registrant’s
proxy statement to be dated on or about March 20, 2008.
TABLE OF CONTENTS
Page
PART
I
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PART II
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106
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106
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It
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PART III
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106
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106
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106
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106
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106
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107
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107
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107
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PART IV
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107
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108
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FS-1
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E-1
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Item
1. BUSINESS
A. Description
of Business
CIGNA
Corporation and its subsidiaries constitute one of the largest investor-owned
health service organizations in the United States. Its subsidiaries
are major providers of health care and related benefits, the majority of which
are offered through the workplace, including: health care products and
services; group disability, life and accident insurance; and workers’
compensation case management and related services. CIGNA Corporation
had consolidated shareholders’ equity of $4.7 billion and assets of $40.1
billion as of December 31, 2007, and revenues of $17.6 billion for the year then
ended. CIGNA’s major insurance subsidiary, Connecticut General Life
Insurance Company (“CG Life”), traces its origins to 1865. CIGNA
Corporation was incorporated in the State of Delaware in 1981.
As used in this document, “CIGNA” and
the “Company” may refer to CIGNA Corporation itself, one or more of its
subsidiaries, or CIGNA Corporation and its consolidated
subsidiaries. CIGNA Corporation is a holding company and is not an
insurance company. Its subsidiaries conduct various businesses, which
are described in this Form 10-K.
CIGNA’s
revenues are derived principally from premiums, fees, mail order pharmacy, other
revenues and investment income as described on page 41
and 42. The financial results of CIGNA’s businesses are reported
in the following segments:
Available
Information
CIGNA’s Internet address is
http://www.cigna.com. CIGNA’s annual report on Form 10-K, quarterly
reports on Form 10-Q, current reports on Form 8-K and any amendments to those
reports are available through CIGNA’s website as soon as reasonably practicable
after the filing or furnishing of such material with the Securities and Exchange
Commission. See “Code of Ethics and Other Corporate Governance
Disclosures” in Part III, Item 10 on page 106 of this Form 10-K for additional
available information.
B. Financial Information
about Business Segments
The financial information included in
the tables that follow is presented in conformity with accounting principles
generally accepted in the United States of America (“GAAP”), unless otherwise
indicated. Certain reclassifications have been made to prior years’
financial information to conform to the 2007 presentation. Industry
rankings and percentages set forth below are for the year ended December 31,
2006, unless otherwise indicated. Unless otherwise noted, statements
set forth in this document concerning CIGNA’s rank or position in an industry or
particular line of business have been developed internally, based on publicly
available information.
Financial
data for each of CIGNA’s business segments is set forth in Note 19 to the
Financial Statements on page 96 of this Form 10-K.
CIGNA’s
Health Care operations (“CIGNA HealthCare”) offer insured and self-funded
medical, dental, behavioral health, vision, and prescription drug benefit plans,
health advocacy programs and other products and services that may be integrated
to provide individuals with comprehensive health care benefit programs.
CIGNA HealthCare also provides disability and life insurance products that
were historically sold in connection with certain experience-rated medical
products. These products and services are provided and administered by
subsidiaries of CIGNA Corporation.
CIGNA
HealthCare is focused on helping to improve the health, well-being and security
of the individuals whom CIGNA serves. CIGNA HealthCare believes the most
sustainable approach to enhancing quality and managing health care costs is to
fully engage consumers in their own health care. Therefore, CIGNA
HealthCare seeks to engage its members by providing actionable information about
health, including information about the cost and quality of care, that members
can use to make informed choices about health care for themselves and their
families.
Underlying
CIGNA HealthCare’s operations is a foundation of clinical expertise and an
ability to provide quality service at a competitive cost. CIGNA
HealthCare’s strengths include: (1) its ability to integrate medical
and specialty product offerings to achieve a more holistic and integrated
approach to members’ health that promotes consistent case management; and (2)
its ability to provide predictive modeling and other analytical tools (for
example, through the Company’s exclusive access to analytical tools and
algorithms developed by the University of Michigan), to assist in providing
targeted outreach and health advocacy by CIGNA’s clinical professionals to CIGNA
HealthCare members.
Principal
Products and Services and Funding Arrangements
With the
exception of HMO and Medicare Part D products, each of CIGNA HealthCare's
products (as described below) is offered with multiple funding options (also
described below). CIGNA may sell multiple products under the same
funding arrangement to the same customer. Accordingly, the revenue
table included in Management’s Discussion and Analysis (MD&A) on
page 49 reflects both the product type and funding
arrangement.
Medical
CIGNA
HealthCare provides a wide array of products and services to meet the needs of
employers and other sponsors of health benefit plans and the employees and
dependents participating in these plans, including:
·
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Health
Maintenance Organizations "(HMOs"). HMOs
are required by law to provide coverage for all basic health
services. They use various tools to facilitate the appropriate
use of health care services through employed and/or contracted health care
providers. HMOs control unit costs by negotiating rates of
reimbursement with providers and by requiring that certain treatments be
authorized for coverage in advance. CIGNA HealthCare offers HMO
plans that require members to obtain all non-emergency services from
participating providers as well as point of service (“POS”) HMO plans that
also provide a lesser level of insurance coverage for out-of-network care
from non-participating providers.
|
·
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Network,
Point of Service ("POS") and Open Access Plus Plans. CIGNA
HealthCare offers a product line of non-HMO managed care benefit
plans. All benefit plans in the managed care product line use
meaningful coinsurance differences for “in-network” versus out-of-network
care, give members the option of selecting a primary care physician, and
use a national provider network, which is somewhat smaller than the
national network used with the preferred provider ("PPO")
plan product line. The “Network” product covers only those
services provided by CIGNA HealthCare participating providers and
emergency services provided by non-participating providers. POS
and Open Access Plus plans cover health care services provided by
participating, (“in-network”), and non-participating (“out-of-network”)
health care providers.
|
·
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Preferred
Provider ("PPO") Plans. CIGNA
HealthCare also offers a PPO product line that features a broader national
network with generally less favorable provider discounts than the managed
care products described above, no option to select a primary care
physician, and in-network and out-of-network coverage, but with lesser
benefit incentives to encourage the use of participating
providers.
|
·
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Voluntary
Plans. CIGNA HealthCare's voluntary medical products are
offered to employers with 51 or more eligible employees and are designed
to meet the needs of the working uninsured (such as hourly or part-time
employees) by offering more limited and
|
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more
affordable coverage than traditional major medical plans. CIGNA HealthCare
strengthened its presence in the voluntary benefits marketplace in 2006
with the acquisition of the Star HRGSM
voluntary health insurance business and the introduction of the
Fundamental CareSM
product that provides higher coverage levels than other limited benefit
plans. |
·
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CIGNA
Choice Fund®,
Health Reimbursement Arrangement ("HRAs"), Health Savings Accounts
("HSAs") and Flexible Spending Accounts ("FSAs"). In
connection with many of the products described above, CIGNA offers the
CIGNA Choice Fund®
suite of consumer-directed products, including HRA, HSA and FSA
options. An HRA allows employers to choose from a variety of
benefit plan designs (such as HMO or PPO) and for employees to fund
unreimbursed health care expenses with reimbursement account funds that
can be rolled over from year to year. HSA plans allow employers
to choose from a variety of benefit plan designs and funding options and
combine a high deductible payment feature for a health plan with a
tax-preferred savings account offering mutual fund investment
options. Funds in an HSA can be used to pay the deductible and
for other eligible tax-deductible medical expenses. In
connection with its consumer-directed products, CIGNA offers Custom
Benefit BuilderSM,
a tool that allows members to customize plan options including copayments
and deductible levels, to create a personalized benefit design that meets
their individual needs. In 2007, CIGNA expanded the
availability of its HRA plans to smaller businesses with 51-200 employees
and also began offering an integrated HSA product to this
segment. The HRA and HSA products for employers with 51-200
employees are now available in 49 states as well as in Puerto Rico and the
U.S. Virgin Islands.
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·
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Stop-Loss
Coverage. CIGNA
HealthCare offers stop-loss insurance coverage to both experience-rated
and self-insured plans. This stop-loss coverage reimburses the
plan for claims in excess of some predetermined amount, for either
specific individuals, the entire group in aggregate, or
both.
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·
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Shared
Administration Services. CIGNA
HealthCare makes available to self-insured Taft-Hartley trusts shared
administration products. CIGNA HealthCare provides these
self-insured plans access to its national provider network and provides
claim re-pricing and other services (e.g. utilization
management).
|
Specialty
Health
Advocacy and CareAlliesSM. Through
its CareAlliesSM brand,
CIGNA offers medical management, disease management, and health advocacy
services to employers and other plan sponsors. CareAlliesSM
services are not only offered to members covered under CIGNA HealthCare
administered plans but also to those employees who have elected coverage under a
plan offered through their employer by competing insurers/third party
administrators. CareAlliesSM offers
a consistent set of services to address the clinical and administrative
inconsistencies that are inherent in the multi-vendor
approach. Through its health advocacy programs, CIGNA HealthCare
works to:
·
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help
healthy people stay healthy;
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·
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help
people change behaviors that are putting their health at
risk;
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·
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help
people with existing health care issues access quality care and practice
healthy self-care; and
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·
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help
people with a disabling illness or injury return to productive work
quickly and safely.
|
In
addition, CIGNA HealthCare offers a wide
array of programs and services to help individuals improve the health of the
mind and body, including:
·
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Early
intervention by CIGNA's network of over 2,500 clinical
professionals.
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·
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CIGNA’s
online health assessment, powered by analytics from the University of
Michigan Health Management Research Center, which helps members identify
potential health risks and learn what they can do to live a healthier
life.
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·
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The
CIGNA Well Aware for Better Health®
program, which helps patients with chronic conditions such as asthma,
diabetes, depression and weight complications better manage their
conditions.
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·
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CIGNA
Health Advisor®,
one of our fastest-growing offerings, which provides consumers with access
to a personal health coach to help them reach their health and wellness
goals.
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·
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CIGNA's
Well Informed program (first available in January 2008), which uses
clinical rules-based software to identify potential gaps and omissions
|
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in
members' health care through analysis of the Company’s integrated medical,
behavioral, pharmacy and lab data allowing CIGNA to communicate the gaps
to the member and the member’s doctor. |
·
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Online
coaching capabilities provided by United Kingdom (U.K.)-based vielife,
which CIGNA acquired in 2006.
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Behavioral
Health. CIGNA Behavioral
Health provides behavioral health care benefit products, behavioral health care
management, employee assistance programs, and work/life programs to employer
sponsored benefit plans, HMOs, governmental entities and disability
insurers. CIGNA Behavioral Health focuses on integrating its programs
and services to facilitate customized, holistic care.
As of
December 31, 2007, CIGNA Behavioral Health’s national network had approximately
61,500 access points to independent psychiatrists, psychologists and clinical
social workers and approximately 5,200 facilities and clinics that are
reimbursed on a contracted fee-for-service basis.
In 2008,
CIGNA plans to integrate the CIGNA Behavioral Health, vielife and
CareAlliesSM brands
and operations into a unified Health Solutions unit that will support CIGNA's
health advocacy strategy and manage the delivery of the Company’s health and
wellness programs, including: condition and disease management, maternity
management, case management, lifestyle management, health coaching (including
online), employee assistance, work/life balance, mental health and substance
abuse, health assessment, oncology support, transplant network/management,
24-hour health information line, wellness consulting, and the Healthy
Rewards® discount
program.
Dental. CIGNA
Dental Health offers a variety of dental care products including managed care,
dental preferred provider organization (“DPPO”), dental exclusive provider
organization (“DEPO”) and traditional indemnity products. Customers
can purchase CIGNA Dental Health products as stand-alone products or integrated
with CIGNA HealthCare’s medical products. As of December 31, 2007,
CIGNA Dental Health members totaled approximately 11 million, representing
employees at more than one-third of all Fortune 100
companies. Managed dental care products are offered in 36 states and
the District of Columbia through a network of independent providers that have
contracted with CIGNA to provide dental services to members.
CIGNA
Dental members access care from one of the largest dental HMO and dental PPO
networks in the U.S., with approximately 107,000 DPPO-contracted access points
(approximately 53,000 unique providers) and approximately 38,000 dental
HMO-contracted access points (approximately 10,000 unique
providers).
CIGNA
Dental Health stresses preventive dentistry; it believes that promoting
preventive care contributes to a healthier workforce, an improved quality of
life, increased productivity and fewer treatment claims and associated costs
over time. CIGNA Dental Health offers members a dental treatment cost
estimator and a dental plan cost estimator to educate individuals on oral health
and aid them in their dental health care decision-making.
Pharmacy. CIGNA
HealthCare offers prescription drug plans to its insured and self-funded
customers both in conjunction with its medical products and on a stand-alone
basis. CIGNA HealthCare has a nationwide network of approximately
57,000 contracted pharmacies that it uses in connection with its HMO, Network,
POS, PPO and Choice Fund®
products. In addition, CIGNA HealthCare provides managed pharmacy
benefit programs in connection with its HMO and POS products as well as Pharmacy
Outcome Improvement programs that take a holistic approach to helping improve
outcomes for members and managing medical costs for customers.
CIGNA
HealthCare's pharmacy products and services are a part of the Company’s efforts
to integrate clinical programs and case management across medical, behavioral
and pharmacy, and implement effective cost-management
programs. Programs that reflect this integration of medical,
behavioral and pharmacy offerings include:
·
|
a
prescription drug price comparison tool that gives members price
comparisons on branded and generic drugs from pharmacy retailers and mail
order, showing out-of-pocket as well as total anticipated costs, of the
prescription;
|
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|
·
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DrugCompareTM
and Medication Library where members can obtain detailed information
and comparisons of medications;
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·
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Prescription
Claim History Tool, which enables consumers to see their combined retail
and home delivery prescription history to help plan for and track
out-of-pocket expenses; and
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·
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CIGNA
HealthCare’s Step Therapy Program, which gradually encourages members to
use generic drugs
|
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for
anti-ulcer, hypertension, high cholesterol and allergic rhinitis
medications through communications with the consumer and the consumer’s
physician. |
CIGNA
Tel-Drug®. CIGNA HealthCare
also offers cost-effective mail order, telephone and on-line pharmaceutical
fulfillment services through its CIGNA Tel-Drug®
operation. CIGNA
Tel-Drug Home Delivery Pharmacy provides a member-focused, efficient home
delivery pharmacy with high standards of quality, accuracy and member care
relating to maintenance and specialty medications. Orders may be
submitted through the mail, via phone or through the internet at
myCIGNA.com. Refill reminders, generic conversion programs and
24-hour access to licensed pharmacists support CIGNA's goals of low net cost,
medication adherence and member service, resulting in a positive Return on
Health SM.
Medicare
Part D. CIGNA's Medicare Part D prescription drug program,
CIGNA Medicare Rx SM,
provides a number of plan options as well as service and information support to
medicare-eligible members aged 65 and over. CIGNA Medicare Rx SM is
available in all 50 states and the District of Columbia.
Retail
Pharmacies. CIGNA
operates 18 retail pharmacies, including on-site retail pharmacies for customers
to serve the needs of CIGNA HealthCare members.
Funding
Arrangements
The
segment’s health care products and services are offered through the following
funding arrangements:
·
|
retrospectively
experience-rated (including minimum premium funding arrangements);
and
|
Guaranteed
Cost. Under guaranteed cost funding arrangements, group
policyholders pay a fixed premium and CIGNA bears the risk for claims and costs
that exceed the premium. The HMO product is offered only on a
guaranteed cost basis.
Retrospectively Experience-rated (Including
Minimum Premium). Under retrospectively experience-rated
funding arrangements, a premium that typically includes a margin to partially
protect against adverse claim fluctuations is determined at the beginning of the
policy period. CIGNA generally bears the risk if claims and expenses
exceed premiums, but has the potential to recover these deficits from margins in
future years if coverage is renewed. For additional discussion, see
“Pricing, Reserves and Reinsurance” on page 7.
Under
minimum premium funding arrangements, instead of simply paying a fixed monthly
premium, the group policyholder establishes and funds a bank account and
authorizes the insurer to draw upon funds in the account to pay
claims. The policyholder pays a monthly residual premium while the
policy is in effect and a supplemental premium (to cover reserves for run-out
claims and expenses) upon termination. Minimum premium funding
arrangements combine insurance protection with an element of
self-funding. The policyholder is responsible for funding all claims
up to a predetermined aggregate, maximum amount, and CIGNA bears the risk for
claim costs incurred in excess of that amount. CIGNA has the
potential to recover this deficit from margins in future years if the policy is
renewed. Accordingly, minimum premium funding arrangements have a
risk profile similar to retrospectively experience-rated insurance
arrangements.
Service. Under the
service funding arrangement, CIGNA HealthCare contracts with employers on an
administrative services only (“ASO”) basis to administer
claims. CIGNA HealthCare collects administrative service fees in
exchange for providing ASO plans with access to CIGNA
HealthCare's applicable participating provider network and for providing
other services and programs, including: quality management, utilization
management; cost containment; health advocacy; 24-hour help line; case
management; disease management; pharmacy benefit management;
behavioral health care management services (through its provider
networks); or a combination of the above. The employer/plan sponsor
is responsible for self-funding all claims, but may purchase stop-loss insurance
from CIGNA HealthCare or other insurers for claims in excess of some
predetermined amount, for either individuals, the entire group in aggregate, or
both.
Financial
information regarding premiums and fees is presented on page 48 in the MD&A
section of this Form 10-K. Other financial information about the
Health Care segment is presented elsewhere in the MD&A section and
Note 19
to CIGNA's 2007 Financial Statements on page 96 of this Form 10-K.
Service
and Quality
CIGNA
HealthCare operates eight service centers that together processed
approximately 107 million medical claims in 2007. Satisfying
customers and members is a primary business objective and critical to the
Company’s success. To address a variety of member issues, CIGNA
HealthCare offers members access to its grievance and appeals
processes. CIGNA operates six member service centers that
members can call toll-free to address requests for information and complaints
and grievances. CIGNA HealthCare customer service representatives are empowered to
immediately resolve a wide range of issues to help members obtain the most
from their benefit plan. In many cases, a customer service
representative can resolve the member’s issue. If an issue cannot be
resolved informally, CIGNA HealthCare has a formal appeals process that can be
initiated by telephone or in writing and involves two levels of internal
review. For those matters not resolved by internal reviews, CIGNA
HealthCare members are offered the option of a voluntary external review of
claims. The CIGNA HealthCare formal appeals process addresses member
inquiries and appeals concerning initial medical necessity based coverage
determinations and other
benefits/coverage determinations. CIGNA HealthCare’s formal appeals
process meets National Committee for Quality Assurance (NCQA), Employee
Retirement Income Security Act (ERISA), Utilization Review Accreditation
Commission (URAC) and/or applicable state regulatory requirements.
CIGNA
HealthCare's commitment to promoting quality care and service to its customers
is reflected in a variety of activities, including: the credentialing
of medical providers and facilities that participate in CIGNA HealthCare's
managed care and PPO networks; the development of the CIGNA Care Network®
described below, and participation in initiatives that provide
information to members to enable educated health care decision
making.
Participating
Provider Network. CIGNA has an extensive national network of
participating health care providers, which as of December 31, 2007
consisted of approximately 5,100 hospitals and approximately 542,000
providers as well as other facilities, pharmacies and vendors of health care
services and supplies. As of December 31, 2006, CIGNA's national
network of participating health care providers consisted of approximately 5,000
hospitals and approximately 519,000 providers.
In most
instances, CIGNA contracts directly with the participating provider to provide
covered services to members at agreed-upon rates of reimbursement. In
some instances, however, CIGNA companies contract with third parties for access
to their provider networks. In addition, CIGNA has entered into
strategic alliances with several regional managed care organizations (Tufts
Health Plan, HealthPartners, Inc., Health Alliance Plan, and MVP Health Plan) to
gain access to their market leading provider networks and
discounts.
CIGNA
Care Network®. CIGNA Care
Network® is a
benefit design option available for CIGNA HealthCare administered plans in 58
service areas across the country. CIGNA Care Network® is a
subset of participating physicians in certain specialties who are designated as
CIGNA Care Network®
providers based on specific quality and cost-efficiency selection
criteria. Members pay reduced co-payments or co-insurance when they
receive care from a specialist designated as a CIGNA Care Network®
provider. CIGNA participating specialists are evaluated annually for
the CIGNA Care Network®
designation.
Provider
Credentialing. CIGNA HealthCare
credentials physicians, hospitals and other health care providers in its
participating provider networks using quality criteria which meets or exceeds
the standards of external accreditation or state regulatory agencies, or
both. Typically, most providers are recredentialed every three
years.
Health
Plan Credentialing. Each of CIGNA’s
23 HMO and POS plans that have undergone an accreditation review have earned the
highest rating possible – Excellent – from the NCQA and have earned Distinction
for NCQA's Quality Plus Member Connections and Physician and Hospital Quality
standards. The Member Connections standards assess a plan's web-based
and telephonic consumer decision support
tools. The Physician and Hospital Quality standards assess how well a
plan provides members with information about physicians and hospitals in its
network to help consumers make informed health care decisions. In
early 2008, CIGNA received “Full” accreditation (the highest rating possible)
from NCQA for its PPO plans and for CIGNA’s Open Access Plus plans
nationwide. The case management and utilization management programs
provided to CIGNA members have been awarded full accreditation by
URAC.
HEDIS®
Measures. In addition,
CIGNA participates in NCQA’s Health Plan Employer Data and Information Set
(“HEDIS®”)
Quality Compass Report. HEDIS®
Effectiveness of Care measures are a standard set of metrics to evaluate the
effectiveness of managed care organization clinical programs. CIGNA’s
national results compare favorably to industry averages.
Technology. CIGNA HealthCare
understands the critical importance of information technology to the level of
service the Company is able to provide to its customers and to the continued
growth of the health care business. The health care marketplace is
evolving and the level of service that is acceptable to consumers today may not
be acceptable tomorrow. Therefore, CIGNA HealthCare continues to
invest in its information technology infrastructure and capabilities including
technology essential to fundamental claim administration and customer service,
as well as tools and Internet-enabled technology that
support CIGNA HealthCare's focus on engaging members in health care
decisions.
For
example, CIGNA HealthCare has developed a range of consumer decision support
tools including:
·
|
myCIGNA.com,
CIGNA’s consumer Internet portal. The portal is personalized
with each member’s CIGNA medical, dental and pharmacy plan
information;
|
·
|
myCignaPlans.com,
a website which allows prospective members to compare plan coverage and
pricing options, before enrolling, based on a variety of
factors. The application gives consumers information on the
total health care cost to them and their
employer;
|
·
|
a
number of interactive online cost and quality information tools that
compare hospital quality and efficiency information, prescription drug
choices and average price estimates and member-specific average
out-of-pocket cost estimates for certain medical procedures;
and
|
·
|
Health
Risk Assessment, an online interactive tool through which consumers can
identify potential health risks and monitor their health
status.
|
In
addition, a special website designed for seniors was launched in 2007 to
offer customized features as well as access to both the myCIGNA.com and
cigna.com websites.
Pricing,
Reserves and Reinsurance
Premiums
and fees charged for HMO and most health insurance products and life insurance
products are generally set in advance of the policy period and are guaranteed
for one year. Premium rates are established either on a guaranteed
cost basis or on a retrospectively experience-rated basis.
Charges to customers established on a
guaranteed cost basis at the beginning of the policy period cannot be adjusted
to reflect actual claim experience during the policy period. A
guaranteed cost pricing methodology reflects assumptions about future claims,
health care inflation (unit cost, location of delivery of care and utilization),
the adequacy of fees charged for administration and risk assumption, effective
medical cost management, expenses, credit risk, enrollment mix, investment
returns, and profit margins. Claim and expense assumptions may be
based in whole or in part on prior experience of the account or on a pool of
accounts, depending on the group size and the statistical credibility of the
experience. Generally, guaranteed cost groups are smaller and less
statistically credible than retrospectively experience-rated
groups. In addition, pricing for health care products that use
networks of contracted providers reflects assumptions about the impact of the
reimbursement rates in the provider contracts on future
claims. Premium rates may vary among accounts to reflect the
anticipated contract mix, family size, industry, renewal date, and other
cost-predictive factors. In some states, premium rates must be
approved by the state insurance departments, and state laws may restrict or
limit the use of rating methods.
Premiums
established for retrospectively experience-rated business may be adjusted for
the actual claim and, in some cases, administrative cost experience of the
account through an experience settlement process subsequent to the policy
period. To the extent that the cost experience is favorable in
relation to the prospectively determined premium
rates, a portion of the initial premiums may be credited to the policyholder as
an experience refund. If claim experience is adverse in relation to
the initial premiums, CIGNA may recover the resulting experience deficit,
according to contractual provisions, through future premiums and experience
settlements, provided the policy remains in force.
CIGNA
HealthCare contracts on an ASO basis with customers who fund their own
claims. CIGNA HealthCare charges these customers administrative fees
based on the expected cost of administering their self-funded
programs. In some cases, CIGNA provides performance guarantees
related to its administrative function. If these standards are not
met, CIGNA HealthCare may be financially at risk up to a stated percentage of
the contracted fee or a stated dollar amount.
In
addition to paying current benefits and expenses under insurance policies and
HMO service agreements, CIGNA HealthCare establishes reserves for amounts
estimated to settle reported claims not yet paid, as well as claims incurred,
but not yet reported. Also, liabilities are established for estimated
experience refunds based on the results of retrospectively experience-rated
policies and applicable contract terms.
As of
December 31, 2007, approximately $1.08 billion, or 69% of the reserves of
CIGNA's Health Care operations comprise liabilities that are likely to be paid
within one year, primarily for medical and dental claims, as well as certain
group disability and life insurance claims. Of the reserve amount
expected to be paid within one year, $258 million relates to amounts recoverable
from certain ASO customers and from minimum premium policyholders, and is offset
by a receivable. The remaining reserves related primarily to
contracts that are short term in nature, but have long term payouts and include
liabilities for group long-term disability insurance benefits and group life
insurance benefits for disabled and retired individuals, benefits paid in the
form of both life and non-life contingent annuities to survivors and contract
holder deposit funds.
CIGNA
HealthCare credits interest on experience refund balances to retrospectively
experience-rated policyholders through rates that are set at CIGNA HealthCare’s
discretion taking investment performance and market rates into
consideration. Generally, for interest-crediting rates set at CIGNA
HealthCare’s discretion, higher rates are credited to funds with longer terms
reflecting the fact that higher yields are generally available on investments
with longer maturities. For 2007, the rates of interest credited
ranged from 3.25% to 4.30%, with a weighted average rate of 3.70%.
The
profitability of CIGNA HealthCare's fully insured health care products depends
on the adequacy of premiums charged relative to claims and
expenses. For medical and dental products, profitability reflects the
accuracy of cost projections for health care (unit costs and utilization), the
adequacy of fees charged for administration and risk assumption and effective
medical cost and utilization management.
CIGNA
HealthCare reduces its exposure to large catastrophic losses under group life,
disability and accidental death contracts by purchasing reinsurance from
unaffiliated reinsurers.
Markets
and Distribution
CIGNA
HealthCare targets the following markets for its products:
·
|
national
accounts, which are multi-site employers with more than 5,000
employees;
|
·
|
regional
accounts, which are generally defined as multi-site employers with more
than 200 but fewer than 5,000 employees, and single-site employees with
more than 200 employees;
|
·
|
small
business and individual, which includes employers with 2 - 200 employees
and individuals;
|
·
|
government,
which includes employees in federal, state and local governments, primary
and secondary schools, and colleges and
universities;
|
·
|
Taft-Hartley
plans, which includes members covered by union trust
funds;
|
·
|
seniors,
which focuses on the health care needs of individuals 50 years and older;
and
|
·
|
voluntary,
which focuses on employers with working uninsured
employees.
|
To date,
the national and regional account markets have comprised a significant amount of
CIGNA HealthCare's business.
CIGNA HealthCare employs group sales
representatives to distribute its products and services through insurance
brokers and insurance consultants or directly to employers. CIGNA
HealthCare also employs representatives
to sell utilization review services, managed behavioral health care and employee
assistance services directly to insurance companies, HMOs, third party
administrators and employer groups. As of December 31, 2007, the
field sales force for the products and services of this segment consisted of
approximately 840 sales representatives in approximately 100 field
locations.
Competition
CIGNA
HealthCare's business is subject to intense competition, and industry
consolidation has created an even more competitive business
environment. While no one competitor or small number of competitors
dominates the health care market, CIGNA expects a continuing trend of
consolidation in the industry with the emergence of consumer engagement
intensifying this trend.
In
certain geographic locations some health care companies may have significant
market share positions. A large number of health care companies and
other entities compete in offering similar products. Competition in
the health care market exists both for employers and other groups sponsoring
plans and for the employees in those instances where the employer offers its
employees the choice of products of more than one health care
company. Most group policies are subject to annual review by the
policyholder, who may seek competitive quotations prior to renewal.
The
principal competitive factors are: quality of service; scope; cost-effectiveness
and quality of provider networks; effectiveness of medical care management;
product responsiveness to the needs of customers and their employees;
cost-containment services; technology; price; and effectiveness of marketing and
sales. In addition, financial strength of the insurer, as indicated
by ratings issued by nationally recognized rating agencies, is also a
competitive factor. For more information concerning insurance
ratings, see “Ratings” in Section J beginning on page 25. CIGNA
HealthCare believes that its national scope, integrated approach to consumer
engagement, breadth of product and funding offerings, clinical care and medical
management capabilities and funding options are strategic competitive
advantages. These advantages allow CIGNA to respond to the diverse
needs of its customer base in each market in which it operates. CIGNA
also believes that its focus on helping to improve the health, well-being and
security of its members will allow it to distinguish itself from its
competitors.
The
principal competitors are:
·
|
other
large insurance companies that provide group health and life insurance
products;
|
·
|
Blue
Cross and Blue Shield
organizations;
|
·
|
stand-alone
HMOs and PPOs;
|
·
|
third
party administrators;
|
·
|
HMOs
affiliated with major insurance companies and hospitals;
and
|
·
|
national
managed pharmacy, behavioral health and utilization review services
companies.
|
Competition also arises from smaller
regional or specialty companies with strength in a particular geographic area or
product line, administrative service firms and, indirectly,
self-insurers. In addition to these traditional competitors, a new
group of competitors is emerging. These new competitors are focused
on delivering employee benefits and services through Internet-enabled technology
that allows consumers to take a more active role in the management of their
health. This is accomplished primarily through financial incentives
and access to enhanced medical quality data. The effective use of the
Company’s health advocacy capabilities, decision support tools (some of which
are web-based) and enabling technology are critical to success in the health
care industry, and CIGNA believes they will be competitive
differentiators. CIGNA believes that it has the capabilities and
appropriate strategy to allow it to compete against both traditional and new
competitors.
Industry
Developments and Strategic Overview
Both
state and federal lawmakers have supported a broad range of health care reform
efforts due to the recent demand for changes to the health care
industry. The proposal and/or passing of any reform initiatives would
affect the health care industry in general and CIGNA, specifically. CIGNA
advocates creating a value-based healthcare system that makes access to care
universal, fosters and rewards quality, and makes care more affordable by
educating consumers to the true costs and quality of care and supporting
better decision making. CIGNA envisions such a system as a partnership
between private and public sectors, taking the best of what the private and
public sector programs offer and creating a system that addresses the needs of
all. CIGNA is intensely
involved in developing workable solutions for reforming America's
healthcare system.
As part of its business strategy, CIGNA
continually evaluates potential acquisitions and other transactions that could
enhance the Company’s competitive capabilities and
provide a basis for membership growth and/or improved medical
costs. In 2007 CIGNA entered
into a definitive agreement to acquire the assets of Great-West Healthcare, the
healthcare division of Great-West Life & Annuity and acquired
Sagamore Health Network, Inc., an Indiana-based health care provider network
vendor.
Also, in
connection with CIGNA's long-term business strategy, the Company intends to
continue to focus on the
fundamentals of its health care business in order to provide consistent,
reliable service to customers at a competitive cost; differentiating
the health care business from its competitors by facilitating consumer
engagement to realize improvement in the individual’s health and well-being;
and segment
expansion, particularly in the voluntary, individual, small employer (fewer than
200 employees) and seniors markets, in which CIGNA HealthCare expects
high-growth opportunities that complement its core
business.
Principal
Products and Services
CIGNA's
Disability and Life operations provide the following insurance products and
their related services: group life insurance, long-term and
short-term disability insurance, workers’ compensation and disability case
management, and accident and specialty insurance. These products and
services are provided by subsidiaries of CIGNA Corporation.
Disability
Insurance
CIGNA
markets group long-term and short-term disability insurance products and
services in all states and statutorily required disability insurance plans in
certain states. These products and services generally provide a fixed
level of income to replace a portion of wages lost because of disability. They
also provide assistance to the employee in returning to work and assistance to
the employer in managing the cost of employee disability. Group
disability coverage is typically employer-paid or a combination of employer and
employee-paid.
CIGNA also provides case management and
related services to workers’ compensation insurers and employers who self-fund
workers’ compensation and disability benefits.
CIGNA’s
disability insurance products may be integrated with behavioral programs,
workers’ compensation, medical programs, social security advocacy, and the
Family and Medical Leave Act and leave of absence
administration. CIGNA believes this integration provides customers
with increased efficiency and effectiveness in disability claims management,
enhances productivity and reduces overall costs to
employers. Combining CIGNA disability and medical programs provides
enhanced opportunities to influence outcomes, reduces the cost of both medical
and disability events and improves the return to work rate. CIGNA has
formalized an integrated approach to health and wellness through
the Disability and Healthcare Connect Program. This
program uses information from the CIGNA HealthCare and Disability databases to
help identify, treat and manage disabilities before they become chronic, longer
in duration and more costly. Proactive outreach from CIGNA Behavioral
Health assists employees suffering from a mental health condition, either as a
primary condition or as a result of another condition. CIGNA may
receive fees for providing these integrated services to clients.
CIGNA is
a leader in returning employees to work quickly. Shorter disability
claim durations mean higher productivity and lower cost for employers and a
better quality of life for their employees. Employees also report a
high degree of satisfaction with the support CIGNA provides them to manage their
disabilities and return them back to work. Data from a 2006 customer
satisfaction survey showed that 9 out of 10 of CIGNA's short-term and long-term
disability claimants were satisfied or very satisfied with how their claims were
handled.
Approximately
5,600 disability policies covering approximately 4.3 million lives were
outstanding as of December 31, 2007.
Life
Insurance
Group
life insurance products include group term life and group universal
life. Group term life insurance may be employer-paid basic life
insurance or employee-paid supplemental life insurance.
CIGNA no
longer actively markets group universal life insurance, but continues to
administer the product for existing contractholders. Group universal
life insurance is a voluntary life insurance product in which the owner may
accumulate cash value. The cash value earns interest at rates
declared from time to time, subject to a minimum guaranteed rate, and may be
borrowed, withdrawn, or used to fund future life insurance
coverage. With group variable universal life insurance, the cash
value varies directly with the performance of the underlying investments and
neither the return nor the principal is guaranteed.
Approximately
6,100 group life insurance policies covering approximately 6.0 million lives
were outstanding as of December 31, 2007.
Other
CIGNA
offers personal accident insurance coverage, which consists primarily of
accidental death and dismemberment and travel accident insurance to
employers. Group accident insurance may be employer-paid or
employee-paid.
CIGNA also offers specialty insurance
services that consist primarily of life, accident and disability insurance to
professional associations, financial institutions, schools and participant
organizations.
Voluntary benefits are those
principally paid by the employee and are offered at the employer’s worksite.
CIGNA
plans provide, among other services, flexible enrollment options, list billing,
medical underwriting, and individual record keeping. CIGNA designed its
voluntary offerings to offer employers a complete and simple way to manage their
benefits, including personalized enrollment communication and administration of
the benefits program.
Markets
and Distribution
CIGNA
markets the group insurance products and services described above to employers,
employees, professional and other associations and groups. In
marketing these products, CIGNA targets customers with 50 or more employees and
employs group sales representatives to distribute the products and services of
this segment through insurance brokers and consultants. As of
December 31, 2007, the field sales force for the products and services of this
segment consisted of approximately 200 sales professionals in 27 field
locations.
Pricing,
Reserves and Reinsurance
Premiums
and fees charged for disability and life insurance products are generally
established in advance of the policy period and are generally guaranteed for one
to three years, but contracts may be subject to early termination.
Premium
rates reflect assumptions about future claims, expenses, credit risk, investment
returns and profit margins. Claim and expense assumptions may be based in whole
or in part on prior experience of the account or on a pool of accounts,
depending on the group size and the statistical credibility of the
experience.
Fees for universal life insurance
products consist of mortality, administrative and surrender charges assessed
against the policyholder’s fund balance. Interest credited and
mortality charges for universal life, and mortality charges on variable
universal life, may be adjusted prospectively to reflect expected interest and
mortality experience.
In addition to paying current benefits
and expenses, CIGNA establishes reserves in amounts estimated to be sufficient
to pay reported claims not yet paid, as well as claims incurred but not yet
reported. For liabilities with longer-term pay-out periods such as
long-term disability, reserves represent the present value of future expected
payments. CIGNA discounts these expected payments using assumptions
for interest rates and the length of time over which claims are expected to be
paid. The annual effective interest rate assumption used in determining reserves
for most of the long-term disability insurance business is 4.75% for claims that
were incurred in 2007 and 2006. For universal life insurance, CIGNA
establishes reserves for deposits received and interest credited to the
contractholder, less mortality and administrative charges assessed against the
contractholder’s fund balance.
The profitability of this segment’s
products depends on the adequacy of premiums charged relative to claims and
expenses. Effectiveness of return to work programs as well as
adequate return on invested assets impact the profitability of disability
insurance products. For life insurance products, the degree to which
future experience deviates from mortality, morbidity and expense assumptions
also affect profitability.
In order to reduce its exposure to
large individual and catastrophe losses under group life, disability and
accidental death contracts CIGNA purchases reinsurance from unaffiliated
reinsurers.
Competition
The principal competitive factors that
affect the products of the Disability and Life segment are underwriting and
pricing, the quality and effectiveness of claims management, relative operating
efficiency, distribution methodologies and producer relations, the variety of
products and services offered, and the quality of customer
service. The Company believes that CIGNA's claims management
capabilities provide a competitive advantage in this marketplace.
For certain products with longer-term
liabilities, such as group long-term disability insurance, the financial
strength of the insurer, as indicated by ratings issued by nationally recognized
rating agencies, is also a competitive factor. For more information
concerning insurance ratings, see “Ratings” in Section J beginning on page
25.
The principal competitors of CIGNA’s
group disability, life and accident businesses are other large and regional
insurance companies that market and distribute these types of
products.
As of December 31, 2007, CIGNA is one
of the top providers of group disability, life and accident insurance, based on
premiums.
Industry
Developments and Strategic Initiatives
The group
insurance market remains highly competitive as the rising cost of providing
medical coverage to employees has forced companies to reevaluate their overall
employee benefit spending. Demographic shifts have further driven
demand for products and services that are sufficiently flexible to meet the
evolving needs of employers and employees who want innovative, cost-effective
solutions to their insurance needs.
Employers
are also expressing a growing interest in employee wellness, absence management
and productivity and recognizing a strong link between health, productivity and
their profitability. As a result, employers are looking to offer
programs that promote a healthy lifestyle, offer assistance in returning to work
and integrate healthcare and disability programs. CIGNA believes it is well
positioned to deliver integrated solutions that address these broad employer and
employee needs. CIGNA also believes that
its strong disability management portfolio and fully integrated programs provide
employers and employees tools to prevent disability and mitigate its impact on
health, productivity and the employers’ profitability.
CIGNA’s
international operations offer life, accident and supplemental health insurance
products and international health care products and services. These
products and services are provided by subsidiaries of CIGNA Corporation,
including foreign operating entities.
Principal
Products and Markets
Life,
Accident and Supplemental Health Insurance
CIGNA International’s life, accident
and supplemental health insurance products generally provide simple, affordable
coverage of risks for the health and financial security of
individuals. These products are marketed primarily through
distribution partners with whom the individual has an affinity
relationship. Supplemental health products provide a specified
payment for a variety of health risks and include personal accident, accidental
death, critical illness, hospitalization, cancer and other dread disease
coverages. Variable universal life insurance products are also
included in the product portfolio. CIGNA International’s life,
accident and supplemental health insurance operations are located in South
Korea, Taiwan, Hong Kong, Indonesia, New Zealand, People’s Republic of China,
Thailand, and the European Union. In the third quarter of 2007, CIGNA
sold its Chilean insurance operations. In the third quarter of 2006,
CIGNA entered into negotiations to sell its Brazilian life insurance business
which is in run-off. The sale, which is subject to regulatory approval, is
expected to close in 2008.
International
Health Care Benefits
CIGNA International’s health care
operations primarily consist of products and services to meet the needs of
multinational companies and their expatriate employees and
dependents. These benefits include medical, dental, vision, life,
accidental death and dismemberment and disability products. The
customers of CIGNA International’s expatriate benefits business are
multinational companies and international organizations headquartered in the
United States, Canada, Europe, the Middle East and other international
locations. The expatriate benefits products and services are offered
through guaranteed cost, experience-rated, administrative services only, and
minimum premium funding arrangements. For definitions of funding arrangements,
see “Funding Arrangements” in Section C on page
5.
In
addition, CIGNA International’s health care operations include medical products,
which are provided through group benefits programs in the United Kingdom and
Spain. These products are primarily medical indemnity insurance coverage, with
some offerings having managed care or administrative service
aspects. These products generally provide an alternative or
supplement to government programs. In the fourth quarter of 2007,
CIGNA sold its Guatemalan health insurance operations.
Distribution
CIGNA
International’s life, accident and supplemental health insurance products are
distributed primarily through direct marketing channels, such as outbound
telemarketing, in-branch bancassurance and direct response
television. Marketing campaigns are conducted through these channels
under a variety of arrangements with affinity partners. These
affinity partners primarily include banks, credit card companies and other
financial institutions.
CIGNA
International’s health care products are distributed through independent brokers
and consultants, select partners as well as CIGNA International’s own sales
personnel.
Pricing,
Reserves and Reinsurance
Premiums
for CIGNA International’s life, accident and supplemental health insurance
products are based on assumptions about mortality, morbidity, customer
retention, expenses and target profit margins, as well as interest
rates. The profitability of these products is affected by the degree
to which future experience deviates from these assumptions.
Fees for
variable universal life insurance products consist of mortality, administrative,
asset management and surrender charges assessed against the contractholder’s
fund balance. Mortality charges on variable universal life may be
adjusted prospectively to reflect expected mortality experience.
Premiums
and fees for CIGNA International’s health care products reflect assumptions
about future claims, expenses, investment returns, and profit
margins. For products using networks of contracted providers,
premiums reflect assumptions about the impact of provider contracts and
utilization management on future claims. Most of the premium volume
for the medical indemnity business is on a guaranteed cost
basis. Other
premiums
are established on an experience-rated basis. Most contracts permit
rate changes at least annually.
The
profitability of health care products is dependent upon the accuracy of
projections for health care inflation (unit cost, location of delivery of care
and utilization), the adequacy of fees charged for administration and risk
assumption and, in the case of managed care products, effective medical cost
management.
In
addition to paying current benefits and expenses, CIGNA International
establishes reserves in amounts estimated to be sufficient to settle reported
claims not yet paid, as well as claims incurred but not yet reported.
Additionally, for some individual life insurance and supplemental health
insurance products, CIGNA International establishes policy reserves which
reflect the present value of expected future obligations less the present value
of expected future premiums net of costs and profits. CIGNA
International defers acquisition costs incurred in the sales of long-duration
life, accident and supplemental health products. For most products,
these costs are amortized in proportion to premium revenue recognized, the
timing of which is impacted by customer retention. For variable
universal life products, acquisition costs are amortized in proportion to
expected gross profits.
CIGNA
International reduces its exposure to large and/or multiple losses arising out
of a single occurrence by purchasing reinsurance from unaffiliated
reinsurers.
Competition
Competitive
factors in CIGNA International’s life, accident and supplemental health
operations include product innovation and differentiation, efficient management
of direct marketing processes, commission levels paid to distribution partners,
and quality of claims and policyholder services.
The
principal competitive factors that affect CIGNA International’s health care
operations are underwriting and pricing, relative operating efficiency, relative
effectiveness in medical cost management, product innovation and
differentiation, producer relations, and the quality of claims and customer
service. In most overseas markets, perception of financial strength
is also an important competitive factor.
For the
life, accident and supplemental health insurance line of business, locally based
competitors are primarily locally based insurance companies, including insurance
subsidiaries of banks. However, insurance company competitors in this
segment primarily focus on traditional product distribution through captive
agents, with direct marketing being a secondary objective. CIGNA
International estimates that it has less than 2% market share of the total life
insurance premiums in any given market in which it operates.
For the
expatriate benefits business, CIGNA International is a market leader in the
U.S., whose primary competitors include U.S.-based and European health insurance
companies with global expatriate benefits operations. For the health
care operations in the UK and Spain, the primary competitors are regional and
local insurers, with CIGNA's market share at less than 5% of the premiums of the
total local healthcare market.
CIGNA
International expects that the competitive environment will intensify as U.S.
and Europe-based insurance and financial services providers pursue global
expansion opportunities.
CIGNA
International conducts some of its international health care benefits operations
and all of its life, accident and supplemental health insurance operations
through foreign operating entities that maintain assets and liabilities in local
currencies. This reduces the exposure to economic loss resulting from
unfavorable exchange rate movements. For information on the effect of
foreign exchange exposure, see “Market Risk” on page 62 and Note 2(R) to
CIGNA’s 2007 Financial Statements on page 78 of this Form
10-K.
South
Korea represents the single largest geographic market for CIGNA International’s
businesses. In 2007, South Korea generated 31% of CIGNA
International’s revenues and 41% of its segment earnings. For
information on the concentration of risk with respect to CIGNA International’s
business in South Korea, see “Other Items Affecting International Results” on
page 53 of this Form 10-K.
Industry
Developments
Pressure
on social health care systems and increased wealth and education in emerging
markets is leading to higher demand for products providing health insurance and
financial security. In the life, accident and supplemental health
business, direct marketing is growing and attracting new competitors while
industry consolidation among financial institutions and other affinity partners
continues. For the international health care benefits business, trade
liberalization and rapid economic growth in emerging markets is leading to
multi-national companies expanding foreign operations.
Other
Operations consists of:
·
non-leveraged
and leveraged corporate-owned life insurance;
·
deferred
gains recognized from the 1998 sale of the individual life insurance and annuity
business and the 2004 sale of the retirement benefits business;
and
·
run-off
settlement annuity business.
The
products and services related to these operations are or were offered by
subsidiaries of CIGNA Corporation.
Corporate-owned
Life Insurance (“COLI”)
Principal Products and
Markets
The
principal products of the COLI business are permanent insurance contracts sold
to corporations to provide coverage on the lives of certain of their
employees. Permanent life insurance provides coverage that, when
adequately funded, does not expire after a term of years. The
contracts are primarily non-participating universal life
policies. The key distinction between leveraged and non-leveraged
COLI products is that, with leveraged COLI, the product design anticipates
borrowing by the policy owner of a portion of the surrender value, while policy
loans are not a significant feature of non-leveraged COLI.
Universal
life policies typically provide flexible coverage and flexible premium
payments. Policy cash values fluctuate with the amount of the
premiums paid, mortality and expense charges assessed, and interest credited to
the policy. Variable universal life policies are universal life contracts in
which the cash values vary directly with the performance of a specific pool of
investments underlying the policy.
The
principal services provided by the corporate-owned life insurance segment are
issuance and administration of the insurance policies (e.g., maintenance of
records regarding cash values and death benefits, claims processing, etc.) as
well as oversight of the investment management for separate account assets that
support the variable universal life product. The principal markets
for COLI products are mid to large sized corporations, including
banks.
Product
Features
Cash
values on universal life policies are credited interest at a declared interest
rate that reflects the anticipated investment results of the assets backing
these policies and may vary with the characteristics of each
product. Universal life policies generally have a minimum guaranteed
declared interest rate which may be cumulative from the issuance date of
the policy. The declared interest rate may be changed monthly, but is
generally changed less frequently. Variable universal life products
do not have a guaranteed minimum crediting rate.
In lieu
of credited interest rates, holders of certain universal life policies may elect
to receive credited income based on changes in an equity index, such as the
S&P 500®. No
such elections have been made since 2004.
Mortality
risk is retained according to guidelines established by CIGNA. To the
extent a given policy carries mortality risk that exceeds these guidelines;
reinsurance is purchased from third parties for the balance.
Distribution
CIGNA's
COLI products are offered through a select group of independent brokers with
particular expertise in the bank market and in the use of COLI for the financing
of benefit plan liabilities.
Industry Developments and Strategic
Initiatives
The
legislative environment surrounding COLI has evolved considerably over the past
decade. Most recently, the Pension Protection Act of 2006 included
provisions related to the notice requirements given to insured employees and
limited coverage to certain more highly compensated employees. These
changes were widely viewed as clarification of existing rules or industry best
practices.
Sale
of Individual Life Insurance & Annuity and Retirement Benefits
Businesses
CIGNA
sold its individual life insurance and annuity business in 1998 and its
retirement business in 2004. Portions of the gains from these sales
were deferred because the principal agreements to sell these businesses were
structured as reinsurance arrangements. The deferred portion relating
to the remaining reinsurance is being recognized at the rate that earnings from
the sold
businesses
would have been expected to emerge, primarily over 15 years on a declining
basis.
Because
the individual life and annuity business was sold in an indemnity reinsurance
transaction, CIGNA is not relieved of primary liability for the reinsured
business. Effective as of December 14, 2007, the purchaser placed the assets
supporting the reserves for the purchased business into a trust for the benefit
of CIGNA which qualifies to support CIGNA's credit for the reinsurance ceded
under Regulation 114 of the New York Department of Insurance. As of
December 31, 2007, the assets in the trust had a value of approximately $4.5
billion.
CIGNA's
sale of its retirement business primarily took the form of an arrangement under
which CIGNA reinsured with the purchaser of the retirement business the general
account contractholder liabilities under an indemnity reinsurance arrangement
and the separate account liabilities under modified coinsurance and indemnity
reinsurance arrangements.
Since the
sale of the retirement benefits business in 2004, the purchaser of that business
has entered into agreements with certain insured party contractholders
(“novation agreements”), which relieved CIGNA of any remaining contractual
obligations to the contractholders. As a result, CIGNA reduced reinsurance
recoverables, contractholder deposit funds, and separate account balances for
these obligations.
The
purchaser of the retirement benefits business deposited assets associated with
the reinsurance of general account contracts into a trust (the "Ceded Business
Trust") to provide security to CIGNA for the related reinsurance recoverables.
The purchaser is permitted to withdraw assets from the Ceded Business Trust
equal to the reduction in CIGNA's reserves whenever a reduction occurs. For
example, reductions will occur when the purchaser enters into additional
novation agreements and directly assumes liability to the insured party. As of
December 31, 2007, assets totaling $4.0 billion remained in the Ceded Business
Trust.
Settlement
Annuity Business
CIGNA's
settlement annuity business is a run-off block of contracts. These
contracts are primarily liability settlements with approximately half of the
payments guaranteed and not contingent on survivorship. In the case of the
contracts that involve non-guaranteed payments, such payments are contingent on
the survival of one or more parties involved in the settlement.
G. Investments and Investment
Income
CIGNA’s
investment operations provide investment management and related services
primarily for CIGNA’s corporate invested assets and the insurance-related
invested assets in its General Account ("Invested Assets"). CIGNA acquires or
originates, directly or through intermediaries, various investments including
private placements, public securities, commercial mortgage loans, real estate
and short-term investments. CIGNA’s Invested Assets are managed
primarily by CIGNA subsidiaries and external managers with whom CIGNA's
subsidiaries contract.
The
Invested Assets comprise a majority of the combined assets of the Health Care,
Disability and Life, Other Operations, and Run-off Reinsurance segments
(collectively, the “Domestic Portfolios”). There are, in addition,
portfolios containing Invested Assets that consist of the assets of the
International segment (collectively, the “International
Portfolios”).
Net
investment income and realized investment gains (losses) are not reported
separately in the investment operations. However, net investment
income is included as a component of earnings for each of CIGNA's operating
segments (Health Care, Disability and Life, Other Operations, Run-off
Reinsurance and International), net of the expenses attributable to the
investment operations.
Assets
Under Management
CIGNA’s
Invested Assets under management at December 31, 2007 totaled $17.5
billion. See Schedule I to CIGNA's 2007 Financial Statements on page
FS-3 of this Form 10-K for more information as to the allocation to types of
investments.
As of
December 31, 2007, CIGNA's separate account funds consisted of:
|
·
|
$1.5
billion in separate account assets that are managed by the buyer of the
retirement benefits business pursuant to reinsurance arrangements
described in "Sale of Individual Life Insurance & Annuity and
Retirement Benefits Businesses" on page 16 of this Form
10-K;
|
|
·
|
$1.7
billion in separate account assets which constitute a portion of the
assets of the CIGNA Pension Plan;
and
|
|
·
|
$3.8
billion in funds which primarily support certain corporate-owned life
insurance, health care and disability and life
products.
|
Types
of Investments
CIGNA invests in a broad range of asset
classes, including domestic and international fixed maturities and common
stocks, commercial mortgage loans, real estate and short-term investments. Fixed
maturity investments include publicly traded and private placement corporate
bonds, government bonds, publicly traded and private placement asset-backed
securities, and redeemable preferred stocks. In connection with
CIGNA's investment strategy to enhance investment yields by selling senior
participations of commercial mortgage loans, as of December 31, 2007, commercial
mortgage loans includes $77 million of commercial mortgage loans originated with
the intent to sell. These commercial mortgage loans held for sale are
carried at the lower of cost or market with any resulting valuation allowance
reported in realized investment gains and losses.
For the International Portfolios, CIGNA
invests primarily in publicly traded fixed maturities, short-term investments
and time deposits denominated in the currency of the relevant liabilities and
surplus.
Fixed
Maturities
CIGNA invests primarily in investment
grade fixed maturities rated by rating agencies (for public investments) and by
CIGNA (for private investments). For information about below
investment grade holdings, see “Investment Assets” on page 60 of this Form
10-K.
Commercial
Mortgages and Real Estate
Commercial mortgage loan investments
are subject to underwriting criteria addressing loan-to-value ratio, debt
service coverage, cash flow, tenant quality, leasing, market, location and
borrower’s financial strength. Such investments consist primarily of
first mortgage loans on commercial properties and are diversified by property
type, location and borrower. CIGNA invests primarily in commercial
mortgages on fully completed and substantially leased commercial
properties. Virtually all of CIGNA’s commercial mortgage loans are
balloon payment loans, under which all or a substantial portion of the loan
principal is due at the end of the loan term. CIGNA holds no direct
residential mortgages. The weighted average loan to value ratio of
the Company’s commercial mortgage loan portfolio as of December 31, 2007 was
approximately 62%.
CIGNA
enters into joint ventures with local partners to develop, lease and manage, and
sell commercial real estate to maximize investment returns. CIGNA's
portfolio of real
estate investments consists of properties under development and stabilized
properties, and is diversified relative to property type and
location. CIGNA also acquires real estate through foreclosure of
commercial mortgage loans. CIGNA rehabilitates, re-leases and sells
foreclosed properties, a process that usually takes from two to four years
unless management considers a near-term sale
preferable. Additionally, CIGNA invests in third party sponsored real
estate funds to maximize investment returns and to maintain diversity with
respect to its real estate related exposure. CIGNA did not sell any
foreclosed properties in 2007.
Mezzanine
and Private Equity Partnerships
CIGNA
invests in limited partnership interests in partnerships formed and managed by
seasoned, experienced fund managers with diverse mezzanine and private equity
strategies.
Derivative
Instruments
CIGNA generally uses derivative
financial instruments to minimize its exposure to certain market
risks. CIGNA has also written derivative instruments to minimize
certain insurance customers’ market risks. In addition, to enhance
investment returns, CIGNA may invest in indexed credit default swaps or other
credit derivatives from time to time. For information about CIGNA’s
use of derivative financial instruments, see Note 10(F) to CIGNA’s 2007
Financial Statements
on page 88 of this Form 10-K.
See also “Investment Assets” on page
60, and Notes 2, 10, and 11 to the Financial Statements on pages 71, 86 and
91 of this Form 10-K for additional information about CIGNA’s
investments.
Domestic
Portfolios – Investment Strategy
As of December 31, 2007 the Domestic
Portfolios had $16.1 billion in Invested Assets, allocated among fixed maturity
investments (67%); commercial mortgage loan investments (20%); and policy loans,
real estate investments and mezzanine and private equity partnership investments
(13%). CIGNA realized gains of $32 million from sales of equity real
estate investments in 2007.
CIGNA generally manages the
characteristics of these assets to reflect the underlying characteristics of
related insurance and contractholder liabilities and related capital
requirements, as well as regulatory and tax considerations pertaining to those
liabilities, and state investment laws. CIGNA’s domestic insurance
and contractholder liabilities as of December 31, 2007, excluding liabilities of
businesses sold through the use of reinsurance arrangements, were associated
with the following products, and the Invested Assets are allocated
proportionally as follows: other life and health, 18%; fully guaranteed annuity,
32%; and interest-sensitive life insurance, 50%.
While the
businesses and products supported are described elsewhere in this Form 10-K, the
Invested Assets supporting CIGNA's insurance and contractholder liabilities
related to each of its segments are as follows:
|
·
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The
Invested Assets supporting CIGNA’s Health Care operating segment are
structured to emphasize investment income, and provide the necessary
liquidity to meet cash flow
requirements.
|
|
·
|
The
Invested Assets supporting CIGNA's Disability and Life operating segment
are also structured to emphasize investment income, and provide necessary
liquidity to meet cash flow requirements. Assets supporting longer-term
group disability insurance benefits and group life waiver of premium
benefits are generally managed to an aggregate duration similar to that of
the related benefit cash flows.
|
|
·
|
The
Invested Assets supporting CIGNA's Other Operations segment are associated
primarily with fully guaranteed annuities (primarily settlement annuities)
and interest-sensitive life insurance (primarily corporate-owned life
insurance products). Because settlement annuities generally do
not permit withdrawal by policyholders prior to maturity, the amount and
timing of future benefit cash flows can be reasonably estimated so funds
supporting these products are invested in fixed income investments that
generally match the aggregate duration of the investment portfolio with
that of the related benefit cash flows. As of December 31,
2007, the duration of assets that supported these liabilities was
approximately 12.4 years. Invested Assets
supporting interest-sensitive life insurance products are primarily fixed
income investments and policy loans. Fixed income investments emphasize
investment yield while meeting the liquidity requirements of the related
liabilities.
|
|
·
|
The Invested Assets
supporting the Run-off Reinsurance segment with respect to guaranteed
minimum
death benefit annuities and guaranteed minimum income benefit annuities
are structured to emphasize investment income, and provide the necessary
liquidity to meet cash flow requirements. For information about
CIGNA’s use of derivative financial instruments in the Run-off Reinsurance
Segment, see Notes 7 and 20(B) to CIGNA’s 2007 Financial Statements
on pages 81 and 99 of this Form
10-K.
|
Investment strategy and results are
affected by the amount and timing of cash available for investment, competition
for investments, economic conditions, interest rates and asset allocation
decisions. CIGNA routinely monitors and evaluates the status of its
investments in light of current economic conditions, trends in capital markets
and other factors. Such factors include industry sector
considerations for fixed maturity investments and mezzanine and private equity
partnership investments, and geographic and property-type considerations for
commercial mortgage loan and real estate investments.
International
Portfolios – Investment Strategy
As of December 31, 2007 the
International portfolios had $1.4 billion in Invested Assets. The
International portfolios are primarily managed by external managers with whom
CIGNA's subsidiaries contract.
The
characteristics of these assets are generally managed to reflect the underlying
characteristics of related insurance and contractholder liabilities, as well as
regulatory and tax considerations in the countries where CIGNA's subsidiaries
operate. Assets are generally invested in the currency of related
liabilities, typically the currency in which the subsidiaries
operate. CIGNA's investment policy allows the investment of
subsidiary assets in U.S. dollars to the extent permitted by
regulation. CIGNA's international Invested Assets as of December 31,
2007 were held in support of statutory surplus and liabilities associated with
the types of insurance products described below.
Accident and health insurance consists
of various individual group and individual life, accident and health
products. Interest sensitive products primarily consist of “return of
premium” products in which the nominal amount of premiums paid for a multi-year
accident and health policy are paid back to the policyholder at the end of the
contract period. Invested Assets supporting these products are fixed
income investments that generally match the aggregate duration of the investment
portfolio with that of the related benefit cash flows.
Principal
Products and Markets
Until
2000, CIGNA offered reinsurance coverage for part or all of the risks written by
other insurance companies (or “cedents”) under life and annuity policies (both
group and individual); accident policies (personal accident, catastrophe and
workers' compensation coverages); and health policies. These products
were sold principally in North America and Europe through a small sales force
and through intermediaries.
In 2000,
CIGNA sold its U.S. individual life, group life and accidental death reinsurance
businesses. CIGNA placed its remaining reinsurance businesses
(including its accident, domestic health, international life and health, and
annuity reinsurance businesses) into run-off as of June 1, 2000 and stopped
underwriting new reinsurance business.
Prior to
2000, CIGNA also purchased reinsurance to reduce the risk of losses on contracts
that it had written. CIGNA determines its net exposure for run-off
reinsurance contracts by estimating the portion of its policy and claim reserves
that it expects will be recovered from its reinsurers (or “retrocessionaires”)
and reflecting these in its financial statements as Reinsurance Recoverables,
or, with respect to guaranteed minimum income benefit contracts discussed below,
as Other Assets.
CIGNA’s
exposures stem primarily from its annuity reinsurance business, including its
reinsurance of guaranteed minimum death benefit and guaranteed minimum income
benefit contracts, and its reinsurance of workers' compensation and other
personal accident risks.
Guaranteed Minimum Death Benefit
Contracts
CIGNA’s
reinsurance operations reinsured guaranteed minimum death benefits under certain
variable annuities issued by other insurance companies. These
variable annuities are essentially investments in mutual funds combined with a
death benefit. CIGNA has equity and other market exposures as a
result of this product.
For
additional information about guaranteed minimum death benefit contracts, see
“Guaranteed Minimum Death Benefits” under “Run-off Reinsurance” on page 53
and Note 7 to CIGNA's 2007 Financial Statements on page 80 of this Form
10-K.
Guaranteed Minimum Income Benefit
Contracts
In
certain circumstances where CIGNA's reinsurance operations reinsured the
guaranteed minimum death benefit, CIGNA also reinsured guaranteed minimum income
benefits under certain variable annuities issued by other insurance companies.
These variable annuities are essentially investments in mutual funds combined
with minimum income and death benefits. When annuitants elect to
receive these minimum income benefits, CIGNA may be required to make payments
which will vary based on changes in underlying mutual fund values and interest
rates. CIGNA has retrocessional coverage for 55% of the exposures on
these contracts, provided by two external reinsurers.
For
additional information about guaranteed minimum income benefit contracts, see
“Guaranteed Minimum Income Benefits” under “Run-off Reinsurance” on page 54, and
Note 20(B) to CIGNA's 2007 Financial Statements on page 99 of this Form
10-K.
Workers'
Compensation and Personal Accident
CIGNA reinsured workers'
compensation and other personal accident risks in the London market and in the
United States. CIGNA purchased retrocessional coverage in these
markets to substantially reduce the risk of loss on these
contracts. Disputes involving a number of these reinsurance and
retrocessional contracts have been substantially resolved and
some of the disputed contracts have been commuted. For more
information see “Legal Proceedings” in Item 3 on pages 35 and 36.
For more information
see “Run-off Reinsurance” on page 53, and Note 8 to CIGNA's 2007
Financial Statements on page 83 of this Form 10-K.
CIGNA and
its subsidiaries are subject to federal, state and international regulations and
CIGNA has established policies and procedures to comply with applicable
requirements.
CIGNA's
insurance and HMO subsidiaries must be licensed by the jurisdictions in which
they conduct business. These subsidiaries are subject to numerous
state and federal regulations related to their business operations, including,
but not limited to:
·
|
the
form and content of customer contracts including benefit mandates
(including special requirements for small groups generally under 50
employees);
|
·
|
the
content of agreements with participating providers of covered
services;
|
·
|
producer
appointment and compensation;
|
·
|
claims
processing and appeals;
|
·
|
underwriting
practices;
|
·
|
reinsurance
arrangements;
|
·
|
unfair
trade and claim practices;
|
·
|
risk
sharing arrangements with providers;
and
|
·
|
operation
of consumer-directed plans (including health savings accounts, health
reimbursement accounts, flexible spending accounts and debit
cards).
|
CIGNA
also complies with regulations in international jurisdictions where foreign
insurers are, in some countries, faced with greater restrictions than their
domestic competitors. These restrictions may include discriminatory licensing
procedures, compulsory cessions of reinsurance, required localization of records
and funds, higher premium and income taxes, and requirements for local
participation in an insurer’s ownership.
Other
types of regulatory oversight are described below.
Regulation
of Insurance Companies
Financial
Reporting
Regulators
closely monitor the financial condition of licensed insurance companies and
HMOs. States regulate the form and content of statutory financial
statements and the type and concentration of permitted
investments. CIGNA's insurance and HMO subsidiaries are required to
file periodic financial reports with regulators in most of the jurisdictions in
which they do business, and their operations and accounts are subject to
examination by such agencies at regular intervals.
Guaranty
Associations, Indemnity Funds, Risk Pools and Administrative Funds
Most
states and certain non-U.S. jurisdictions require insurance companies to support
guaranty associations or indemnity funds, which are established to pay claims on
behalf of insolvent insurance companies. In the United States, these
associations levy assessments on member insurers licensed in a particular state
to pay such claims.
Several
states also require HMOs to participate in guaranty funds, special risk pools
and administrative funds. For additional information about guaranty
fund and other assessments, see Note 20(D) to CIGNA’s 2007 Financial Statements
on page 100 of this Form 10-K.
Some
states also require health insurers and HMOs to participate in assigned risk
plans, joint underwriting authorities, pools or other residual market mechanisms
to cover risks not acceptable under normal underwriting standards.
Solvency
and Capital Requirements
Many
states have adopted some form of the National Association of Insurance
Commissioners (“NAIC”) model solvency-related laws and risk-based capital rules
(“RBC rules”) for life and health insurance companies. The RBC rules
recommend a minimum level of capital depending on the types and quality of
investments held, the types of business written and the types of liabilities
incurred. If the ratio of the insurer’s adjusted surplus to its
risk-based capital falls below statutory required minimums, the insurer could be
subject to regulatory actions ranging from increased scrutiny to
conservatorship.
In
addition, various non-U.S. jurisdictions prescribe minimum surplus requirements
that are based upon solvency, liquidity and reserve coverage
measures. During
2007, CIGNA’s HMOs and life and health insurance subsidiaries, as well as
non-U.S. insurance subsidiaries, were compliant with applicable RBC and non-U.S.
surplus rules.
The NAIC
is considering changing statutory reserving rules for variable
annuities. Any changes would apply to CIGNA's reinsurance contracts
covering guaranteed minimum death benefits and guaranteed minimum income
benefits, and would impact CIGNA's overall surplus level.
Holding
Company Laws
CIGNA's
domestic insurance companies and certain of its HMOs are subject to state laws
regulating subsidiaries of insurance holding companies. Under such
laws, certain dividends, distributions and other transactions between an
insurance or HMO subsidiary and its affiliates may require notification to, or
approval by, one or more state insurance commissioners.
Oversight
of Marketing, Advertising and Broker Compensation
State
and/or federal regulatory scrutiny of life and health insurance company and HMO
marketing and advertising practices, including the adequacy of disclosure
regarding products and their administration, may result in increased regulation.
Products offering limited benefits, such as those issued in connection with the
Star HRG business acquired in July 2006, may attract increased regulatory
scrutiny. States have responded to concerns about the marketing,
advertising and administration of insurance and HMO products and administrative
practices by increasing the number and frequency of market conduct examinations
and imposing larger penalties for violations of applicable laws and
regulations.
In recent
years, perceived abuses in broker compensation practices have been the focus of
greatly heightened regulatory scrutiny. This increased regulatory
focus may lead to legislative or regulatory changes that would affect the manner
in which CIGNA and its competitors compensate brokers. For more
information regarding general governmental inquiries relating to CIGNA
companies, see “Legal Proceedings” in Item 3 on pages 35 and
36.
Licensing
Requirements
Pharmacy
Licensure Laws
Certain CIGNA companies are pharmacies
which dispense prescription drugs to participants of benefit plans administered
or insured by CIGNA subsidiary HMOs and insurance companies. These
pharmacy-subsidiaries are subject
to state licensing requirements and regulation.
Claim
Administration, Utilization Review and Related
Services
CIGNA
subsidiaries contract for the provision of claim administration, utilization
management and other related services with respect to the administration of
self-insured benefit plans. These CIGNA subsidiaries are subject to state
licensing requirements and regulation.
Federal
Regulations
Employment
Retirement Income Security Act
CIGNA
sells most of its products and services to sponsors of employee benefit plans
that are governed by the Federal Employment Retirement Income Security Act
(“ERISA”). CIGNA companies may be subject to requirements imposed by
ERISA on plan fiduciaries and parties in interest, including regulations
affecting claim and appeals procedures for health, dental, disability, life and
accident plans.
Medicare
Regulations
Several
CIGNA subsidiaries engage in businesses that are subject to federal Medicare
regulations such as:
·
|
those
offering individual and group Medicare Advantage (HMO) coverage in
Arizona;
|
·
|
contractual
arrangements with the federal government for the processing of certain
Medicare claims and other administrative services;
and
|
·
|
those
offering Medicare Pharmacy (Part D) and Medicare Advantage Private
fee-for-service products that are subject to federal Medicare
regulations.
|
Federal
Audits of Government Sponsored Health Care Programs
Participation
in government sponsored health care programs subjects CIGNA to a variety of
federal laws and regulations and risks associated with audits conducted
under the
programs (which may occur in years subsequent to provision by CIGNA of the
relevant services under audit). These risks may include reimbursement
claims as well as potential fines and penalties. For example, the
federal government requires Medicare and Medicaid providers to file detailed
cost reports for health care services provided. These reports may be
audited in subsequent years. CIGNA HMOs that contract to provide
community-rated coverage to participants in the federal Employees Health Benefit
Plan may be required to reimburse the federal government if, following an audit,
it is determined that a federal employee group did not receive the benefit of a
discount offered by a CIGNA HMO to one of the two groups closest in size to the
federal employee group. See “Health Care” in Section C beginning on
page 2 for additional information about CIGNA’s participation in government
health-related programs.
Privacy
and Information Disclosure and Portability Regulations
The
Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) imposes
requirements for guaranteed issuance (for groups with 50 or fewer lives),
electronic data security standards, and renewal and portability, on health care
insurers and HMOs. In addition, HIPAA regulations required the
assignment of a unique national identifier for providers by May,
2007. The federal government and states (as well as most non-U.S.
jurisdictions) impose requirements regarding the use and disclosure of
identifiable information about individuals and, in an effort to deal with the
growing threat of identity theft, the handling of privacy and security
breaches.
Antitrust
Regulations
CIGNA
companies are also engaged in activities that may be scrutinized under federal
and state antitrust laws and regulations. These activities include
the administration of strategic alliances with competitors, information sharing
with competitors and provider contracting.
Anti-Money
Laundering Regulations
Certain
CIGNA lines of business are subject to United States Department of the Treasury
anti-money laundering regulations. Those lines of business have
implemented anti-money laundering policies designed to insure their affected
products comply with the regulations.
Investment-Related
Regulations
Depending
upon their nature, CIGNA's investment management activities are subject to U.S.
federal securities laws, ERISA, and other federal and state laws governing
investment related activities. In many cases, the investment
management activities and investments of individual insurance companies are
subject to regulation by multiple jurisdictions.
Regulatory
Developments
The
business of administering and insuring employee benefit programs, particularly
health care programs, is heavily regulated by federal and state laws and
administrative agencies, such as state departments of insurance and the federal
Departments of Labor and Justice, as well as the courts. In the
growing area of consumer-driven plans, health savings accounts and health
reimbursement accounts are also regulated by the United States Department of the
Treasury and the Internal Revenue Service. For information on
Regulatory and Industry Developments, see page 56 in the MD&A section
and Note 20(D) to CIGNA's 2007 Financial Statements on page 100 of this
Form
10-K.
Federal
regulation and legislation may affect CIGNA’s operations in a variety of
ways. In addition to proposals discussed above related to increased
regulation of the health care industry, other proposed federal measures that may
significantly affect CIGNA’s operations include calls for universal health care
coverage, market reforms achieved through state and federal legislation,
modifications of the Medicare program, and employee benefit
regulation including modification to the tax treatment of employee
benefits.
The
economic and competitive effects of the legislative and regulatory proposals
discussed above on CIGNA’s business operations will depend upon the final form
of any such legislation or regulation.
CIGNA and
certain of its insurance subsidiaries are rated by nationally recognized rating
agencies. The significance of individual ratings varies from agency
to agency. However, companies assigned ratings at the top end of the
range have, in the opinion of the rating agency, the strongest capacity for
repayment of debt or payment of claims, while companies at the bottom end of the
range have the weakest capacity.
Insurance
ratings represent the opinions of the rating agencies on the financial strength
of a company and its capacity to meet the obligations of insurance policies. The
principal agencies that rate CIGNA’s insurance subsidiaries characterize their
insurance rating scales as follows:
|
•
|
A.M.
Best Company, Inc. (“A.M. Best”), A++ to S (“Superior” to
“Suspended”);
|
|
•
|
Moody’s
Investors Service (“Moody’s”), Aaa to C (“Exceptional” to
“Lowest”);
|
|
•
|
Standard
& Poor’s Corp. (“S&P”), AAA to R (“Extremely Strong” to
“Regulatory Action”); and
|
|
•
|
Fitch,
Inc. (“Fitch”), AAA to D (“Exceptionally Strong” to “Order of
Liquidation”).
|
As of
February 27, 2008, the insurance financial strength ratings for CIGNA
subsidiaries, Connecticut General Life Insurance Company (CG Life) and Life
Insurance Company of North America (LINA) were as follows:
|
CG
Life
|
LINA
|
|
Insurance
Ratings(1)
|
Insurance Ratings
(1)
|
|
|
|
A.M.
Best
|
A
|
A
|
|
(“Excellent,”
|
(“Excellent,”
|
|
3rd
of 16)
|
3rd
of 16)
|
Moody’s
|
A2
|
A2
|
|
(“Good,”
|
(“Good,”
|
|
6th
of 21)
|
6th
of 21)
|
S&P
|
A
|
|
|
(“Strong,”
|
|
|
6th
of 21)
|
|
Fitch
|
A+
|
A+
|
|
(“Strong,”
|
(“Strong,”
|
|
5th
of 24)
|
5th
of 24)
|
_______________
(1)
|
Includes the rating assigned, the
agency’s characterization of the rating and the position of the rating in
the agency’s rating scale (e.g., CG Life’s rating by A.M. Best is the 3rd
highest rating awarded in its scale of
16).
|
Debt ratings are assessments of the
likelihood that a company will make timely payments of principal and
interest. The principal agencies that rate CIGNA’s senior debt
characterize their rating scales as follows:
|
•
|
Moody’s,
Aaa to C (“Exceptional” to
“Lowest”);
|
|
•
|
S&P,
AAA to D (“Extremely Strong” to “Default”);
and
|
|
•
|
Fitch,
AAA to D (“Highest” to “Default”).
|
The commercial paper rating scales for
those agencies are as follows:
|
•
|
Moody’s,
Prime-1 to Not Prime (“Superior” to “Not
Prime”);
|
|
•
|
S&P,
A-1+ to D (“Extremely Strong” to “Default”);
and
|
|
•
|
Fitch,
F-1+ to D (“Very Strong” to “Distressed”).
|
As of
February 27, 2008, the debt ratings assigned to CIGNA Corporation by the
following agencies were as follows:
Debt
Ratings(1)
CIGNA
CORPORATION
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|
Commercial
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|
Senior
Debt
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Paper
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Moody’s
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Baa2
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P2
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(“Adequate,”
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(“Strong,”
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9th
of 21)
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2nd
of 4)
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S&P
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BBB+
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A2
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(“Adequate,”
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(“Good,”
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8th
of 22)
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3rd
of 7)
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Fitch
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BBB+
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F2
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(“Good,”
8th
of 24)
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(“Moderately
Strong,”
3rd
of 7)
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(1)
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Includes
the rating assigned, the agency’s characterization of the rating and the
position of the rating in the applicable agency’s rating
scale.
|
In
February 2007, Moody’s upgraded CIGNA Corporation’s senior debt rating to “Baa2”
from “Baa3” and upgraded the financial strength ratings of CG Life and LINA to
“A2” from “A3.” At the same time, Moody’s upgraded the commercial
paper rating to “P2” from “P3”. In March 2007, S&P upgraded CIGNA
Corporation’s senior debt rating to “BBB+” from “BBB” and upgraded the financial
strength ratings of CG Life to “A” from “A-.” At the same time, Fitch
upgraded CIGNA Corporation’s senior debt rating to “BBB+” from “BBB” and
upgraded the financial strength ratings of CG Life and LINA to “A+” from
“A.” CIGNA is committed to maintaining appropriate levels of capital
in its subsidiaries to support finacial strength ratings that meet
customers’ expectations, and to improving the earnings of the health care
business. Lower ratings at the parent company level increase the cost to borrow
funds. Lower ratings of CG Life could adversely affect new sales and retention
of current business.
Portions
of CIGNA’s insurance business are seasonal in nature. Reported claims under
group health products are generally higher in the first quarter.
CIGNA and
its principal subsidiaries are not dependent on business from one or a few
customers. No customer accounted for 10% or more of CIGNA’s consolidated
revenues in 2007. CIGNA and its principal subsidiaries are not dependent on
business from one or a few brokers or agents. In addition, CIGNA’s insurance
businesses are generally not committed to accept a fixed portion of the business
submitted by independent brokers and agents, and generally all such business is
subject to its approval and acceptance.
CIGNA had
approximately 26,600, 27,100, and 28,000 employees as of December 31, 2007, 2006
and 2005, respectively.
CIGNA’s
businesses face risks and uncertainties, including those discussed below and
elsewhere in this report. These factors represent risks and uncertainties that
could have a material adverse effect on CIGNA’s business, results of operations
and financial condition. These risks and uncertainties are not the
only ones CIGNA faces. Others risks and uncertainties that CIGNA does not
know about now, or that the Company does not now think are significant, may
impair its business or the trading price of its securities. The
following are significant risks identified by CIGNA.
If CIGNA does not
execute on its strategic initiatives, there could be a material adverse effect
on CIGNA’s results of operations and in certain situations, CIGNA's financial
condition.
The
future performance of CIGNA’s business will depend in large part on CIGNA’s
ability to execute effectively and implement its strategic initiatives.
These initiatives include: executing CIGNA's consumer engagement strategy,
including designing products to meet emerging market trends and ensuring that an
appropriate infrastructure is in place to meet the needs of customers and
members; continuing to reduce medical costs; market expansion, in particular in
the individual and small business markets, as well as growth in medical and
specialty membership; and further improving the efficiency of operations,
including lowering operating costs and enabling higher value
services.
Successful
execution of these initiatives depends on a number of factors
including:
·
|
the
ability to gain and retain customers and members by providing appropriate
levels of support and service for CIGNA’s products, as well as avoiding
service and health advocacy related
errors;
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·
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the
ability to attract and retain sufficient numbers of qualified
employees;
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·
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the
negotiation of favorable provider
contracts;
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·
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CIGNA's
ability to develop and introduce new products or programs, because of the
inherent risks and uncertainties associated with product development,
particularly in response to government regulation or the increased focus
on consumer directed products;
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·
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the
identification and introduction of the proper mix or integration of
products that will be accepted by the marketplace;
and
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·
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the
ability of CIGNA’s products and services to differentiate CIGNA from its
competitors and for CIGNA to demonstrate that these products and services
(such as disease management and health advocacy programs, provider
credentialing and other quality care initiatives) result in improved
health outcomes and reduced costs.
|
If
CIGNA does not adequately invest in and effectively execute improvements in its
information technology infrastructure and improve its functionality, it will not
be able to deliver the service required in the evolving
marketplace.
CIGNA's
success in executing its consumer engagement strategy depends on the Company’s
continued improvements to its information technology infrastructure and customer
service offerings. The marketplace is evolving and the level of service that is
acceptable to consumers today will not necessarily be acceptable tomorrow. The
Company must continue to invest in long term solutions that will enable it to
meet customer expectations. CIGNA's success is dependent, in large part, on
maintaining the effectiveness of existing technology systems and continuing to
deliver and enhance technology systems that support the Company’s business
processes in a cost-efficient and resource-efficient manner. CIGNA
also must develop new systems to meet the current market standard and keep pace
with continuing changes in information processing technology, evolving industry
and regulatory standards and customer needs. System development
projects are long term in nature, may be more costly than expected to complete,
and may not deliver the expected benefits upon completion. If
the Company does not effectively manage and upgrade its technology portfolio,
CIGNA's operating results may be adversely affected.
If
CIGNA fails to properly maintain the integrity or security of its data or to
strategically implement new information systems, there could be a material
adverse effect on CIGNA’s business.
CIGNA’s
business depends on effective information systems and the integrity and
timeliness of the data it uses to run its business. CIGNA’s business
strategy requires providing members and providers with Internet-enabled products
and information to meet their needs. CIGNA’s
ability
to adequately price its products and services, establish reserves, provide
effective and efficient service to its customers, and to timely and accurately
report its financial results also depends significantly on the integrity of the
data in its information systems. If the information CIGNA relies upon
to run its businesses were found to be inaccurate or unreliable due to fraud or
other error, or if CIGNA were to fail to maintain effectively its information
systems and data integrity, the Company could have problems with, among other
things: operational disruptions, which may impact customers,
physicians and other health care providers; determining medical cost estimates
and establishing appropriate pricing; retaining and attracting customers; and
regulatory compliance.
If CIGNA
were unable to maintain the security of any sensitive data residing on the
Company’s systems whether due to our own actions or those of any vendors, our
reputation would be adversely affected and we could be exposed to litigation or
other actions, fines or penalties, any of which could adversely affect our
business or financial condition.
If
premiums are insufficient to cover the cost of health care services delivered to
members, or if CIGNA’s estimates of medical claim reserves for its guaranteed
cost and experience-rated businesses based upon estimates of future medical
claims are inadequate, profitability could decline.
CIGNA’s
profitability depends, in part, on its ability to accurately predict and control
future health care costs through underwriting criteria, provider contracting,
utilization management and product design. Premiums in the health care business
are generally fixed for one-year periods. Accordingly, future cost increases in
excess of medical cost projections reflected in pricing cannot generally be
recovered in the contract year through higher premiums. Although CIGNA bases the
premiums it charges on its estimate of future health care costs over the fixed
premium period, actual costs may exceed what was estimated and reflected in
premiums. Factors that may cause actual costs to exceed premiums include:
medical cost inflation; higher than expected utilization of medical services;
the introduction of new or costly treatments and technology; and membership
mix.
CIGNA
records medical claims reserves for estimated future payments. The Company
continually reviews estimates of future payments relating to medical claims
costs for services incurred in the current and prior periods and makes necessary
adjustments to its reserves. However, actual health care costs may exceed what
was estimated.
If CIGNA fails to
manage successfully its outsourcing projects and key vendors, CIGNA’s financial
results could be harmed.
CIGNA
takes steps to monitor and regulate the performance of independent third parties
who provide services or to whom the Company delegates selected functions. These
third parties include information technology system providers, independent
practice associations and specialty service providers.
In
addition to the software applications and human resource operations support IBM
had previously provided pursuant to several smaller contracts, in 2006, CIGNA
entered into an agreement with IBM to operate significant portions of its
information technology infrastructure, including the provision of services
relating to its call center application, enterprise content management,
risk-based capital analytical infrastructure and voice and data communications
network. The 2006 contract with IBM includes several service level
agreements, or SLAs, related to issues such as performance and job disruption
with significant financial penalties if these SLAs are not
met. However, the Company may not be adequately indemnified against
all possible losses through the terms and conditions of the agreement. In
addition, some of CIGNA’s termination rights are contingent upon payment of a
fee, which may be significant. If CIGNA's relationship with IBM is
terminated,
the Company may experience disruption of service to customers, which could
affect CIGNA's business, results of operations, and financial condition.
Arrangements
with key vendors may make CIGNA’s operations vulnerable if third parties fail to
satisfy their obligations to the Company, as a result of their performance,
changes in their own operations, financial condition, or other matters
outside of CIGNA’s control. Certain legislative authorities
have in recent periods discussed or proposed legislation that would restrict
outsourcing and, if enacted, could materially increase CIGNA’s
costs. Further, CIGNA may not fully realize on a timely basis the
anticipated economic and other benefits of the outsourcing projects or other
relationships it enters into with key vendors which could result in substantial
costs or other operational or financial problems that could adversely impact the
Company’s financial results.
A
downgrade in the financial strength ratings of CIGNA’s insurance subsidiaries
could adversely affect new sales and retention of current business, and a
downgrade in CIGNA's debt ratings would increase the cost of borrowed
funds.
Financial
strength, claims paying ability and debt ratings by recognized rating
organizations are an important factor in establishing the competitive position
of insurance companies and health benefits companies. Ratings
information by nationally recognized ratings agencies is broadly disseminated
and generally used throughout the industry. CIGNA believes the claims paying
ability and financial strength ratings of its principal insurance subsidiaries
are an important factor in marketing its products to certain of CIGNA’s
customers. In addition, CIGNA Corporation’s debt ratings impact both
the cost and availability of future borrowings, and accordingly, its cost of
capital. Each of the rating agencies reviews CIGNA’s ratings periodically and
there can be no assurance that current ratings will be maintained in the future.
In addition, a downgrade of these ratings could make it more difficult to raise
capital and to support business growth at CIGNA’s insurance
subsidiaries.
As of
February 27, 2008, the insurance financial strength ratings for CG Life, the
Company’s principal insurance subsidiary, were as follows:
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CG
Life
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Insurance
Ratings(1)
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|
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A.M.
Best
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A
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(“Excellent,”
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3rd
of 16)
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Moody’s
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A2
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(“Good,”
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6th
of 21)
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S&P
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A
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(“Strong,”
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6th
of 21)
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Fitch
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A+
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(“Strong,”
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5th
of 24)
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___________
(1)
Includes the rating assigned, the agency’s characterization of the rating and
the position of the rating in the agency’s rating scale (e.g., CG Life’s rating
by A.M. Best is the 3rd highest awarded in its scale of 16).
A
description of CIGNA Corporation ratings, other subsidiary ratings, as well as
more information on these ratings, is included in “Ratings” in Section J
beginning on page 25.
Unfavorable
claims experience related to workers’ compensation and personal accident
insurance exposures in CIGNA’s Run-off Reinsurance business could result in
losses.
Unfavorable
claims experience related to workers’ compensation and personal accident
insurance exposures in CIGNA’s run-off reinsurance business is possible and
could result in future losses. Further, CIGNA could have losses attributable to
its inability to recover amounts from retrocessionaires or ceding companies
either due to disputes with the retrocessionaires or ceding companies or their
financial condition. If CIGNA’s reserves for amounts recoverable from
retrocessionaires or ceding companies, as well as reserves associated with
underlying reinsurance exposures are insufficient, it could result in
losses.
If
CIGNA’s program for its guaranteed minimum death benefits contracts fails to
reduce the risk of stock market declines, it could have a material adverse
effect on the Company’s financial condition.
As part
of its run-off reinsurance business, CIGNA reinsured a guaranteed minimum death
benefit under certain variable annuities issued by other insurance
companies. CIGNA adopted a program to reduce equity market risks
related to these contracts by selling domestic and foreign-denominated
exchange-traded futures contracts. The purpose of this program is to
reduce the adverse effects of potential future domestic and international stock
market declines on CIGNA’s liabilities for these contracts. Under the
program, increases in liabilities under the annuity contracts from a declining
equity market are offset by gains on the futures contracts. However,
if CIGNA were to have difficulty in entering into appropriate futures contracts,
or stock market declines expose CIGNA to higher rates of partial surrender
(which are not covered by the program), there could be a material adverse effect
on the Company’s financial condition. See “Run-off Reinsurance” in
Section H on page 21 for more information on the program.
If
actual experience differs significantly from CIGNA’s assumptions used in
estimating CIGNA’s liabilities for reinsurance contracts covering guaranteed
minimum death benefits or minimum income benefits, it could have a material
adverse effect on CIGNA’s consolidated results of operations, and in certain
situations, could have a material adverse effect on CIGNA's financial
condition.
CIGNA
estimates reserves for guaranteed minimum death benefit and minimum income
benefit exposures are based on assumptions regarding lapse, partial surrender,
mortality, interest rates, volatility, reinsurance recoverables, and, for
minimum income benefit exposures, annuity income election
rates. These estimates are currently based on CIGNA’s experience and
future expectations. CIGNA monitors actual experience to update these
reserve estimates as necessary. CIGNA regularly evaluates the
assumptions used in establishing reserves and changes its estimates if actual
experience or other evidence suggests that earlier assumptions should be
revised. Further, CIGNA could have losses attributable to its
inability to recover amounts from retrocessionaires.
Significant
stock market declines could result in increased pension plan expenses and the
recognition of additional pension obligations.
CIGNA has
a pension plan that covers a large number of current employees and retirees.
Unfavorable investment performance due to significant stock market declines or
changes in estimates of benefit costs, if significant, could adversely affect
CIGNA’s results of operations or financial condition by significantly increasing
its pension plan expenses and obligations.
Significant
changes in market interest rates affect the value of CIGNA's financial
instruments that promise a fixed return and, as such, could have an adverse
effect on CIGNA's results of operation, financial condition and cash
flows.
As an
insurer, CIGNA has substantial investment assets that support its policy
liabilities. Generally low levels of interest rates on investments, such as
those experienced in United States financial markets during recent years, have
negatively impacted the level of investment income earned by the Company in
recent periods, and such lower levels of investment income would continue if
these lower interest rates were to continue. Substantially all of the
Company’s investment assets are in fixed
interest-yielding debt securities of varying maturities, fixed redeemable
preferred securities and commercial mortgage loans. The value of
these investment assets can fluctuate significantly with changes in market
conditions. A rise in interest rates could reduce the value of the
Company’s investment portfolio and increase interest expense if CIGNA were to
access its available lines of credit. The Company is also exposed to interest
rate and equity risk based upon the discount rate and expected long-term rate of
return assumptions associated with the Company’s pension and other
post-retirement obligations and certain guaranteed benefit
products. Sustained declines in interest rates or equity returns
could have an adverse impact on the funded status of the Company’s pension
plans, the ultimate benefit payout on these guaranteed products, and the
Company’s re-investment yield on new investments.
New
accounting pronouncements or guidance may require CIGNA to change the way in
which it accounts for operations and may affect the Company’s financial
results.
The
Financial Accounting Standards Board, the Securities and Exchange Commission,
and other regulatory bodies may issue new accounting standards or
pronouncements, or changes in the interpretation of existing standards or
pronouncements, from time to time, which could have a significant effect on
CIGNA's reported results for the affected period.
CIGNA
faces risks related to litigation and regulatory investigations.
CIGNA is
routinely involved in numerous claims, lawsuits, regulatory audits,
investigations and other legal matters arising in the ordinary course of the
business of administering and insuring employee benefit programs, including
benefit claims, breach of contract actions, tort claims, and disputes regarding
reinsurance arrangements. In addition, CIGNA incurs and likely will
continue to incur liability for claims related to its health care business, such
as failure to pay for or provide health care, poor outcomes for care delivered
or arranged, provider disputes, including disputes over compensation, and claims
related to self-funded business. Also, there are currently, and may be in the
future, attempts to bring class action lawsuits against the
industry. In addition, CIGNA is involved in pending and threatened
litigation arising out of its run-off reinsurance and retirement
operations.
Court
decisions and legislative activity may increase CIGNA’s exposure for any of
these types of claims. In some cases, substantial non-economic or punitive
damages may be sought. CIGNA currently has insurance coverage for some of these
potential liabilities. Other potential liabilities may not be covered by
insurance, insurers may dispute coverage or the amount of insurance may not be
sufficient to cover the entire damages awarded. In addition, certain types of
damages, such as punitive damages, may not be covered by insurance, and
insurance coverage for all or certain forms of liability
may
become unavailable or prohibitively expensive in the future.
A
description of material legal actions in which CIGNA is currently involved is
included under “Legal Proceedings” in Item 3 on pages 35 and 36 and
Note 20(E) to CIGNA’s 2007 Financial Statements on page 101 of this Form
10-K. The outcome of litigation and other legal matters is always uncertain, and
outcomes that are not justified by the evidence or existing law can
occur. CIGNA believes that it has valid defenses to the legal matters
pending against it and is defending itself vigorously. Nevertheless,
it is possible that resolution of one or more legal matters could result in
losses material to CIGNA’s consolidated results of operations, liquidity or
financial condition.
CIGNA’s
business is subject to substantial government regulation, which, along with new
regulation, could increase its costs of doing business and could adversely
affect its profitability.
CIGNA’s
business is regulated at the international, federal, state and local levels. The
laws and rules governing CIGNA’s business and interpretations of those laws and
rules are subject to frequent change. Broad latitude is given to the agencies
administering those regulations. Existing or future laws and rules could force
CIGNA to change how it does business, restrict revenue and enrollment growth,
increase health care, technology and administrative costs including pension
costs and capital requirements, take other actions such as changing our reserve
levels with respect to certain reinsurance contracts, and increase CIGNA’s
liability in federal and state courts for coverage determinations, contract
interpretation and other actions.
CIGNA
must comply with the various regulations applicable to its
business. If CIGNA fails to comply, the Company’s business could be
adversely affected. In addition, CIGNA must obtain and maintain
regulatory approvals to market many of its products, to increase prices for
certain regulated products and to consummate some of its acquisitions and
divestitures. Delays in obtaining or failure to obtain or maintain these
approvals could reduce the Company’s revenue or increase its costs.
For
further information on regulatory matters relating to CIGNA, see “Regulation” in
Section I on page 22 and “Legal Proceedings” in Item 3 on pages 35 and
36.
CIGNA
operates a pharmacy benefit management business, which is subject to a number of
risks and uncertainties in addition to those CIGNA faces with its health care
business.
CIGNA's
pharmacy benefit management business is subject to federal and state regulation,
including: the application of federal and state anti-remuneration laws;
compliance requirements for pharmacy benefit manager fiduciaries under ERISA,
including compliance with fiduciary obligations under ERISA in connection with
the development and implementation of items such as formularies, preferred drug
listings and therapeutic intervention programs, contracting network practices,
specialty drug distribution and other transactions and potential liability
regarding the use of patient-identifiable medical information; and federal and
state laws and regulations related to the operation of Internet and mail-service
pharmacies. Failure to comply with any of these laws or regulations
could affect the Company’s business, results of operations, and financial
condition. Furthermore, a number of federal and state legislative
proposals are being considered that could adversely affect a variety of pharmacy
benefit industry practices, including without limitation, the receipt of rebates
from pharmaceutical manufacturers, the regulation of the development and use of
formularies, and legislation imposing additional rights to access drugs for
individuals enrolled in managed care plans.
The
Company’s pharmacy benefit management business would also be adversely affected
by an inability to contract on favorable terms with pharmaceutical manufacturers
and could suffer claims and reputational harm in connection with purported
errors by CIGNA's mail order or retail pharmacy
businesses. Disruptions at any of the Company's pharmacy business
facilities due to failure of technology or any other failure or disruption to
these systems or to the infrastructure due to fire, electrical outage, natural
disaster, acts of terrorism or some other catastrophic event could reduce
CIGNA's ability to process and dispense prescriptions and provide products and
services to customers, which could negatively impact the Company’s business,
results of operations, and financial condition.
CIGNA
faces competitive pressure, particularly price competition, which could reduce
product margins and constrain growth in CIGNA’s health care
businesses.
While
health plans compete on the basis of many factors, including service quality of
clinical resources, claims
administration
services and medical management programs, and quality and sufficiency of
provider networks,
CIGNA expects that price will continue to be a significant basis of competition.
CIGNA’s customer contracts are subject to negotiation as customers seek to
contain
their costs, and customers may elect to reduce benefits in order to constrain
increases in their benefit costs. Such an election may result in lower premiums
for the Company’s products, although it may also reduce CIGNA’s costs.
Alternatively, the Company’s customers may purchase different types of products
that are less profitable, or move to a competitor to obtain more favorable
premiums.
In
addition, significant merger and acquisition activity has occurred in the health
care industry giving rise to speculation and uncertainty regarding the status of
companies, which potentially can affect marketing efforts and public perception.
Consolidation may make it more difficult for the Company to retain or increase
customers, to improve the terms on which CIGNA does business with its suppliers,
or to maintain its position or increase profitability. Factors such as business
consolidations, strategic alliances, legislative reform and marketing practices
create pressure to contain premium price increases, despite increasing medical
costs. For example, the Gramm-Leach-Bliley Act gives banks and other
financial institutions the ability to affiliate with insurance companies, which
may lead to new competitors with significant financial resources in the
insurance and health benefits fields. If CIGNA does not compete
effectively in its markets, if the Company sets rates too high in highly
competitive markets to keep or increase its market share, if membership
does not increase as it expects, or if it declines, or if CIGNA loses accounts
with favorable medical cost experience while retaining or increasing membership
in accounts with unfavorable medical cost experience, CIGNA’s product margins
and growth could be adversely affected.
Public
perception of CIGNA's products and practices as well as of the health benefits
industry, if negative, could reduce enrollment in CIGNA’s health benefits
programs.
The
health care industry in general, and CIGNA specifically, are subject to negative
publicity, which can arise either from perceptions regarding the industry or
CIGNA's business practices or products. This risk may be increased as
CIGNA offers new products, such as products with limited benefits or an
integrated line of products, targeted at market segments, beyond those in which
CIGNA traditionally has operated. Negative publicity may adversely affect the
CIGNA brand and
its ability to market its products and services, which could reduce the number
of enrollees in CIGNA's health benefits programs and adversely affect CIGNA’s
profitability.
Large-scale
public health epidemics, bio-terrorist activity, natural disasters or other
extreme events could cause CIGNA’s covered medical and disability expenses,
pharmacy costs and mortality experience to rise significantly, and in severe
circumstances, could cause operational disruption.
If
widespread public health epidemics such as an influenza pandemic, bio-terrorist
or other attack, or catastrophic natural disaster were to occur, CIGNA’s covered
medical and disability expenses, pharmacy costs and mortality experience could
rise significantly, depending on the government’s actions and the responsiveness
of public health agencies and insurers. In addition, depending on the
severity of the situation, a widespread outbreak could curtail economic activity
in general, and CIGNA's operations in particular, which could result in
operational and financial disruption to CIGNA, which among other things may
impact the timeliness of claims and revenue.
CIGNA's
business depends on the uninterrupted operation of its systems and business
functions, including information technology and other business
systems.
CIGNA’s
business is highly dependent upon its ability to perform, in an efficient and
uninterrupted fashion, its necessary business functions, such as: claims
processing and payment; internet support and customer call centers; and the
processing of new and renewal business. A power outage, pandemic, or failure of
one or more of information technology, telecommunications or other systems could
cause slower system response times resulting in claims not being processed as
quickly as clients desire, decreased levels of client service and client
satisfaction, and harm to CIGNA's reputation. In addition, because CIGNA’s
information technology and telecommunications systems interface with and depend
on third party systems, CIGNA could experience service denials if demand for
such service exceeds capacity or a third party system fails or experiences an
interruption. If sustained or repeated, such a business
interruption, systems failure or service denial could result in a
deterioration of CIGNA’s ability to pay claims in a timely
manner,
provide customer service, write and process new and renewal business, or perform
other necessary corporate
functions. This could result in a materially adverse effect on CIGNA’s business
results and liquidity.
A
security breach of CIGNA’s computer systems could also interrupt or damage
CIGNA’s operations or harm CIGNA's
reputation. In addition, CIGNA could be subject to liability if sensitive
customer information is misappropriated from CIGNA’s computer systems. These
systems may be vulnerable to physical break-ins, computer viruses, programming
errors, attacks by third parties or similar disruptive problems. Any publicized
compromise of security could result in a loss of customers or a reduction in the
growth of customers, increased operating expenses, financial losses, additional
litigation or other claims, which could have a material adverse effect on
CIGNA’s business.
CIGNA is
focused on further developing its business continuity program to address
the continuation of core business operations. While CIGNA continues to test and
assess its business continuity program to satisfy the needs of
CIGNA’s core business operations and addresses multiple business
interruption events, there is no assurance that core business operations could
be performed upon the occurrence of such an event.
CIGNA
faces a wide range of risks, and its success depends on its ability to identify,
prioritize and appropriately manage its enterprise risk exposure.
As a
large company operating in a complex industry, CIGNA encounters
a variety of risks as identified in this Risk Factor discussion. CIGNA devotes
resources to developing enterprise-wide risk management processes, in addition
to the risk management processes within its businesses. Failure to appropriately
identify and manage these risks, as well as the failure to identify and take
advantage of appropriate opportunities, can materially affect CIGNA’s
profitability, its ability to retain or grow business, or, in the event of
extreme circumstances, CIGNA’s financial condition.
CIGNA
faces risks relating to its ability to effectively deploy its
capital.
CIGNA’s
operations have generated significant capital in recent periods and the Company
has significant ability to raise additional capital. In deploying its capital to
fund its investments in operations, share repurchases, potential acquisitions
or other
capital uses, CIGNA's financial results could be adversely affected if it does
not appropriately balance its risks and opportunities.
CIGNA
is subject to potential changes in the political environment which affects
public policy and can adversely affect the markets for our
products.
While it
is not possible to predict when and whether fundamental policy changes would
occur, these could include policy changes on the local, state and federal level
that could fundamentally change the dynamics of CIGNA’s industry,
such as a much larger role of the government in the health care
arena. Changes in public policy could materially affect CIGNA's
profitability, its ability to retain or grow business, or in the event of
extreme circumstances, its financial condition.
If
CIGNA does not successfully manage the pending acquisition and integration of
Great-West Healthcare (or any other acquisition), its results of operations and
financial condition may be adversely affected.
CIGNA
entered into a definitive agreement to acquire Great-West Healthcare with the
expectation that the acquisition will result in various benefits, including,
among others, a broader distribution and provider network in certain geographic
areas, an expanded range of health benefits and products, cost savings,
increased profitability of the acquired business by improving its total medical
cost position, and achievement of operating efficiencies. Achieving the
anticipated benefits of the acquisition is subject to a number of uncertainties,
including whether CIGNA integrates Great-West Healthcare in an efficient and
effective manner, and general competitive factors in the marketplace. Failure to
achieve these anticipated benefits could limit CIGNA’s ability to grow
membership particularly in the small business segment, result in increased
costs, decreases in the amount of expected revenues and diversion of
management’s time and energy and could materially impact CIGNA’s business,
results of operations, and financial condition.
CIGNA
faces intense competition to attract and retain key people.
CIGNA
would be adversely impacted if it failed to attract additional key people and
retain current key people as this could result in the inability to effectively
execute the Company’s key initiatives and business strategy.
None.
CIGNA's
headquarters, along with CIGNA Group Insurance, CIGNA International, portions of
CIGNA HealthCare and CIGNA's staff support operations, are located in
approximately 450,000 square feet of leased office space at Two Liberty Place,
1601 Chestnut Street, Philadelphia. CIGNA HealthCare is located in
approximately 825,000 square feet of owned office space in the Wilde Building,
located at 900 Cottage Grove Road, Bloomfield, Connecticut. In
addition, CIGNA owns or leases office buildings, or parts thereof, throughout
the United States and in other countries. CIGNA believes its
properties are adequate and suitable for its business as presently
conducted. For additional information concerning leases and property,
see Notes 2(H) and 18 to CIGNA's 2007 Financial Statements on pages 75
and 96 of this Form 10-K. This paragraph does not include
information on investment properties.
CIGNA is
routinely involved in numerous claims, lawsuits, regulatory and IRS audits,
investigations and other legal matters arising, for the most part, in the
ordinary course of the business of administering and insuring employee benefit
programs. An increasing number of claims are being made for
substantial non-economic, extra-contractual or punitive damages. The
outcome of litigation and other legal matters is always uncertain, and outcomes
that are not justified by the evidence can occur. CIGNA believes that
it has valid defenses to the legal matters pending against it and is defending
itself vigorously. Nevertheless, it is possible that resolution of
one or more of the legal matters currently pending or threatened could result in
losses material to CIGNA’s consolidated results of operations, liquidity or
financial condition.
In
re Managed Care Litigation
On April
7, 2000, several pending actions were consolidated in the United States District
Court for the Southern District of Florida in a multi-district litigation
proceeding captioned In re
Managed Care Litigation. The consolidated cases include Shane v. Humana, Inc., et al.
(CIGNA subsidiaries added as defendants in August 2000), Mangieri v. CIGNA Corporation
(filed December 7, 1999 in the United States District Court for the Northern
District of Alabama), Kaiser
and Corrigan v. CIGNA Corporation, et al. (class of health care providers
certified on March 29, 2001) and Amer. Dental Ass’n v. CIGNA Corp.
et. al. (a putative class of dental providers).
In 2004,
the Court approved a settlement agreement between the physician class and
CIGNA. A dispute over disallowed claims under the settlement
submitted by a representative of certain class member physicians is proceeding
to arbitration. Separately, in April 2005, the Court approved a
settlement between CIGNA and a class of non-physician health care
providers. Only the Amer. Dental Ass’n case
remains unresolved. CIGNA's motion to dismiss the case is
pending.
In the
fourth quarter of 2006, pursuant to a settlement, CIGNA received a favorable $22
million pre-tax ($14 million after tax) insurance recovery related to this
litigation. In the first quarter of 2007, CIGNA received an
additional $5 million pre-tax ($3 million after-tax) insurance recovery related
to this litigation. CIGNA is pursuing further recoveries from two
additional insurers.
Broker Compensation
Beginning
in 2004, CIGNA, other insurance companies and certain insurance brokers received
subpoenas and inquiries from various regulators, including the New York and
Connecticut Attorneys General and the Florida Office of Insurance Regulation
relating to their investigations of insurance broker
compensation. CIGNA received a subpoena from the U.S. Attorney’s
Office for the Southern District of California in October 2005 and the San Diego
District Attorney
in March 2006 and has provided information to them about a broker, Universal
Life Resources (ULR). On June 6, 2007, the Company received a letter from the
San Diego District Attorney, detailing its potential claims and penalties
against the Company subsidiaries, and outlining potential civil
litigation. The Company denies the allegations and will vigorously
defend itself in the event of litigation. In addition, in January
2006, CIGNA received a subpoena from the U.S. Department of Labor and is
providing information to that Office about another broker. CIGNA is
cooperating with the inquiries and investigations.
On
November 18, 2004, The People
of the State of California by and through John Garamendi, Insurance Commissioner
of the State of California v. Universal Life Resources, et al. was filed
in the Superior Court of the State of California for the County of San Diego
alleging that defendants (including CIGNA and several other insurance holding
companies) failed to disclose
compensation
paid to ULR and that, in return for the compensation, ULR steered clients to
defendants. The plaintiff
sought injunctive relief only. On July 9, 2007, the parties to this
lawsuit entered into a non-monetary settlement in which some of CIGNA's
subsidiaries agreed to maintain certain disclosure practices regarding
contingent compensation. This settlement does not resolve the
regulator’s claim for recovery of attorneys’ fees and costs.
On August
1, 2005, two CIGNA subsidiaries, Connecticut General Life Insurance Company and
Life Insurance Company of North America, were named as defendants in a
consolidated amended complaint filed in In re Insurance Brokerage Antitrust
Litigation, a multi-district litigation proceeding consolidated in the
United States District Court for the District of New Jersey. The complaint
alleges that brokers and insurers conspired to hide commissions, increasing the
cost of employee benefit plans, and seeks treble damages and injunctive relief.
Numerous insurance brokers and other insurance companies are named as
defendants.
The court
permitted plaintiffs to file an amended complaint, which plaintiffs did on May
22, 2007. The defendants filed a motion to dismiss the federal
antitrust, RICO and state law claims and a motion to dismiss and for summary
judgment regarding the ERISA fiduciary claims. On August 31, 2007,
the court granted the defendants’ motion to dismiss the federal antitrust
claims. On September 28, 2007, the court granted the defendants’
motion to dismiss plaintiffs’ RICO claims. On January 14, 2008, the
court granted summary judgment in favor of defendants as to plaintiffs’ ERISA
claims. On February 13, 2008, the court entered an order dismissing
plaintiffs' state law claims and the complaint in its entirety. The
court ordered the clerk to enter judgment against plaintiffs and in favor of the
defendants. Plaintiffs have filed a notice of appeal. CIGNA
denies the allegations and will continue to vigorously defend
itself.
Amara
Cash Balance Pension Plan Litigation
On
December 18, 2001, Janice Amara filed a purported class action lawsuit, now
captioned Janice C. Amara,
Gisela R. Broderick, Annette S. Glanz, individually and on behalf of all others
similarly situated v. CIGNA Corporation and CIGNA Pension Plan, in the
United States District Court for the District of Connecticut against CIGNA
Corporation and the CIGNA Pension Plan on behalf of herself and other similarly
situated participants in the CIGNA Pension Plan affected by the 1998 conversion
to a cash balance formula. The plaintiffs allege various ERISA
violations including, among other things, that the Plan’s cash balance formula
discriminates against older employees; the conversion resulted in a wear away
period (during which the pre-conversion accrued benefit exceeded the
post-conversion benefit); and these conditions are not adequately disclosed in
the Plan. The plaintiffs were granted class certification on December 20, 2002,
and seek equitable relief. A non-jury trial began on September 11-15,
2006. Due to the court’s schedule, the proceedings were adjourned and the trial
was completed on January 25, 2007. On February 15, 2008, the court
issued a decision finding in favor of CIGNA Corporation and the CIGNA Pension
Plan on the age discrimination and wear away claims and finding in favor of the
plaintiffs on many aspects of the disclosure claims. The court has
ordered the parties to file simultaneous briefs on March 17, 2008 regarding the
relief, if any, to be awarded to the plaintiffs on the claims on which the
plaintiffs prevailed, and to file responsive briefs on March 31, 2008. The
Company will continue to vigorously defend itself.
Run-off
Reinsurance Litigation
In
connection with CIGNA's Run-off reinsurance operations, described on page 21,
CIGNA purchased extensive retrocessional reinsurance for its Unicover contracts
and also for some other segments of its non-Unicover business. During
2007 CIGNA entered into a settlement that resolved the appeal of an adverse
court award in a retrocessional enforcement arbitration. That appeal, captioned
CIGNA EUROPE INSURANCE COMPANY
SA-NV v. John Hancock Life Insurance Company was pending in the High
Court of Justice, Queen’s Bench Division, Commercial Court and the case was
dismissed in the fourth quarter of 2007. Other disputes concerning
retrocessional contracts have been substantially resolved or
settled. The effect of these settlements has been reflected in the
results of the Run-off Reinsurance segment, which is discussed on page
53.
Item 4. SUBMISSION OF MATTERS TO A VOTE OF
SECURITY HOLDERS
None.
All
officers are elected to serve for a one-year term or until their successors are
elected. Principal occupations and employment during the past five
years are listed below.
MICHAEL
W. BELL, 44, Executive Vice President and Chief Financial Officer of CIGNA
beginning December 2002.
DAVID M.
CORDANI, 42, President, CIGNA HealthCare beginning July 2005; Senior Vice
President, Customer Segments & Marketing, CIGNA HealthCare from July 2004
until July 2005; and Senior Vice President and Chief Financial Officer, CIGNA
HealthCare, from September 2002 until July 2004.
H. EDWARD
HANWAY, 56, Chairman of CIGNA since December 2000; Chief Executive Officer of
CIGNA since January 2000; and President and a Director of CIGNA since January
1999.
PAUL E.
HARTLEY, 51, President of CIGNA International beginning June 2005; and President
and Chief Executive Officer, CIGNA International, Asia Pacific region from June
1998 to June 2005.
JOHN M.
MURABITO, 49, Executive Vice President of CIGNA beginning August
2003, with responsibility for Human Resources and Services; and Senior Vice
President, Human Resources and Corporate Services from March 2000 until August
2003 at Monsanto Company.
CAROL ANN
PETREN, 55, Executive Vice President and General Counsel of CIGNA beginning May
2006; Senior Vice President and Deputy General Counsel of MCI from August 2003
until March 2006; and Deputy General Counsel of Sears, Roebuck and Company from
February 2001 until June 2003.
KAREN S.
ROHAN, 45, President of CIGNA Group Insurance beginning November 2005; President
of CIGNA Dental & Vision Care beginning April 2004; President of CIGNA
Specialty Companies from November 2004 until November 2005; and Chief
Underwriting Officer, CIGNA HealthCare from January 2003 until April
2004.
MICHAEL
WOELLER, 55, Executive Vice President and Chief Information Officer, CIGNA
Corporation beginning October 2007; Vice Chairman and Senior Vice President and
Chief Information Officer, Canadian Imperial Bank of Commerce from April 2000
until October 2007.
Item 5. MARKET FOR
REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF
EQUITY SECURITIES
The
information under the caption “Quarterly Financial Data--Stock and Dividend
Data” appears on page 104 and the number of shareholders of record as of
December 31, 2007 appears under the caption “Highlights” on page 38 of this
Form 10-K. CIGNA’s common stock is listed with, and trades on, the New York
Stock Exchange under the symbol “CI.”
Issuer
Purchases of Equity Securities
None.
Item
6. SELECTED
FINANCIAL DATA
Highlights
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Dollars
in millions, except per share amounts)
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
|
2004
|
|
|
2003
|
|
Revenues
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premiums
and fees and other revenues
|
|
$ |
15,376 |
|
|
$ |
13,987 |
|
|
$ |
14,449 |
|
|
$ |
15,153 |
|
|
$ |
15,299 |
|
Net
investment income
|
|
|
1,114 |
|
|
|
1,195 |
|
|
|
1,359 |
|
|
|
1,643 |
|
|
|
2,594 |
|
Mail
order pharmacy revenues
|
|
|
1,118 |
|
|
|
1,145 |
|
|
|
883 |
|
|
|
857 |
|
|
|
764 |
|
Realized
investment gains (losses)
|
|
|
15 |
|
|
|
220 |
|
|
|
(7 |
) |
|
|
523 |
|
|
|
151 |
|
Total
revenues
|
|
$ |
17,623 |
|
|
$ |
16,547 |
|
|
$ |
16,684 |
|
|
$ |
18,176 |
|
|
$ |
18,808 |
|
Results
of Operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Health
Care
|
|
$ |
679 |
|
|
$ |
653 |
|
|
$ |
688 |
|
|
$ |
763 |
|
|
$ |
429 |
|
Disability
and Life
|
|
|
254 |
|
|
|
226 |
|
|
|
227 |
|
|
|
182 |
|
|
|
155 |
|
International
|
|
|
176 |
|
|
|
138 |
|
|
|
109 |
|
|
|
76 |
|
|
|
55 |
|
Run-off
Reinsurance
|
|
|
(11 |
) |
|
|
(14 |
) |
|
|
(64 |
) |
|
|
(115 |
) |
|
|
(359 |
) |
Other
Operations
|
|
|
109 |
|
|
|
106 |
|
|
|
339 |
|
|
|
424 |
|
|
|
333 |
|
Corporate
|
|
|
(97 |
) |
|
|
(95 |
) |
|
|
(12 |
) |
|
|
(114 |
) |
|
|
(127 |
) |
Realized
investment gains (losses), net of taxes
|
|
|
10 |
|
|
|
145 |
|
|
|
(11 |
) |
|
|
361 |
|
|
|
98 |
|
Income
from continuing operations
|
|
|
1,120 |
|
|
|
1,159 |
|
|
|
1,276 |
|
|
|
1,577 |
|
|
|
584 |
|
Income
(loss) from discontinued operations, net of taxes
|
|
|
(5 |
) |
|
|
(4 |
) |
|
|
349 |
|
|
|
- |
|
|
|
48 |
|
Cumulative
effect of accounting change, net of taxes
|
|
|
- |
|
|
|
- |
|
|
|
- |
|
|
|
(139 |
) |
|
|
- |
|
Net
income
|
|
$ |
1,115 |
|
|
$ |
1,155 |
|
|
$ |
1,625 |
|
|
$ |
1,438 |
|
|
$ |
632 |
|
Income
per share from continuing operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$ |
3.95 |
|
|
$ |
3.50 |
|
|
$ |
3.34 |
|
|
$ |
3.85 |
|
|
$ |
1.39 |
|
Diluted
|
|
$ |
3.88 |
|
|
$ |
3.44 |
|
|
$ |
3.28 |
|
|
$ |
3.81 |
|
|
$ |
1.39 |
|
Net
income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$ |
3.94 |
|
|
$ |
3.49 |
|
|
$ |
4.25 |
|
|
$ |
3.51 |
|
|
$ |
1.51 |
|
Diluted
|
|
$ |
3.87 |
|
|
$ |
3.43 |
|
|
$ |
4.17 |
|
|
$ |
3.48 |
|
|
$ |
1.50 |
|
Common
dividends declared per share
|
|
$ |
0.04 |
|
|
$ |
0.03 |
|
|
$ |
0.03 |
|
|
$ |
0.14 |
|
|
$ |
0.44 |
|
Total
assets
|
|
$ |
40,065 |
|
|
$ |
42,399 |
|
|
$ |
44,893 |
|
|
$ |
81,059 |
|
|
$ |
90,199 |
|
Long-term
debt
|
|
$ |
1,790 |
|
|
$ |
1,294 |
|
|
$ |
1,338 |
|
|
$ |
1,438 |
|
|
$ |
1,500 |
|
Shareholders’
equity
|
|
$ |
4,748 |
|
|
$ |
4,330 |
|
|
$ |
5,360 |
|
|
$ |
5,203 |
|
|
$ |
4,607 |
|
Per
share
|
|
$ |
16.98 |
|
|
$ |
14.63 |
|
|
$ |
14.74 |
|
|
$ |
13.14 |
|
|
$ |
10.92 |
|
Common
shares outstanding (in
thousands)
|
|
|
279,588 |
|
|
|
98,654 |
|
|
|
121,191 |
|
|
|
132,007 |
|
|
|
140,591 |
|
Shareholders
of record
|
|
|
8,696 |
|
|
|
9,117 |
|
|
|
9,440 |
|
|
|
10,249 |
|
|
|
9,608 |
|
Employees
|
|
|
26,600 |
|
|
|
27,100 |
|
|
|
28,000 |
|
|
|
28,600 |
|
|
|
32,700 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Effective
January 1, 2007, CIGNA changed its presentation to report the results of
the Run-off Retirement business within Other Operations. Prior period
results
have been restated to conform to this presentation.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During
2007, CIGNA completed a three-for-one stock split of CIGNA's common
shares. All per share figures have been adjusted to reflect the stock
split.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro
forma common shares outstanding, calculated as if the stock split had
occurred at the beginning of the prior periods, were as follows: 295,963
in 2006;
363,573
in 2005; 396,021 in 2004 and 421,772 in 2003.
|
|
Item 7. MANAGEMENT’S DISCUSSION AND ANALYSIS
OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
Forward-Looking
Statements
In this
filing and in other marketplace communications, CIGNA Corporation and its
subsidiaries (the Company) makes certain forward-looking statements relating to
its financial condition and results of operations, as well as to trends and
assumptions that may affect the Company. Generally, forward-looking
statements can be identified through the use of predictive words (e.g., “Outlook
for 2008”). Actual results may differ from the Company’s
predictions. Some factors that could cause results to differ are
discussed throughout Management’s Discussion and Analysis, including in the
Cautionary Statement on page 64. The forward-looking statements
contained in this filing represent management’s current estimate as of the date
of this filing. Management does not assume any obligation to update
these estimates.
Reclassifications
Certain
insignificant reclassifications have been made to prior years' amounts to
conform to the presentation of 2007 amounts.
Overview
The
Company constitutes one of the largest investor-owned health service
organizations in the United States. Its subsidiaries are major providers of
health care and related benefits, the majority of which are offered through the
workplace, including health care products and services such as: medical
coverages, pharmacy, behavioral health, dental benefits, and disease management,
group disability, life and accident insurance; and disability and workers’
compensation case management and related services. In addition, the
Company has an international operation that offers life, accident and
supplemental health insurance products and international health care products
and services to businesses and individuals in selected markets. The Company also
has certain inactive businesses, including a run-off reinsurance
operation. See “Business – Item 1” in the Company’s Form 10-K for
additional information on its segments.
The
Company generates revenues, net income and cash flow from operations
by:
·
|
maintaining
and growing its customer base;
|
·
|
charging
prices that reflect emerging
experience;
|
·
|
investing
available cash at attractive rates of return for appropriate durations;
and
|
·
|
effectively
managing other operating expenses.
|
The
Company’s ability to increase revenue, net income and operating cash flow is
directly related to its ability to address broad economic and industry factors
and execute its strategic initiatives, the success of which is measured by
certain key factors as discussed below.
Key
factors affecting the Company’s results include:
·
|
the
ability to profitably price products and services at competitive
levels;
|
·
|
the
volume of customers served and the mix of products and services purchased
by those customers;
|
·
|
the
Company’s ability to cross sell its various health and related benefit
products;
|
·
|
the
relationship between other operating expenses and revenue;
and
|
·
|
the
effectiveness of the Company’s capital deployment
initiatives.
|
The
Company’s results are influenced by a range of economic and other factors,
especially:
·
|
cost
trends and inflation for medical and related
services;
|
·
|
utilization
patterns of medical and other
services;
|
·
|
the
tort liability system;
|
·
|
developments
in the political environment both domestically and
internationally;
|
·
|
interest
rates, equity market returns and foreign currency
fluctuations;
|
·
|
regulations
and tax rules related to the administration of employee benefit plans;
and
|
·
|
federal
and state regulation.
|
The
Company regularly monitors the trends impacting operating results from the above
mentioned key factors and economic and other factors. The Company
develops strategic and tactical plans designed to improve performance and
maximize its competitive position in the markets it serves. The
Company’s ability to achieve its financial objectives is dependent upon its
ability to effectively execute these plans and to appropriately respond to
emerging economic and company-specific trends.
The
Company is continuing to improve the performance of and profitably grow the
health care operations; as well as continuing to profitably grow the disability
and life insurance and international businesses; and managing the risks
associated with the run-off reinsurance operations. In the health
care businesses, the Company has operational improvement initiatives (see pages
50-52) in place to:
(1)
|
offer
products that meet emerging consumer and market
trends;
|
(2)
|
underwrite
and price products effectively;
|
(3)
|
grow
medical membership;
|
(4)
|
effectively
manage medical costs;
|
(5)
|
deliver
quality member and provider
service;
|
(6)
|
maintain
and upgrade information technology systems;
and
|
(7)
|
reduce
other operating expenses.
|
The
Company believes that the health care business model is evolving to one that
focuses more directly on the role and needs of the health care
consumer. The consumer-directed environment presents particular
challenges by requiring a more complex service model and products specifically
designed to meet the emerging market needs of the consumer. In order
to meet the emerging market challenges, the Company is investing in product
development, service, technology, educational resources and customer support
tools to assist consumers in making more informed choices regarding their health
care and to achieve better health outcomes. These investments and execution of
related initiatives are critical to respond to increasing consumer
demands. The Company believes that its investments in these areas
will position it to more effectively meet emerging market needs and better
position the Company to be a leader in the health care industry.
(In
millions)
|
|
|
|
|
|
|
|
|
|
Financial
Summary
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Premiums
and fees
|
|
$ |
15,008 |
|
|
$ |
13,641 |
|
|
$ |
13,695 |
|
Net
investment income
|
|
|
1,114 |
|
|
|
1,195 |
|
|
|
1,359 |
|
Mail
order pharmacy revenues
|
|
|
1,118 |
|
|
|
1,145 |
|
|
|
883 |
|
Other
revenues
|
|
|
368 |
|
|
|
346 |
|
|
|
754 |
|
Realized
investment gains
|
|
|
|
|
|
|
|
|
|
|
|
|
(losses)
|
|
|
15 |
|
|
|
220 |
|
|
|
(7 |
) |
Total
revenues
|
|
|
17,623 |
|
|
|
16,547 |
|
|
|
16,684 |
|
Benefits
and expenses
|
|
|
15,992 |
|
|
|
14,816 |
|
|
|
14,891 |
|
Income
from continuing
|
|
|
|
|
|
|
|
|
|
|
|
|
operations
before taxes
|
|
|
1,631 |
|
|
|
1,731 |
|
|
|
1,793 |
|
Income
taxes
|
|
|
511 |
|
|
|
572 |
|
|
|
517 |
|
Income
from continuing
|
|
|
|
|
|
|
|
|
|
|
|
|
operations
|
|
|
1,120 |
|
|
|
1,159 |
|
|
|
1,276 |
|
Income
(loss) from discontinued
|
|
|
|
|
|
|
|
|
|
operations,
net of taxes
|
|
|
(5 |
) |
|
|
(4 |
) |
|
|
349 |
|
Net
income
|
|
$ |
1,115 |
|
|
$ |
1,155 |
|
|
$ |
1,625 |
|
Realized
investment gains
|
|
|
|
|
|
|
|
|
|
|
|
|
(losses),
net of taxes
|
|
$ |
10 |
|
|
$ |
145 |
|
|
$ |
(11 |
) |
The
Company’s consolidated results of operations include results from discontinued
operations, which are discussed on page 56.
Special
Items
In order
to facilitate an understanding and comparison of results of operations and
permit analysis of trends in underlying revenue, expenses and income from
continuing operations, the following table presents special items, which
management believes are not representative of the underlying results
of operations. See “Quarterly Financial Data” on page 104 for
special items reported quarterly in 2007 and 2006.
SPECIAL
ITEMS
|
|
|
|
|
|
|
|
|
Pre-Tax
|
|
|
After-Tax
|
|
|
|
Benefit
|
|
|
Benefit
|
|
(In
millions)
|
|
(Charge)
|
|
|
(Charge)
|
|
2007
|
|
|
|
|
|
|
Completion
of IRS examination
|
|
$ |
- |
|
|
$ |
23 |
|
Reserve
charge on guaranteed minimum
|
|
|
|
|
|
|
|
|
income benefit contracts
|
|
|
(86 |
) |
|
|
(56 |
) |
Total
|
|
$ |
(86 |
) |
|
$ |
(33 |
) |
2006
|
|
|
|
|
|
|
|
|
Charge
associated with settlement of
shareholder litigation
|
|
$ |
(38 |
) |
|
$ |
(25 |
) |
Cost
reduction charge
|
|
|
(37 |
) |
|
|
(23 |
) |
Total
|
|
$ |
(75 |
) |
|
$ |
(48 |
) |
2005
|
|
|
|
|
|
|
|
|
Accelerated
amortization of deferred
|
|
|
|
|
|
|
|
|
gain
on sale of retirement benefits
|
|
|
|
|
|
|
|
|
business
|
|
$ |
322 |
|
|
$ |
204 |
|
Cost
reduction charge
|
|
|
(51 |
) |
|
|
(33 |
) |
IRS
tax settlement
|
|
|
6 |
|
|
|
81 |
|
Charge
associated with a modified
|
|
|
|
|
|
|
|
|
coinsurance
arrangement
|
|
|
(12 |
) |
|
|
(8 |
) |
Total
|
|
$ |
265 |
|
|
$ |
244 |
|
Special
items for 2007 consisted of:
·
|
previously
unrecognized tax benefits resulting from the completion of the IRS
examination for the 2003 and 2004 tax years;
and
|
·
|
a
charge for changes in the long-term assumptions for annuitization and
lapse rates for guaranteed minimum income benefit
contracts.
|
Special
items for 2006 consisted of:
·
|
a
charge associated with the settlement of the shareholder class action
lawsuit brought against the Company. This charge included
certain costs to defend and was net of expected insurance recoveries;
and
|
·
|
a
charge for severance costs resulting from a review of staffing levels in
the Health Care operations and in supporting
areas.
|
Special
items for 2005 consisted of:
·
|
accelerated
amortization of deferred gain on the sale of the retirement benefits
business;
|
·
|
a
charge for severance costs associated with streamlining the operations of
the Health Care operations and supporting areas. The Company
substantially completed this program in
2006;
|
·
|
a
tax benefit primarily from the release of tax reserves and valuation
allowances resulting from the completion of the IRS audit for years
2000-2002; and
|
·
|
a
charge associated with a modified coinsurance arrangement resulting from
the sale of the retirement benefits business in
2004.
|
The
impact of these special items on the segments is shown in the “Results of
Operations” table within each segment discussion.
Overview of 2007
Consolidated Results of Operations
Income
from continuing operations excluding the special items discussed above decreased
in 2007, compared with 2006, principally reflecting lower realized investment
gains primarily due to lower gains from sales of equity interests in real estate
limited liability entities of $145 million.
These
factors were partially offset by higher earnings in the Health Care (see page
48), Disability and Life (see page 52), International (see page 53) and Run-off
Reinsurance (see page 53) segments.
Overview of 2006
Consolidated Results of Operations
Income
from continuing operations in 2006, excluding the special items discussed above,
increased compared to 2005 principally reflecting:
·
|
improved
realized investment results primarily due to sales of equity interests in
real estate limited liability entities of $165 million
after-tax;
|
·
|
lower
losses in the Run-off Reinsurance segment;
and
|
·
|
higher
earnings in the International segment driven by growth in the expatriate
employee benefits business and the life, accident and health insurance
business.
|
These
factors were partially offset by lower segment earnings in the Health Care
segment (see page 48).
Outlook for
2008
The
Company expects full year 2008 income from continuing operations, excluding
realized investment results, the results of the guaranteed minimum income
benefits (GMIB) business and special items, to be higher than the comparable
2007 amount primarily due to earnings growth in the
Health Care, Disability and Life and International segments, tempered by lower
earnings in the Run-off Reinsurance segment. The Company’s outlook is
subject to the factors cited in the Cautionary Statement on page
64.
Management
is not able to estimate 2008 income from continuing operations under generally
accepted accounting principles because it includes realized investment gains
(losses), the results of the GMIB business and special items. Information is not
available for management to reasonably estimate future realized investment gains
(losses), the results of the GMIB business under a new accounting standard (see
Note 2(B) to the Consolidated Financial Statements) or special (non-recurring)
items, due, in part, to interest rate and stock market volatility and other
internal and external factors.
Revenues
The
Company’s revenues are derived from a variety of sources. See Note
2(S) to the Consolidated Financial Statements for further details.
Total
revenue increased by 7% in 2007, compared with 2006 and decreased by 1% in 2006,
compared with 2005. Changes in the components of total revenue are
described more fully below.
Premiums and
Fees
Premiums
and fees increased 10% in 2007, compared to 2006, primarily attributable to
higher specialty revenues and growth in medical membership as well as
strong renewal pricing on existing business in the Health Care
segment (see page 48) and strong business growth in the Disability
and Life (see page 52) and International segments (see page 53).
Premiums
and fees decreased marginally in 2006 reflecting the loss of a large
prescription drug contract of $1.1 billion. Excluding the loss of
this contract, premiums and fees increased 9% in 2006, compared with 2005
primarily due to membership growth and rate increases in the Health Care,
Disability and Life and International segments (see pages 48-53).
Net
Investment Income
Net
investment income decreased 7% in 2007. This decrease was primarily
attributable to share repurchase activity and lower average assets driven by a
decline in the Health Care segment resulting from:
·
|
a
shift in business from guaranteed cost products to administrative services
only (ASO) products; and
|
·
|
pre-funding
of Medicare Part D claims.
|
Net
investment income decreased 12% in 2006 as a result of the 2006 conversion of
the single premium annuity business to indemnity reinsurance (see page 55
for additional information) and share repurchase activity.
Net
investment income also reflects the impact of yields, which were lower in 2007
and higher in 2006 as a result of changes in interest rates.
Mail
Order Pharmacy Revenues
Mail
order pharmacy revenues in 2007 were comparable to 2006. Mail order
pharmacy revenues increased 30% in 2006, compared with 2005, primarily due to
higher volume.
Other
Revenues
Other
revenues for the Company include certain Health Care specialty products,
including behavioral health and disease management, results from futures
contracts in the run-off reinsurance operations and amortization of deferred
gains associated with sold businesses.
Other
revenues increased 6% in 2007, as compared with 2006, primarily due to lower
losses from futures contracts in the run-off reinsurance operations partially
offset by lower other revenues in the Disability and Life segment (see page
52).
Other
revenues decreased 54% in 2006, as compared with 2005, primarily due to lower
deferred gain amortization associated with the sold retirement benefits business
and higher losses from futures contracts in the run-off reinsurance
operations.
Realized
Investment Gains (Losses)
Realized
investment gains (losses) were higher in 2006, compared with 2007 and 2005,
primarily due to sales of equity interests in real estate limited liability
entities.
The
preparation of consolidated financial statements in accordance with accounting
principles generally accepted in the United States of America (GAAP) requires
management to make estimates and assumptions that affect reported amounts and
related disclosures in the consolidated financial
statements. Management considers an accounting estimate to be
critical if:
·
|
it
requires assumptions to be made that were uncertain at the time the
estimate was made; and
|
·
|
changes
in the estimate or different estimates that could have been selected could
have a material effect on the Company’s consolidated results of operations
or financial condition.
|
Management
has discussed the development and selection of its critical accounting estimates
with the Audit Committee of the Company’s Board of Directors and the Audit
Committee has reviewed the disclosures presented below.
In
addition to the estimates presented in the following table, there are other
accounting estimates used in the preparation of the Company’s consolidated
financial statements, including estimates of liabilities for future policy
benefits other than those identified in the following table, as well as
estimates with respect to unpaid claims and claim expenses, postemployment and
postretirement benefits other than pensions, certain compensation accruals, and
income taxes.
Management
believes the current assumptions used to estimate amounts reflected in the
Company’s consolidated financial statements are appropriate. However,
if actual experience differs from the assumptions used in estimating amounts
reflected in the Company’s consolidated financial statements, the resulting
changes could have a material adverse effect on the Company’s consolidated
results of operations, and in certain situations, could have a material adverse
effect on the Company’s liquidity and financial condition.
See Note
2(B) to the Consolidated Financial Statements for further information on
significant accounting policies that impact the Company.
The
table that follows presents information about the Company’s most critical
accounting estimates, as well as the effects of hypothetical changes in
the material assumptions used to develop each estimate.
|
Balance
Sheet Caption /
Nature
of Critical Estimate Item
|
Assumptions
/ Approach Used
|
Effect
if Different Assumptions Used
|
Future
policy benefits –
Guaranteed
minimum death benefits
These
liabilities are estimates of the present value of net amounts expected to
be paid, less the present value of net future premiums expected to be
received. The amounts to be paid represent the excess of the
guaranteed death benefit over the values of contractholders’
accounts. The death benefit coverage in force at December 31,
2007 (representing the amount payable if all approximately 750,000
contractholders had died as of that date) was approximately $4.2
billion.
Liabilities
for future policy benefits for these contracts as of December 31 were as
follows:
· 2007 –
$848 million
· 2006
– $862 million
|
The
Company estimates these liabilities based on assumptions for lapse,
partial surrender, mortality, interest rates (mean investment performance
and discount rate), and volatility. These assumptions are based
on the Company’s experience and future expectations over the long-term
period. The Company monitors actual experience to update these
estimates as necessary.
Lapse
refers to the full surrender of an annuity prior to a contractholder’s
death.
Partial
surrender refers to the fact that most contractholders have the ability to
withdraw substantially all of their mutual fund investments while
retaining any available death benefit coverage in effect at the time of
the withdrawal. Equity market declines could expose the Company
to higher rates of partial surrender, the effect of which is not covered
by the Company’s program to substantially reduce market
risks.
Interest
rates include both (a) the mean investment performance assumption
considering the Company's program to reduce equity market exposures using
futures contracts, and (b) the liability discount rate
assumption.
Volatility
refers to market fluctuations that affect the costs of the program adopted
by the Company to reduce equity market risks associated with these
liabilities.
|
Current
assumptions used to estimate these liabilities are detailed in Note 7 to
the Consolidated Financial Statements. If an unfavorable change
were to occur to those assumptions, the approximate after-tax decrease in
net income would be as follows:
· 10%
increase in mortality rates - $50 million
· 10% decrease in lapse rates - $20
million
· 10% increase in future partial surrenders - $5
million
· 50 basis point decrease in interest
rates:
· Mean Investment Performance - $30
million
· Discount Rate - $20 million
· 10% increase in volatility - $35
million
The
amounts would be reflected in the Run-off Reinsurance
segment.
|
Health
Care medical claims payable
Medical
claims payable for the Health Care segment include both reported claims
and estimates for losses incurred but not yet reported.
Liabilities
for medical claims payable as of December 31 were as
follows:
· 2007 –
gross $975 million; net $717 million
· 2006
– gross $960 million; net $710 million
· 2005
– gross $1.2 billion; net $823 million
These
liabilities are presented above both gross and net of reinsurance and
other recoverables.
These
liabilities generally exclude amounts for administrative services only
business.
See
Note 5 to the Consolidated Financial Statements for additional
information.
|
The
Company develops estimates for Health Care medical claims payable using
actuarial principles and assumptions based on historical and projected
claim payment patterns, medical cost trends, which are impacted by the
utilization of medical services and the related costs of the services
provided (unit costs), benefit design, seasonality, and other relevant
operational factors. The Company consistently applies these
actuarial principles and assumptions each reporting period, with
consideration given to the variability of these factors, and recognizes
the actuarial best estimate of the ultimate liability within a level of
confidence, as required by actuarial standards of practice, which require
that the liabilities be adequate under moderately adverse
conditions.
The
Company's estimate of the liability for medical claims incurred but not
yet reported is primarily calculated using historical claim payment
patterns and expected medical cost trends. The Company analyzes
the historical claim payment patterns by comparing the dates claims were
incurred, generally the dates services were provided, to the dates claims
were paid to determine “completion factors”, which are a measure of the
time to process claims. A completion factor is calculated for
each month of incurred claims. The Company uses historical
completion factors combined with an analysis of current trends and
operational factors to develop current estimates of completion
factors. The Company estimates the ultimate liability for
claims incurred in each month by applying the current estimates of
completion factors to the current paid claim data. The
difference between this estimate of the ultimate liability and the current
paid claim data is the estimate of the remaining claims to be paid for
each incurral month. These monthly estimates are aggregated and
included in the Company's Health Care medical claims payable at the end of
each
|
For
the year ended December 31, 2007, actual experience differed from the
Company's key assumptions, resulting in $80 million of favorable incurred
claims related to prior years’ medical claims payable of 1.3% of the
current year incurred claims as reported for the year ended December 31,
2006. For the year ended December 31, 2006, actual experience differed
from the Company's key assumptions, resulting in $173 million of favorable
incurred claims related to prior years’ medical claims, or 2.6% of the
current year incurred claims reported for the year ended December 31,
2005. Specifically, the favorable impact is due to faster than
expected completion factors and lower than expected medical cost trends,
both of which included an assumption for moderately adverse
experience.
The
corresponding impact of favorable prior year development on net income was
$8 million for the year ended December 31, 2007 and $54 million for the
year ended December 31, 2006. The change in the amount of the
incurred claims related to prior years in the medical claims payable
liability does not directly correspond to an increase or decrease in the
Company's net income. See Note 5 to the Consolidated Financial
Statements for additional information.
Recent
variances were 1.3% for the year ended December 31, 2007 and 2.6% for the
year ended December 31, 2006 related to the impact of the prior year
medical claims payable; and 0.1% for the year ended December 31, 2007 and
0.8% for the year
|
|
reporting
period. Completion factors are used to estimate the health care
medical claims payable for all months where claims have not been
completely resolved and paid, except for the most recent month as
described below.
Completion
factors are impacted by several key items including changes in the level
of claims processed electronically versus manually (auto-adjudication),
changes in provider claims submission rates, membership changes and the
mix of products. As noted, the Company uses historical
completion factors combined with an analysis of current trends and
operational factors to develop current estimates of completion
factors. This approach implicitly assumes that historical
completion rates will be a useful indicator for the current
period. It is possible that the actual completion rates for the
current period will develop differently from historical patterns, which
could have a material impact on the Company's medical claims payable and
net income.
Claims
incurred in the most recent month have limited paid claim data, since a
large portion of health care claims are not submitted to the Company for
payment in the month services have been provided. This makes
the completion factor approach less reliable for claims incurred in the
most recent month. As a result, in any reporting period, for
the estimates of the ultimate claims incurred in the most recent month,
the Company primarily relies on medical cost trend analysis, which
reflects expected claim payment patterns and other relevant operational
considerations. Medical cost trend is impacted by several key
factors including medical service
utilization and unit costs and the Company’s ability to manage these
factors through benefit design, underwriting, provider contracting and the
Company's medical management initiatives. These factors are
affected by changes in the level and mix of medical benefits offered,
including inpatient, outpatient and pharmacy, the impact of copays and
deductibles, changes in provider practices and changes in consumer
demographics and consumption behavior.
Because
historical trend factors are often not representative of current claim
trends, the trend experienced for the most recent history along with an
analysis of emerging trends, have been taken into consideration in
establishing the liability for medical claims payable at December 31, 2007
and 2006. It is possible that the actual medical trend for the
current period will develop differently from the expected, which could
have a material impact on the Company's medical claims payable and net
income.
For
each reporting period, the Company evaluates key assumptions by comparing
the assumptions used in establishing the medical claims payable to actual
experience. When actual experience differs from the assumptions used in
establishing the liability, medical claims payable are increased or
decreased through current period net income. Additionally, the
Company evaluates expected future developments and emerging trends which
may impact key assumptions. The estimation process involves
considerable judgment, reflecting the variability inherent in forecasting
future claim payments. The adequacy of these estimates is
highly sensitive to changes in the Company's key assumptions, specifically
completion factors, which are impacted by actual or expected changes in
the submission and payment of medical claims, and medical cost trends,
which are impacted by actual or expected changes in the utilization of
medical services and unit costs.
See
Note 5 to the Consolidated Financial Statements for additional
information.
|
ended
December 31, 2006 related to the impact on net income. The Company
believes that based on the current mix of business as of December 31,
2007, relative to the health care medical claims payable, the annual
impact of each 1% variance between the actual and expected incurred
medical claims on the Company’s net income would be approximately $35
million, favorable or unfavorable dependent on the direction of the actual
versus expected variance.
Based
on the current mix of business, the Company would reasonably expect the
variance between actual and expected incurred medical claims to be within
the range of +/- 0% to 1%. This potential variance is expected
to be driven evenly by completion factors and monthly medical cost
trends. While these ranges are consistent with the more recent
variation in actual completion factors and medical trend assumptions,
including the impact of recent operational and environmental changes,
there is significant uncertainty regarding the ultimate outcome of actual
results versus individual assumptions, and accordingly, more precision is
not appropriate.
The
amounts would be reflected in the Health Care
segment.
|
Balance
Sheet Caption /
Nature
of Critical Estimate Item
|
Assumptions
/ Approach Used
|
Effect
if Different Assumptions Used
|
Accounts
payable, accrued expenses and other liabilities, and Other assets
-
Guaranteed
minimum income benefits
These
liabilities are estimates of the present value of net amounts expected to
be paid, less the present value of net future premiums expected to be
received. The amounts to be paid represent the excess of the
expected value of the income benefit over the value of the annuitants’
accounts at the time of annuitization.
The
assets associated with these contracts represent receivables in connection
with reinsurance that the Company has purchased from two external
reinsurers, which covers 55% of the exposures on these
contracts.
Net
liabilities related to these contracts as of December 31 were as follows:
· 2007 –
$313 million
· 2006
– $88 million
As
of December 31, net amounts recoverable related to these contracts from
two external reinsurers were as follows:
· 2007 –
$197 million
· 2006
– $46 million
Additional
liabilities associated with the cost of reinsurance as of December 31 were
as follows:
· 2007 –
$24 million
· 2006
– $47 million
As
discussed in Note 2(B) to the Consolidated Financial Statements, the
Company will implement SFAS No. 157, “Fair Value Measurements,” on January
1, 2008. The new requirements that focus on exit price to
measure fair value will impact the current assumptions and resulting
estimated fair value of assets and liabilities for guaranteed minimum
income benefits and are expected to reduce the Company's net income at
implementation between $125 million to $150 million, net of estimated
reinsurance recoverable.
|
The
Company estimates the fair value of the assets and liabilities associated
with these contracts using assumptions as to market returns and volatility
of the underlying equity and bond mutual fund investments, interest rates,
mortality, lapse, credit risk and annuity election
rates. Changes in fair value are reported in other operating
expenses.
Annuity
election rates refer to the proportion of annuitants who elect to receive
their income benefit as an annuity.
Lapse
refers to the full surrender of an annuity prior to annuitization of the
policy.
The
Company has been monitoring annuity election rate experience and, in 2007,
increased its assumption related to annuity election rates resulting in a
charge (net of reinsurance) of $75 million pre-tax. Also in 2007, the
Company completed a review of lapse experience for these contracts. As a
result of the review, the Company decreased its lapse assumption resulting
in a charge (net of reinsurance) of $11 million pre-tax; because fewer
annuitants are expected to lapse coverage, the Company’s expected claims
increase. In combination, the Company recognized in the second
quarter of 2007 a total charge of $56 million after-tax ($86 million
pre-tax) for these changes in the long-term assumptions. This
charge is reflected as a special item (see page 40).
Credit
risk refers to the ability of these reinsurers to pay.
Interest
rates include both (a) the liability discount rate assumption and (b) the
projected interest rates used to calculate the reinsured income benefit at
the time of annuitization (claim interest rate).
Volatility
refers to the degree of variation of future market returns of the
underlying mutual fund investments.
|
After
implementation of SFAS 157, the Company will consider the various
assumptions used to estimate fair values of assets and liabilities
associated with these contracts in two categories. The first
group of assumptions consists of future annuitant behavior including
annuity election rates, lapse, and mortality as well as retrocessionnaire
credit risk. Current assumptions used to estimate these
liabilities are detailed in Note 20 to the Consolidated Financial
Statements. The Company will estimate a hypothetical market
participant's view of these assumptions considering the actual and
expected experience of the Company and other relevant and available
industry sources. If an unfavorable change were to occur in
these assumptions before the implementation of SFAS No. 157, the
approximate after-tax decrease in net income, net of estimated reinsurance
recoverable, would be as follows:
·
10%
decrease in mortality - less than $1 million
·
10%
increase in annuity election rates - $5 million
·
10%
decrease in lapse rates – $3 million
·
10%
decrease in amounts recoverable from reinsurers (credit risk) - $10
million
After
the implementation of SFAS No. 157, the potential effects on net income of
unfavorable changes in these assumptions are generally expected to be 50%
to 100% more than noted above, primarily because the liabilities, net of
reinsurance recoverable will be higher at the date of
implementation. In addition to these assumptions, the Company
will estimate a risk and profit charge that a hypothetical market
participant would require to assume this business.
The
second group of assumptions used to estimate these fair values consist of
capital markets inputs including market returns and discount rates, claim
interest rates and market volatility. After the implementation
of SFAS No. 157, the Company's results of operations are expected to be
more volatile in future periods because these assumptions will be based
largely on market-observable inputs at the close of each period including
risk free interest rates and market implied volatilities. If
the following unfavorable changes were to occur after the implementation
of SFAS No. 157 on January 1, 2008, the approximate after-tax decrease in
net income, net of estimated reinsurance recoverable, would be as
follows:
·
50
basis point decrease in risk free interest rates (which are aligned with
LIBOR) used for projecting market returns and discounting - $15 to $20
million
·
50
basis point decrease in interest rates used for projecting claim exposure
(7 year Treasury rates) - $30 million
· 10%
increase in market volatility - $5 million
In
addition, if annuitants' account values as of December 31, 2007 declined
by 10% due to the performance of the underlying mutual funds, the
approximate after-tax decrease in net income net of estimated reinsurance
recoverable would be approximately $35 million.
All
of these estimated impacts due to unfavorable changes could vary from
quarter to quarter depending on actual reserve levels, the actual market
conditions or changes in the anticipated view of a hypothetical market
participant as of any future valuation date.
The
amounts would be reflected in the Run-off Reinsurance
segment. See Note 2(B) to the Consolidated Financial Statements
for further information.
|
Balance
Sheet Caption /
Nature
of Critical Estimate Item
|
Assumptions
/ Approach Used
|
Effect
if Different Assumptions Used
|
Reinsurance
recoverables –
Reinsurance
recoverables in
Run-off
Reinsurance
Collectibility
of reinsurance recoverables requires an assessment of risks that such
amounts will not be collected, including risks associated with reinsurer
default and disputes with reinsurers regarding applicable
coverage.
Gross
and net reinsurance recoverables in the Run-off Reinsurance segment as of
December 31, were as follows:
· 2007
– gross $203 million; net $191
million
· 2006
– gross $506 million; net $360 million
· 2005
– gross $565 million; net $417 million
|
The
amount of reinsurance recoverables in the Run-off Reinsurance segment, net
of reserves, represents management’s best estimate of recoverability,
including an assessment of the financial strength of
reinsurers. The ultimate amounts received are dependent, in
certain cases, on the resolution of disputes with reinsurers, including
the outcome of arbitration and litigation proceedings.
|
A
10% reduction of net reinsurance recoverables due to uncollectibility at
December 31, 2007, would reduce net income by approximately $15 million
after-tax.
The
amounts would be reflected in the Run-off Reinsurance
segment.
See
Note 8 to the Consolidated Financial Statements for additional
information.
|
Accounts
payable, accrued expenses and other liabilities-pension
liabilities
These
liabilities are estimates of the present value of the qualified and
nonqualified pension benefits to be paid (attributed to employee service
to date) net of the fair value of plan assets. The accrued pension
benefit liability as of December 31 was as follows:
· 2007 –
$628 million
· 2006
– $843 million
See
Note 9 to the Consolidated Financial Statements for additional
information.
|
The
Company estimates these liabilities with actuarial models using various
assumptions including discount rates and an expected return on plan
assets.
Discount
rates are set considering actual annualized yields for high quality,
long-term corporate bonds, adjusted to reflect the duration of the pension
liabilities.
The
expected return on plan assets for the domestic qualified pension plan is
developed considering actual historical returns, current and expected
market conditions, plan asset mix and management’s investment
strategy. In addition, to measure pension costs the Company
uses a market-related asset value method for domestic qualified pension
plan assets invested in non-fixed income investments, which are
approximately 80% of total plan assets. This method recognizes
market appreciation or depreciation in the non-fixed income portfolio over
5 years, a method that reduces the short-term impact of market
fluctuations on pension cost.
The
declining interest rate environment has resulted in an accumulated
unrecognized actuarial loss of $0.4 billion at December 31,
2007. The actuarial loss adjusted for unrecognized changes in
market-related asset values is amortized over the remaining service life
of pension plan participants if the loss exceeds 10% of the market-related
value of plan assets or 10% of the projected benefit obligation, whichever
is greater. As of December 31, 2007, approximately $0.3 billion
of the adjusted actuarial loss exceeded 10% of the projected benefit
obligation. As a result, approximately $35 million after-tax will be
expensed in 2008 net income. For the year ended December 31,
2007, $77 million after-tax was expensed in net income.
|
Changes
to the Company's assumptions for discount rates and the expected return on
domestic qualified plan assets will not change required cash contributions
to the pension plan, as the Company funds at least the minimum amount
required by ERISA. Using past experience, the Company expects
that it is reasonably possible that a favorable or unfavorable change in
these key assumptions of 50 basis points could occur. An
unfavorable change is a decrease in these key assumptions with resulting
impacts as discussed below.
If
discount rates for the qualified and nonqualified pension plans decreased
by 50 basis points:
·
annual
pension costs for 2008 would increase by approximately $15 million,
after-tax; and
·
the
accrued pension benefit liability would increase by approximately $200
million as of December 31, 2007 resulting in an after-tax decrease to
shareholders’ equity of approximately $130 million as of December 31,
2007.
If
the expected return on domestic qualified pension plan assets decreased by
50 basis points, annual pension costs for 2008 would increase by
approximately $10 million, after-tax.
If
the December 31, 2007 fair values of domestic qualified plan assets
decreased by 10%, the accrued pension benefit liability would increase by
approximately $340 million as of December 31, 2007 resulting in an
after-tax decrease to shareholders’ equity of approximately
$220 million.
A
favorable change is an increase in these key assumptions and would result
in impacts to annual pension costs, the accrued pension liability and
shareholders’ equity in an opposite direction, but similar
amounts.
|
Balance
Sheet Caption /
Nature
of Critical Estimate Item
|
Assumptions
/ Approach Used
|
Effect
if Different Assumptions Used
|
Investments
– Fixed maturities
Recognition
of losses from “other
than
temporary” impairments of
public
and private placement
fixed
maturities
Losses
for “other than temporary” impairments of fixed maturities must be
recognized in net income based on an estimate of fair value by
management.
Changes
in fair value are reflected as an increase or decrease in shareholders’
equity. A decrease in fair value is recognized in net income
when the decrease is determined to be “other than temporary.”
Determining
whether a decline in value is “other than temporary” includes an
evaluation of the reasons for and the significance of the decrease in
value of the security as well as the duration of the
decrease.
|
Management
estimates the amount of an “other than temporary” impairment when a
decline in value is expected to persist, using quoted market prices for
public securities with active markets and generally the present value of
future cash flows for private placement bonds and other public
securities. Expected future cash flows are based on historical
experience of the issuer and management’s expectation of future
performance. See “Quality Ratings” on page 60 for
additional information.
The
Company recognized "other than temporary" impairments of investments in
fixed maturities as follows (after-tax, excluding policyholder
share):
· 2007 –
$20 million
· 2006 –
$18 million
· 2005 –
$12 million
See
Note 10(A) to the Consolidated Financial Statements for a discussion of
the Company’s review of declines in fair value.
|
For
all fixed maturities with cost in excess of their fair value, if this
excess was determined to be other-than-temporary, the Company's net income
as of December 31, 2007 would have decreased by approximately $81 million
after-tax.
For
private placement bonds considered impaired, a decrease of 10% of all
expected future cash flows for the impaired bonds would reduce net income
by approximately $1 million
after-tax.
|
Operating
segments generally reflect groups of related products, but the International
segment is generally based on geography. The Company measures the
financial results of its segments using “segment earnings (loss),” which is
defined as income (loss) from continuing operations excluding realized
investment gains (losses). Beginning in 2007, the Company reports the
results of the run-off retirement business in Other Operations. Prior
periods have been restated to conform to this presentation. See Note
19 to the Consolidated Financial Statements for additional segment information
and a reconciliation of segment earnings (loss) to the Company’s consolidated
income from continuing operations.
Segment
Description
The
Health Care segment includes medical, dental, behavioral health, prescription
drug and other products and services that may be integrated to provide consumers
with comprehensive health care solutions. This segment also includes
group disability and life insurance products that were historically sold in
connection with certain experience-rated medical products that continue to be
managed within the health care business.
These
products and services are offered through guaranteed cost, retrospectively
experience-rated and service funding arrangements. For a
description of funding arrangements, see page 5 in this Form
10-K.
The
company measures the operating effectiveness of the Health Care segment using
the following key factors:
·
|
sales
of specialty products to core medical
customers;
|
·
|
changes
in operating expenses per member;
and
|
·
|
medical
expense as a percentage of premiums (medical cost ratio) in the guaranteed
cost business.
|
Results
of Operations
(In
millions)
|
|
|
|
|
|
|
|
|
|
Financial
Summary
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Premiums
and fees
|
|
$ |
10,666 |
|
|
$ |
9,830 |
|
|
$ |
10,177 |
|
Net
investment income
|
|
|
202 |
|
|
|
261 |
|
|
|
275 |
|
Mail
order pharmacy revenues
|
|
|
1,118 |
|
|
|
1,145 |
|
|
|
883 |
|
Other
revenues
|
|
|
250 |
|
|
|
226 |
|
|
|
208 |
|
Segment
revenues
|
|
|
12,236 |
|
|
|
11,462 |
|
|
|
11,543 |
|
Mail
order pharmacy cost
|
|
|
|
|
|
|
|
|
|
|
|
|
of
goods sold
|
|
|
904 |
|
|
|
922 |
|
|
|
690 |
|
Benefits
and other expenses
|
|
|
10,295 |
|
|
|
9,534 |
|
|
|
9,804 |
|
Benefits
and expenses
|
|
|
11,199 |
|
|
|
10,456 |
|
|
|
10,494 |
|
Income
before taxes
|
|
|
1,037 |
|
|
|
1,006 |
|
|
|
1,049 |
|
Income
taxes
|
|
|
358 |
|
|
|
353 |
|
|
|
361 |
|
Segment
earnings
|
|
$ |
679 |
|
|
$ |
653 |
|
|
$ |
688 |
|
Realized
investment gains,
|
|
|
|
|
|
|
|
|
|
|
|
|
net
of taxes
|
|
$ |
14 |
|
|
$ |
105 |
|
|
$ |
1 |
|
Special
item (after-tax)
|
|
|
|
|
|
|
|
|
|
|
|
|
included in segment earnings:
|
|
|
|
|
|
|
|
|
|
Cost
reduction charge
|
|
$ |
- |
|
|
$ |
(15 |
) |
|
$ |
(14 |
) |
The
Health Care segment's earnings in all years presented were impacted by favorable
after-tax prior year claim development of $8 million, $54 million and $137
million, in 2007, 2006 and 2005, respectively.
The
amount of prior year claim development recorded in 2007, compared with 2006, is
lower due to actual medical cost trends and completion factors being more in
line with initial assumptions.
The
amount of prior year claim development recorded in 2006 and in 2005 was
attributable to better than expected completion factors reflecting shorter
claims processing times due to more timely submission of claims as well as
higher auto adjudication rates. Additionally, lower than expected medical cost
trends also contributed to the favorable results. These results were driven by
lower inpatient, outpatient and pharmacy service utilization and successful
provider contracting initiatives as well as the mix of services
provided.
Excluding
such prior year claim development and the special items noted in the table
above, segment earnings in 2007 increased over 2006 due to:
·
|
increased
earnings from the specialty
businesses;
|
·
|
margin
improvements in the stop-loss
product;
|
·
|
a
lower medical cost ratio in the guaranteed cost business of 160 basis
points due to strong renewal pricing increases in excess of medical cost
trend; and
|
·
|
aggregate
medical membership growth of approximately 800,000 members,
including growth in the voluntary/ limited benefits
business.
|
These
factors were partially offset by lower margins in the experience-rated business
as well as lower net investment income due to lower average assets and lower
yields.
Excluding
prior year claim development and the special items noted in the table above,
segment earnings for 2006 were higher than 2005 due to:
·
|
higher
earnings from the specialty businesses associated with core medical
members;
|
·
|
higher
medical membership of approximately 300,000
members;
|
·
|
improved
cost productivity from expense reduction initiatives reflected in lower
operating costs per member; and
|
·
|
lower
losses in the Medicare Part D program of $11 million
after-tax.
|
These
factors were partially offset by lower results in the guaranteed cost business
reflecting premium increases which were less than medical cost increases and
lower experience-rated earnings.
Revenues
The table
below shows premiums and fees for the Health Care segment:
(In
millions)
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Medical:
|
|
|
|
|
|
|
|
|
|
Commercial
HMO 2
|
|
$ |
2,220 |
|
|
$ |
2,744 |
|
|
$ |
2,646 |
|
Open
access/Other
|
|
|
|
|
|
|
|
|
|
|
|
|
guaranteed
cost3
|
|
|
1,657 |
|
|
|
946 |
|
|
|
463 |
|
Voluntary/limited
benefits
|
|
|
160 |
|
|
|
72 |
|
|
|
- |
|
Total
guaranteed cost
1
|
|
|
4,037 |
|
|
|
3,762 |
|
|
|
3,109 |
|
Experience-rated
medical1,
4
|
|
|
1,877 |
|
|
|
1,760 |
|
|
|
2,836 |
|
Dental
|
|
|
773 |
|
|
|
776 |
|
|
|
899 |
|
Medicare
|
|
|
349 |
|
|
|
321 |
|
|
|
286 |
|
Medicare
Part D 6
|
|
|
326 |
|
|
|
215 |
|
|
|
- |
|
Other
medical
5
|
|
|
1,062 |
|
|
|
929 |
|
|
|
926 |
|
Total
medical
|
|
|
8,424 |
|
|
|
7,763 |
|
|
|
8,056 |
|
Life
and other non-medical
|
|
|
235 |
|
|
|
305 |
|
|
|
399 |
|
Total
premiums
|
|
|
8,659 |
|
|
|
8,068 |
|
|
|
8,455 |
|
Fees
1,6
|
|
|
2,007 |
|
|
|
1,762 |
|
|
|
1,722 |
|
Total
premiums and fees
|
|
$ |
10,666 |
|
|
$ |
9,830 |
|
|
$ |
10,177 |
|
1 Premiums
and/or fees associated with certain specialty products are also
included.
2 Includes
premiums of $82 million for 2006 associated with the health care members in
Tucson, Arizona (see Medical Membership below).
3 Includes
premiums associated with other risk-related products primarily open access
products.
4 Includes
minimum premium members, who have a risk profile similar to experience-rated
funding arrangements. The risk portion of minimum premium revenue is
reported in experience-rated medical premium whereas the self funding portion of
minimum premium revenue is recorded in fees.
5Other
medical premiums include risk revenue for stop-loss and specialty
products.
6Represent
administrative service fees for medical members and related specialty product
fees for non-medical members as well as fees related to Medicare
Part
D.
Premiums and
fees. Premiums and fees increased 9% in 2007, compared with 2006,
primarily reflecting:
·
|
strong
renewal pricing on existing business, particularly in the guaranteed cost
business;
|
·
|
higher
Medicare Part D premiums of $111
million;
|
·
|
growth
in specialty revenues; and
|
·
|
aggregate
medical membership growth, including the voluntary/ limited benefits
business.
|
In
addition, premiums and fees in 2007 reflect a change in the mix of products to
more service-only products from guaranteed cost products.
Premiums
and fees reflect the loss in 2006 of a large prescription drug contract of $1.1
billion in the experience-rated business. The loss of this contract
had minimal impact to earnings, however the final settlement of this contract
did result in net cash outflows in 2006.
Excluding
the loss of this contract, premiums and fees increased by 9% in 2006, compared
with 2005, primarily due to increased guaranteed cost membership and rate
increases, as well as premiums and fees associated with the Medicare Part D and
voluntary/limited benefits businesses.
Other
revenues. Other revenues for the Health Care segment consist of revenues
earned on direct channel sales of certain specialty products, including
behavioral health and disease management.
Other
revenues increased 11% in 2007 and 9% in 2006 primarily due to business
growth.
Benefits
and Expenses
Health
Care segment benefits and expenses consist of the following:
(In
millions)
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Medical
claims expense
|
|
$ |
6,798 |
|
|
$ |
6,111 |
|
|
$ |
6,305 |
|
Other
benefit expenses
|
|
|
225 |
|
|
|
260 |
|
|
|
347 |
|
Mail
order pharmacy
|
|
|
|
|
|
|
|
|
|
|
|
|
cost
of goods sold
|
|
|
904 |
|
|
|
922 |
|
|
|
690 |
|
Other
operating expenses
|
|
|
3,272 |
|
|
|
3,163 |
|
|
|
3,152 |
|
Total
benefits and expenses
|
|
$ |
11,199 |
|
|
$ |
10,456 |
|
|
$ |
10,494 |
|
Medical claims
expense. Medical claims expense included favorable prior year
claim development of $12 million in 2007, $83 million in 2006 and $211 million
in 2005. Excluding the prior year claim development, medical claims
expense increased 10% in 2007 compared to 2006 primarily due to medical trend,
increased Medicare Part D membership and the impact of the Star HRG
operations. The increase in medical claims expense for the guaranteed
cost business was more than offset by the increase in premiums as demonstrated
by the improvement in the medical cost ratio to 84.2% from 85.8%.
Excluding
prior year claim development and the loss of a large prescription drug contract,
medical claims expense increased 14% in 2006, compared with 2005. This increase
was due to the impact of medical trend as demonstrated by a worsening in the
medical cost ratio in the guaranteed cost business to 85.8% from 84.1%, the
introduction of Medicare Part D in 2006 and the impact of Star HRG, which was
acquired in July 2006.
See Note
5 to the Consolidated Financial Statements for additional information about
medical claims payable and medical claims expense.
Other
operating expenses. Other
operating expenses include expenses related to both retail and mail order
pharmacy, disease management, voluntary and limited benefits and Medicare claims
administration businesses.
Excluding
these items, other operating expenses increased in 2007, compared with 2006,
reflecting membership growth and higher spending on information technology,
including market facing capabilities. This increase was partially
offset by productivity savings which were reflected in lower operating expenses
per member due to the success of various expense reduction
initiatives.
Other
operating expenses for 2006 include the favorable impact of a $22 million
pre-tax ($14 million after-tax) insurance recovery resulting from a litigation
matter. Other operating expenses increased in 2006 reflecting costs
associated with certain revenue growth initiatives and amortization of software
development. Excluding these items, other operating expenses for 2006
reflect productivity improvements.
Other
Items Affecting Health Care Results
Medical
Membership
The
Company's medical membership includes any individual for whom the Company
retains medical underwriting risk, who uses the Company’s network for services
covered under their medical coverage or for whom the Company administers medical
claims.
(In
thousands)
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Guaranteed
cost:
|
|
|
|
|
|
|
|
|
|
Commercial
HMO
|
|
|
523 |
|
|
|
764 |
|
|
|
813 |
|
Medicare
|
|
|
31 |
|
|
|
32 |
|
|
|
32 |
|
Open
access/Other
|
|
|
|
|
|
|
|
|
|
|
|
|
guaranteed
cost1
|
|
|
515 |
|
|
|
366 |
|
|
|
214 |
|
Total
guaranteed cost, excluding
|
|
|
|
|
|
|
|
|
|
voluntary/limited
benefits
|
|
|
1,069 |
|
|
|
1,162 |
|
|
|
1,059 |
|
Voluntary/limited
benefits
|
|
|
180 |
|
|
|
164 |
|
|
|
- |
|
Total
guaranteed cost
|
|
|
1,249 |
|
|
|
1,326 |
|
|
|
1,059 |
|
Experience-rated
2
|
|
|
907 |
|
|
|
935 |
|
|
|
1,129 |
|
Service3
|
|
|
8,013 |
|
|
|
7,128 |
|
|
|
6,902 |
|
Total
medical membership
|
|
|
10,169 |
|
|
|
9,389 |
|
|
|
9,090 |
|
1 Includes
membership associated with other risk-related products, primarily open access
products.
2 Includes minimum
premium members, who have a risk profile similar to experience-rated funding
arrangements. The risk portion of minimum premium revenue is reported
in experience-rated medical premium whereas the self funding portion of minimum
premium revenue is recorded in fees.
3 Includes
approximately 25 thousand members obtained through the acquisition of Mid-South
Administrative Group, LLC, which was effective January 1, 2007, and includes 340
thousand members related to Sagamore Health Network, which was acquired on
August 1, 2007.
During
2007, medical membership increased by 8.3%, including members from the August 1,
2007 acquisition of Sagamore Health Network, Inc. Excluding this
acquisition, medical membership increased 4.7% due to growth in the service
business.
During
2006, the Company's medical membership increased by 3% including approximately
164,000 members with voluntary or other limited health care benefits coverage as
a result of the Star HRG acquisition in 2006. Excluding this
acquisition, medical membership increased 1.5% reflecting growth in service and
other guaranteed cost, partially offset by lower experience-rated
membership.
In 2006,
approximately 54,000 health care members in Tucson, Arizona were transitioned to
the Company as the result of an antitrust requirement to divest certain
contracts in connection with the merger of two health care industry
competitors. Given the unique nature of this transaction, the
Company
did not include these members in its reported medical membership until affected
customers renewed on the Company’s contracts. As of December 31,
2007, all customers
were up for renewal and the Company renewed contracts for approximately 36,000
members. These members are now included in the above medical
membership results.
In
addition, in 2006, approximately 84,000 members were reclassified from
experience-rated to administrative service only. This change had no
impact on reported revenues or segment earnings.
Operational
Improvement Initiatives
The
Company continues to devote its efforts to becoming the leading health service
organization. As such, the Company is focused on several initiatives
including developing and enhancing a consumer focused service
model. This effort is expected to require significant investments
over the next 3-5 years. These investments will enable the Company to
grow its membership and to improve operational effectiveness and profitability
by developing innovative products and services that promote consumer engagement
at a competitive cost. Executing on these operational improvement
initiatives is critical to attaining a leadership position in the health care
marketplace.
Offering products
that meet emerging consumer and market trends. The CIGNATURE®,
CareAlliesSM, and
CIGNA Choice Fund® suite of products offers various options to consumers and
employers and are key to our consumer engagement strategy. Offerings
include: choice of benefit, participating provider network, funding, medical
management, and health advocacy options. Through the CIGNA Choice
Fund®, the Company offers a set of consumer-directed capabilities that includes
options for health reimbursement arrangements and/or health savings accounts and
enables consumers to make effective health decisions using information tools
provided by the Company.
In July
2006, the Company acquired Star HRG, a leading provider of low cost health plans
and other employee benefits coverage for hourly and part-time workers and their
families. This acquisition complements the Company’s existing product
portfolio by giving the Company the capability to offer voluntary health
insurance coverage. Also in 2006, the Company acquired vielife, a
U.K. based leading provider of integrated online health management and coaching
programs and entered into a long-term agreement with the University of Michigan
to access certain intellectual property related to identification of health
risks and employer worksite health and wellness programs.
Underwriting and
pricing products effectively. One of the Company’s key
priorities is to achieve strong profitability in a competitive health care
market. The Company is focused on effectively managing pricing and
underwriting decisions at both the case and overall business level, particularly
for the
guaranteed
cost business as demonstrated in the improvement in the guaranteed cost medical
cost ratio by 160 basis points in 2007 excluding prior year claim
development.
Growing
medical membership results. The Company continues to
focus on growing its medical membership by:
·
|
increasing
its share of the national and regional
segments;
|
·
|
providing
a diverse product portfolio that meets current market needs as well as
emerging consumer-directed trends;
|
·
|
developing
and implementing the systems, information technology and infrastructure to
deliver member service that keeps pace with the emerging consumer-directed
market trends;
|
·
|
ensuring
competitive provider networks; and
|
·
|
maintaining
a strong clinical quality in medical, specialty health care and disability
management.
|
The
Company is focused on segment expansion most notably in the voluntary,
individual and small employer (less than 200 employees) and senior
segments. In an effort to achieve these objectives, the Company took
the following strategic actions:
In
November 2007, the Company announced its agreement to acquire Great-West
Healthcare of Denver, Colorado. This acquisition will enable the Company to
broaden its distribution reach and provider network, particularly in the western
regions of the United States, and expand the range of health benefits and
products it offers. The Company is targeting an April 1, 2008 closing
date. See “Liquidity and Capital Resources Outlook” on page 58
for more information about funding this acquisition.
Additionally,
the Company acquired Memphis-based Mid-South Administrative Group, LLC in
January 2007 to give the Company an expanded local presence in Memphis and
western Tennessee.
The
Company formed strategic alliances with New York-based MVP Health Care/Preferred
Care in September 2006 and with Minnesota-based HealthPartners in April
2006. The Company believes that its medical management model, focus
on clinical quality and ability to integrate health and related benefit
solutions position the Company to continue to improve membership
results.
These
actions have enabled the Company to strengthen its national provider network; to
enhance its ability to provide superior medical disease management programs and
importantly, to grow membership while lowering medical costs in key geographic
areas.
Effectively
managing medical costs. The Company operates under a
centralized medical management model, which helps facilitate consistent levels
of care for its members and reduces infrastructure expenses.
The
Company is focused on continuing to effectively manage medical utilization and
unit costs. To help achieve this, the Company continues to focus on
renegotiating contracts with providers and certain facilities to limit increases
in medical reimbursement
costs. In addition, the Company seeks to strengthen its network
position in selected markets and, on August 1, 2007, acquired Sagamore Health
Network, Inc. in Indiana. Sagamore provides access to an extensive preferred
provider network and offers access to a broad range of utilization review and
case management services to health claim payer organizations, self-insured
employers and third-party administrators. In the future, the Company
may pursue additional acquisitions and strategic alliances.
Delivering
quality member and provider service. The Company is focused on
delivering competitive service to members, providers and customers. The Company
believes that further enhancing quality service can improve member retention
and, when combined with useful health information and tools, can help motivate
members to become more engaged in their personal health, and will promote
healthy outcomes thereby removing cost from the system. The evolution
of the consumer-driven healthcare market is driving increased product and
service complexity and is raising consumers’ expectations with respect to
service levels, which is expected to require significant investment, management
attention and heightened interaction with customers.
The
Company is focused on the development and enhancement of a service model that is
capable of meeting the challenges brought on by the increasing product and
service complexity and the heightened expectations of health care
consumers. The Company continues to invest in the development and
implementation of systems and technology to improve the member and provider
service experience, enhance its capabilities and improve its competitive
position.
Maintaining and
upgrading information technology systems. The Company’s current
business model and long-term strategy require effective and reliable information
technology systems. The Company’s current systems architecture will
require continuing investment to meet the challenges of increasing consumer
demands from both our existing and emerging customer base to support its
business growth and strategies, improve its competitive position and provide
appropriate levels of service to consumers. The Company is focused on
providing these enhanced strategic capabilities in response to increasing
consumer expectations, while continuing to provide a consistent, high quality
consumer service experience with respect to the Company’s current
programs. Further integration of the Company’s multiple
administrative and customer facing platforms is required to support the
Company's internal needs and growth strategies, and to ensure reliable,
efficient and effective customer service both in today’s employer focused model
as well as in a consumer directed model. The Company’s ability to
obtain and effectively deploy capital to make these investments will influence
the timing and the impact these initiatives will have on its
operations.
Reducing other
operating expenses. The Company operates in an intensely competitive
marketplace and its ability to establish a meaningful cost advantage is key to
achieving its initiatives. Accordingly, the Company continues to focus on
initiatives that will increase its operating efficiency and responsiveness to
customers.
The
Company’s health advocacy capabilities support its recent membership
growth. The Company must be able to deliver those capabilities
efficiently and cost-effectively. The Company must continue to
identify additional cost savings to further improve its competitive cost
position. Savings generated from the Company’s operating efficiency
initiatives provide capital to make investments that will enhance its
capabilities in the areas of consumerism, particularly product development, the
delivery of member service and health advocacy and related technology. See Note
6 to the Consolidated Financial Statements for further information on
initiatives to reduce operating expenses.
Segment
Description
The
Disability and Life segment includes group disability, life, accident and
specialty insurance and case management for disability and workers’
compensation.
For a
description of Disability and Life’s products and services, see page 11 in the
“Business” section of this Form 10-K.
Key
factors for this segment are:
·
|
premium
growth, including new business and customer
retention;
|
·
|
benefits
expense as a percentage of earned premium (loss ratio);
and
|
·
|
other
operating expense as a percentage of earned premiums (expense
ratio).
|
Results
of Operations
(In
millions)
|
|
|
|
|
|
|
|
|
|
Financial
Summary
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
Premiums
and fees
|
|
$ |
2,374 |
|
|
$ |
2,108 |
|
|
$ |
2,065 |
|
Net
investment income
|
|
|
276 |
|
|
|
256 |
|
|
|
264 |
|
Other
revenues
|
|
|
131 |
|
|
|
161 |
|
|
|
198 |
|
Segment
revenues
|
|
|
2,781 |
|
|
|
2,525 |
|
|
|
2,527 |
|
Benefits
and expenses
|
|
|
2,435 |
|
|
|
2,214 |
|
|
|
2,208 |
|
Income
before taxes
|
|
|
346 |
|
|
|
311 |
|
|
|
319 |
|
|