Elevance Health Reports Second Quarter 2023 Results

July 19, 2023 | Last Trade: US$409.40 0.99 -0.24

Second quarter GAAP net income was $7.79 per share, including net negative adjustment items of $1.25 per share. Adjusted net income was $9.04* per share.
Operating revenue grew 12.7% year-over-year to $43.4 billion
Operating gain grew 12.0% year-over-year to $2.6 billion
Medical enrollment increased 938 thousand members year-over-year to 48.0 million members
Third quarter 2023 dividend of $1.48 per share declared to shareholders

INDIANAPOLIS / Jul 19, 2023 / Business Wire / Elevance Health, Inc. (NYSE: ELV) reported second quarter 2023 results reflecting strong financial performance, including double-digit growth in revenue, operating earnings, and adjusted earnings per share.

“Our solid execution and continued progress of our strategy to become a lifetime trusted health partner resulted in strong second quarter and first half results,” said Gail K. Boudreaux, President and CEO. “Our focused efforts to optimize our mature businesses, invest in high-growth opportunities, and accelerate our growth through Carelon to meet the whole health needs of consumers positions us well for the rest of 2023 and beyond.”

Given the strong performance in the first half of the year and momentum across Elevance Health, we now expect GAAP net income to be greater than $29.09 per share in 2023, and adjusted net income to be greater than $32.85 per share.

_{*Refer to GAAP reconciliation tables.}

CONSOLIDATED HIGHLIGHTS

Earnings Per Share: GAAP net income was $7.79 per share in the second quarter, including net negative adjustment items of $1.25 per share. Adjusted net income was $9.04* per share.

_{*Please refer to the GAAP reconciliation tables.}

Membership: Medical membership totaled approximately 48.0 million as of June 30, 2023, an increase of 938 thousand, or 2.0 percent year-over-year, driven primarily by growth in Medicaid, BlueCard, ACA health plan, and Medicare Advantage members, partially offset by attrition in our Employer Group risk-based business.

During the second quarter of 2023, medical membership decreased by 135 thousand driven by attrition in Medicaid due to the resumption of eligibility redeterminations.

Operating Revenue: Operating revenue was $43.4 billion in the second quarter of 2023, an increase of $4.9 billion, or 12.7 percent year-over-year. The increase was primarily driven by premium rate increases in our Health Benefits business and higher premium revenue due to membership growth in Medicaid and Medicare. The increase in operating revenue was further attributable to growth in pharmacy product revenue within CarelonRx driven by growth in external pharmacy members served and the acquisition of BioPlus in the first quarter of 2023.

Benefit Expense Ratio: The benefit expense ratio was 86.4 percent in the second quarter of 2023, a decrease of 70 basis points year-over-year. The decrease was driven by premium rate adjustments to more accurately reflect cost of care.

Medical claims reserves established at December 31, 2022 developed in line with the Company’s expectations as of the second quarter of 2023.

Days in Claims Payable: Days in Claims Payable was 46.5 days as of June 30, 2023, an increase of 0.5 days from March 31, 2023 and a decrease of 1.3 days compared to June 30, 2022. The timing of certain provider pass-through payments and corresponding reserves set in the prior year had the effect of increasing Days in Claims Payable by 1.8 days in the second quarter of 2022. Adjusting for these impacts, Days in Claims Payable would have increased 0.5 days year-over-year.

Operating Expense Ratio: The operating expense ratio was 11.1 percent in the second quarter of 2023, unchanged from 11.1 percent in the second quarter of 2022.

Operating Cash Flow: Operating cash flow was approximately $2.0 billion, or 1.1 times net income in the second quarter of 2023.

Share Repurchase Program: During the second quarter of 2023, the Company repurchased 1.4 million shares of its common stock for $646 million, at a weighted average price of $457.34. Year-to-date, as of the end of the second quarter, the Company repurchased 2.7 million shares of its common stock for $1.3 billion, at a weighted average price of $466.62. As of June 30, 2023, the Company had approximately $5.6 billion of Board-approved share repurchase authorization remaining.

Cash Dividend: During the second quarter of 2023, the Company paid a quarterly dividend of $1.48 per share, representing a distribution of cash totaling $350 million.

On July 18, 2023, the Audit Committee of the Company's Board of Directors declared a third quarter 2023 dividend to shareholders of $1.48 per share. The third quarter dividend is payable on September 22, 2023, to shareholders of record at the close of business on September 8, 2023.

Investment Portfolio & Capital Position: During the second quarter of 2023, the Company recorded net losses of $121 million. During the second quarter of 2022, the Company recorded net losses of $231 million. These amounts are excluded from adjusted earnings per share.

As of June 30, 2023, the Company’s net unrealized loss position in the investment portfolio was $1.9 billion, consisting primarily of fixed maturity securities. As of June 30, 2023, cash and investments at the parent company totaled approximately $1.0 billion.

REPORTABLE SEGMENTS

Elevance Health has four reportable segments: Health Benefits, the aggregation of our Commercial & Specialty Business and Government Business (comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard businesses, Medicaid, Medicare, and Federal Health Products & Services businesses); CarelonRx (formerly IngenioRx); Carelon Services (formerly known as Diversified Business Group); and Corporate & Other (comprised of businesses that do not individually meet the quantitative thresholds for an operating division as well as corporate expenses not allocated to our other reportable segments).

Elevance Health, Inc.
Reportable Segment Highlights
(Unaudited)

(In millions)	Three Months Ended June 30						Six Months Ended June 30
	2023		2022		Change		2023		2022		Change
			(Restated)						(Restated)
Operating Revenue
Health Benefits	$38,000		$34,396		10.5	%	$75,280		$68,423		10.0	%
Carelon¹	11,907		10,054		18.4	%	23,243		19,685		18.1	%
Corporate & Other	287		315		(8.9	)%	538		588		(8.5	)%
Eliminations	(6,817	)	(6,283	)	8.5	%	(13,786	)	(12,328	)	11.8	%
Total Operating Revenue²	$43,377		$38,482		12.7	%	$85,275		$76,368		11.7	%

Operating Gain (Loss)
Health Benefits	$2,148		$1,781		20.6	%	$4,307		$3,632		18.6	%
Carelon¹	632		592		6.8	%	1,353		1,190		13.7	%
Corporate & Other	(152	)	(27	)	NM³		(201	)	(49	)	NM³
Total Operating Gain²	$2,628		$2,346		12.0	%	$5,459		$4,773		14.4	%

Operating Margin
Health Benefits	5.7	%	5.2	%	50	bp	5.7	%	5.3	%	40	bp
Carelon¹	5.3	%	5.9	%	(60	) bp	5.8	%	6.0	%	(20	) bp
Total Operating Margin²	6.1	%	6.1	%	—	bp	6.4	%	6.3	%	10	bp

1.	Operating Revenue and Operating Gain for Carelon for the three months ended June 30, 2023 included $8,466 and $496 for CarelonRx; $3,441 and $136 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the three months ended June 30, 2022 included $7,071 and $479 for CarelonRx; $2,983 and $113 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the six months ended June 30, 2023 included $16,490 and $1,008 for CarelonRx; $6,753 and $345 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the six months ended June 30, 2022 included $13,754 and $877 for CarelonRx; $5,931 and $313 for Carelon Services, respectively.
2.	See “Basis of Presentation.”
3.	"NM" = calculation not meaningful.

Health Benefits: Operating gain in the Health Benefits segment totaled $2.1 billion in the second quarter of 2023, an increase of $367 million from $1.8 billion in the second quarter of 2022, representing growth of approximately 21%. The increase was primarily driven by premium rate adjustments to more accurately reflect cost of care and membership growth in Medicaid, partially offset by a charge associated with a court ruling impacting health plans in a certain state related to prior years' COVID-19 costs.

Carelon: Operating gain in the Carelon segment was $632 million in the second quarter of 2023, an increase of $40 million from $592 million in the second quarter of 2022. The increase was primarily driven by improved performance in our medical management business and the expansion of our post-acute care services, partially offset by higher medical cost trends and the non-recurrence of an out of period favorable adjustment in the second quarter of 2022 in CarelonRx.

Corporate & Other: The Company reported an operating loss of $152 million in the Corporate & Other segment for the second quarter of 2023, a decrease of $125 million from an operating loss of $27 million in the second quarter of 2022, driven by an increase in unallocated corporate expenses.

Basis of Presentation

Operating revenue and operating gain/loss are the key measures used by management to evaluate performance in each of its reporting segments, allocate resources, set incentive compensation targets and to forecast future operating performance. Operating gain/loss is calculated as total operating revenue less benefit expense, cost of products sold and operating expense. It does not include net investment income, net gains/losses on financial instruments, interest expense, amortization of other intangible assets, gains/losses on extinguishment of debt or income taxes, as these items are managed in a corporate shared service environment and are not the responsibility of operating segment management. Refer to the GAAP reconciliation tables.
Operating margin is defined as operating gain divided by operating revenue.

Conference Call and Webcast

Management will host a conference call and webcast today at 8:30 a.m. Eastern Daylight Time (“EDT”) to discuss the company’s second quarter results and outlook. The conference call should be accessed at least 15 minutes prior to the start of the call with the following numbers:

888-947-9963 (Domestic)		800-391-9853 (Domestic Replay)
312-470-0178 (International)		203-369-3269 (International Replay)

The access code for today's conference call is 3972058. There is no access code for the replay. The replay will be available from 11:30 a.m. EDT today, until the end of the day on August 18, 2023. The call will also be available through a live webcast at www.elevancehealth.com under the “Investors” link. A webcast replay will be available following the call.

About Elevance Health, Inc.

Elevance Health is a lifetime, trusted health partner fueled by its purpose to improve the health of humanity. The company supports consumers, families, and communities across the entire care journey – connecting them to the care, support, and resources they need to lead healthier lives. Elevance Health’s companies serve approximately 118 million people through a diverse portfolio of industry-leading medical, digital, pharmacy, behavioral, clinical, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on Twitter and Elevance Health on LinkedIn.

Elevance Health, Inc.
Membership and Other Metrics
(Unaudited)

				Change from
Medical Membership (in thousands)	June 30, 2023	June 30, 2022	March 31, 2023	June 30, 2022		March 31, 2023
Individual	949	803	942	18.2	%	0.7	%
Employer Group Risk-Based	3,765	4,020	3,798	(6.3	)%	(0.9	)%
Commercial Risk-Based	4,714	4,823	4,740	(2.3	)%	(0.5	)%
BlueCard^®	6,737	6,445	6,607	4.5	%	2.0	%
Employer Group Fee-Based	20,160	20,086	20,278	0.4	%	(0.6	)%
Commercial Fee-Based	26,897	26,531	26,885	1.4	%	—	%
Medicare Advantage	2,059	1,946	2,053	5.8	%	0.3	%
Medicare Supplement	926	942	925	(1.7	)%	0.1	%
Total Medicare	2,985	2,888	2,978	3.4	%	0.2	%
Medicaid	11,759	11,181	11,889	5.2	%	(1.1	)%
Federal Employees Health Benefits	1,634	1,628	1,632	0.4	%	0.1	%
Total Medical Membership	47,989	47,051	48,124	2.0	%	(0.3	)%
Other Membership (in thousands)
Life and Disability Members	4,686	4,779	4,771	(1.9	)%	(1.8	)%
Dental Members	6,728	6,620	6,743	1.6	%	(0.2	)%
Dental Administration Members	1,694	1,589	1,697	6.6	%	(0.2	)%
Vision Members	9,850	9,385	9,904	5.0	%	(0.5	)%
Medicare Part D Standalone Members	263	276	264	(4.7	)%	(0.4	)%
Other Metrics (in millions)
CarelonRx Quarterly Adjusted Scripts	77.4	76.4	75.7	1.3	%	2.2	%
Carelon Services Consumers Served	103.6	104.7	104.0	(1.1	)%	(0.4	)%

Elevance Health, Inc.
Consolidated Statements of Income
(Unaudited)

*(In millions, except per share data)*	Three Months Ended June 30
	2023			2022			Change
				(Restated)
Revenues
Premiums	$	36,589		$	33,076		10.6	%
Product revenue		4,859			3,568		36.2	%
Service fees		1,929			1,838		5.0	%
Total operating revenue		43,377			38,482		12.7	%
Net investment income		416			381		9.2	%
Net losses on financial instruments		(121	)		(231	)	NM
Total revenues		43,672			38,632		13.0	%

Expenses
Benefit expense		31,604			28,795		9.8	%
Cost of products sold		4,327			3,069		41.0	%
Operating expense		4,818			4,272		12.8	%
Interest expense		261			208		25.5	%
Amortization of other intangible assets		221			166		33.1	%
Total expenses		41,231			36,510		12.9	%

Income before income tax expense		2,441			2,122		15.0	%

Income tax expense		585			488		19.9	%

Net income		1,856			1,634		13.6	%

Net (income) loss attributable to noncontrolling interests		(3	)		3		NM

Shareholders' net income	$	1,853		$	1,637		13.2	%

Shareholders' net income per diluted share	$	7.79		$	6.73		15.8	%

Diluted shares		237.8			243.4		(2.3	)%

Benefit expense as a percentage of premiums		86.4	%		87.1	%	(70	) bp
Operating expense as a percentage of total operating revenue		11.1	%		11.1	%	—	bp
Income before income tax expense as a percentage of total revenue		5.6	%		5.5	%	10	bp

"NM" = calculation not meaningful

Elevance Health, Inc.
Consolidated Statements of Income
(Unaudited)

*(In millions, except per share data)*	Six Months Ended June 30
	2023			2022			Change
				(Restated)
Revenues
Premiums	$	72,457		$	65,861		10.0	%
Product revenue		8,881			6,869		29.3	%
Service fees		3,937			3,638		8.2	%
Total operating revenue		85,275			76,368		11.7	%
Net investment income		803			741		8.4	%
Net losses on financial instruments		(234	)		(382	)	NM
Total revenues		85,844			76,727		11.9	%

Expenses
Benefit expense		62,390			57,026		9.4	%
Cost of products sold		7,808			5,952		31.2	%
Operating expense		9,618			8,617		11.6	%
Interest expense		512			409		25.2	%
Amortization of other intangible assets		456			295		54.6	%

Total expenses		80,784			72,299		11.7	%

Income before income tax expense		5,060			4,428		14.3	%

Income tax expense		1,200			1,015		18.2	%

Net income		3,860			3,413		13.1	%

Net (income) loss attributable to noncontrolling interests		(18	)		13		NM

Shareholders' net income	$	3,842		$	3,426		12.1	%

Shareholders' net income per diluted share	$	16.10		$	14.05		14.6	%

Diluted shares		238.7			243.9		(2.1	)%

Benefit expense as a percentage of premiums		86.1	%		86.6	%	(50	) bp
Operating expense as a percentage of total operating revenue		11.3	%		11.3	%	—	bp
Income before income tax expense as a percentage of total revenue		5.9	%		5.8	%	10	bp

"NM" = calculation not meaningful

Elevance Health, Inc.
Consolidated Balance Sheets

(In millions)	June 30, 2023			December 31, 2022
Assets	(Unaudited)			(Restated)
Current assets:
Cash and cash equivalents	$	9,991		$	7,387
Fixed maturity securities		28,021			25,952
Equity securities		272			953
Premium receivables		7,431			7,083
Self-funded receivables		3,896			4,663
Other receivables		5,196			4,298
Other current assets		4,936			5,281
Total current assets		59,743			55,617

Long-term investments:
Fixed maturity securities		775			752
Other invested assets		5,993			5,685
Property and equipment, net		4,547			4,316
Goodwill		25,274			24,383
Other intangible assets		10,703			10,315
Other noncurrent assets		2,133			1,687
Total assets	$	109,168		$	102,755

Liabilities and equity
Liabilities
Current liabilities:
Medical claims payable	$	16,165		$	15,596
Other policyholder liabilities		5,954			5,933
Unearned income		4,458			1,112
Accounts payable and accrued expenses		5,033			5,607
Short-term borrowings		265			265
Current portion of long-term debt		—			1,500
Other current liabilities		9,696			9,683
Total current liabilities		41,571			39,696

Long-term debt, less current portion		24,859			22,349
Reserves for future policy benefits		797			803
Deferred tax liabilities, net		1,852			2,015
Other noncurrent liabilities		1,777			1,562
Total liabilities		70,856			66,425

Shareholders’ equity
Common stock		2			2
Additional paid-in capital		8,761			9,084
Retained earnings		31,608			29,647
Accumulated other comprehensive loss		(2,166	)		(2,490	)
Total shareholders’ equity		38,205			36,243
Noncontrolling interests		107			87
Total equity		38,312			36,330
Total liabilities and equity	$	109,168		$	102,755

Elevance Health, Inc.
Consolidated Statements of Cash Flows
(Unaudited)

*(In millions)*	Six Months Ended June 30
	2023			2022
				(Restated)
Operating activities
Net income	$	3,860		$	3,413
Adjustments to reconcile net income to net cash provided by operating activities:
Net losses on financial instruments		234			382
Equity in net earnings of other invested assets		73			(258	)
Depreciation and amortization		895			751
Deferred income taxes		(393	)		(181	)
Share-based compensation		139			122
Changes in operating assets and liabilities:
Receivables, net		(299	)		(662	)
Other invested assets		(42	)		32
Other assets		(529	)		(412	)
Policy liabilities		583			1,548
Unearned income		3,346			(182	)
Accounts payable and other liabilities		160			632
Income taxes		391			(159	)
Other, net		1			(33	)
Net cash provided by operating activities		8,419			4,993

Investing activities
Purchases of investments		(17,648	)		(13,253	)
Proceeds from sale of investments		5,339			7,140
Maturities, calls and redemptions from investments		10,656			4,347
Changes in securities lending collateral		145			(620	)
Purchases of subsidiaries, net of cash acquired		(1,651	)		(609	)
Purchases of property and equipment		(651	)		(549	)
Other, net		(46	)		(58	)
Net cash used in investing activities		(3,856	)		(3,602	)

Financing activities
Net proceeds from commercial paper borrowings		90			250
Net proceeds from (repayments of) short-term borrowings		(90	)		(100	)
Net proceeds from (repayments of) long-term borrowings		666			357
Changes in securities lending payable		(145	)		620
Changes in bank overdrafts		(500	)		817
Repurchase and retirement of common stock		(1,268	)		(1,169	)
Cash dividends		(701	)		(618	)
Proceeds from issuance of common stock under employee stock plans		81			116
Taxes paid through withholding of common stock under employee stock plans		(99	)		(88	)
Other, net		5			10
Net cash (used in) provided by financing activities		(1,961	)		195

Effect of foreign exchange rates on cash and cash equivalents		2			(10	)

Change in cash and cash equivalents		2,604			1,576
Cash and cash equivalents at beginning of period		7,387			4,880

Cash and cash equivalents at end of period	$	9,991		$	6,456

Elevance Health, Inc.
Reconciliation of Medical Claims Payable

	Six Months Ended June 30						Years Ended December 31
	2023			2022			2022			2021			2020
(In millions)	(Unaudited)			(Unaudited)

Gross medical claims payable, beginning of period	$	15,348		$	13,282		$	13,282		$	11,135		$	8,647
Ceded medical claims payable, beginning of period		(6	)		(21	)		(21	)		(46	)		(33	)
Net medical claims payable, beginning of period		15,342			13,261			13,261			11,089			8,614

Business combinations and purchase adjustments		—			133			133			420			339

Net incurred medical claims:
Current year		61,290			55,737			113,414			100,440			85,094
Prior years redundancies¹		(1,112	)		(972	)		(869	)		(1,703	)		(637	)
Total net incurred medical claims		60,178			54,765			112,545			98,737			84,457

Net payments attributable to:
Current year medical claims		48,217			42,882			98,997			88,156			74,629
Prior years medical claims		11,409			10,401			11,600			8,829			7,692
Total net payments		59,626			53,283			110,597			96,985			82,321

Net medical claims payable, end of period		15,894			14,876			15,342			13,261			11,089
Ceded medical claims payable, end of period		8			13			6			21			46
Gross medical claims payable, end of period	$	15,902		$	14,889		$	15,348		$	13,282		$	11,135

Current year medical claims paid as a percentage of current year net incurred medical claims		78.7	%		76.9	%		87.3	%		87.8	%		87.7	%

Prior year redundancies in the current year as a percentage of prior year net medical claims payable less prior year redundancies in the current year		7.8	%		7.9	%		7.0	%		18.1	%		8.0	%

Prior year redundancies in the current year as a percentage of prior year net incurred medical claims		1.0	%		1.0	%		0.9	%		2.0	%		0.8	%

1. Negative amounts reported for net incurred medical claims related to prior years result from claims being settled for amounts less than originally estimated.

Elevance Health, Inc. GAAP Reconciliation (Unaudited)

Elevance Health, Inc. has referenced “Adjusted Net Income” and “Adjusted Net Income Per Share,” which are non-GAAP measures, in this document. These non-GAAP measures are not intended to be alternatives to any measure calculated in accordance with GAAP. In addition to these non-GAAP measures, references are made to the measures “Operating Revenue” and “Operating Gain.” Each of these measures is provided to further aid investors in understanding and analyzing the company’s core operating results and comparing Elevance Health, Inc.’s financial results. A reconciliation of Operating Revenue to Total Revenue is set forth in the Consolidated Statements of Income herein. A reconciliation of the non-GAAP measures to the most directly comparable measures calculated in accordance with GAAP, together with a reconciliation of reportable segments operating gain to income before income tax expense, is reported below. Prior amounts may be grouped differently to conform to current presentation.

	Three Months Ended June 30								Six Months Ended June 30
(In millions, except per share data)	2023			2022			Change		2023			2022			Change
Shareholders' net income - As reported	$	1,853		$	1,653		12.1	%	$	3,842		$	3,458		11.1	%
Impact of Accounting Standards Update 2018-12 Adoption		—			(16	)				—			(32	)
Shareholders' net income - Restated	$	1,853		$	1,637		13.2	%	$	3,842		$	3,426		12.1	%
Add / (Subtract):
Net losses on financial instruments		121			231					234			382
Amortization of other intangible assets		221			166					456			295
Transaction and integration related costs		55			14					81			23
Litigation expenses		2			4					3			5
Tax impact of non-GAAP adjustments		(103	)		(111	)				(200	)		(189	)
Net adjustment items		296			304					574			516
Adjusted shareholders' net income	$	2,149		$	1,941		10.7	%	$	4,416		$	3,942		12.0	%

Shareholders' net income per diluted share - As reported	$	7.79		$	6.79		14.7	%	$	16.10		$	14.18		13.5	%
Impact of Accounting Standards Update 2018-12 Adoption		—			(0.06	)				—			(0.13	)
Shareholders' net income per diluted share - Restated		7.79			6.73		15.8	%		16.10			14.05		14.6	%
Add / (Subtract):
Net losses on financial instruments		0.51			0.95					0.98			1.57
Amortization of other intangible assets		0.93			0.68					1.91			1.21
Transaction and integration related costs		0.23			0.06					0.34			0.09
Litigation expenses		0.01			0.02					0.01			0.02
Tax impact of non-GAAP adjustments		(0.43	)		(0.46	)				(0.84	)		(0.77	)
Rounding impact		—			(0.01	)				—			(0.01	)
Net adjustment items		1.25			1.24					2.40			2.11
Adjusted shareholders' net income per diluted share	$	9.04		$	7.97		13.4	%	$	18.50		$	16.16		14.5	%

	Full Year 2023 Outlook
Shareholders' net income per diluted share	Greater than $29.09
Add / (Subtract):
Net losses on financial instruments	$0.98
Transaction and integration related costs	$0.34
Litigation expenses	$0.01
Amortization of other intangible assets	$3.68
Tax impact of non-GAAP adjustments	Approximately $(1.25					)
Net adjustment items	$3.76
Adjusted shareholders' net income per diluted share	Greater Than $32.85

	Three Months Ended June 30								Six Months Ended June 30
*(In millions)*	2023			2022			Change		2023			2022			Change
				(Restated)								(Restated)
Income before income tax expense	$	2,441		$	2,122		15.0	%	$	5,060		$	4,428		14.3	%
Net investment income		(416	)		(381	)				(803	)		(741	)
Net losses on financial instruments		121			231					234			382
Interest expense		261			208					512			409
Amortization of other intangible assets		221			166					456			295
Reportable segments operating gain	$	2,628		$	2,346		12.0	%	$	5,459		$	4,773		14.4	%

Forward-Looking Statements

This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent required by law, we do not undertake to update or revise any forward-looking statements to reflect events or circumstances occurring after the date hereof. These risks and uncertainties include, but are not limited to: trends in healthcare costs and utilization rates; reduced enrollment; our ability to secure and implement sufficient premium rates; the impact of large scale medical emergencies, such as public health epidemics and pandemics, including COVID-19, and other catastrophes; the impact of new or changes in existing federal, state and international laws or regulations, including healthcare laws and regulations, or their enforcement or application; the impact of cyber-attacks or other privacy or data security incidents or breaches or our failure to comply with any privacy or security laws or regulations, including any investigations, claims or litigation related thereto; information technology disruptions; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; our ability to contract with providers on cost-effective and competitive terms; failure to effectively maintain and modernize our information systems; risks associated with providing pharmacy, healthcare and other diversified products and services, including medical malpractice or professional liability claims and non-compliance by any party with the pharmacy services agreement between us and CaremarkPCS Health, L.L.C.; risks associated with mergers, acquisitions, joint ventures and strategic alliances; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness and the risk that increased interest rates or market volatility could impact our access to or further increase the cost of financing; a downgrade in our financial strength ratings; the effects of any negative publicity related to the health benefits industry in general or us in particular; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.

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