Humana Inc. and its subsidiaries operate as a health and well-being company. As of December 31, 2015, the company had approximately 14.2 million members in its medical benefit plans, as well as approximately 7.2 million members in its specialty products. Products The company’s medical and specialty insurance products allow members to access health care services primarily through its networks of health care providers with whom the company has contracted. These products might vary in the degree to which members have coverage. Health maintenance organizations (HMOs) generally require a referral from the member’s primary care provider before seeing certain specialty physicians. Preferred provider organizations (PPOs) provide members the freedom to choose a health care provider without requiring a referral. Point of service (POS) plans combine the advantages of HMO plans with the flexibility of PPO plans. In general, POS plans allow members to choose, at the time medical services are needed, to seek care from a provider within the plan’s network or outside the network. In addition, the company offers services to its health plan members, as well as to third parties that promote health and wellness, including pharmacy solutions, provider, home based, and clinical programs, as well as services and capabilities to advance population health. At the core of the company’s strategy is its integrated care delivery model, which unites quality care, high member engagement, and data analytics. Segments The company operates through three segments: Retail, Group, and Healthcare Services. Retail segment This segment includes products sold on a retail basis to individuals, including medical and supplemental benefit plans. Medicare The company has participated in the Medicare program for private health plans and has established a national presence, offering approximately 1 type of Medicare plan in all 50 states. The company has a membership base that provides the company with ability to expand its network of PPO and HMO providers. The company employs strategies, including health assessments and clinical guidance programs, such as lifestyle and fitness programs for seniors to guide Medicare beneficiaries in making decisions with respect to their health care. Medicare is a federal program that provides persons age 65 and over and some disabled persons under the age of 65 certain hospital and medical insurance benefits. The Centers for Medicare and Medicaid Services (CMS), an agency of the United States Department of Health and Human Services, administers the Medicare program. Hospitalization benefits are provided under Part A, without the payment of any premium, for approximately 90 days per incident of illness plus a lifetime reserve aggregating 60 days. Eligible beneficiaries are required to pay an annually adjusted premium to the federal government to be eligible for physician care and other services under Part B. Beneficiaries eligible for Part A and Part B coverage under traditional fee-for-service Medicare are still required to pay out-of-pocket deductibles and coinsurance. This program is referred to as Medicare FFS. As an alternative to Medicare FFS, in geographic areas where a managed care organization has contracted with CMS pursuant to the Medicare Advantage program, Medicare beneficiaries might choose to receive benefits from a Medicare Advantage organization under Medicare Part C. Pursuant to Medicare Part C, Medicare Advantage organizations contract with CMS to offer Medicare Advantage plans to provide benefits at least comparable to those offered under Medicare FFS. Prescription drug benefits are provided under Part D. Individual Medicare Advantage Products The company contracts with CMS under the Medicare Advantage program to provide a range of health insurance benefits, including wellness programs, chronic care management, and care coordination, to Medicare eligible persons under HMO, PPO, and private fee-for-service (PFFS) plans in exchange for contractual payments received from CMS, usually a fixed payment per member per month. With each of these products, the beneficiary receives benefit
humana inc (HUM:New York Consolidated)
500 West Main Street
Louisville, KY 40202
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