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Elevance Health Reports Third Quarter 2023 Results

ELV

  • Third quarter GAAP net income was $5.45 per share, including net negative adjustment items of $3.54 per share. Adjusted net income was $8.99* per share.
  • Operating gain, excluding adjustment items, grew 12.6% year-over-year to $2.5 billion.
  • Operating cash flow was $2.6 billion.

Elevance Health, Inc. (NYSE: ELV) reported third quarter 2023 results reflecting strong financial performance across the enterprise.

“Elevance Health delivered another quarter of solid performance reflecting the strength and balance of our diversified portfolio of businesses, our continued investments in innovation and growth, and our relentless focus on affordability, simplicity, and customer experience,” said Gail K. Boudreaux, President and CEO. “With affordability a paramount concern for all payors and a more uncertain forward-looking operating environment, we took action during the third quarter that will enhance our ability to act nimbly and operate efficiently. Along with the earnings power of our Health Benefits and Carelon businesses, we are well-positioned to meet our commitments to all of our stakeholders while continuing to advance our whole health strategy.”

As a result of outperformance year-to-date, the Company now expects GAAP net income to be greater than $26.40 per share in 2023, and adjusted net income to be greater than $33.00 per share.

*Refer to GAAP reconciliation tables.

CONSOLIDATED HIGHLIGHTS

Earnings Per Share: GAAP net income was $5.45 per share in the third quarter, including net negative adjustment items of $3.54 per share. Adjusted net income was $8.99* per share.

*Please refer to the GAAP reconciliation tables.

Membership: Medical membership totaled approximately 47.3 million as of September 30, 2023, an increase of 42 thousand, or 0.1 percent year-over-year, driven primarily by growth in BlueCard, Affordable Care Act health plans, and Medicare Advantage membership, partially offset by attrition in Medicaid due to the resumption of eligibility redeterminations and a new entrant into one of our state Medicaid programs in the third quarter, as well as declines in our Employer Group risk-based business.

During the third quarter of 2023, medical membership decreased by 664 thousand driven by attrition in Medicaid due to the aforementioned dynamics.

Operating Revenue: Operating revenue was $42.5 billion in the third quarter of 2023, an increase of $2.9 billion, or 7.2 percent year-over-year. The increase was primarily driven by higher premium revenue in our Health Benefits business and growth in pharmacy product revenue in CarelonRx due to 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 86.8 percent in the third quarter, an improvement of 40 basis points year-over-year. The improvement was driven by premium rate adjustments in recognition of medical cost trend.

Medical claims reserves established at December 31, 2022 developed within the range of the Company’s expectations as of the third quarter of 2023.

Days in Claims Payable:Days in Claims Payable was 48.6 days as of September 30, 2023, an increase of 2.1 days from June 30, 2023 and an increase of 0.9 days compared to September 30, 2022.

Operating Expense Ratio: The operating expense ratio was 12.9% in the third quarter of 2023, an increase of 150 basis points from 11.4% in the third quarter of 2022. The increase was due to a business optimization charge recognized in the quarter.

In the third quarter, we completed a strategic review of our operations, assets, and investments to enhance operating efficiency, refine the focus of our investments in innovation and optimize our physical footprint. This resulted in a net charge of $697 million, comprised of the write-off of certain information technology assets and contract exit costs, a reduction in staff including the relocation of certain job functions, and the impairment of assets associated with the closure or partial closure of data centers and offices.

Operating Cash Flow: Operating cash flow was approximately $2.6 billion, or 2.0 times net income in the third quarter of 2023, a decrease of $2.3 billion as compared to the prior year quarter. The year-on-year decrease was driven by the receipt of an additional month of CMS payments in the third quarter of 2022.

Share Repurchase Program: During the third quarter of 2023, the Company repurchased 1.1 million shares of its common stock for $480 million, at a weighted average price of $451.68. Year-to-date, as of the end of the third quarter, the Company repurchased 3.8 million shares of its common stock for $1.7 billion, at a weighted average price of $462.42. As of September 30, 2023, the Company had approximately $5.1 billion of Board-approved share repurchase authorization remaining.

Cash Dividend:During the third quarter of 2023, the Company paid a quarterly dividend of $1.48 per share, representing a distribution of cash totaling $348 million.

On October 17, 2023, the Audit Committee of the Company's Board of Directors declared a fourth quarter 2023 dividend to shareholders of $1.48 per share. The fourth quarter dividend is payable on December 21, 2023, to shareholders of record at the close of business on December 6, 2023.

Investment Portfolio & Capital Position:During the third quarter of 2023, the Company recorded net losses of $124 million. During the third quarter of 2022, the Company recorded net losses of $57 million. These amounts are excluded from adjusted earnings per share.

As of September 30, 2023, the Company’s net unrealized loss position in the investment portfolio was $2.4 billion, consisting primarily of fixed maturity securities. As of September 30, 2023, cash and investments at the parent company totaled approximately $1.7 billion.

REPORTABLE SEGMENTS

Elevance Health has four reportable segments: Health Benefits (comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard, Medicaid, Medicare, and Federal Health Products & Services businesses); CarelonRx; Carelon Services; 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 September 30

Nine Months Ended September 30

2023

2022

Change

2023

2022

Change

(Restated)

(Restated)

Operating Revenue

Health Benefits

$

36,744

$

35,065

4.8

%

$

112,024

$

103,488

8.2

%

Carelon1

11,892

10,403

14.3

%

35,135

30,088

16.8

%

Corporate & Other

242

211

14.7

%

780

799

(2.4

)%

Eliminations

(6,398

)

(6,054

)

5.7

%

(20,184

)

(18,382

)

9.8

%

Total Operating Revenue2

$

42,480

$

39,625

7.2

%

$

127,755

$

115,993

10.1

%

Operating Gain (Loss)

Health Benefits

$

1,847

$

1,634

13.0

%

$

6,154

$

5,266

16.9

%

Carelon1

650

641

1.4

%

2,003

1,831

9.4

%

Corporate & Other2

(741

)

(24

)

NM4

(942

)

(73

)

NM4

Total Operating Gain3

$

1,756

$

2,251

(22.0

)%

$

7,215

$

7,024

2.7

%

Operating Margin

Health Benefits

5.0

%

4.7

%

30 bp

5.5

%

5.1

%

40 bp

Carelon1

5.5

%

6.2

%

(70) bp

5.7

%

6.1

%

(40) bp

Total Operating Margin2

4.1

%

5.7

%

(160) bp

5.6

%

6.1

%

(50) bp

1.

Operating Revenue and Operating Gain for Carelon for the three months ended September 30, 2023 included $8,518 and $477 for CarelonRx; $3,374 and $173 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the three months ended September 30, 2022 included $7,249 and $516 for CarelonRx; $3,154 and $125 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the nine months ended September 30, 2023 included $25,008 and $1,485 for CarelonRx; $10,127 and $518 for Carelon Services, respectively. Operating Revenue and Operating Gain for Carelon for the nine months ended September 30, 2022 included $21,003 and $1,393 for CarelonRx; $9,085 and $438 for Carelon Services, respectively.

2.

Operating gain for Corporate & Other for the three and nine months ended September 30, 2023 included a business optimization charge of $697.

3.

See “Basis of Presentation.”

4.

"NM" = calculation not meaningful.

Health Benefits: Operating gain in the Health Benefits segment totaled $1.8 billion in the third quarter of 2023, an increase of $213 million from $1.6 billion in the third quarter of 2022, representing growth of 13.0%. The increase was primarily driven by premium rate adjustments to cover medical cost trend on higher levels of post-pandemic care.

Carelon: Operating gain in the Carelon segment was $650 million in the third quarter of 2023, an increase of $9 million from $641 million in the third quarter of 2022. The increase was primarily driven by the continued expansion of our post-acute care services business, the acquisition of BioPlus in the first quarter of 2023, and improved performance in our Behavioral Health business, partially offset by the non-recurrence of out of period fee-based revenue recognized in the third quarter of 2022 in CarelonRx.

Corporate & Other: The Company reported an operating loss of $741 million in the Corporate & Other segment for the third quarter of 2023, a decrease of $717 million from an operating loss of $24 million in the third quarter of 2022, driven by business optimization charges.

Basis of Presentation

  1. 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.
  2. 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 third 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)

866-405-7293 (Domestic Replay)

312-470-0178 (International)

203-369-0605 (International Replay)

The access code for today's conference call is3972058. 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 November 17, 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 117 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)

September 30,
2023

September 30,
2022

June 30,
2023

September 30,
2022

June 30,
2023

Individual

999

800

949

24.9

%

5.3

%

Employer Group Risk-Based

3,754

3,988

3,765

(5.9

)%

(0.3

)%

Commercial Risk-Based

4,753

4,788

4,714

(0.7

)%

0.8

%

BlueCard®

6,756

6,453

6,737

4.7

%

0.3

%

Employer Group Fee-Based

20,166

20,184

20,160

(0.1

)%

%

Commercial Fee-Based

26,922

26,637

26,897

1.1

%

0.1

%

Medicare Advantage

2,064

1,969

2,059

4.8

%

0.2

%

Medicare Supplement

928

945

926

(1.8

)%

0.2

%

Total Medicare

2,992

2,914

2,985

2.7

%

0.2

%

Medicaid

11,018

11,319

11,759

(2.7

)%

(6.3

)%

Federal Employees Health Benefits

1,640

1,625

1,634

0.9

%

0.4

%

Total Medical Membership

47,325

47,283

47,989

0.1

%

(1.4

)%

Other Membership (in thousands)

Life and Disability Members

4,611

4,796

4,686

(3.9

)%

(1.6

)%

Dental Members

6,775

6,655

6,728

1.8

%

0.7

%

Dental Administration Members

1,708

1,577

1,694

8.3

%

0.8

%

Vision Members

9,861

9,628

9,850

2.4

%

0.1

%

Medicare Part D Standalone Members

261

274

263

(4.7

)%

(0.8

)%

Other Metrics (in millions)

CarelonRx Quarterly Adjusted Scripts

77.3

76.9

77.4

0.5

%

(0.1

)%

Carelon Services Consumers Served

104.8

105.3

103.6

(0.5

)%

1.2

%

Elevance Health, Inc.

Consolidated Statements of Income

(Unaudited)

(In millions, except per share data)

Three Months Ended

September 30

2023

2022

Change

(Restated)

Revenues

Premiums

$

35,259

$

33,722

4.6

%

Product revenue

5,177

3,972

30.3

%

Service fees

2,044

1,931

5.9

%

Total operating revenue

42,480

39,625

7.2

%

Net investment income

493

371

32.9

%

Net losses on financial instruments

(124

)

(57

)

NM

Total revenues

42,849

39,939

7.3

%

Expenses

Benefit expense

30,606

29,421

4.0

%

Cost of products sold

4,648

3,437

35.2

%

Operating expense

5,470

4,516

21.1

%

Interest expense

259

213

21.6

%

Amortization of other intangible assets

212

225

(5.8

)%

Total expenses

41,195

37,812

8.9

%

Income before income tax expense

1,654

2,127

(22.2

)%

Income tax expense

354

529

(33.1

)%

Net income

1,300

1,598

(18.6

)%

Net (income) loss attributable to noncontrolling interests

(11

)

5

NM

Shareholders' net income

$

1,289

$

1,603

(19.6

)%

Shareholders' net income per diluted share

$

5.45

$

6.62

(17.7

)%

Diluted shares

236.5

242.2

(2.4

)%

Benefit expense as a percentage of premiums

86.8

%

87.2

%

(40) bp

Operating expense as a percentage of total operating revenue

12.9

%

11.4

%

150 bp

Income before income tax expense as a percentage of total revenue

3.9

%

5.3

%

(140) bp

"NM" = calculation not meaningful

Elevance Health, Inc.

Consolidated Statements of Income

(Unaudited)

(In millions, except per share data)

Nine Months Ended

September 30

2023

2022

Change

(Restated)

Revenues

Premiums

$

107,716

$

99,583

8.2

%

Product revenue

14,058

10,841

29.7

%

Service fees

5,981

5,569

7.4

%

Total operating revenue

127,755

115,993

10.1

%

Net investment income

1,296

1,112

16.5

%

Net losses on financial instruments

(358

)

(439

)

NM

Total revenues

128,693

116,666

10.3

%

Expenses

Benefit expense

92,996

86,447

7.6

%

Cost of products sold

12,456

9,389

32.7

%

Operating expense

15,088

13,133

14.9

%

Interest expense

771

622

24.0

%

Amortization of other intangible assets

668

520

28.5

%

Total expenses

121,979

110,111

10.8

%

Income before income tax expense

6,714

6,555

2.4

%

Income tax expense

1,554

1,544

0.6

%

Net income

5,160

5,011

3.0

%

Net (income) loss attributable to noncontrolling interests

(29

)

18

NM

Shareholders' net income

$

5,131

$

5,029

2.0

%

Shareholders' net income per diluted share

$

21.56

$

20.67

4.3

%

Diluted shares

238.0

243.3

(2.2

)%

Benefit expense as a percentage of premiums

86.3

%

86.8

%

(50) bp

Operating expense as a percentage of total operating revenue

11.8

%

11.3

%

50 bp

Income before income tax expense as a percentage of total revenue

5.2

%

5.6

%

(40) bp

"NM" = calculation not meaningful

Elevance Health, Inc.

Consolidated Balance Sheets

(In millions)

September 30,
2023

December 31,
2022

Assets

(Unaudited)

(Restated)

Current assets:

Cash and cash equivalents

$

10,919

$

7,387

Fixed maturity securities

27,811

25,952

Equity securities

165

953

Premium receivables

7,883

7,083

Self-funded receivables

3,756

4,663

Other receivables

5,293

4,298

Other current assets

5,358

5,281

Total current assets

61,185

55,617

Long-term investments:

Fixed maturity securities

816

752

Other invested assets

6,118

5,685

Property and equipment, net

4,248

4,316

Goodwill

25,291

24,383

Other intangible assets

10,491

10,315

Other noncurrent assets

2,329

1,687

Total assets

$

110,478

$

102,755

Liabilities and equity

Liabilities

Current liabilities:

Medical claims payable

$

16,176

$

15,596

Other policyholder liabilities

5,681

5,933

Unearned income

4,332

1,112

Accounts payable and accrued expenses

5,983

5,607

Short-term borrowings

265

Current portion of long-term debt

799

1,500

Other current liabilities

10,366

9,683

Total current liabilities

43,337

39,696

Long-term debt, less current portion

24,045

22,349

Reserves for future policy benefits

807

803

Deferred tax liabilities, net

1,779

2,015

Other noncurrent liabilities

1,971

1,562

Total liabilities

71,939

66,425

Shareholders’ equity

Common stock

2

2

Additional paid-in capital

8,830

9,084

Retained earnings

32,103

29,647

Accumulated other comprehensive loss

(2,512

)

(2,490

)

Total shareholders’ equity

38,423

36,243

Noncontrolling interests

116

87

Total equity

38,539

36,330

Total liabilities and equity

$

110,478

$

102,755

Elevance Health, Inc.

Consolidated Statements of Cash Flows

(Unaudited)

(In millions)

Nine Months Ended September 30

2023

2022

(Restated)

Operating activities

Net income

$

5,160

$

5,011

Adjustments to reconcile net income to net cash provided by operating activities:

Net losses on financial instruments

358

439

Equity in net earnings of other invested assets

70

(304

)

Depreciation and amortization

1,321

1,202

Deferred income taxes

(361

)

(183

)

Impairment of property and equipment

446

Share-based compensation

217

191

Changes in operating assets and liabilities:

Receivables, net

(727

)

(678

)

Other invested assets

(46

)

46

Other assets

(936

)

(465

)

Policy liabilities

333

1,588

Unearned income

3,220

2,548

Accounts payable and other liabilities

1,717

598

Income taxes

257

(41

)

Other, net

3

(35

)

Net cash provided by operating activities

11,032

9,917

Investing activities

Purchases of investments

(24,337

)

(19,612

)

Proceeds from sale of investments

7,830

9,402

Maturities, calls and redemptions from investments

14,531

7,606

Changes in securities lending collateral

55

(677

)

Purchases of subsidiaries, net of cash acquired

(1,570

)

(623

)

Purchases of property and equipment

(970

)

(854

)

Other, net

(82

)

(91

)

Net cash used in investing activities

(4,543

)

(4,849

)

Financing activities

Net proceeds from commercial paper borrowings

375

Net proceeds from (repayments of) short-term borrowings

(265

)

(10

)

Net proceeds from (repayments of) long-term borrowings

666

304

Changes in securities lending payable

(54

)

685

Changes in bank overdrafts

(523

)

181

Repurchase and retirement of common stock

(1,748

)

(1,748

)

Cash dividends

(1,049

)

(924

)

Proceeds from issuance of common stock under employee stock plans

112

152

Taxes paid through withholding of common stock under employee stock plans

(99

)

(91

)

Other, net

5

16

Net cash used in financing activities

(2,955

)

(1,060

)

Effect of foreign exchange rates on cash and cash equivalents

(2

)

(16

)

Change in cash and cash equivalents

3,532

3,992

Cash and cash equivalents at beginning of period

7,387

4,880

Cash and cash equivalents at end of period

$

10,919

$

8,872

Elevance Health, Inc.

Reconciliation of Medical Claims Payable

Nine Months Ended September 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

91,058

84,177

113,414

100,440

85,094

Prior years redundancies1

(1,342

)

(901

)

(869

)

(1,703

)

(637

)

Total net incurred medical claims

89,716

83,276

112,545

98,737

84,457

Net payments attributable to:

Current year medical claims

77,048

70,453

98,997

88,156

74,629

Prior years medical claims

12,097

11,219

11,600

8,829

7,692

Total net payments

89,145

81,672

110,597

96,985

82,321

Net medical claims payable, end of period

15,913

14,998

15,342

13,261

11,089

Ceded medical claims payable, end of period

4

3

6

21

46

Gross medical claims payable, end of period

$

15,917

$

15,001

$

15,348

$

13,282

$

11,135

Current year medical claims paid as a percentage of current year net incurred medical claims

84.6

%

83.7

%

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

9.6

%

7.3

%

7.0

%

18.1

%

8.0

%

Prior year redundancies in the current year as a percentage of prior year net incurred medical claims

1.2

%

0.9

%

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. Net adjustment items per share may not sum due to rounding.

Three Months Ended
September 30

Nine Months Ended
September 30

(In millions, except per share data)

2023

2022

Change

2023

2022

Change

Shareholders' net income - As reported

$

1,289

$

1,618

(20.3

)%

$

5,131

$

5,076

1.1

%

Impact of Accounting Standards Update 2018-12 Adoption

(15

)

(47

)

Shareholders' net income - Restated

$

1,289

$

1,603

(19.6

)%

$

5,131

$

5,029

2.0

%

Add / (Subtract):

Net losses on financial instruments

124

57

358

439

Amortization of other intangible assets

212

225

668

520

Business optimization charges

697

697

BCBSA litigation settlement

(24

)

(24

)

Transaction and integration related costs

73

13

154

36

Litigation expenses

2

6

5

11

Tax impact of non-GAAP adjustments

(270

)

(72

)

(470

)

(261

)

Net adjustment items

838

205

1,412

721

Adjusted shareholders' net income

$

2,127

$

1,808

17.6

%

$

6,543

$

5,750

13.8

%

Shareholders' net income per diluted share - As reported

$

5.45

$

6.68

(18.4

)%

$

21.56

$

20.86

3.4

%

Impact of Accounting Standards Update 2018-12 Adoption

(0.06

)

(0.19

)

Shareholders' net income per diluted share - Restated

5.45

6.62

(17.7

)%

21.56

20.67

4.3

%

Add / (Subtract):

Net losses on financial instruments

0.52

0.24

1.50

1.80

Amortization of other intangible assets

0.90

0.93

2.81

2.14

Business optimization charges

2.95

2.93

BCBSA litigation settlement

(0.10

)

(0.10

)

Transaction and integration related costs

0.31

0.05

0.65

0.15

Litigation expenses

0.01

0.02

0.02

0.05

Tax impact of non-GAAP adjustments

(1.14

)

(0.30

)

(1.97

)

(1.07

)

Net adjustment items

3.54

0.84

5.93

2.96

Adjusted shareholders' net income per diluted share

$

8.99

$

7.46

20.5

%

$

27.49

$

23.63

16.3

%

Full Year 2023 Outlook

Shareholders' net income per diluted share

Greater than $26.40

Add / (Subtract):

Net losses on financial instruments

$

1.50

Business optimization charges

$

2.93

Transaction and integration related costs

$

0.65

Litigation expenses

$

0.02

Amortization of other intangible assets

$

3.69

Tax impact of non-GAAP adjustments

Approximately $(2.19)

Net adjustment items

$

6.60

Adjusted shareholders' net income per diluted share

Greater Than $33.00

Three Months Ended
September 30

Nine Months Ended
September 30

(In millions)

2023

2022

Change

2023

2022

Change

(Restated)

(Restated)

Income before income tax expense

$

1,654

$

2,127

(22.2

)%

$

6,714

$

6,555

2.4

%

Net investment income

(493

)

(371

)

(1,296

)

(1,112

)

Net losses on financial instruments

124

57

358

439

Interest expense

259

213

771

622

Amortization of other intangible assets

212

225

668

520

Reportable segments operating gain

$

1,756

$

2,251

(22.0

)%

$

7,215

$

7,024

2.7

%

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.