SAN JUAN, Puerto Rico,
Feb. 25, 2021 /PRNewswire/
-- Triple-S Management Corporation (NYSE:GTS), a leading
healthcare company in Puerto Rico,
today announced its fourth quarter 2020 results.
Roberto Garcia-Rodriguez,
President and Chief Executive Officer, commented: "During the
fourth quarter, our enhanced Medicare Advantage and Medicaid
offerings, along with our superior service and premier brand,
enabled us to further increase our membership numbers and
premiums. Our solid performance was due, in great part, to
our team's outstanding efforts to provide critical support to our
members, providers and communities throughout an extremely
challenging year."
"In 2021 we will continue investing in informatics and clinical
management capabilities that improve service and health outcomes
for our members. As we implement our integrated
healthcare-delivery agenda over the next four years, we will be
firmly positioned to generate sustainable and profitable growth as
the preferred healthcare services company in Puerto Rico."
Fourth Quarter 2020 Consolidated Results and Other
Highlights
- Net income of $26.2 million, or
$1.13 per diluted share, versus net
income of $13.2 million, or
$0.55 per diluted share, in the
prior-year period;
- Adjusted net income of $4.2
million, or $0.18 per diluted
share, versus adjusted net income of $6.0
million, or $0.25 per diluted
share, in the prior-year period;
- Operating revenues of $969.8
million, a 16.7% increase from the prior-year period,
primarily reflecting higher Managed Care net premiums earned;
- Consolidated loss ratio of 86.2%, a 520 basis point increase
from the fourth quarter of 2019, reflecting higher Managed Care
utilization;
- Medical loss ratio (MLR) of 89.4%, 570 basis points higher than
the same period last year;
- Consolidated operating loss of $3.9
million, compared with operating income of $8.7 million in the prior-year period.
Selected Segment Quarterly Details
Managed Care
- Managed Care premiums earned were $873.1
million, up 17.7% year-over-year.
-
- Medicare premiums earned of $392.5
million increased 14.7% from the prior-year period. The
increase was largely due to an addition of approximately 27,000
member months, which primarily reflects a more competitive product
offering and higher premium rates resulting from an increase in the
premium rate benchmark and membership risk score.
- Medicaid premiums earned of $270.3
million increased 34.8% from the prior-year period,
primarily reflecting higher member months of approximately 168,000;
higher average premium rates following two premium rate increases
in 2020; and the reinstatement of the HIP Fee pass-through in
2020.
- Commercial premiums earned of $210.3
million increased 5.8% from the prior-year period, mainly
reflecting higher average premium rates, the reinstatement of the
HIP Fee pass-through in 2020 and a reduction in the estimated MLR
rebate accrual (which was originally recorded as a reduction of
premiums) as utilization of services trended to almost-normalized
levels. These increases were partially offset by a reduction of
approximately 10,000 fully insured member months.
- Reported MLR of 89.4% increased 570 basis points from the
prior-year period, primarily reflecting unfavorable prior period
reserve development, higher non-COVID-19 utilization of services,
higher costs associated with the treatment of COVID-19 and
increased benefits in the Medicare product offering in 2020.
- Managed care operating expenses of $119.9 million decreased by $5.7 million, or 4.5%, from the prior-year
period, primarily reflecting lower provision for bad debts and
professional services, offset in part by the reinstatement of the
HIP fee in 2020. The segment operating expense ratio was 13.7%, a
320 basis-point improvement from the prior-year quarter.
Life Insurance Segment
- Premiums earned, net of $51.1
million increased 8.5% from the prior-year period, resulting
from new sales and the acquisition of a life insurance portfolio in
the second quarter of 2020.
- Operating income was $7.6
million, a 72.7% increase compared to $4.4 million in the prior-year period, primarily
reflecting higher premiums in the 2020 quarter.
Property and Casualty Segment
- Premiums earned, net of $25.1
million increased 10.1% from the prior-year period.
- Operating income was $8.9
million, compared with an operating loss of $0.5 million during the prior-year period,
primarily driven by lower losses and operating expenses in the 2020
quarter.
- Reserves related to Hurricane Maria were $183 million as of December 31, 2020. As of December 31, 2020, 355 of the total 17,783
Maria-related claims remained outstanding.
2021 Outlook
The Company is initiating the following full year 2021
guidance:
- Consolidated operating revenue is expected to be between
$3.98 billion and $4.02 billion, which includes Managed Care
premiums earned, net between $3.58
billion and $3.62
billion;
- Consolidated claims incurred ratio is expected to be between
83.0% and 84.0%, while Managed Care MLR is expected to be between
86.0% and 87.0%;
- Consolidated operating expense ratio is expected to be between
15.5% and 16.5%;
- The effective tax rate is expected to be between 29.0% and
31.0%; and
- Adjusted net income per diluted share is expected to be between
$2.95 and $3.15. Adjusted net income per diluted share does
not account for any potential share repurchase activity during
2021. The Company is assuming a weighted average diluted share
count for full year 2021 of 23.6 million shares.
Conference Call and Webcast
Management will host a conference call and webcast today at
8:30 a.m. Eastern Time to discuss its
financial results for the three months ended December 31, 2020. To participate, callers within
the U.S. and Canada should
dial 1-877-300-8521 and international callers should dial
1-412-317-6026 at least ten minutes before the call.
To listen to the webcast, participants should visit the
"Investor Relations" section of the Company's website at
www.triplesmanagement.com several minutes before the event is
broadcast and follow the instructions provided to ensure they have
the necessary audio application downloaded and installed. This
program is provided at no charge to the user. An archived version
of the call, also located on the "Investor Relations" section of
Triple-S Management's website, will be available about two hours
after the call ends for one year. This news release, along with
other information relating to the call, will be available on the
"Investor Relations" section of the website.
About Triple-S Management Corporation
Triple-S Management Corporation is a healthcare services company
and one of the top players in the Puerto Rico healthcare industry, with over 60
years of experience as the premier brand serving more people
through the most attractive provider networks on the island.
We have the exclusive right to use the Blue Cross Blue Shield name
and mark throughout Puerto Rico,
the U.S. Virgin Islands,
Costa Rica, the British Virgin Islands and Anguilla, and we offer a broad portfolio of
managed care and related products in the Commercial, Medicare
Advantage and Medicaid markets. Triple-S is also a well-known brand
in the life insurance and property and casualty insurance markets
in Puerto Rico, with strong
customer relationships and a significant market share. For more
information about Triple-S Management, visit
www.triplesmanagement.com or contact
investorrelations@ssspr.com.
Non-GAAP Financial Measures
This earnings release presents information about the Company's
adjusted net income, which is a non-GAAP financial metric provided
as a complement to the results provided in accordance with
accounting principles generally accepted in the United States of America (GAAP). A
reconciliation of adjusted net income to net income, the most
comparable GAAP financial measure, is provided in the accompanying
tables found at the end of this release.
Forward-Looking Statements
This document contains forward-looking statements, as defined in
the Private Securities Litigation Reform Act of 1995.
Forward-looking statements include information about possible or
assumed future sales, results of operations, developments,
regulatory approvals or other circumstances. Sentences that include
"believe", "expect", "plan", "intend", "estimate", "anticipate",
"project", "may", "will", "shall", "should" and similar
expressions, whether in the positive or negative, are intended to
identify forward-looking statements.
All forward-looking statements in this news release reflect
management's current views about future events and are based on
assumptions and subject to risks and uncertainties. Consequently,
actual results may differ materially from those expressed here as a
result of various factors, including all the risks discussed and
identified in public filings with the U.S. Securities and Exchange
Commission (SEC).
In addition, the Company operates in a highly competitive,
constantly changing environment, influenced by very large
organizations that have resulted from business combinations,
aggressive marketing and pricing practices of competitors, and
regulatory oversight. The following factors, if markedly different
from the Company's planning assumptions (either individually or in
combination), could cause Triple-S Management's results to differ
materially from those expressed in any forward-looking statements
shared here:
- Trends in health care costs and utilization rates
- Ability to secure sufficient premium rate increases
- Competitor pricing below market trends of increasing costs
- Re-estimates of policy and contract liabilities and
reserves
- Changes in government laws and regulations of managed care,
life insurance or property and casualty insurance
- Significant acquisitions or divestitures by major
competitors
- Introduction and use of new prescription drugs and
technologies
- A downgrade in the Company's financial strength ratings
- Litigation or legislation targeted at managed care, life
insurance or property and casualty insurance companies
- Ability to contract with providers and government agencies
consistent with past practice
- Ability to successfully implement the Company's disease
management, utilization management and Star ratings programs
- Ability to maintain Federal Employees, Medicare and Medicaid
contracts
- Volatility in the securities markets and investment losses and
defaults
- General economic downturns, major disasters and epidemics
This list is not exhaustive. Management believes the
forward-looking statements in this release are reasonable. However,
there is no assurance that the actions, events or results
anticipated by the forward-looking statements will occur or, if any
of them do, what impact they will have on the Company's results of
operations or financial condition. In view of these uncertainties,
investors should not place undue reliance on any forward-looking
statements, which are based on current expectations. In addition,
forward-looking statements are based on information available the
day they are made, and (other than as required by applicable law,
including the securities laws of the
United States) the Company does not intend to update or
revise any of them in light of new information or future
events.
Readers are advised to carefully review and consider the various
disclosures in the Company's SEC reports.
Earnings Release
Schedules and Supplemental Information
|
Condensed
Consolidated Balance
Sheets.................................................................................
Exhibit I
|
Condensed
Consolidated Statements of
Earnings.....................................................................
Exhibit II
|
Condensed
Consolidated Statements of Cash
Flows.................................................................
Exhibit III
|
Segment Performance
Supplemental
Information....................................................................
Exhibit IV
|
Reconciliation of
Non-GAAP Financial
Measures.......................................................................
Exhibit V
|
Exhibit
I
|
|
Condensed
Consolidated Balance Sheets
|
(dollar amounts in
thousands)
|
Unaudited
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31,
2020
|
|
December 31,
2019
|
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Investments
|
$
|
1,874,024
|
|
$
|
1,643,637
|
Cash and cash
equivalents
|
|
110,989
|
|
|
109,837
|
Premium and other
receivables, net
|
|
488,840
|
|
|
567,692
|
Deferred policy
acquisition costs and value of business acquired
|
|
248,325
|
|
|
234,885
|
Property and
equipment, net
|
|
131,974
|
|
|
88,588
|
Other
assets
|
|
234,266
|
|
|
174,187
|
|
|
|
|
|
|
|
|
|
|
|
Total
assets
|
$
|
3,088,418
|
|
$
|
2,818,826
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and
Stockholders' Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Policy liabilities
and accruals
|
$
|
1,550,798
|
|
$
|
1,425,477
|
Accounts payable and
accrued liabilities
|
|
487,356
|
|
|
370,483
|
Short-term
borrowings
|
|
30,000
|
|
|
54,000
|
Long-term
borrowings
|
|
52,751
|
|
|
25,694
|
|
|
|
|
|
|
|
|
|
|
|
Total
liabilities
|
|
2,120,905
|
|
|
1,875,654
|
|
|
|
|
|
|
|
|
|
Stockholders'
equity:
|
|
|
|
|
|
|
Common
stock
|
|
23,430
|
|
|
23,800
|
|
Other stockholders'
equity
|
|
944,800
|
|
|
920,065
|
|
|
|
|
|
|
|
|
|
|
|
Total Triple-S
Management Corporation stockholders' equity
|
|
968,230
|
|
|
943,865
|
|
|
|
|
|
|
|
|
|
|
|
Non-controlling
interest in consolidated subsidiary
|
|
(717)
|
|
|
(693)
|
|
|
|
|
|
|
|
|
|
|
|
Total stockholders'
equity
|
|
967,513
|
|
|
943,172
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and
stockholders' equity
|
$
|
3,088,418
|
|
$
|
2,818,826
|
Exhibit
II
|
|
Condensed
Consolidated Statements of Earnings
|
(dollar amounts in
thousands, except per share data)
|
Unaudited
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the Three
Months Ended
|
|
For the Twelve
Months Ended
|
|
|
|
|
|
|
|
|
December
31,
|
|
December
31,
|
|
|
|
|
|
|
|
|
2020
|
|
2019
|
|
2020
|
|
2019
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premiums earned,
net
|
|
$
|
948,084
|
|
$
|
810,364
|
|
$
|
3,605,450
|
|
$
|
3,252,880
|
|
Administrative
service fees
|
|
|
3,830
|
|
|
2,251
|
|
|
12,585
|
|
|
9,946
|
|
Net investment
income
|
|
|
15,253
|
|
|
16,393
|
|
|
57,547
|
|
|
62,007
|
|
Other operating
revenues
|
|
|
2,597
|
|
|
2,218
|
|
|
8,991
|
|
|
8,553
|
|
|
Total operating
revenues
|
|
|
969,764
|
|
|
831,226
|
|
|
3,684,573
|
|
|
3,333,386
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net realized
investment gains on sale of securities
|
|
|
821
|
|
|
1,077
|
|
|
641
|
|
|
5,843
|
|
Net unrealized
investment gains on equity investments
|
|
|
25,067
|
|
|
7,892
|
|
|
7,639
|
|
|
32,151
|
|
Other income,
net
|
|
|
3,368
|
|
|
847
|
|
|
9,585
|
|
|
4,206
|
|
|
Total
revenues
|
|
|
999,020
|
|
|
841,042
|
|
|
3,702,438
|
|
|
3,375,586
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Benefits and
expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Claims
incurred
|
|
|
|
817,419
|
|
|
656,752
|
|
|
2,946,820
|
|
|
2,666,256
|
|
Operating
expenses
|
|
|
156,230
|
|
|
165,777
|
|
|
655,899
|
|
|
569,406
|
|
|
Total operating
costs
|
|
|
973,649
|
|
|
822,529
|
|
|
3,602,719
|
|
|
3,235,662
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest
expense
|
|
|
2,173
|
|
|
1,991
|
|
|
7,986
|
|
|
7,672
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total benefits and
expenses
|
|
|
975,822
|
|
|
824,520
|
|
|
3,610,705
|
|
|
3,243,334
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before
taxes
|
|
|
23,198
|
|
|
16,522
|
|
|
91,733
|
|
|
132,252
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense
(benefit)
|
|
|
(2,952)
|
|
|
3,300
|
|
|
24,568
|
|
|
39,375
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
26,150
|
|
|
13,222
|
|
|
67,165
|
|
|
92,877
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss attributable
to the non-controlling interest
|
|
|
(4)
|
|
|
(7)
|
|
|
(24)
|
|
|
(17)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
attributable to Triple-S Management Corporation
|
|
$
|
26,154
|
|
$
|
13,229
|
|
$
|
67,189
|
|
$
|
92,894
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share
attributable to Triple-S Management Corporation:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per
share
|
|
$
|
1.13
|
|
$
|
0.55
|
|
$
|
2.90
|
|
$
|
3.98
|
|
Diluted net income
per share
|
|
$
|
1.13
|
|
$
|
0.55
|
|
$
|
2.88
|
|
$
|
3.97
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average of
common shares
|
|
|
23,067,274
|
|
|
23,839,165
|
|
|
23,179,544
|
|
|
23,318,742
|
|
Diluted weighted
average of common shares
|
|
|
23,237,694
|
|
|
23,901,874
|
|
|
23,309,742
|
|
|
23,385,293
|
Exhibit
III
|
|
Condensed
Consolidated Statements of Cash Flows
|
(dollar amounts in
thousands)
|
Unaudited
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the Twelve
Months Ended
|
|
|
|
|
|
|
December
31,
|
|
|
|
|
|
|
2020
|
|
2019
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by
(used in) operating activities
|
$
|
257,845
|
|
$
|
(16,826)
|
|
|
|
|
|
|
|
|
|
Cash flows from
investing activities:
|
|
|
|
|
|
|
Proceeds from
investments sold or matured:
|
|
|
|
|
|
|
|
Securities available
for sale:
|
|
|
|
|
|
|
|
Fixed
maturities sold
|
|
149,265
|
|
|
424,239
|
|
|
Fixed
maturities matured/called
|
|
84,416
|
|
|
21,258
|
|
|
Securities held to
maturity - fixed maturities matured/called
|
|
1,079
|
|
|
1,708
|
|
|
Equity investments
sold
|
|
134,926
|
|
|
169,153
|
|
|
Other invested assets
sold
|
|
17,013
|
|
|
4,554
|
|
Acquisition of
investments:
|
|
|
|
|
|
|
|
Securities available
for sale - fixed maturities
|
|
(287,998)
|
|
|
(449,043)
|
|
|
Securities held to
maturity - fixed maturities
|
|
(1,088)
|
|
|
(1,078)
|
|
|
Equity
investments
|
|
(248,123)
|
|
|
(143,972)
|
|
|
Other invested
assets
|
|
(30,178)
|
|
|
(28,501)
|
|
Increase in other
investments
|
|
(5,683)
|
|
|
(2,981)
|
|
Net change in policy
loans
|
|
402
|
|
|
(1,392)
|
|
Net capital
expenditures
|
|
(57,873)
|
|
|
(20,820)
|
|
Capital contribution
to equity method investees
|
|
(8,184)
|
|
|
(11,418)
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in
investing activities
|
|
(252,026)
|
|
|
(38,293)
|
|
|
|
|
|
|
|
|
|
Cash flows from
financing activities:
|
|
|
|
|
|
|
Change in outstanding
checks in excess of bank balances
|
|
(3,249)
|
|
|
(2,384)
|
|
Net change in
short-term borrowings
|
|
(24,000)
|
|
|
54,000
|
|
Proceeds of long-term
borrowings
|
|
30,841
|
|
|
-
|
|
Repayments of
long-term borrowings
|
|
(3,883)
|
|
|
(3,236)
|
|
Repurchase and
retirement of common stock
|
|
(14,982)
|
|
|
(9,989)
|
|
Dividends
paid
|
|
-
|
|
|
(11)
|
|
Proceeds from
policyholder deposits
|
|
25,740
|
|
|
28,879
|
|
Surrender of
policyholder deposits
|
|
(15,134)
|
|
|
(19,847)
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in)
provided by financing activities
|
|
(4,667)
|
|
|
47,412
|
|
|
|
|
|
|
|
|
|
|
|
Net increase
(decrease) in cash and cash equivalents
|
|
1,152
|
|
|
(7,707)
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash
equivalents, beginning of period
|
|
109,837
|
|
|
117,544
|
|
|
|
|
|
|
|
|
|
Cash and cash
equivalents, end of period
|
$
|
110,989
|
|
$
|
109,837
|
Exhibit
IV
|
|
Segment
Performance Supplemental Information
|
|
(Unaudited)
|
Three months ended
December 31,
|
|
Twelve months
ended December 31,
|
(dollar amounts in
millions)
|
2020
|
2019
|
Percentage
Change
|
|
2020
|
2019
|
Percentage
Change
|
Premiums earned,
net:
|
|
|
|
|
|
|
|
|
Managed
Care:
|
|
|
|
|
|
|
|
|
|
Commercial
|
$ 210.3
|
$ 198.8
|
5.8%
|
|
$
815.6
|
$
801.2
|
1.8%
|
|
|
Medicare
|
392.5
|
342.3
|
14.7%
|
|
1,553.5
|
1,408.0
|
10.3%
|
|
|
Medicaid
|
270.3
|
200.5
|
34.8%
|
|
953.2
|
778.3
|
22.5%
|
|
|
|
Total Managed
Care
|
873.1
|
741.6
|
17.7%
|
|
3,322.3
|
2,987.5
|
11.2%
|
|
Life
Insurance
|
51.1
|
47.1
|
8.5%
|
|
196.0
|
182.2
|
7.6%
|
|
Property and
Casualty
|
25.1
|
22.8
|
10.1%
|
|
92.0
|
87.7
|
4.9%
|
|
Other
|
|
|
(1.2)
|
(1.1)
|
(9.1%)
|
|
(4.8)
|
(4.5)
|
(6.7%)
|
|
|
|
|
Consolidated premiums
earned, net
|
$ 948.1
|
$ 810.4
|
17.0%
|
|
$ 3,605.5
|
$ 3,252.9
|
10.8%
|
Operating revenues:
1
|
|
|
|
|
|
|
|
|
Managed
Care
|
$ 882.3
|
$ 751.5
|
17.4%
|
|
$ 3,356.1
|
$ 3,025.3
|
10.9%
|
|
Life
Insurance
|
57.8
|
54.4
|
6.3%
|
|
223.3
|
209.5
|
6.6%
|
|
Property and
Casualty
|
27.5
|
25.1
|
9.6%
|
|
101.0
|
97.5
|
3.6%
|
|
Other
|
|
|
2.2
|
0.2
|
1000.0%
|
|
4.2
|
1.1
|
281.8%
|
|
|
|
|
Consolidated
operating revenues
|
$ 969.8
|
$ 831.2
|
16.7%
|
|
$ 3,684.6
|
$ 3,333.4
|
10.5%
|
Operating income
(loss): 2
|
|
|
|
|
|
|
|
|
Managed
Care
|
$
(18.2)
|
$
5.1
|
(456.9%)
|
|
$
38.3
|
$
61.9
|
(38.1%)
|
|
Life
Insurance
|
7.6
|
4.4
|
72.7%
|
|
27.8
|
21.9
|
26.9%
|
|
Property and
Casualty
|
8.9
|
(0.5)
|
1880.0%
|
|
19.9
|
14.5
|
37.2%
|
|
Other
|
|
|
(2.2)
|
(0.3)
|
633.3%
|
|
(4.1)
|
(0.6)
|
583.3%
|
|
|
|
|
Consolidated
operating (loss) income
|
$
(3.9)
|
$
8.7
|
(144.8%)
|
|
$
81.9
|
$
97.7
|
(16.2%)
|
Operating margin:
3
|
|
|
|
|
|
|
|
|
Managed
Care
|
(2.1%)
|
0.7%
|
-280 bp
|
|
1.1%
|
2.0%
|
-90 bp
|
|
Life
Insurance
|
13.1%
|
8.1%
|
500 bp
|
|
12.4%
|
10.5%
|
190 bp
|
|
Property and
Casualty
|
32.4%
|
(2.0%)
|
3,440 bp
|
|
19.7%
|
14.9%
|
480 bp
|
|
Consolidated
|
(0.4%)
|
1.0%
|
-140 bp
|
|
2.2%
|
2.9%
|
-70 bp
|
Depreciation and
amortization expense
|
$
3.5
|
$
3.9
|
(10.3%)
|
|
$
14.4
|
$
14.6
|
(1.4%)
|
|
|
1
|
Operating revenues
include premiums earned, net, administrative service fees and net
investment income.
|
2
|
Operating income or
loss include operating revenues minus operating costs. Operating
costs include claims incurred and operating expenses.
|
3
|
Operating margin is
defined as operating income or loss divided by operating
revenues.
|
Managed Care
Additional Data
|
|
Managed Care
Additional Data
|
Three months ended
December 31,
|
|
Twelve months
ended December 31,
|
(Unaudited)
|
|
2020
|
2019
|
|
2020
|
2019
|
Member months
enrollment:
|
|
|
|
|
|
|
Commercial:
|
|
|
|
|
|
|
|
Fully-insured
|
961,725
|
971,270
|
|
3,882,185
|
3,844,106
|
|
|
Self-insured
|
303,732
|
353,843
|
|
1,285,366
|
1,426,353
|
|
|
|
Total
Commercial
|
1,265,457
|
1,325,113
|
|
5,167,551
|
5,270,459
|
|
Medicare
Advantage
|
410,779
|
384,038
|
|
1,631,059
|
1,540,476
|
|
Medicaid
|
|
1,237,098
|
1,069,428
|
|
4,515,196
|
4,257,181
|
|
|
|
|
Total member
months
|
2,913,334
|
2,778,579
|
|
11,313,806
|
11,068,116
|
Claim liabilities
(in millions)
|
|
|
|
$
445.7
|
$
341.3
|
Days claim
payable
|
|
|
|
58
|
49
|
Premium
PMPM:
|
|
|
|
|
|
|
Managed
Care
|
$
334.57
|
$
305.85
|
|
$
331.29
|
$
309.85
|
|
|
Commercial
|
218.67
|
204.68
|
|
210.09
|
208.42
|
|
|
Medicare
Advantage
|
955.50
|
891.32
|
|
952.45
|
914.00
|
|
|
Medicaid
|
218.50
|
187.48
|
|
211.11
|
182.82
|
Medical loss
ratio:
|
89.4%
|
83.7%
|
|
84.5%
|
84.6%
|
|
Commercial
|
87.8%
|
81.3%
|
|
79.1%
|
82.4%
|
|
Medicare
Advantage
|
82.7%
|
75.0%
|
|
80.9%
|
79.8%
|
|
Medicaid
|
|
100.3%
|
100.9%
|
|
94.9%
|
95.4%
|
Adjusted medical loss
ratio: 1
|
87.1%
|
85.7%
|
|
83.5%
|
86.1%
|
|
Commercial
|
82.8%
|
80.6%
|
|
78.0%
|
84.0%
|
|
Medicare
Advantage
|
82.8%
|
81.9%
|
|
79.9%
|
81.4%
|
|
Medicaid
|
|
96.7%
|
97.1%
|
|
94.1%
|
96.8%
|
Operating expense
ratio:
|
|
|
|
|
|
|
Consolidated
|
16.4%
|
20.4%
|
|
18.1%
|
17.5%
|
|
Managed
Care
|
13.7%
|
16.9%
|
|
15.4%
|
14.5%
|
|
|
1
|
The adjusted medical
loss ratio accounts for subsequent adjustments to estimates, such
as prior-period reserve developments and Medicare premium
adjustments and presents them in their corresponding
period.
|
Managed Care
Membership by Segment
|
|
Managed Care
Membership by Segment
|
As of December
31,
|
|
|
|
|
|
|
2020
|
2019
|
Members:
|
|
|
|
|
|
Commercial:
|
|
|
|
|
Fully-insured
|
320,180
|
322,973
|
|
|
Self-insured
|
99,478
|
117,696
|
|
|
|
Total
Commercial
|
419,658
|
440,669
|
|
Medicare
Advantage
|
|
|
|
|
137,092
|
127,789
|
|
Medicaid
|
|
422,023
|
355,465
|
|
|
|
|
Total
members
|
978,773
|
923,923
|
Exhibit
V
|
|
Reconciliation of
Non-GAAP Financial Measures
|
|
|
|
|
|
|
|
Adjusted Net
Income
|
(Unaudited)
|
|
Three months
ended
December 31,
|
Twelve months
ended
December 31,
|
(dollar amounts in
millions)
|
2020
|
2019
|
|
2020
|
2019
|
Net income
|
|
$26.2
|
$13.2
|
|
$67.2
|
$92.9
|
Less
adjustments:
|
|
|
|
|
|
|
Net realized
investment gains, net of tax
|
0.7
|
0.8
|
|
0.5
|
4.7
|
|
Unrealized gains on
equity investments
|
20.1
|
6.3
|
|
6.1
|
25.7
|
|
Private equity
investment income, net of tax
|
1.2
|
0.1
|
|
3.7
|
1.0
|
|
Contingency
accrual
|
-
|
-
|
|
(20.0)
|
-
|
|
|
Adjusted net
income
|
$
4.2
|
$
6.0
|
|
$76.9
|
$61.5
|
|
|
Diluted adjusted net
income per share
|
$0.18
|
$0.25
|
|
$3.30
|
$2.63
|
Adjusted net income is a non-GAAP financial metric and should
not be considered a substitute for, or superior to, financial
measures calculated in accordance with GAAP. Management
believes that the use of this adjusted net income and adjusted net
income per share provides investors and management useful
information about the earnings impact of realized and unrealized
investment gains or losses, as well as other non-recurring items
impacting the Company's results of operations. This non-GAAP
metric does not consider all the items associated with the
Company's operations as determined in accordance with GAAP.
As a result, one should not consider these measures in
isolation.
FOR FURTHER
INFORMATION:
|
|
|
|
AT THE
COMPANY:
|
INVESTOR
RELATIONS:
|
Juan José
Román-Jiménez
|
Mr. Garrett
Edson
|
EVP and Chief
Financial
Officer
|
ICR
|
(787)
749-4949
|
(787)
792-6488
|
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SOURCE Triple-S Management Corporation