(In Millions, Except Per Share Data or as Otherwise Stated Herein)
This Management's Discussion and Analysis of Financial Condition and Results of
Operations, or MD&A, should be read in conjunction with the accompanying
consolidated financial statements and notes, our consolidated financial
statements and notes as of and for the year ended December 31, 2019 and the MD&A
included in our 2019 Annual Report on Form 10-K. References to the terms "we,"
"our," "us," or "Anthem" used throughout this MD&A refer to Anthem, Inc., an
Indiana corporation, and unless the context otherwise requires, its direct and
indirect subsidiaries. References to the "states" include the District of
Columbia, unless the context otherwise requires.
Results of operations, cost of care trends, investment yields and other measures
for the three and six months ended June 30, 2020 are not necessarily indicative
of the results and trends that may be expected for the full year ending
December 31, 2020, or any other period.
Overview
We are one of the largest health benefits companies in the United States in
terms of medical membership, serving greater than 42 million medical members
through our affiliated health plans as of June 30, 2020. We serve our members as
the Blue Cross licensee for California and as the Blue Cross and Blue Shield, or
BCBS, licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine,
Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire,
New York (in the New York City metropolitan area and upstate New York), Ohio,
Virginia (excluding the Northern Virginia suburbs of Washington, D.C.) and
Wisconsin. In a majority of these service areas, we do business as Anthem Blue
Cross, Anthem Blue Cross and Blue Shield, and Empire Blue Cross Blue Shield or
Empire Blue Cross. We also conduct business through arrangements with other BCBS
licensees as well as other strategic partners. Through our subsidiaries, we also
serve customers in numerous states across the country as AIM Specialty Health,
Amerigroup, Aspire Health, Beacon, CareMore, Freedom Health, HealthLink,
HealthSun, Optimum HealthCare, Simply Healthcare, and/or Unicare. Also, in the
second quarter of 2019, we began providing pharmacy benefits management, or PBM,
services through our IngenioRx subsidiary. We are licensed to conduct insurance
operations in all 50 states and the District of Columbia through our
subsidiaries.
For additional information about our organization, see Part I, Item 1,
"Business" and Part II, Item 7, "Management's Discussion and Analysis of
Financial Condition and Results of Operations," included in our 2019 Annual
Report on Form 10-K. Additional information on our segments can be found in this
MD&A and in Note 15, "Segment Information" of the Notes to Consolidated
Financial Statements included in Part I, Item 1 of this Form 10-Q.
COVID-19
In March 2020, the World Health Organization declared the outbreak of a novel
strain of coronavirus, or COVID-19, a global health pandemic and recommended
containment and mitigation measures worldwide. The COVID-19 outbreak has also
been declared a national emergency in the United States and continues to spread
domestically and in other countries globally. To mitigate the spread of this
virus, beginning in March 2020 most states imposed shelter-in-place or
stay-at-home orders, which generally required businesses not considered
essential to close their physical offices. While these orders have largely been
lifted, many states and local authorities continue to impose certain
restrictions on the conduct of businesses and individuals. The virus and efforts
to prevent its spread have drastically impacted the global economy, causing
market instability and increasing unemployment in the United States.
In response to the COVID-19 pandemic, federal and state legislation has been,
and we expect will continue to be, enacted that will impact our business. For
additional information on existing legislation related to the impact of the
COVID-19 pandemic on our business, see "Regulatory Trends and Uncertainties" in
this MD&A.
As COVID-19 continues to spread, we remain focused on increasing access and
coverage for our members, adapting tools and policies to assist consumers and
care providers, and leveraging data and advanced analytics to provide innovative
solutions. We launched an online COVID-19 assessment tool and enhanced the
digital capabilities of Sydney Care, our mobile app, to include a symptom
checker feature, as well as virtual text visit and video visit features. The
symptom checker feature guides users through a resulting action plan depending
upon the results of the user's assessment, and the virtual text

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feature connects users to certified physicians who can provide medical care, including prescribing medication and ordering lab work during consults as necessary. Through at least September 30, 2020, we are providing expanded telehealth coverage including for mental health as well as some physical, occupational and speech therapy, and are continuing to waive cost shares for in-network telehealth visits, including telephonic visits and those for mental health, for our members in fully-insured employer plans, Individual plans, Medicare plans and Medicaid plans, where permissible. We also introduced a suite of digital tools, including C19 Navigator and C19 Explorer, through our online portal and mobile apps. C19 Navigator is a dashboard solution designed for our employer customers and provides member data and updates related to COVID-19. C19 Explorer aggregates real-time COVID-19 data to present trends and predictions for our communities and is designed to support public health officials, business leaders and consumers so they can make informed, data-driven decisions during this pandemic. The other digital tools are available to help individuals with mental health support or emergency services such as finding assistance with food, transportation, and childcare. We made other changes to our membership benefits and business operations in response to the COVID-19 pandemic and may make additional changes in the future. We relaxed early prescription refill policies for maintenance and specialty medications and are encouraging the use of home delivery services to ensure access to necessary medications. We are waiving cost sharing for in-network COVID-19 diagnostic tests and treatment through December 31, 2020 for members enrolled in our fully-insured employer plans, Individual plans and Medicare Advantage plans. Self-insured employers who previously chose to adopt cost sharing waivers for treatment can choose to extend the waivers through the end of 2020. Further, we are providing a one-time premium credit to members enrolled in select Individual plans and fully-insured employer customers. In addition, individuals in stand-alone and group dental plans will also receive a one-time credit. Future regulatory action could require us to provide additional coverage or credits related to COVID-19 treatments. We are also providing support to care provider partners of our affiliated health plans that is designed to help them continue to focus on caring for patients, including funding to support telehealth capabilities, quality-based programs and personal protective equipment, or PPE, and extending financial assistance to targeted independent primary care physician organizations and multispecialty groups who are facing financial pressure during this crisis. Additionally, we are actively working with care providers to accelerate claims processing for outstanding accounts receivables, resolving claims where possible and appropriate, as well as accelerating payments to support state-specific Medicaid programs. We are simplifying access to care by temporarily suspending select prior authorization requirements for respiratory services and medical equipment critical to COVID-19 treatment and temporarily extending prior authorizations on elective inpatient and outpatient procedures issued before May 30, 2020. We are also providing in-network dental providers a PPE Credit per patient, per visit, from June 15, 2020 through the end of August 2020. The safety, health and wellbeing of our employees remains a top priority as we face these challenges together and continue our work in support of those we serve. To protect our employees and mitigate the spread of COVID-19, we implemented travel limitations and introduced workplace modifications consistent with the Centers for Disease Control and Prevention guidelines and social distancing protocols. We are gradually reopening our offices in accordance with local guidelines; however, the majority of our workforce continues to work remotely. In addition to transitioning to a remote work environment, we expanded our employee benefits to provide additional support, including up to 80 hours of paid emergency leave if employees are experiencing symptoms of COVID-19 or caring for young children whose schools have been closed. We also expanded the use of sick time to include caregiving related to COVID-19 and provided a one-time premium credit to our covered associates. With many individuals and families impacted by the COVID-19 pandemic in a variety ways, we remain committed to lifting up our local communities through a variety of partnership and relief efforts. For example, during the second quarter of 2020, we contributed $50 million to the Anthem Foundation to support its COVID-19 response and recovery efforts, such as emergency response, food insecurity, mental health and care provider safety resources. To address food insecurity and other needs for the most vulnerable, our affiliated health plans are reaching out to Medicaid beneficiaries to facilitate connections with state and social services, that can enroll, or help in enrolling, newly eligible and at-risk members in the Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children. Our affiliated health plans are also directly contacting Medicare Advantage and Medicaid consumers to help them make sure they have necessary medications on hand, their nutritional needs are being met and critical health needs are being addressed during this time of social distancing and isolation.



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To date, the COVID-19 pandemic has not had a material adverse impact on our
business, cash flows, financial condition or results of operations. However, the
COVID-19 pandemic is evolving and its impact will depend on future developments,
which are highly uncertain and cannot be predicted at this time. As such, the
COVID-19 pandemic, including the changes we make in response to it and any
further steps taken to expand or otherwise modify the services delivered to our
members, could have a material adverse impact on our business, cash flows,
financial condition and results of operations going forward. These impacts
include, but are not limited to, the following:
•Our covered medical expenses, including preventive care and COVID-19 treatment,
may rise;
•Our membership may decline;
•Our membership mix may change to less profitable lines of business;
•Premium receipts from our Commercial and Government customers may be delayed or
uncollectable;
•Reimbursements for benefit payments made on behalf of our self-insured
customers may be delayed or uncollectable;
•Our suppliers' operations may be interrupted;
•Our operations may be interrupted;
•Our access to credit to meet liquidity may become limited and our credit rating
may be negatively impacted; and
•Our investment returns may be reduced and investment values may become
impaired.
We are focused on continuing to navigate these challenges and taking measures to
address the impacts of the COVID-19 pandemic. To preserve our liquidity and
enhance financial flexibility, we are delaying certain tax payments as permitted
by the Internal Revenue Service and the Coronavirus Aid, Relief, and Economic
Security, or CARES, Act and are monitoring our discretionary spending.
We will continue to monitor the COVID-19 pandemic as well as resulting
legislative and regulatory changes that may impact our business. For additional
discussion regarding our risk factors, see Part I, Item 1A, "Risk Factors"
included in our 2019 Annual Report on Form 10-K and Part II, Item 1A, "Risk
Factors" included in our Quarterly Report on Form 10-Q for the quarter ended
March 31, 2020.
Business Trends
The Patient Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010, as amended, or collectively, the ACA, has changed
and may continue to make broad-based changes to the U.S. healthcare system. We
expect the ACA will continue to impact our business model and strategy. Also,
the legal challenges regarding the ACA, including a federal district court
decision invalidating the ACA, or the 2018 ACA Decision, which judgment has been
stayed pending appeal, could significantly disrupt our business. During 2019, we
modestly expanded our participation in the Individual ACA-compliant market. Our
strategy has been, and will continue to be, to only participate in rating
regions where we have an appropriate level of confidence that these markets are
on a path toward sustainability, including, but not limited to, factors such as
expected financial performance, regulatory environment, and underlying market
characteristics. We currently offer Individual ACA-compliant products in 91 of
the 143 rating regions in which we operate. In addition, the continuing growth
in our government-sponsored business exposes us to increased regulatory
oversight.
In the second quarter of 2019, we began using IngenioRx to market and offer PBM
services to Anthem health plan customers throughout the country, as well as to
external customers outside of the health plans we own. Our comprehensive PBM
services portfolio includes services such as formulary management, pharmacy
networks, prescription drug database, member services and mail order
capabilities. In July 2019, we announced our first contract win with a
third-party health insurer, Blue Cross of Idaho, and IngenioRx began providing
PBM services under that contract on January 1, 2020. Also in the second quarter
of 2019, IngenioRx began delegating certain PBM administrative functions, such
as claims processing and prescription fulfillment, to CaremarkPCS Health,
L.L.C., which is a subsidiary of CVS Health Corporation, pursuant to a five-year
agreement. With IngenioRx, we retain the responsibilities for clinical and
formulary strategy and development, member and employer experiences, operations,
sales, marketing, account management and retail network strategy. From December
2009 through December 2019, we delegated certain PBM functions and
administrative services to Express Scripts Inc., or Express Scripts, pursuant to
our PBM agreement with Express Scripts, or the ESI PBM Agreement. We began
transitioning existing members from Express Scripts to IngenioRx in the second
quarter of 2019, and completed the transition of all of our members by January
1, 2020. We expect IngenioRx to provide our members with more cost-effective
solutions and improve our ability to integrate pharmacy benefits within our
medical and specialty platform.

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Pricing Trends: We strive to price our healthcare benefit products consistent
with anticipated underlying medical cost trends. We continue to closely monitor
the COVID-19 pandemic and the impacts it may have on our pricing, such as
continued deferral of non-emergent or elective health services, surges in
COVID-19 related hospitalizations, and the cost of a potential COVID-19 vaccine.
We frequently make adjustments to respond to legislative and regulatory changes
as well as pricing and other actions taken by existing competitors and new
market entrants. Product pricing in our Commercial & Specialty Business segment,
including our Individual and Small Group lines of business, remains competitive.
Revenues from the Medicare and Medicaid programs are dependent, in whole or in
part, upon annual funding from the federal government and/or applicable state
governments. The ACA imposed an annual Health Insurance Provider Fee, or HIP
Fee, on health insurers that write certain types of health insurance on U.S.
risks. We price our affected products to cover the impact of the HIP Fee, when
applicable. The HIP Fee was suspended for 2019, has resumed for 2020 and has
been permanently eliminated effective in 2021.
Medical Cost Trends: Our medical cost trends are primarily driven by increases
in the utilization of services across all provider types and the unit cost
increases of these services. We work to mitigate these trends through various
medical management programs such as utilization management, condition
management, program integrity and specialty pharmacy management, as well as
benefit design changes. There are many drivers of medical cost trends that can
cause variance from our estimates, such as changes in the level and mix of
services utilized, regulatory changes, aging of the population, health status
and other demographic characteristics of our members, epidemics, pandemics,
advances in medical technology, new high cost prescription drugs, and healthcare
provider or member fraud. Our underlying Local Group medical cost trends reflect
the "allowed amount," or contractual rate, paid to providers. The COVID-19
pandemic has caused, and may continue to cause, deferral of non-emergent or
elective health services, which has decreased our claim costs in the short-term
and could increase our claim costs in the long-term and affect our medical cost
trends. Further, the cost and volume of covered services related to the COVID-19
disease could have a material adverse effect on our claim costs. In response to
the current crisis, we expanded coverage for certain members in our affiliated
health plans for testing and treatment related to a COVID-19 diagnosis through
December 31, 2020. Governmental action has required us to provide full coverage
for COVID-19 testing to our members, and future governmental action could
require us to provide additional coverage. We continue to closely monitor the
COVID-19 pandemic and its impacts to our business, financial condition, results
of operations and medical cost trend.
For additional discussion regarding business trends, see Part I, Item 1,
"Business" included in our 2019 Annual Report on Form 10-K.
Regulatory Trends and Uncertainties
Federal and state legislation has been enacted, and is likely to continue to be
enacted, in response to the COVID-19 pandemic that has had, and we expect will
continue to have, a significant impact on all of our lines of business,
including mandates to waive cost-sharing on COVID-19 testing and related
services. The federal government enacted the Coronavirus Preparedness and
Response Supplemental Appropriations Act, the Families First Coronavirus
Response Act and the CARES Act in March 2020 and the Paycheck Protection Program
and Health Care Enhancement Act in April 2020. These acts provide, among other
things, prohibitions on prior authorization and cost-sharing for certain items
and services related to COVID-19 tests, reforms including waiving Medicare
originating site restrictions for qualified providers providing telehealth
services, financial support to health care providers, including expansion of the
Medicare accelerated payment program to all providers receiving Medicare
payments, and funding to replenish and administer small business loan programs
to help small businesses keep their workers employed and healthcare benefits
covered in the group market.
In addition, these legislative reforms and the Internal Revenue Service Notice
2020-23, or IRS Notice 2020-23, issued in April 2020 in response to the COVID-19
pandemic include tax deferrals and other beneficial provisions, including a
delay of certain payroll and federal income tax payments, which we expect to
have a positive impact on our 2020 cash flows. For more information on measures
we have taken to increase our cash on hand, see "Future Sources and Uses of
Liquidity" in this MD&A.
Regulatory changes have also been enacted, and are likely to continue to be
enacted, at the state and federal level in response to the COVID-19 pandemic.
Those changes, which could have a significant impact on health benefits,
consumer eligibility for public programs, and our cash flows, include mandated
expansion of premium payment terms including the time period for which claims
can be denied for lack of payment, mandates related to prior authorizations and
payment levels to providers, additional consumer enrollment windows, and an
increased ability to provide services through telehealth. We

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are providing extensions to premium payment terms in certain situations and
continue to work closely with state regulators that are mandating or requesting
such relief.
The ACA presented us with new growth opportunities, but also introduced new
risks, regulatory challenges and uncertainties, and required changes in the way
products are designed, underwritten, priced, distributed and administered.
Changes to our business environment are likely to continue as elected officials
at the national and state levels continue to enact, and both elected officials
and candidates for election continue to propose, significant modifications to
existing laws and regulations, including changes to taxes and fees. In addition,
the legal challenges regarding the ACA, including the 2018 ACA Decision, which
judgment has been stayed pending appeal, continue to contribute to this
uncertainty. In a separate development, in April 2020, the U.S. Supreme Court
ruled that the federal government is required to pay health insurance companies
for amounts owed, as calculated under the risk corridor program of the ACA. In
June 2020, the U.S. Court of Federal Claims entered a final judgment stipulating
that we are entitled to reimbursement for risk corridor amounts from 2014, 2015
and 2016. We will review developments and recognize the impact, if any, in a
future reporting period. We will continue to evaluate the impact of the ACA as
any further developments or judicial rulings occur.
The annual HIP Fee is allocated to health insurers based on the ratio of the
amount of an insurer's net premium revenues written during the preceding
calendar year to the amount of health insurance premium for all U.S. health risk
for those certain lines of business written during the preceding calendar year.
We record our estimated liability for the HIP Fee in full at the beginning of
the year with a corresponding deferred asset that is amortized on a
straight-line basis to selling, general and administrative expense. The final
calculation and payment of the annual HIP Fee is due by September 30th of each
fee year. The HIP Fee is non-deductible for federal income tax purposes. Our
affected products are priced to cover the increased selling, general and
administrative and income tax expenses associated with the HIP Fee. The total
amount due from allocations to all health insurers is $15,523 for 2020. For the
three and six months ended June 30, 2020, we estimated our portion of the HIP
Fee to be $420 and $837, respectively, which were recognized as general and
administrative expense. There was no corresponding expense for 2019 due to the
suspension of the HIP Fee for 2019.
For additional discussion regarding regulatory trends and uncertainties and risk
factors, see Part I, Item 1, "Business - Regulation", Part I, Item 1A, "Risk
Factors", and the "Regulatory Trends and Uncertainties" section of Part II, Item
7, "Management's Discussion and Analysis of Financial Condition and Results of
Operations" included in our 2019 Annual Report on Form 10-K and Part II, Item
1A, "Risk Factors" included in our Quarterly Report on Form 10-Q for the quarter
ended March 31, 2020.
Other Significant Items
On February 28, 2020, we completed our acquisition of Beacon Health Options,
Inc., or Beacon, the largest independently held behavioral health organization
in the country. At the time of acquisition, Beacon served more than thirty-four
million individuals across all fifty states. This acquisition aligns with our
strategy to diversify into health services and deliver both integrated solutions
and care delivery models that personalize care for people with complex and
chronic conditions. For additional information, see Note 3, "Business
Acquisitions," of the Notes to Consolidated Financial Statements included in
Part 1, Item 1 of this Form 10-Q.
In January 2019, we exercised our contractual right to terminate the ESI PBM
Agreement, and we completed the transition of our members from Express Scripts
to IngenioRx on January 1, 2020. Notwithstanding our termination of the ESI PBM
Agreement, the litigation between us and Express Scripts regarding the ESI PBM
Agreement continues. For additional information regarding this lawsuit, see Note
11, "Commitments and Contingencies - Litigation and Regulatory Proceedings -
Express Scripts, Inc. Pharmacy Benefit Management Litigation," of the Notes to
Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
In May 2017, we announced that we were terminating the Agreement and Plan of
Merger, or Cigna Merger Agreement, between us and Cigna Corporation. For
additional information about ongoing litigation related to the Cigna Merger
Agreement, see Note 11, "Commitments and Contingencies - Litigation and
Regulatory Proceedings - Cigna Corporation Merger Litigation," of the Notes to
Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.

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Selected Operating Performance
For the twelve months ended June 30, 2020, total medical membership increased
1.6, or 3.9%. Our medical membership grew in both our Government Business and
Commercial & Specialty Business segments. The increase in medical membership in
our Government Business segment was primarily due to fully-insured membership
growth in our Medicaid and Medicare businesses. The increase in medical
membership in our Commercial & Specialty Business segment was primarily driven
by growth in our self-funded business, partially offset by declines in our
fully-insured membership.
Operating revenue for the three months ended June 30, 2020 was $29,178, an
increase of $4,001, or 15.9%, from the three months ended June 30, 2019.
Operating revenue for the six months ended June 30, 2020 was $58,626, an
increase of $9,061, or 18.3%, from the six months ended June 30, 2019. The
increase in operating revenue for the three and six months ended June 30, 2020
compared to 2019 was primarily driven by pharmacy product revenue related to the
launch of IngenioRx, as well as higher premium revenue in our Government
Business segment.
Net income for the three months ended June 30, 2020 was $2,276, an increase of
$1,137, or 99.8%, from the three months ended June 30, 2019. Net income for the
six months ended June 30, 2020 was $3,799, an increase of $1,109, or 41.2%, from
the six months ended June 30, 2019. The increase in net income for the three and
six months ended June 30, 2020 compared to 2019 was due to higher operating
results in all of our segments. The increase was partially offset by higher
income tax expense and lower net investment income.
Our diluted earnings per share, or EPS, was $8.91 for the three months ended
June 30, 2020, which represented a 104.4% increase from EPS of $4.36 for the
three months ended June 30, 2019. Our fully-diluted EPS was $14.85 for the six
months ended June 30, 2020, which represented a 44.5% increase from
fully-diluted EPS of $10.28 for the six months ended June 30, 2019. The increase
in EPS for the three and six months ended June 30, 2020 compared to 2019
resulted primarily from the increase in net income.
Operating cash flow for the six months ended June 30, 2020 and 2019 was $8,025
and $3,067, respectively. This increase was primarily attributable to higher net
income in 2020, a delay of our estimated federal income and certain payroll tax
payments as permitted by the CARES Act and IRS Notice 2020-23, and higher
premium receipts as a result of the HIP Fee reinstatement for 2020.

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Membership

The following table presents our medical membership by customer type, funding arrangement and reportable segment as of June 30, 2020 and 2019. Also included below is other membership by product. At this time, the following table does not include membership resulting from our acquisition of Beacon. The medical membership and other membership data presented are unaudited and in certain instances include estimates of the number of members represented by each contract at the end of the period. For a more detailed description of our medical membership, see the "Membership" section of Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in our 2019 Annual Report on Form 10-K.


                                                       June 30
(In thousands)                                     2020      2019      Change    % Change
Medical Membership
Customer Type
Local Group                                       15,616    15,670       (54 )     (0.3 )%
Individual                                           711       741       (30 )     (4.0 )%
National:
National Accounts                                  7,872     7,693       179        2.3  %
BlueCard®                                          6,171     6,009       162        2.7  %
Total National                                    14,043    13,702       341        2.5  %
Medicare:
Medicare Advantage                                 1,366     1,170       196       16.8  %
Medicare Supplement                                  921       877        44        5.0  %
Total Medicare                                     2,287     2,047       240       11.7  %
Medicaid                                           8,180     7,099     1,081       15.2  %
Federal Employees Health Benefits                  1,616     1,593        23        1.4  %

Total Medical Membership by Customer Type 42,453 40,852 1,601 3.9 % Funding Arrangement Self-Funded

                                       25,888    25,433       455        1.8  %
Fully-Insured                                     16,565    15,419     1,146        7.4  %

Total Medical Membership by Funding Arrangement 42,453 40,852 1,601 3.9 % Reportable Segment Commercial & Specialty Business

                   30,370    30,113       257        0.9  %
Government Business                               12,083    10,739     1,344       12.5  %
Total Medical Membership by Reportable Segment    42,453    40,852     1,601        3.9  %
Other Membership
Life and Disability Members                        5,110     4,906       204        4.2  %
Dental Members                                     6,096     5,931       165        2.8  %
Dental Administration Members                      1,318     5,523    (4,205 )    (76.1 )%
Vision Members                                     7,457     7,161       296        4.1  %
Medicare Part D Standalone Members                   392       287       105       36.6  %






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Medical Membership
Total medical membership grew in both our Government Business and Commercial &
Specialty Business segments as well as by funding arrangement. Fully-insured
membership increased primarily due to growth in our Medicaid and Medicare
businesses, partially offset by the membership decreases in our fully-insured
Local Group business. Local Group membership decreased due to lapses and
in-group change exceeding sales. Self-funded medical membership increased
primarily as a result of membership increases in our National Accounts business
resulting from our acquisition of a third-party administrator and sales and
favorable in-group changes exceeding lapses. The increase in self-funded
membership was further attributable to higher BlueCard® activity at other Blue
Cross Blue Shield Association, or BCBSA, plans whose members reside in or travel
to our licensed areas. Medicaid membership increased primarily due to organic
growth in existing markets due to the temporary suspension of eligibility
recertification during the COVID-19 pandemic as well as our acquisition
of Medicaid plans in Missouri and Nebraska. Medicare membership increased
primarily due to higher sales during open enrollment.
Other Membership
Our other membership can be impacted by changes in our medical membership, as
our medical members often purchase our other products that are ancillary to our
health business. We have experienced growth in our life and disability and
dental memberships primarily due to higher sales in our Local Group business.
Dental administration membership decreased due to the lapse of a large dental
administration services contract. Vision membership increased due to higher
sales in our Medicare and Local Group businesses.

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