(In Millions, Except Per Share Data or as Otherwise Stated Herein)
On May 18, 2022, our shareholders approved a proposal to amend our amended and
restated articles of incorporation to change our name from Anthem, Inc. to
Elevance Health, Inc., which amendment and name change went into effect on June
27, 2022. We began operating as Elevance Health, Inc. and trading under our new
ticker symbol "ELV" on June 28, 2022. References to the terms "we," "our," "us,"
or "Elevance Health" used throughout this Management's Discussion and Analysis
of Financial Condition and Results of Operations ("MD&A") refer to Elevance
Health, Inc., an Indiana corporation, and unless the context otherwise requires,
its direct and indirect subsidiaries. References to the "states" include the
District of Columbia and Puerto Rico, unless the context otherwise requires.
This 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, 2021 and the MD&A included in our 2021
Annual Report on Form 10-K.
Results of operations, cost of care trends, investment yields and other measures
for the three and six months ended June 30, 2022 are not necessarily indicative
of the results and trends that may be expected for the full year ending
December 31, 2022, or any other period.
Overview
Elevance Health is a health company with the purpose of improving the health of
humanity. We are the largest health insurer in the United States in terms of
medical membership, serving over 47 million medical members through our
affiliated health plans as of June 30, 2022. We are an independent licensee of
the Blue Cross and Blue Shield Association ("BCBSA"), an association of
independent health benefit plans. We serve our members as the Blue Cross
licensee for California and as the Blue Cross and Blue Shield ("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. In addition, we conduct business through arrangements with other BCBS
licensees as well as other strategic partners. Through our subsidiaries, we also
serve customers in numerous states as AIM Specialty Health, Amerigroup, Aspire
Health, Beacon, CareMore, Freedom Health, HealthLink, HealthSun, Integra Managed
Care, MMM, Optimum HealthCare, Simply Healthcare, and/or UniCare. We offer
pharmacy benefits management ("PBM") services through our IngenioRx, Inc.
("IngenioRx") subsidiary. We are licensed to conduct insurance operations in all
50 states, the District of Columbia and Puerto Rico through our subsidiaries.
As part of our name change to Elevance Health, on June 15, 2022 we announced
that over the next several years we will organize our brand portfolio into the
following core go-to-market brands:
•Anthem Blue Cross/Anthem Blue Cross and Blue Shield - represents our existing
Anthem-branded and affiliated Blue Cross and/or Blue Shield licensed plans;
•Wellpoint - we intend to unite select non-BCBSA licensed Medicare, Medicaid and
Commercial plans under the Wellpoint name; and
•Carelon - this brand will bring together our healthcare brands and
capabilities, including our Diversified Business Group and IngenioRx business
under a single brand name. We now refer to our Diversified Business Group as
Carelon. In January 2023, IngenioRx will become CarelonRx.
There are currently no segment changes associated with this branding strategy.
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 2021 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.
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COVID-19
The COVID-19 pandemic continues to impact the global economy, cause market
instability and uncertainty in the labor market and put pressure on the
healthcare system, and it has impacted, and will likely continue to impact, our
membership, benefit expense and members behavior, including how members access
healthcare services. See "Business Trends" below for a discussion of the impact
of COVID-19 on our pricing and medical costs.
The COVID-19 pandemic continues to evolve and the full extent of its impact will
depend on future developments, which are highly uncertain and cannot be
predicted at this time. We will continue to monitor the COVID-19 pandemic as
well as resulting legislative and regulatory changes to manage our response and
assess and mitigate potential adverse impacts to our business. For additional
discussion regarding our risks related to the COVID-19 pandemic and our other
risk factors, see Part I, Item 1A, "Risk Factors" included in our 2021 Annual
Report on Form 10-K.
Business Trends
We made the decision to modestly expand our participation in the Individual
on-exchange products through state- or federally-facilitated marketplaces (the
"Public Exchange") for 2022 after also expanding in 2021. As a result, for 2022
we are offering Public Exchange products in 122 of the 143 rating regions in
which we operate, in comparison to 103 of 143 rating regions in 2021. 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. 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 continuing growth in our government-sponsored business
exposes us to increased regulatory oversight.
Our IngenioRx subsidiary markets and offers PBM services to our affiliated
health plan customers throughout the country, as well as to customers outside of
the health plans we own. Our comprehensive PBM services portfolio includes
features such as formulary management, pharmacy networks, a prescription drug
database, member services and mail order capabilities. IngenioRx delegates
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.
Pricing Trends: We strive to price our health benefit products consistent with
anticipated underlying medical cost trends. We continue to closely monitor the
COVID-19 pandemic (including new COVID-19 variants, which may be more contagious
or severe, or less responsive to treatment or vaccines) and the impacts it may
have on our pricing, such as surges in COVID-19 related hospitalizations,
infection rates, the cost of COVID-19 vaccines, testing and treatment and the
return of non-COVID-19 healthcare utilization to our estimate of normal levels,
based on historical utilization patterns. 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.
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 care and condition management, program
integrity and specialty pharmacy management and utilization 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, contracting
inflation and healthcare provider or member fraud.
At its onset, the COVID-19 pandemic caused a decrease in utilization of
non-COVID-19 health services, which decreased our claim costs in 2020. As the
pandemic continued through 2021, our non-COVID-19 healthcare utilization
experience gradually increased and largely normalized. Our COVID-19 related
healthcare expenses increased during 2021 as new variants (Delta and Omicron)
emerged and vaccinations and boosters became available.
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The Omicron surge quickly declined during the first quarter of 2022, with
COVID-19 inpatient authorizations, provider-based tests, visits and vaccinations
all decreasing to lower levels by the end of the first quarter of 2022;
concurrently, non-COVID-19 healthcare utilization throughout the second quarter
of 2022 recovered from lower levels earlier in the year. For the remainder of
2022, we anticipate additional claim costs for new pharmaceutical treatments for
COVID-19 and compliance with governmental regulations on COVID-19 testing
reimbursement. We expect claims costs related to COVID-19 testing, treatment and
hospitalizations will continue throughout 2022 even during periods with lower
COVID-19 infection and confirmed case activity. The ongoing cost and volume of
covered services related to the COVID-19 pandemic may have a material adverse
effect on our future claim costs. We continue to closely monitor the COVID-19
pandemic and its impacts on our business, financial condition, results of
operations and medical cost trends.
For additional discussion regarding business trends, see Part I, Item 1,
"Business" included in our 2021 Annual Report on Form 10-K.
Regulatory Trends and Uncertainties
Federal and state governments have enacted, and may continue to enact,
legislation and regulations in response to the COVID-19 pandemic that have had,
and we expect will continue to have, a significant impact on health benefits,
consumer eligibility for public programs and our cash flows for all lines of
business, and which have introduced increased uncertainty around our cost
structure. These actions, which are or have been in effect for various
durations, provide, among other things:
•mandates to waive cost-sharing for COVID-19 testing (including over-the-counter
testing in accordance with state and federal requirements), vaccines and related
services;
•reforms, including waiving Medicare originating site restrictions for qualified
providers of telehealth services;
•financial support to healthcare providers, including expansion of the Medicare
accelerated payment program to all providers receiving Medicare payments;
•mandated expansion of premium payment terms, including the time period for
which claims can be denied for lack of payment; and
•mandates related to prior authorizations and payment levels to providers,
additional consumer enrollment windows and an increased ability to provide
telehealth services.
At the end of the currently enacted public health emergency, which has been
extended until October 2022, Medicaid eligibility recertification will resume.
Recertifications could begin as early as November 2022, but may not occur until
2023 in certain states, and we expect a decline in our Medicaid membership once
recertification resumes. At the same time, we expect growth in our Commercial
risk-based and fee-based plans, including through the Public Exchange, as
members exiting Medicaid in our fourteen Commercial states seek coverage
elsewhere.
Beginning in July 2022, the health plan price transparency regulations issued in
October 2020 by the U.S. Departments of Health and Human Services, Labor and
Treasury (the "Health Plan Transparency Rule") require us to disclose, on a
monthly basis, detailed pricing information regarding negotiated rates for all
covered items and services between the plan or issuer and in-network providers
and historical payments to, and billed charges from, out-of-network providers.
Additionally, beginning in 2023, we will be required to make available to
members personalized out-of-pocket cost information and the underlying
negotiated rates for 500 covered healthcare items and services, including
prescription drugs. In 2024, this requirement will expand to all items and
services.
The Consolidated Appropriations Act of 2021, which was enacted in December 2020
(the "Appropriations Act"), has impacted and in the future may have a material
effect upon our business, including procedures and coverage requirements related
to surprise medical bills and new mandates for continuity of care for certain
patients, price comparison tools, disclosure of broker compensation, mental
health parity reporting, and reporting on pharmacy benefits and drug costs. The
requirements of the Appropriations Act applicable to us have varying effective
dates, some of which were effective in December 2021 and others that have been
extended since the enactment of the Appropriations Act.
The American Rescue Plan Act of 2021, (the "Rescue Plan"), which was enacted in
March 2021, contains several health-related provisions that have impacted our
business, including expansion of premium tax credits for our Public Exchange
business and full subsidization of the Consolidated Omnibus Budget
Reconciliation Act ("COBRA") continuation coverage for those who were
involuntarily terminated or had their work hours reduced. The Rescue Plan's
premium tax credit
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provisions became effective in January 2021, while the COBRA premium
subsidization was effective from April 2021 through September 2021. Expiration
of the premium tax credit provisions on December 31, 2022, unless extended by
Congress, may have an adverse effect upon our business.
Since its enactment in 2010, the Patient Protection and Affordable Care Act and
the Health Care and Education Reconciliation Act of 2010, as amended
(collectively, the "ACA"), has introduced new risks, regulatory challenges and
uncertainties, has impacted our business model and strategy and has required
changes in the way our products are designed, underwritten, priced, distributed
and administered. We expect the ACA will continue to significantly impact our
business and results of operations, including pricing, minimum medical loss
ratios and the geographies in which our products are available, and as a result
of future modifications of, and guidance by federal regulatory agencies related
to, the ACA and our businesses more broadly. We will continue to evaluate the
impact of the ACA as any further developments occur.
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 2021 Annual Report on Form 10-K.
Other Significant Items
Business and Operational Matters
As mentioned above, we began operating as Elevance Health on June 28, 2022. This
change is intended to better reflect our business and our journey from a
traditional health benefits organization to a lifetime, trusted health partner.
Elevance Health supports health at every stage, offering health plans and
clinical, behavioral, pharmacy and complex-care solutions that promote whole
health.
On May 5, 2022, we completed our acquisition of Integra Managed Care
("Integra"). Integra is a managed long-term care plan that serves New York state
Medicaid members, enabling adults with long-term care needs and disabilities to
live safely and independently in their own homes.
On June 29, 2021, we completed our acquisition of MMM Holdings, LLC ("MMM") and
its Medicare Advantage plan, Medicaid plan and other affiliated companies. MMM
is a Puerto Rico-based integrated healthcare organization and seeks to provide
its Medicare Advantage and Medicaid members with a whole health experience
through its network of specialized clinics and wholly owned independent
physician associations. This acquisition aligns with our vision to be an
innovative, valuable and inclusive healthcare partner by providing care
management programs that improve the lives of the people we serve.
On April 28, 2021, we completed our acquisition of myNEXUS, Inc. ("myNEXUS").
myNEXUS is a comprehensive home-based nursing management company for payors and,
at the time of acquisition, delivered integrated clinical support services for
Medicare Advantage members across twenty states. This acquisition aligns with
our strategy to manage integrated, whole person multi-site care and support by
providing national, large-scale expertise to manage nursing services in the home
and facilitate transitions of care.
For additional information, see Note 3, "Business Acquisitions," of the Notes to
Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q.
In 2020, we introduced enterprise-wide initiatives to optimize our business and
as a result, recorded a charge of $653 in selling, general and administrative
expenses. We believe these initiatives largely represent the next step forward
in our progression towards becoming a more agile organization, including process
automation and a reduction in our office space footprint. In the fourth quarter
of 2021, we identified additional office space reductions and related fixed
asset impairments due to the continuing COVID-19 pandemic and recorded a charge
of $202 in selling general and administrative expenses. For additional
information, see Note 4, "Business Optimization Initiatives," of the Notes to
Consolidated Financial Statements included in Part I, Item 1 of this Quarterly
Report on Form 10-Q.
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Litigation Matters
In the consolidated multi-district proceeding in the United States District
Court for the Northern District of Alabama (the "Court") captioned In re Blue
Cross Blue Shield Antitrust Litigation ("BCBSA Litigation"), the BCBSA and Blue
Cross and/or Blue Shield licensees, including us (the "Blue plans") have
approved a settlement agreement and release (the "Subscriber Settlement
Agreement") with the plaintiffs representing a putative nationwide class of
health plan subscribers. Generally, the lawsuits in the BCBSA Litigation
challenge elements of the licensing agreements between the BCBSA and the
independently owned and operated Blue plans. The cases were brought by two
putative nationwide classes of plaintiffs, health plan subscribers and
providers, and the Subscriber Settlement Agreement applies only to the putative
subscriber class. No settlement agreement has been reached with the provider
plaintiffs at this time, and the defendants continue to contest the consolidated
cases brought by the provider plaintiffs.
If approved by the Court, the Subscriber Settlement Agreement will require the
defendants to make a monetary settlement payment, our portion of which is
estimated to be $594, and will include certain terms imposing non-monetary
obligations on the defendants. As of June 30, 2022, the liability balance
accrued for our estimated remaining payment obligation was $507, net of payments
made. All terms of the Subscriber Settlement Agreement are subject to approval
by the Court before they become effective. For additional information regarding
the BCBSA Litigation, see Note 11, "Commitments and Contingencies - Litigation
and Regulatory Proceedings - Blue Cross Blue Shield Antitrust Litigation," of
the Notes to Consolidated Financial Statements included in Part I, Item 1 of
this Quarterly Report on Form 10-Q.
Selected Operating Performance
For the twelve months ended June 30, 2022, total medical membership increased by
2.7 million, or 6.1%. The Government Business segment increase was driven
primarily by the continued temporary suspension of Medicaid eligibility
recertification during the COVID-19 pandemic. In addition, Medicaid membership
growth was impacted by the launch of our Healthy Blue managed care alliance in
North Carolina in the third quarter of 2021, the acquisition of Ohio Medicaid
members through the purchase of a Medicaid contract in the first quarter of 2022
and the acquisition of Integra in the second quarter of 2022, as well as organic
growth in our Medicare Advantage business. Our Commercial & Specialty Business
segment experienced organic growth in both our Group fee-based and Group
risk-based membership as sales exceeded lapses. BlueCard membership increased
due to favorable membership activity at other BCBSA plans whose members reside
in or travel to our licensed areas. Individual membership increased due to our
Public Exchange expansion in 2022.
Operating revenue for the three months ended June 30, 2022 was $38,482, an
increase of $5,203, or 15.6%, from the three months ended June 30, 2021.
Operating revenue increased primarily as a result of higher premium revenue in
our Medicaid business, including due to membership growth from the continued
temporary suspension of Medicaid eligibility recertification during the COVID-19
pandemic, the acquisition of MMM in the second quarter of 2021, the acquisition
of Ohio Medicaid members through the purchase of a Medicaid contract in the
first quarter of 2022, as well as from premium rate increases to cover medical
cost trends and membership growth in our Medicare Advantage and Commercial &
Specialty Business risk-based businesses. The increase in operating revenue was
further attributable to increased pharmacy product revenue in our IngenioRx
segment, the acquisition of Integra in the second quarter of 2022 and the launch
of our Healthy Blue managed care alliance in North Carolina in the third quarter
of 2021.
Operating revenue for the six months ended June 30, 2022 was $76,368, an
increase of $10,991, or 16.8%, from the six months ended June 30, 2021. This
increase in operating revenue was primarily driven by higher premium revenue in
our Medicaid business, including due to membership growth from the continued
temporary suspension of Medicaid eligibility recertification during the COVID-19
pandemic, the acquisition of MMM in the second quarter of 2021 and the
retroactive reinstatement of a Medicare directed payment program. Membership
growth and premium rate increases to cover medical cost trends in our Medicare
Advantage and Commercial & Specialty Business risk-based businesses also
contributed to higher premium revenue. The increase in operating revenue was
further attributable to increased pharmacy product revenue in our IngenioRx
segment, the acquisition of Ohio Medicaid members through the purchase of a
Medicaid contract in the first quarter of 2022, the launch of our Healthy Blue
managed care alliance in North Carolina in the third quarter of 2021 and the
acquisition of Integra in the second quarter of 2022.
Net income for the three months ended June 30, 2022 was $1,650, a decrease of
$151, or 8.4%, from the three months ended June 30, 2021. The decrease in net
income was primarily due to losses on financial instruments in 2022, as compared
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to gains on financial instruments in 2021, as well as increased intangible
amortization in 2022 related to recent acquisitions and the rebranding of our
products, as we expect to retire certain trade names in the future. These
decreases were partially offset by operating gain increases in each of our
business units.
Net income for the six months ended June 30, 2022 was $3,445, a decrease of $23,
or 0.7%, from the six months ended June 30, 2021. The decrease in net income was
primarily due to losses on financial instruments in 2022, as compared to gains
on financial instruments in 2021, as well as increased intangible amortization
in 2022 related to recent acquisitions and the rebranding of our products, as we
expect to retire certain trade names in the future. These decreases were
partially offset by a net operating gain increase from our business units.
Our fully-diluted shareholders' earnings per share ("EPS") was $6.79 for the
three months ended June 30, 2022, which represented a 6.3% decrease from EPS of
$7.25 for the three months ended June 30, 2021. Our diluted shares for the three
months ended June 30, 2022 were 243.4, a decrease of 4.0, or 1.6%, compared to
the three months ended June 30, 2021. The decrease in EPS for the three months
ended June 30, 2022 resulted primarily from reduced shareholders' net income,
partially offset by the impact of fewer diluted shares outstanding.
Our fully-diluted shareholders' EPS was $14.18 for the six months ended June 30,
2022, which represented a 1.6% increase from fully-diluted EPS of $13.95 for the
six months ended June 30, 2021. Our diluted shares for the six months ended June
30, 2022 were 243.9, a decrease of 3.9, or 1.6%, compared to the six months
ended June 30, 2021. The increase in EPS for the six months ended June 30, 2022
resulted primarily from the impact of fewer diluted shares outstanding.
Operating cash flow for the six months ended June 30, 2022 and 2021 was $4,993
and $4,188, respectively. The increase was primarily due to higher net income in
2022, excluding the non-cash impact of losses/gains on investments, as we
recognized realized losses during the first six months of 2022 compared to
realized gains in the first six months of 2021. The increase was further
attributable to the timing of working capital changes.
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Membership
The following table presents our medical membership by reportable segment and
customer type as of June 30, 2022 and 2021. Also included below is other
membership by product. 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 2021 Annual Report on Form 10-K.
June 30
(In thousands) 2022 2021 Change % Change
Medical Membership
Commercial & Specialty Business:
Individual 803 738 65 8.8 %
Group Risk-Based 4,020 3,851 169 4.4 %
Commercial Risk-Based 4,823 4,589 234 5.1 %
BlueCard® 6,445 6,235 210 3.4 %
Group Fee-Based 20,086 19,372 714 3.7 %
Commercial Fee-Based 26,531 25,607 924 3.6 %
Total Commercial & Specialty Business 31,354 30,196 1,158 3.8 %
Government Business:
Medicare Advantage 1,946 1,824 122 6.7 %
Medicare Supplement 942 936 6 0.6 %
Total Medicare 2,888 2,760 128 4.6 %
Medicaid 11,181 9,754 1,427 14.6 %
Federal Employees Health Benefits 1,628 1,631 (3) (0.2) %
Total Government Business 15,697 14,145 1,552 11.0 %
Total Medical Membership 47,051 44,341 2,710 6.1 %
Other Membership
Life and Disability Members 4,779 4,732 47 1.0 %
Dental Members 6,620 6,606 14 0.2 %
Dental Administration Members 1,589 1,497 92 6.1 %
Vision Members 9,385 7,819 1,566 20.0 %
Medicare Part D Standalone Members 276 433 (157) (36.3) %
Medical Membership
Medical membership increased in both our Government Business and Commercial &
Specialty Business segments primarily due to organic growth. The Government
Business segment organic growth was primarily driven by the continued temporary
suspension of Medicaid eligibility recertification during the COVID-19 pandemic.
In addition, Medicaid membership growth was impacted by the launch of our
Healthy Blue managed care alliance in North Carolina in the third quarter of
2021, the acquisition of Ohio Medicaid members through the purchase of a
Medicaid contract in the first quarter of 2022 and the acquisition of Integra in
the second quarter of 2022, as well as organic membership growth in Medicare
Advantage. Our Commercial & Specialty Business segment experienced organic
growth in both our Group fee-based and Group risk-based membership as sales
exceeded lapses. BlueCard membership increased due to favorable membership
activity at other BCBSA plans whose members reside in or travel to our licensed
areas. Individual membership increased due to our Public Exchange expansion in
2022.
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. Life and disability membership increased primarily due to new
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sales of disability products, partially offset by lapses and negative in-group
change of life membership. Dental membership increased primarily due to sales
exceeding lapses in our Group risk-based accounts and penetration increases in
our Federal Employees Health Benefits ("FEHB") program, partially offset by the
loss of a significant Group fee-based account. Dental administration membership
increased primarily due to increased sales to other BCBS plans associated with
the FEHB program. Vision membership increased primarily due to the launch of a
new entry level vision product in our Group markets, as well as the growth in
our Medicare Advantage business. Medicare Part D Standalone membership declined
as we discontinued certain legacy products.
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