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## Global Health Care Segment 

## Segment Description 

As discussed in the Introduction section of this MD&A and Note 23 to the Consolidated Financial Statements, effective December 31, 2012, the Company changed its reporting segments. The Global Health Care segment now includes the Company’s international health care business, previously reported in the former International segment and excludes certain disability and life business that is now reported in the Group Disability and Life segment. Prior year information has been conformed to the new segment presentation. The international health care business is included in the Commercial operating segment. 

Global Health Care aggregates the following two operating segments: 

The Commercial  operating segment includes both the U.S. commercial and international health care businesses that offer insured and self-insured medical, dental, behavioral health, vision, and prescription drug benefit plans, health advocacy programs and other products and services that may be integrated to provide comprehensive global health care benefit programs to employers and their employees, including globally mobile individuals. Cigna, either directly or through its partners, offers some or all of these products and services in all 50 states, the District of Columbia, the GLYPH<127> 

## Results of Operations 

U.S. Virgin Islands, Canada, Europe, the Middle East, and Asia. Cigna services its globally mobile customers virtually everywhere in the world. These products and services are offered through a variety of funding arrangements such as administrative services only (ASO), guaranteed cost and retrospectively experience rated. 

The Government  operating segment offers Medicare Advantage plans to seniors in 13 states and the District of Columbia, Medicare Part D plans in all 50 states and the District of Columbia and Medicaid plans. Results for the Government operating segment include HealthSpring from the date of acquisition, January 31, 2012. GLYPH<127> 

The Company measures the operating effectiveness of the Global Health Care segment using the following key factors: 

segment earnings and adjusted income from operations; GLYPH<127> 

customer growth; GLYPH<127> 

sales of specialty products; GLYPH<127> 

other operating expense as a percentage of segment revenues (operating expense ratio); and GLYPH<127> 

medical expense as a percentage of premiums (medical care ratio) in the guaranteed cost and Medicare businesses. GLYPH<127> 

<img src='content_image/240463.jpg'>

Segment earnings increased 28% in 2012 compared with 2011, due to higher adjusted income from operations, partially offset by the special items related to the realignment and efficiency plan charge, the costs associated with the acquisition of HealthSpring and a litigation matter. Segment earnings increased 18% in 2011 compared with 2010, due to higher adjusted income from operations. 

The Global Health Care segment’s adjusted income from operations increased 34% in 2012, as compared with 2011 reflecting: 

strong earnings contributions from the government segment, primarily attributable to the acquired HealthSpring business reflecting effective medical cost and pharmacy management programs; GLYPH<127> 

