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continued to put up stellar results Thursday, saying fourth-quarter earnings more than doubled on a major improvement in the profitability of its health care insurance underwriting for commercial customers.

The company also forecast much-better-than-expected operating results for 2004, sending the shares up sharply in premarket trading.

Aetna, based in Hartford, Conn., earned $249.5 million, or $1.56 a share, in the latest quarter, compared with earnings of $98.2 million, or 63 cents a share, last year. Operating earnings, a metric used in the insurance industry that excludes realized investment gains and losses, came out to $1.50 a share in the latest quarter. Aetna also had a gain of 18 cents a share in the latest period for an adjustment of a previous cost estimate.

Before everything, the company earned $1.32 a share in the quarter ended Dec. 31, 2003, easily surpassing analysts' estimates for earnings of $1.18 a share. Revenue was $4.6 billion in the latest quarter, down from $4.7 billion a year ago, but also eclipsing analysts' forecasts of $4.5 billion, as compiled by Thomson One Analytics.

The company estimated 2004 operating earnings at $6.25 to $6.35 a share, well above the $6.02 per share forecast by analysts.

In its main health care segment, Aetna had net income of $219.4 million, up from $85.5 million a year ago, reflecting costs that declined faster than revenue. On a companywide basis, pretax operating margins rose to 7.7% from 4.7% a year ago, while the after-tax operating margin was 5.5% in the latest quarter compared with 2.1% a year ago. The year-ago quarter also included a $45 million pretax charge for facilities closures and severance.

Aetna shares recently traded for $74 on Instinet, up from its Wednesday close of $71.60.