PART II ITEM 7 Management’s Discussion and Analysis of Financial Condition and Results of Operations average membership in the guaranteed cost and ASO commercial businesses, particularly in the targeted market segments: Middle, Select and Individual; revenue growth in the U.S. commercial business, primarily due to a higher ASO customer base resulting in higher fees, as well as additional sales of stop loss and specialty products; GLYPH<127> growth in the international health care business; and GLYPH<127> increased specialty margins including behavioral and pharmacy products. GLYPH<127> higher operating expenses, primarily attributable to investments in technology and initiatives to expand business capabilities as well as to support business growth; and GLYPH<127> strong revenue growth in the international health care business; GLYPH<127> growth in specialty revenues, as well as rate increases on most products consistent with underlying trend; GLYPH<127> a lower guaranteed cost medical care ratio and higher experience- rated margins in the commercial business driven by low medical services utilization trend, as well as favorable prior year claim development. These favorable effects were partially offset by the estimated cost of premium rebates calculated under the minimum medical loss ratio requirements of Health Care Reform; and GLYPH<127> higher net investment income of 14% in 2011, primarily reflecting increased average asset levels driven by membership growth, as well as higher income from partnership investments. GLYPH<127> modestly higher medical care ratios in our commercial risk businesses due to slightly higher utilization. GLYPH<127> growth in premiums and fees of 9% in 2011 (excluding the impact of exiting the Medicare IPFFS business), primarily due to higher GLYPH<127> The Global Health Care segment’s adjusted income from operations increased 17% in 2011, as compared with 2010 reflecting: These favorable impacts were partially offset by: The table below shows premiums and fees for the Global Health Care segment: Revenues (In millions) 2012 2011 2010 Medical: Guaranteed cost  (1) $ 4,256 $ 4,176 $ 3,929 Experience-rated  (2) 2,022 1,934 1,823 Stop loss 1,672 1,451 1,287 International health care 1,648 1,344 976 Dental 1,005 894 804 Medicare 4,969 489 1,470 Medicaid 207 - - Medicare Part D 1,421 685 615 Other 677 600 543 Total medical 17,877 11,573 11,447 Fees  (3) 3,096 2,870 2,687 TOTAL PREMIUMS AND FEES 20,973 14,443 14,134 Less: Medicare IPFFS - - 827 Premiums and fees, excluding Medicare IPFFS $20,973 $14,443 $13,307 (1) Excludes international health care guaranteed cost premiums. (2) Includes minimum premium business that has a risk profile similar to experience-rated funding arrangements. The risk portion of minimum premium revenue is reported in experience-rated medical premium whereas the self funding portion of minimum premium revenue is reported in fees. Also, includes certain non-participating cases for which special customer level reporting of experience is required. (3) Includes fees related to the U.S. and international health care businesses. Fees related to Medicare Part D of $61 million in 2011 and $57 million in 2010 have been reclassified to premiums to conform to current presentation. Premiums and fees  increased 45% in 2012, compared with 2011, primarily reflecting growth in the government segment due to the acquisition of HealthSpring. Revenue growth in the U.S. commercial business was driven by rate increases on most products consistent with underlying cost trends and a higher ASO customer base, resulting in higher fees, stop loss revenues and specialty product penetration. In addition, revenue in the international health care business increased primarily due to the conversion of the Vanbreda business from service to insurance contracts and, to a lesser extent, other business growth. Premiums and fees increased 2% in 2011 compared with 2010. Excluding the impact of exiting the Medicare IPFFS business, premiums and fees rose 9% in 2011, compared with 2010, due primarily to higher revenues in the international health care and U.S. commercial businesses. International health care revenues increased due to business growth and the acquisition of Vanbreda. In the U.S. commercial business, the increase in revenues was attributable primarily to membership growth in the ASO business and higher average membership in guaranteed cost, driven by strong retention and sales in targeted market segments. Rate increases on most products consistent with underlying cost trends and higher 42 CIGNA CORPORATION -  2012 Form  10-K