Regarding our results, in the third quarter, we recorded an after-tax special item benefit of $35 million or $0.10 per share for integration and transaction related costs.
During the quarter, we delivered adjusted revenue of $44 billion and adjusted earnings per share of $5.73 per share, all while continuing to reinvest back in our business to fund growth, expansion and ongoing innovation, and we continue to return significant value to our shareholders.
With our high performing health service portfolio and sharp focus on executing our strategy, we are confident in our ability to continue driving growth and are again raising our full-year 2001 guidance for adjusted earnings per share and revenue.
Separately, in early October we also announced an agreement with Chubb to sell our life, accident and supplemental benefits business in our International Markets platform in seven countries for $5.75 billion.
We expect to realize about $5.4 billion in net after-tax proceeds and complete the transaction in 2022 following regulatory approvals.
It's our privilege to serve almost 10 million active duty service members, retirees and their families.
UPMC has been an Evernorth pharmacy client for 16 years and this agreement illustrates how we are collaborating across our enterprise to deliver greater affordability and differentiated value for health plan clients.
For 2022 calendar year, 89% of our Medicare Advantage customers will be in four star or greater plans nationally.
And in our individual and family plan business, we've driven strong growth in this year, increasing customers by 47% through the third quarter.
We are positioning ourselves to build on this momentum in the individual family plan business by expanding our addressable markets, again as we enter in three new states and 93 new counties in 2022.
These new markets offer the potential to reach an additional 1.5 million customers.
Specifically for 2021, we are committed to delivering our increased guidance for full-year adjusted earnings per share of at least $20.35.
For full year 2021, we remain on track for generating at least $7.5 billion of cash flow from operations and we expect to return more than $7 billion to shareholders in 2021 through dividends and share repurchase.
Looking into 2022, we expect to grow earnings per share by at least 10% off of our increased 2021 guidance of at least $20.35 per share.
Importantly, I would remind you that approximately 80% of our revenues are from service-based businesses that are not significantly exposed to medical cost fluctuations.
Key consolidated financial highlights in third quarter 2021 include adjusted revenue growth of 9% to $44.3 billion, adjusted earnings growth of 20% to $1.9 billion after tax, and adjusted earnings-per-share growth of 30% to $5.73.
Third quarter 2021 adjusted revenues grew 13% to $33.6 billion.
Adjusted pharmacy script volume increased 8% to 411 million scripts and adjusted pre-tax earnings grew 7% to $1.5 billion compared to third quarter 2020.
Third quarter adjusted revenues were $10.5 billion and adjusted pre-tax earnings were approximately $1 billion.
The net effect of these claim cost impacts produced a medical care ratio of 84.4% in the third quarter.
Turning to membership, w ended the quarter with 17 million total medical customers, an increase of approximately 368,000 customers year-to-date.
In our international markets business, third quarter adjusted revenues were $1.6 billion and adjusted pre-tax earnings were $250 million.
Corporate and Other operations delivered a third quarter adjusted loss of $275 million.
We are raising our adjusted earnings per share guidance for full-year 2021 to at least $20.35 per share, reflecting the strength of the quarter, the favorable impact of our year-to-date share repurchase and acknowledgment of the ongoing fluidity of the broader environment.
This represents earnings per share growth of at least 10% from 2020, consistent with our long-term earnings per share growth range of 10% to 13%, even with the ongoing challenges associated with COVID-19 and while having significantly increased our dividend in 2021.
These dynamics are fully contemplated in our 2021 expectation for adjusted earnings per share of at least $20.35 and our 2022 expectation for earnings per share growth of at least 10% off this 2021 guidance.
We now expect full-year 2021 consolidated adjusted revenues of at least one $172 billion, representing growth of at least 11% from 2020, when adjusting for the divestiture of our Group Disability and Life business.
I would note this revenue growth rate significantly exceeds our projected long-term average annual growth goal of 6% to 8% and represents a third consecutive year of significant revenue outperformance since our combination with Express Scripts in late 2018.
For Evernorth, we continue to expect full-year 2021 adjusted earnings of at least $5.8 billion, representing growth of at least 8% over 2020, reflecting the significant value we create for our customers and clients.
For U.S. Medical, we continue to expect full-year 2021 adjusted earnings of at least $3.5 billion.
Underlying this updated outlook, we now expect the 2021 medical care ratio to be in the range of 84% to 84.5%, which includes our expectations for elevated medical costs for Individual special enrollment period customers.
Regarding total medical customers, we continue to expect 2021 growth of at least 350,000 customers.
For full-year 2021, we continue to expect at least $7.5 billion of cash flow from operations, reflecting the strong capital efficiency of our well-performing businesses.
Year-to-date, as of November 3, 2021, we have repurchased 26.5 million shares for $6.3 billion and we now expect full-year 2021 weighted average shares of approximately 342 million shares.
This includes the impact of the $2 billion accelerated share repurchase that we announced in the third quarter.
On October 27th, we declared a $1 per share dividend payable on December 22nd to shareholders of record as of December 7th.
We now expect 2021 full-year adjusted earnings of at least $20.35 per share, representing growth of at least 10% from 2020 consistent with our long-term earnings per share growth rate range of 10% to 13%, and we expect to grow 2022 adjusted earnings per share at least 10% off our raised 2021 guidance.

Summary:
Specifically for 2021, we are committed to delivering our increased guidance for full-year adjusted earnings per share of at least $20.35.
Looking into 2022, we expect to grow earnings per share by at least 10% off of our increased 2021 guidance of at least $20.35 per share.
Key consolidated financial highlights in third quarter 2021 include adjusted revenue growth of 9% to $44.3 billion, adjusted earnings growth of 20% to $1.9 billion after tax, and adjusted earnings-per-share growth of 30% to $5.73.
The net effect of these claim cost impacts produced a medical care ratio of 84.4% in the third quarter.
We are raising our adjusted earnings per share guidance for full-year 2021 to at least $20.35 per share, reflecting the strength of the quarter, the favorable impact of our year-to-date share repurchase and acknowledgment of the ongoing fluidity of the broader environment.
These dynamics are fully contemplated in our 2021 expectation for adjusted earnings per share of at least $20.35 and our 2022 expectation for earnings per share growth of at least 10% off this 2021 guidance.
We now expect full-year 2021 consolidated adjusted revenues of at least one $172 billion, representing growth of at least 11% from 2020, when adjusting for the divestiture of our Group Disability and Life business.
Underlying this updated outlook, we now expect the 2021 medical care ratio to be in the range of 84% to 84.5%, which includes our expectations for elevated medical costs for Individual special enrollment period customers.
We now expect 2021 full-year adjusted earnings of at least $20.35 per share, representing growth of at least 10% from 2020 consistent with our long-term earnings per share growth rate range of 10% to 13%, and we expect to grow 2022 adjusted earnings per share at least 10% off our raised 2021 guidance.