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maintenance organization (HMO)2. IHC was Health Plans’ sole
corporate member.
Health Plans was licensed to operate an HMO in the State of
Utah and was permitted to offer a variety of health plans to
individuals and employers in the communities that it served.
Health Plans did not own any medical facilities or employ any
physicians. Health Plans offered its plans to: (1) Individuals
and their families; (2) the employees of both large and small
employers; and (3) individuals covered by Medicaid. Health Plans
operated the largest HMO within the IHC system and the State of
Utah. In June 1985, respondent recognized Health Plans as an
organization described in section 501(c)(3) that is exempt from
taxation pursuant to section 501(a).
2 Utah Code Ann. sec. 31A-8-101(5) (1999 Repl.) defines the
term “Health maintenance organization” (HMO) as follows:
(5) “Health maintenance organization” means any
person, other than an insurer licensed under Chapter 7
or an individual who contracts to render professional
or personal services that he performs himself, which:
(a) furnishes at a minimum, either directly
or through arrangement with others, basic health
care services to an enrollee in return for prepaid
periodic payments agreed to in amount prior to the
time during which the health care may be
furnished; and
(b) is obligated to the enrollee to arrange
for or to directly provide available and
accessible health care.
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Last modified: May 25, 2011