- 9 - high quality care to members of the community, including elderly and disadvantaged persons, and it may conduct research and educational demonstration projects with various health care delivery systems. Petitioner was licensed to operate an HMO in the State of Utah and was subject to regulation by the Utah Insurance Commissioner. Petitioner used the same network of health care providers used by Health Plans. 2. IHC Group, Inc. In July 1991, Health Plans organized Group as a nonprofit affiliate for the purpose of establishing a federally qualified medical group model HMO.5 Health Plans was Group’s sole corporate member. Group was licensed to operate an HMO in the State of Utah and was subject to regulation by the Utah Insurance Commissioner. IHC had effective control of Health Plans, petitioner, and Group by virtue of its authority (direct and indirect) to elect their boards of trustees. Health Plans, petitioner, and Group shared the same officers and trustees. II. Petitioner’s Operations Health Plans structured its health plans in conjunction with 5 Group was considered a closed panel, medical group model HMO because Group contracted for physician services with physician medical groups and required its enrollees to agree to coordinate all of their medical care through a primary care physician (PCP) or so-called gatekeeper. In cases in which the PCP determined that an enrollee should be seen by a medical specialist, the PCP generally was expected to refer the enrollee to a specialist within the PCP’s medical group.Page: Previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Next
Last modified: May 25, 2011