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addition, Health Plans, petitioner, and Group entered into
provider agreements with Davis Hospital and Medical Center,
located in Davis County, Utah, because there were no Health
Services hospitals in the immediate area.
During the 2-year period including 1997 and 1998, UMC
accounted for approximately 50 percent of all inpatient hospital
services provided to petitioner’s enrollees by independent Utah
hospitals. During the 2-year period including 1997 and 1998, UMC
accounted for approximately 42 percent of all outpatient hospital
services provided to petitioner’s enrollees by independent Utah
hospitals.
Petitioner maintained a Core Wellness Program under which
its enrollees were provided health care information and a variety
of health care services at no additional charge. Petitioner’s
Core Wellness Program included annual worksite health screenings,
group health risk profiles, a 24-hour nurse hotline, ergonomics
assessment and consulting, worksite health seminars, and a health
newsletter. Petitioner did not offer its Core Wellness Program
to the general public.
B. IHC Senior Care Health Plan
Between 1996 and 1998, petitioner offered a Medicare “risk”
health plan known as IHC Senior Care (Senior Care plan). Under
petitioner’s Senior Care plan, Medicare eligible enrollees agreed
to obtain their Medicare Part A (hospital services) and Medicare
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