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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. Petitioner’s IHC Senior Care Health Plan
Between 1993 and 1998, petitioner offered a Medicare “cost”
health plan known as IHC Senior Care (Senior Care plan). Between
1996 and 1998, Care offered a Medicare “risk” health plan of the
same name. Under petitioner’s Senior Care plan, Medicare
eligible enrollees who paid the required premium were entitled to
obtain physician services (and a number of additional services
not covered by Medicare) from petitioner’s panel of primary care
physicians and specialists and were relieved of the obligation to
pay any deductible or co-insurance payments under Medicare Part B
(physician services). Enrollees in petitioner’s Senior Care plan
retained their eligibility for Medicare Part A (hospital
services) and continued to pay Medicare Part A premiums to the
Government.9
9 Under Care’s Senior Care plan, Medicare eligible enrollees
agreed to obtain their Medicare Part A (hospital services) and
Medicare Part B (physician services) from Care’s network of
providers and Care was compensated by the Government for each
enrollee on a prepaid, capitation basis.
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