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Care, and Group shared many of the same corporate officers and
trustees. IHC and its affiliates conducted their strategic
planning, established their priorities, and attempted to
implement their business plans on an enterprise basis, even
though each entity had its own management team and budget.
II. Petitioner’s Operations
A. In General
Petitioner operated as a State-licensed HMO offering health
plans known as SelectMed, SelectMed Plus, IHC Care, IHC Care
Plus, IHC Direct Care, IHC Direct Care Plus, Health Choice, and
IHC Access. Petitioner collected premiums from its enrollees
and, as petitioner did not itself provide health care services
(as explained below), it arranged for its enrollees to receive
comprehensive health care services, including preventive care,
outpatient services, inpatient hospital services, emergency
services, out-of-area services, and miscellaneous services such
as ambulance and pharmacy services.
Petitioner, Care, and Group marketed several different
health plans encompassing a range of health services at varying
prices. Petitioner offered its various health plans to: (1)
Individuals and their families; (2) employees of both large
employers (more than 50 employees) and small employers (2 to 50
employees); and (3) individuals covered by Medicaid.
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