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petitioner applied a 37-percent discount to estimated market rate
fees for SCPs.
2. SelectMed Plus
Petitioner’s SelectMed Plus plan offered enrollees access to
the SelectMed panel of physicians along with a point-of-service
option. SelectMed Plus enrollees choosing SelectMed physicians
received higher “preferred” levels of service, whereas SelectMed
Plus enrollees choosing a non-SelectMed physician received lower
“standard” benefits.
Consistent with its policy under the SelectMed plan,
petitioner compensated PCPs and SCPs on a discounted fee-for-
service basis settled against a capitation budget.
3. IHC Care
Petitioner’s IHC Care plan offered enrollees access to a
panel of approximately 2,600 PCPs and SCPs. Like the SelectMed
plan, enrollees in the IHC Care plan were required to select a
PCP for their general medical care and for referral to a SCP.
Petitioner compensated IHC Care PCPs and SCPs on a
discounted fee-for-service basis. During 1999, petitioner
applied discounts of 26 percent and 38 percent to estimated
market rate fees for PCPs and SCPs, respectively.
4. IHC Care Plus
Petitioner’s IHC Care Plus plan offered enrollees access to
the IHC Care panel of physicians along with a point-of-service
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