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option. IHC Care Plus enrollees choosing IHC Care physicians
received higher “preferred” levels of service, whereas IHC Care
enrollees choosing a non-IHC Care physician received lower
“standard” benefits.
Petitioner compensated IHC Care Plus 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.
5. IHC Direct Care
Petitioner’s IHC Direct Care plan offered enrollees access
to the IHC Care panel of physicians. However, enrollees in the
IHC Direct Care plan were not required to select a PCP or rely on
a PCP for a referral to a SCP.
Petitioner compensated IHC Direct 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.
6. IHC Direct Care Plus
Petitioner’s IHC Direct Care Plus plan offered enrollees
access to the IHC Care panel of physicians along with a
point-of-service option. IHC Direct Care Plus enrollees choosing
IHC Direct Care physicians received higher “preferred” levels of
service, whereas IHC Direct Care Plus enrollees choosing a non-
IHC Direct Care physician received lower “standard” benefits.
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