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During 1999, petitioner’s enrollees represented
approximately one-fifth of Utah’s total population and
petitioner’s IHC Access plan enrollees constituted nearly 50
percent of Utah residents that were eligible for managed Medicaid
benefits.
Despite petitioner’s open enrollment policy and the wide
acceptance of its plans by individuals and groups alike,
petitioner’s operations differed materially from the operations
of Sound Health Association HMO and Geisinger HMO.
Significantly, petitioner did not own or operate its own medical
facilities, did not employ (to any significant extent) its own
physicians, and did not offer free medical care to the needy.
Additionally, petitioner did not institute any program whereby
individuals were permitted to become members while paying reduced
premiums, and, aside from the few free health screenings that
petitioner conducted in 1999, petitioner did not provide or
arrange to provide any free or low cost health care services.
The record does not reflect whether petitioner applied surplus
funds to improve facilities, equipment, patient care, or to
enhance medical training, education, and research. See Rev. Rul.
83-157, 1983-2 C.B. 94.
Importantly, the record does not reveal why petitioner
applied an adjusted community rating methodology to determine
premiums for individual and small employer group enrollees while
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