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In its service area, petitioner provided (and continues to
provide) health insurance to individuals and to groups who
entered into contracts with petitioner for health insurance
coverage and who paid premiums for the coverage. Consistent with
its social mission, generally the physical condition of
individuals and of the individual members of the groups applying
for health insurance was not a basis for petitioner to decline to
provide health insurance coverage.
As of January 1, 1987, not including health insurance
contracts that petitioner had entered into directly with
individuals, petitioner had outstanding 23,526 health insurance
group contracts.1
Generally, sponsoring organizations for each group contract,
such as employers, as well as the individual members of each
group were to pay premiums to petitioner, and petitioner was to
provide health insurance coverage to the individual members of
each group and, where applicable, to the spouse and to the
dependents of each member.2
1 Because a number of groups had entered into more than one
contract with petitioner, the 23,526 group contracts in effect on
Jan. 1, 1987, represented 12,579 separate groups.
2 The manner by which the payment of premiums to petitioner
with regard to each group contract was divided between the group
sponsor and its individual members was decided by each group, and
petitioner had no say in that matter. References herein to
“premiums” do not distinguish between the portion thereof to be
paid by a sponsoring group and the portion thereof to be paid by
(continued...)
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