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by each group because at any time a group could stop paying the
premiums owed to petitioner which would result in the
cancellation by petitioner of the contract.
Groups whose health insurance group contracts with
petitioner were terminated were placed by petitioner on a
prospective customer list that was used by petitioner in
subsequent years to contact the groups and, where appropriate, to
seek renewal of the contracts.
As of January 1, 1987, in petitioner’s 21-county service
area no other health insurance company maintained a better
provider network (consisting of hospitals, doctors, and other
providers of health care) or offered better health care benefits
at premium rates comparable to those of petitioner, and in its
service area petitioner maintained a dominant share of the
medical health insurance market.
By 1987, however, the national health insurance marketplace
was experiencing rising health care costs, the emergence of new
health care products, and the continued growth of alternative
health care product delivery services such as Health Maintenance
Organizations (HMOs), Preferred Provider Organizations (PPOs),
and health insurance plans administered by third party
administrators.
As a result, by 1987, petitioner faced increased competition
from HMOs and from PPOs.
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