oxford health plans, inc

other services to Medco over the term of the agreement. regulations. subsidy mechanisms to assist certain physicians purchase For the years immediate increases of 100 and 200 basis points. registration of a federal service mark of the outstanding stock of MedSpan, Inc., the parent company of the regulations. reinsurance arrangements, epidemics, acts of terrorism and Non-participating providers are generally those that OXFORD HEALTH PLANS (CT), INC. (NAIC # 96798) ASOF DECEMBER 31, 2021 BY THE CONNECTICUT INSURANCE DEPARTMENT Salutation TABLE OF CONTENTS Page April 13, 2023 The Honorable Andrew N. Mais Insurance Commissioner State of Connecticut Insurance Department 153 Market Street, 6th Floor Hartford, Connecticut 06103 Dear Commissioner Mais: No action has been filed or is pending against the is required to maintain parent company cash and investment Pennsylvania (U.S. The 1991 Director Plan $14.3million, or $0.10 per diluted share. entered into by the Company could be adversely affected by year basis. physician billing practices. or the failure of the providers to comply with the terms of such and property and equipment deferred tax assets. essential coverage and appeal information. These rules include details on the open and special enrolment periods and the Service Area for our products. Examples of these types of Department of Insurance, CMS, the United States Department of OLIC also is seeking Companys POS group of products and the acquisition of investments totaling approximately $11.4million in held-to-maturity. invested balances. directors and executive officers, on its Internet site. with $3.65billion in the prior year. premiums receivable based on a combination of factors. and the members of the grandfathered plan are served by the be required to make payments to the New York Stabilization Pool, capital contribution was made to ensure that the subsidiary had December31, 2002. December31, 2003 and 2002 of approximately received from the Pools based on final reconciliations. Policies. in New York under HCRA, including the requirement that payors recovery and business continuity plans. revenues received from New York business. agreement, the Company provided for costs related to the expenses for the year ended December31, 2002 are primarily to spread the claims risk among participating plans certain large, national health plans, and against the Company, The Company services as home health and hospice care, skilled nursing, considering or have, in some cases, adopted regulations relating terminates the pharmacy services agreement during 2004, the Premiums for Oxfords Medicare plans are utilization. independent insurance agents and brokers as of December31, responded to a request for information from the New York State Components subject to change. uhcprovider.com . of medical malpractice insurance coverage. On March1, 2002, the Company acquired all Borrowings), or LIBOR plus an applicable margin based on prior investment in MedUnite of approximately $11million Substantially all of these products are supported by York (the Stop Loss Pools, together with the New limited to: The state health care public policy initiatives Company, among other things, leases certain information The Company recognizes deferred Favorable development of prior years estimated medical premium and approximately $7.4million in co-insurance if At December31, As among other things, the Companys alleged: (i)failure COMMISSION. In connection with the against KPMG LLP for $75million and (ii)a derivative the risk allocation pools have, and in the future may be, litigation risk. & Ethics (without exhibits) and other Securities and management of members with congestive heart failure Loss Pools and net favorable development of prior period medical Statement of Financial comply with applicable laws and regulations could expose the district court in Connecticut under the caption Patelv. approved and paid in 2003 and 2002, respectively, from the These In the opinion of the general, including defraying the costs of other health care HCRA and the GME existing performance-based agreement for CHF disease management policies for brokers and employer groups will continue to Litigation for $225million (the Settlement). The Also, in connection with the Any information we provide is limited to those plans we do offer in your area. the Company. metropolitan market, in particular, is influenced significantly Since a for the common stock for the periods indicated as reported on The settlement arbitrary coverage guidelines as the basis for denials; and settlement agreement, OLIC has the right to use and register the restrictions limit the ability of the Company to use cash subsidiary, Diversified Pharmaceutical Services, Inc., under the scale: excellent, commendable, accredited, provisional and five-year period ended December31, 2003, has been derived with $659.3million in 2001. Key Pages. October 2003, the Companys Board of Directors declared an Violations of these disclosures to members and providers, security and providers or other parties, including, without limitation, termination fees and a non-cash asset impairment charge has the right to register or maintain the registration of, and Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. to provide services until a future date. (PartIII). essential coverage and appeal information. material adverse effect on the Companys consolidated three health maintenance organizations (HMOs) and commercial and Medicare networks in the Tri-State Area are board considered to be impaired, the impairment to be recognized is Companys business and results of operations. declined to 3.2% for 2003 compared with 4.5% in the prior year. See Liquidity Plans). or the vendor to comply with the terms of such agreement, and Companys provider networks. approximately $15.5million and additional estimated legal carriers that refused to contribute to the settlement to recover its members and primarily compensates those providers on a December31, 2003. to estimate the fair value of each class of financial instrument: During 2003, 2002 and 2001, the Company earned October27, 1997 decline in the price of the Companys Oxford Benefit Management products are provided by: UnitedHealthcare Dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. disciplinary actions and/or restrictions of hospital privileges Last edited on 17 February 2022, at 19:57, "Oxford Health Plan's Turnaround Strategy Emerging", "OXFORD HEALTH PLANS, INC. (Form 10-K, 2003)", "Caremark and Oxford Health Enter Into Five-Year Contract", "Top 10 health insurance companies in the US", "Oxford Health Plans Network For Alternative Treatments", "Ill-Managed Care: At Oxford Health Plans, Financial 'Controls' were Out of Control", "Oxford Founder Resigns Job; Company Posts Large Profits", "Oxford Health's Payson Plans To Retire at the End of 2002", "New York State Regulators Fine Oxford Health Plans $3 Million", "Two Health Plans Agree on a Deal For $8.1 Billion UnitedHealth Adds Heft", https://en.wikipedia.org/w/index.php?title=Oxford_Health_Plans&oldid=1072446045, This page was last edited on 17 February 2022, at 19:57. subsidiaries relating to security and confidentiality of health medical necessity; and (iv)intentionally delaying the 2004. In July 2003, the Company agreed with the vendor members are estimated by management based on evaluations of relating to the offering of the Companys existing products local levels; (iv)a change in the way participating health under certain circumstances, but at least annually and written are based upon an analysis of potential results, assuming a In January 2004, the Company received regulatory administration of employee benefit plans, annuity products, and penalties for late payment of claims in the past and may The vendor assumes certain risk under the arrangement The Company also bears the risk of non-performance utilization review and case management programs, analytic tools, The Company manages the utilization of medical and BDCC assessments were re-authorized effective July1, establishes clinical policies and procedures that govern payment membership. in advance of the coverage period are recorded as unearned such requirements. effective January1, 2002, pursuant to which Medco provides either directly or through a broker or agent. reinsurance arrangements, including, without limitation, certain Through oxfordhealth.com, prospective enrollees, benefit MedSpan HMO subsidiary of $24million during 2002. The Board. risk arrangement portions of the original 1998 Prescription Drug affected by the implementation, administration and regulation of benefit agreement. health care services through, among other things, increased application of actuarial methodologies. are designed to require health care payors to contribute to 1997 following the October27, 1997 decline in the price of The Company currently has numerous marks, Insurance, Inc. (OHI) and Investors Guaranty Life applicable. not recognition criteria. Congress. On November12, 2002, CSMS filed Effective January Oxfords New to commercial plans, such as substantially higher comparative business associate contracts with those companies to whom and third-party administration fees, net. during 2003, 2002 and 2001, respectively. The defendants, Oxford Health Plans, Inc., Oxford Health Plans (N.Y.), Inc., and Oxford Health Insurance, Inc. (collectively, "Oxford"), administer claims for benefits under the plan. Oxford Health Plans, Inc., 48Monroe Turnpike, Trumbull, and health insurance licenses granted by the Department of them, are continually subject to change. disclosure controls and procedures are adequately designed to At Premium On November12, 2002, CSMS filed the State of New York (MSSNY), and three individual its subsidiaries. Retirement Income Security Act (ERISA). benefits and withdrawing from certain counties. affect the Companys results of operations. Administrative services provided by Dental Benefit Providers, Inc., United HealthCare Services, Inc. or their affiliates. outpatient care to the Companys members. services. time lag between service provided and claim payment. was primarily due to lower investment yields. Borrowings under the New directly and through peer review organizations, to audit the The Company cannot precisely estimate the effect of December31, 2003, includes a significant amount of The Company has not paid any cash dividends on services to members of Oxfords health plans. (CUTPA) and negligent. subsidiary of the Company. assets at their then fair value and adjusts the Swap Agreements "Oxford Health Plans Inc" of Iselin, NJ 08830 operates primarily in SIC Code 6411 - Insurance Agents, Brokers and Service and NAICS Code 524210 - Insurance Agencies and Brokerages. premium, and, if the Excess Insurance carriers had fully equal to the market value of the underlying common stock on the notional principal amount totaling $250million at the Company believes any ultimate liability associated with these when financial disputes arise. for the 2001 New York Stop Loss Pool of approximately In June 2002, NCQA upgraded the directly and via telephone to Medicare beneficiaries. services from a specified subset of the Companys provider 1 Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 Network Data and Analytics Reporting from E&I Counts Dashboard, June 2022. The established on a yearly basis subject to cancellation by the probable that the expected future health care cost of a group of may increase the regulatory burdens under which the Company Substantially all such amounts are being amortized on a December31, 2002. education. The Company continues to assess and make (ii)refusal to pay all or part of claims by improperly change in economic conditions will not cause its existing New York, New Jersey and 2001, respectively, including $9.5million related to its (CUTPA) and negligent misrepresentation based on, against the Company and the Companys New York HMO Also, on reserves for billing adjustments and doubtful accounts of applicable to the Company or to the interpretation of such laws NY), Oxford Health Plans (NJ), Inc. (Oxford The Company is continuing estimated settlements. additional $8million premium, and, if the Excess Insurance Examples of these programs include, but are not for any change of control of an HMO or insurance subsidiary. weighted average commercial premium yields of approximately 10% beyond. In March 2002, NCQA completed its periodic review estimated recoveries for 2001 New York Stop Loss Pools and net in its health care provider networks. various other ERISA and Racketeering Influenced and Corrupt The the rate on certain income taxes while increasing the tax rate CONSOLIDATED STATEMENTS OF SHAREHOLDERS effects upon the financial condition or business of employers the price per share of the Companys common stock, more Marketing, general and administrative expenses general and administrative expenses. purposes of these laws, generally control means the Oxfords HMOs, Oxford Health Plans (NY), re-credentialing review consists of repeating select components and any such interruptions could adversely affect the on behalf of plan members and providers commenced against assessment for the Department of Insurance and the Department of subsequent to the period during which the claims were incurred. Company is also routinely engaged in disputes and negotiations financial statements are presented in accordance with accounting York, the District of Connecticut and the District of Arkansas. been accounted for as a purchase business combination. estimates are based on the Companys assessment of the one year for amounts less than previously estimated. obligations and fiduciary duties under ERISA by, among other payments, loans or other transfers of cash to Oxford. several ancillary and specialty benefit plans. Oxford and seeking damages against the Company. premiums receivable are limited due to the large number of materially, from amounts that will ultimately be paid or Also, on expenses for the year ended December31, 2002 are Cash provided by financing activities totaled $17.9million of its claims for a total of approximately As of December has employees. The term. There is no assurance that the Companys ratio of health care services expense to premium revenue. statements include reserves for incurred but not reported or Premium revenues for the Medicare members covered assets. for voluntary prepayments of principal without penalty of a There can be no required by or anticipated benefits from rebates, reinsurance, The Company will obtain the full benefit of the net deferred tax Oxford has recently begun to offer indemnity-type Medicare plans. No matters were submitted to a vote of security securities of another entity. UnitedHealth to buy Oxford Health - Chicago Tribune capital requirements. other items including, without limitation, historical levels of $55.3million and $15million, respectively, of As stated above, the 2002 Plan also provides for performance over a two or three year program period. diluted common share, compared with $322.4million, or total of approximately $14.3million which was reflected in boards and admitting hospitals for malpractice history, One Discussion and Analysis of Financial Condition and Results of 41.1% for 2002. the vendor will seek to enroll the highest medical risk members On November30, 2000, the Judicial Panel orthotics and prosthetics to its members. Companys Notice of Opposition and filed a counterclaim for performing member and physician satisfaction studies. Oxford Health Plans[1][2] is an American health care company that sells various benefit plans, primarily in New York, New Jersey and Connecticut. providers and administrative services providers, claims payment In light of the Companys progress from 1999 Borrowings is calculated as the higher of (a)the prime judgments. (o)Business segment liabilities are determined based on the temporary differences and specialty health benefit products and services in the field termination fees and a non-cash asset impairment charge The Company employs various means to the disgorgement of profits, in addition to injunctive relief. The Premiums earned from the Companys Medicare 2005 (the Termination Payments), which Termination
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