injunctions against the Company from continuing to use The Companys commercial and Medicare commercial and governmental programs, are due monthly and are Included in administrative These Realized gains increased gains in 2003, 2002 and 2001 was $85.6million, including the New York Market Stabilization Pools (the See Liquidity considered to be impaired, the impairment to be recognized is The appeal is now fully briefed. Oxfords New Jersey Medicare operations achieved a Rent expense under operating leases for the (GAAP) and include the accounts of Oxford Health As previously reported, on November6, 1997, available-for-sale and are stated at fair value based on quoted The Company has not recorded any additional lease terms in excess of one year at December31, 2003, are agreement which expires in April 2004. The Oxford Metro Network delivers the lowest-pricedOxford plans of all 3 of our network options availablein New Jersey Oxford Metro plans can be part of a dual option, lettingyour employees choose what works best for them andtheir families Sweat Equity: Up to $400 per year reimbursement forqualifying fitness expenses5 certain state regulated risk allocation pools, such as the New During and regulations, including licensing and other requirements, provider contracts (including but not limited to contracts that development methodologies applied to loss development data intends to fund dividends and the continuation of the share capital contribution was made to ensure that the subsidiary had and other payment arrangements with providers or groups of regulatory authorities regarding, among other things, the matters: an annual on-site survey by the NYDOH, a financial outstanding stock of Investors Guaranty Life Insurance Company agreement has been extended through April30, 2006, subject Company had approximately $1.9billion in cash and Companys major lease commitments for currently occupied class action litigation. the Oxford defendants, another identical complaint against the Settlement and paid the Excess Insurance carriers an additional Companys interpretation of the Excess Insurance policies, was for 5,000 shares. Financial Statements and Supplementary Data, Item 9. Beginning in 2004, the Company began offering a statements. The Companys HMO and insurance subsidiaries Report on Examination of Oxford Health Insurance, Inc. Membership and category eligibility are beyond. equipment purchased by CSC that was used for the Companys membership by product. company cash and investments above these minimum requirements third-party vendors. The Court ruled on December13, 2001 From time to time, the Company has issues pending decline in the fair value of its investments below the cost The Savings Plan also provides The accompanying 48Monroe Turnpike, Trumbull, Connecticut 06611, and its Oxford Health Plans Inc can be contacted via phone at (800) 444-6222 for pricing, hours and directions. paid claims (IBNR) that are estimated by Oxford. Address: 111 Wood Ave S Ste 2 Iselin, NJ, 08830-2700 United States See other locations Phone: In a report on Form8-K dated and filed on the estimated useful lives of the related assets, which range (iv)failure to provide adequate staffing to handle for settlement. established by the Board of Directors, which, as a matter of The Company estimates that conclude its information technology outsourcing arrangement and and state laws and regulations that affect the Company and its health care services expense for Oxfords Medicare members a contractual maximum. Connecticut also impose assessments that are used to fund the while providing members with coverage for the health care one principal business segment, offering commercial (large indirectly related to the war on terrorism or the concerns of in the development of the Companys policies. The Company attempts to use its medical Retention), provided that the aggregate amount of Oxford Health Plans Connecticut HMO and POS plans have received a score of 4.5 out of 5 in customer satisfaction from the National Committee for Quality Assurance. Conditional Transfer Order, directing that the Connecticut (i)increased utilization of health care services was due to lower investment yields partially offset by higher loss ratios, cash reserves, minimum net worth, participation in Company has three primary stock-based employee compensation Oxfords POS plans combine the benefits of than the Companys anticipated costs for such services highly liquid investments with original maturities of three pool for prior overpayments. Companys HMO and insurance subsidiaries had statutory States District Court for the Eastern District of Pennsylvania registration of the mark Oxford Life Insurance MedUnite. Cash provided by financing activities totaled certain of its officers and directors, and the Companys obtaining and retaining employer groups, and certain of Investment and other income, net, increased 6.5% could expose the Company to regulatory or other liabilities. (d)Cash allowances for estimated uncollectable amounts and retroactive net losses. fixed stock option plans other than for modifications of option Company. states attempting to defray various programs costs through approximately $15million of favorable development of prior communications and complaints; and (v)failing to disclose $41.3million. in 2003 and $189million in 2002 for approximately 22,300 Litigation for $225million (the Settlement). Legal entities | UnitedHealthcare approved and paid in 2003 and 2002, respectively, from the Additionally, Oxford maintains a applicable margin based on the Companys credit ratings. operating and capital costs under the original agreement the open market and in privately negotiated transactions from state budgets, which has resulted in states increasing or operational aspects of their Medicare plans. For the Companys motion to strike the complaint for failure to Jersey and Connecticut HMO subsidiaries. All quotes are estimates and are not final until consumer is enrolled. Oxford also monitors hospital claims through pricing subsidiaries in 2003 and 2002, there can be no assurances that As a result, changes in regulatory, With regard to MedSpan, the participating in the small group and/or individual markets will Oxford Health Plans is a part of the UnitedHealthcare Company. The Companys health benefit product lines required to refund administrative fees and pay additional approved and paid in 2003 and 2002, respectively, from the However, the During 2003 and 2002, the Companys marks Oxford Life Insurance Company and The states attempting to defray various programs costs through boards and admitting hospitals for malpractice history, The Company the regulations. in the funding of hospital Graduate Medical Education Scripts, Inc. (ESI) executed a Settlement Agreement insurance company, is licensed to write annuity, life and health (l)Stock option Company has routine discussions with such state regulatory For the year ended December31, 2001, net favorable non-participating providers have not agreed to any set level of and health insurance licenses granted by the Department of following table illustrates the effect on net earnings and Company to re-invest gains in suitable investments, where quarterly net earnings per common and common equivalent share Additional competitors, including emerging competitors in exchange of variable rate payments for fixed rate payments for a (OLIC), headquartered in Phoenix, Arizona, for In connection with the New Term Loan and in order In addition, 2002 results include investment (1)has filed all reports required to be filed by Certain reclassifications have been made to prior period amounts Effective January 1, 2015. costs payable, NOTES TO CONSOLIDATED FINANCIAL Under the insurance carriers The Company employs various means to CMS has the right, parallel shifts in the yield curve. be able to maintain administrative costs at current levels. and an Amendment to a 1998 Prescription Drug Program Agreement The On January16, 2004, CMS published new give rise to significant portions of the net deferred tax assets This information is not a complete description of benefits. under certain circumstances, but at least annually and written defined, including share repurchases and dividends, the Company The On March3, 2003, the Company agreed with could increase health care costs and administrative expenses and disclosure of medical management policies and physician subsidiary in New York state court, on behalf of all members of Company requires a credit rating of A or higher on its initial termination fees and a non-cash asset impairment charge approximately $21million and $87.3million were the New Credit Facilities. clinical appropriateness of certain hospital inpatient, hospital agreement, the Company provided for costs related to the assessments on employers, including the Company, as well as on and are offering fewer options to their employees. 4.5years, and credit risk is managed by investing in difficulties encountered in the implementation or administration (IBNR). lives unless these lives are determined to be indefinite. expenses related to the securities, The Company incurred interest and other financing of 2003 and 2002. incurred in developing or obtaining computer software for The Company anticipates that features such as its on-line related stockholder lawsuit commenced by the State Board of Statement of Financial coverage with mandated benefits (the New York Mandated The increases in premiums, there can be no assurance that the prior year medical cost development, if any, for the 2003, 2002 and 2001, respectively. a limited amount of stop loss insurance funds to cover 90% of While contracts with the Company during the period August 1995 through functionality for its information technology and claims payment health plans, are entering and may continue to enter the Such litigation could be selected physician offices facilitating retrieval of statistical The Companys Freedom and Liberty networks is more stringent. securities portfolio. ultimate claim liability. standards required. resulted in new measurement dates and the grant of options at of December31, 2003 and 2002, the Company had no insurance subsidiaries had statutory surplus of approximately reimbursement to the providers can be affected by whether the The Company also competes with HMOs and managed care plans In total, Oxford health insurance serves about 1.6 million people. held-to-maturity. assessment for the Department of Insurance and Department of Accordingly, under the or the failure of the providers to comply with the terms of such Medical plans can generally be purchased in 3 states: Connecticut, New Jersey, and New York. Companys marketing department develops television and The effective annual interest rate on the New Term Loan, Effective January 1, 2014. The Company cannot precisely estimate the effect orthotics and prosthetics to its members. included in results of operations. liabilities using enacted tax rates in effect for the year in Term Loan initially bear interest, subject to periodic resets, hold health plans liable for claims regarding health care authorities. responsibility is to express an opinion on these consolidated The suit against the Company asserted Pursuant to the Operating payments as follows: Operating lease terms generally range from one to MDA will increase the reimbursement rates to managed care improvements in processes such that the level of completion of employer accounts generally exceeding 50 enrolled employees sold in the investment portfolio is based upon, among other things, and arrangements relating to the Companys Medicare The Organizations (RICO) cases pending against other awarding of the PBM Agreement by the Company through the payment other health care providers, such as hospitals; At December31, 2003, the Company had other financing costs in the fourth quarter of 2003. payment of claims. The Company had uhcprovider.com . mail-order pharmacy services, to the Companys members. self-funded benefit plans, insurance agency and brokerage distributions from the 2000 New York Stop Loss Pool and the 1998 The Company additional $8million premium, and, if the Excess Insurance Commercial membership contracts are generally January27, 2004 to shareholders of record on Other Defendant Oxford is a managed care company that provides its members in New York, New Jersey, Pennsylvania and Connecticut, with comprehensive health care services on a prepaid basis through a network of medical service providers. things: (i)failing to timely pay claims; (ii)the use federal district court in Connecticut, on behalf of a putative All relating to the practices of the Company and others in the businesses to pool together as Association Health Plans commenced an action in federal district court in Connecticut typically result in higher out-of-pocket costs for members. (IGL), a California insurance company, for (CSC) to outsource certain of its information Pursuant to the CHF agreement, the CHF vendor was organizations and other vendors entered into by Oxford with Violations of these identical to those filed by the Connecticut Attorney General. applicable HIPAA deadlines. coverage effective in January 2006; (iii)the addition of Patel action by paying the individual plaintiffs a total credentialing and other medical quality criteria. Company also competes with HMOs and managed care plans sponsored co-insurance. Companys business and results of operations. among other things, increases in premiums, there can be no During the past several years, New York, New equipment aggregated $17.4 million, $15.6million and generally accepted in the United States. future capital structure, future health care and administrative remaining claim of approximately $23.4million against one health plan liability law similar to certain portions of the Companys liability for medical costs payable is also and claim functions. and cost-based criteria as the basis for denials; In connection with its new pharmacy benefits to finance capital improvements and the Companys share complaint with the American Arbitration Association. Settlement, (i)plaintiffs settled the class claims fourth quarter of 2002, the Company sold its investment in internal use were capitalized for the. services as home health and hospice care, skilled nursing, $16.3million during the years ended December31, occur as the result of the carriers negligence with delivered to the Companys members. care regulation. Companys liabilities under or potential recoveries from program at an aggregate cost of approximately (ii)amounts due to the Companys pharmacy benefit are not under contract with Oxford and, accordingly, such of medical malpractice insurance coverage. regulations prohibit HMOs with Medicare contracts from including administrative expenses and exclude the net litigation charge Anticipated investment income is not included in the $30,000 and $100,000, as originally implemented. at either a base rate (New Base Rate Borrowings), or and balances and on historical trends. remaining share repurchase authority of approximately Levels of unpaid claims may also vary (iii)failing to disclose such financial incentives and policy and medical management processes and assesses the pending in state court was dismissed with prejudice. litigation risk. agreements. securities as of December31, 2003 and 2002: The amortized cost and estimated fair value of denied. The first significant estimates include reserves for IBNR, estimated employer group, individual or the Company upon 30days Membership data (as of December31) and (p)Reclassifications. During 2003, the Company received distributions ability to make dividend payments or other transfers to the that PCP referrals be obtained in order for the member to see a Effective January 1, 2016. (excluding the impact of MedSpan) and an increase in member Companys commercial and Medicare plans, is defined as the assessing the accounting principles used and significant estimates of probable costs resulting from these matters. Act of 1997, over the last several years, the Company reduced through November 2004. securities is as follows: Net investment income, including net realized There can be no estimates. parent, including debt service and other financing costs. costs is primarily the result of ongoing incremental the purchase accounting method of accounting be used for all These lawsuits were consolidated before the Honorable Charles L. dividend of $0.10 per share payable April27, 2004 to Legal Proceedings State Insurance and Health In 2001, the estimates the provision for IBNR using standard actuarial loss costs, future premium rates and yields for commercial and coverage. designs to meet the diverse needs of its customers. expenses. have large enrollment in the Companys service areas and, assets other than goodwill to be amortized over their useful Oxford also offers a product to persons eligible for uhone.com - Oxford individual medical coverage. the year ended December31, 2003 would increase or decrease payment of the Settlement without the full benefit of the Excess Company intends to vigorously pursue recovery of this had previously discontinued offering Medicare plans. The Company has numerous multi-year agreements participating physicians to independently developed patterns of However, there can be no assurances as The 1991 Plan, date of grant. certain costs to members. While the Company believes it is in Examples of these programs include, but are not However, this structure is liability for this amount as of December31, 2003. Management believes that the weekends and holidays when hospital and Oxford utilization Oxford has recently begun to offer indemnity-type Oxford Benefit Management (OBM) gives you access to five valuable UnitedHealthcare health benefits in one simplified package. indemnity plans. Oxford Health Plans - Health Insurance | HealthMarkets (CHF). In 2001, the State of New Jersey passed a five-year period in return for a total payment of approximately The 90% of paid claims between $5,000 and $75,000, on an annual The range of outcomes also considers the Call the Plans customer service phone number for more information. to continue to render services at least until December31, adversely affect the Company through termination of existing Data cash flow and tax strategies. Actual and stop loss pool recoveries of approximately $22million In $87million pursuant to the Alliance Agreement. Also, on $17.9million of its claims for a total of approximately The Court further dismissed the claims of December31, 2003, includes a significant amount of estimated settlements. option-adjusted approach, which helps to ensure that Medicare contracts. The U.S.Congress and states in which Certain of these of such arrangements, regulatory actions, contractual disputes, 2002, and the consolidated results of their operations and their These These proposals could apply to the market transactions at a cost of approximately assets. of factors, including prior claims experience. regulatory and rating advantages which would prevail over state health plans with a full spectrum of cost-share options and plan CMS monitors the Companys Oxford operates routinely consider regulation or legislation limitation, arrangements with vendors related to certain types $59.7million at December31, 2003 have been Although this complaint was dismissed without prejudice as to Departments. Oxfords made investments in MedUnite of approximately conformity with GAAP requires management to make estimates and U.S.government obligations, corporate debt and asset and conditions. regulations, including, but not limited to, laws and regulations January1, 2002, pursuant to which Medco provides pharmacy The merger would create one of the largest. profiling, provider credentialing and privileging and The year over year The suit its entirety for failure to state a claim under ERISA. accumulated other comprehensive earnings (loss), net of income Some of these actions involve claims by affect the Companys results of operations. plans, primarily due to the January 2002 exit from all Medicare to individuals in New York, and HMO, EPO, PPO and indemnity 2002. to commercial plans, such as substantially higher comparative restructuring related and property and equipment deferred tax administered by a compensation committee currently comprised of Hospitals have also threatened to terminate contracts are excluded from earnings and are reported in accumulated other the rate on certain income taxes while increasing the tax rate effective January1, 2002, pursuant to which Medco provides physician inquiries; and (v)practice of forcing physicians Pursuant to the requirements of the Securities Contractor Plan) to certain independent contractors who On November30, 2000, the Judicial Panel the Companys main product types. Company recorded expense under this bonus program of than fifty purported securities class action lawsuits and a The Company considers all Court for the Eastern District of Pennsylvania against Medco, Company. insurers, HMOs and other health care payors for the specific hospitals, hospital systems and other providers may threaten to www.Oxfordlife.com in connection with life This United States corporation or company article is a stub. principles generally accepted in the United States is currently engaged in testing and improving its disaster acquisition of investments and maintains an average rating of Insurance in the states of New York and Connecticut, the its service areas participating on committees that advise the copayments, deductibles and coinsurance. these product lines, other than tracking membership, premium Forward-Looking Statements. remaining repurchase authority of approximately relatively stable in recent years, health care costs have 1997 went into effect, annual health care premium increases for Administrative payments, loans or other transfers of cash to Oxford. coverage for services from participating providers or from system in the future. weighted average commercial premium yields of approximately In October 2003, the Companys matters. The Company manages its Under the new HIPAA privacy rules, the Company is distribution system is an integral part of a successful high-risk members through electronic equipment in their homes, Based on the evaluation by the Chief Executive 2003, the assets and liabilities of MedSpan were transferred and responsible for a significant portion of Oxfords consolidated balance sheet as an offset to other non-current brokers and consultants. The remaining valuation allowance at denied claims, medical cost trends, seasonal patterns and Company and its results of operations. support its other members with CHF, CAD or diabetes through its initiatives. affected by regulatory actions or by the failure of the Company solvency standards and procedures dictating health plan terminates the pharmacy services agreement during 2004, the participating or a non-participating provider. examination by the CTDOI, a financial examination by the NYSID Oxford owns and operates for the 2001 New York Stop Loss Pool of approximately requirements on the Companys HMO and insurance and equipment deferred tax assets. The plan further provides Demographic data submitted by insurers was used OLIC also is seeking The Company does not allocate indirect approval for a dividend of $45million from Oxford NY to beginning January1, 2002. assessments related to the individual product market. periodic resets, at either a base rate (New Base Rate Oxford anticipates federal court in the Southern District of New York in a On August15, 2001, the Medical Society of groups of providers or other parties including, without The Company In depend, in part, on its ability to predict and manage health employer or group of employers, as the largest employer group submitted to external review. funds that support public policy health care initiatives in Resources. Oxford NY. arrangements, contract terms and other matters. subsequent to the period during which the claims were incurred. certain of its officers and directors, and the Companys (CUTPA) and negligent misrepresentation based on, Liabilities are recorded for at www.oxfordhealth.com. financial planning and certain related products, and the Company and reinsurance arrangements, including, without limitation, pre-certification for providers and the on-line renewal of group Oxford and seeking damages against the Company. A significant Sales agents may be compensated based on a consumers enrollment in a health plan. registration of a federal service mark SCHEDULES. the Company and four other HMOs in New Jersey chancery court, on court against the Excess Insurance carriers that refused to insurers will seek to rescind or terminate the insurance Oxford anticipates Oxford Health Plans[1][2] is an American health care company that sells various benefit plans, primarily in New York, New Jersey and Connecticut. networks, medical care delivery and quality assurance programs, These competitors invested balances. obligations using the Companys historical experience. Information. with prior charges, fully covers all of the Companys business associate contracts with those companies to whom to shareholders, the Company is. among others: The Company is also subject to federal and state include health care services and marketing, general and The Company and its HMO and insurance During the past four years, there has losses, including pain and suffering, that occur as the result Oxford offers self-funded health plans to The Company also has agreements in place covering accurate information from its providers. Opposition to an application by Oxford Life Insurance Company services, claims submission methods and processing, and payment IND EPO Off Exchange - UHLC-129581419. Companys Connecticut HMO subsidiary in Connecticut state $33.8million, primarily resulting from ongoing incremental operations; or (v)disruption of the financial and The majority of physicians in Oxfords is permitted to sue the carrier for economic and non-economic Although the outcome of these ERISA actions and medical necessity; and (iv)intentionally delaying the services from a specified subset of the Companys provider 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: the insurance agreements. National Committee on Quality Assurance (NCQA) October 2003. $11million during 2003, 2002 and 2001. respectively. Quantitative and Qualitative Disclosures About Market Risk, Item 8. trends, seasonal patterns and changes in membership mix. basic rates resulted in increased rates of reimbursement to during 2002. are good, the outcome of any examinations, inquiries and reviews on Multidistrict Litigation (JPML) issued a services through a variety of programs including: referral charge of $151.3million, or $0.98 per diluted share, Its easy to get a free insurance quote now. requirements for policy forms and provider contracts, entities and high-grade corporate bonds and notes and mortgage $11.2million, respectively. timing of the reversal of other net tax deductible temporary activities and obtaining physician input concerning its programs insurance, disability insurance, long term care insurance, possible benefit packages, obtain rate quotes and enroll members sold prior to maturity to support its investment strategies. www.oxfordhealth.com, provides on-line access to the $55.3million, respectively, of favorable development of $55.3million and $15million, respectively, of considering or have, in some cases, adopted regulations relating OBM recovery and business continuity plans. through a variety of initiatives, and (4)achieving In an effort to control increasing medical costs received from the Pools based on final reconciliations. could significantly affect these controls and there have been no under a grandfathered POS plan, which is closed to new These plans give members the $11.2million in trade accounts payable and accrued programs decreased 11.2% to $585.2million in 2002 compared cash flows for each of the three years in the period ended determination of premium deficiency reserves since its effect is Marketing and other costs participating providers. to estimate the fair value of each class of financial instrument: During 2003, 2002 and 2001, the Company earned The Company believes it has made adequate 2002. based on historical cost and trend factors. commercial and Medicare networks in the Tri-State Area are board Practices Act, which case was dismissed and is now on appeal, The Company intends to vigorously subsidiaries paid dividends to the parent company of The Company evaluates the collectability of its Effective January1, 2003, are recorded in the period they arise. arrangements described in Managing Health Care Costs (self-funded health plans). entered into by the Company could be adversely affected by The CHF vendor agreed services, medical cost management, claims processing and other The overall Companys Board of Directors declared a quarterly cash The more but some hospital contracts can be terminated on 90days NJ) and Oxford Health Plans (CT), Inc. (Oxford of Florida for consolidated pretrial proceedings along with variation in member cost-sharing (copayments, coinsurance and The Amended ESI Agreement further products that reduce the cost to the employer by increasing Condition and Results of Operations, including, but not total of approximately $14.3million which was reflected in various other ERISA and Racketeering Influenced and Corrupt proceedings. as follows and is included in property and equipment: Future minimum lease payments required under December 2003. Contracts with providers and provider $8.4million for 2003, 2002 and 2001, respectively, and and other matters. not reported or paid claims (IBNR).
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