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UNH
2015
UnitedHealth Group is a diversified health and well-being company dedicated to helping people live healthier lives and making the health system work better for everyone. The terms “we,” “our,” “us,” “its,” “UnitedHealth Group,” or the “Company” used in this report refer to UnitedHealth Group Incorporated and its subsid...
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1
UNH
2015
Through our diversified family of businesses, we leverage core competencies in advanced, enabling technology; health care data, information and intelligence; and clinical care management and coordination to help meet the demands of the health system. These core competencies are deployed within our two distinct, but str...
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2
UNH
2015
UnitedHealthcare provides health care benefits to an array of customers and markets. UnitedHealthcare Employer & Individual serves employers ranging from sole proprietorships to large, multi-site and national employers, public sector employers and other individuals and serves the nation’s active and retired military an...
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3
UNH
2015
Optum is a health services business serving the broad health care marketplace, including payers, care providers, employers, governments, life sciences companies and consumers, through its OptumHealth, OptumInsight and OptumRx businesses. These businesses have dedicated units that help improve overall health system perf...
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4
UNH
2015
Through UnitedHealthcare and Optum, in 2015, we processed one half trillion dollars in gross billed charges and we managed nearly $200 billion in aggregate health care spending on behalf of the customers and consumers we serve. Our revenues are derived from premiums on risk-based products; fees from management, adminis...
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UNH
2015
•OptumRx.
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UNH
2015
For our financial results and the presentation of certain other financial information by segment, including revenues and long-lived fixed assets by geographic source, see Note 14 of Notes to the Consolidated Financial Statements included in Part II, Item 8, “Financial Statements.”
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7
UNH
2015
Through its health benefits offerings, UnitedHealthcare is enabling better health, helping to control rising health care costs and creating a better health care experience for its customers. UnitedHealthcare’s market position is built on:
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UNH
2015
•innovation for customers and consumers.
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9
UNH
2015
UnitedHealthcare utilizes Optum’s capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively and create a simpler consumer experience.
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10
UNH
2015
In the United States, UnitedHealthcare arranges for discounted access to care through networks that include 1 million physicians and other health care professionals and approximately 6,000 hospitals and other facilities.
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UNH
2015
UnitedHealthcare is subject to extensive government regulation. See further discussion of our regulatory environment below under “Government Regulation” and in Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.”
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UNH
2015
UnitedHealthcare Employer & Individual offers an array of consumer-oriented health benefit plans and services nationwide for large national employers, public sector employers, mid-sized employers, small businesses, individuals and military service members in the TRICARE west region. UnitedHealthcare Employer & Individu...
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UNH
2015
Through its risk-based product offerings, UnitedHealthcare Employer & Individual assumes the risk of both medical and administrative costs for its customers in return for a monthly premium, which is typically a fixed rate per individual served for a one-year period. When providing administrative and other management se...
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14
UNH
2015
The consolidated purchasing capacity represented by the individuals UnitedHealth Group serves makes it possible for UnitedHealthcare Employer & Individual to contract for cost-effective access to a large number of conveniently located care professionals and facilities. UnitedHealthcare Employer & Individual’s UnitedHea...
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15
UNH
2015
UnitedHealthcare Employer & Individual typically distributes its products through consultants or direct sales in the larger employer and public sector segments. In the smaller group segment of the commercial marketplace, UnitedHealthcare Employer & Individual’s distribution system consists primarily of direct sales and...
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UNH
2015
UnitedHealthcare Employer & Individual also distributes its products through professional employer organizations, associations, private equity relationships and, increasingly, through both multi-carrier and its own proprietary private exchange marketplaces. UnitedHealthcare Marketplace is a shopping platform for employ...
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17
UNH
2015
UnitedHealthcare Employer & Individual’s diverse product portfolio offers a continuum of benefit designs, price points and approaches to consumer engagement, which provides the flexibility to meet the needs of employers of all sizes, as well as the needs of individuals shopping for health benefits coverage. Cost pressu...
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UNH
2015
performing care providers), alternative access to affordable and convenient care (such as through telehealth appointments with registered nurses and physicians) and a new consumer-responsive service model called Advocate4Me.
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19
UNH
2015
UnitedHealthcare Employer & Individual offers its products through affiliates that are licensed as insurance companies, health maintenance organizations (HMOs), or third-party administrators (TPAs). The market for health benefit products is shifting, with benefit and network offerings shaped, at least in part, by the r...
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20
UNH
2015
Employers are seeking to offer comprehensive health benefits that improve the health and wellness of their populations and as a result, lower overall health care costs, while improving employee satisfaction. By promoting a healthy workforce, employers can maximize productivity and lower overall health care costs. Unite...
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21
UNH
2015
Traditional Products. Traditional products include a full range of medical benefits and network options from managed plans, such as Choice and Options PPO, to more traditional indemnity products. The plans offer a full spectrum of covered services, including preventive care, direct access to specialists and catastrophi...
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22
UNH
2015
Consumer Engagement Products. Consumer engagement products couple plan design with financial accounts to increase individuals’ responsibility for their health and well-being. This suite of products includes high-deductible consumer-driven benefit plans, which include health reimbursement accounts (HRAs), health savings...
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23
UNH
2015
Clinical and Pharmacy Products. UnitedHealthcare Employer & Individual offers a comprehensive suite of clinical and pharmacy benefits management products, which complement its service offerings by improving quality of care, engaging members and providing cost-saving options. All UnitedHealthcare Employer & Individual m...
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24
UNH
2015
Each medical plan has a core set of clinical programs embedded in the offering, with additional services available depending on funding type (fully insured or self-funded), line of business (e.g., small business, key accounts, public sector, national accounts or individuals) and clinical need. UnitedHealthcare Employer...
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25
UNH
2015
•employee assistance programs.
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26
UNH
2015
UnitedHealthcare Employer & Individual’s comprehensive and integrated pharmaceutical management services promote lower costs by using formulary programs to produce better unit costs, encouraging consumers to use drugs that offer improved value and outcomes and supporting the appropriate use of drugs based on clinical e...
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UNH
2015
Specialty Offerings. UnitedHealthcare Employer & Individual also delivers dental, vision, life and disability product offerings through an integrated approach, including a network of more than 22,000 vision offices and more than 80,000 dental offices, in private and retail settings.
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UNH
2015
UnitedHealthcare Military & Veterans. UnitedHealthcare Military & Veterans’ responsibility as a contractor is to augment the military’s direct care system by providing managed care support services, provider networks, medical management, claims/enrollment administration and customer service.
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29
UNH
2015
UnitedHealthcare Military & Veterans is the provider of health care services for nearly 3 million active duty and retired military service members and their families in 21 states under the Department of Defense’s (DoD) TRICARE Managed Care Support contract. The contract began on April 1, 2013. The DoD is moving from th...
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30
UNH
2015
UnitedHealthcare Medicare & Retirement provides health and well-being services to individuals age 50 and older, addressing their unique needs for preventive and acute health care services, as well as services dealing with chronic disease and other specialized issues common among older individuals. UnitedHealthcare Medi...
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31
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2015
UnitedHealthcare Medicare & Retirement offers a selection of products that allow people to obtain the health coverage and services they need as their circumstances change. UnitedHealthcare Medicare & Retirement is positioned to serve seniors who find that affordable, network-based care provided through Medicare Advanta...
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32
UNH
2015
UnitedHealthcare Medicare & Retirement’s seniors-focused care management model enables it to operate at a medical cost level below that of traditional Medicare. This model is based on more than 20 years of expertise in chronic disease care management, underpinned by a proprietary technology platform. These capabilities...
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33
UNH
2015
Premium revenues from the Centers for Medicare & Medicaid Services (CMS) represented 26% of UnitedHealth Group’s total consolidated revenues for the year ended December 31, 2015, most of which were generated by UnitedHealthcare Medicare & Retirement.
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34
UNH
2015
UnitedHealthcare Medicare & Retirement has extensive distribution capabilities and experience, including direct marketing to consumers on behalf of its key clients: AARP, the nation’s largest membership organization dedicated to the needs of people age 50 and over, and state and U.S. government agencies. Products are a...
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35
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2015
Medicare Advantage. UnitedHealthcare Medicare & Retirement provides health care coverage for seniors and other eligible Medicare beneficiaries primarily through the Medicare Advantage program administered by CMS, including Medicare Advantage HMO plans, preferred provider organization (PPO) plans, Point-of-Service plans...
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36
UNH
2015
Medicare Advantage plans are designed to compete at the local level, taking into account member and care provider preferences, competitor offerings, our historical financial results, our quality and cost initiatives and the long-term payment rate outlook for each geographic area. Starting in 2012, and phased in through...
[-0.011191941797733307, 0.00897301733493805, 0.009148196317255497, -0.0473889522254467, 0.006637308280915022, 0.04014825448393822, -0.015000445768237114, 0.00788950826972723, -0.03500969335436821, -0.016635442152619362, 0.0012189483968541026, 0.049594901502132416, -0.020281745120882988, -0.0038279686123132706, -0.01144...
37
UNH
2015
UnitedHealthcare Medicare & Retirement offers innovative care management, disease management and other clinical programs, integrating federal, state and personal funding through its continuum of Medicare Advantage products. For high-risk patients in certain care settings and programs, UnitedHealthcare Medicare & Retire...
[-0.00020971160847693682, -0.02262222394347191, -0.005449173040688038, -0.0435667522251606, 0.014753044582903385, 0.04503140598535538, -0.014420169405639172, 0.00572213064879179, -0.029852280393242836, 0.0030541331507265568, 0.007283317390829325, 0.026590099558234215, -0.0030591264367103577, -0.006730743683874607, -0.0...
38
UNH
2015
comprehensive set of care information that bridges across home, hospital and nursing home care settings. Proprietary predictive modeling tools help identify members at high risk and allow care managers to reach out to those members and create individualized care plans that help them obtain the right care, in the right ...
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39
UNH
2015
Medicare Part D. UnitedHealthcare Medicare & Retirement provides Medicare Part D benefits to beneficiaries throughout the United States and its territories through its Medicare Advantage and stand-alone Medicare Part D plans. UnitedHealthcare Medicare & Retirement offers two stand-alone Medicare Part D plans: the AARP ...
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40
UNH
2015
Medicare Supplement. UnitedHealthcare Medicare & Retirement is currently serving more than 4 million seniors nationwide through various Medicare Supplement products in association with AARP. UnitedHealthcare Medicare & Retirement offers a full range of supplemental products at diverse price points. These products cover...
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41
UNH
2015
UnitedHealthcare Community & State is dedicated to serving state programs that care for the economically disadvantaged, the medically underserved and those without the benefit of employer-funded health care coverage, in exchange for a monthly premium per member from the state program. In some cases, these premiums are ...
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42
UNH
2015
States using managed care services for Medicaid beneficiaries select health plans by using a formal bid process or by awarding individual contracts. A number of factors are considered by UnitedHealthcare Community & State when choosing programs for participation, including the state’s commitment and consistency of supp...
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43
UNH
2015
•other programs (e.g., developmentally disabled, rehabilitative services) - 6 markets; and
[-0.008546310476958752, -0.015057784505188465, -0.012012314051389694, -0.0171197522431612, 0.0025961112696677446, 0.017214709892868996, -0.009631555527448654, 0.006168943829834461, -0.024350201711058617, 0.011869874782860279, 0.0010530274594202638, 0.033317044377326965, -0.017865857109427452, -0.018679792061448097, -0....
44
UNH
2015
•MMP - 2 markets.
[-0.02243058755993843, -0.005129760596901178, -0.0032215563114732504, -0.008334607817232609, -0.023045489564538002, 0.015506246127188206, -0.009089868515729904, 0.007733072154223919, -0.007311997003853321, -0.01923576556146145, 0.015519613400101662, 0.02573234774172306, -0.0017001730157062411, -0.013795211911201477, -0...
45
UNH
2015
These health plans and care programs offered are designed to address the complex needs of the populations they serve, including the chronically ill, those with disabilities and people with a higher risk of medical, behavioral and social conditions. UnitedHealthcare Community & State administers benefits for the unique ...
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46
UNH
2015
UnitedHealthcare Community & State leverages the national capabilities of UnitedHealth Group locally, supporting effective care management, strong regulatory partnerships, greater administrative efficiency, improved clinical outcomes and the ability to adapt to a changing national and local market environment. UnitedHe...
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47
UNH
2015
among family, physicians, other health care providers, and government and community-based agencies and organizations to facilitate continuous and effective care.
[-0.012380211614072323, 0.003127563977614045, -0.008927537128329277, -0.012692318297922611, 0.014109800569713116, 0.015371229499578476, 0.009129106067121029, 0.01797211356461048, -0.01241922564804554, -0.018557313829660416, -0.0010460433550179005, -0.0024334529880434275, 0.019012467935681343, -0.0011370743159204721, -0...
48
UNH
2015
The LTSS market represents only 6% of the total Medicaid population, yet accounts for more than 30% of total Medicaid expenditures. The LTSS population is made up of 3 million individuals who qualify for additional benefits under LTSS programs and represent a subset of the 16 million ABD Americans. Currently, 25% of th...
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49
UNH
2015
There are more than 10 million individuals eligible for both Medicare and Medicaid. MMP beneficiaries typically have complex conditions with costs of care that are far higher than typical Medicare or Medicaid beneficiaries. While these individuals’ health needs are more complex and more costly, they have been historica...
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50
UNH
2015
UnitedHealthcare Global participates in international markets through national “in country” and cross-border strategic approaches. UnitedHealthcare Global’s cross-border health care business provides comprehensive health benefits, care management and care delivery for multinational employers, governments and individual...
[-0.007629779167473316, -0.00039924707380123436, 0.016411973163485527, -0.021127600222826004, -0.006043553352355957, 0.01768360286951065, -0.010775738395750523, 0.011265845969319344, -0.0018627390963956714, -0.001441346132196486, -0.005725645925849676, 0.012504360638558865, -0.011623491533100605, -0.02271713875234127, ...
51
UNH
2015
Amil. Amil provides medical and dental benefits to more than 5 million people. Amil operates hospitals and specialty, primary care and emergency services clinics across Brazil, principally for the benefit of its members. Amil’s patients are also treated in its contracted provider network of more than 26,000 physicians ...
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52
UNH
2015
Other Operations. UnitedHealthcare Global includes other diversified global health services operations with a variety of offerings for international customers, including:
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53
UNH
2015
•global expatriate insurance solutions.
[-0.014580141752958298, -0.018067294731736183, 0.002627377165481448, -0.029489777982234955, -0.031192168593406677, 0.00880711991339922, -0.018726283684372902, 0.00010977794590871781, 0.018067294731736183, 0.0028556210454553366, -0.009459245018661022, 0.025618216022849083, 0.019399002194404602, 0.00981619767844677, -0.0...
54
UNH
2015
•Those who need care: the consumers who need the right support, information, resources and products to achieve their health goals.
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55
UNH
2015
•Those who provide care: pharmacies, hospitals, physicians’ and other care providers’ practices and other health care facilities seeking to modernize the health system and support the best possible patient care and experiences.
[-0.0047796303406357765, 0.008389144204556942, 0.0050539798103272915, -0.019237516447901726, -0.008627134375274181, 0.02575579658150673, 0.016791509464383125, 0.008494917303323746, -0.012388696894049644, 0.006395978853106499, 0.015720555558800697, 0.014517383649945259, -0.007853666320443153, -0.004548251628875732, -0.0...
56
UNH
2015
•Those who pay for care: health plans, employers, state, federal and municipal agencies, governmental departments and nonprofit associations devoted to ensuring the populations they sponsor receive high-quality care, administered and delivered efficiently and effectively.
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57
UNH
2015
•Those who innovate for care: global life sciences organizations dedicated to developing more effective approaches to care, enabling technologies and medicines that improve care delivery and health outcomes.
[-0.006615742109715939, 0.008084811270236969, -0.004814735613763332, -0.018996020779013634, -0.00922851637005806, 0.0198899507522583, -0.0066814725287258625, 0.025450723245739937, -0.012929125688970089, 0.0051828245632350445, 0.016734903678297997, 0.025726791471242905, -0.004988920409232378, -0.01618276908993721, 0.005...
58
UNH
2015
•OptumRx specializes in pharmacy care services.
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59
UNH
2015
OptumHealth is a diversified health and wellness business serving the physical, emotional and health-related financial needs of more than 78 million unique individuals. OptumHealth enables population health management through programs offered by employers, payers, government entities and, increasingly, directly with th...
[-0.002204230288043618, -0.0064652953296899796, -0.0028038613963872194, -0.029988251626491547, -0.013801563531160355, 0.05158836767077446, 0.0010635913349688053, 0.004565905779600143, -0.0012310860911384225, -0.016682472079992294, -0.00412036944180727, 0.004016522783786058, -0.0034302915446460247, -0.027442332357168198...
60
UNH
2015
OptumHealth offers its products on a risk basis, where it assumes responsibility for health care costs in exchange for a monthly premium per individual served, and on an administrative fee basis, under which it manages or administers delivery of the products or services in exchange for a fixed monthly fee per individua...
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61
UNH
2015
OptumHealth sells its products primarily through its direct sales force, strategic collaborations and external producers in three markets: employers (which includes the sub-markets of large, mid-sized and small employers), payers (which includes the sub-markets of health plans, TPAs, underwriter/stop-loss carriers and ...
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62
UNH
2015
OptumHealth is organized into two primary operating groups: OptumCare and Optum Consumer Solutions (OCS).
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63
UNH
2015
•OptumCare partners closely with care providers to improve both the health of the populations they serve and the efficiency and cost-effectiveness of local care systems. Through networks comprised of employed, managed and contracted physicians, advanced practitioners and other providers, OptumCare assists care provider...
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64
UNH
2015
•Mobile Care Delivery. OptumCare’s mobile care delivery business provides occupational health, medical and dental readiness services, treatments and immunization programs. These solutions serve a number of government and commercial clients, including the U.S. military.
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65
UNH
2015
OCS.
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66
UNH
2015
•Population Health Management Services: OCS serves people through population health management services that meet both the preventative care and health intervention needs of consumers across the care continuum - physical health and wellness, mental health, complex medical conditions, disease management, hospitalization...
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67
UNH
2015
•Distribution: This business provides sales and services through digital, phone and in-person interaction to assist individuals in selecting and understanding their benefits. OCS provides contact center support, multimodal software, data analysis and licensed sales agents that help clients acquire, retain and service l...
[-0.0021515183616429567, 0.008185450918972492, 0.017866449430584908, -0.026639437302947044, -0.01945546828210354, 0.029323410242795944, -0.011523726396262646, 0.005831967107951641, -0.002693988149985671, 0.01282565388828516, 0.009694351814687252, 0.019802650436758995, -0.017906509339809418, -0.00013342669990379363, -0....
68
UNH
2015
•Financial Services: This business provides a range of health care financial products for individuals, employers, health care professionals and payers. OCS is a leading provider of consumer health care accounts. OCS also offers electronic claims payment services to care providers through Optum Bank, a wholly-owned subs...
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69
UNH
2015
OptumInsight provides services, technology and health care expertise to major participants in the health care industry. OptumInsight’s capabilities are focused on modernizing the health system through technology, analytics and information that help drive higher quality and greater efficiency in the health care system. ...
[-0.00638673035427928, 0.0035448363050818443, 0.0036653405986726284, -0.02803734503686428, -0.006125637795776129, 0.03995388746261597, 0.0005975007079541683, -0.010189312510192394, -0.005844460800290108, -0.013677243143320084, 0.01638859137892723, 0.01624130830168724, -0.001204206608235836, -0.027046531438827515, -0.00...
70
UNH
2015
Many of OptumInsight’s software and information products, advisory consulting arrangements and outsourcing contracts are delivered over an extended period, often several years. OptumInsight maintains an order backlog to track unearned revenues under these long-term arrangements. The backlog consists of estimated revenu...
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71
UNH
2015
OptumInsight’s products and services are sold primarily through a direct sales force. OptumInsight’s products are also supported and distributed through an array of alliances and business partnerships with other technology vendors, who integrate and interface OptumInsight’s products with their applications.
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72
UNH
2015
OptumInsight provides capabilities targeted to the needs of four primary market segments: care providers (e.g., physician practices and hospital systems), payers, governments and life sciences organizations.
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73
UNH
2015
Care Providers. Serving five out of six U.S. hospitals and tens of thousands of physician practices, OptumInsight provides capabilities that help drive financial performance, meet compliance requirements and deliver health intelligence. OptumInsight brings an array of solutions to help care providers, with particular f...
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74
UNH
2015
Payers. OptumInsight serves approximately 300 health plans by helping them improve operational and administrative efficiency, understand and optimize growth while managing risk, deliver on clinical performance and compliance goals and build and manage strong provider networks. OptumInsight is also helping payer clients...
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75
UNH
2015
Governments. OptumInsight provides services to federal and state government clients that are tailored to them as government payers, including data and analytics technology, claims management and payment accuracy services and strategic consulting. In addition, OptumInsight provides custom system integration expertise an...
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76
UNH
2015
Life Sciences. OptumInsight provides services to global life sciences organizations. These companies look to OptumInsight for data analytics and expertise in core areas of health economics and outcomes research; market access and reimbursement consulting; integrated clinical and health care claims data and informatics ...
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77
UNH
2015
OptumRx provides a full spectrum of pharmacy care services to more than 66 million people in the United States through its network of more than 67,000 retail pharmacies and multiple home delivery facilities throughout the country. In 2016, OptumRx expects to manage nearly $80 billion in pharmaceutical spending, includi...
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78
UNH
2015
The 2015 acquisition of Catamaran Corporation (Catamaran) allows OptumRx to better serve more people. OptumRx’s comprehensive whole-person approach integrates demographic, medical, pharmaceutical and other clinical data and than applies analytics to drive clinical care insight to support care treatments and compliance,...
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79
UNH
2015
OptumRx provides pharmacy care services to a substantial majority of UnitedHealthcare members. Additionally, OptumRx manages specialty pharmacy benefits across nearly all of UnitedHealthcare’s businesses with services, including patient support and clinical programs designed to ensure quality and deliver value for cons...
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80
UNH
2015
trusts and government entities. These clients rely on OptumRx for components or all of their pharmacy care services. OptumRx’s distribution system consists primarily of health insurance brokers and other health care consultants and direct sales.
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81
UNH
2015
Most of our health and well-being businesses are subject to comprehensive federal, state and international laws and regulations. We are regulated by federal, state and international regulatory agencies that generally have discretion to issue regulations and interpret and enforce laws and rules. The regulations can vary...
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82
UNH
2015
If we fail to comply with, or fail to respond quickly and appropriately to changes in, applicable laws, regulations and rules, our business, results of operations, financial position and cash flows could be materially and adversely affected. See Part I, Item 1A, “Risk Factors” for a discussion of the risks related to c...
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83
UNH
2015
We are subject to various levels of U.S. federal regulation. For example, when we contract with the federal government, we are subject to federal laws and regulations relating to the award, administration and performance of U.S. government contracts. CMS regulates our UnitedHealthcare businesses and certain aspects of ...
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84
UNH
2015
UnitedHealthcare Community & State has Medicaid and CHIP contracts that are subject to federal regulations regarding services to be provided to Medicaid enrollees, payment for those services and other aspects of these programs. There are many regulations affecting Medicare and Medicaid compliance and the regulatory env...
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85
UNH
2015
Health Care Reform. Health Reform Legislation expands access to coverage and modifies aspects of the commercial insurance market, as well as the Medicaid and Medicare programs, CHIP and other aspects of the health care system.
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86
UNH
2015
Among other requirements, Health Reform Legislation expanded dependent coverage to age 26, expanded benefit requirements, eliminated certain annual and lifetime maximum limits, eliminated certain pre-existing condition limits, required coverage for preventative services without cost to members, required premium rebates...
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87
UNH
2015
Health Reform Legislation and the related federal and state regulations are affecting how we do business and could impact our results of operations, financial position and cash flows. See also Part I, Item 1A, “Risk Factors” for a discussion of the risks related to Health Reform Legislation and related matters.
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88
UNH
2015
Privacy, Security and Data Standards Regulation. The administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA), apply to both the group and individual health insurance markets, including self-funded employee benefit plans. Federal regulations related...
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89
UNH
2015
The Health Information Technology for Economic and Clinical Health Act (HITECH) significantly expanded the privacy and security provisions of HIPAA. HITECH imposes additional requirements on uses and disclosures of health information; includes new contracting requirements for HIPAA business associate agreements; extend...
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90
UNH
2015
The use and disclosure of individually identifiable health data by our businesses is also regulated in some instances by other federal laws, including the Gramm-Leach-Bliley Act (GLBA) or state statutes implementing GLBA. These federal laws and state statutes generally require insurers to provide customers with notice ...
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91
UNH
2015
ERISA. The Employee Retirement Income Security Act of 1974, as amended (ERISA), regulates how our services are provided to or through certain types of employer-sponsored health benefit plans. ERISA is a set of laws and regulations that is subject to periodic interpretation by the U.S. Department of Labor (DOL) as well ...
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92
UNH
2015
Health Care Regulation. Our insurance and HMO subsidiaries must be licensed by the jurisdictions in which they conduct business. All of the states in which our subsidiaries offer insurance and HMO products regulate those products and operations. The states require periodic financial reports and establish minimum capita...
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93
UNH
2015
Health plans and insurance companies are regulated under state insurance holding company regulations. Such regulations generally require registration with applicable state departments of insurance and the filing of reports that describe capital structure, ownership, financial condition, certain intercompany transaction...
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94
UNH
2015
Some of our business activity is subject to other health care-related regulations and requirements, including PPO, MCO, utilization review (UR), TPA, pharmacy care services, durable medical equipment or care provider-related regulations and licensure requirements. These regulations differ from state to state and may co...
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95
UNH
2015
Guaranty Fund Assessments. Under state guaranty association laws, certain insurance companies can be assessed (up to prescribed limits) for certain obligations to the policyholders and claimants of impaired or insolvent insurance companies (including state insurance cooperatives) that write the same line or similar lin...
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96
UNH
2015
Pharmacy Regulation. OptumRx’s businesses include home delivery and specialty pharmacies that must be licensed as pharmacies in the states in which they are located. Certain of our home delivery and specialty pharmacies must also register with the U.S. Drug Enforcement Administration and individual state controlled sub...
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97
UNH
2015
State Privacy and Security Regulations. A number of states have adopted laws and regulations that may affect our privacy and security practices, such as state laws that govern the use, disclosure and protection of social security numbers and sensitive health information or that are designed to implement GLBA or protect...
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98
UNH
2015
Corporate Practice of Medicine and Fee-Splitting Laws. Certain of our businesses function as direct medical service providers and, as such, are subject to additional laws and regulations. Some states have corporate practice of medicine laws that prohibit specific types of entities from practicing medicine or employing ...
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99
UNH
2015
Consumer Protection Laws. Certain of our businesses participate in direct-to-consumer activities and are subject to regulations applicable to on-line communications and other general consumer protection laws and regulations.
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