Businessweek

company typically enters into contracts with hospitals that provide for per-day and/or per-case rates, often with fixed rates for ambulatory, surgery and emergency room services. The company also has hospital contracts that provide for reimbursement based on a percentage of the charges billed by the hospital. The company’s medical plans generally require notification of elective hospital admissions, and it monitors the length of hospital stays. Physicians who participate in its networks generally admit their patients in network-based products to participating hospitals using referral procedures that direct the hospital to contact its patient management unit to confirm the patient's membership status and facilitate the patient management process. This unit also assists members and providers with related activities, including the subsequent transition to the home environment and home care. Case management assistance for complex cases is provided by a special unit. Other Providers: Laboratory, imaging, urgent care and other freestanding health facility providers are generally paid under fee-for-service arrangements, except for certain laboratory services. Principal Markets and Sales The company offers a range of traditional, voluntary and consumer-directed health insurance products and related services, many of which are available nationwide. It markets a range of customers, including employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. The company markets both Insured and ASC products and services primarily to employers that sponsor its products (also called plan sponsors) for the benefit of their employees and their employees' dependents. It also sells Insured plans directly to individual consumers in a number of states. The company offers Insured Medicare coverage on an individual basis, as well as through employer groups to their retirees. Medicaid and SCHIP members are enrolled on an individual basis. Health Care products are sold through its sales personnel, as well as through independent brokers, agents and consultants who assist in the production and servicing of business. GROUP INSURANCE Group Insurance products consist primarily of life insurance, disability insurance, and long-term care insurance products. Life Insurance Products consist principally of group term life insurance, the amounts of which may be fixed or linked to individual employee wage levels. The company also offers voluntary spouse and dependent term life insurance, and group universal life and accidental death and dismemberment insurance. The company offers life insurance products on an Insured basis. Disability Insurance Products provide employee income replacement benefits for both short-term and long-term disability. The company also offers disability products with additional case management features. Similar to Health Care products, the company offers disability benefits on both an Insured and employer-funded basis. The company also provides absence management services to employers, including short-term and long-term disability administration and leave management. Long-Term Care Insurance Products provide benefits to cover the cost of care in private home settings, adult day care, assisted living or nursing facilities. Long-term care benefits were offered primarily on an Insured basis. The product was available on both a service reimbursement and disability basis. Principal Markets and Sales The company offers its Group Insurance products in 49 states, as well as Washington, D.C., Guam, Puerto Rico, the U.S. Virgin Islands and Canada. Depending on the product, the company markets to a range of customers from small employer groups to large, multi-site and/or multi-state employer programs. The company markets Group Insurance products and services primarily to employers that sponsor its products for the benefit of their employees and their employees' dependents. Some Group Insurance products are sold directly to employees of employer groups on a fully employee-funded basis. In some cases, t