TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Inspection
Name of the organization
Medica Health Plans
Employer identification number
41-1242261
41-1242261
| Return Reference | Explanation |
|---|---|
| Form 990 Part III Line 4a | MEDICA HEALTH PLANS (MHP) IN 2018 PROVIDED HMO COVERAGE TO ENROLLEES IN THE STATE OF MINNESOTA'S SENIOR CARE PLUS (MSC+) AND SPECIAL NEEDS BASIC CARE PROGRAMS (SNBC). MSC+ PROVIDES MANAGED CARE FOR LOW-INCOME PEOPLE IN MINNESOTA WHO ARE AGES 65 OR OLDER ON MEDICAL ASSISTANCE. SNBC PROVIDES MANAGED CARE FOR INDIVIDUALS AGES 18-64 ON MEDICAL ASSISTANCE AND ARE CERTIFIED WITH PHYSICAL, DEVELOPMENTAL OR MENTAL DISABILITIES. A TOTAL OF 16,789 MEDICA MEMBERS 55.9% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2018. THERE WERE 4,056 MINNESOTA SENIOR CARE PLUS MEMBERS AND 12,733 SPECIAL NEEDS BASIC CARE MEMBERS. STATE OF MINNESOTA HEALTH CARE PROGRAMS MINNESOTA REQUIRES A HEALTH PLAN THAT CONTRACTS WITH THE MINNESOTA DEPARTMENT OF HUMAN SERVICES (DHS) TO PROVIDE MANAGED CARE BE LICENSED BY THE MINNESOTA DEPARTMENT OF HEALTH (MDH) AS AN HMO. MINNESOTA HEALTH CARE PROGRAMS COVER PEOPLE WHO CANNOT GET OR AFFORD HEALTH INSURANCE ELSEWHERE AND HELPS THEM PAY SOME OR ALL MEDICAL BILLS. DHS MANAGES THE ENROLLMENT OF ENROLLEES AND ENFORCES ELIGIBILITY RULES THAT PERTAIN TO INCOME, ASSETS AND OTHER FACTORS. MEDICAS MANAGED CARE PRODUCTS SERVE ADULTS WITH DISABILITIES, SOME CHILDREN WITH DISABILITIES, AND LOW-INCOME PEOPLE 65 OR OLDER. MANAGED CARE IS AVAILABLE FOR LOW-INCOME PEOPLE 65 OR OLDER WHO ARE ASSESSED TO REQUIRE AN INSTITUTIONAL LEVEL OF CARE. MINNESOTA DHS DETERMINES CAPITATED RATES AS A COMPONENT OF THE ANNUAL CONTRACT NEGOTIATION PROCESS WITH MHP AND PAYS MHP A FIXED RATE PER ENROLLEE PER MONTH. MHP BEARS THE RISK FOR THE TOTAL COST OF CARE FOR THESE ENROLLEES. -IN 2018 MEDICA HEALTH PLANS MEDICAL LOSS RATIO FOR STATE OF MINNESOTA HEALTH PROGRAMS WAS 89.7%. -THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 5.6% INCLUDING PREMIUM TAXES. FORM 990 PART III LINE 4C IN 2018, MHP PARTICIPATED IN MINNESOTA SENIOR HEALTH OPTIONS (MSHO), A MEDICARE-RELATED PRODUCT, IN MINNESOTA. ENROLLMENT IN THAT PRODUCT WAS 11,132 OR 37.0% OF MHP'S TOTAL ENROLLMENT. MSHO IS A PRODUCT FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID. IN 2018, MEDICA STARTED OFFERING MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENT PLANS. MEDICARE ADVANTAGE HAD ENROLLMENT OF 391 MEMBERS OR 1.3% OF MHPS TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND PART B BENEFITS. MEDICARE SUPPLEMENT HAD ENROLLMENT OF 1,224 MEMBERS OR 4.1% OF MHPS TOTAL ENROLLMENT. MEDICARE SUPPLEMENT IS A PLAN THAT HELPS PAY SOME HEALTH CARE COSTS THAT MEDICARE DOES NOT COVER, SUCH AS COPAYMENTS, COINSURANCE, AND DEDUCTIBLES. |
| Form 990 Part III Line 4d | MEDICA HEALTH PLANS INTERCOMPANY ADMINISTRATIVE AGREEMENTS MHP HAS MANAGEMENT AGREEMENTS WITH RELATED ENTITIES TO PROVIDE ADMINISTRATIVE SERVICES. MHP IS REIMBURSED FOR THESE SERVICES MONTHLY. IN 2018, MHP WAS REIMBURSED FOR $295,212,476 IN INTERCOMPANY ADMINISTRATIVE EXPENSES, REPORTED AS REVENUE ON THE 990. CONTRIBUTIONS BY MEDICA ON BEHALF OF MEMBERS BEYOND CONTRACTED SERVICES IN 2018 MHP SPENT APPROXIMATELY $2.5 MILLION TO PROVIDE ADDITIONAL, NON-STATE PLAN SERVICES ON BEHALF OF THE FOLLOWING CATEGORIES OF MINNESOTA HEALTH CARE PROGRAMS: MSC+; MSHO; AND SNBC. NON-STATE PLAN SERVICES INCLUDED: VALUE OF WAIVED FAMILY DEDUCTIBLES; MSC+/MSHO ELDERLY WAIVER FOR NON-ELIGIBLE MEMBERS; NON-MEDICARE PART D PHARMACY COPAYMENTS; AND NON-MEDICARE VALUE OF COST-SHARING WAIVED COPAYS. OTHER COMMUNITY BENEFITS MHP PROVIDED OTHER COMMUNITY BENEFITS WITH A WIDE RANGE OF PROGRAMS AND INITIATIVES TO PROMOTE PUBLIC AND INDIVIDUAL HEALTH, REDUCE DISPARITIES IN ACCESS TO CARE, IMPROVE HEALTH CARE SYSTEM PERFORMANCE, AND HELP PROVIDE FINANCIAL ASSISTANCE TO ACCESS CARE. COLLABORATIVE EFFORTS MHP DONATES FUNDING, EMPLOYEE TIME AND OTHER RESOURCES IN SUPPORT OF MORE THAN TWO DOZEN COLLABORATIVE EFFORTS WITH LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS. EXAMPLES INCLUDE: MINNESOTA COMMUNITY MEASUREMENT, WHICH PROMOTES COMMUNITY-BASED, EVIDENCE-BASED CARE, AND QUALITY COMPARISONS OF PROVIDER GROUPS AND CLINICS; INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT, WHICH PROVIDES EVIDENCE-GRADED GUIDELINES AND ASSESSMENTS. HEALTH AND WELLNESS PROGRAMS PROVIDING COMMUNITY BENEFIT MEDICA UNDERTAKES A VARIETY OF INITIATIVES TO MAKE HEALTH CARE MORE AFFORDABLE, AVAILABLE AND EFFECTIVE. EXAMPLES INCLUDE: -IMPROVEMENTS IN RATES OF ANNUAL SCREENINGS AMONG MEMBERS FOR DISEASES SUCH AS CANCERS, HEART DISEASE AND DIABETES, PRE AND POST-BIRTH MATERNITY CARE, IMMUNIZATIONS, AND ANNUAL DENTAL VISITS. -REDUCTIONS IN MEDICALLY UNNECESSARY ER VISITS AND IN-PATIENT HOSPITAL ADMISSIONS -TYING PROVIDER REIMBURSEMENT TO IMPROVEMENTS IN CARE OUTCOMES, QUALITY AND EFFICIENCY -INCREASED PARTICIPATION IN EXERCISE. MY HEALTH REWARDS FROM MEDICA INCLUDES AN ARRAY OF ONLINE TOOLS AND RESOURCES THAT MAKE IT EASY FOR MEDICA MEMBERS TO ASSESS THEIR HEALTH STATUS, AND TO CUSTOMIZE AND FOLLOW PERSONALIZED PROGRAMS FOR A HEALTHIER LIFESTYLE AND DIET. IN 2018, THE CORE MY HEALTH REWARDS FROM MEDICA PROGRAM WAS PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS. FIT CHOICES BY MEDICA PROVIDED MEDICA MEMBERS WITH (A) A $20 MONTHLY MEMBERSHIP CREDIT FOR EXERCISING AT A PARTICIPATING HEALTH CLUB TWELVE OR MORE DAYS PER MONTH AND (B) THE OPPORTUNITY FOR PERSONAL COACHING AND A PERSONALIZED NUTRITION AND FITNESS PLAN. IN 2018, FIT CHOICES BY MEDICA WAS AVAILABLE AT NO COST TO MHP'S FULLY INSURED MEMBERS. TOBACCO CESSATION COACHING MEDICA'S TOBACCO CESSATION COACHING PROGRAM IS A SELF-DIRECTED PROGRAM OFFERING A WIDE VARIETY OF TOOLS AND RESOURCES TO HELP MEMBERS QUIT TOBACCO USE. COACHING SUPPORT INCLUDES PRIVATE, CONFIDENTIAL ACCESS TO TRAINED HEALTH COACHES. THERE WAS NO COST TO MEDICA MEMBERS TO PARTICIPATE IN THE TOBACCO CESSATION COACHING PROGRAM. MEDICAL AND MENTAL HEALTH DISEASE MANAGEMENT AND PATIENT SUPPORT MEDICA IN 2018 OFFERED A PORTFOLIO OF DISEASE MANAGEMENT PROGRAMS FOR PHYSICAL AND MENTAL HEALTH, TOBACCO CESSATION, HEALTHY PREGNANCY, COMMON CHRONIC MEDICAL DISEASES, AND RARE AND COMPLEX DISEASES. THESE PROGRAMS PROVIDE EDUCATION AND RESOURCES THAT HELP SUPPORT THE MEMBERS' ABILITY TO MANAGE CHRONIC CONDITIONS. THE GOALS ARE TO IMPROVE HEALTH AND QUALITY OF LIFE, REDUCE COMPLICATIONS THROUGH EARLY INTERVENTION AND MONITORING, PROMOTE MEDICAL CARE AND COMPLIANCE WITH THE PATIENT'S PHYSICIAN-RECOMMENDED MEDICAL TREATMENT REGIMEN, AND TO IMPROVE SATISFACTION WITH HEALTH CARE SERVICES. MEDICA'S DISEASE MANAGEMENT PROGRAMS WERE PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS, AND TO MINNESOTA STATE HEALTH CARE PROGRAM ENROLLEES SERVED BY MEDICA. THERE IS NO COST TO ELIGIBLE MEDICA MEMBERS. |
| Form 990 Part VI Line 6 | MEMBERS EXIST WITHIN MEDICA HEALTH PLANS AS MEMBERS COVERED UNDER REGULATED INSURANCE PLANS. |
| Form 990 Part VI Line 7a | THE MEMBERSHIP OF MEDICA HEALTH PLANS ELECTS THE CONSUMER BOARD MEMBERS. |
| Form 990 Part VI Line 11b | MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND FINANCE DIRECTOR REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| Form 990 Part VI Line 12c | ANNUALLY ALL EMPLOYEES OF MEDICA HEALTH PLANS AND DIRECTORS OF ALL MEDICA ENTITIES COMPLETE A CONFLICT OF INTEREST DISCLOSURE AND ARE REQUIRED TO REVIEW THE CONFLICT POLICY. ALL POTENTIAL CONFLICTS ARE REVIEWED BY LEGAL/COMPLIANCE. |
| Form 990 Part VI Line 15a | THE BOARD'S PERSONNEL AND COMPENSATION COMMITTEE REVIEWS AND OBTAINS THE BOARD'S APPROVAL OF THE TOTAL COMPENSATION FOR THE PRESIDENT/CEO AND REVIEWS AND APPROVES THE TOTAL COMPENSATION RECOMMENDATIONS MADE BY THE CFO FOR THE EXECUTIVE AND SENIOR VICE PRESIDENTS; REVIEWS ALL OFFICER COMPENSATION AND PERFORMANCE GOALS APPROVED BY THE CEO ANNUALLY. THE PERSONNEL AND COMPENSATION COMMITTEE ALSO REVIEWS AND RECOMMENDS TO THE BOARD, OFFICER AND NON-OFFICER COMPENSATION GUIDELINES FOR THE COMPANY AND ITS SUBSIDIARIES PERIODICALLY REVIEWING MARKET DATA TO ASSESS THE COMPANY'S COMPETITIVE POSITION. PROCESS OUTSIDE THE CHARTER: THE PERSONNEL AND COMPENSATION COMMITTEE WORKS WITH AN OUTSIDE CONSULTANT IN REVIEWING MARKET COMPETITIVE DATA THAT AIDS IN SETTING THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. |
| Form 990 Part VI Line 19 | MEDICA DOES NOT CONSIDER ITS CONFLICT OF INTEREST POLICY TO BE A CONFIDENTIAL OR PROPRIETARY DOCUMENT. THEREFORE, MEDICA WOULD MAKE THIS POLICY AVAILABLE TO ANYONE WHO REQUESTS IT. CERTAIN MEDICA ENTITIES ARE REQUIRED TO FILE ANNUAL FINANCIAL STATEMENTS WITH THE REGULATORS. MEDICA CONSIDERS FINANCIAL STATEMENTS THAT ARE FILED WITH THE REGULATORS TO BE PUBLIC DOCUMENTS. ARTICLES AND BYLAWS, CONFLICT OF INTEREST POLICY, AND FORM 990S ARE AVAILABLE UPON REQUEST. |
| Form 990 Part VII Line Section B Line 1 | CERTAIN INDIVIDUALS REPORTED ON FORM 990, PART VII SPLIT THEIR TIME BETWEEN SEVERAL OF THE MEDICA ENTITIES (MEDICA HEALTH PLANS, MEDICA Community Health Plan, Medica Holding Company, MEDICA FOUNDATION, MEDICA INSURANCE COMPANY, MEDICA SELF-INSURED, MEDICA AFFILIATED SERVICES, MEDICA HEALTH MANAGEMENT, AND MMSI, INC). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. |
| Form 990 Part XI Line 9 | CHANGES IN NET ASSETS: CHANGE IN VALUE OF NONADMITTED ASSETS $31,738,363 STAT GROSS UP FOR DEPRECIATION $(2,753,479) TRANSFER TO MHC $(55,000,000) TOTAL TO FORM 990, PART XI, LINE 9 $(26,015,116) |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018
Additional Data
| Software ID: | |
| Software Version: |