Full Description

UnitedHealth Group Incorporated (UnitedHealthcare), incorporated in January 1977, is a diversified health and well-being company. The Company operates in four segments: Health Care Services, OptumHealth, Ingenix and Prescription Solutions. The Company’s Health Care Services segment consists of UnitedHealthcare, Ovations and AmeriChoice businesses. OptumHealth serves approximately 60 million individuals with its diversified offering of health, financial and ancillary benefit services and products that assist consumers in navigating the healthcare system and accessing services. Ingenix offers database and data management services, software products, publications, consulting and actuarial services and business process outsourcing services. Prescription Solutions offers a suite of integrated pharmacy benefit management (PBM) services to approximately 10 million people, through approximately 60,000 retail network pharmacies and two mail service facilities as of December 31, 2008. In November 2009, OptumHealth Inc. announced that it acquired global employee assistance program (EAP) provider, PPC Worldwide.

On May 30, 2008, the Company acquired Unison Health Plans (Unison). Unison provides government-sponsored health plan coverage to people in Pennsylvania, Ohio, Tennessee, Delaware, South Carolina and Washington, through a network of independent health care professionals. On February 25, 2008, the Company completed the acquisition of Sierra Health Services, Inc., a diversified health care services company. On January 10, 2008, UnitedHealthcare acquired Fiserv Health, Inc. (Fiserv Health), a subsidiary of Fiserv, Inc. Fiserv Health is an administrator of medical benefits and also provides care facilitation services, specialty health solutions and pharmacy benefit management (PBM) services.

Health Care Services

UnitedHealthcare offers an array of consumer-oriented health benefit plans and services for national employers, public sector employers, mid-sized employers, small businesses and individuals nationwide. UnitedHealthcare also provides administrative and other management services to customers that self-insure the medical costs of their employees and their dependents, for which UnitedHealthcare receives a fixed service fee per individual served.

UnitedHealthcare offers its products through affiliates that are licensed as insurance companies and health maintenance organizations. UnitedHealthcare arranges for discounted access to care through more than 580,000 physicians and other health care professionals, and 4,900 hospitals across the United States. UnitedHealthcare’s distribution system consists primarily of brokers and direct and Internet sales in the individual market; brokers in the small employer group market, and brokers and other consultant-based or direct sales for employer and public sector groups.

Ovations provides health and well-being services for individuals aged 50 and older, addressing their needs for preventative and acute healthcare services, as well as for services dealing with chronic disease and other specialized issues for older individuals. Ovations provide products and services in all 50 states, the District of Columbia and the United States territories. Ovations participates nationally in the Medicare program, offering a range of Medicare products, including Medigap products that supplement fee-for-service coverage health-plan-type programs under Medicare Advantage, Medicare Part D prescription drug coverage and discount card offerings, and special offerings for chronically ill, and Medicare and Medicaid dual eligible.

The Ovations Secure Horizons division provides healthcare coverage for the seniors and other Medicare beneficiaries primarily through the Medicare Advantage program administered by Centers for Medicare & Medicaid Services (CMS). SecureHorizons offers Medicare Advantage HMO plans, preferred provider organization (PPO) plans, special needs plans, point-of-service (POS) plans and private-fee-for-service plans. Under the Medicare Advantage programs, SecureHorizons provides health insurance coverage to Medicare beneficiaries in exchange for a fixed monthly premium per member from CMS that varies based on the geographic areas, in which members reside.

Ovations provide the Medicare prescription drug benefit (Part D) to beneficiaries throughout the United States and its territories. Among the several Part D plans it offers, Ovations provides a Medicare prescription drug coverage plan by American Association of Retired Persons (AARP). Ovations provide Part D drug coverage through its Medicare Advantage program, Special Needs Plans and stand-alone prescription drug plans. As of December 31, 2008, including Ovations had enrolled approximately 5.5 million members in the Part D program, including approximately 4.1 million in the stand-alone Part D plans and approximately 1.4 million in Medicare Advantage plans incorporating Part D coverage.

Ovations Insurance Solutions offers a range of health insurance products and services to AARP members. Ovations provide Medicare supplement and hospital indemnity insurance from its insurance company affiliates to approximately 3.8 million AARP members. Additional Ovations services include a nurse healthline service, a Medicare supplement offering that provides consumers with a hospital network and around-the-clock access to healthcare information.

Through its Evercare division, Ovations offers individualized care planning and care benefits for aging, disabled and chronically ill individuals. Evercare serves approximately 400,000 individuals (including approximately 245,000 individuals in the Medicare Advantage products) across the United States in long-term care settings, including nursing homes, community-based settings and private homes, as well as through hospice and palliative care. Evercare offers services through care management and clinical programs. Evercare Solutions for Caregivers is an eldercare service program providing service coordination, consultation, claim management and information resources nationwide. Evercare also operates hospice and palliative care programs in 10 states.

AmeriChoice provides network-based health and well-being services to beneficiaries of State Medicaid Children’s Health Insurance Programs (SCHIP), and other government-sponsored healthcare programs. As of December 31, 2008, AmeriChoice provided services to nearly 2.4 million individuals in 22 states and in the District of Columbia. AmeriChoice also offers government agencies a number of diverse management service programs, including clinical care consulting program, disease and conditions management, pharmacy benefit services, and administrative and technology services.

OptumHealth

OptumHealth provides ancillary insurance benefits and facilitates the financing of healthcare services through account-based programs. Its products are distributed through the three markets that it serves: the employer market for both UnitedHealth Group customers and unaffiliated parties; the payer market for Health Care Services health plans, independent health plans, third-party administrators and reinsurers, and the public sector market for Medicare and state Medicaid offerings through partnerships with Ovations, AmeriChoice and other intermediaries. OptumHealth is organized into four groups: Care Solutions, Behavioral Solutions, Specialty Benefits and Financial Services (Exante).

Care Solutions serves approximately 40 million people through personalized health management solutions. It delivers its services through the use of evidence-based best practices and technology. Its clinically focused product portfolio includes programs focused on disease management, care advocacy, wellness and complex condition management, such as cancer, solid organ transplant, infertility and congenital heart disease. Care Solutions also provides benefit administration and clinical and network management for chiropractic, physical therapy, occupational therapy and other complementary and alternative care services through its national network consisting of approximately 23,000 chiropractors, 15,000 physical and occupational therapists and 7,000 complementary and alternative health professionals. Care Solutions also offers treatment decision support, consumer health information, private health portals and consumer health marketing services to address daily living concerns and assist individuals in accessing the health care system.

Behavioral Solutions serves 43 million individuals with its employee assistance programs, work/life offerings, and clinically driven behavioural health, substance abuse and psychiatric disability management programs. Its programs employ predictive modelling, outcomes management, supportive coaching and evidenced-based practices to assist individuals in managing stress, depression, substance abuse and other personal challenges. Behavioral Solutions customers have access to a national network of approximately 83,000 clinicians and counselors and approximately 2,500 facilities in 4,600 locations.

Specialty Benefits includes dental, vision, life, critical illness, short-term disability and stop loss product offerings. Approximately 15 million individuals receive their vision benefits through Specialty Benefits and its network of approximately 30,000 vision professionals in private and retail settings. Dental benefit management and related services are provided to six million consumers through a network of approximately 110,000 dentists. Stop-loss insurance is marketed throughout the United States through a network of third-party administrators, brokers and consultants.

Financial services are provided through OptumHealth Bank and OptumHealth Financial Services (formerly known as Exante Bank and Exante Financial Services, respectively). Financial services provide health-based financial services for consumers, employers, payers and healthcare professionals. These financial services include HSAs, HRAs, and flexible spending accounts offered through OptumHealth Bank, a Utah-chartered industrial bank. Financial Services health benefit card programs include electronic systems for verification of benefit coverage and eligibility. Financial Services also provides electronic payment and statement services for healthcare professionals and payers.

Ingenix

Ingenix offers pharmaceutical data consulting and research services on a nationwide and international basis. As of December 31, 2008, Ingenix’s customers included approximately 6,000 hospitals, 240,000 physicians, 1,500 payers and intermediaries, 260 Fortune 500 companies, 300 life sciences companies, and 250 government entities, as well as other UnitedHealth Group businesses. Ingenix is engaged in the simplification of health care administration with information and technology. Ingenix helps customers document, code and bill for the delivery of care services. It also sells reference materials and coding guides that health care professionals use to bill payers for their services.

The Ingenix companies are divided into two groups: information services and i3. Ingenix’s products include healthcare utilization reporting and analytics, physician clinical performance benchmarking, clinical data warehousing, analysis and management responses for medical cost trend management, decision-support portals for evaluation of health benefits and treatment options, and claims management tools for administrative error. Information Services uses its software applications that manage clinical and administrative data across diverse information technology environments. Ingenix offers electronic data interchange (EDI) services helping healthcare providers and payers.

Ingenix provides other services on an outsourced basis, such as verification of physician credentials, health care professional directories, healthcare effectiveness data and information set reporting, and fraud and abuse detection and prevention services. Information Services also offers consulting services, including actuarial and financial advisory work through its Ingenix Consulting division and healthcare policy research and management consulting through its subsidiary, The Lewin Group, as well as product development, healthcare professional contracting and medical policy management. Information Services also provides healthcare information technology (IT) consulting for healthcare professionals. Information Services publishes print and electronic media products that provide customers with information regarding medical claims coding, reimbursement, billing and compliance issues.

Ingenix’s i3 division helps to coordinate and manage clinical trials for products in development for pharmaceutical and biotechnology companies. i3’s services include global contract research services, protocol development, investigator identification and training, regulatory assistance, project management, data management, biostatistical analysis, quality assurance, medical writing and staffing resource services. i3 delivers contract research services in 56 countries and is focused on oncology, the central nervous system, respiratory and pulmonary diseases, and endocrinology. i3 uses science-based evaluation and analysis and services to support pharmaceutical and biotechnology development.

Prescription Solutions

Prescription Solutions integrated PBM services include retail network pharmacy management, mail order pharmacy services, specialty pharmacy services, benefit design consultation, drug utilization review, formulary management programs, disease therapy management and adherence programs. Prescription Solutions distribution system consists primarily of brokers and other consultant-based or direct sales. Prescription Solutions Consumer Health Products business distributes diabetic testing and other specialized medical supplies, over the counter items, vitamins, minerals and supplements directly to members homes.

The Company competes with Aetna Inc., Cigna Corporation, Coventry Health Care, Inc., Health Net, Inc., Humana Inc., Kaiser Permanente, WellPoint, Inc., Medco Health Solutions, Inc., CVS/Caremark Corporation and Express Scripts, Inc.