Profile: WellPoint Inc (WLP)
30 Jul 2014
WellPoint, Inc. (WellPoint), incorporated on July 17, 2001, is a health benefit company in terms of medical membership in the United States, serving 34.3 million medical members through its affiliated health plans and a total of 65.3 million individuals through all subsidiaries as of December 31, 2011. The Company manages its operations through three segments: Commercial, Consumer, and Other. The Company is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA), an association of independent health benefit plans. The Company offers a spectrum of network-based managed care plans to the large and small employer, individual, Medicaid and senior markets. Its managed care plans include preferred provider organizations (PPOs); health maintenance organizations (HMOs); point-of-service plans (POS) plans; traditional indemnity plans and other hybrid plans, including consumer-driven health plans (CDHPs); and hospital only and limited benefit products. In February 2014, WellPoint sold its online contact lens retail subsidiary 1-800 CONTACTS to private equity firm Thomas H. Lee Partners.
The Company serves its members as the Blue Cross licensee for California and as the Blue Cross and Blue Shield (BCBS), licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as BCBS in 10 New York city metropolitan and surrounding counties, and as Blue Cross or BCBS in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, District of Columbia), and Wisconsin. The Company does business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in its New York service areas). The Company also serves customers throughout the country as UniCare and in certain California, Arizona and Nevada markets.
The Company provides an array of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs and other administrative services. The Company also provides an array of specialty products and services including life and disability insurance benefits, dental, vision, behavioral health benefit services, radiology benefit management, analytics-driven personal health care guidance and long-term care insurance. The Company provides services to the Federal Government in connection with the Federal Employee Program (FEP), and various Medicare programs.
The Company’s Commercial and Consumer segments both offers a diversified mix of managed care products, including PPOs, HMOs, traditional indemnity benefits and POS plans, as well as a variety of hybrid benefit plans including CDHPs, hospital only and limited benefit products. Its Commercial segment includes Local Group (including UniCare), National Accounts and certain other ancillary business operations (dental, vision, life and disability and workers’ compensation). Business units in the Commercial segment offer fully-insured products and provide an array of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs and other administrative services.
The Company’s Consumer segment includes Senior, State-Sponsored and Individual businesses. Its Senior business includes services, such as Medicare Advantage (including private fee-for-service plans and special needs plans), Medicare Part D, and Medicare Supplement, while its State-Sponsored business includes its managed care alternatives for Medicaid and State Children’s Health Insurance Plan programs. Individual business includes individual customers under age 65 and their covered dependents. Its Other segment includes the Comprehensive Health Solutions business unit (CHS). Its Other segment also includes results from its Federal Government Solutions (FGS), business. FGS business includes FEP and National Government Services, Inc. (NGS), which acts as a Medicare contractor in several regions across the nation.
Preferred Provider Organization products offer the member an option to select any health care provider, with benefits reimbursed by the Company at a higher level when care is received from a participating network provider. Consumer-Driven Health Plans (CDHPs) provide consumers with increased financial responsibility, choice and control regarding how their health care dollars are spent. Indemnity products offer the member an option to select any health care provider for covered services. Health Maintenance Organization (HMO) products include managed care benefits, generally through a participating network of physicians, hospitals and other providers. Point-of-Service (POS) products blend the characteristics of HMO, PPO and indemnity plans.
The Company provides administrative services to large group employers that maintain self-funded health plans. These administrative services include underwriting, actuarial services, medical management, claims processing and other administrative services for self-funded employers. Self-funded health plans are also able to use its provider networks and to realize savings through its negotiated provider arrangements, while allowing employers the ability to design certain health benefit plans in accordance with their own requirements and objectives. The Company also underwrites stop loss insurance for self-funded plans.
BlueCard host members are generally members who reside in or travel to a state in which a WellPoint subsidiary is the Blue Cross and/or Blue Shield licensee and who are covered under an employer sponsored health plan serviced by a non-WellPoint controlled BCBS licensee, who is the home plan. The Company performs certain administrative functions for BlueCard host members, for which it receives administrative fees from the BlueCard members’ home plans. Other administrative functions, including maintenance of enrollment information and customer service, are performed by the home plan. The Company offers a variety of senior plans, products and options, such as Medicare supplement plans, Medicare Advantage (including private fee-for-service plans and special needs plans) and Medicare Part D Prescription Drug Plans (Medicare Part D). Medicare Advantage plans provide Medicare beneficiaries with a managed care alternative to traditional Medicare and often include a Medicare Part D benefit. In addition, its Medicare Advantage special needs plans provide Medicare beneficiaries who have chronic diseases and conditions with tailored benefits designed to meet their needs. Medicare Part D offers a prescription drug plan to Medicare and dual eligible (Medicare and Medicaid) beneficiaries. The Company offers these plans to customers through its health benefit subsidiaries throughout the country, including CareMore.
The Company offers a range of health insurance plans with a variety of options and deductibles for individuals under age 65 who are not covered by employer-sponsored coverage. Some of its products target certain demographic populations, such as uninsured younger individuals between the ages of 19 and 29, families and those transitioning between jobs or early retirees. The Company has contracts to serve members enrolled in Medicaid, State Children’s Health Insurance programs and other publicly funded health care programs for low income and/or high medical risk individuals. The Company provides services in California, Indiana, Kansas, Massachusetts, New York, South Carolina, Texas, Virginia, West Virginia and Wisconsin. It markets and sells an integrated prescription drug product to both fully-insured and self-funded customers through its health benefit subsidiaries throughout the country. The product includes features, such as drug formularies, a pharmacy network and maintenance of a prescription drug database and mail order capabilities. The Company has delegated certain functions and administrative services related to its integrated prescription drug products to Express Scripts, under a 10 year contract. Express Scripts manages the network of pharmacy providers, operates mail order pharmacies and processes prescription drug claims on its behalf, while it sells and support the product for clients, make formulary decisions and set drug benefit design strategy and provide front line member support.
The life products include term life and accidental death and dismemberment. The Company offers short-term and long-term disability programs, usually in conjunction with its health plans. The Company offers specialized behavioral health plans and benefit management. These plans cover mental health and substance abuse treatment services on both an inpatient and an outpatient basis. The Company offers outpatient diagnostic imaging management services to health plans. These services include utilization management for advanced diagnostic imaging procedures, network development and optimization, patient safety, claims adjudication and provider payment. The Company offers evidence based and analytics-driven personal health care guidance.
The Company’s dental plans include networks in certain states in which it operates. Many of the dental benefits are provided to customers enrolled in its health plans and are offered on both a fully-insured and self-funded basis. Its members also have access to additional dental providers through its participation in the National Dental GRID, a national dental network developed by and for BCBS plans. Additionally, the Company offers managed dental services to other health care plans to assist those other health care plans in providing dental benefits to their customers. Its vision plans include networks within the states where the Company operates. Many of the vision benefits are provided to customers enrolled in its health plans and are offered on both a fully-insured and self-funded basis.
The Company offers long-term care insurance products to its California members through a subsidiary. The long-term care products include tax-qualified and non-tax qualified versions of a skilled nursing home care plan and comprehensive policies covering skilled, intermediate and custodial long-term care and home health services. Through its subsidiary, NGS, the Company serves as a fiscal intermediary, carrier and Medicare administrative contractor providing administrative services for the Medicare program, which generally provides coverage for persons who are 65 or older and for persons who are disabled or with end-stage renal disease. Part A of the Medicare program provides coverage for services provided by hospitals, skilled nursing facilities and other health care facilities. Part B of the Medicare program provides coverage for services provided by physicians, physical and occupational therapists and other professional providers, as well as certain durable medical equipment and medical supplies.
120 Monument Circle
INDIANAPOLIS IN 46204
Company Web Links
- WellPoint medical cost ratio drives second-quarter profit beat
- UPDATE 2-WellPoint medical cost ratio drives 2nd-quarter profit beat
- UPDATE 2-Cigna says early Obamacare enrollee costs are high
- WellPoint's Obamacare business making a profit, so far
- UPDATE 3-WellPoint's Obamacare business making a profit, so far