Mount Carmel Health Plan Inc

What it reported doing in 2024

Mount carmel health plan was formed in 1996 for the purpose of providing comprehensive health care coverage to seniors in central Ohio as a wholly owned subsidiary of mount carmel health system, a tax-exempt health care system under irc section 501(c)(3). The service area was expanded to cover parts of Iowa in 2021. Mount carmel health plan is a nonprofit organization that offers benefits through a medicare advantage plan (medigold) approved by the centers of medicare and medicaid services (cms) that replaces traditional medicare coverage. Medigold serves seniors and other medicare beneficiaries in 62 Ohio counties and 58 Iowa counties.mount carmel health plan entered into a contract with cms in 1996 as part of a demonstration program to determine the effectiveness of health care providers in providing medicare coverage to seniors. Medigold members elect to have mount carmel health plan (instead of the federal government) administer the benefits of medicare part a and part b, and medigold also offers pharmaceutical coverage under medicare part d. Mount carmel health plan is required to provide coverage for everything that the federal medicare program covers, plus medigold also covers additional items such as: unlimited inpatient hospital days covered at 100% with no deductible; outpatient surgery for a small co-payment; diagnostic and testing services for a small co-payment; home health care and skilled nursing care coverage when necessary; prescription drug benefits; physician office visits with fixed co-payments; and unlimited generic drug coverage.mount carmel health plan has been recognized frequently as the plan that provides the "best value to seniors" in the central Ohio market as measured by independent sources along with consistently receiving the highest marks for customer satisfaction and service in the state of Ohio as measured by the cms cahps surveys. As an integral part of mount carmel health system, mount carmel health plan is a community-based managed health care organization that works in collaboration with employers, individual members, physicians, health care providers, and community and governmental agencies to continually improve the health of its members by providing exceptional coverage and access to high quality and cost-effective care. Please visit our website for additional information: www.thpmedicare.org/mount-carmel

Financial Efficiency

• Mission deployment rate: 88.5%; rating input score 88
• Program expense ratio: 94.2%; rating input score 94
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 68th percentile among comparable filings
• Pay-setting controls: 0 of 6 controls in place; rating input score 0
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Missing
  • Board or committee approval: Missing
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Yes; rating input score 100

Accountability

• Independent voting board: 66.7%; rating input score 67; 19th percentile among comparable filings
• Governance controls: 7 of 9 controls in place; rating input score 78
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Fail
  • Other executive compensation review process: Fail
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 4.6%; rating input score 55; 55th percentile among comparable filings
• Total-asset coverage ratio: 0.88; rating input score 35; 35th percentile among comparable filings
• Liabilities to assets ratio: 0.16; rating input score 74; 74th percentile among comparable filings
• Officer compensation ratio: 0.2%; rating input score 91; 91st percentile among comparable filings

Growth

• Program expense growth: 1.5% per year; rating input score 100; 13th percentile among comparable filings
• Revenue growth: 3.7% per year; rating input score 100; 29th percentile among comparable filings
• Asset growth: 5.6% per year; rating input score 100; 41st percentile among comparable filings