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TABLE OF CONTENTS
ELMC Group, LLC Acquires Leading Medical Stop-Loss Underwriter IOA Re, Inc., Expanding Capabilities in Self-Funded Healthcare Market
MyHealthGuide Source: ELMC Group, LLC, 9/22/2016, elmcgroup.com
NEW YORK -- ELMC Group, LLC, a manager of premier, full-service managing general underwriters (MGUs) specializing in underwriting medical stop-loss insurance, announced that it has signed an agreement to purchase IOA Re, Inc., a longstanding, highly-reputable MGU headquartered in East Norriton, PA.
In connection with the acquisition of IOA Re, J.C. Flowers & Co. LLC, a leading private investment firm dedicated to investing globally in the financial services industry, will acquire a controlling interest in ELMC.
"The acquisition of IOA Re will allow ELMC to expand its reach in the self-funded healthcare market and offer new opportunities for growth," said Richard Fleder, co-founder and CEO of ELMC. "The addition embodies our commitment to providing a best-in-class platform for delivering smart, straightforward medical stop-loss solutions to our carrier, broker, TPA and client partners," said Fleder.
"We are pleased to combine our strengths to meet the demands of the rapidly-changing marketplace," said John Parker, president of IOA Re. "The ELMC platform enables us to reach a larger audience as well as strengthen our risk positions and capture profits through its offshore captive strategy," Parker said.
Eric Rahe, a Managing Director of J.C. Flowers, added, "We believe this is an ideal time to invest in the medical stop-loss insurance sector, as more businesses are choosing to self- insure. Not only is this a sector we know well, but by partnering with the highly respected ELMC and IOA Re teams, we feel confident we can further enhance the company's standing in the industry."
IOA Re entered the medical stop-loss business in 1982 and remains a well-regarded organization. Beyond its key medical stop-loss product, IOA Re's lines of business include managed care (HMO and provider excess insurance), and workers' compensation catastrophe reinsurance; all lines of business which ELMC remains firmly committed to supporting.
IOA Re's affiliated holding, Insurance Resources and Auditing Services (IRAS), provides professional auditing and insurance services for external MGUs, insurers, reinsurers, managed care organizations, TPAs and self-insured employers.
The acquisition of IOA Re represents a strong complement to ELMC's existing operations, including Midwest Reinsurance Underwriters, RxReins and DiversitySL. The breadth and depth of IOA Re's underwriting and operating platform provides an ideal springboard which will enable the organization to expand its reach in the self-funded healthcare market as well as the reinsurance space as a whole.
ELMC owns, manages and seeks to acquire premier MGUs across the nation that specialize in underwriting medical stop-loss insurance for self-funded health plans. ELMC provides a best-in-class platform for delivering medical stop-loss solutions to brokers, carriers and clients. Contact Mary Ann Carlisle at email@example.com and visit elmcgroup.com.
About J.C. Flowers
J.C. Flowers is a leading private investment firm dedicated to investing globally in the financial services industry. Founded in 1998, the firm has invested more than $15 billion of capital in 45 portfolio companies in 16 countries across a range of industry subsectors including banking, insurance and reinsurance, securities firms, specialty finance, and services and asset management. With approximately $6 billion of assets under management, J.C. Flowers has offices in New York and London. Visit jcfco.com.
About IOA Re
IOA Re is a managing general underwriter based in East Norriton, PA, with offices located throughout the United States. While medical stop-loss is IOA Re's largest product line, IOA Re enjoys a strong reputation and client following in managed care, special risk, workers' compensation and other associated lines of business. Its affiliated holding, IRAS, provides professional auditing and insurance services for external MGUs, insurers, reinsurers, managed care organizations, TPAs and self-insured employers. Visit www.ioare.com.
Health Care Administrators Association (HCAA) Announces
2017 Executive Forum
All HCAA members, as well as non-member TPAs are invited to attend this
conference. Early-bird registration and conference room rate discounts are
available through November 18, 2016. For more information on registration,
or to view the full schedule of session descriptions and speaker bios, visit
the HCAA website.
The Health Care Administrators Association is the nation's most prominent nonprofit trade association that supports the education, networking, resource and advocacy needs of third-party administrators (TPAs), insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers and health care consultants. For nearly 35 years, HCAA has taken a leadership role in legislative advocacy, working to increase its influence with policymakers and other stakeholders in order to transform the self-funding industry and expand its role within health care. Visit www.HCAA.org, connect at @HCAAinfo, HCAA LinkedIn or HCAA YouTube.
Advanced Medical Pricing Solutions (AMPS) Launches Interactive Margin Erosion Calculator and Broker Tool Kit
MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 9/23/2016, www.advancedpricing.com
ATLANTA, GA -- Advanced Medical Pricing Solutions (AMPS), a Physician Led, Technology Driven healthcare cost management company has launched its newest tools for brokers and payers to deliver critical information and solutions to the self-funded market.
AMPS leads the cost-containment industry by delivering dramatic savings to self-funded employers and their members through its Medical Bill Review (MBR) and Reference Based Reimbursement (RBR) programs. They've now made available two new interactive tools to assist brokers and payers to help guide their Clients to solutions that will have the biggest impact on their medical spend. These dynamic resources are located on the AMPS website, www.advancedpricing.com.
The AMPS Margin Erosion Calculator allows users to visualize the erosion of profit margins as benefits increase over time. Just plug in real data including annual revenue, benefit expense (including pharmacy), pre-tax margin, and estimated tax rate. Users can also choose the default assumptions for revenue and expense growth. The tool will chart the estimated impact of healthcare costs on company margins over 5 years and create a pdf report sent to you via email. The Margin Erosion Calculator provides a powerful analysis when talking to self-funded employers about the importance of considering proven alternatives to the standard PPO options.
The Broker Tool Kit provides brokers with multiple informational resources including white papers, email blasts, and other useful information to discuss the impact of medical spend on a self-funded Health Plan, and options to mitigate the negative trend line.
"We're very excited about the launch of these new services. They're designed to empower brokers and payers by providing additional tools to help them manage the impact of increasing healthcare costs on their Clients' bottom line. And because these tools are online they can be accessed at any time", said John Powers, Executive Vice President of Sales, at AMPS.
Advanced Medical Pricing Solutions is a cutting edge healthcare cost management company providing unique solutions to dramatically reduce Health Plan medical spend and employee out-of-pocket costs. Focusing on aggressive alternatives to traditional PPOs, this Physician Led, Technology Driven company offers industry leading savings through Reference Based Reimbursement (RBR) solutions, Medical Bill Review services, Direct Provider Contracting, and flexible Out-of-Network Repricing options. Contact John Powers, Executive VP, Sales, at 630-361-2525, firstname.lastname@example.org and visit
Health Payer Consortium (HPC) Expands The "Paid Claim Refund" Program
MyHealthGuide Source: Health Payer Consortium, 9/23/2016, www.healthpayerconsortium.com
St. Louis MO -- Through the "Paid Claim Refund" program, Health Payer Consortium (HPC) identifies trends and noncompliant charges, per federal billing guidelines, on large in and out of network claims. After these noncompliant charges have been identified, HPC works with the Provider to procure a refund check. This program is successful for almost every Payer, Network, and Claim Type.
"Some claims will have a few thousand in savings while others will have a few hundred thousand in savings. You never know until after we review your claims with our proprietary solutions," says Patrick Crites, President of HPC. "Since we perform these services on large paid claims, the refunds can be substantial and we have procured refunds on claims that were a year old."
"Many cost containment solutions miss large errors and there are also noncompliant billing trends that do not become widely known until after large claims have been paid. Reviewing large claims after they have been paid should become a part of every payers cost containment efforts," says Jason Nau, VP of Operations at HPC. "These are charges that should not have been billed for in the first place."
If you would like more information about getting a refund on your paid claims or any of our other services, please see Patrick Crites, Patrick.email@example.com, at SIIA this week or send an email to Jason Nau at firstname.lastname@example.org and he will schedule a convenient time for a confidential discussion.
About Health Payer Consortium
HPC is designed to be a member-owned innovation company that combines the benefits of in-sourcing, outsourcing, and innovation management for Healthcare Payers. Our mission is to utilize our unique business model to deliver industry-leading services and savings while eliminating third party profit stacking. The ultimate goal is to shift profits back to Payers and their clients. We offer refunds on paid claims, compliance audits, medical bill review, negotiations, editing, network repricing, and reference based repricing. We also have a separate case management division which provides a full suite of case management and utilization review services. Check us out at www.healthpayerconsortium.com.
The Phia Group's Plan Appointed Claim Evaluator® (PACE) Celebrates First Anniversary
MyHealthGuide Source: The Phia Group, 9/22/2016, www.phiagroup.com
The Phia Group's Plan Appointed Claim Evaluator® (PACE) service will celebrate its first anniversary in October. As the premier fiduciary transfer and final, internal appeals handling service on the market, PACE has quickly become a game changer for TPAs, brokers and self-funded groups, alike.
Tim Callender, a Staff Attorney with The Phia Group and Phia's Lead PACE Counsel commented on the service's anniversary, "It's incredible to see how our involvement in a difficult appeal can avoid litigation and assure the governing plan document is properly followed. Time and again we are handling appeals that involve extremely complex exclusions or medical necessity issues that would have been interpreted incorrectly without PACE. It feels good to know that PACE is protecting plan fiduciaries, helping TPAs and brokers avoid litigation, and assure proper outcomes. It's good for the industry."
Over the past year, The Phia Group's PACE service has seen adoption in all regions of the nation and is set to eclipse 100,000 employee lives.
About The Phia Group
The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets. Contact Tim Callender, Esq., email@example.com, 781-535-5631 and visit www.phiagroup.com.
VRx byMail Delivers for Employers and Members
MyHealthGuide Source: Veridicus Health (VRx), 9/23/2016, www.veridicushealth.com
Veridicus Health (VRx) opened its own, state-of-the-art mail order pharmacy, VRx byMail, on July 1st of this year. VRx byMail delivers maintenance medications straight to your door or office with deeper discounts than retail pharmacy outlets. The additional savings realized from mail order helps reduce both member and employer healthcare costs while giving members more convenient access to their medications.
VRx byMail is located in Salt Lake City, Utah and services members across the United States. VRx byMail's integration with other Veridicus Health offerings, including VRx pharmacy benefit management (PBM) and clinical services, means members have one point of contact for all pharmacy inquiries.
Pharmacist In Charge (PIC), Dr. Justin Bryner, Pharm D. clarified a major difference on how VRx byMail will operate versus other mail order pharmacies:
"Traditionally, mail order pharmacies have been viewed as lacking the personal touch that comes with your neighborhood pharmacy. We wanted to change that. It's exciting to know that we give members the convenience of mail order delivery for maintenance medications while maintaining a neighborhood pharmacy feel."
In speaking to the importance of VRx byMail, Veridicus Health President, Doug Burgoyne, said, "By establishing an internal mail order pharmacy, our clients experience substantial savings opportunities and more control over their pharmacy benefits. At the same time, members can take advantage of the convenience and savings of mail order while still experiencing the same level of customer service they've come to expect from Veridicus Health."
Many PBMs require mandatory mail order, taking control away from employers and members while bolstering profit margins. Veridicus Health and its PBM, VRx, maintain a more client- facing position of true transparency and plan control by allowing the employer to choose how to utilize mail order services in a way that serves their benefit goals.
Veridicus Health provides guidance and education around benefit designs and plan options, but clients always have the freedom to choose whether or not to participate in mail order, without any penalties or additional administrative fees.
Veridicus Health has also announced the opening of a specialty pharmacy in the coming months to help address the rising costs and impacts of specialty medications. Watch for more news from Veridicus Health in the coming weeks and months.
About Veridicus Health
Veridicus Health provides transparent, pass-through pharmacy benefit management services to clients and members throughout the United States. Located in Salt Lake City, Utah, VeridicusHealth uses a lowest net cost pharmacy benefit model to help employer groups and members manage the rising pharmacy costs and avoid waste. Contact Joyce Canning, VP Client Development, at 801.990.9967, firstname.lastname@example.org and visit www.veridicushealth.com.
Cayman Captives Boosted by Stop-Loss
MyHealthGuide Source: Cayman News, 9/22/2016
So far, 2016 has been a very active year for new captive insurance formations, with 23 new licenses granted over the first six months of the year, according to the Cayman Islands Monetary Authority. This number exceeded the issuance of licenses in the whole of 2015.
"Historically, November and December are the busiest months in terms of new captive formations, and if the same applies to 2016, the year will be another phenomenal year for the jurisdiction in terms of new captive/(re)insurance company formations," said Ruwan Jayasekera, Head of Insurance Supervision at CIMA.
"CIMA is seeing a shifting trend in new captive/(re)insurance company formations, with more and more companies being formed to assume unrelated and non-traditional risks," he added. Changes made to the main insurance law, supporting regulations and the regulatory framework within the last five years to accommodate sophistication and innovation have had a positive impact on the insurance industry, with insurance groups, intermediaries and hedge-funds in particular choosing Cayman to house their (re)insurance subsidiaries."
"Even with consolidation taking place throughout the healthcare system in the United States by way of mergers and acquisitions, it is encouraging to see the formation of new healthcare captives to write traditional med-mal liability insurance, as well as non-traditional risks, such as cyber risks and medical stop loss," Jayasekera said.
About Cayman Islands Monetary Authority
The Cayman Islands Monetary Authority began operations on 1 January 1997. It was established as a body corporate under the Monetary Authority Law, which was brought into force on that date. Visit www.cimoney.com.ky.
Tokio Marine HCC Stop Loss Group Announces Johnny Banks as Vice President of Marketing in the Southeast Region
MyHealthGuide Source: Tokio Marine HCC, 9/21/2016, www.tmhcc.com/life
Tokio Marine HCC -- Stop Loss Group is pleased to introduce Johnny Banks as Vice President of Marketing in the Southeast Region.
Johnny Banks brings over 30 years of insurance experience including the last nine years working with Brokers and Administrators placing Medical Stop Loss in the Southeast. Johnny is a graduate of Virginia Tech.
In his new position, Johnny will be responsible for maintaining and enhancing producer relationships, renewing existing business, generating new business and facilitating proposal activity. His territories include Tennessee, Arkansas, Kentucky, as well as parts of Georgia and North Louisiana.
If you have any questions or need additional information, please contact Johnny directly at (770) 693-6423 or email@example.com. Please send all RFPs and information related to RFPs firstname.lastname@example.org.
About Tokio Marine HCC - Stop Loss Group
A member of the Tokio Marine HCC group of companies. Tokio Marine HCC is the marketing name used to describe the affiliated companies under the common ownership of HCC Insurance Holdings, Inc. Tokio Marine HCC's products are underwritten by American Contractors Indemnity Company, HCC International Insurance Company PLC, HCC Life Insurance Company, HCC Specialty Insurance Company, Houston Casualty Company, Lloyd's Syndicate 4141, United States Surety Company and U.S. Specialty Insurance Company. Contact Tracy Creekbaum at email@example.com, 770-693-6507, and visit www.tmhcc.com/life.
Cypress Benefit Administrators Expands TPA Team with Laurie Molle, Director of Client Services
MyHealthGuide Source: Cypress Benefit Administrators, 9/7/2016, www.cypressbenefit.com
Appleton, WI -- A third party administrator (TPA) headquartered in Appleton, Wisconsin, with four additional locations across the United States, Cypress Benefit Administrators has hired Laurie Molle to serve as its Director of Client Services.
Molle's 12-plus years of professional business experience in the health care industry includes her most recent role as Vice President of Operations for a national TPA.
Working from Cypress's Appleton location, Molle will focus on managing the TPA's fast-growing book of business and its internal operations, including heading up the Group Administration, Vendor Relations and Compliance departments at the company.
"Laurie will be an important asset to the Cypress team as we continue to grow throughout the country," said Tom Doney, president and CEO of Cypress. "We are excited to welcome her as she brings such a great base of knowledge and real-world experience in self-funding," he shared. "She is well-known among her previous clients and throughout the industry for her expertise in TPA operations."
Having established her versatile skillset in business over the years, Molle has led the efforts of multiple teams in her previous employment and also has expertise in a wide variety of TPA functional areas, including claim operations, vendor relationships, compliance and client and broker relations.
"I am excited to be part of a firm that is a recognized leader in the TPA industry," Molle said. "I look forward to working with a world-class team of employee benefits professionals at Cypress and contributing to the ongoing growth of the company."
About Cypress Benefit Administrators
A privately held company headquartered in Appleton, Wis., Cypress Benefit Administrators has been pioneering the way toward cost containment in self-funded health benefits since 2000. The TPA is the country's first to bring claims administration, consumer driven health plans and proven cost control measures together into one package for companies ranging from 50 employees to thousands of employees. It serves employer-clients across the U.S. with additional locations in Portland and Salem, Ore., Omaha, Neb. and Denver, Col. For more information on Cypress Visit www.cypressbenefit.com.
Zurich Seeks Business
Development Manager to sell Medical Stop Loss Solutions
Qualified applicants may apply @: https://zurich.taleo.net/careersection/zurich_ext_cs/jobdetail.ftl?job=160007C0&lang=en&sns_id=mailto#.V-A7veYO_eM.mailto
Zurich is a Swiss insurance carrier with over 140 years serving businesses worldwide, including 100 years in the United States. We have proven our commitment to delivering reliable and comprehensive insurance solutions to our customers. All of our passion goes into helping understand, manage and minimize risks. Visit www.ZurichNA.com.
IMG Stop Loss
Seeks Underwriter Trainee -- Stop Loss
Knowledge Skills and Abilities
Qualified candidates can send their resumes directly to HR@imglobal.com.
For more than 25 years, International Medical Insurance (IMG) has dedicated its efforts to providing international medical insurance, travel insurance and impeccable service to the international community. It's our specialty. We realize that traveling abroad can be an exciting experience. We also know that anything can happen while you're away from home - whether visiting short-term or living abroad indefinitely. It's important to be prepared for any unexpected illness, injury or medical emergency. Many traditional medical plans simply are not designed for international travel. Visit www.imglobal.com.
IMG Stop Loss Seeks Stop Loss Underwriter
Knowledge Skills Abilities
Qualified candidates can send their resumes directly to HR@imglobal.com .
For more than 25 years, International Medical Insurance (IMG) has
dedicated its efforts to providing international medical insurance, travel
insurance and impeccable service to the international community. It's our
specialty. We realize that traveling abroad can be an exciting experience.
We also know that anything can happen while you're away from home - whether
visiting short-term or living abroad indefinitely. It's important to
be prepared for any unexpected illness, injury or medical emergency. Many
traditional medical plans simply are not designed for international travel.
Is Rarely the Best Choice for Price or Quality, Report Shows
"Across the U.S. health care system, one of the easiest ways to reduce
costs would be to redirect patients from low-quality/high-cost facilities to
high-quality/low-cost alternatives," said Tabah. "In the short term, we
could save $100 per year per person -- or $25 billion annually -- with that
one simple switch. In the long term, the dynamic effects of competition on
hospital leadership would lead to better quality and cost of care."
FairChex meets a profound need for transparency in healthcare by rating hospitals based on their price and quality outcomes -- down to the level of an individual procedure. A subscription-based software platform gives health plan administrators the tools needed to help patients make informed decisions about where they choose to have planned procedures. Each patient who chooses an A/A+ hospital over a C-grade facility (or below) can save a plan more than $10,000 -- while receiving an equivalent or better level of care. Visit www.FairChex.com.
About Global Excel Management Inc.
Global Excel is a full-service cost containment, claims management and medical assistance company located in Canada. It offers a complete range of services to over 300 international, Canadian and U.S. domestic clients located in more than 40 countries around the world. Global Excel manages approximately 105,000 inpatient, outpatient and non-medical cases per year and processes in excess of $850 million in healthcare claims annually. Contact Benjamin Tabah at Benjamin.Tabah@globalexcel.com and visit www.globalexcel.com.
Employer Groups See Mixed Bag in EEOC Wellness Plan Ruling
MyHealthGuide Source: Carmen Castro-Pagan, 9/22/2016, BNA Pension & Benefits Daily
Case: EEOC v. Orion Energy Systems, Inc. Case 1:14-cv-01019-WCG. Court's Ruling (Compliments of BenefitsLink.com)
Employer groups are at odds over what a recent decision by a federal court in Wisconsin on the EEOC's wellness plan regulation will actually mean for the rule and future lawsuits.
A Sept. 19 decision by the U.S. District Court for the Eastern District of Wisconsin allows Orion Energy Systems Inc. to require employees who want to enroll in the company's health-care plan to undergo medical examination or pay full premium coverage. Some are calling it a win for the Equal Employment Opportunity Commission and others are claiming a partial victory for the employer side.
The decision in EEOC is the first to weigh in on a new regulation by the agency that allows employers to offer limited financial incentives to encourage employees to participate in wellness programs without violating federal law.
This is a "mixed result" for employers, Kathryn Wilber, senior counsel for the American Benefits Council in Washington, told Bloomberg BNA Sept. 22. Orion won on the voluntary standard issue, but there should be a concern about the court's application of the safe harbor provision in the Americans with Disabilities Act, Wilber said.
Frank C. Morris, an employee benefits attorney at Epstein Becker Green in Washington, D.C., agrees. "This is a classic split decision," Morris said. Orion "scored a big win" since the court found that its wellness program didn't violate the ADA because it was voluntary despite the fact that not participating in it would mean that an employee would have to pay 100 percent of the health-care premiums, Morris told Bloomberg BNA Sept. 22.
ADA's Safe Harbor Provision
The ADA includes a safe harbor provision related to the insurance industry, which employers have successfully used to contest the EEOC's challenges to the medical examinations they require as part of their wellness programs.
Another federal court in Wisconsin held last year in EEOC v. Flambeau, Inc. (W.D. Wis. 2015) ruled that the safe harbor provision allows employers to design insurance plans that require otherwise-prohibited medical examinations and inquiries as a condition of enrollment in a plan. That case is currently on appeal to the U.S. Court of Appeals for the Seventh Circuit, but it may be dismissed on jurisdictional grounds.
After Flambeau was decided, the EEOC issued regulations on employer-sponsored wellness plans. The regulations provide, among other things, that the ADA's safe harbor provision doesn't apply to medical examinations taken in connection with a wellness program like the ones at issue in this case and Flambeau.
The Orion court said that the EEOC's take on the ADA's safe harbor provision was a "permissible interpretation" of the statute and could be applied retroactively.
Employers' Take on the Safe Harbor Ruling
The EEOC is "no doubt thrilled with the decision--they got almost everything they wanted," James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington, told Bloomberg BNA Sept. 22.
The Orion decision is "the first that really comes from a court that gives some perspective as to the regulation and how the safe harbor applies to these set of facts," Wilber said.
Employers have taken a position that the safe harbor applies and the court essentially ruled that out in this case, she said. The deference the court is giving to the safe harbor provision isn't what employers were hoping for, Wilber said.
Employers that want to assert the safe harbor defense should make sure that their wellness plan is really part of their health plan and that there is evidence that it is used to assist in underwriting, classifying and administering risk under the statutory language and as demonstrated in Flambeau, Morris said.
Medical examinations that are voluntary and part of a health plan don't violate the ADA. This was the rationale used by the court in ruling for Orion.
Some employer groups see this as a win for their side. The Orion decision is a "very strong rebuttal" to the EEOC's final regulation that the limited incentives that employers can provide to participants in wellness plans can't go over 30 percent, Mark Wilson, chief economist at the HR Policy Association in Washington, told Bloomberg BNA Sept. 21.
The EEOC's final regulation provides that if an employer wishes to incentivize or penalize employees' participation, the program remains voluntary if the employer provides a financial incentive at or below 30 percent of the total cost for self-only coverage.
In Orion, the court said that the EEOC didn't argue that this part of the regulation applied retroactively. The EEOC, instead, argued that Orion's program wasn't voluntary, but compulsory, because it shifted 100 percent of the premium cost to an employee who opted out.
The court wasn't persuaded by this argument. "Even a strong incentive is still no more than an incentive; it is no compulsion," the court said. "Orion's wellness initiative is voluntary in the sense that it is optional," the court added.
The Orion court didn't rule on the 30 percent incentive cap in the EEOC's regulation. Moving forward, employers should carefully review the risks of using more than a 30 percent incentive for health plans as this limit is consistent with the Affordable Care Act rules for health-contingent plans, Morris said.
More Lawsuits and Appeals?
The Orion decision is significant because it may be the only one of a trio of cases brought by the EEOC that gets resolved on the merits. Late in 2014, the EEOC brought lawsuits challenging wellness programs at Honeywell International Inc., Flambeau Inc. and Orion Energy.
The case against Honeywell ended when a federal court in Minneapolis denied the EEOC's request to block the company from penalizing workers who didn't participate in a corporate wellness program.
The Flambeau court relied on the Eleventh Circuit decision in Seff v. Broward County, 691 F.3d 1221 (11th Cir. 2012), to uphold the medical examinations required in the employer's wellness plan. In that case, the appeals court said that Broward County, Fla.'s wellness program fit within the ADA's safe harbor provision for insurance plans.
Employer groups believe that more lawsuits will follow. The EEOC will likely ignore the court's decision and will keep bringing lawsuits against other employers, Wilson said.
Asked whether he believed that the EEOC would likely wait until its regulation become effective in January 2017 to bring more lawsuits challenging employers' wellness programs, Morris said yes.
"I think they will wait until 2017 unless they see a case where they allege special circumstances," Morris said.
If Orion is appealed, and upheld on the circuit level, then there is a disagreement between the Eleventh and Seventh circuits, which would be a good reason for the Supreme Court to take up the case, Gelfand said.
The EEOC didn't immediately respond to Bloomberg BNA's request for comments.
Getting Pharmacogenomics Into the Clinic
Genotype-guided prescribing--also referred to as pharmacogenetics, or PGx--is
expected to become routine as genetic profiling becomes more commonplace.
How Does Pharmacogenomics Work?
"Genetic variability affects essentially every single gene in the human
genome and sometimes it's going to affect genes whose proteins are critical
for drug response," said Mary V. Relling, PharmD, chair of the
pharmaceutical sciences department at St Jude Children's Research Hospital.
Frye added that clinical research is needed to better understand what level
of value genetic testing adds for patients seeking treatment for depression.
"Value added can mean many things--getting better faster, complete remission
of symptoms, less side effect burden, better quality of life, [and] less
hospital cost are only a few examples," he said.
According to a 2015 Nature review article that Relling coauthored, drugs
currently known to be affected by "actionable" inherited pharmacogenes
represent around 7% of FDA-approved medications and 18% of US outpatient
prescriptions. In addition to antidepressants and blood thinners, these
drugs include, antivirals, chemotherapy agents, immunosuppressants, pain
relievers, and statins, among others, making the field of pharmacogenomics
relevant for precision medicine in a variety of medical specialties.
Additional challenges stand in the way of pharmacogenomics implementation.
Physicians say they need tools to help them understand and use the tests.
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 8/8/2016)
Source: MyHealthGuideEditor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
The Value of Self-Funding
MyHealthGuide Source: The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, www.SIEFOnline.org The Self-Insurance Educational Foundation, Inc. (SIEF has published The Value of Self-Funding.
Self-funding is an important contributor to the financial and physical health of America's wellness future. Self-funding is more than processing claims and receiving premiums, it provides quality coverage and proactive healthcare management for employers of all sizes and industries.
About the SIEF
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501(c)(3) non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). The foundation's mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.SIEFOnline.org.
Video Highlighting Captive Solutions for Mid-market Companies
MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF), 5/11/2016, www.siefonline.org
The Self-Insurance Educational Foundation (SIEF) announced that it has released a new video highlighting captive insurance solutions for mid-market companies, including stop-loss captive programs, enterprise risk captives, and property & casualty group captives. Please click here to access the video.
The video can be accessed through the Foundation's web site at www.siefonline.org or by clicking here. The video includes a separate video focused on self-insured group health plans. Both videos can be private labeled by individual companies interested in using them for their own purposes. Contact Justin Miller at firstname.lastname@example.org or 800-851-7789 for more information about private labeling.
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501 c 3 non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). Its mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.siefonline.org.
ICD-10 Readiness Tools
MyHealthGuide Source: Industry Study Group (ISG), 9/19/2015
In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list. On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. The new ICD-10-CM Trigger list is endorsed by SIIA and HCAA and supported by SPBA.
Below are useful links for members of the self-funded community including TPAs, stop-loss carriers, MGUs, and others.
September 25-27, 2016
October 17-19, 2016
December 1-2, 2016 -
A Hybrid Conference and Internet Event
January 29-31, 2017
January 30-February 1, 2017
February 8-10, 2017
Schedule and registration: www.hcaa.org/?page=2017EFSchedule
March 15-17, 2017
March 27-29, 2017 - A Hybrid Conference and Internet Event
March 28-30, 2017
April 18-19, 2017
September 13-15, 2017