MyHealthGuide Newsletter
News for the Self-Funded Community
6/27/2016

Published weekly by MyHealthGuide, LLC (www.MyHealthGuide.com). This Newsletter is for personal, non-commercial use only.  This weekly newsletter is FREE OF CHARGE to subscribers.  Subscribe free. Send news, press releases and announcements to mailto:Info@MyHealthGuide.comClick here if Newsletter stops arriving.

TABLE OF CONTENTS

General & Company News

People News

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News



Self-Insured Political Action Committee (SIPAC) Fund-Raisers Exceed $120,000

MyHealthGuide Source: Self-Insured Political Action Committee (SIPAC), 6/22/2106, SIPAC

The SIPAC strengthens The Self-Insurance Institute of America's (SIIA) political voice in Washington. Several fund-raising dinner events have successfully concluded with over $120,000 being raised.  "After expenses, we have netted well over $100,000," said Mike Ferguson, President & CEO, Self-Insurance Institute of America.  "This campaign has been a tremendous success!"

Through the SIPAC, SIIA supports and builds relationships with elected officials who understand and share our common goals and interest, as well as educate those that may be unfamiliar with the self-insurance marketplace. SIPAC has enabled SIIA to participate in a significant number of exclusive events for Congressional Members of both parties who are involved with our issues.

Here are highlights of some of the events.

Oklahoma City

The Self-Insurance Political Action Committee (SIPAC) launched its inaugural national dinner on April 12 at Broadway 10 Restaurant in Oklahoma City. SIIA President & CEO Mike Ferguson was joined by 10 association members for the first of 14 dinners scheduled this spring at some of the best restaurants in cities across the country.

"What a great start for the SIPAC fundraising campaign!" said Tom Belding, president of Professional Reinsurance Marketing Service and member of the event host committee. "Everyone had a great time and really understood why it was so important to support the cause."

The host committee also included, Charlie Caldwell, CEO of Midlands Management Corp., Marc Marion, Vice President with American Fidelity Assurance, and Jerry Messick, CEO of Elevate Captives.

SIPAC_OK
SIPAC event in Oklahoma City

Attendees included:

  • Robert Baisden of International Assurance of TN,
    Brent Haggard of Universal Fidelity Life Insurance Company,
    David Johnson of Self-Insured Solutions,
    Tyler Laughlin of the Oklahoma Department of Insurance,
    Sherri Tetachuk of Renalogic, and
    Barney Welch of Associated Underwriters.

Hartford

The SIPAC dinner campaign on May 11 was held at the Capital Grille in Hartford, CT. Don Drelich of D.W. Van Dyke & Co. and Rob Melillo of Guardian Life Insurance hosted the event. Don commented on the dinner, "I was glad we got to support SIPAC in Hartford and enjoyed the conversation among old colleagues and new."

SIPAC_Hartford
SIPAC event in Hartford

 The attendees included:

  • Chris Mancini of Captive Global, LLC,
    Marty Nagle of Guardian Life Insurance, and
    Brad Nieland of Sun Life. 

New York

The SIPAC dinner on May 12 was held at the Grand Havana Club in New York City. The club is a popular venue for many SIIA members in the area. "The dinner was a great success," said host Alex Giordano of Cabot Underwriters, LLC. "I enjoyed getting together with people from all parts of the self-insurance industry."

SIPAC_NY
SIPAC event in New York

The attendees included:

  • Richard Felder of ELMC Holdings, LLC,
    Liz Mariner of Re-Solutions,
    Fred Miller of D.W. Van Dyke & Co.,
    Todd Owen of Windsor Strategy Partners, LLC, and
    Simeon Schindelman of MagnaCare.

Boston

The SIPAC event on May 13 in Boston was hosted by Adam Russo, CEO of the Phia Group. This single dinner pulled in $12,000 that can be used for targeted political contributions this election cycle.

"I was so glad we were able to host a dinner for SIPAC in Boston. It is a hub for the self-insurance industry and it was very beneficial to get people together to discuss all aspects of self-insurance while having a great meal," said Russo.

SIPAC_Boston
SIPAC event in Boston

The attendees included:

  • Peter Borans of Advanced Medical Strategies,
    Mike Branco of the Phia Group,
    Chris Brown of Berkley Accident and Health,
    Denise Doyle of Stop Loss Insurance,
    Gerald Gates of AmWins,
    Steven Gransbury of QBE,
    Deb Hodges of Health Plans Inc.,
    John Jones of Moulton Bellingham,
    Ron Peck of the Phia Group,
    Michael O'Malley of Strategic Risk Solutions, and
    Robert Tierney of StarLine Group.

Philadelphia

On June 7, 2016, the SIPAC had a great turnout for its dinner in Philadelphia at restaurant Amada hosted by Andrew Cavenagh of Pareto Captive, Bob Clemente of Specialty Care Management, and Jeff Simpson of Gordon, Fournaris & Mammarella. The 18 dinner participants raised more than $15,000.

"I am thrilled that Philly brought home the most money and most attendees of all the dinners so far. I know all the guests realize how important the cause is, and it was great to see them all band together in support," said Cavenagh. 

SIPAC_Boston
SIPAC event in Philadelphia

The attendees included:

  • John Capasso of Captive Planning Associates, LLC
    Andrew Clayton of Pareto Captive
    Eric Dove of Excess Reinsurance Underwriters
    Debra Gaglioti of Captive Planning Associates, LLC
    Rick Garrison of Specialty Care Management
    Steve Kelly of ELAP Services
    Andy Lewis of Pareto Captive
    Jim Loomis of The Loomis Company
    Jim Loomis Jr. of The Loomis Company
    Mark Martinelli of Wipfli LLP
    Kristen McKenna of Pareto Captive
    John Naughton of Keystone Risk Partners
    Joel Pina of Keystone Risk Partners
    JJ Purdy of Garnet Captive Services

Minneapolis

On June 16, 2016, the SIPAC fundraising dinner was held in Minneapolis at the Capital Grille downtown hosted by Michael Meloch of TPAC Underwriters, Inc. 

"The dinner last night was a great time," said Meloch. "I was glad to get everyone together in my hometown to catch up, meet new people, and raise money for SIPAC. This is certainly the year to contribute with the upcoming election."

SIPAC_Boston
SIPAC event in Minneapolis

Dinner guests included:

  • Dan Bolgar of PartnerRe America Insurance Co.
    Rick Eldridge of the Intuitive Companies
    John Nelson of RGA
    Stu Thompson of The Builders Group
    Bob Tierney of StarLine
    Dale Vaughn of StarLine

Irving, TX

On June 17, 2016, the SIPAC  event was held in Irving, TX at La Cima Club hosted by Mark Stadler of BridgeHealth. He said of the dinner, "I had the opportunity to host my guests at La Cima Club, which is a beautiful venue and has great food. Although we were a small group, it was a good opportunity to talk on a more personal level and learn more about new and old colleagues."

SIPAC_Boston
SIPAC event in Irving, TX
Attendees included:

  • Vicki Burgess of Crum & Forster,
    Thomas Kelly of HealthSmart,
    Joanie Verinder of Group & Pension Administrators, and
    Mike Ferguson with SIIA.

Nashville

Finally, on June 21, SIPAC's last dinner of this campaign was held at The Southern Restaurant hosted by Kevin Doherty, Partner, Nelson Mullins;  Bob Shupe, CEO, EPS, LLC and Ernie Clevenger, President, CareHere / MyHealthGuide.

Clevenger said, "Nashville was the perfect place to wrap up the SIPAC dinner campaign. We are pleased that the fundraiser was so successful, and that we were part of reaching the fundraising total."

SIPAC_Boston
SIPAC event in Nashville

The dinner attendees included:

  • Bill Beeler of HCS Benefits
    Bill Buechler of Crowe Horwath
    Danny Dugan of North America Administrators
    Charlie Fox, III of Golden Triangle
    Duke Niedringhaus of J.W. Terrill, Inc.
    Andy Rhea of Iroquois Captive
    Scott Stone of Arsenal Insurance Management
    Robert Tierney of StarLine
    Scott Williams Golden Triangle
    Polli Yount of Golden Triangle

How you can participate

SIIA would like to thank everyone who made these events a success.  If you would like to be part of one of these dinners, there is still time! Please contact Wrenne Bartlett at wbartlett@siia.org and 800-851-7789.

Federal law prohibits contributions from corporations. You may refuse to contribute without reprisal. SIPAC will not favor or disadvantage anyone by reason of the amount contributed or the decision not to contribute. SIPAC participants must be US citizens or permanent resident aliens.

About SIIA

The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally.  Visit www.SIIA.org.

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Zelis Healthcare Introduced to Healthcare Community, Offers Integrated Suite of Claims Cost Containment and Payments Technology

MyHealthGuide Source: Zelis Healthcare, 6/13/2016, www.zelis.com

BEDMINSTER, NJ and ATLANTA, GA -- Zelis Healthcare announced the launch of its new corporate brand. Zelis Healthcare leads the industry with innovative technology and solutions that address the complex payment-related needs of its clients.

Zelis Healthcare delivers a powerful and unique end-to-end technology platform addressing the claims cost containment and payments needs of healthcare payors including large and medium-sized health plans, TPAs, Taft-Hartley Plans, providers and patients. The company provides a comprehensive array of network management, claims integrity, payment remittance solutions and analytical services for medical, dental and workers' compensation claims to over 500 payor clients. In addition, the company delivers electronic payments and explanation of payments to over 200,000 healthcare providers and serves patients with provider lookup and medical referral services.

"Our new name, Zelis Healthcare, is a reflection of our zeal to deliver exceptional value," said Doug Klinger, Chief Executive Officer. "The name is based on four attributes that partners and clients consistently use to define our organization. We are known to be genuine in our partnerships, tenacious in the pursuit of solutions that deliver client value, impassioned about producing results that exceed expectations, and innovative in our approach to fulfilling client needs. With our four companies united as one company and brand, we can deliver greater efficiencies and savings, more actionable insights, and even greater results," Klinger added.

The foundation of Zelis Healthcare is four best-in-class companies, each with leading capabilities in their respective niches: Premier Healthcare Exchange (PHX), Stratose, Pay- Plus® Solutions (PPS) and GlobalCare. The announcement of the new brand underscores the powerful combination of these complementary businesses to create a single company offering an end-to-end platform spanning network management, claims integrity, payment remittances and analytical services for medical, dental and workers' compensation claims.

The company also unveiled a new corporate structure that links three operating divisions:

  • Network Solutions is led by Tina Ellex, President.  Tina had served as President of Stratose.
  • Claims Integrity is led by Lori Sempervive, President.  Lori was a founding member of PHX and the company's former Chief Operating Officer.
  • Zelis Payments is led by Jay Ver Hulst, President.  Jay was co-founder for former President of Pay-Plus Solutions

Zelis Healthcare is led by its executive team, including Klinger, Ellex, Sempervive, Ver Hulst, Chief Revenue Officer Terry Harris, Chief Information Officer Meridith Herdes, Chief Financial Officer Robert Hemmer, Chief Marketing Officer Leo Garneau and Chief Human Resource Officer Matt Hintz.

"Our leadership team, organizational structure and Company vision has been designed to take the best of our existing capabilities and add additional resources, expertise and talents so we can maintain our intense focus on our clients while continuing to lead the industry with innovative technology and solutions," Klinger added.

About Zelis Healthcare

Zelis Healthcare delivers a powerful and unique end-to-end technology platform addressing the claims cost containment and payments needs of healthcare payors including large and medium-sized health plans, TPAs, Taft-Hartley Plans, providers and patients. The company provides a comprehensive array of network management, claims integrity, payment remittance solutions and analytical services for medical, dental and workers' compensation claims to over 500 payor clients. In addition, the company delivers electronic payments and explanation of payments to over 200,000 healthcare providers and serves patients with provider lookup and medical referral services. Zelis Healthcare is a leader in new product innovation and technology development with a long track record of successfully addressing the complex needs of the healthcare community. Visit www.zelis.com.

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Wells Fargo and Others Dropping HSA Business Despite Growth Potential

MyHealthGuide Source: Business Insurance, 6/13/2016

Some big-name financial institutions recently exited the health savings account business despite the market's steady growth. A main reason: The prospects and potential profits aren't big enough compared with their other businesses. The latest to leave is Wells Fargo & Co., which confirmed in late May it is selling its HSA business.

U.S. Bancorp, Huntington Bancshares Inc., M&T Bank Corp. and The Bancorp Inc., as well as insurer Assurant Inc., all sold their HSA management businesses and/or their HSA accounts within the past 12 months. JPMorgan Chase & Co. sold its HSA business in early 2015.

As Pensions & Investments reported May 16, HSA deposit assets and the investment assets within HSAs have grown consistently -- although their sizes are small compared with retirement accounts such as 401(k) plans and individual retirement accounts.

Large financial institutions with many lines of business are getting out of HSAs to concentrate on bigger and more profitable businesses, said Roy Ramthun, president of HSA Consulting Services, Silver Spring, Maryland.

"They have other priorities, and this (HSA management) is too small a piece," Mr. Ramthun said. HSA management requires investments in technology that executives at large institutions might decide are not worth the effort given their expected return on investment.

"The more the HSA market matures, the more consolidation you will see," said Eric Remjeske, president of Devenir Group L.L.C., a Minneapolis-based investment adviser and consultant in the HSA business.

Total HSA assets reached $30.2 billion in 2015, about triple the amount in 2009, said the latest annual survey by Devenir. Investments accounted for $4.2 billion, or 14% of last year's total, according to the survey based on the 100 largest HSA managers.

The potential for growth in HSA assets has prompted giants such as Fidelity Investments, Boston, and Bank of America Merrill Lynch, New York, to continue pursuing their HSA management strategies.

However, for the dropouts -- at least those willing to comment -- HSAs no longer fit their long-term strategies.

"Wells Fargo periodically reviews its businesses and determined that the sale of (our) Health Benefit Services to an industry leader would provide our customers with a better platform for the future," the company said in a statement.

"Health Benefit Services has been a well-managed business for our company," the Wells Fargo statement continued. "This decision was not an easy one to make. However, we believe that it allows us to focus on businesses that are more core to Wells Fargo's future."

Wells Fargo is selling its HSA business to Optum Bank Inc., part of United Health Group Inc., Minnetonka, Minnesota. A May 31 notice on the Optum website welcomed Wells Fargo HSA account holders, noting the transaction is awaiting regulatory approval.

Representatives of Optum and Wells Fargo didn't provide transaction details, the number of HSA participants or the HSA assets that Optum was acquiring. Sources estimated Wells Fargo's HSA business covers 650,000 participants and $1.9 billion in assets.

"By and large, the acquirers" (investment) offerings tend to be broader than those of the sellers," said Devenir's Mr. Remjeske, referring to the recent HSA deals.

Richard Davis, chairman, CEO and president of U.S. Bancorp, told securities analysts Jan. 15 that HSA management wasn't part of his long-term strategy. "We are in every business line that we're in that we want," according to a transcript of the company's quarterly earnings call.
"We're not in anything we don't want to be in," Mr. Davis said. "We don't covet anything we don't have. We just want to be better at what we're doing and do it better, deeper, wherever we are."

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New World Medical Network, a Boutique Domestic Medical Travel Platform, Seeks Partnership with Employee Benefits or Consulting Firm

MyHealthGuide Source: New World Medical Network via PRWEB, 6/21/2016, www.NewPatient.net

New York, NY  -- New World Medical Network, a growing boutique domestic medical travel platform, seeks to partner with an employee benefits broker or consulting firm to serve as a distinct differentiator in the health care market. New World presently enjoys clients held through national employee benefit brokers, TPAs and directly contracted self-insured organizations.

The New World platform allows self-insured organizations to save roughly 50% off select low- to moderate-risk procedures as compared to the cost in their own area. It further allows the employee to receive treatment with zero out-of-pocket costs and/or a bonus for utilizing the service. Travel-for-two is included in the bundle.

"The emersion of healthcare consumerism is creating a whole new future in the medical industry. The cost and delivery of quality medical care today, with the stretch of resources and diminishing clinicians, is being forced to change. We are poised to be a great bolt-on for an organization which shares our vision," shared President and CEO, Cathy Nenninger. When asked why such a marriage would be a good idea, Ms. Nenninger replied, "Simply put, partnering with a broker or consulting firm allows the combined platform and delivery system to operate seamlessly right out-of-the-box." Organizations interested in a partnership should reach New World via email here or by phone at (631) 942-6040.

About New World

New World Medical Tourism LLC, is run by experienced healthcare and insurance professionals and caters to the self-insured marketplace - TPAs, companies, municipalities, and unions - with its one-cost, all-inclusive approach to non-emergent medical procedures and surgeries called "One Price Healthcare." New World is also known by its trademarked byline "Great Care. Less Cost. New World." New World Network consists of quality, accredited medical facilities within the United States as well as Costa Rica often saving organizations an average of 50% off U.S. costs. The program attaches to an existing health plan, achieved with a simple amendment to the plan document; there is no need for Open Enrollment and the program can be implemented at any time. New World can be reached at 800-475-PATIENT (7284) or by visiting www.NewPatient.net.

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ECHO Health Awarded 2016 Top Workplaces Honor

MyHealthGuide Source: ECHO Health, Inc., 6/21/2016, www.echohealthinc.com

Westlake, OH -- ECHO Health, Inc. has been awarded a 2016 Top Workplaces honor by The Plain Dealer. The Top Workplaces lists are based solely on the results of an employee feedback survey administered by WorkplaceDynamics, LLC, a leading research firm that specializes in organizational health and workplace improvement. Several aspects of workplace culture were measured, including alignment, execution, and connection, just to name a few.

"The Top Workplaces award is not a popularity contest. Oftentimes, people assume it's all about fancy perks and benefits," says Doug Claffey, CEO of WorkplaceDynamics. "To be a Top Workplace, organizations must meet our strict standards for organizational health. Who better to ask about work life than the people who live the culture every day--the employees. Time and time again, our research has proven that what's most important to them is a strong belief in where the organization is headed, how it's going to get there, and the feeling that everyone is in it together." Claffey adds, "Without this sense of connection, an organization doesn't have a shot at being named a Top Workplace."

"We are truly honored to receive this recognition from The Plain Dealer, but more importantly, from our own employees," says William Davis, Chairman and CEO of ECHO Health, Inc. "Each individual's feedback about their experience with us means everything to me and ECHO® as a company; without our staff, our vision of revolutionizing the future of payment processing would fall short."

About ECHO Health, Inc.

ECHO Health, Inc. is the leading provider of electronic healthcare payment solutions. ECHO processes 50 million claims and pays more than $10 billion annually to providers and members through industry-leading payers. Founded in 1997, ECHO is a privately held company located in Westlake, Ohio. Call 440.835.3511, ext. 118 and visit www.echohealthinc.com.

About WorkplaceDynamics, LLC

Headquartered in Exton, PA, WorkplaceDynamics specializes in employee feedback surveys and workplace improvement. This year alone, more than two million employees in over 6,000 organizations will participate in the Top Workplaces™ campaign--a program it conducts in partnership with more than 40 prestigious media partners across the United States. Workplace Dynamics also provides consulting services to improve employee engagement and organizational health. WorkplaceDynamics is a founding B Corporation member, a coalition of organizations that are leading a global movement to redefine success in business by offering a positive vision of a better way to do business.

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People News



Equian Announces  Shankar Narayanan Appointed as Chief Operations Officer and Chris Reed Named Group President of Data Mining & Audit

MyHealthGuide Source: Equian, 6/6/2016, www.equian.com.

Indianapolis, IN -- Equian, a leader in healthcare payment integrity, is pleased to announce two new executive hires to meet the needs of their rapidly growing company - Shankar Narayanan will be appointed as Chief Operations Officer while Chris Reed was named Group President of Data Mining & Audit.

"We welcome our two most recent executive hires to the Equian family," says Scott Minge, CEO. "The experiences both gentlemen have gained throughout their executive careers will be a healthy addition to Equian as we are accelerating our investments in innovation, analytics and service excellence. Proven results are the cornerstone of these individuals' DNA. Our market is complex and our customers desire expertise, scale and innovation that require continued investment in our leadership team. I am pleased these industry leaders chose to join the Equian team."

With over 17 years of leadership experience in the healthcare industry, Shankar Narayanan will be responsible for operations, technology, integration, and business performance management in his Chief Operations Officer role at Equian. Prior to joining Equian, Shankar was a member of the executive leadership team at Cognizant as the Global Head of Life Science. During his tenure Shankar led initiatives that drove industry-leading growth, operational- and process-improvement programs as well as new capabilities and scale through acquisition integration and product innovation.

Chris Reed comes to Equian as Group President of Data Mining & Audit with extensive expertise in operations, technology, innovation and business processes. Most recently, Chris was the VP of Strategy for MetLife's US Group Insurance where he designed the future state operating model of his division working closely with internal and external stakeholders. Throughout his 18-year tenure with MetLife, he held multiple leadership positions including VP of Operations, Business Development and Business Architecture for both US and Global Service Centers.

Mr. Narayanan and Mr. Reed commented that they are excited to join the Equian family and help lead the expanded use of Equian's full spectrum of payment integrity services and increase the savings provided to our clients.

About Equian

Equian is a leading end-to-end payment integrity organization. The company's platform manages over $250 billion of claims data in their innovative platform designed to assist clients by avoiding, identifying, pricing, analyzing, and ultimately recovering inaccurate transactions in the complex environments of healthcare, workers compensation, and property & casualty markets. Equian acts on data to pay the right party, for the right amount, at the right time delivering over $1.25 billion in actionable savings throughout the payment spectrum. Contact Diann Marsh, Corporate Marketing at dmarsh@equian.com and visit www.equian.com.

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About 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, Client Specific Provider Access, and flexible Out-of-Network Repricing options.

Contact AMPS if you are looking for:

  • A Partner that is invested in your success,
  • Alternative solutions to drive Dramatic Plan savings and
  •  Flexible options to meet your unique needs.

For more information about AMPS services contact John Powers, Executive VP, Sales, at 630-361-2525 or via email at jpowers@advancedpricing.com and visit www.advancedpricing.com.

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Brentwood Services Administrators Inc. Promotes Margie Dodson To Claims Manager in Birmingham Office and Adds Stephanie Bryant as Senior Claim Representative

MyHealthGuide Source:  Brentwood Services Administrators Inc. (BSA), 6/20/2016, www.bwood.com

Margie Dodson, Claims Manager

BRENTWOOD, TN -- Brentwood Services Administrators Inc. (BSA), with a claims office in Birmingham, Ala., recently has promoted Margie Dodson to the position of claims manager for the Birmingham operations, according to Jeff Pettus, president and chief executive officer of Brentwood Services Administrators Inc.

As claims manager, she oversees the claims' management for the Birmingham office to ensure timely, accurate handling of claims, quality claims services and appropriate resolution of claim discrepancies. She is supervising the claims staff in the Alabama office under the direction of Mark Sparks, senior vice president of claims.

Dodson joined BSA five years ago as a senior claim representative. She soon was promoted to claim supervisor in 2011, and then to assistant claim manager in 2014, providing account supervision while assisting with operational issues for the branch.

With over 25 years of claims experience, she previously was employed with Avizent in Birmingham as a senior claim adjuster. She holds a bachelor of science degree in business administration from Wallace State College in Hanceville, Ala.

Stephanie Bryant, Senior Claim Representative

The Company has also employed Stephanie Bryant in the position of senior claim representative in the Brentwood office, according to Pettus.

In her new position, Bryant's duties include reviewing, processing, and handling workers' compensation claims as assigned by Bonnie Moser, claims supervisor. Bryant determines the compensability of the claim and extent of liability; and communicates directly with clients, employers, injured workers, physicians, and attorneys to manage claims in a timely and economic manner.

Prior to joining BSA, Bryant was a senior workers' compensation adjuster for Gallagher Bassett in Nashville, Tenn. She has over 20 years of experience in the field of workers' compensation claims. She majored in mathematics at Pellissippi State University in Knoxville.

About Brentwood Services Inc.

Brentwood Services Inc. is an independent employee-owned company headquartered in Brentwood, Tenn., and specializing over the past 26 years in structuring and managing alternative market solutions for employers and insurance providers.  Contact John Smitherman, senior vice president of sales, at  bsiinfo@bwood.com,  (800) 524-0604 or (615) 263-1300 and visit www.bwood.com.
 
About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers" compensation and other casualty lines. BSA's aggressive coordinated approach to claims administration and loss control has a proven track record of reducing the cost of claims for its clients. BSA also provides underwriting, policy management and accounting services to association-sponsored pools and mutual insurance companies. 

About Brentwood Reinsurance Intermediaries Inc.

Brentwood Reinsurance Intermediaries Inc. or BrentRe, an independent, full-service, insurance broker and reinsurance intermediary, provides customized risk management solutions to traditional writers of specialty insurance and self-insureds. Services encompass reinsurance program design, placement and management; self-insurance solutions; guaranteed cost and deductible insurance with a focus on workers" compensation; excess liability lines; and accident and health reinsurance.

About CompPoint Managed Care Inc.

CompPoint Managed Care Inc., a managed care provider and wholly owned subsidiary of BSI, offers medical case management, utilization review, medical bill review, pharmacy benefits management and other ancillary services designed to control claim costs.

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Advanced Medical Pricing Solutions (AMPS) Adds Kirk Fallbacher as COO/CTO

MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 6/23/2016, www.advancedpricing.com

ATLANTA, GA -- Advanced Medical Pricing Solutions (AMPS), a Physician Led, Technology Driven cost-containment company continues to strengthen the organization by adding Kirk Fallbacher as COO /CTO. He is responsible for daily operations of the company, including IT integration and innovation, as well as overseeing new product development.

Kirk is a seasoned operations and technology executive with over 20 years' experience serving Healthcare and Insurance, combined with in-depth expertise in IT strategy, service delivery, enterprise integration, application development and analytic solutions. Prior to joining AMPS, he was a Partner with Netrix, LLC, a full service IT consulting firm, where his responsibilities included leading the Software and Healthcare Practices, specializing in Healthcare Decision Support Systems, Clinical Integration, eHealth Implementations, Portals and Business Intelligence. He has also served in leadership roles at several consulting and software firms that in some capacity have all served the healthcare market. His past positions range from executive management to technology leadership, as President of NVISIA, a boutique consulting firm; CTO/COO of Swingtide, a management consulting firm; President of Geneva software, a systems software vendor acquired by Platinum Technology; Vice President of Preferred Systems, a systems software vendor acquired by Computer Associates; Manager at Ernst & Young; and Engineer at Novell, Inc.

Kirk holds an undergraduate degree in Computer Science and Mathematics, Western Illinois University, Cum Laude. He also serves on the 2016 Healthcare Advisory Board for Ingram Micro and has previously served as a Founding Board Member of the Bonfield Express Foundation and a Board Member of District 58 Education Foundation.

"The addition of Kirk to our Executive Team gives us yet another critical resource to keep AMPS at the leading edge of the cost-containment market. His ability to understand the complete market dynamic will enable us to further enhance our services to our Clients and prospective Clients." said Mike Dendy, CEO and Co-Chair of AMPS.

About 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, Client Specific Provider Access, and flexible Out-of-Network Repricing options.

Contact AMPS if you are looking for:

• A Partner that is invested in your success
• Alternative solutions to drive Dramatic Health Plan savings
• Flexible options to meet your unique needs

For more information about AMPS services contact John Powers, Executive VP, Sales, at 630-361-2525 or via email at jpowers@advancedpricing.com and visit www.advancedpricing.com.

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ECHO Health Chairman and CEO, William Davis Named EY Entrepreneur Of The Year® 2016 Award winner in Northeast Ohio

MyHealthGuide Source: ECHO Health, Inc., 6/21/2016, www.echohealthinc.com

Westlake, OH -- EY announced that Chairman and CEO, William Davis of ECHO Health, Inc., a leading innovator of payment solutions, received the EY Entrepreneur Of The Year® 2016 Award in Northeast Ohio. This year marks the 30th anniversary of the EY Entrepreneur Of The Year Award program. The award recognizes outstanding entrepreneurs who demonstrate excellence and extraordinary success in such areas as innovation, financial performance, and personal commitment to their businesses and communities. Mr. Davis was selected by an independent panel of judges, and the award was presented at a special gala event at the Huntington Convention Center of Cleveland on June 9, 2016.

"It is an honor to be chosen for such an esteemed award," says Davis. "There is no doubt in my mind that the reason I was selected for this award is largely in part to the amazing team at ECHO. Their dedication, passion and ingenuity have turned mere ideas into the current reality of payment processing." ECHO Health, Inc. is a leading innovator in payment processing, serving over 75,000 companies, processing more than 50 million payment transactions and paying over $10 billion annually.

Since 1986, EY has honored entrepreneurs whose ingenuity, spirit of innovation and discipline have propelled their companies' success, invigorated their industries, and benefited their communities. Now in its 30th year, the program has honored the inspirational leadership of such entrepreneurs as Howard Schultz of Starbucks Coffee Company, Robert Unanue of Goya Foods, and Mindy Grossman of HSN. Recent US national winners include Reid Hoffman and Jeff Weiner of LinkedIn; Hamdi Ulukaya, founder of Chobani; and 2015 winners Andreas Bechtolsheim and Jayshree Ullal of Arista Networks.

As a Northeast Ohio award winner, Mr. Davis is now eligible for consideration for the Entrepreneur Of The Year 2016 national program. Award winners in several national categories, as well as the Entrepreneur Of The Year National Overall Award winner, will be announced at the Entrepreneur Of The Year National Awards gala in Palm Springs, California, on November 19, 2016. The awards are the culminating event of the Strategic Growth Forum™, the nation's most prestigious gathering of high-growth, market- leading companies. The US Entrepreneur Of The Year Overall Award winner then moves on to compete for the World Entrepreneur Of The Year Award in Monaco, June 2017.

About ECHO Health, Inc.

ECHO Health, Inc. was founded in 1997 by William Davis, a healthcare payment visionary and pioneer with over 30 years industry experience. In cooperation with Chase Manhattan Bank and Tandem Computers, Mr. Davis developed a proprietary payment system for the healthcare industry. ECHO is now the country's leading provider of electronic payment solutions, serving over 75,000 companies, processing more than 50 million payment transactions and paying over $10 billion annually. Call 440.835.3511, ext. 118 and visit www.echohealthinc.com.

About EY Entrepreneur Of The Year®

EY Entrepreneur Of The Year is the world's most prestigious business award for entrepreneurs. The unique award makes a difference through the way it encourages entrepreneurial activity among those with potential and recognizes the contribution of people who inspire others with their vision, leadership and achievement. As the first and only truly global award of its kind, Entrepreneur Of The Year celebrates those who are building and leading successful, growing and dynamic businesses, recognizing them through regional, national and global awards programs in more than 145 cities in more than 60 countries.

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Job News


Berkley Accident and Health Seeks Vice President, Benefits Captives

MyHealthGuide Source: Berkley Accident and Health, 6/24/2016, www.BerkleyAH.com

Berkley Accident and Health is seeking a Vice President, Benefits Captives to be located in our Hamilton Square, NJ office. The ideal candidate will have the proven ability to run an employee benefits business segment with strong aptitude for marketing and underwriting strategy. The incumbent will lead the development of the company's captive business strategy and will develop competitive advantages through market positioning of our benefit captive and products.

  • Position: Vice President, Benefits Captives
    Business Segment: Group Captives Division
    Reports to: Christopher Brown, President & CEO
    Location: Hamilton Square, NJ

VP, Benefits Captives Job Summary

  • Leadership and P&L responsibility for the company's captive division and EmCap product
  • Management responsibility for Underwriting and Account Management
  • Responsible for market segmentation, target marketing and niche market identification
  • Drives product development and competitive analysis for captive products
  • Develops and executes revenue growth plans for captive products sold through the company's sales organization
  • Senior leadership role in the company

VP, Benefits Captives Essential duties include:

  • Management of Underwriting and Account Management staff
  • Develops pricing and underwriting policies and practices with support from the company's actuarial staff
  • Leads product development, implementation and maintenance of insurance programs, standards and procedures for all aspects of the company's captive products
  • Develops competitive advantages through market positioning, rate development, and coverage comparisons among competitors.
  • Develops strategy for marketing, sales promotion and communications materials for captive products
  • Strategically analyzes key performance indicators, market data, competitor activity, and market trends utilizing quantitative and qualitative analysis with support from the company's CFO, IT, Marketing & Actuarial staff
  • Provides guidance for process improvement & administrative policies in support of captive products.

VP, Benefits Captives Qualifications include:

  • Bachelor's degree required, MBA preferred
  • 10 years of Self-funding experience and a comprehensive understanding of the medical stop loss business
  • Stop loss underwriting experience
  • Experience with captive insurance arrangements
  • Leadership experience with an ability to manage growth and think strategically.
  • Strong business aptitude. Able to make decisions with broad management authority limits with considerable room for discretion and interpretation.
  • Consultative skill with an ability to assess unique customer needs and be able to creatively develop innovative and practical programs and solutions.
  • Excellent organizational, verbal, and written communication as well as interpersonal and relationship building skills with the ability to influence organization performance.
  • Proficient and developing financial plans and long-range goals and objectives.
  • Able to collaborate at the company's senior leadership level to gain divergent opinion alignment.

In addition:

  • Exhibit professional behavior that exemplifies the company's cultural image of creativity and innovation as an employee of Berkley Accident & Health
  • Establish and maintain positive working relationships with management and staff to further the company's mission
  • Have strong consulting and interpersonal skills with an ability to interact with brokers, clients and service vendors.
  • Ability to travel 10- 15%.

If you have suitable qualifications and would like to put your resume under consideration please forward it to our Human Resources Department: Careers@BerkleyAH.com

About Berkley

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States. Visit www.BerkleyAH.com.

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Berkley Accident and Health Seeks Stop Loss Underwriter Manager

MyHealthGuide Source: Berkley Accident and Health, 6/24/2016, www.BerkleyAH.com

Berkley Accident and Health is seeking an Underwriting Manager.  The position is a seasoned underwriting professional who has the years of experience and knowledge to exercise independent judgment to arrive at assigned sales and profitability targets. In this role, you will collaborate with Regional Sales Managers to efficiently quote, negotiate, and sell target business with assigned producers. Berkley Underwriting Managers are expected to conduct both financial and clinical analysis and develop contingencies as require. 

  • Position: Stop Loss Underwriter Manager
    Reports to: Sr. Underwriting Manager
    Location: Marlborough, MA

Stop Loss Underwriter Manager Essential duties include:

  • Assess daily workflow and determine daily priorities working with a team of Regional Sales Managers to ensure deadlines are met
  • Travel with Regional Sales managers to meet with producers
  • Collaborate with Regional Sales Managers to achieve assigned financial targets
  • Composes, prepares, and generates correspondence, proposals, and reports as needed or required
  • Conduct clinical risk evaluations utilizing available resources
  • Have the ability to analyze risk and make pricing recommendations
  • Evaluate and propose pricing on Stop Loss business within stated authority limits
  • Review Applications, Policies, Plan Documents/Amendments, and proposal contingencies ensuring that they are complete, accurate, and in accordance with the sold case terms

Stop Loss Underwriter Manager Qualifications include:

  • Strong time management skills
  • Ability to work independently and as part of a team
  • Strong math, communication, and analytical skills
  • Strong negotiation skills
  • Strong multi-tasking ability
  • Proficient in Microsoft Word and Excel
  • Bachelor's Degree and 7+ years of Stop Loss Underwriting experience or equivalent combination of education and experience

If you have suitable qualifications and would like to put your resume under consideration please forward it to our Human Resources Department: Careers@BerkleyAH.com

About Berkley

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States. Visit www.BerkleyAH.com.

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Berkley Accident and Health Seeks Claims Analyst

MyHealthGuide Source: Berkley Accident and Health, 6/24/2016, www.BerkleyAH.com

Berkley Accident and Health is seeking a full-time Claims Analyst. This position, reporting to our Director of Claims, will focus on claims adjudication of Employer Stop Loss and Captive claims, with an emphasis on carrier (Blues, UHC, CIGNA, Aetna) business. The individual in this position will work closely with the claims and medical management departments. The impact of this position is accurate and timely claims adjudication and superior customer service.

  • Position: Claim Analyst
    Reports to: Director of Claims
    Location: Hamilton, NJ or Marlborough, MA

Claims Analyst Essential duties include:

  • Process employer stop loss and captive claims within defined authority limits
  • Handle customer service calls and correspondence from Brokers and TPAs
  • Participate in Installation calls and meetings for all product lines
  • Other duties as assigned

Claims Analyst Qualifications include:

  • 5+ years claims experience in the reinsurance industry
  • Knowledge of medical terminology, ICD9; ICD10 and CPT codes
  • Excellent analytical, problem solving, time management, and organizational skills, with an attention to detail
  • Ability to work productively while maintaining excellent quality
  • Proficient in Microsoft Office software
  • Knowledge of David Young system preferred
  • Excellent verbal, written, and interpersonal skills
  • Ability to work independently and as team member
  • Ability to demonstrate initiative and take ownership of tasks to completion
  • Ability to communicate with both internal and external customers and provide superior customer service in an effective and timely manner
  • Solid work ethic and positive attitude
  • Excellent attendance record

If you have suitable qualifications and would like to put your resume under consideration,
please forward it to our Human Resources Department: Careers@BerkleyAH.com

About Berkley

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States. Visit www.BerkleyAH.com.

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Berkley Accident and Health Seeks Clinical Risk Manager

MyHealthGuide Source: Berkley Accident and Health, 6/24/2016, www.BerkleyAH.com

Berkley Accident and Health is seeking a full-time Clinical Risk Manager. This position, reporting to our AVP of Medical Management, affords a seasoned Case Manager the ability to use their knowledge and experience in a unique and rewarding manner. Clinical Risk Managers do not interact directly with patients; instead they provide consulting services for internal and external clients and their delegated entities in order to promote a thorough understanding of current and anticipated clinical needs and expected claims costs while facilitating the use of unique solutions to insure optimal care and claims outcomes. Our Clinical Risk Managers play an integral role in support of Berkley's vision to be recognized as the industry leader in risk management services by assuring optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered which also promoting client satisfaction and retention.

  • Position: Clinical Risk Manager
    Reports to: Director, ccSTAT
    Location: Hamilton, NJ

Clinical Risk Manager Essential duties include:

  • Ensure effective risk management.
  • Consult with internal and external clients on high cost claims and successfully engages effective clinical risk management strategies.
  • Determine need for extra contractual agreements and/or engagement of specialty resources and acts as a liaison until claim is complete.
  • Establish reserve recommendations.
  • Assist with medical necessity determinations and claim audits.
  • Assist underwriters in the evaluation and assessment of clinical and claims data to identify and quantify known and potential risk.
  • Provide concise, detailed, and accurate reporting of data analysis findings, observations and recommendations to underwriting.
  • Effectively explain complex clinical conditions to a lay person.
  • Develop and maintain strong client, TPA and vendor relationships.
  • Consult with clients and TPAs on case management issues, alternative levels of care, program development, quality improvement, claim issues, and educational needs.
  • Participate in TPA implementation calls.
  • Facilitate timely and accurate intake, triaging, tracking and documentation of potential/actual claims. Quickly, thoroughly, and correctly assess a potential/actual claim situation, determine need to impact, develop a sound strategy and successfully influence stakeholders to produce a meaningful clinical and/or financial outcome.
  • Accurately analyze transplant contracts, recommend best option, facilitate execution of third party transplant center of excellent access agreement, and assure timely referral.
  • Document activity and outcomes accurately and promptly.

Clinical Risk Manager Qualifications include:

  • Requires BA/BS or higher in Nursing/health related field with 5-7 years clinical experience, or Associate or Diploma Degree and 7-10 years clinical experience with a  current unrestricted license as a health professional
  • 5+ years of case management experience
  • CCM, CRRN, or CPUM preferred
  • Group medical, managed care, health insurance, stop loss, or reinsurance experience
  • Able to set goals and handle multiple tasks, clients, and projects simultaneously; able to appropriately balance priorities, deadlines and deliverables. Able to quickly adapt to change, work under tight deadlines and stressful conditions.
  • Intermediate level of investigative, analytical, and problem-solving skills
  • Expert negotiating, persuasion, and conflict resolution skills
  • Ability to work well within a team and actively participate in team projects
  • Must have excellent oral, written, and interpersonal communication skills. PC skills to include word processing, spreadsheet, and database applications. Intermediate typing skills.
  • Maintain regular and predictable attendance
  • Ability to travel 15%

If you have suitable qualifications and would like to put your resume under consideration, please forward it to Human Resources: Careers@BerkleyAH.com.

About Berkley

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States. Visit www.BerkleyAH.com.

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Berkley Accident and Health Seeks Underwriter for Managed Care Segment

MyHealthGuide Source: Berkley Accident and Health, 6/24/2016, www.BerkleyAH.com

Berkley Accident and Health is seeking a full-time Underwriter for its Managed Care segment. This position will solicit, write, and retain a profitable book of Managed Care/Reinsurance business. Requiring extensive underwriting analysis and sound judgment, this role will be responsible for contributing to the achievement of Berkley Accident and Health's financial plans by meeting established premium growth and profitability goals.

  • Position: Underwriter -- Managed Care
    Reports to: Director of Managed Care Excess
    Location: Hamilton Square, NJ

Managed Care Underwriter Essential duties include:

  • Assess risk to ensure that the risk meets established underwriting criteria
  • Evaluate, price and propose rates based on established underwriting guidelines while meeting profitability standards set by management
  • Manage assigned workload to meet productivity and time service standards
  • Maintain quote logs and ensure that appropriate action is taken within the requested due date
  • Develop and maintain successful relationships with target sources

Managed Care Underwriter Qualifications include:

  • 5+ years in underwriting HMO Reinsurance and Provider Excess Loss insurance coverages or first-dollar underwriting experience
  • BA or BS degree or equivalent work experience
  • Strong knowledge of risk evaluation and the rating of targeted business, as well as  current industry trends and markets
  • Strong knowledge of available products
  • Excellent communication and negotiation skills with internal and external customers
  • Ability to be productive independently, yet work in a team environment
  • Strong organizational, planning, and time management skills
  • Creativity and problem-solving skills a plus
  • Proficient in Microsoft Word, Excel, and Outlook

In addition:

  • Must exhibit professional behavior at all times while representing or being identified as an employee of Berkley Accident and Health
  • Establish and maintain positive working relationships with management and staff to further the company's mission

If you have suitable qualifications and would like to put your resume under consideration, please forward it to Human Resources: Careers@BerkleyAH.com.

About Berkley

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States. Visit www.BerkleyAH.com.

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Swiss Re Corporate Solutions Seeks Senior Underwriter - Scottsdale, AZ

MyHealthGuide Source: Swiss Re, 6/7/2016, www.SwissRe.com

  • Senior Underwriter (14855)
    Scottsdale (U7610001)
    Corporate Title: Vice President
    Division: CSR-Regions (50001530)
    Department: CSRI-North America (50002501)

About the role

Swiss Re Corporate Solutions" Underwriting team is highly skilled and experienced in the production of new and renewal rate development for groups that self-fund their Medical plans. The incumbent will follow Swiss Re underwriting guidelines, policies and procedures to calculate Stop Loss rates and factors.

Your responsibilities will include:

  • Examines and evaluates claim experience, loss ratio and other data to determine degree of risk, underwriting and market selection
  • Communicates with sales executives, partners and underwriting management to obtain further information, prepare proposals and service existing accounts
  • Assists sales, claims, accounting and support staff in resolving problems and questions.
  • Evaluates the experience for a group and compares the risk against the loss potential due to claim severity and/or frequency.
  • Coordinate all administrative duties related to existing and prospective accounts
  • Responsible for all underwriting and policy file documentation which is in compliance with Underwriting Policies and Procedures and Internal Audit process.
  • Maintain profitable business according to departmental goals
  • Responsible for documentation of Underwriting fields to include identifying drivers of medical expenses in new and renewal cases
  • Manage production and standards as defined by management
  • Adhere to underwriting guidelines and position papers
  • Manage workflow including workflow adjustments during high volume periods, and partner relationships as assigned by management
  • Assist sales with developing and cultivating new relationships
  • Provide feedback used by Senior Management to develop Underwriting policies and procedures
  • Mentor Associate Underwriters

About You

We're looking for someone who has these values, abilities, and skills:

  • Bachelor's degree in a related field preferred or equivalent experience
  • Five or more years of medical stop loss insurance underwriting experience
  • Strong oral and written communications skills
  • Strong analytical skills and the ability to pay attention to details
  • Knowledge of common medical terminology, diseases and their related risks
  • Familiarity with Excel and Word programs
  • Dynamic and collaborative.
  • Distinguished across multiple elements of Swiss Re's Leadership Model (thinks strategically, innovates, responds actively, collaborates, promotes excellence, stays accessible, fosters constructive debate, demonstrates an enterprise mindset).

Travel Requirement: Approx. 10%

If you are interested, please click https://career2.successfactors.eu/sfcareer/jobreqcareer?jobId=14855&company=SwissRe&username

The Company is an equal opportunity employer. It is the practice of the Company to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled.

During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed.

About Swiss Re Corporate Solutions

Backed by nearly 150 years of experience, significant capacity and the financial strength of the Swiss Re Group, our Corporate Solutions team solves the risk management and financing needs of corporations around the globe.

We offer more than 40 products across a broad array of sectors, from sole-proprietor law firms to Fortune 100 companies with complex property, casualty and financial service needs. We invite you to browse & learn how much more there is to Swiss Re than reinsurance.  Visit www.swissre.com/corporate_solutions/.

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Swiss Re Corporate Solutions Seeks Underwriter - Scottsdale, AZ

MyHealthGuide Source: Swiss Re, 6/7/2016, www.SwissRe.com

  • Underwriter (14944) - Scottsdale

About the role

Swiss Re Corporate Solutions" Underwriting team is highly skilled and experienced in the production of new and renewal rate development for groups that self-fund their Medical plans. The incumbent will follow Swiss Re underwriting guidelines, policies and procedures to calculate Stop Loss rates and factors.

Your responsibilities will include:

  • Examines and evaluates claim experience, loss ratio and other data to determine degree of risk, underwriting and market selection
  • Communicates with sales executives, partners and underwriting management to obtain further information, prepare proposals and service existing accounts
  • Assists sales, claims, accounting and support staff in resolving problems and questions.
  • Evaluates the experience for a group and compares the risk against the loss potential due to claim severity and/or frequency.
  • Coordinate all administrative duties related to existing and prospective accounts
  • Responsible for all underwriting and policy file documentation which is in compliance with Underwriting Policies and Procedures and Internal Audit process.
  • Maintain profitable business according to departmental goals
  • Responsible for documentation of Underwriting fields to include identifying drivers of medical expenses in new and renewal cases
  • Manage production and quality standards as defined by management
  • Adhere to underwriting guidelines and position papers
  • Manage workflow including workflow adjustments during high volume periods, and partner relationships as assigned by management

About You

We're looking for someone who has these values, abilities, and skills:

  • Bachelor's degree in a related field preferred or equivalent experience
  • Three or more years of medical stop loss and/or health insurance underwriting experience
  • Strong oral and written communications skills
  • Strong analytical skills and the ability to pay attention to details
  • Knowledge of common medical terminology, diseases and their related risks
  • Familiarity with Excel and Word programs

Travel Requirement: Approx. 10%

If you are interested, click https://career2.successfactors.eu/sfcareer/jobreqcareer?jobId=14944&company=SwissRe&username .

The Company is an equal opportunity employer. It is the practice of the Company to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled.

During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed.

About Swiss Re Corporate Solutions

Backed by nearly 150 years of experience, significant capacity and the financial strength of the Swiss Re Group, our Corporate Solutions team solves the risk management and financing needs of corporations around the globe.

We offer more than 40 products across a broad array of sectors, from sole-proprietor law firms to Fortune 100 companies with complex property, casualty and financial service needs. We invite you to browse & learn how much more there is to Swiss Re than reinsurance.  Visit www.swissre.com/corporate_solutions/.

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Market Trends, Studies, Books & Opinions



How Level-Funding Introduces Small Businesses to Self-Funding

MyHealthGuide Source: NFIB, 6/22/2016

To manage costs and customize benefits, some small businesses have switched to from fully-insured to alternative insurance plans--such as level-funded, sometimes called self-funded, plans. These alternatives require businesses to assume more risk in managing employee healthcare, but they can save employers money and offer increased benefits if they're implemented and managed properly.

Level-Funded Insurance

Level-funded insurance is managed similarly to traditional fully insured plans, and business owners and employees won't notice a lot of difference once the plans are in place, says Todd Page, Senior Vice President of Sales and Marketing at JLBG Health in Chicago.

With their plan administrators, employers decide on a dollar amount they are able to pay to cover annual employee health expenses--for small businesses, the amount is typically $10,000 to $20,000. This amount is split into monthly payments and added to the monthly cost to administer the plan. The plan administrator pays employee claims directly to providers out of these funds.

The primary difference between level-funded plans and fully insured plans is that unused funds are returned to the business at the end of the year. "If you buy a fully insured plan, and you don't use your insurance, you don't get any money back," Page says. "If you allot $10,000 worth of claims under a level-funded plan, and you only burn through $7,000 worth of claims, you get a $3,000 refund."

For small businesses with relatively low healthcare expenses, this refund can make a huge difference. The average return of premium is 42 percent, Page says. "It's only a little more than they pay now for full insurance, but they have a chance of getting that refund or return of premium," he says.

Level-funded insurance requires business owners to take on more risk and more responsibility in managing employee healthcare benefits. If your claims in a given year exceed your plan allotment, your healthcare expenses for that year could be higher than what you budgeted. But the potential of getting refunds each year mitigates the risk for many business owners.

Mike Ferguson, President of the Self-Insurance Institute of America, Inc., says customization and cost control are the biggest benefits of level-funded insurance. "You have access to claims data, so you're better able to figure out where [employees] access coverage the most and increase benefits in those areas to better meet employees' needs," he says.

While most businesses will save money long-term through level-funded insurance, Ferguson says it's important to view it as a long-term risk-management strategy. Similar to investing in the stock market, costs and gains fluctuate year-to-year. "You'll have some years where if you look at it in isolation, you would have done better in a fully insured environment," he says. "But many years, your claims experience will be less costly than your insurance premium [would have been]."

Stop-Loss Insurance

Most small businesses with level-funded insurance maintain stop-loss insurance to manage risk and cover medical expenses that exceed available funds. This means your business will be protected from catastrophic loss in the event that healthcare costs exceed the amount you were prepared to pay. Stop-loss insurance rates vary based on plan details, number of employees covered, and other factors, but they are typically much less expensive than fully insured plans.

Finding The Right Fit

Ferguson says businesses that benefit most from level-funded insurance are those with relatively stable workforces, so they can better predict future claims. They are also willing to put in the effort required to properly manage the plans. "The ones who are always monitoring their plans, making adjustments, tweaking benefits packages [benefit most]," Ferguson says. "It requires a little time and effort on behalf of the executive team to make the most of it."

The Patient Protection and Affordable Care Act (Obamacare) adds complexity. For businesses with 50 or more employees, level-funded plans are only sufficient to avoid tax penalties if they meet the coverage provisions outlined in the PPACA. However, level-funded plans are handled differently than traditional plans under the PPACA, Page says. Unlike traditional insurance plans, they are underwritten. Group plans under PPACA are not required to answer to medical questions, but alternative plans assess the level of risk through an underwriting process. If your business is high-risk, premiums and upfront costs will be so high that it might not be worthwhile. If you are low-risk, though, the cost savings can be substantial.

"Letting the insurance company assess risk trickles down to savings for you. If you're a sick group, they're going to upcharge you so much, you're better off staying fully insured. If you're a relatively healthy group, you could pay half of what you would on a traditional plan," Page says.

For businesses considering level-funded insurance, the best option is to consult a third-party insurance administrator or specialist to assess risk, compare plan costs and benefits, and create a plan that will provide sufficient benefits to avoid penalties under the PPACA.

About NFIB

The National Federation for Independent Business (NFIB) represents 325,000 small businesses in all 50 states and Washington, D.C., and is dedicated to leveling the playing field with Big Business, Big Government, and Big Labor in every key area -- taxes, healthcare, regulations, and more. Visit www.NFIB.com.

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Legislative & Regulatory News


House Republican Leadership Re-Affirms Importance of Self-Insurance

MyHealthGuide Source: Self-Insurance Institute of America, 6/23/2016, www.SIIA.org

On June 23, House Republicans unveiled a white paper meant to set forth a plan for future health care policy reform efforts, which included a key provision promoted by SIIA lobbyists directly to GOP leadership.

Aimed at reforming and repealing large portions of the Affordable Care Act (ACA), including the exchanges, one critical piece of the white paper for SIIA members is the inclusion of policy language (page 18 of the paper)  mirroring the Self-Insurance Protection Act (SIPA).

  • Protecting Employers' Flexibility for Self - Insurance
    Self-insured health plans play an important role in our nation’s health care system. Many companies provide health insurance directly to their employees instead of contracting with a third-party insurer. An employer who self-insures (also known as “self-funding”) assumes the financial risk of employee health expenses by paying health care providers directly or reimbursing employees as claims arise, instead of paying a fixed premium to an insurance company. Thus, self-insured employers are able to structure their plans to meet the unique needs of their employees.

As previously reported, this SIIA-backed legislation was introduced to prevent regulators from designating stop-loss insurance as health insurance.

Though the white paper is simply a policy blueprint, the inclusion of this language is a step forward in ensuring the continued availability and growth of the self-insurance marketplace. The full text of the white paper can be found here.

The inclusion of this discussion point further demonstrates that SIIA's expanded advocacy activities are helping key policymakers better understand the importance of self-insurance to their constituents. And this advocacy work has been strengthened by a more robust Self-Insurance Political Action Committee (SIPAC).

Largely focused on drawing back parts of the ACA, the paper outlines policy changes such as giving individuals and states more flexibility on healthcare plans, providing affordable healthcare tax credits, increasing state Medicaid flexibility, and strengthening tools such as HSAs. As we have seen in the past, other policy ideas include permitting insurance coverage across state lines and allowing small businesses to pool together for increased efficiency and affordability.

While it is important to note that this white paper is not a final legislative package, it does offer an outline of Republican policy ideas which leadership does hope to turn into legislation as they move past the upcoming election.

As health policy continues to be debated and drafted by both parties, SIIA will continue to be an active and vocal advocate on behalf of the self-insurance industry, and we will continue to keep you updated as to those activities.

About SIIA

The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally.  Contact SIIA Washington Counsel Chris Condeluci at ccondeluci@siia.org or SIIA Vice President of Government Relations Ryan Work at rwork@siia.org and visit www.SIIA.org.

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Medical News


Low-Density Lipoprotein Cholesterol (LDL) Levels Below 70 mg/dL Offer No Additional Risk Reduction in Adverse Cardiac Outcomes

MyHealthGuide Source: Morton Leibowitz, MD, et  al, 6/20/2016, JAMA Abstract

Patients with Low-Density Lipoprotein Cholesterol (LDL-C) levels of 70 to 100 mg/dL taking statins had lower risk of adverse cardiac outcomes compared with those with LDL-C levels between 100 and 130 mg/dL, but no additional benefit was gained by achieving LDL-C of 70 mg/dL or less according to a study published in the Journal of American Medical Association.

International guidelines recommend treatment with statins for patients with preexisting ischemic heart disease to prevent additional cardiovascular events but differ regarding target levels of low-density lipoprotein cholesterol (LDL-C). Trial data on this question are inconclusive and observational data are lacking.

They study using data from a health care organization in Israel covering more than 4.3 million members during the period 2009 to 2013. The study included patients had ischemic heart disease, were aged 30 to 84 years, were treated with statins, and were at least 80% adherent to treatment or, in a sensitivity analysis, at least 50% adherent. Patients with active cancer or metabolic abnormalities were excluded.

Exposures Index LDL-C was defined as the first achieved serum LDL-C measure after at least 1 year of statin treatment, grouped as low (≤70.0 mg/dL), moderate (70.1-100.0 mg/dL), or high (100.1-130.0 mg/dL).

The study's main outcome was major adverse cardiac events included acute myocardial infarction, unstable angina, stroke, angioplasty, bypass surgery, or all-cause mortality. The hazard ratio of adverse outcomes was estimated using 2 Cox proportional hazards models with low vs moderate and moderate vs high LDL-C, adjusted for confounders and further tested using propensity score matching analysis.

Study findings

  • The cohort with at least 80% adherence included 31,619 patients, for whom the mean (SD) age was 67.3 (9.8) years.
  • Of this population, 27% were female and 29% had low, 53% moderate, and 18% high LDL-C when taking statin treatment.
  • Overall, there were 9,035 patients who had an adverse outcome during a mean 1.6 years of follow-up (6.7 per 1000 persons per year).
  • The adjusted incidence of adverse outcomes was not different between low and moderate LDL-C, but it was 11% lower with moderate vs high LDL-C.
  • Among 54,884 patients with at least 50% statin adherence, 6% higher in the low vs moderate groups and 13% lower in the moderate vs high groups.

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Recurring Resources



Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/16/2016)

MyHealthGuide Source:  MyHealthGuide

Editor'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.
Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and update is encouraged.
Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital/Equity
(Millions)
1 CIGNA     $2,701
2015
 
  Source - CIGNA Financial Supplement 2015, P.5 12/31/2015
2 Sun Life Financial     $1,034
2014
 
  Source - Sun Life 2/12/2015 Management Discussion of "13% stop loss growth over 2013" of 2013 premium of $915.2M provided by Scott Beliveau, Sun Financial 4/28/2014
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A+)
$907
2015
$29,700 as part of Tokio Marine Group
  Source - Ketrice Williams, 5/6/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$807
2015
$396
12/31/2015
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$751.4
2015
$588
12/31/2015
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
$728
2014
$3,360.6
12/31/2014
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
10/8/2014
 
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
3/31/2016
 
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $253
2/1/2016
 
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
10 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
11 Munich Re Stop Loss, Inc.   American Alternative Insurance Company (AAIC),
TransAmerica
$147
2015
 
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
2015
$1,200
  Source - Lauren Woods, VP Marketing Fairmont Specialty, 1/4/2016
13 The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$104
12/2014
 
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
2016
$6,800
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
15
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
  Source - Mark Nichols, Managing Director.  7/20/2012

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. 

  • ACE America
  • Aetna
  • Amalgamated Life
  • American Fidelity Assurance Company 
  • American National Life Insurance Company of Texas
  • Berkley Accident and Health
  • BEST Re 
  • Blue Cross Blue Shield (various regions)
  • International Insurance Agency Services, LLC (IIS)
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • UnitedHealthcare

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:

  • Ratings from Best, S&P, Moodys and others (data collection began 6/2012)
  • Capital size of the insurance company (data collection began 6/2012)
  • Reinsurance purchased and from whom
  • Length in the business (data collection began 6/2012)
  • Number of open litigation claims
  • Is stop-loss a core business or ancillary business?
  • % age of risk retained vs. ceded
  • Average stop-loss claim processing turn-around time
  • % age of claims denied
Should reader interest indicate such measures are important, this Newsletter will attempt to collect and report.  

Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.  

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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.

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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 jmiller@siia.org or 800-851-7789 for more information about private labeling.

About 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). 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.

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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. Please find links to the ISG White Paper on the process and to the new ICD-10-CM Trigger list 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.

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Upcoming Conferences


July 19-21, 2016
MCIA Eleventh Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA). This year's program will feature key captive regulators, captive owners and leading service providers addressing a variety of timely educational topics. The conference also serves as the premier networking event for those doing captive insurance business (or would like to) in the growing Montana captive domicile. Lodge at Whitefish Lake, Montana. (www.lodgeatwhitefishlake.com). Block of reserved rooms released on May 18, 2016. Contact Shane Byars at 866/388-6242, or sbyars@mtcaptives.org.  Visit www.mtcaptives.org.

September 19-21, 2016
MCRA's 2016 Conference presented by Managed Care Risk Association.   Don't miss out on what this year's conference has to offer. We will hear speakers address the potential impacts on the ACA from this year's election; join in a discussion with industry underwriters to share lessons learned with underwriting Exchange business; receive information on today's concerns with specialty pharmacy, and much more. Agenda:

  • Monday
    • Cocktail Welcome Reception in Stratus Rooftop Lounge
  • Tuesday
    • Election Impact / ACO / Market Update: David Smith, Leavitt Partners
      Bringing New Talent to Your Door: Abbe Sodikoff, The Jacobson Group
      The State of ACA and Where We Are Headed: Robert Field, Drexel University
      Specialty Pharmacy: Susan Faust, Diplomat
  • Wednesday
    • Panel Discussion: Lessons Learned 2014 to 2016
      Making Sense of Clinical Trials: Melinda Baxter, ROSE® Program
      Transparency in Healthcare: Dir. Marty Makary, Johns Hopkins

The MCRA hotel room rate at Hotel Monaco is $249 which allows use of many hotel amenities without an additional resort fee. Reserve your room now by visiting our website for a link to the Hotel Monaco reservation site: www.mcraweb.org. Registration and Information: www.mcraweb.org

September 25-27, 2016
36th Annual National Educational Conference & Expo presented by Self-Insurance Institute of America. Austin, TX. www.SIIA.org 

October 17-19, 2016
SPBA Fall Meeting (members only). Minneapolis, MN. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

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January 30-February 1, 2017
26th Annual National Health Benefits Conference & Expo.   Real-world education with numerous sessions focusing on case study evaluations and addressing many of today's hottest topics and issues from the latest ACA regulations to wellness program trends. To assist you in continuing your education, we are also pleased to provide CE credit for numerous designations including PHR/SPHR/GPHR, CIMA, CPA, CHES/MCHES, CEBS CPE and more! And because we understand that education goes beyond the classroom, this three-day program is designed to give attendees numerous opportunities to network with peers, speakers and exhibitors. ​Clearwater, FL.  Registration and information: https://www.hbce.com/Pages/Default.aspx 

February 8-10, 2017
Executive Forum 2017
presented by Health Care Administrators Association (HCAA). Bellagio, Las Vegas, NC. www.HCAA.org  

March 15-17, 2017
SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

September 13-15, 2017
SPBA Fall Meeting (members only). Cincinnati, OH. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

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Editorial Notes, Disclaimers & Disclosures


  • Articles are edited for length and clarity.
  • Articles are selected based on relevance and diversity.
  • No content in this Newsletter should be construed as legal advice. All legal questions should be directed to your own personal or corporate legal resource.
  • Internet links are tested at the time of publication.  However, links change or expire often.
  • Articles do not necessarily reflect views held by the Publisher.
  • Disclosure: Owner of MyHealthGuide also has ownership interest in CareHere, LLC® and LabInsight®
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Clevenger Ernie Clevenger
President & Publisher
MyHealthGuide, LLC
Clevenger@MyHealthGuide.com