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TABLE OF CONTENTS
New Stop Loss MGU, Greymatter Risk Management, LLC, Formed
MyHealthGuide Source: Greymatter Risk Management, 4/10/2015
The Managing Members are pleased to announce the formation and introduction of a new stop loss Managing General Underwriter, Greymatter Risk Management, LLC effective April 1, 2015.
Greymatter Risk will be led by long time insurance and stop loss executive, Arlene Cayetano, President/CEO, located in Indianapolis, IN. Arlene is joined by a management team of seasoned and qualified professionals with an average experience of 30+ years in the stop loss industry.
The new MGU will specialize in providing stop loss insurance to Taft-Hartley health plans and public sector employers. Greymatter Risk has established a relationship with Transamerica Premier Life Insurance Company which carries the following financial strength ratings* as of most recent report: A.M. Best A+ (2nd of 16 categories); Fitch AA- (4th of 19 categories); Moody's A1 (5th of 21 categories); Standard & Poor's AA- (4th of 21 categories).
Sales is headed by Jim McEntee, Executive Vice President of Sales, and brings with him 30+ years of experience specifically dedicated to the Taft-Hartley, public and labor sectors on a national scale. For products and sales inquiries, Jim may be contacted at telephone number 770-280-5270 or email firstname.lastname@example.org.
Brokers, consultants and TPAs interested in submitting Requests for Proposal should forward their RFPs to email@example.com.
EEOC's Proposal for Wellness Programs
Bravo Wellness is giving employers a free compliance consultation on their wellness plan. Click on the link to register: http://promotion.bravowell.com/free-compliance-consultation.
About Bravo Wellness
Bravo Wellness has been a disruptive force in the wellness industry since its inception in 2008. Bravo pioneered the outcomes-based wellness incentive space and carefully designs compliant incentives that result in unprecedented engagement levels. Bravo's case studies prove and demonstrate sustained health improvement and reduced claims spending-all while equipping individuals to make better choices and providing thoughtful alternatives to those for whom special exceptions are warranted. With roots in data management, compliance and technology, Bravo recognizes that it's rarely the lack of activities that makes a program unsuccessful, it's often the lack of motivation and engagement -- a problem that can be solved. Visit www.bravowell.com.
America's Choice Provider Network (ACPN) and JMS & Associates (JMS) Joint Venture to Expand ACPN's National Provider Network
MyHealthGuide Source: JMS & Associates (JMS), 4/13/2015, www.jmsassoc.com and www.acpnusa.com
America's Choice Provider Network (ACPN) and JMS & Associates (JMS) enter into a joint venture to expand ACPN's National Provider Network. The results of this venture will provide ACPN with a winning formula by blending ACPN's unique contracting style with the back-office strength derived through JMS resources and technology based solutions that will dramatically accelerate the development of ACPN's provider network.
The newly opened call center facility in Farmington Hills, Michigan uses state-of-the-art technologies that will be used to support network development and other payor related customer service inquiries.
"The ACPN team and product were a great fit for JMS, our clients, and partners, and will also provide additional opportunities for the health care community as a whole to reduce claim payment and claim processing costs without risk or investment " stated by Frank Gigliotti, CEO JMS and Associates, Inc.
"With over 120,000 provider locations and growing fast, Providers, Payors, and Patients will all benefit through ACPN's future growth by further reducing the payment cycle, eliminating balance billing issues, and reducing customer service inquiries. Having JMS as a partner will enable ACPN with cutting-edge technology, higher service levels, and enhanced provider contracting to the healthcare industry," says Seth Breeden, General Manager, ACPN.
JMS is a Michigan based corporation with over 30 years of experience providing human resource and technology outsourcing solutions. For its health care insurance partners, JMS supports front-end and back-office claim processing services that improve most aspects of the claim payment cycle. The JMS value proposition is derived through our focus on performance and productivity that results in lower operating costs, quick turn-around, and higher quality. Contact Shana Boley at firstname.lastname@example.org, 877-489-8881 x207 and visit www.jmsassoc.com.
ACPN is an independent, multi-specialty national provider network that has developed its own proprietary network and technology for the purpose of achieving consistency in healthcare transactions, simplifying claims adjudication processes, creating reasonable reimbursement arrangements and establishing reliable healthcare access for all parties; providers, payers and patients. Visit www.acpnusa.com.
The Actuarial Society of Greater New York Announces its Spring Conference
MyHealthGuide Source: The Actuarial Society of Greater New York, 4/15/2015, www.goasny.org
Actuarial Society of Greater New York is pleased to announce an exciting educational program at this
year's ASNY Spring Meeting. The meeting will commence with a general
professionalism session followed by breakout sessions.
breakout sessions an accomplished group of industry leaders will
present on a broad range of topics of interest including actuarial
and IT partnerships, actuarial governance, and evolving regulations.
At the conclusion of the meeting, we will have an evening networking
reception where you can connect with actuaries and other insurance
professionals and executives.
Total expected Continuing Education credits: 4.2 credits. As an approved provider of the American Academy of Actuaries, ASNY certifies that it believes in good faith that the above sessions meet the requirements under the U.S. Qualification Standards. The Continuing Education credits for each session and the applicable actuarial practice areas will be provided with a more detailed agenda.
About The Actuarial Society of Greater New York
Founded on September 1, 1932, the Actuarial Society of Greater New York (ASNY) is a non-profit actuarial organization committed to four major objectives: further the development of actuarial science and knowledge, provide grants to fund these efforts, assist in the ongoing education of ASNY members and offer continuing education. Visit www.goasny.org.
MCM Welcomes Connie J. Wolf as Vice President of Sales
MyHealthGuide Source: MCM Solutions for Better Health, 4/16/2015, www.medicalcost.com
CHICAGO, IL - MCM Solutions for Better Health, a national leader in providing population health management services, is pleased to announce the addition of Connie J. Wolf as Vice President of Sales.
Connie J. Wolf brings with her over 35 years of industry experience in life and health insurance with a focus on self-funding. An attendee of both the University of New Mexico and Wright State University in Ohio, Connie comes to us with tremendous passion and knowledge in Medical Self-Funding, Stop Loss, Third Party Administration (TPA), Cost Containment, and Benefit Consulting.
Connie formed and owned Managed Health Resources, a TPA in Oklahoma, and was co-owner of Employer's Resource Group, a Professional Employer's Organization. Prior to joining MCM, Connie was the Self Funding Specialist for Frates Benefit Administrators. Connie is a member of the Society of Professional Benefit Administrators.
Mike O'Connor, President, stated, "The addition of Connie to our executive leadership team reflects MCM's commitment to being the market leader in offering innovative and cost effective Solutions for Better Health. Her experience in self-funding and employee benefits for both the small and large group market provides the perfect skill set needed for our Vice President of Sales position. Our team is thrilled to have her on board."
Medical Cost Management Corporation, dba MCM Solutions for Better Health, was founded by Michael O'Connor in 1986. They are a leading provider of population health management programs that cover the entire continuum of care. MCM is a physician directed company that is URAC accredited and licensed in all states with requirements. MCM and its subsidiary Med-Care provide services to over 550 plans representing over 600,000 members on a nationwide basis. Visit www.medicalcost.com.
Rockport Benefits Announces Addition of Susan Herzog
MyHealthGuide Source: Rockport Benefits, LLC, 4/13/2015, www.rockportbenefits.com
Beverly, MA -- Rockport Benefits, LLC is delighted to announce its latest addition, R.N., Susan Herzog.
"Sue has worked alongside me for many years. She is a very well respected nurse consultant and will be an invaluable asset. We are proud and fortunate to have her on board," states Managing Director, Amy Argeros.
Sue's responsibilities will include conducting medical reviews, acting as a cost containment liaison and providing consultative services both internally and externally. Rockport Benefit's business partners will be afforded the opportunity to prosper from Sue's knowledge, expertise and genuine willingness to help.
About Rockport Benefits
Rockport Benefits, LLC has been formed with the hope of providing a refreshing alternative to the Medical Stop Loss market, offering the same reliability and consistency to which you are accustomed, fused with a true optimism and excitement toward our future capabilities. Contact Amy K. Argeros, Managing Director, at 978-969-0658, email@example.com and visit www.rockportbenefits.com.
Bravo Wellness Adds to Its Team
In addition to the growing business development team, Bravo Wellness has also added a consulting Medical Director. Dr. Joseph Berley has spent 20 years helping companies achieve success through corporate wellness programs. He will guide Bravo and their wellness provider partners to examine and enhance the clinical efficacy of their customer solutions.
Bravo is also excited to announce the internal promotion of Tony Bodak to Vice President of Operations. Formerly Bravo's Director of Data & Analytics, Bodak led the effort to reshape and enhance client aggregate reporting to help Bravo stand out in the industry. His scientific approach to planning will be leveraged to further advance Bravo's cycle-based offering and will act to better service clients. Bodak's appointment will allow Bravo to strengthen areas that entail heavy transactional work, management of sensitive data, and strict timelines for turnaround, with fulfillment and opportunities for operational efficiencies and process improvements.
"As Bravo continues to meet the growing needs of employers, brokers, captives, MEWAs, and private exchanges, not only will these individuals bring another layer of expertise to our organization, but they will also act as a reminder that outcomes-based wellness incentive plans are growing," stated Jim Pshock, Bravo Wellness founder and CEO. "We are excited for what the future holds in employee benefits and wellness and couldn't be happier to have each of these individuals on our team."
About Bravo Wellness
Bravo Wellness has been a disruptive force in the wellness industry since its inception in 2008. Bravo pioneered the outcomes-based wellness incentive space and carefully designs compliant incentives that result in unprecedented engagement levels. Bravo's case studies prove and demonstrate sustained health improvement and reduced claims spending-all while equipping individuals to make better choices and providing thoughtful alternatives to those for whom special exceptions are warranted. With roots in data management, compliance and technology, Bravo recognizes that it's rarely the lack of activities that makes a program unsuccessful, it's often the lack of motivation and engagement-a problem that can be solved. Visit www.bravowell.com to learn more. Contact Heather Bowers, Senior Marketing Specialist, at 877.662.7286 ext. 572, HeatherBowers@bravowell.com and visit www.bravowell.com and www.incentisoft.com.
Cypress Benefit Administrators' Tom Doney Named CEO/Executive of the Year
MyHealthGuide Source: Cypress Benefit Administrators, 4/13/2015, www.cypressbenefit.com
APPLETON, WI -- Tom Doney, president and CEO of Cypress Benefit Administrators, has been named CEO/Executive of the Year by Post-Crescent Media, a part of Gannett Co., Inc., the national media corporation headquartered in Virginia. Post-Crescent Media serves the Fox River Valley region of Eastern Wisconsin.
Doney, who co-founded Cypress in 2000 with Marsha Phillips, received the honor as part of the newspaper's recently published 60th Annual Report.
Cypress is a leading third party health benefit administrator (TPA) headquartered in Appleton, Wis., with clients in all 50 states. Once a two-person operation, the company now has additional locations in Portland and Salem, Ore., Omaha, Neb. and Denver, Col., and employs more than 100 people.
In January, Doney was named chairman of the Society for Professional Benefit Administrators (SPBA), the national association that represents the self-funding industry. Cypress was also one of 14 firms nationally to win a Gold Well Workplace Award through the Wellness Council of America and its Wellness Council of Wisconsin affiliate in 2013.
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 third party administrator (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. Visit www.cypressbenefit.com.
HCC Life Insurance Company
Has Immediate Opening for Regional Marketing Representative
in Plano, TX Office
Business Controls and Policies
Position Knowledge, Skills, and Requirements
Interested candidates should email their resume to firstname.lastname@example.org.
About HCC Life Insurance
HCC Life Insurance Company (HCC Life) is an Indiana-domiciled
life insurance company with an extensive product portfolio including
medical stop loss, group term and short term medical insurance. HCC
Life has consistently held an A+ (Superior) rating for financial
strength by A.M. Best Company as well as AA (Very Strong) ratings by
Standard & Poor's and Fitch Ratings.
Three's a Crowd: Challenges in Adding the Broker/TPA in a Third Party Action
MyHealthGuide Source: Thomas A. Croft, Esq., Self-Insurer's From the Bench, May 2015
The Group is peeved that the stop loss reimbursement claim has not been paid, even though their TPA paid the underlying claim under the Plan. What can happen under such circumstances? As we all know, lots.
I infer that the group, either through counsel or directly, asked the TPA why the TPA paid the claim if the stop loss carrier has refused to pay it, on whatever basis (exclusion under the Plan, under the stop loss policy, lack of eligibility, or a host of other possible reasons). The TPA will respond that the stop loss carrier is wrong, being unreasonable, etc.
What will the group do next to get the stop loss claim paid?
One option is for the group to sue (or initiate arbitration against, if the stop loss contract so provides) the stop loss carrier, on the theory that the claim denial was improper, add a claim for "bad faith" under one or more of several theories, and see how that plays out, leaving the TPA out of the equation.
Another, more aggressive option, is to sue both the TPA and the stop loss carrier, arguing that the group did nothing wrong, and that either, in the alternative: 1) the stop loss carrier denied the claim improperly; or 2) the TPA breached its contract with the group and/or negligently paid the claim without adequate investigation. Alternative pleading is perfectly permissible, essentially allowing a claim that says either party #1 is liable or party #2 is liable-either way the group is entitled to a recovery-or so the pleading goes.
Another option for the group is to cut a deal with the TPA which says, essentially, that if we don't win our case against the stop loss carrier then the TPA agrees to make up the difference.
Yet another option I have seen recently is for BOTH the TPA and the group to sue the stop loss carrier for improperly denying the claim, for bad faith, etc. This is a defective choice in my view, as the TPA has no cause of action against the stop loss carrier whatsoever. There is no contract between the TPA and the stop loss carrier. Therefore, there cannot conceivably be a breach of contract action. The TPA is the agent of the group-NOT the stop loss carrier-and it has no rights against the stop loss carrier capable of enforcement in my view. So what explains such cases?
One possibility is that the TPA has agreed to indemnify the group for its losses, but wants to piggyback on the group's (now completely indemnified) claim against the carrier. If there was a valid assignment of the group's claim against the carrier in return for the TPA's promise of indemnity, then it is the TPA-and ONLY the TPA-that has any cause of action against the stop loss carrier as the "real party in interest," i.e., the only entity with a real economic stake in the controversy. The group no longer has any damages because it has been indemnified by its TPA.
Federal Rule of Civil Procedure 17(a)-and most state analogue rules-require that an action be prosecuted in the name of the "real party in interest." The typical remedy for an action not being prosecuted in the name of the party with the true economic interest in the transaction is, after a motion or objection by the defendant, that the "real party in interest be substituted "for the plaintiff who isn't. Often, such a motion cannot practically be brought until after some discovery takes place, and the agreement between the TPA and the group is disclosed. A grant of such a motion would eliminate the group from the case.
Tactically, I do not think this serves the group well, as leaving the TPA as the only plaintiff in the suit seems somehow less compelling than having the insured group as the sole plaintiff. (Rule 17(a)(3) speaks in terms of "ratification" by the real party in interest as an alternative to substitution, but in my experience, substitution is the more likely outcome.)
Adding TPA, Broker or Other in a Third Party Action
Under many of the scenarios described above, the defending party (be it the carrier or the TPA) will try to add the "missing party" to the case via what is known as a "third-party action." For example, a stop loss carrier might attempt to add the broker or the TPA to the case in a case where the broker/TPA participated in the disclosure process and there was a disclosure-based denial of a large claim. The theory of the carrier might be that the broker/TPA was negligent in gathering/providing the disclosure information, and should pay all or some of the judgment in the event the group prevails in the case.
(There may be many reasons the group chose to sue the stop loss carrier only-the group did not believe that the broker/TPA did anything wrong, a long-time business relationship with the broker/TPA, trial tactical reasons, etc., etc.). In any event, "adding" a party to a case via a third party action is not as simple as it might seem. In the hypothetical above, under Federal Rule of Civil Procedure 14(a)(1), one must get permission from the Court in most circumstances to add the additional party, and, whether or not permission is required, must ultimately show that the nonparty " is or may be liable to it for all or part of the [plaintiff's] claim against it." Otherwise, the third-party action is defective and subject to dismissal upon motion of the proffered third-party defendant, the plaintiff, or both.
Challenges in Adding the Broker/TPA as a Third Party
In the above hypothetical, the stop loss carrier is essentially trying to add the broker/TPA on the theory that the alleged disclosure problems were the fault of the broker/TPA, or at least partially so, such that the broker/TPA should share in the liability to the group, should there be any. This should not work under existing procedure in the federal-and most state-courts for the following reasons.
First and foremost, the broker/TPA could never be liable to the stop loss carrier defendant: the broker (or TPA) is the agent for the group in the self-funded context, and has liability, if any, to the group and only the group, and the group has not sued them. So, the stop loss carrier's claim cannot meet the threshold test for bringing in a third-party defendant-the broker/TPA cannot be liable to "it." (Actual fraud might be an exception, but is beyond the scope of the discussion here.).
One "end-run" attempted by the carrier in such a situation may be to attempt to rely on the "contribution" statutes of the State's law applicable to the controversy. Contribution is typically provided in one of many forms in the several states. Essentially, the concept is that where two parties combine to cause a single injury to an injured plaintiff, the liability is apportioned between them in the manner specified by the applicable contribution statute. In the above hypothetical, the carrier would argue that the broker/TPAs actions in allegedly providing defective disclosure and the actions of the carrier (in denying the claim) somehow "combined," such that an action for contribution lies between the carrier and the broker/TPA, thus providing the predicate for a Rule 14(a)(1) third-party action by the carrier against the broker/TPA. This may sometimes be a tactical move by the stop loss carrier to attempt to implicate the broker/TPA's E&O coverage and bring it to the table at a mediation and/or at trial.
The astute reader will see the flaw in this tactic. It is this: if the carrier improperly denied the stop loss claim, then nothing the broker/TPA did caused any damage to the group. Put differently, either there was no disclosure problem sufficient to deny the claim so the stop loss carrier wrongfully denied it, or there was negligent conduct by the broker/TPA sufficient to cause a disclosure problem justifying a denial, in which case the stop loss carrier is not liable for anything. It's one or the other; it can't be both. In neither event could the broker/TPA be liable to the stop loss carrier, and the prerequisites of Rule 14(a) are not present, such that the third-party action should be dismissed.
[There is a related problem-beyond the scope of this article-regarding the status of the broker/TPA and the stop loss carrier as "joint tortfeasors" under state law-typically a requirement for any valid contribution action to lie. I will spare the reader a discussion of that, but I don't think it alters the result.].
To summarize-there are a myriad of possibilities and angles when brokers, TPAs, groups and stop loss carriers become embroiled in multi-party litigation. These can be expensive to sort out. The existence of arbitration clauses in either the stop loss contract or broker agreement or TPA agreement can compound these exponentially. For example, can the broker/TPA be compelled to participate in an arbitration required by the stop loss contract for claims disputes? The law on these kinds of issues is unclear and evolving, and may be the subject of future articles.
In the meantime, the old saw about two being a "party" and three (or more) being an unmanageable "crowd" applies in my judgment. At the National Conference in October, I will be narrating a full-fledged "mock mediation" of a three-party dispute between a carrier, a TPA and a self-insured group, complete with counsel, party representatives, and an experienced mediator. Those with interest in these kinds of issues may want to attend.
About the Author
Thomas A Croft is a magna cum laude graduate of Duke University (1976) and an honors graduate of Duke University School of Law (1979), where he earned membership in the Order of the Coif, reserved for graduates in the top 10% of their class. He returned to Duke Law in 1980 as Lecturer and Assistant Dean (1980-1982) and as Senior Lecturer and Associate Dean for Administration (1982-1984). He also taught at the University of Arkansas-Little Rock law school, where he was an Associate Professor of Law (1990-91), earning teacher of the year honors.
Until 2004, when he specialized in medical stop loss litigation and consulting, Tom practiced general commercial litigation. He was a partner in the litigation section of a major Houston firm in the late 1980s, and moved to the Atlanta area in 1991. He has been honored as a Georgia "Super-Lawyer" by Atlanta Magazine for the last eight years running, and holds an AV® Preeminent rating from Martindale-Hubble®.
Tom currently consults extensively on medical stop loss claims and related issues, as well as with respect to HMO Excess Reinsurance, Medical Excess of Loss Reinsurance, and Provider Excess Loss Insurance. He maintains an extensive website analyzing more than one hundred cases and containing more than fifty articles published in the Self-Insurer Magazine over many years. See www.stoplosslaw.com. He regularly represents and negotiates on behalf of stop loss carriers, MGUs, Brokers, TPAs, and Employer Groups informally, as well as in litigated and arbitrated proceedings, and has mediated as an advocate in many stop-loss related mediations. Tom can be reached at 770-674-4292 and email@example.com.
EEOC Wellness Rule Eases Fears for Employers
MyHealthGuide Source: Andrea Davis, 4/16/2015, EBN Benefit News
The Equal Employment Opportunity Commission released a proposed rule this week on wellness programs, removing what at least one business group calls a "big cloud" that has been hovering over employers as they struggle to ensure their wellness incentive programs don't run afoul of the EEOC.
The EEOC has come under fire in recent months for what some say was a lack of clarity on wellness programs. Last October, the agency filed a lawsuit against Honeywell over its wellness program, claiming the program violated the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act by imposing penalties on employees who refused to participate in the company's biometric screening program.
Thursday's proposed rule aims to clarify how Title I of the ADA applies to employer wellness programs that are part of group health plans.
The proposed rule removes confusion for employers who are complying with the Health Insurance Portability and Accountability Act and the Affordable Care Act rules with respect to their wellness incentives, says Steve Wojcik, vice president, public policy with the National Business Group on Health. "If you're complying with HIPAA and ACA rules you shouldn't have any problems with the ADA," he says.
The EEOC proposed rule coincides with an FAQ about wellness programs from the Departments of Labor, Health and Human Services and the Treasury, which aims to clarify what it means for a health-contingent wellness program to be "reasonably designed" and how compliance with DOL and HHS regulations on wellness programs affect compliance with other laws, such as HIPAA and the ADA.
"I think it's very good news, at the end of the day, for employers. It removes a big cloud that had hung over the wellness program since the legal action of the EEOC," says Wojcik.
The Senate and House of Representatives have introduced identical bills (S. 620 and H.R. 1189) to reaffirm laws already in existence that allow for employee wellness programs tied to a financial reward. How these bills will be affected by the EEOC proposed rule remains to be seen, says Tami Simon, managing director for Buck Consultants at Xerox.
"If the EEOC is pretty quick to turn around a final version [of the proposed rule] after the public comment period closes, we'll have to see what the final rule says, then the House and Senate will have to decide if a bill is still needed," she says.
The proposed rule is a step in the right direction, she says, and the EEOC "appears to understand the need for consistency among the different laws that apply many of the rules that come from HIPAA and the Affordable Care Act. … At the end of the day, though, the question is how is that application going to actually work itself out?"
The EEOC has also published a fact sheet for small businesses and a Q&A for the general public.
EEOC Issues Proposed Rule on Application of the ADA to Employer Wellness Programs
MyHealthGuide Source: The U.S. Equal Employment Opportunity Commission, 4/16/2015, EEOC Release
WASHINGTON -- The U.S. Equal Employment Opportunity Commission (EEOC) published a Notice of Proposed Rulemaking (NPRM) describing how Title I of the Americans with Disabilities Act (ADA) applies to employer wellness programs that are part of group health plans. The NPRM is available in the Public Inspection portion of the Federal Register, and will be officially published on Monday, April 20, 2015. Members of the public have 60 days from that date (or until Friday, June 19) to submit comments.
The EEOC's proposed rule would provide much needed guidance to both employers and employees about how wellness programs offered as part of an employer's group health plan can comply with the ADA consistent with provisions governing wellness programs in the Health Insurance Portability and Accountability Act (HIPAA), as amended by the Affordable Care Act. In addition, the EEOC is also publishing a Fact Sheet for Small Businesses and a Question and Answer document for the general public.
Many employers that provide health insurance also offer workplace wellness programs intended to encourage healthier lifestyles or prevent disease. These programs sometimes use health risk assessments and biometric screenings to determine an employee's health risk factors, such as body weight and cholesterol, blood glucose, and blood pressure levels. Some of these programs offer financial and other incentives for employees who participate or achieve certain health outcomes.
Although the ADA limits the circumstances in which employers may ask employees about their health or require them to undergo medical examinations, it allows such inquiries and exams if they are voluntary and part of an employee health program.
The NPRM further requires that if an employee health program seeks information about employee health or medical examinations, the program must be reasonably likely to promote health or prevent disease. Employees may not be required to participate in a wellness program, and they may not be denied health coverage or disciplined if they refuse to participate
The EEOC's proposed rule makes clear that wellness programs are permitted under the ADA, but that they may not be used to discriminate based on disability. The rule explains that under the ADA, companies may offer incentives of up to 30 percent of the total cost of employee-only coverage in connection with wellness programs. These programs can include medical examinations or questions about employees' health (such as questions on a health risk assessment).
This limit is generally consistent with limits that HIPAA imposes on wellness programs. The rule also makes clear however, that the ADA provides important safeguards to employees to protect against discrimination based on disability. Accordingly, medical information collected as a part of a wellness program may be disclosed to employers only in aggregate form that does not reveal the employee's identity, and must be kept confidential in accordance with ADA requirements.
Amendments to Regulations Under the Americans With Disabilities Act
MyHealthGuide Source: Federal Register, 4/20/2015, Federal Register Full Text Article
The Equal Employment Opportunity Commission (EEOC) is issuing a proposed rule that would amend the regulations and interpretive guidance implementing Title I of the Americans with Disabilities Act (ADA) as they relate to employer wellness programs. The proposed rule amends the ADA regulations to provide guidance on the extent to which employers may use incentives to encourage employees to participate in wellness programs that include disability-related inquiries and/or medical examinations.
This proposed rule provides guidance on the extent to which the ADA permits employers to offer incentives to employees to promote participation in wellness programs that are employee health programs.
A wellness program may be part of a group health plan or may be offered outside of a group health plan. The references in the proposed rule regarding the requirement to provide a notice and the use of incentives, and changes to the corresponding section of the interpretive guidance, apply only to wellness programs that are part of or provided by a group health plan or by a health insurance issuer offering group health insurance in connection with a group health plan.
The term "group health plan" includes both insured and self-insured group health plans and is used interchangeably with the term "health plan" throughout the preamble. All of the other proposed changes to the regulations apply to all "health programs," which include wellness programs whether or not they are offered as part of or outside of a group health plan or group health insurance coverage. The term "incentives" includes both financial and in-kind incentives, such as time-off awards, prizes, or other items of value.
Montana Governor Signs Captive Legislation
MyHealthGuide Source: Montana Captive Insurance Association, Inc., 4/13/2015, www.mtcaptives.org
Montana Governor Steve Bullock last week signed separate bills that will further improve the state's regulatory environment for captive insurance.
H.B. 536 authorizes public sector entities in the state to establish captive insurance companies, while H.B. 537 clarifies existing statutes to specify that captive insurance companies can be set up as limited liability companies (LLCs).
Working in conjunction with the office of Montana Commissioner of Securities and Insurance (CSI), the Montana Captive Insurance Association (MCIA) spearheaded an effective lobbying campaigned that secured passaged of both bills with minimal opposition. Since the founding of the association more than 10 years ago, MCIA has supported multiple legislative improvements to the captive statute and has never been turned away.
"We are once again pleased to report to our membership and the larger captive insurance industry that MCIA has been successful in making meaningful improvements to what is already one of the country's premier captive domiciles," said association President John Jones. "We certainly could not have done this without the support of our members and from our regulator partners at CSI."
Learn more about these legislative/regulatory developments and more at MCIA's upcoming annual conference, scheduled for July 21-23, 2015 in Whitefish, MT. Details can be accessed on-line at www.mtcaptives.org, or by calling 866/388-6242.
About Montana Captive Insurance Association, Inc.
Montana licensed its first captive insurance company in January 2002. Since then the number of active captive insurance companies has grown to 65. These captives insure rural hospitals, nursing homes, fuel stations, commercial trucking firms, an investment firm, a medical professional firm, a construction company and attorneys. Visit www.mtcaptives.org.
Bre.ast Cancer Treatment
Cost and Outcomes Reported
The authors note that the price society is willing to pay for an additional year of life remains controversial in the United States and suggest that more research is needed to determine how to best contain costs while continuing to advance patient care.
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/4/2015)
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.
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.
April 23, 2015 - webinar
1:00 PM EST to 2:00 PM EST
April 23, 2015 - webinar 11:00 a.m. EST
May 6-8, 2015
May 11, 2015 - 1:00 PM - 7:00 PM
June 3-5, 2015
June 15-17, 2015
July 15-17, 2015
July 21-23, 2015
September 14-16, 2015
September 28-30, 2015
February 9-11, 2016
March 30-April 1, 2016
July 13-15, 2016
October 17-19, 2016
February 8-10, 2017
March 15-17, 2017
September 13-15, 2017