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TABLE OF CONTENTS
Health Plans®'s StayFit™ Plan Introduces Health Index
Calculator™ to Motivate Health Behavior Change
StayFit' s preliminary data shows members use the Health Index
Calculator as many as 4-5 times in a year and receive at least three
self-directed mobile reminder Alerts with fresh content daily! The
tool is superior to the HRA in every way including engagement since
the Calculator talks less time to complete and provides a higher
level of integration to employer sponsored resources that help
participants achieve their health to wealth goals.
About The StayFit™ Plan a division of Simplicity Health Plans
GPA's Nurse Navigator Presented at MCG Client Forum Conference
MyHealthGuide Source: Group & Pension Administrators, Inc., 7/17/2014, www.GPATPA.com
Dallas, TX -- GPA leadership recently presented at the annual MCG Client Forum Conference in Orlando, Florida. The focus of the conference, "Delivering High--Value Care," highlighted the innovative ways the GPA Nurse NavigatorSM team helps clients, members and providers through enhanced patient access to appropriate care. The GPA HealthWatchSM Executive Director, Barbara Derlein, RN, CCM, CDMS, AATMC, and Manager of the Nurse Navigator program, Rosie Fields, RN, CCM, spoke to attendees from large insurance carriers, federal government representatives and third party administrators. The GPA program delivers high value care tailored specifically to meet each client's individual needs based upon their unique employee base.
The GPA Nurse Navigator patient concierge program continues to be recognized for successfully addressing rising healthcare costs, reducing questions about healthcare benefit plans and providing quality and cost effective patient options for medical care. The program is designed to serve as a standardized tool that is built on a foundation of evidence-based guidelines to proactively educate members regarding their benefits, healthcare options, and the costs variations of care. The Nurse Navigator program effectively collaborates with other internal GPA programs such as Corporate Care Clinic, Wellness, Disease Management, Utilization Review and Care Management to provide members an innovative and comprehensive solution meeting their healthcare needs.
This unique GPA approach to medical cost containment and patient empowerment has earned the Nurse Navigator program the national recognition this forum offers.
About Group & Pension Administrators, Inc.
Group & Pension Administrators, Inc. (GPA) is the largest independently owned third-party administrator (TPA) in the Southwest, providing high-quality and custom healthcare benefit management solutions to self-insured employers. For over 40 years, GPA has combined its value of service excellence with a commitment to clients. They combine industry-leading technology and tools with "high-touch" patient care to deliver the healthiest employees and the "healthiest" bottom line. Contact Barbara Derlein at 972.744.2466, BarbaraD@gpatpa.com and visit www.GPATPA.com .
Care guidelines from MCG provide fast access to evidence-based best practices and care-planning tools across the continuum of care, supporting clinical decision-making and documentation and enabling efficient transitions between care settings. Eight of the 10 largest U.S. health plans and more than 1,200 hospitals use our evidence-based guidelines and software to help drive effective care for 70% of commercially insured Americans, resulting in better outcomes and contained costs.
Risk Solutions Captive, Inc. Featured on Radio Program Inside Healthcare: Critical Thinking for Turbulent Times
MyHealthGuide Source: Risk Solutions Captive, Inc., 7/17/2014, www.risksolutionscaptive.com
Hendersonville, TN (July 17th, 2014): Bill Beeler, President of Risk Solutions Captive, Inc. (RSC), was recently featured on the radio program Inside Healthcare: Critical Thinking for Turbulent Times. Beeler and the host of the show, Robert Chamberlain, discussed how American businesses today have different options related to their healthcare, specifically in the self-funding arena, one of which is the new captive product offered by Risk Solutions Captive.
Beeler explains, "Employers have become more aware of the health benefits they provide to their employees because of the mandated benefits that are part of ACA as well as the penalties and fines associated for employers that do not provide the minimum benefits as well as the affordable benefits. This has made employers pay more attention to their plan, want more information about their plan, and try to find out what drives the cost of their plan. Until now they have not had this information. All they've had from a carrier is a set of rates and a premium increase. Those days have come to an end…Employers want more knowledge. They want more data that they can act upon."
Partnering with Health Cost Solutions and a highly-rated reinsurance carrier, Risk Solutions Captive provides employers and benefit consultants with ACA compliant options designed specifically for their employees.
"Risk Solutions Captive is basically an insurance company; we have our certificate of authority in the State of Tennessee, we market to employers with 50 employees and above, down to 25 if they have a favorable population, and we allow those groups to participate in our captive, RSC, but we also set up a separate captive cell for that employer group below RSC and they're responsible for a portion of the risk on the front end. Anything over a certain dollar amount cedes to RSC and then over a certain dollar amount it goes to the reinsurance carrier. It allows those employers to get into the self-funded environment and not experience those peaks and valleys of a self-funded plan," Beeler said.
Click here to hear the complete interview and learn how Risk Solutions Captive is addressing the growing cost of healthcare coverage through affordable self-funding options.
About Risk Solutions Captive, Inc.
Risk Solutions Captive, Inc. (RSC) provides innovative solutions for companies with 50 or more employees in the self-funded arena. RSC's partnership with Health Cost Solutions (HCS), the TPA, provides the foundation for RSC with a variety of services including claims payment, cost containment, billing, reporting, COBRA and HIPAA services. By partnering with a highly rated reinsurance carrier and Health Cost Solutions, Risk Solutions Captive offers risk protection from high-dollar claims exposure and the highest quality TPA services. Contact Bill Beeler at email@example.com, 800.526.3919 and visit www.risksolutionscaptive.com .
Pay-Plus® Solutions Launches New Web Destination
MyHealthGuide Source: Pay-Plus® Solutions, Inc. (PPS), 7/14/2014, www.ppsonline.com
Clearwater, FL -- Pay-Plus® Solutions, Inc. (PPS), a leading provider of electronic payments to healthcare Providers, is proud to announce the launch of its new web destination, www.ppsonline.com. The website focuses on Pay-Plus' service offerings and also expands upon PPS's mission to provide world class customer service while building customer value through innovation and technology. The new site provides clients and visitors with an enhanced user experience, featuring multi-media elements, greater content detail and easier navigation. Other enhancements to the site enable visitors to easily register for Pay-Plus services, access live helpdesk support and watch a video overview of Pay-Plus' payment processing solution.
"Our website & member portals have become a daily destination which allow our customers to conveniently and securely manage their businesses and are great examples of the innovation we continue to bring to the healthcare payment market," stated Jay Ver Hulst, President of Pay-Plus® Solutions. "With the launch of our new website and commitment to future enhancements, we continue to introduce leading technologies that allow us to keep our products focused and tailored to the needs of our customers."
Pay-Plus® Solutions, Inc. (PPS), a PHX Company, delivers easy, fast and reliable electronic payments and explanation of payments to healthcare providers upon adjudication of valid and payable medical claims and reconciliation. The PPS system utilizes a patent pending process to deliver funds electronically via ACH and EOPs directly to healthcare providers via its web-based portal www.ppsonline.com. PPS is the only system designed exclusively for healthcare that combines banking functions, claim payments and remittance and integration with traditional paper processes. Contact Leo J. Garneau III, Chief Marketing Officer, SVP, at firstname.lastname@example.org, (888) 311-3505 ext. 296 and visit www.ppsonline.com .
Advanced Medical Strategies Adds Alice Jamba as Vice President of Clinical Services
MyHealthGuide Source: Advanced Medical Strategies, 7/18/2014, www.mdstrat.com
LYNNFIELD, Mass. -- Advanced Medical Strategies, the vanguard firm of physician-led claim specialists to health care payors, and publishers of the PredictDx diagnosis cost prediction software, has expanded its staff to include Alice Jamba, RN, as Vice President of Clinical Services. Her role will be to assist the company with clinical research and product development. Jamba joins as AMS continues to solidify its status as the premier clinical review organization.
Jamba adds more than 40 years of medical experience to the AMS underwriting support and clinical review team, having cut her teeth as an RN at New York Presbyterian Medical Center before slowly transitioning into medical review and research in 2003. Her un-paralleled breadth lies in having served as both a healthcare provider and an insurance specialist. Since her transition to the business side she has lent her expertise to a number of companies including Greenwood International insurance and Healthmarket.
"I am personally very excited to have an acquisition like Jamba on board," says Stacy Borans, MD, Founder and Chief Medical Officer at AMS, "I know how invaluable it is to balance that clinical experience with solid business acumen, and we're confident that her skills and experience will help AMS to continue its growth and product development goals.
Jamba joins the AMS team to help accommodate growing industry demand for AMS' core medical review and claim auditing services, and to provide an additional expert eye for clinical review. Among other duties, Jamba will assist AMS with expanding its database of catastrophic diagnoses, available through AMS' PredictDx subscription. Currently PredictDx can accurately predict the total long-term costs of more than 160 catastrophic diagnoses, including 95% of all cancers. Jamba also will assist with AMS' claim auditing and independent medical review processes to ensure speed and accuracy of service.
"I admire AMS as a physician-led organization. That level of detail is reflected in an 'each-case-is-unique' approach to claims auditing and review, and I really think that philosophy leads to maximized cost-savings for healthcare payors," says Jamba. "I'm excited to get started."
AMS is continuing to grow going forward as PredictDx is enhanced and as AMS adds to its growing list of healthcare payors and third party administrators looking to augment their stop-loss initiatives for catastrophic claims with more thorough medical review.
About Advanced Medical Strategies
Advanced Medical Strategies is a physician-lead company specializing in advancing the most innovative and proactive solutions for healthcare payors looking to provide excellent care with cost-effective methods. AMS aims to provide peace of mind when dealing with all facets of medical claims. Contact Danae Lambeth, National Sales Director, at (781) 224-9711 x107, Danae@mdstrat.com and visit www.mdstrat.com .
EmployerDirect Promotes Joni Guerrero to Vice President of Operations
MyHealthGuide Source: EmployerDirect, 7/17/2014, www.edhc.com
AUSTIN, TX -- EmployerDirect, a leader in value-based healthcare that helps large, self-insured employers provide transparency for the quality and cost of their employees' planned medical procedures, announced that it promoted Joni Guerrero to Vice President of Operations. Joni has more than 20 years of management experience and has been EmployerDirect's Senior National Account Manager since February 2013. In her new position, she will provide direction and guidance to the operational activities of the company, as well as assist in maximizing growth and profitability.
Prior to EmployerDirect, Joni provided analytical and technical support as a government contractor for Vinculum Solutions. She was also Vice President of Operations for NuVANTE, Inc. In addition, Joni worked for EverydayWealth and the Internal Revenue Service. She holds a bachelor's degree in Government from the University of Texas, where she also received former Vice President Al Gore's Hammer Award for her re-engineering efforts toward making government work better and cost less.
"Joni's leadership has helped increase the utilization of our SurgeryPlus benefit," said Thomas Johnston, CEO of EmployerDirect. "She has also been instrumental in fostering an environment of innovation at EmployerDirect, and we look forward to her input as a member of our executive team."
"I'm honored to be recognized for my contributions and am further energized to continue playing a pivotal role in the growth of the company," said Joni Guerrero. "My focus will be to manage both the Personal Medical Concierge Services and Client Relations management teams. Our mission is to provide our clients and their employee members a superior experience by facilitating the entire placement for the members, beginning with our selective group of surgeons of excellence. We also shepherd the members through the rest of the medical process via our care coordinators, all while providing both the client and member great savings."
About EmployerDirect Healthcare
EmployerDirect, a leader in value-based healthcare, transforms the way self-funded employer health plans purchase healthcare for their members, saving 30-50 % on planned medical procedures with the potential to reduce total plan cost by 6-10 %. The company also offers a unique medical concierge service called SurgeryPlus that assists covered members with selecting a provider, scheduling a procedure, transferring medical records, coordinating travel logistics and negotiating surgery costs BEFORE the surgery occurs. Call (888)241-8537 and visit www.edhc.com .
Brentwood Services Administrators Adds Theodore Roose, Susan White, and Promotes LaTronya Roberts
MyHealthGuide Source: Brentwood Services Administrators, 7/17/2014, www.bwood.com
Theodore Roose, Senior Claim Representative
BRENTWOOD, TN -- Brentwood Services Administrators recently has named Theodore Roose, of Hoover, Ala., to the position of senior claim representative, according to Jeff Pettus, president and chief executive officer of Brentwood Services Administrators Inc. (BSA).
Mark Sparks, regional claim manager for BSA in Birmingham, Ala., points out, "Brentwood is delighted to bring Ted aboard. With over 40 years of experience in our industry, Ted's knowledge will be invaluable to our clients as well as our staff. I don't think we could have found a more suitable candidate."
In his new position, Roose is involved with reviewing, processing and handling workers' compensation claims. He determines the compensability of the claim and extent of liability, as well as communicates directly with clients, employers, injured workers, physicians and attorneys to manage claims in a timely and economic manner.
Before joining BSA, Roose was employed as a multi-line claims supervisor for American Mining Insurance Co. in Birmingham, Ala. Professionally, Roose is an associate member of the Alabama Self-Insured Association, and a past president and member of the Alabama Workers Compensation Organization. He also organized and served as president for Workers Compensation Association of Alabama and the Mid-South Workers Compensation Association in Memphis, Tenn.
Roose graduated from the University of Alabama with a bachelor of science in finance from the College of Commerce and Business Administration.
Susan White, Claim Specialist
The Company employed Susan White, of Freeport, Ill, as a claim specialist, according to Pettus.
Luca DeVecchi, AIC, SCLA, BSA claims manager, explains, "Ms. White brings to BSA more than 20 years of experience in workers' compensation claims handling, most recently serving as senior claim specialist for Sedgwick Claims Management. She has multi-jurisdiction experience with an emphasis in Illinois, Iowa, Missouri and Kansas."
In her new position, White is responsible for reviewing, processing and handling workers' compensation claims, as well as determining the compensability of claims and extent of liability. She communicates directly with clients, employers, injured workers, physicians, and attorneys to manage claims in a timely and economic manner.
Prior to joining BSA, she began in the insurance industry as a claim adjuster for Western States Insurance in Freeport, Ill., where she was employed for 10 years. White also previously worked for General Casualty/QBE Insurance for 17 years.
White graduated from Highland Community College in Freeport, Ill, with a degree in education She also holds a Texas claims license. White holds an INS Certificate, as well as an associate in claims and associate in insurance designations.
LaTronya Roberts, Claim Examiner II
The Company promoted LaTronya Roberts, of Mt. Juliet, Tenn., on its Tennessee Claims Department team to the position of claim examiner II, according to Pettus.
Shirley Mahorney, BSA claims supervisor, reports, "LaTronya is handling medical-only claims for several Georgia accounts, and is working exceptionally well on her own."
In her new position, Roberts is responsible for reviewing, processing and handling workers' compensation claims. In addition, she 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 her promotion, Roberts had served as a claim assistant in the BSA Occupational Accident Department since April 2013. Previously, she worked for Amerigroup as a customer services representative.
Roberts received her associate of applied science (AAS) degree, with a paralegal studies major, from Volunteer State College in Gallatin, Tenn.
About Brentwood Services Inc.
Brentwood Services Inc., an independent employee-owned company headquartered in Brentwood, Tenn., specializes in structuring and managing alternative market solutions for employers and insurance providers.
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. (BRII) provides insurance and reinsurance brokerage services encompassing self-insurance, guaranteed cost and deductible insurance with a focus on workers' compensation, excess liability lines, and accident and health reinsurance. Contact John Smitherman, vice president of sales, at email@example.com, (800) 524-0604 or (615) 263-1300, and visit www.bwood.com .
benefitsCONNECT Announces Megan Chiarello as Integrated Sales and Marketing Strategist
MyHealthGuide Source: benefitsCONNECT via inShare, 7/17/2014, www.benefitsCONNECT.net
Rancho Cordova, CA -- benefitsCONNECT, a leader in online benefits enrollment and administration, is pleased to announce the hiring of Megan C. Chiarello as the new Integrated Sales and Marketing Strategist. After years of increasing responsibility and exceptional performance in the health insurance benefits industry, Ms. Chiarello has taken on this new role to lead strategy initiatives at benefitsCONNECT. Ms. Chiarello will lead new sales focused marketing strategies to increase broker participation in benefits administration technology platforms especially with new ACA requirements driving adaption within the industry.
In addition to broker initiatives Ms. Chiarello will also work with both core and voluntary carriers to strategize ways to drive employee enrollment participation through cutting edge technology partnered with broker level service. She also works closely with the Media Department at benefitsCONNECT to deliver creative multimedia campaigns integrating video, avatars, and 2D-3D motion graphics into broker centric employee benefits enrollment campaigns.
Never one to sit still, Ms. Chiarello is also part of the active sales team. She educates brokers on the value of both large group and small group enrollment technologies, broker agency management systems, enrollment communication and value to carriers of a technology centric enrollment and communication solution. She will also perform a significant role in rolling out the benefitsCONNECT and Marketplace Private Exchange Platform to brokers and enrollment firms wanting to offer their own Private Exchange.
Ms. Chiarello attended the University of North Florida where she majored in Political Science with a minor in Communications and English.
benefitsCONNECT, a web-based benefits administration and enrollment system, provides HRIS functionality to the employer and employee, payroll and vendor data integration, consolidated billing, employee benefits and statements, employee self-service and communications, manager self-service and communications, broker commission tracking, as well as COBRA and FSA/HRA tracking. Enrollment and eligibility data is exchanged electronically though an advanced, EDI-enabled, Software as a Service (SaaS) platform.
About Transcend Technologies Group, Inc.
Founded in 2001, Transcend Technologies Group, Inc. (dba benefitsCONNECT) is a privately held company that specializes in Internet-based software applications for the health insurance and benefits industry. Transcend licenses benefitsCONNECT for benefits administration and online enrollment and agencyMANAGER for agency management functionality, and has established clients across the Unites State who entrust their book of business to benefitsCONNECT products. Contact Sales at 916-421-4000, sales@benefitsCONNECT.net and visit www.benefitsCONNECT.net .
Integro Appoints Ruth Kilduff as Chairman and Anne Anderson as President of US Operations
MyHealthGuide Source: Integro via inShare, 7/16/2014, www.integrogroup.com
New York, NY -- International insurance brokerage and risk management firm Integro Insurance Brokers announced the appointment of Ruth Kilduff as Chairman, and Anne Anderson as President of its United States operations, Integro USA.
Both Kilduff and Anderson are Integro veterans. Kilduff leads the firm's Healthcare practice and its Boston operations, while Anderson leads the firm's New York operations. Both are also members of the firm's Operations Committee.
The Kilduff and Anderson appointments follow a recently announced management reordering to better accommodate the firm's rapid growth, improve segmentation and enhance collaboration. Marc Kunney, formerly President of Integro USA, had been named President of Integro's North America operations.
"Ruth and Anne are proven and respected leaders," Kunney said. "They represent Integro at its finest and I'm delighted to welcome them to their new leadership roles. I'm confident their passion, expertise and creativity will assist us through our growth as we continue to deploy Integro's client-centric business model and personalized service."
Ruth Kilduff brings more than 30 years of experience in healthcare, as well as healthcare insurance, to her new role as Chairman of Integro USA. She has specific expertise in professional liability, alternative risk financing and risk consulting. Prior to joining Integro in 2006, Kilduff served as a Managing Director at Marsh. She is a Registered Nurse and a graduate of Massachusetts General Hospital School of Nursing and received her Clinical Nurse Specialist designation from Boston University.
Anne Anderson has more than 30 years of experience in risk management account design, placement and service implementation with a background in underwriting, facultative reinsurance and brokerage. She joined the firm in 2005. Previously, Anderson served as Integro's Property & International Practice Leader, as well as in similar roles at Palmer & Cay and at Marsh. She is a graduate of Cornell University, and a member of the Sponsor Board of the American Bankers Association.
About Integro USA
From offices in Atlanta, Boston, Chicago, New York and San Francisco, Integro USA provides quality broking services to US clients facing complex risks.
Integro is an insurance brokerage and risk management firm focused primarily on serving organizations with complex risks. Clients credit Integro's superior technical abilities and creative, collaborative work style for securing superior program results and pricing. The firm's acknowledged capabilities in brokerage, risk analytics and claims are rewriting industry standards for service and quality. Launched in 2005, Integro and its family of specialty insurance and reinsurance companies, some having served clients for more than 150 years, operate from offices in the United States, Canada, Bermuda and the United Kingdom. Its U.S. headquarter office is located at 1 State Street Plaza, 9th Floor, New York, NY 10004. 1-877-688-8701. Visit www.integrogroup.com .
Strategies Seeks Stop Loss Underwriter
Skills & Qualifications
Interested candidates can email resumes to firstname.lastname@example.org .
About Beacon Risk Strategies
Beacon Risk Strategies is an AmWINS Group Company with offices in
Seattle and Atlanta. Beacon understands that relationships matter.
Our customers trust our expertise to deliver a competitive advantage
in everything we do. Brokers, administrators and reinsurers expect a
higher standard that comes from working with Beacon. We have a
thoughtful approach to underwriting and a tenacious focus on
delivering superior cost containment, claims administration and
customer service. Visit
Litigation Might Trump Arbitration in Stop Loss Contracts
No cases I have seen have considered whether
the deemer clause operates to render a self-insured ERISA plan
exempt from an exception under a state anti-insurance arbitration
statute for "contracts between insurance companies." Compare
v. Louisville Bedding Co. (Ky. App. 2013), available at
StopLossLaw.com, pages 13-14 of the Court's opinion, where the court essentially punted on the even more basic
issue of whether the stop-loss insured was an insurer at all.
Similarly, in Pacificare Health Systems, Inc. v. Book, 538 U.S. 401 (2003), the U.S. Supreme Court considered whether arbitration clauses limiting the arbitrators' ability to award "punitive or exemplary damages" or "extra-contractual damages of any kind" were enforceable where the group of plaintiffs asserted various claims, including claims under the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. § 1961 et seq. ("RICO"). The Supreme Court concluded that the matter of the enforceability of the arbitration clause under these circumstances was for the arbitrator in the first instance, and thus ordered the case to arbitration for a decision on the issue of arbitrability itself. See Suskin & Badnya article, below at note 2, for further details on the splits among the federal circuits on these types of issues generally.
To return to the "wolf" in the stop loss context, because many states have statutorily based remedies for a variety of insurer misconduct, even an otherwise valid arbitration clause might well be subject to attack on the grounds that it unconscionably interferes with important state public policy. This kind of assault might be particularly problematic where the state has a separate "bad faith" statute directed at insurers providing for other than contractual damages, as opposed to a simple common law doctrine supporting bad faith damages under certain circumstances.
Losing the 'Advantage' of Arbitration
If the arbitration clause in the policy form is unenforceable for some reason, then so be it. If we don't include one at all, we lose the "advantage" of arbitrating (no jury, limitation of remedies, unlevel playing field) for sure.
just adds another lawyer of issues to litigate or arbitrate about.
I am not opposed to arbitration generally. It is often a superior
means of dispute resolution. What I am opposed to is the knee-jerk
preference that many insurance executives (and not necessarily their
in-house counsel) have for the inclusion of arbitration clauses in
their policies--a preference that seems more informed by myth than
About Tom Croft
SIIA Updates on New York and Washington
MyHealthGuide Source: Self-Insurance Institute of America, 7/17/2014,
New York: Expanded Grassroots Advocacy Campaign Takes Shape
Specific developments covered during today's meeting included the Self-Insurance Protection Act (SIPA), state insurance exchange assessments and implications of the recent U.S. Supreme Court Ruling in the Hobby Lobby case.
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 State Government Relations Director, Adam Brackemyre at email@example.com or SIIA Government Relations Coordinator Kevin McKenney at firstname.lastname@example.org and visit www.SIIA.org .
DOL Provides FAQ on ACA, ERISA and Contraceptive Coverage
MyHealthGuide Source: US Departments of Labor, Health and Human Services (HHS), and the Treasury 7/17/2014, DOL FAQ
Below is Frequently Asked Question (FAQ) regarding implementation of the Affordable Care Act. This FAQ has been prepared by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/), this FAQ answers a question from stakeholders to help people understand the law and benefit from it, as intended.
Disclosure with respect to Preventive Services
Q: My closely held for-profit corporation's health plan will cease providing coverage for some or all contraceptive services mid-plan year. Does this reduction in coverage trigger any notice requirements to plan participants and beneficiaries?
Yes. For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage.
Specifically, the Department of Labor's longstanding regulations at 29 CFR 2520.102-3(j)(3) provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan.
Accordingly, if an ERISA plan excludes all or a subset of contraceptive services from coverage under its group health plan, the plan's SPD must describe the extent of the limitation or exclusion of coverage.
For plans that reduce or eliminate coverage of contraceptive services after having provided such coverage, expedited disclosure requirements for material reductions in covered services or benefits apply. See ERISA section 104(b)(1) and 29 CFR 2520.104b-3(d)(1), which generally require disclosure not later than 60 days after the date of adoption of a modification or change to the plan that is a material reduction in covered services or benefits. Other disclosure requirements may apply, for example, under State insurance law applicable to health insurance issuers.
Intervention Improves Chronic Pain
Researchers concluded that the intervention was effective, even though most trial participants reported pain that had been present for many years, that involved multiple sites, and that had been unsuccessfully treated with numerous analgesics. The improvement in pain with minimal opioid initiation or dose escalation is noteworthy, given increasing concerns about the consequences of long-term opioid use.
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 6/21/2014)
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.
July 22-24, 2014
July 23, 2014
Webinar 2:00 p.m. - 3:30 p.m. EST
You will receive a separate email notice indicating your
confirmation or waitlist status for each event.
Questions can be submitted on
www.REGTAP.info using "Submit an Inquiry" and note the
"Reinsurance Program" in your question text.
August 18-20, 2014
Comprehensive preparatory training for healthcare information
security professionals who are working to earn the HealthCare
Information Security and Privacy Practitioner (HCISPP) credential
from (ISC)². Nashville, TN.
October 16, 2014
J.W. Marriott Desert Ridge, Phoenix, AZ. contact Justin Miller
800/851-7789, or email@example.com.
Information and Registration:
January 18-20, 2015
January 25-27, 2015
February 10-11, 2015
March 18-20, 2015
May 6-8, 2015
September 28-30, 2015
March 30-April 1, 2016
October 17-19, 2016
March 15-17, 2017
September 13-15, 2017