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TABLE OF CONTENTS
Goldman Sachs Invests $30 Million in Marathon Health, a National Leader in Worksite Health Centers
MyHealthGuide Source: MarketWired, 7/12/2016
BURLINGTON, VT -- Marathon Health, one of the nation's leading providers of worksite health centers, announced that Goldman Sachs completed a $30 million equity investment and minority position in the company. Marathon Health will use proceeds from the investment to meet the ever-changing healthcare needs of its customers and expand its national presence, continuing the rapid growth it has experienced since its founding in 2005.
The investment highlights Marathon Health's leadership in developing the worksite health center market and demonstrated impact in creating healthier and more productive employees. Marathon Health's health risk management model of care has delivered a 10-15 percent reduction in net per member per month healthcare costs across its book of business, contributing to the growth and profitability of the businesses it serves. The company provides care for more than 250,000 individuals at over 140 employer locations nationwide.
"Employer organizations, including corporations, government entities, unions, health systems, and school districts alike are challenged to solve healthcare access, cost, and quality challenges. Building on the vision of our founders, Richard Tarrant and Robert Hoehl, to deliver the right care at the right place by the right provider, we have answered this challenge to change the way healthcare is experienced and delivered," said Jerry Ford, CEO of Marathon Health. "This investment bolsters Marathon Health's commitment to our people, who we call Ambassadors, and the partnerships formed with our customer base."
"It was clear in our review that Marathon Health delivers great value to its customers," said Antoine Munfa, Vice President in Goldman Sachs' Private Capital Investing group. "We are impressed with the company's integrated health coaching and clinical care methodology, healthcare cost and outcomes analytics, and total population health management approach."
Marathon Health also announced the appointment of Antoine Munfa and Marathon Health Chief Financial Officer Scott LaPlant to its Board of Directors.
About Goldman Sachs Private Capital Investing
Private Capital Investing ("PCI") is Goldman Sachs' investment platform dedicated to providing junior capital to growth and middle market companies throughout North America. PCI invests $20 million - $150 million per transaction in the form of common, preferred, and structured equity. Contact: email@example.com.
About Marathon Health
Marathon Health offers a proven solution for helping employers reduce the total cost of healthcare. The Marathon Health approach integrates the best practices of onsite primary care, health assessment with risk identification, coaching and advocacy, and disease management for high cost chronic conditions. Marathon Health supports its unique model with an eHealth Portal delivering medical content, interactive diet and fitness tools, a personal health record, and an electronic medical record to manage care. Visit www.marathon-health.com.
Premise Health Acquires TransformHealthRx, a Georgia-based Company Offering On-Clinics and Wellness Centers to Employer Groups
MyHealthGuide Source: Holly Fletcher, 7/15/2016, The Tennessean
Premise Health, a company that runs on-site clinics for employers, is expanding its portfolio of clinics that serve groupings of employers.
Premise bought TransformHealthRx, a company out of Statesboro, Ga., that offers clinics and wellness centers to employer groups in addition to onsite clinics.
TransformHealthRx is similar to IMWell Health, an Arkansas-based company that runs clinics for mid-size employers, school districts and municipalities in the Southwest. Premise, based in Brentwood, bought IMWell earlier this year.
TransformHealthRx operates 17 sites in Georgia, North Carolina, Tennessee, Idaho and Indiana. Premise runs more than 500 sites in 46 states, Guam and Puerto Rico, for employers including Fortune 1000 companies.
Acquiring TransformHealthRx gives the company the chance to "improve the cost and quality of employer health care to a broader market," said Stu Clark, CEO of Premise Health in a statement.
On-site clinics are a way for employers to manage health care costs. The clinic staff can work with employees to manage chronic conditions and keep the network of providers more narrow, which helps keep costs down.
TransformHealthRx will keep its leadership team and will take advantage of clinical and technology resources as well as capital under Premise, said CEO and Founder Allison Judge, who called the deal a "natural next step" for the firm.
Premise is a portfolio company of Water Street Healthcare partners, a Chicago-based private equity fund. It was established in 2014 via a merger of CHS Health Services and Take Care Employer Solutions. Premise employees close to 4,500 with about 500 in Middle Tennessee. Visit www.premisehealth.com.
(SIM) Relaunches with New Features for Growing Global Self-insurance Sector
QBE North America Named to Short List for U.S. Captive Service Awards
MyHealthGuide Source: qbena.com, 7/18/2016
Marblehead, MA -- QBE North America is pleased to announce that it has been added to the short-list for the U.S. Captive Service Awards in the Insurance Company of the Year category.
QBE North America's Accident & Health Division is a leading writer of Medical Stop Loss and one of only a few direct-writing carriers to specialize in the development and securitization of "true" captives for medical stop loss. QBE works exclusively with Single-Parent and tightly controlled Group Captives and delivers unparalleled expertise through a dedicated captive underwriting team, skilled specifically in both medical self-funding and alternative risk transfer mechanisms.
A primary focus for QBE is working with single-parent captives to expand their utility to include medical stop loss. "Unique to QBE is our ability to provide coverage either as a reinsurer (assume risk) or as an insurer (cede risk) in order to provide the most appropriate structural options to the captive. Our ability to provide stop loss as a reinsurance transaction significantly reduces the internal expenses (fronting, collateralization, premium tax, carrier retention expense, etc.) to optimize the captive's efficiency and return performance", according to Steve McFarland, Vice President -- Underwriting, Special Markets.
As previously mentioned; QBE works only with "true captives". We do not support the large heterogeneous "open-market" structures that, due to their size, composition diversity, and structural rigidity, more closely resemble stop loss "MGU programs" rather than true group captives, according to Phillip Giles, Vice President -- Sales & Marketing.
QBE is expert in working with tightly controlled groups of like-minded employers to develop finely tailored group MSL captive solutions. "Our customized approach addresses the population-specific needs of each individual employer to more accurately respond to their independent benefit objectives", continued Giles. "These more focused groups will also capitalize on increased participation engagement of all members and improve performance in reducing the overall cost of providing healthcare benefits to employees. This approach provides levels of structural agility, market responsiveness, and management control not available through the more common "open market" group programs".
"It's an honor for QBE to be recognized on the short list for this award, said QBE Accident & Health President, Steve Gransbury. "We pride ourselves on having the deep alternative risk expertise and agility needed to deliver truly innovative and responsive self-funded solutions to our clients".
The U.S. Captive Service Awards Ceremony is presented by Captive Review Magazine and will be held on August 8, 2016 in Burlington Vermont.
QBE's North American-based Accident & Health division provides exemplary coverage and services to support the specialized needs of self-insured employers as a leading direct-writing provider of medical stop loss, including single-parent and group captive programs requiring stop loss insurance.
QBE North America is part of QBE Insurance Group Limited, one of the largest insurers and reinsurers worldwide. Headquartered in Sydney, Australia, QBE operates out of 43 countries around the globe, with a presence in every key insurance market. The North America division, headquartered in New York, conducts business through its property and casualty insurance subsidiaries. QBE insurance companies are rated "A" (Excellent) by A.M. Best and "A+" by Standard & Poor's. Contact Phillip C. Giles, CEBS, Vice President -- Sales & Marketing, at 910.420.8104 or visit qbena.com.
6 Degrees Health, Inc. Expands Its OURproviders™ Network with Four Regional
"The addition of these providers is a great step for our network. Each of
them give patients in those regions access to another high quality
transplant center and some nationally ranked specialties." states Neal
Franzer, Director of Operations for 6 Degrees Health, Inc. CEO,
also commented, "We are excited to see continued growth in our transplant
network, and we will be expanding on our new orthopedic network in the next
6 Degrees Health is a Specialty Network and Cost Management organization
focusing on advanced mitigation strategies, prospective and retrospectively,
with transplants, cancer, cardiac and other complex high-dollar care. 6
Degrees Health delivers a customized, transparent, and defensible
counter-offense complimented by superb Provider relations. OURsolutions™
products and tools are contained entirely "In-House", boasting significant
data, benchmark support, leading industry metrics, complimenting software
and technology … ensuring we are an invaluable resource to our clients. Our
savvy negotiations and claims analysis are produced with no upfront fees or
commitments … a clear indication and testimony to our results. OURsolutions™
is designed for Insurers, Third Party Administrators, Stop Loss and
Reinsurance carriers, Self-Insured Employee Health Plans, Health Maintenance
Organizations, and Government Health Plans. OURsolutions™ promotes improved
patient outcomes, optimizes Payor savings, and delivers the incremental
volume to OURproviders™. There is no equal in the market achieving a win-win
for Patient, Payor and Provider. Contact David Vizzini, President & CSO, 6
Degrees Health, Inc., at firstname.lastname@example.org, 503-640-9933 ext.
102 and visit www.6degreeshealth.com.
INETICO Achieves 20% to 50% Increases in Savings for Self-funded and Captive Employer Healthplan Groups
MyHealthGuide Source: INETICO, 7/19/2016
Tampa, FL -- INETICO, has consistently achieved 20% to 50% increases in savings for their self-funded and captive employer healthplan groups with little to no provider pushback through Reference Based Repricing (RBR). This fair payment process can only be successfully executed by a team of skilled professionals.
Healthplans enjoying the increase in these savings have not experienced the provider pushback noted in the industry specifically because of INETICO's approach to mitigate the balance billing of the employers healthplan members. First, the proactive set up and design of the RBR program is the critical component to these positive outcomes. Next, bypassing a litigious approach and focusing on provider relationship development has been the key to expansion of INETICO's RBR program.
Additionally, INETICO does not outsource any of its RBR services. All aspects are performed in house utilizing the cutting edge web-based platform INETIPASS.
Employers have had enough of year over year increases in premiums and healthplan members are fed up with increases in deductibles and co-payments that have resulted in cost-shifting directly to their wallets. The consumers (both employers and employees) are demanding accountability and transparency. RBR is one of the first steps INETICO has employed to re-establish an open conversation fair payment between the patient and provider. After all, RBR sits at the core of the value-based deliver and payment of services.
RBR is rapidly expanding beyond early-adopter status. As an employer or broker, finding yourself at the late-adopter or laggard end of the scale of diffusion of innovation means that you have already lost the opportunity to manage this critical conversation. The result will either mean the employer will look for a broker that can bring them the significant savings that are required to continue paying their employees fairly or, from the employees perspective, they will be looking for an employer who can help them achieve an income with secure healthplan benefits that don't have their salaries leaking out of their paychecks.
About INETICO, Inc.
Established in 2004, INETICO provides healthcare cost containment services to self-funded, fully insured and various health care entities across all of the United States. INETICO has developed its products and people with a mission: INETICO is committed to strengthening the fiscal health of the Plan while improving the clinical health of the Plan Members." Call 1-877-601-2200, email Marketing@Inetico.com and visit www.INETICO.com.
Alacura Launches Groundbreaking Healthcare Benefits Management Solution Specializing in Medical Transportation
MyHealthGuide Source: Alacura, 7/21/2016, www.alacura.com
Dallas, TX -- Alacura, the nation's first comprehensive medical transportation benefits management (MTBM) company, is pioneering a new healthcare management industry focused on medical transportation. Alacura is headquartered in Dallas, TX, with operations in Scottsdale, AZ and is a medical transportation network that reaches across the U.S. and internationally.
In an industry that has virtually no central core of coordination, Alacura is the first and only MTBM company with the largest air transportation network in the U.S. The company is positioned to revolutionize management of the medical transportation industry by creating end-to-end coordination between transportation providers, health plans and patients, while driving down the cost of medical transportation for both patients and healthcare payors.
"Medical transportation is extremely expensive and fragmented but does not have to be," said David Boone, Alacura's CEO. "Alacura provides expert management of transportation services to improve the medical transportation experience for patients, streamline coordination and services for health plans and create logistical efficiencies for transportation providers, while reducing costs throughout the system."
Boone explained that with Alacura, payors benefit from lower costs and reliable quality services for their members, patients have access to quality transportation, and providers can grow their business with increased access to transports. This is a win-win-win for the entire industry. One critical element is the elimination of balance billing when members work with Alacura. There have been countless news articles written about the devastating bills that consumers have received from providers that are out of network, and the member's insurance company does not pay the entire bill. As the leading MTBM, Alacura is positioned to coordinate the end-to-end logistics of the industry and create efficiencies for transportation providers. Providers that are part of the Alacura network can reduce the need to heavily invest in demand generation, minimize repositioning costs, and create certainty of collections that eliminates the need for revenue cycle management.
The aging baby boomer population, combined with Medicaid expansion and a health services trend toward care at centers of excellence, is dramatically impacting the need for quality, affordable non-emergent medical transportation services. Often, the need for this type of medical transportation comes at a very difficult time in a patient's or family's life. Alacura takes the stress and burden off of the patient by streamlining the acquisition and coordination of medical transportation. Alacura is responding to that unique opportunity by creating a new model for medical transportation and benefits management that leads to better business, better process and better care for healthcare payors, providers and patients alike.
Alacura is the first and only medical transportation benefits management company dedicated to simplifying bedside-to-bedside non-emergent medical transportation for patients. Alacura manages the nation's largest fixed-wing transportation provider network ready to help patients 24/7/365 with one-call-does-it-all convenient, personal service. Alacura seeks to improve financial, operational and clinical performance for healthcare payers and administrators, their member patients, and transportation providers. Visit www.alacura.com.
Re-Solutions Announces Addition of Tina Nissinen as Vice President
MyHealthGuide Source: Re-Solutions, 7/19/2016
Minneapolis, MN -- Re-Solutions, a Risk Strategies company, is pleased to announce the addition of Tina Nissinen as vice president. Nissinen's hiring is part of Re-Solutions' ongoing strategy to expand its market presence and attract the most-talented and experienced professionals.
Prior to joining Re-Solutions, Nissinen was an account executive managing
HMO Reinsurance and Provider Excess client relationships and program
placement at Towers Perrin/Towers Watson and, most recently, at Stratis Risk
Solutions Insurance Services, LLC.
Swiss Re Corporate Solutions Appoints Christine Harman and Gabriel Poppie to US Central Region Leadership Positions
MyHealthGuide Source: Swiss Re Corporate Solutions, 7/18/2016, www.swissre.com/corporatesolutions
NEW YORK -- Swiss Re Corporate Solutions strengthens its North American Central Region leadership team with two appointments. Christine Harman joins the company as Senior Vice President, Head Casualty, US Central Region. Gabriel Poppie is named Senior Vice President, Head of Sales Central Region. Both will be based in Chicago, Illinois.
Ms. Harman will be responsible for leading the company's Central Region Casualty team and growing its capabilities and revenue in the umbrella and excess liability lines of business. A proven leader in the Chicago marketplace, Ms. Harman brings almost 20 years of industry experience including claims, underwriting and team leadership roles at a variety of commercial carriers.
Robley Moor, Head of Casualty North America, states: "Christine's strong casualty underwriting background provides a solid foundation from which we will continue expanding our portfolio. A great fit for Corporate Solutions, she is dedicated to maintaining long-term broker and client relationships."
Mr. Poppie, who has been a key account manager at Swiss Re Corporate Solutions since 2013, will become Head of Sales Central Region. In his new role, he is tasked with generating new business, managing relationships with key regional brokers and driving growth. With over 16 years of industry experience, he is an expert in a wide range of industries and segments and new business origination. Mr. Poppie began his career in 2000 with Marsh in St. Louis.
Sylvain Bouteillé, Head of Sales North America, says: "Swiss Re Corporate Solutions has a strong focus on internal talent development. Gabe has been a great asset to our key account management strategy in North America. I'm delighted that he will lead our regional sales activities. He is committed to strengthening our regional relationships."
About Swiss Re Corporate Solutions
Swiss Re Corporate Solutions offers innovative, high-quality insurance capacity to mid-sized and large multinational corporations across the globe. Our offerings range from standard risk transfer covers and multi-line programmes, to highly customised solutions tailored to the needs of our clients. Swiss Re Corporate Solutions serves customers from over 50 offices worldwide and is backed by the financial strength of the Swiss Re Group. For more information about Swiss Re Corporate Solutions, please visit www.swissre.com/corporatesolutions and follow us on Twitter @SwissRe_CS.
Munich Health North America Announces the Hiring of Ellen Hyser
MyHealthGuide Source: Munich Health North America, 07/13/2016 www.munichhealthna.com
MINNEAPOLIS, MN -- the Managed Care and Reinsurance Solutions Division of Munich Health North America, a leading provider of healthcare reinsurance solutions, is pleased to announce an addition to its Minneapolis, Minnesota office.
Ellen Hyser will assume the role of Client Manager dedicated to the Program Business, initially focusing on Managed Care quota share opportunities. Ellen has over 25 years of experience in the healthcare industry with roles in Operations, Claims, and Sales, most recently with UMR, a Third party Administrator of United Healthcare, where she was the Director of Account Management for the North Texas and Oklahoma markets. Ellen and her family will be relocating to the Minneapolis area from Frisco, Texas.
Dave Sipprell, President of Managed Care and Reinsurance Solutions, comments: "We are very pleased to have Ellen join our team here in Minneapolis. Ellen has been in may management and leadership positions throughout her career, and we look forward to bringing her expertise to Munich Health North America!"
About Munich Health
Munich Health is one of three business segments of Munich Re, where all international health care business in insurance and reinsurance operations, as well as related services, are pooled under the Munich Health brand. Contact Stephen Fedele, Marketing Manager, at SFedele@munichhealth.com, +1 (609) 243-4238, and visit www.munichhealthnare.com.
AIG Announces Bill Edrington as Vice President of Stop Loss and Voluntary Distribution Development
MyHealthGuide Source: AIG, 7/19/2016, www.aig.com
Bill Edrington has joined AIG as Vice President of Stop Loss and Voluntary Distribution Development.
Bill will be responsible for driving top-line growth and retention of AIG's Stop Loss, Organ Transplant and Voluntary Benefits coverages nationally. He will manage key national strategic relationships and stop loss panel partnerships, and provide subject matter expertise to support regional field leadership and regional distribution teams.
Bill comes to AIG with a successful track record in stop loss sales and sales leadership with key carriers in the market. Most recently, he served as Managing Director of Marketing and Business Development at Symetra.
Dan Palermino, Vice President and Head of Core and Voluntary Benefit Sales, Group Benefits, AIG Consumer Insurance, said, "I am confident that Bill's experience and collaborative approach to our business aligns perfectly with our strategic focus on growing AIG's Group Benefits business in the mid- and large-market segments with key strategic distribution partners."
Bill is based in AIG's Atlanta office and can be reached at email@example.com.
AIG is the marketing name for the worldwide property-casualty, life and retirement, and general insurance operations of American International Group, Inc. All products and services are written or provided by subsidiaries or affiliates of American International Group, Inc. Visit www.aig.com.
MCM Announces Changes in Leadership
We are also excited to announce the addition of a new sales person to the
MCM team, Matt Rose. Matt has significant experience in the population
health management space having been a key sales person with Interlink.
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.
Sales Consultant for Wisconsin and Nebraska Territories
Essential duties and responsibilities
Education and/or experience
Send resumes to Brienne Wilson, PHR, SHRM-CP, HR Manager, at BWilson@auxiant.com.
International Medical Group
- Stop-loss Seeks Experienced Senior Claims Auditor
Knowledge Skills and Abilities
Qualified candidates can send their resumes directly to HR@imglobal.com
About International Medical Group
Blue Cross Blue Shield of Massachusetts and Indigo Insurance Services
Seeks Stop Loss Sales Executive
For more details and to apply go to https://bcbsma.wd5.myworkdayjobs.com/en-US/BCBSMA/job/Boston/Indigo-National-Stop-Loss-Sales-Executive_R00070-3
About Blue Cross Blue Shield of Massachusetts
A Dose of Reality:
PBM's Job is Rarely To Save Costs
The Role of the PBM
A report says that eighty percent (80%) of employers agree or somewhat agree that their Pharmacy Benefit Manager (PBM) is sufficiently managing drug costs. I'm sure -- if asked about medical expenses in general -- the same respondents would be full of complaints. Yet, when we focus on drug costs which -- as described above -- are one of the (if not the) fastest growing drivers of plan expense, 80%+ of plan sponsors are satisfied. Someone isn't getting the memo!
Plan sponsors contract with PBMs directly or through their third party claims administrator, to decide what drugs are covered, what the costs shall be and, as it relates to payment to pharmacies, the where, when and how much. Further, plans rely upon their PBM to set the participant cost-share and establish pharmacy networks. PBMs therefore serve many important roles; none of which are -- first and foremost -- dedicated to identifying cost containment opportunities.
Some plan sponsors think that they simply pay the PBM for the cost of any
drugs actually dispensed and usually an administrative fee for managing the
prescription drug program. Little do they know, but many other costs -- and
conflicts -- impact the bottom line when it comes to prescription drug
purchasing and distribution, above and beyond the problem of rising drug
PBM's Job Rarely Includes Reducing Drug Cost
PBMs are contractually tasked to complete a particular set of jobs. Rarely does that include reducing costs for the plan, no matter what. PBMs enter into contractual arrangements with other entities, to achieve their duties, even when those other entities may not share the same goals as the plan. For instance, PBMs may enter into contracts with retailers, where -- in exchange for steerage -- said retailers provide discounts to PBMs. Is that retailer the best option for the plan? Who knows?!?! Can we confidently say that said steerage is being driven with plan cost savings as the chief impetus? Not with any confidence; no.
A significant source of revenue for PBMs comes from drug manufacturers in the form of rebates. Brand-name drug manufacturers have the ability to financially incentivize PBMs to stimulate demand for their drugs; using discounts and rebates as a form of compensation to PBMs. Meanwhile, few people know that there are at least two types of rebates: performance and access. Generally speaking, PBMs are only obligated to share performance rebates with the plan, meaning that drug purchasing, usage and other plan spending may not be producing the most cost-effective path for the plan, despite putting the greatest number of rebate dollars into the pocket of the PBM.
These and other contractual relationships may represent a conflict of
interest for the PBM, because the PBM stands to gain additional revenue from
parties with interests competing with those of the plan.
Yet, most agree that PBMs still offer valuable services. If that is the case and we all agree that the cost of prescription drugs is skyrocketing, plans are obligated to: (1) implement programs either themselves, with third parties, or with their PBMs to make cost containment priority #1 and (2) recognize the limits and needs PBMs deal with -- noting that if the plan wants to use a PBM, they may need to be flexible in their demands and expectations.
Actions to Avoid Conflicts
An exasperated professional said it best when he remarked that people are not even remotely up to speed on the cost of new drugs and therapies. There is, he said, a new therapy on its way that will cost benefit plans more than $1 million per year; (insert Dr. Evil laughter here). One of the hottest topics in our industry today is "price transparency for hospitals." How about transparency here? If a benefit plan's current arrangement would allow them to get slapped with a $1 million claim for the purchase of a drug or medical supply and they didn't have measures in place to provide early warning, stop payment pre-purchase and analyze the situation to identify any and all alternatives, they deserve what they get! With price inflation on current medication and a storm of high cost drugs brewing on the horizon, pipeline monitoring that allows for real-time actionable recommendations is a must.
Whether these measures are implemented by PBMs seeking to self-police themselves and counterbalance incentives to ignore cost containment, or, are provided by third party cost containment partners, the time to take drug costs seriously hasn't come... it's already been here for years. Act now or no amount of sugar will help this medicine go down.
About the Author
Ron E. Peck, Esq. is The Phia Group's Senior Vice President and General Counsel. Ron has been a member of The Phia Group's team since 2006. In that time he has been an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third party recovery disputes and spearheaded efforts to combat the steadily increasing costs of healthcare. Ron's theories and innovative ideas regarding all industry issues are well regarded and he is routinely asked to speak at industry events on these and other topics . Ron obtained his Juris Doctorate from Rutgers University School of Law and earned his Bachelor of Sciences Degree from Cornell University. Ron is also a dedicated member of SIIA's Government Relations Committee.
DOL Holds Modest Sway With Courts on Benefits Issues
Although the department has filed ERISA-related briefs in all the federal
circuit courts and several district and state courts, its win-loss record
doesn't vary significantly by court. In most courts, the department has won
about as many cases as it's lost.
Despite this mixed record in the circuit courts, the department has had
significantly more luck in the federal district courts. There, the
department's 11 amicus briefs have resulted in seven victories.
Most of these briefs argued against the judge-made presumption of prudence
that a number of courts once used to dismiss lawsuits against fiduciaries of
employer stock plans. With the exception of the Sixth Circuit--which crafted
a slightly more worker-friendly presumption--most courts were unpersuaded by
the DOL's arguments.
Switching Strategies on Plan Fiduciaries
Surprisingly, none of the DOL's Obama-era amicus briefs have argued that a
particular state law is preempted by the federal law.
Mixed Results on Standing
Over the course of eight amicus briefs, the DOL has championed an expansive
view of which individuals have standing to bring claims under ERISA.
The department has had no success convincing courts that pension plan
participants have standing to sue over mismanagement regardless of how well
their plan is funded. Both the Fourth and Eighth Circuits have denied
standing to participants in well-funded pension plans over the department's
objections, and other courts have come to similar conclusions.
Winning the Claims Procedure Battle
Forum Selection Clauses
What Comes Next?
Links to many of the department's benefits-related amicus briefs are available at the DOL website: https://www.dol.gov/sol/media/briefs/main.htm.
Higher Risk of Death via
Transfusion when Blood Donor is Young or Female
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/16/2016)
Source: MyHealthGuideEditor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
The Value of Self-Funding
MyHealthGuide Source: The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, www.SIEFOnline.org The Self-Insurance Educational Foundation, Inc. (SIEF has published The Value of Self-Funding.
Self-funding is an important contributor to the financial and physical health of America's wellness future. Self-funding is more than processing claims and receiving premiums, it provides quality coverage and proactive healthcare management for employers of all sizes and industries.
About the SIEF
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501(c)(3) non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). The foundation's mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.SIEFOnline.org.
Video Highlighting Captive Solutions for Mid-market Companies
MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF), 5/11/2016, www.siefonline.org
The Self-Insurance Educational Foundation (SIEF) announced that it has released a new video highlighting captive insurance solutions for mid-market companies, including stop-loss captive programs, enterprise risk captives, and property & casualty group captives. Please click here to access the video.
The video can be accessed through the Foundation's web site at www.siefonline.org or by clicking here. The video includes a separate video focused on self-insured group health plans. Both videos can be private labeled by individual companies interested in using them for their own purposes. Contact Justin Miller at firstname.lastname@example.org or 800-851-7789 for more information about private labeling.
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501 c 3 non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). Its mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.siefonline.org.
ICD-10 Readiness Tools
MyHealthGuide Source: Industry Study Group (ISG), 9/19/2015
In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list. On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. The new ICD-10-CM Trigger list is endorsed by SIIA and HCAA and supported by SPBA.
Below are useful links for members of the self-funded community including TPAs, stop-loss carriers, MGUs, and others.
August 15-16, 2016
September 19-21, 2016
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
October 17-19, 2016
December 1-2, 2016 -
A Hybrid Conference and Internet Event
January 30-February 1, 2017
February 8-10, 2017
March 15-17, 2017
March 27-29, 2017 - A Hybrid Conference and Internet Event
March 28-30, 2017
September 13-15, 2017