MyHealthGuide Newsletter
News for the Self-Funded Community
12/5/2016

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

TABLE OF CONTENTS

General & Company News

People News

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News


Windsor Strategy Solutions Announces Major Data Update for Actuarial Advisor Rating Model and Health Benefits Consulting Suite

MyHealthGuide Source: Windsor Strategy Solutions, 11/30/2016, www.windsorstrategy.solutions

Princeton Junction, NJ -- Windsor Strategy Solutions, a leading health care actuarial software firm, announced a major update to its industry-leading rating manual, Actuarial Advisor, and its Health Benefits Consulting Suite.

With this update, the model's detailed claim distributions are based a new claims data set that is more than five times larger than Windsor Strategy Solutions used previously. The data set is updated annually in order to capture and utilize the most recent healthcare trends. The size and richness of the database allows for the development of claim distributions reflecting 34 medical service categories, 8 pharmaceutical categories and over 200 claim size ranges.

"With this larger and more detailed data set we have further enhanced the capabilities of Actuarial Advisor, the most comprehensive and flexible actuarial rating manual available today," said Todd Owen, CEO of Windsor Strategy Solutions.

The Actuarial Advisor rating manual accommodates a wide range of user inputs, including plan designs, trends, demographics and provider network discounts. Users are able to generate and evaluate customized rates for both fully insured and excess loss health insurance programs.

The new data set also powers the company's Health Benefits Consulting Suite. This suite is comprised of three powerful and easy to use tools that help benefits consultants and their clients make improved decisions on the design of their health plans. The Health Benefits Consulting Suite includes the following tools:

  • Actuarial Assistant
  • Risk Decision Support
  • Experience and Migration Predictive

To arrange a demonstration of Actuarial Advisor, or the Health Benefits Consulting Suite, please contact Neeru Sachdeva at nsachdeva@wspactuaries.com or 609.275.6550.

More information, as well as online demos of the tools in the Health Benefit Consulting Suite, are available at our website: www.windsorstrategy.solutions

Windsor Strategy Solutions develops cutting edge software for employee benefits professionals who want powerful and easy to use tools that deepen their understanding and consulting capabilities for their client's health benefits plans. Our Health Benefits Consulting Suite and Actuarial Advisor rating model are used by consultants, brokers, TPAs, MGUs, re-insurers, stop-loss carriers and consulting actuaries.

About Windsor Strategy Solutions

Located in Princeton Junction, NJ. Windsor Strategy Solutions, is an actuarial software firm focused on innovation in health plan pricing and design. For more information, contact Todd Owen at towen@windsorstrategy.solutions. and visit www.windsorstrategy.solutions.

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IHP Partners with AmWINS Group Benefits to Centralize and Enhance Client Experience

MyHealthGuide Source: Innovative Health Plan (IHP), 12/2/2016, www.innovativehealthplan.com

New Haven, CT -- Innovative Health Plan (IHP) has partnered with AmWINS Group Benefits (AmWINS), a leading provider of employee benefits and administrative services, to create an unmatched client experience through expanded onsite services and broker offerings. This  partnership was created to benefit both members and employers on a day-to-day basis, as well as the brokers that work to connect their clients with the best partners available.

This partnership takes IHP's client experience to the next level by providing onsite nurse management through AmWINS; both companies value member health above all else and understand that centralized care is key to client satisfaction and long-term healthcare savings.

In addition to onsite nursing care for clients, this partnership allows IHP to bring a unique line of ancillary products to market and offer services to clients with as few as 10 lives, as well as enhance their broker support through enhanced online services.

"We believe in creating a seamless client experience and this partnership elevates offerings for both AmWINS and IHP," said Henry Santos, Vice President of Sales at AmWINS. "We are eager to bring these changes to our current clients and move into new employer markets with such strong product offerings."

"Through this partnership with AmWINS, we are excited to be able to centralize all services and administration," said Allen Jackson, CEO of IHP. "Our hope is to continue to provide services that improve the health of our members while saving our clients money in the long run."

For more information about the partnership between IHP and AmWINS, please contact Cheryll Shubert at cshubert@innovativehealthplan.com.

About Innovative Health Plan, Inc.

As a leader in innovative pricing solutions and self-funded plan options, Innovative Health Plan (IHP) brings cost control and transparency to healthcare providers. Unlike traditional health plans, IHP provides its clients with custom benefits, evidence-based care management, performance measurements and online administration. They serve clients with 10-2000 lives across the country. Visit www.innovativehealthplan.com.

About AmWINS Group Benefits

AmWINS Group Benefits, a division of AmWINS Group, Inc., is a leading wholesale broker of comprehensive group insurance programs and administrative services. Working with benefit brokers and consultants, AmWINS Group Benefits designs, distributes and administers customized health benefit products and services for retired and active populations in private and public organizations.

Headquartered in Charlotte, North Carolina, AmWINS is a leader in the specialty insurance brokerage industry with offices in 105 locations across 15 countries, including 81 in the United States. The firm has expertise across a diversified mix of property, casualty, group benefits and specialty insurance products. AmWINS also offers value-added services to support its  products, including product development, underwriting, premium/claims administration, and actuarial services.  Visit www.amwins.com.

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ECHO® Tops Crain's List of Fastest Growing Companies

MyHealthGuide Source: ECHO® , 12/2/2016, www.echohealthinc.com

WESTLAKE, OH -- Westlake-based ECHO Health Inc. was named fastest growing company in Northeast Ohio by Crain's Business Cleveland. With revenues of $65.8 million in 2015 and impressive five-year growth of 1,365 percent, ECHO significantly outperformed the other 51 companies making the annual list.

"Northeast Ohio is home to many innovative, successful companies and ECHO is proud to be leading the way, "said William Davis, ECHO's Chairman & CEO. "We are committed to seeing the local business economy thrive and are thrilled that ECHO can play such a significant role in that growth and prosperity."

The company's impressive growth is not just being recognized locally, as last month ECHO was named one of the fastest-growing private companies in the nation by Inc. Magazine. Plans to expand into other markets and diversify service offerings signal that this growth is just the beginning for ECHO as they look to process $100 billion in payments in the coming years.

"Our business is built for the sole purpose of making the payment process simpler for our clients and saving them time, money and headaches. As we continue to grow, our commitment to innovation, creating efficiencies and leveraging our 20+ years of expertise will grow with us," concluded Davis.

About ECHO Health Inc.

ECHO Health Inc. is a leading provider of electronic payment solutions. ECHO serves more than 75,000 companies, processes more than 50 million payment transactions and pays more than $12 billion annually. Founded in 1997, ECHO is a privately-held company located in Westlake, Ohio. Call 440.835.3511, ext. 118. and visit www.echohealthinc.com.

About Crain

Crain's Fastest Growing Companies recognizes the entrepreneurial spirit, innovative business tactics and skyrocketing revenue growth of the 52 fastest growing companies in Northeast Ohio. Eligible companies must be privately held, at least five years old and located in Northeast Ohio, among other criteria.

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ELAP Spurned by University of Utah Health Care

MyHealthGuide Source: Molly Mulebriar, 11/29/2016, RiskManager.us Blog Entry

Providers in Utah are experiencing the "Reference Based  Pricing" (RPB) wave.  The following letter is available at by emailing RiskManager@RiskManagers.us.

"University of Utah Health Care, representing 4 hospitals and over 1,400 board certified physicians, has become aware of agents, brokers, and/or third-party administrators promoting the implementation of plans, such as ELAP Services, which discourage direct network and contract development with health care hospitals and providers. These programs intend to reimburse providers on a "usual and customary" or "Medicare cost plus" basis, and attempt to insulate patients or employers from collection attempts by providers."

"The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other "cost plus" plans being promoted in Utah or surrounding states. We will be advising employers and employees that any proposed discounted benefits offered by these plans will not be accepted without a formal, mutually signed agreement between the patient and University of Utah Health Care. Patients on these plans may be liable and financially responsible up to 100% of standard billed charges."

"University of Utah Health Care has existing managed care contracts and partnerships with many reputable local, regional and national health plans, in which the parties have agreed to mutually acceptable terms and conditions that provide value and protection to your clients. We welcome and encourage plans that have full contractual and comprehensive network coverage to all University of Utah Hospitals and Clinics, and University of Utah Medical Group physicians."

"If you would like to enquire whether a plan is fully participating with University of Utah Health Care, please contact me directly at 801-587-6484, or mark.zenger@hsc.utah.edu."

Kind regards, Mark Zenger, MBA, MHA Senior Director, Payer Relations and Contracting University of Utah Health Care

About RBP

Reference Based Pricing (RBP) / Cost Plus method of health care reimbursement started in Texas in 2007. That was nine years ago. Providers initially fought hard to suppress the movement, even going to such lengths as threatening plan sponsors with legal action, or worse, refusal to treat plan members, or both.

Nine years later Texas hospitals are still treating RBP plan members and cashing reimbursement checks. The consensus is RBP is here to stay, and growing rapidly. Whereas hospitals did not reach out to plan sponsors directly before, now we see a movement between hospital systems and employer groups forming collaborative efforts on a local basis as equal partners. Texas was an early adopter of RBP plans.

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People News



BlueCross BlueShield of South Carolina's Judy Davis Passes

MyHealthGuide Source: Phil Gardham and Scott Hinton, BlueCross BlueShield of South Carolina, 12/1/2016

COLUMBIA – Judith Monastra Davis, 57, of Columbia, South Carolina passed away on November 24, 2016 at Palmetto Health Richland following an extended illness. She was born on January 13, 1959 in Mansfield, Ohio to Basil Herman Monastra and Carmella Greer Monastra of Lexington, Ohio, who survive. She also is survived by her husband of thirty years, Gerald L. (Jerry) Davis, Jr. of Columbia, South Carolina.
JudyDavis
Judy Davis
January 13, 1959 - November 24, 2016

"I am deeply saddened by the loss of Judy Davis who passed away Thanksgiving night after a hard-fought battle with cancer," says David Pankau, CEO, BlueCross BlueShield of South Carolina.

Judy Davis started BlueCross BlueShield of South Carolina as chief legal counsel more than 22 years ago. One of the first accomplishments was the restructuring the corporate Law Department transforming the department into a viable business segment providing dedicated legal counsel and support.

Judy was promoted in 2007 to executive vice president and chief legal officer. In this position, she served as the senior officer responsible for five of corporation's subsidiaries: Companion Life, Companion Captive Insurance, Companion Property & Casualty Insurance Co., Companion Commercial Insurance Company and UCI Medical Affiliates. Senior management of three divisions also reported directly to her -- including the Law Department , government Affairs and Corporate Marketing Communications.

Under Judy's leadership, Companion Life flourished, excelling in niche and specialty markets. The company also realized a long-held goal of being licensed to sell its products in all 50 states. Judy successfully navigated our P&C subsidiary through extensive changes in this industry, and also oversaw the divesture of this particular company from our corporate portfolio.

Judy was a dedicated community champion.  She served on the board of directors or in leadership positions for many nonprofit, civic and educational entities, lending her gracious and genuine leadership style and skills to each organization. In 2006, she chaired the United Way of the Midlands campaign, helping to raise $9.5 million. Some of the other organizations Judy worked tirelessly for include the Central Carolina Community Foundation, S.C. Campaign to Prevent Teen Pregnancy, Trinity Housing Corporation, EngenuitySC, SC Launch, the Palmetto Conservation Foundation, Columbia College and the S.C. Governor's School for Science and Mathematics -- to name just a few.

She was especially known and appreciated as a mentor, cheerleader and champion to countless people for whom she served as an inspiration and role model. Judy's motto in life was: "If you can put yourself out there and make a difference, you can change the world." I know that there are many people here at BlueCross and throughout the state who have benefited firsthand from her advice and encouragement to push themselves farther, set goals and then go for them. Judy was deeply committed to the success of individuals within our company. She took it as a personal responsibility and challenge to find ways to lift people up and help them realize their untapped potential. She did this because it was an important part of who she was, not as a job requirement.

To no one's surprise, Judy won numerous awards and accolades for her professional and philanthropic efforts. Insurance Networking News (INN) named Judy one of six 2011 Women in Insurance Leadership winners. In 2010, she was recognized with the Girl Scouts Women of Distinction Award. She has also been the recipient of the United Way of the Midlands' Alyce Kemp DeWitt Award, Palmetto Center for Women's Tribute to Women in Industry (TWIN) Award for Volunteerism and the Association of Fundraising Professionals' Outstanding Volunteer Fundraising award. In 2014, Judy received the highly prestigious Humanitarian of the Year award from the United Way of the Midlands. These are just a few of the many well-deserved acknowledgments of the wise, generous and wonderful person she was.

Judy also had a great sense of humor, and often joked about being listed on the agenda for BlueCross' Board of Directors meetings as "Other." Of course, the "technical" reason for this rather vague listing was because of the wide variety of divisions and corporate entities that fell under her leadership. But in reality, "other" was an apt description for Judy -- because she truly was in a class of her own.

"We will miss Judy dearly, and I know you join me in sending our deepest sympathies to her husband, Jerry, as well as her parents and brother -- and everyone who had the great fortune to know her," added Pankau.

About BlueCross BlueShield of South Carolina

Headquartered in Columbia and operating in South Carolina for nearly 70 years, BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The company is leading provider of stop loss to self-funded employers and other services for the self-funded community.  Visit www.southcarolinablues.com

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Brentwood Services Administrators Employs Stephanie Greene as Senior Claim Representative

MyHealthGuide Source: Brentwood Services Administrators Inc., 11/28/2016. www.BWood.com

BRENTWOOD, TN -- Brentwood Services Administrators Inc. has employed Stephanie Greene as a senior claim representative in the DeKalb County office in Stone Mountain, Ga., according to Jeff Pettus, president and chief executive officer of BSA.

As senior claim representative, Greene is responsible for reviewing, processing and handling medical workers' compensation claims as assigned by Lizzie Simmons, claims supervisor in the BSA DeKalb County office.  Greene determines the compensability of the claim and extent of liability, as well as communicates directly with clients, employers, injured workers, physicians and attorneys, and manages claims in a timely and economic manner.

Previously, Greene was a senior claim examiner with Broadspire, in Atlanta, Ga. She holds adjusters licensing in many states. Greene attended Hartford Secretarial School in West Hartford, Conn., and  received a certification from their medical assistant program.

About Brentwood Services Inc.

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

About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers' compensation and other casualty lines throughout the contiguous 48 states. 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 brokerage services encompassing self-insurance, guaranteed cost and deductible insurance with a focus on workers' compensation. Reinsurance intermediary services include workers' compensation, accident and health, general and automobile liability casualty and specialty coverages. Clients include corporations, governmental entities, insurance companies and captive insurance companies. Visit www.brentre.com.

About CompPoint Managed Care Inc.

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

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Job News



AMPS Seeks Sales Executives

MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 12/2/2016, www.advancedpricing.com

To steal a quote from Steve Jobs, we are not looking for those who want to sell sugar water the rest of their lives. We are looking for people to join us to change the employer sponsored benefit world. Some may call it crazy but, we believe that helping employers provide affordable healthcare benefits to their employees can change the world.

Due to the success of our Reference Based Reimbursement solution, AMPS is looking to add three sales professionals to our team. We are seeking one sales professional in Texas, another in the pacific northwest and one who will work out of our headquarters in Atlanta, Georgia. Regardless of where you reside, AMPS will always find a spot on our team for a proven top performer.

This isn't your average help wanted ad. We are not your average company, and we are not seeking an average sales representative. At AMPS we absolutely love what we do, and our corporate culture is a direct reflection of that. To see if you have what it takes to shift paradigms and move mountains, contact John Powers at jpowers@advancedpricing.com.

About AMPS

Advanced Medical Pricing Solutions (AMPS) is a leading edge healthcare cost management company providing unique solutions to dramatically reduce Health Plan medical spend and employee out-of-pocket costs. Focusing on aggressive alternatives to traditional PPOs, this Physician Led – Technology Driven company offers industry leading savings through Reference Based Reimbursement, Medical Bill Review, direct contracting solutions. Visit www.advancedpricing.com.

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HHC Group Seeks VP of Sales

MyHealthGuide Source: HHC Group, 12/2/2016, www.hhcgroup.com

Gaithersburg, MD -- HHC Group has an immediate opening for a sales professional.

Candidates for VP of Sales position must be experienced in Self-Funding, Medical Stop Loss and/or Managed Healthcare sales. Five or more years of sales experience is required, experience in Cost Containment is preferred. We will consider candidates from around the country for a possible work-at-home / remote employment arrangement.

Job Qualifications

  • Must have worked with third-party administrators, insurance carriers, managing general underwriters, self-funded healthcare plans, self-administered labor unions, or other similarly situated organizations.
  • Have a working knowledge of health insurance rules, regulations, and industry standards is required with an understanding of ERISA.
  • Have existing contacts.
  • Work history showing employment progression.
  • Have a proven record of growing sales and establishing and maintaining client relationships.
  • Have a college degree with 10 years or more experience.
  • Professional designations in Insurance, Business or Sales helpful.
  • Pass a background check
  • Working knowledge of the Microsoft software programs including Word, Excel and PowerPoint.

Candidate must be reliable, have professional oral and written communication skills and an excellent track record in Account Management and Customer Service. Have a first-class work ethic and attention to detail and the ability to manage multiple projects simultaneously.

Send resume to Robert Serber at rserber@hhcgroup.com or jobs@hhcgroup.com.

About H.H.C. Group

H.H.C. Group's service offerings include, but are not limited to, Claim Editing, Claim Negotiations, Claim Repricing, Medical Bill Review (Audit), Medical Peer Review, Case Management, Utilization Review, Data Mining, Claim Scrubbing, Disease Management, DRG Validation, Medicare Claim Repricing, Pharmacy Consulting, Transplant Networks, and we provide case review, analysis and reporting as a URAC Accredited Independent Review Organization.  Visit www.hhcgroup.com.

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Market Trends, Studies, Books & Opinions



2016 Medical Stop-Loss Premium Survey

MyHealthGuide Source: Aegis Risk for the International Society of Certified Employee Benefit Specialists (ISCEBS), December 2016, Aegis 2016 Medical Stop-Loss Premium Survey (full text with graphs)

Executive Summary

This year's survey, its tenth year, reflects the ongoing rise in stop-loss premiums and a continued commitment to employer-sponsored, self-funded health plans. The occurrence of truly catastrophic claimants--in excess of $1 million--is further verified with over 18% of respondents reporting such a claimant in the last two policy years.

Stop loss remains the primary focus of risk management, with interest in private exchanges nearly disappearing at 1% amongst respondents. Captive arrangements show increased interest, but still slight at 14%. Additional updates are provided on individual stop-loss deductible by employer size and other coverage provisions, including aggregate stop loss. The primary focus of the survey remains current premium rates, as shown in the following graphs and tables. Stop-loss premium reflecting over 560,000 covered employees is measured.

Average Stop-Loss Premium--It Varies

Stop-loss coverage among plan sponsors varies greatly--causing development of an average premium cost--a difficult, if not irrelevant, task. Each group has an individual stop-loss (ISL) deductible and contract type that varies from another--all with significant impact on premiums.  Enrollment size and group demographics are other variables.

However, normalization of responses can be reasonably attained: Larger plans typically select higher Individual Stop-Loss (ISL) deductibles, and contract type can be accounted for by underwriting ratios. For this survey, all contracts are equated to a mature "paid" contract.

When plotted on a graph, a trend line can be drawn showing average premium cost by size of deductible for the continuum of coverage. Further variation may still exist due to PPO networks, pharmacy coverage, broker commissions and group demographics. However, as the survey's intent is to show plan sponsor total expense, a strong approximation of average premium cost is still made.

A Focus on Renewal Decisions

With the increased expense of stop-loss premium and the growing exposure to catastrophic risk, the stop-loss renewal decision often involves internal audiences beyond benefits and human resources. Finance and/or CFO continue to be predominantly involved at 69%, consistent with recent years. Reflective of the organizational risk of catastrophic self-funded health claimants, Risk Management is involved in 18%, up from 11% in 2015.

As to renewal change in ISL deductible, respondents are increasingly uncertain until they perform a review (50%), with fewer focused on a preference to keep it at the current level (37%).
Do you plan to change your ISL deductible? 2015 2016
No. Prefer to keep at the current level 42% 37%
Yes. Will seek a moderate increase
to offset rate increase
8% 13%
Uncertain. Will review a range and
make a determination
48% 50%
None of above 2% 0%
     
Which internal audiences are involved in the stop-loss review and final coverage decision? Check all that apply: 92% 88%
Benefits/Human Resources 
Risk Management
11%  18%
Finance/CFO 66%  69%
Executive Leadership
(e.g., CEO, President)
45%  45%
Other 2% 7%


Contract Type (or Claims Basis)

Contract type has many variations, with "Paid" (i.e., 36/12 and longer) and its close equivalents 24/12 and 12/24 accounting for 78% of plans. All are choices for ongoing, comprehensive coverage.

  • Paid basis - 35%
  • 24/12 - 33%
  • 12/24 - 10%
  • 12/15 - 9%
  • 12/12 - 6%
  • 12/18 - 4%
  • 18/12 - 2%
  • 15/12 - 1%

Individual Annual and Lifetime Maximums

Reflecting the Affordable Care Act's removal of health plan annual and lifetime dollar limits (which governs the underlying medical plan but not stop loss), nearly all stop-loss programs had full, unlimited annual and lifetime limits by 2015. As such, it is no longer measured by the survey.

For 2015, its last measured year, only 6% had an annual reimbursement maximum, and only 2% reported a lifetime reimbursement maximum.

Aggregating Specific Deductibles (ASDs)

ASDs, which are separate deductibles requiring fulfillment before any ISL reimbursements, are often leveraged for their ability to ease renewal rate increases. However, they come with a direct transfer of risk back to the policyholder.  Of respondents,

  • 18% reported an ASD, with the average size being 59% of the underlying ISL.
  • In an example, if an ISL is $200,000, the ASD, on average, is $118,000 (59%).
  • For adjustment to the survey, any reported ASD was divided by three (an approximation of the number of claimants necessary to fulfill) and added to the reported ISL for the survey response.

Aggregate Coverage

This additional coverage, against overutilization of the health plan, is most prevalent alongside ISL deductibles of $200,000 or less and enrollments around or below 1,000. It becomes less common at higher deductibles and/or enrollments--as those tend to be risk savvier or more stable plans.

  • 125% is the prevalent level, chosen by 87% of those with aggregate
    coverage, with
  • 120%, 110% and 115% reported in frequencies of 3% to 4% each.
  • Average monthly premium varies. If alongside an ISL of $200,000 or less, the average is $6.95.
  • At higher deductibles, the average is $3.28.
  • Median premium overall is $4.60.

Although it is a significantly lower expense than ISL, purchasers of aggregate are advised to remain diligent on this expense as well. Several respondents reported premium in excess of $15.00--often for coverage at 115% and 110%.

ISL Deductible by Employee Size

Selection of an ISL deductible is an important decision for any plan sponsor. An organization's own risk tolerance should be its strongest guide--those more risk savvy, if not larger, can manage with higher deductibles. A trend line reflecting the average response is provided in the full version with graphics.  However, an estimate application of the trend line is provided below:

  • 500 employees - ISL Deductible: $140,000
  • 1,000 employees - $220,000
  • 2,000 employees - $348,000
  • 3,000 employees - $450,000
  • 4,000 employees - $550,000
  • 5,000 employees - $640,000

Catastrophic Claimants

Fueled by health care reform and rising costs, alternative delivery and risk mechanisms are being offered or discussed with self-funded plan sponsors, including private exchanges and captive arrangements. However, maintaining the status quo seems most prevalent, with 77% responding "none of the above," consistent with recent years.  For 2016,

  • Captives have the greatest  interest but is still slight at 14%.
  • Dropping stop loss - 6%
  • Reverting to fully insured coverage - 5%
  • Engaging in a private exchange - 1%
  • Dropping employer-sponsored coverage altogether - 0%
  • Other - 2%
  • None of the above - 77%

Presence of Catastrophic Claimants

The rising level of truly catastrophic claimants (>$500,000) continues to alarm plan sponsors and underwriters alike. Various attributions include more aggressive hospital billing post-removal of health plan dollar limits as well as specialty pharmacy and participant morbidity.  When inquired on the last two policy periods,

  • 57% of respondents incurred a claimant in excess of $500,000--similar to 56% in
    2015.
  • However, claimants in excess of $1 million remain significant at 18%, with 5% of those in excess of $1.5 million.

Lasered Claimants

At the initial writing of coverage, or potentially at renewal, an underwriter may exclude--or laser--certain individuals from coverage. This may occur at a higher deductible or possibly to full exclusion. Of respondents,

  • 10% reported the presence of at least one known lasered claimant--down from 18% in 2015.
  • However another 10% were uncertain.

2017 Renewal Premiums and Strategies

Stop loss typically renews at higher than underlying medical trend due to leveraging--whereby an unchanged deductible bears a larger percentage of future claims. Historically, this may produce requested increase of 20% or higher. However, actual stop-loss pricing, as measured by this survey over the past two years, generally reflects a net increase of 9-13%--with greater uptick in the past year.

Contributing dynamics may include the ongoing inflow of alternative capital into the reinsurance markets, helping to maintain competitive or "soft" pricing, offset by evolving claim threat from the highest claimants, often in excess of $5 million. Altogether, we illustrate (as opposed to forecast) a 12% leveraged trend for 2017 premiums. Actual plan results will vary, especially for those with significant and ongoing claim activity or, alternatively, stronger claim results.

Renewal Strategies

Actions to reduce your stop-loss premium and ensure adequate coverage:

  •  Index deductible to medical trend. If not annually, at least biannually.
  • Be aggressive! Ask for reductions or review competitive offers, including dividend contracts. Leverage your plan data, including PPO discounts.
  • Carefully manage your claims disclosure. Avoid coverage gaps due to non-disclosed claimants.
  • Match your risk and your stop-loss contract. Seek those that "mirror" your health plan document and offer "laser-free" renewals with rate caps.
  • Be knowledgeable. Identify the best carrier options, including those more known in the property/casualty and reinsurance markets.
  • Use an experienced broker or consultant. Stop loss is highly specialized coverage, with very high claim exposures. It is not an employee benefit. A less experienced advisor can cost your plan hundreds of thousands in premium costs if not in uncovered claims.

About Aegis Risk

Aegis Risk is a specialty consulting firm with a dedicated focus on stop loss--throughout the plan year. We help our employer clients and broker/consultant partners obtain:

• Aggressive proposals from leading underwriters
• Market insights, including underwriting and pricing dynamics
• Ongoing claims monitoring and filing support
• Internal risk pool structuring and other creative approaches.

Contact Ryan Siemers, CEBS, at (703) 778-6520, ryan.siemers@aegisrisk.com and visit www.aegisrisk.com.

About the International Society of Certified Employee Benefit Specialists (ISCEBS)

The International Society of Certified Employee Benefit Specialists is a nonprofit educational association providing continuing education opportunities for those who hold or are pursuing the Certified Employee Benefit Specialist® (CEBS)®, Compensation Management Specialist (CMS), Group Benefits Associate (GBA) or Retirement Plans Associate (RPA) designation offered through the CEBS® program. Visit www.iscebs.org.

About The Survey

Sponsored jointly by Aegis Risk and the International Society of Certified Employee Benefit Specialists. The 2016 Aegis Risk Medical Stop-Loss Premium Survey represents 252 plan sponsors covering over 560,000 employees with over $190 million in annual stop-loss premium. Respondents range in size from 39 employees to over 48,000. The 2017 survey opens late spring 2017, with release in late summer. Visit www.aegisrisk.com to participate or register for notification. All respondents receive an immediate copy upon its release. Employers as well as brokers and consultants are encouraged to participate.

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Legislative & Regulatory News


How Telemedicine and Onsite Clinics Mesh with HSAs

MyHealthGuide Source: Christopher A. Beinecke, Counsel, Haynes and Boone, LLP, 11/29/2016, Employee Benefit News Article

For all of their advantages, health savings accounts do not easily co-exist with many other benefits. This article focuses on the HSA-compatibility issues employers face when implementing telemedicine and/or an onsite clinic in conjunction with a high deductible health plan with an HSA and potential solutions.

HSA eligibility

In order for an individual to be eligible to make or receive HSA contributions, he or she must be covered under an HDHP and not have any other disqualifying coverage. Other disqualifying coverage includes many arrangements that do not qualify as an HDHP and that pay for medical  expenses, including most forms of traditional health insurance, Medicare, and general purpose healthcare flexible spending accounts and health reimbursement arrangements that can reimburse an individual's medical expenses. This includes the expenses of a covered spouse or dependent.

Through what is best described as scattered guidance, there are a number of exceptions to this other disqualifying coverage rule:

  • Coverage for preventive services (including within the HDHP itself)
  • "Permitted insurance," including property and casualty insurance that pays benefits for accident or injury, workers' compensation, insurance for a specified illness or disease (e.g. cancer, diabetes, asthma), and indemnity coverage
  • "Permitted coverage," including dental, vision, accident, disability, and long term care coverage
  • Employee assistance program, disease management, and wellness coverage that do not provide significant medical care benefits
  • Arrangements that provide medical benefits only after the statutory minimum deductible for an HDHP has been met (which also means coverage under more than one HDHP does not create an HSA eligibility conflict), known as "post-deductible benefits"
  • Services for which the individual has paid fair market value (effectively meaning that there was no other disqualifying coverage with respect to the services.)
  • An arrangement may fit under more than one exception.

Pain points

An employer generally has no obligation to police the eligibility status of its employees outside its own knowledge and only a limited ability to force a recovery of HSA contributions when: (i) the individual was never eligible for an HSA contribution, (ii) an amount contributed was in excess of the statutory annual limit, or (iii) there is clear case of administrative error.

An individual who has made or received an ineligible contribution must take a corrective taxable distribution for the ineligible contribution plus any related earnings before their personal income tax return due date for that year (generally April 15 of the following year) or pay a 6% excise tax on the ineligible amount. The excise tax is not a one-shot penalty that absolves the ineligible amount and continues each year until the corrective distribution is taken. Admittedly, unless the individual self-reports, the IRS needs to be aware of the ineligible contribution in order to penalize the individual.

Note that other disqualifying coverage does not generally affect HSA contributions the individual was eligible for or his/her ability to use those funds to reimburse for qualifying medical expenses.

Telemedicine, onsite health clinics, and HSA eligibility solutions

It is reasonable to assume that many telemedicine and onsite health clinic benefits will be considered other disqualifying coverage and cause an HSA eligibility issue without some sort of solution to resolve the conflict.

First, limit the scope. The benefits could be limited in scope to services that do not interfere with HSA eligibility such as preventive services, dental or vision care, first aid (in the case of the clinic), or other services deemed insignificant care by the IRS such as immunizations and  providing non-prescription pain relievers.

This solution falls into the category of legally correct but not particularly useful, as limiting the scope of telemedicine and/or onsite health clinic benefits in this manner can defeat the purpose of meaningfully lowering the cost of the employer's health plan.

Second, provide only post-deductible benefits. If the benefits are restricted to an HDHP participant until after he or she has met their HDHP deductible, there is no HSA conflict. This solution also falls into the category of legally correct but not particularly useful and can be both  difficult and impractical to administer.

Third, charge fair market value for the services. If the HDHP participants pay the fair market value (FMV) for the services received, there is no HSA conflict. While unpleasant, this is often the most practical solution to implement. There is no guidance explicitly directing how to calculate FMV for these benefits, which should make several approaches reasonable:

  • (a) Use the Medicare reimbursement rate for the given service;
  • (b) Use the in-network usual, customary, and reasonable charge for the given service; and
  • (c) Develop standard rates for services/bundles of services based on the expected cost of providing them through the telemedicine or onsite health clinic benefit.

Flat rates are very common for telemedicine and clinic "visits" with additional charges for labs, tests, or prescriptions. An employer (particularly a healthcare system) may determine a discount is appropriate when determining the appropriate rates to take into account the lower cost of providing the services through an onsite clinic or via telemedicine compared to general medical facilities. It is also not unusual for third-party administrators to have developed standard rates for services using the methods described above that employers can implement.

 If there is a monthly cost for access to the telemedicine or onsite health clinic benefit, that could be factored into the FMV fee calculation.

HSA contributions can be used to offset the cost of services for the telemedicine and onsite health clinic benefits, and employers can provide HSA seeding contributions to assist. No fee needs to be charged for limited scope services (e.g.,preventive, dental, vision, etc.). Although it adds a layer of administrative complexity, it is also true that the clinic does not need to charge anything once the individual has met the HDHP deductible for the year.

If point-of-service charges are limited to HDHP participants, it does raise a potential nondiscrimination issue under the Tax Code. However, if there is a reasonable mix of both highly and non-highly compensated participants in the HDHP and other medical plan options, this should not present a problem.

We recommend that the costs for telemedicine and onsite health clinic benefits that are fully integrated with medical coverage (e.g., you must be a participant in the medical coverage to use the telemedicine and/or clinic benefit) accumulate toward the individual's out-of-pocket maximum limit in that medical coverage. An employer could choose to exclude these costs from the corresponding deductible.

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Medical News


PPIs May Increase Stroke Risk

MyHealthGuide Source: Bruce Jancin, 11/23/2016, Internal Medical News by MDedge

NEW ORLEANS – The use of proton pump inhibitors (PPIs) such as omeprazole, was associated with significantly increased risk of having a first ischemic stroke in a large nationwide Danish cohort study, Thomas S. Sehested, MD, reported at the American Heart Association scientific sessions.

The study was a review of 245,676 Danes above age 30 who were free of prior MI or stroke when they underwent elective GI endoscopy during 1997-2012. After a 30-day postendoscopy grace period during which 1,476 patients had a first MI, stroke, or died of any cause, the final study population was 244,200, of whom 43.7% were PPI users during the grace period and beyond.

During a median 5.8 years of follow-up, 9,489 subjects (3.9%) had a first ischemic stroke. Because of the comprehensive nature of Denmark's interlocking birth to death registries, there was virtually no loss to follow-up in this study.

The unadjusted incidence of ischemic stroke in PPI nonusers was 55.7 per 10,000 person-years, compared with 88.9 per 10,000 in PPI users.

The PPI users were slightly older than nonusers by roughly 3 years. They were also an absolute 5% more likely to be hypertensive and an absolute 1.7% more likely to be regular users of NSAIDs. All of these differences, while modest, were statistically significant because of the large patient numbers involved.

In a multivariate analysis adjusted for age, sex, calendar year, comorbid diabetes, hypertension, alcohol use disorder, heart failure, peptic ulcer, peripheral artery disease, kidney disease, aspirin, oral anticoagulants and  other medications, and socioeconomic status,

Study findings

  •  Users of PPIs were 19% more likely to have a first ischemic stroke than nonusers.

In Denmark, most PPIs are prescription only and use is easily trackable, it's estimated that, at any given time, 7% of the adult population is taking a PPI, often not as directed in the labeling.

There was the mounting evidence that PPIs may constitute an independent risk factor for acute MI and other cardiovascular events. For example, a recent meta-analysis of 17 randomized controlled trials totaling 7,540 participants published through mid-2015 concluded that the use of PPIs was associated with a 70% increase in cardiovascular risk (Neurogastroenterol Motil. 2016 Aug 30. doi: 10.1111/nmo.12926).

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Recurring Resource



Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 11/11/2016)

MyHealthGuide Source:  MyHealthGuide Editor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.

Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and update is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital/Equity
(Millions)
1 CIGNA     $2,701
2015
 
  Source - CIGNA Financial Supplement 2015, P.5 12/31/2015
2 Sun Life Financial > 30 Years   $1,155
2015
 
  Source - Sun Life Financial, Financial Planning and Analysis department (8/8/2016)
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A++)
$907
2015
$29,700 as part of Tokio Marine Group
  Source - David Grider, 11/11/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$807
2015
$396
12/31/2015
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$751.4
2015
$588
12/31/2015
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
$728
2014
$3,360.6
12/31/2014
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
10/8/2014
 
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
3/31/2016
 
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $253
2/1/2016
 
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
10 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
11 Munich Re Stop Loss, Inc.   American Alternative Insurance Company (AAIC),
TransAmerica
$147
2015
 
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
2015
$1,200
  Source - Lauren Woods, VP Marketing Fairmont Specialty, 1/4/2016
13 The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$104
12/2014
 
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
2016
$6,800
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
15
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
  Source - Mark Nichols , Managing Director.  7/20/2012

Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above. 

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

Stop-loss Premium Volume is not the Whole Story

Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:

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

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

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The Value of Self-Funding

MyHealthGuide Source:  The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, www.SIEFOnline.org The Self-Insurance Educational Foundation, Inc. (SIEF has published The Value of Self-Funding.

Self-funding is an important contributor to the financial and physical health of America's wellness future. Self-funding is more than processing claims and receiving premiums, it provides quality coverage and proactive healthcare management for employers of all sizes and industries.

About the SIEF

The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501(c)(3) non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). The foundation's mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.SIEFOnline.org.

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Video Highlighting Captive Solutions for Mid-market Companies

MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF), 5/11/2016, www.siefonline.org

The Self-Insurance Educational Foundation (SIEF) announced that it has released a new video highlighting captive insurance solutions for mid-market companies, including stop-loss captive programs, enterprise risk captives, and property & casualty group captives. Please click here to access the video.

The video can be accessed through the Foundation's web site at www.siefonline.org or by clicking here.  The video includes a separate video focused on self-insured group health plans. Both videos can be private labeled by individual companies interested in using them for their own purposes. Contact Justin Miller at jmiller@siia.org or 800-851-7789 for more information about private labeling.

About SIEF

The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501 c 3 non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). Its mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.siefonline.org.

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ICD-10 Stop Loss Trigger Diagnosis 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.

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Upcoming Conferences


December 6, 2016 - Webinar 3:00 p.m. ET / 12:00 p.m. PT
The Right Stop Loss Solution = Savings & Security presented by UBA Benefits and UMR.  Stop loss coverage is a key element to self-funded benefits plans, offering important protection against high-dollar claims. These policies contain complex and binding language, making it essential that you choose the right stop loss partner and understand the parameters of the agreement you are entering into. Steven W. Goethel, CEBS, Vice President Customer Solutions -- Stop Loss & Reporting, of UMR will walk you through the key concepts of stop loss coverage, specific policy points to be aware of, and what to look for in a stop loss partner. To receive a $50 discount, enter code UUbaR12616 when registering at https://webinars.ubabenefits.com/Register/tabid/1981/Default.aspx?wid=217

December 13, 2016 - Webinar 1:00 PM (EST) to 2:00 PM
2017 Phia Forecast presented by The Phia Group.  2016 has been another huge year for self-funding, and a year of significant  change for healthcare in general - and with the results of the recent presidential election, 2017 is slated to be an exciting year as well. 2016 has played host to all sorts of new federal regulations, state laws, market trends, and cost-containment options, and we expect 2017 to be even more unpredictable...but still great for self-funding.  Registration: https://attendee.gotowebinar.com/register/4054860723610114563

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January 18, 2017 - Webinar 1-2:15 PM EST
Data-Driven Medicare Reference Contracting presented by The Self-Insurance Institute of America (SIIA).  The State of Montana and other employers have expressed a desire for transparency, comparability, consistency, and predictability in healthcare pricing. Using data comparing allowed amounts to Medicare as a common reference, contracts have been developed that keep the more efficient providers revenue neutral while encouraging broader financial efficiency. This presentation will discuss the goals, process and outcomes of the development of a network of Medicare reference-based contracted providers. Click here to register.

  • Ron Dewsnup, President & General Manager, Allegiance Benefit Plan Management
  • Marilyn Bartlett, Administrator, Health Care and Benefits Division, State of Montana
  • MODERATOR: Mike Ferguson, President & CEO, Self Insurance Institute of America, Inc. (SIIA)

January 25, 2016 - Webinar 1-2:15 PM EST
The Evolving Use of Enterprise Risk Captives presented by The Self-Insurance Institute of America (SIIA).  The use of Enterprise Risk Captives (ERC) has steadily increased over the past few years as smaller and mid-sized companies have established these ART programs for more diverse risk exposure. With recent tax code changes increasing the annual premium limit to $2.2 million and imposing some ownership restrictions to qualify for the 831(b) tax election, the evolution of ERC use may accelerate further. Leading industry experts will share their opinion and perspectives on this topic as part of a moderated panel discussion. Click here to register.

  • Michael Serricchio, Senior Vice President, Marsh Captive Solutions
  • Patrick Theriault, Managing Director, Strategic Risk Solutions, Inc.
  • MODERATOR: Jeff Simpson, Esq., Partner, Gordon, Fournaris & Mammarella, PA

January 29-31, 2017
2017 AAPAN Annual Forum!.  This year's forum features session tracks tailored to group health, workers' compensation and specialty health markets. Keynoters will challenge attendees to think outside the box and offer insights into healthcare public policy under the new administration. And we've expanded the number of opportunities for quality networking.  Ritz-Carlton, Dove Mountain, Tucson, AZ at the  resort January 29 - 31, 2017. Early bird registration runs through September 30, 2016. Information and registration: http://aapan.org/AnnualForum.aspx

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

February 1, 2016 - Webinar 1-2:15 PM EST
Medical Travel Trends for Mid-Market Self-Insured Employers presented by The Self-Insurance Institute of America (SIIA).  Taking a page from the travel surgery playbooks that the large, high-profile companies have followed over the past few years, mid-size or smaller employers and plan sponsors now recognize that the site of service significantly impacts the cost of care and is a key determining factor in selecting where to have procedures performed - everything from MRIs and diagnostics to complex surgeries. Learn how Third Party Administrators and employers are educating and incentivizing employees to make better choices - from reducing coinsurance to eliminating copayments, paying travel expenses or cash rewards. The goal is to help employees seek the right care at the right time in the right place. Click here to register.

  • Mark Kendall, Senior Partner, HUB International
  • Simeon Schindelman, CEO, Brighton Health Plan Solutions
  • Carrie Hatch, Chief Operating Officer, Ameriben
  • MODERATOR: Laura Carabello, Publisher, Media Travel Today

February 8, 2017 - Webinar 1-2:15 PM EST
The Enemy Within: Dealing With Fraud in Your Workers' Compensation Fund presented by The Self-Insurance Institute of America (SIIA). No one wants to hear that even though you believe you are doing everything "right" - rigorous annual clean audits, regular external reviews by reinsurance partners, an active internal audit function, and rigorous policies regularly reviewed through the AGRIP Recognition Standards - things can still go wrong. In this case, we will hear about one pool's very personal experience - recently concluded with the criminal sentencing of a long-time employee - and the lessons learned. From discovering the fraud - which involved embezzlement of over $1 million over a 10 year period - to working with the authorities, managing the public relations, and dealing with employee morale. By sharing this experience, it may prevent it from happening in other pools / funds. Click here to register.

  • Shelly Brotzge, Senior Client Advisor, Midwest Employers Casualty Company
  • Dubravka Romano, Associate Exec. Director for Risk Management Services, Texas Assoc. of School Boards
  • MODERATOR: Mike Ferguson, President & CEO, Self Insurance Institute of America, Inc. (SIIA)

February 8-10, 2017
Executive Forum 2017
presented by Health Care Administrators Association (HCAA). Bellagio, Las Vegas, NC. Kicking off just 19 days after our country's new president is sworn into office, you can bet we'll have plenty to talk about. We've lined up what may be our most impressive slate of presenters ever to:

  • Examine the impact on the self-funding industry of the electorate's choice of a new administration,
  • Explore tech and social communication changes that may well disrupt your current strategies, and
  • Expose you to new and unique ways for your business to thrive in in this Brave New World.

Schedule and registration: www.hcaa.org/?page=2017EFSchedule

February 15, 2017 - Webinar 1-2:15 PM EST
Referenced Based Pricing - The Hospital's Perspective presented by The Self-Insurance Institute of America (SIIA). While there has been increased discussion within the self-insurance industry on the relative merits of various reference-based pricing approaches, this session will look at this trend from the opposite direction. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements. Click here to register.

  • SPEAKER: Emily Scott, Esq., Attorney, Hirschler Fleischer
  • MODERATOR: Mike Ferguson, President & CEO, Self Insurance Institute of America, Inc. (SIIA)

February 22, 2017 - Webinar 1-2:15 PM EST
Cost Containment Strategies and Opportunities for Employers in Stop-Loss Captive presented by The Self-Insurance Institute of America (SIIA). Self-Insured employers continue to be trailblazers on implementing effective health care cost containment strategies. This session will explore strategies that can work particularly well when employers are pooled together as part of stop-loss captive programs. It will also highlight certain cost management services that smaller and mid-sized self-insured employers can only access, or access at a lower cost, when pooled with other employers. Click here to register.

  • Scott Byrne, RVP - Western Territory, Berkley Accident & Health
  • Michael Madden, Division Senior Vice President, Artex Risk Solutions
  • MODERATOR: Mike Ferguson, President & CEO, Self Insurance Institute of America, Inc. (SIIA)

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

March 27-29, 2017 -  A Hybrid Conference and Internet Event
17th Population Health Colloquium.  The Leading Forum on Innovations in Population Health & Care Coordination Academic Partner: Jefferson College of Population Health. Loews Philadelphia Hotel, Philadelphia, PA. Information and registration: www.populwww.populationhealthcolloquiumspecialedition.com/index.html

March 28-30, 2017
Self-Insured Health Plan Executive Forum presented by The Self-Insurance Institute of America. 

  • Health care industry thought leader Dave Chase will deliver a TED-style talk on how self-insured employers are playing an increasingly important role in helping to save the country's dysfunctional health care system.
  • A panel of technology visionaries will discuss winning technology strategies for companies involved in the self-insurance marketplace.
  • SIIA lobbyists will provide updates on key legislative/regulatory developments at both the state and federal level, and detail the association's advocacy strategy for 2017.
  • As a follow-up to sessions held at SIIA's recent National Conference & Expo covering referenced-based pricing/Medicare-plus topics, we'll have a session focused specifically about how to best defend against balance billing.
  • Captive insurance experts will highlight business development opportunities for self-insurance industry service providers in connection with stop-loss captive programs.

For sponsorships, contact Justin Miller at jmiller@siia.org. The Forum will be held at the beautiful JW Marriott Tucson Starr Pass Resort and Spa. Information and Registration

April 18-19, 2017
SIIA 2017 International Conference presented by The Self-Insurance Institute of America, Inc. Focus on Latin America and self-insurance-related business opportunities emerging within the region. Condado Vanderbilt Hotel. San Juan, Puerto Rico.  Visit www.SIIA.org

May 3-4, 2017
SIIA Legislative Conference presented by The Self-Insurance Institute of America, Inc. Washington Marriot Metro Center Hotel. Washington, DC.  Visit www.SIIA.org

May 16-18, 2017
Self-Insured Workers' Compensation Executive Forum presented by The Self-Insurance Institute of America. The Omni Grove Park Inn. Asheville, NC. www.SIIA.org

July 17-19, 2017
HCAA TPA Summit 2017 presented by Health Care Administrators Association.  Hilton Hotel at the Ballpark. St. Louis, MO

October 8-10, 2017
37th Annual National Educational Conference & Expo presented by The Self-Insurance Institute of America. JW Marriott Phoenix Desert Ridge Resort & Spa. Phoenix, AZ. www.SIIA.org

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

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Editorial Notes, Disclaimers & Disclosures


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