General & Company News
Market Trends, Studies, Books & Opinions
Legislative & Regulatory News
Editorial Notes, Disclaimers & Disclosures
General & Company News
RxResults Unveils MemberChoice to Combat Rising Drug Costs for
Self-Funded Employers and Their Employees
MyHealthGuide Source: RxResults, 7/30/2015, www.rxresults.com
Little Rock, AR -- Pharmacy costs are expected to
rise by 16% between 2013 and 2016, and to continue to rise at that rate
through the end of 2023. In addition, the rising cost of drugs has
contributed to patients not taking their drugs as prescribed or not at all,
resulting in $290B annually in healthcare costs. Employers must begin to
implement risk management tools in order to control company health plan
costs and lower costs for their employees (plan members).
Little Rock based pharmacy risk management company, believes MemberChoice is
a smart option for employers who want to help their health plan members save
money and feel better, and also improve the company's bottom line.
"MemberChoice is being introduced to market at the right time. Employers and
insurers are seeing unsustainable increases in pharmacy spending and some
are left with no choice but to shift cost to employees who are company
health plan members. MemberChoice puts members in charge by providing them
with lower cost options to expensive brand medications based on unbiased,
clinically sound recommendations from the University of Arkansas for Medical
Sciences (UAMS) College of Pharmacy", says Tery Baskin, President and CEO.
- Prescription claims analysis by unbiased UAMS College of Pharmacy experts
- Targeting high cost drugs and providing lower cost alternatives that provide
the same or better patient benefit
- Immediate savings for the employer (5-10% of total pharmacy spending) and
- Member friendly communication and incentives designed to motivate plan
Freedom for plan members to make the change and save through a completely
- Frequent communications with members, their physicians and pharmacists to
educate and inform, and a call center for one-on-one consultation
Baskin states that, "Employers are torn between managing the cost of
providing health care benefits and being able to retain talent in the
workforce. They are faced with getting members more engaged in spending
medical cost dollars wisely. We have put an incentive program in place along
with education to help keep your members engaged and making the right
decisions about pharmacy spending."
RxResults is a next-generation Pharmacy Benefits Risk Management company started by Tery Baskin in 2009 has grown into a talented team of
pharmacists, physicians and industry experts. RxResults continues to see
ever-rising pharmacy costs putting unnecessary strain on employers. In an
effort to reduce wasteful pharmacy spending, while providing access to
medications proven safe and most effective to members, RxResults focuses on:
- A comprehensive suite of evidence-based products to help employers and
employees manage their pharmacy costs
- Easy to understand, customized reporting for help employers make better
decision when planning benefits
- A high level of customer service to inform and educate employers and
employees of their cost saving options
6 Degrees Health, Inc. and Indiana University Health agree to an Exclusive
Transplant Network Agreement for the State of Indiana
MyHealthGuide Source: 6 Degrees Health, Inc., 07/31/2015,
Beaverton, OR -- 6 Degrees Health is proud to announce the addition of
Indiana University Health to OURproviders™.
Indiana University Health (IUH) is one of the few hospitals in the country
to be Medicare certified to perform all major solid organ transplants,
including liver, kidney, pancreas, intestinal and multivisceral, heart and
lung transplants. Combine the exceptional solid organ program with the IUH
Melvin and Bren Simon Cancer Center and the Riley Hospital for Children, and
you truly have a destination transplant solution.
"As the 5th largest transplant center in the U.S., Indiana University Health
(IUH) is centrally located and a big draw for many of our clients. When 6
Degrees approached IUH, we came at the deal with the desire to partner on a
very unique and strategic level. 6 Degrees is entering an extremely busy
couple of months, with a number of substantial network deals being
finalized. The IUH network agreement is a landmark deal for 6 Degrees, and a
great way to kick off some of the most significant hospital additions in our
history … stay tuned," states Scott Ray, 6 Degrees Health's CEO & General
About 6 Degrees Health, Inc.
6 Degrees Health is a Specialty Network focusing on mitigating the risks
with transplants, cancer, cardiac and other complex high-dollar care.
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™. The keystone of 6 Degrees Health's
solutions is its proprietary analytics platform (VeritasDx™) … there is no
equal in the market executing the transparency necessary to achieve a
win-win for Patient, Payor and Provider. Contact David Vizzini, President, 6
Degrees Health, Inc., at email@example.com, 503-640-9933 ext.
102 and visit www.6degreeshealth.com.
PHX Highlights Its Seventh Annual
MyHealthGuide Source: Premier Healthcare Exchange (PHX), Inc.,7/27/2015,
Bedminster, NJ -- Premier Healthcare Exchange (PHX), Inc., a
leading provider of healthcare cost management services recently hosted 250
healthcare stakeholders at its seventh annual Forum at the St. Regis Monarch
Beach. The theme of this year's 3 day event was "Making Tomorrow Today".
"These are truly fast moving times in our industry. We are starting to hear
words like; consumerism, transparency and digital marketing", stated
Todd Roberti, CEO, PHX. "In the past we would all wait it out and
we would all think it's just another FAD. Not this time, technology is far
more advanced compared to the past. Our seventh annual Forum is an ideal
platform to come together for collaboration, strategizing, and to embrace
the trend of acting now upon the many opportunities which will make our
industry stronger, more productive and ultimately, sustainable."
Highlights of this year's event included discussions on future company
initiatives, panel sessions spotlighting vendor partner value-added business
opportunities, as well as, topics focused on future technologies within the
healthcare industry. Additionally, PHX stressed the importance of embracing
the innovative trends of tomorrow, today. As one Forum attendee commented,
"As always PHX has delivered a first class event that not only provided
information that will help us better prepare for the future, but also
network with fellow attendees and share information and ideas that can help
us better serve our clients."
Speakers at this year's Forum included: Robert Herjavec, Shark Tank,
Will to Win"; Scientist and Entrepreneur, Daniel Kraft, M.D.
"The Future of
Healthcare and Medicine: Where can Technology Take Us?"; Deputy
Administrator & Director of CMS, Dr. Shantanu Agrawal,
"Bending the Cost
Curve of Medicine at the Centers for Medicare and Medicaid"; Leanne
Gassaway, Vice President of State Affairs, AHIP, "Creating an Affordable,
Stable and Accessible System for Consumers"; Marlon Dungo, Vice President of
Commercial Acceptance and Rob Rydell, Vice President of Healthcare,
MasterCard, "ePayments in a B2B World"; and Mike Ferguson, President of
SIIA, "Legislative/Regulatory Update for the Self-Insurance Industry".
Premier Healthcare Exchange (PHX) was incorporated in 2001. The company
provides advanced network and cost management solutions for health plans
that combine claim processing automation with professional services to
deliver a timely, centralized approach to healthcare cost management. This
approach results in a significant reduction in payment errors, appreciable
improvement in the time needed to bring claims to resolution and in savings
that substantially reduce the healthcare costs of its clients. PHX solutions
are utilized by industry leading insurance companies, Taft-Hartley Funds,
Health Maintenance Organizations (HMOs) and Third Party Administrators
(TPAs). Visit www.phx-online.com.
Rockport Benefits, LLC's
Extends Gratitude for Support
MyHealthGuide Source: Rockport Benefits, LLC, 7/28/2015,
Beverly, MA -- As the fateful 4th quarter faces us all in the not so distant
future, Rockport Benefits, LLC would like to extend our gratitude to all of
you who have already demonstrated your support.
"We have had a great start
and are looking forward to a fulfilling 4th quarter," says
Amy K. Argeros,
Managing Director. "To our Business Partners, stay tuned for upcoming cost saving offerings,
which will be rolled out shortly. We are hopeful that our new strategies are
both easy to implement and their savings potential is quickly realized."
"To our Market Peers, we plan to join you in maintaining the underwriting
integrity necessary to promote this business, creating more opportunity for
those desiring to join the self- funded arena. Best of luck with your 4th
About Rockport Benefits
Offering 20+ years of medical stop loss expertise combined with the strength
of an A+ rated Carrier and full suite of Underwriting, Claims and Risk
Management Services, Rockport Benefits balances its rich historical
perspective with a newly energized approach to today's industry. Contact Amy Argeros
at firstname.lastname@example.org, 978-969-0658
and visit www.rockportbenefits.com.
American Specialty Health
Appoints Jerome Bonhomme as Chief Technology Officer
MyHealthGuide Source: American Specialty Health, 7/27/2015,
SAN DIEGO -- Jerome Bonhomme has joined American Specialty
Health Incorporated (ASH) as chief technology officer, effective
immediately. Bonhomme will lead ASH's new consumer technology department,
focused on developing, maintaining and expanding the company's
consumer-facing web site capabilities and innovative applications, and
enhancing internal systems and platforms.
Bonhomme has a broad background as a software technology executive, with
substantial experience in developing ecommerce platforms, applications and
architecture to support customer engagement, product launches and marketing
"As consumers demand more customized and personalized health and wellness
offerings to keep them actively engaged in staying fit and healthy, American
Specialty Health will be a premier provider of that technology," said ASH
Chairman and CEO George DeVries. "By offering individuals the responsive
programs they want on the platforms they prefer, we will continue to sustain
our mission to empower individuals to live healthier and longer. We are
thrilled to have Jerome on board as we continue to pursue excellence in
Bonhomme previously was vice president of software engineering at Lytx in
San Diego. There, he was responsible for all software engineering and
product development, delivering a next generation platform and implementing
new software engineering processes. While at Lytx he also filed several
patents in the domain of geo-spatial data processing.
In 2004, Bonhomme joined Sony Electronics to develop the architecture and
launch Store.Sony.com, Sony's online store. Later he became part of Sony's
global technology team as director and chief architect for the Global
eCommerce Platform. He led the creation of a single cohesive platform to
serve each country with its own language and fulfillment capabilities.
Bonhomme is a graduate of the University Sorbonne in Paris, where he earned
a MS in electrical engineering and a MS in computer science. He worked in
several technology positions in France and San Diego before settling at
BroadVision in San Diego as a technical manager in 2000. In this role,
Bonhomme developed new generations of their platforms and helped launch four
About American Specialty Health
American Specialty Health Incorporated (ASH) is one of the nation's premier
independent and privately-owned specialty health services organizations,
offering specialty health provider networks and programs, fitness and
exercise programs, and population health solutions for health plans,
insurance carriers and employer groups. Operating from offices in Carmel
(Indianapolis), Ind., San Diego, Calif., Southlake (Dallas), Texas, and
Columbia, S.C., ASH has more than 1,200 employees and administers services
for more than 34 million members nationwide. Additional products offered
through ASH and its subsidiaries include Healthyroads®, FitnessCoach™,
Active&Fit®, Silver&Fit® and others. Call 800-848-3555 and visit
www.ashcompanies.com. Follow us on LinkedIn or Twitter
QBE Accident & Health
Announces Mike Millea as Assistant Vice President
MyHealthGuide Source: QBE Accident, 7/31/2015,
New York, NY -- QBE North America announces an addition to its Accident &
Health Division's Medical Stop Loss Underwriting team.
Mike Millea has joined QBE Accident & Health as Assistant Vice President -
Lead Underwriter. Mike has more than 15 years of experience in the medical
stop loss industry and comes to QBE from HCC Life where he most recently
served as Senior Consulting Underwriter. His background includes significant
business development and account management experience.
We are very happy and excited to have Mike join QBE Accident & Health, said
Steve Gransbury, President of QBE A&H. Mike's knowledge and experience
provides additional expertise and depth to our rapidly expanding stop loss
team and will contribute greatly to our growth.
Mike will work out of QBE's Marblehead, Massachusetts office and can be
reached at: email@example.com
QBE's North America operations are part of QBE Insurance Group Limited, one
of the top 20 insurers and reinsurers worldwide. Headquartered in Sydney,
Australia, QBE operates out of 38 countries around the globe, with a
presence in every key insurance market. The North America operation,
headquartered in New York, conducts business through various 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, Vice President -- Sales & Marketing, Accident &
Health, at 910.420.8104, firstname.lastname@example.org and visit
Administrators Hires Irma McCoy as a Claim Representative and Selects Peggy
Mellentine as Claim Examiner
MyHealthGuide Source: Brentwood Services Administrators Inc. (BSA), 7/31/2015,
Irma McCoy, Claim Representative
BRENTWOOD, TN -- Brentwood Services Administrators Inc.
(BSA)., headquartered in Brentwood, Tenn., recently hired Irma McCoy
claim representative in the General Liability Department in the corporate
office in Brentwood, according to Jeff Pettus, president and chief executive
officer of BSA.
As a claim representative, McCoy is responsible for reviewing,
investigating, assessing negligence, evaluating and negotiating settlements
of general liability claims as assigned by her general liability claims
supervisor, Teresa Jenkins. She assesses comparative negligence of the
parties involved, as well as communicates directly with clients, claimants
and attorneys to manage claims in a timely and economic manner.
Previously, McCoy was a claim adjuster for Nationwide/HIC in Nashville,
Tenn., assigned to investigate, evaluate and negotiate claims. She also has
been employed by C.N.A. and Aetna Life & Casualty.
With diverse experience in handling claims including special accounts, she
has held licensing in multiple states and has a strong commitment to
McCoy graduated from Southeastern University of Hammond, La., with a
bachelor of arts degree.
Peggy Mellentine, Claim Examiner
BSA also selected Peggy
Mellentine for the position of claim examiner in the Champaign, Ill.,
office, according to Pettus, president and chief executive officer of
In her new position under the supervision of Luca DeVecchi, claims manager,
Mellentine will be processing and handling workers' compensation claims as
assigned by her claims supervisor. In addition, she determines the
compensability of the claim to the extent of liability, and communicates
directly with clients, employers, injured workers, physicians and attorneys
to manage claims in a timely and economic manner.
Prior to joining BSA, Mellentine served as a workers' compensation claim
representative investigating and managing claims for QBE Insurance in
With 13 years of claim handling experience and 24 years in the insurance
industry, Mellentine has earned her INS designation. She attended Highland
College in Freeport for one year where she obtained her certification in
clerical business studies.
About Brentwood Services Inc.
Brentwood Services Inc. is an independent employee-owned company
headquartered in Brentwood, Tenn., and specializing over the past 25 years
in structuring and managing alternative market solutions for employers and
insurance providers. Contact John Smitherman, senior vice
president of sales for Brentwood Services Inc., at (800) 524-0604 or (615)
263-1300, email@example.com and
About Brentwood Services Administrators Inc.
Brentwood Services Administrators Inc. provides claims management and loss
control services to employers and employer associations with self-insured
and large deductible programs for workers' compensation and other casualty
lines. BSA's aggressive coordinated approach to claims administration and
loss control has a proven track record of reducing the cost of claims for
its clients. BSA also provides underwriting, policy management and
accounting services to association-sponsored pools and mutual insurance
About Brentwood Reinsurance Intermediaries Inc.
Brentwood Reinsurance Intermediaries Inc. (BRII) provides insurance and
reinsurance brokerage services encompassing self-insurance, guaranteed cost
and deductible insurance with a focus on workers' compensation, excess
liability lines, and accident and health reinsurance.
HCC Life Has Two Immediate Openings for an
Underwriter or Senior Underwriter in Plano, TX and Minnetonka, MN
MyHealthGuide Source: HCC Life Insurance Company, 7/17/2015,
HCC Life Insurance company has two immediate openings for an Underwriter or
Senior Underwriter in our Plano, TX and Minnetonka, MN offices.
The Underwriter/Senior Underwriter establishes, maintains, and develops
producer relationships, and has expanded underwriting authority and business
development responsibility. This position reports to the Senior Vice
Responsibilities include, but are not limited to:
Relying on experience and judgment, the Senior Underwriter is responsible
for accomplishing the following assignments. These assignments are broad in
nature and work can be difficult.
- Meet annual company goals for profitability, renewal retention, revenue
growth, and new business production.
- Evaluates risk acceptability within established guidelines and set
appropriate rates and factor levels.
- Analyze proposed plan changes to acceptability and cost.
- Work in conjunction with the Marketing department to follow-up on quoted
- Communicates with TPA/Broker's to answer questions, explain decisions, deal
with problems, build, and maintain productive relationships. Respond
appropriately and in a timely manner to service requests.
- Complete RFP's timely and follow-up for status and competitive numbers.
Position Knowledge, Skills, and Requirements
- Bachelor's degree in Business Administration, Accounting or Finance or a
related field or the equivalent education and/or experience
- Prefer work towards CEBS, FMLI, or CLU certification
- Minimum of five years of medical stop-loss underwriting experience
We offer a competitive base salary and benefits package, including bonus
potential and a 401k plan with 6% company match.
Any offer of employment will be contingent upon positive criminal background
and credit checks. EEO Employer.
Interested individuals should
send resume to Tracy Creekbaum,
Marketing Specialist, at TCREEKBAUM@hcclife.com.
About HCC Life
HCC Life Insurance Company (HCC Life) is an Indiana-domiciled life
insurance company with an extensive product portfolio including medical stop
loss, group term and short term medical insurance. HCC Life has consistently
held an A+ (Superior) rating for financial strength by A.M. Best Company as
well as AA (Very Strong) ratings by Standard & Poor's and Fitch Ratings.
HCC Life has more than 35 years of experience and is a leading provider of
medical stop loss insurance through brokers, consultants and third party
administrators. Guided by an 8-person executive management team whose
members have an average of more than 20 years of insurance experience, the
entire HCC Life staff works together with third-party administrators and
brokers to find the best solution to managing risk for our mutual clients.
Our commitment to medical stop loss enables HCC Life to remain a stable
partner for producers in a constantly changing marketplace. Unlike many
providers of medical stop loss, HCC Life assumes 100 percent of the risk,
and is therefore responsible for all underwriting, claims and administrative
decisions. Visit www.HCCLife.com.
WellSystems and Continental Benefits Seek Stop Loss Managers, Underwriters,
IT Analysts and More
WellSystems and Continental Benefits, 7/24/2015,
WellSystems and Continental Benefits, partner companies located in Tampa,
Florida are actively recruiting for several positions, including:
- Manager of Stop Loss Marketing
- Stop Loss Underwriters
- Account Managers
- IT Business Analysts (Including those with clinical and care management
experience, vendor integration, data integration and system set-up)
- Plan Builders
- Health Care EDI Analysts
- Health Care Data Analysts
- TPA Sales Professionals in Midwest and Northeast
We are the fastest growing administrator of health benefits in the United
States, offering a completely integrated technical platform, access to
multiple carrier networks and the full complement of industry-leading cost
control, service and analytics.
We are very forward thinking in our compensation and benefits programs and
are led by a team of the top experts in the TPA and group health benefits
industries. For information on any of these positions, please send an e-mail
to Glenn McLellan, President at
WellSystems provides services to various
types of payers including carriers, health plans, TPAs and
provider-sponsored networks and community health plans. Visit
About Continental Benefits
is a full-service TPA operating on a national basis and providing services
to Plan Sponsors ranging from 100 to 25,000 covered employees. In our first
two years of operation we have surpassed 750,000 covered participants.
IHC Risk Solutions (IHCRS),
Seeks Regional Sales Executive for the Mid-Atlantic Region
MyHealthGuide Source: IHC Risk Solutions (IHCRS), 7/23/2015,
IHC Risk Solutions (IHCRS), a national direct writer of medical stop-loss,
is seeking a highly motivated and energetic Regional Sales Executive for the
Mid-Atlantic region of the United States. Candidates must be able to
develop, grow, and maintain a profitable block of business, with a special
emphasis on maintaining and growing existing partnerships.
Candidates are required to have the following
- Medical stop-loss sales experience or related industry with a good
knowledge of self-funding and stop-loss. Captive and organ transplant
products knowledge helpful.
- Existing contacts with key distribution channels (brokers/ third-party
- Knowledge of key industry factors including health care reform and
- Excellent communication skills enabling proper interaction with
prospects/clients as well as internal underwriters
- Strong presentation skills for individual, board room, and conference
- Ability to represent IHCRS at industry events, affiliations, associations,
- Willingness to travel as required (50%) and manage budget
- Goal oriented with ability to follow defined business plan
- Exhibits excellent time management skills
- Capable of using current technology systems including Salesforce, DY, and
- Ideal candidate would be located in the Baltimore/DC Metro Area
- Ability to comply with IHC's corporate practices and procedures
- Compensation commensurate with experience
- Comprehensive Benefits package including medical benefits and 401K
Interested candidates should forward their resumes to
firstname.lastname@example.org today! We are motivated to fill this
position so do not delay.
IHC Risk Solutions (IHCRS) offers medical stop-loss, group stop-loss
captives, and an Organ Transplant Solution program. IHCRS is a full service
direct writer for self-insured employer groups in all 50 states and is a
member of the IHC Group, an insurance organization composed of Independence
Holding Company (NYSE:IHC) and its operating subsidiaries. Coverage is
underwritten by Standard Security Life Insurance Company of New York, also a
member of the IHC Group. The IHC Group is built on financial strength and
stability of IHC which has over $1 billion in assets as of June 2013 and
over 25 years in the stop-loss business. Visit
Market Trends, Studies, Books & Opinions
Why the ACA Creates a
Golden Ticket for TPAs
MyHealthGuide Source: Bob Carlson,, Healthx, 7/31/2015,
In Charlie and the Chocolate Factory, highly sought-after Golden Tickets
gave a lucky few entry into the wonders of Willy Wonka's facility. In a
similar fashion, the Affordable Care Act is providing new
opportunities for TPAs. While its full economic
ramifications probably won't be determined for a few years, or maybe even a
generation, it's clear that the ACA has completely re-energized an industry
that feared fading into the sunset just a few years ago.
Handling ACA Challenges and Complexity
Many of the new opportunities for TPAs result from challenges and complexity
associated with the ACA. For example:
Small and mid-size employers who wanted to continue providing employees with
health insurance were uncertain of what the changes would mean or how to
document compliance. Others realized they needed to offer a plan for the
first time to avoid fines. In both cases, they turned to TPAs for guidance.
Accountable care organizations (ACOs) found they needed help managing new
administrative tasks that accompany moving to a pay-for-performance model.
Niche players like hospitals and municipal groups found greater incentive to
continue offering self-funded health insurance. TPAs With their deep
expertise in insurance administration, their understanding of how to drive
member participation, and their flexibility to tailor programs to suit the
specific needs of groups from 25 covered lives and up, the changes brought
about by the ACA are directly in the TPAs' wheelhouses. In fact, they are
proving better suited to the ACA than the large, full-insurance carriers for
the self-funded employer market.
Increasing Business from Bread-and-Butter Clients
While self-funded employers have always been the bread-and-butter of TPAs,
many have recently been able to expand that market downward as a result of
two primary forces:
- Changes brought about by Reinsurance carriers make it more attractive to
self-fund (such as creation of coverages with smaller specific and aggregate
- Reinsurance carriers have also begun offering coverages
where claims reimbursement takes place immediately and claims auditing takes
place afterwards, helping employers manage risk more effectively.
The requirement for employers to offer some form of health insurance to
employees or face significant government fines.
The result is more small employers are now looking into what types of
affordable health plans they can offer. This is where TPAs shine.
Added bonus: Flexibility to Tailor Plans and Programs
Unlike large carriers who only offer a handful of off-the-shelf options,
TPAs have the flexibility to tailor their self-funded plans to the specific
needs of each employer. They also have the administrative capacity to manage
the entire program for employers -- including complex, ACA-specific
requirements such as calculating and reporting on the number of covered
employees based on hours worked.
Once programs are set up, TPAs are also in a better position than large
carriers to drive employee engagement with it. For example, they can:
- Build portals that match the employer's website in terms of design,
branding, and language. This is important because employees -- especially
those with less insurance literacy -- are far more likely to feel good about
and trust a portal that looks like it's from their employer rather than an
- Set requirements that drive usage of the portal, such as making the portal
the only option for enrollment or requiring an employee to complete an
online HRA to be eligible for the company contribution to health insurance
(with the employer's approval, of course). Engaging employees through the
portal, rather than sending information such as explanations of benefits
(EOBs) through regular mail, can help TPAs bring their administrative costs
down further, making it more affordable for employers to offer health
- Incorporate other services into the portal with one-click access, such as
health risk assessments and wellness programs. By doing so, employers make
it easier for employees to become and remain healthier. In addition, reports
generated through those services can help brokers and TPAs develop new
programs, such as rewards for smoking cessation and exercise, which address
specific health concerns of that group. These programs not only help
employers lower claims; they also contribute to reducing time lost due to
avoidable illnesses, improving productivity.
TPAs across the country are already seeing results. One that already had a
small business program in place has doubled its revenue in the last two
years by adding new, smaller self-funded employers. Others that have added
this capability have created new markets for themselves and established a
position as the dominant player in their area. And the surface has only been
Healthx is the healthcare
industry’s leading digital engagement platform for connecting payers,
providers, consumers, employers and brokers. Visit
National Health Expenditure Projections, 2014--24: Spending Growth
at 5.8% Faster
Than Recent Trends
MyHealthGuide Source: Nathaniel Weixel, 7/29/2015, Sean P. Keehan,
et al, CMS, 7/15/2015,
Health Affairs and Nathaniel Weixel, 7/29/2015, CMS
Health spending is projected to grow to nearly $5.5 trillion in the next 10
years, spurred on by the Affordable Care Act's coverage expansions, an aging
population and a stronger economy, according to a July 28
report from the
In the report, published in the journal
Health Affairs, actuaries at the
Centers for Medicare & Medicaid Services projected
- spending on hospitals,
drugs and insurance will grow 5.8 percent per year from 2014 to 2024 -- just
over 1 percentage point faster than the gross domestic product over that
- As a result, the health spending share of the economy is
projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024.
Legislative & Regulatory News
'Cadillac Tax' Guidance Raises Concerns for TPAs & Employers
MyHealthGuide Source: Self-Insurance Institute of American, 7/31/2015,
The U.S. Treasury Department issued its
much-anticipated "second" Notice providing suggestions on how the Department
intends to implement the so-called Cadillac Tax - officially referred to as
the Excise Tax on High Cost Employer-Sponsored Health Coverage (the "Excise
In the "first" Notice released on the Excise Tax -
issued on February 23, 2015 - Treasury sought public feedback on
- (1) what
"type" of health coverage should be counted for purposes of the Tax,
- (2) how
to "value" the health coverage that must be included in the Tax's
- (3) how to determine the Tax's annual dollar thresholds
(which if exceeded, triggers the Tax).
This recently released Notice -
Notice 2015-52 - supplements Notice 2015-16 by addressing additional issues
- (1) identifying the entity liable to pay the Excise Tax liability,
- (2) describing how the Tax liability may be allocated among these entities,
- (3) explaining how actual payment of the Tax may be made to the Internal
Revenue Service ("IRS"). Comments on Notice 2015-52 are due October 1st.
Please note, after Treasury considers the public comments submitted on both
Notices, the Department intends to issue proposed regulations implementing
the Excise Tax. It is unclear when these proposed regulations will be
issued, but there is a good chance that proposed regulations could be
released by the end of this year or early 2016, and final regulations
following on in mid- to late-2016.
Key provisions of the notice are as
A. Treasury Suggests Two Different Approaches When It Comes to Determining
What Entity Pays the Excise Tax In the Case of Self-Insured Benefits
According to the statute, the Excise Tax is imposed pro rata on insurance
companies and administrators of self-insured arrangements, and also the
employer in certain cases. Notice 2015-52 confirms that the Excise Tax is
payable by an insurance company in the case of a fully-insured employer
plan. The Notice also confirms that the employer is liable to pay a portion
of the Excise Tax attributable to employer contributions to a health savings
account ("HSA"), along with employee contributions made to an HSA through a
Code section 125 cafeteria plan. Unfortunately, in the case of self-insured
benefits, however, Treasury did not confirm that the Excise Tax is payable
by a third-party administrator ("TPA") or, alternatively, the employer
sponsoring the self-insured plan. Instead, Treasury said that the Department
is considering two approaches for determining "who the administrator" is for
purposes of the Tax.
- Under the first approach, the entity liable for paying the Excise Tax would
be the entity "responsible for performing the day-to-day plan administration
functions, such as receiving and processing claims for benefits, responding
to inquiries, or providing a technology platform for benefits information."
Treasury went so far as to say that the Department anticipates that this
entity would be the TPA for the self-insured benefits, except in "rare
circumstances" where the employer administers its own plan (or owns a TPA
performing these functions).
- Under the second approach, the entity liable for paying the Excise Tax would
be the entity "that has the ultimate authority or responsibility under the
arrangement with respect to the administration of the plan benefits
(including final decisions on administrative matters), as well as authority
or responsibility over eligibility determinations, claims administration,
and arrangements with service providers (including the authority to
terminate service provider contracts)." Treasury stated that the Department
anticipates the entity with such ultimate administrative authority or
responsibility under the arrangement would be identifiable based on the
terms of the plan documents, and often would not be the person that performs
the day-to-day routine administrative functions under the plan. In other
words, it would appear that the employer would be responsible for paying the
Excise Tax if the second approach were adopted.
B. Other Noteworthy Matters Addressed By Treasury
1. The Period for Determining the Amount of the Tax Payable
Treasury confirmed that the Tax would be determined based on the calendar
year. Treasury also confirmed that the Tax liability would be determined by
the employer soon after the end of the calendar year (so the employer can
then notify the entities responsible for paying the Tax as soon as possible
to ensure that these entities can pay the Tax liability in a timely manner).
Treasury highlighted specific instances where it may be difficult for an
employer to sufficiently calculate the Tax liability soon after the end of
the calendar year (e.g., in cases where self-insured plans use different
methods for the determination of the COBRA applicable premium, or in the
case of experience-rated arrangements). Treasury has requested comments on
how to address these issues.
2. Exclusion of the Cost of the Tax from the Tax's Calculation
Treasury recognizes that in cases where the Excise Tax is payable by an
insurance company or an administrator of self-insured benefits, the Tax
liability will be passed through to the employer. In this case, Treasury
does not want these passed-through liabilities in the form of, for example,
administrative fees that may be included in determining the COBRA applicable
premium or a premium load, to be counted when determining if the aggregate
cost of health coverage exceeds the Tax's dollar thresholds for the year.
But, Treasury is concerned that excluding these amounts may not be
administrable, and therefore, the Department is requesting comments on this
3. Requirement To Notify the Entities Responsible for Paying the Excise Tax
According the statue, after the employer determines the amount of the Excise
Tax liability that is payable by a particular entity, the employer is
required to notify that entity (along with the IRS) of the amount of the Tax
owed. Treasury is in the process of considering both the form in which the
information must be provided, and the time at which the information must be
provided. The Department requested comments on administrative issues raised
by this notice requirement.
4. Actual Payment of the Excise Tax Liability
Treasury suggests that the Department may add the Excise Tax liability
otherwise payable by an insurance company, an administrator, and/or the
employer on the Form 720, which is currently used to pay excise taxes for
violations of certain other group health plan requirements.
What Does All of This Mean?
TPAs and self-insured employers should be concerned about Treasury's
suggestion that entities that provide various administrative services for
self-insured plans should pay the Excise Tax. In the case of TPAs, these
entities do not want to be saddled with the Tax liability. For self-insured
employers, these companies would like to avoid the administrative
complexities associated with ultimately paying the Tax as it is passed
through by the TPA. The employer community has already petitioned Treasury
to eliminate this "tax-within-a-tax" and simply impose the Tax on the
employer. For this reason, it was surprising that Treasury so clearly
articulated that the Department was considering to impose the Tax on TPAs as
one of its approaches.
SIIA Response Preview
SIIA intends to submit public comments on this issue, as well as other
issues discussed in the Notice. Association lobbyists have already
communicated to Senate Finance Committee staff the concern the
self-insurance community should have over imposing the Excise Tax on the
actual administrator of self-insured benefits. Additional updates will be
forthcoming. Should you have any questions regarding this notice in the
meantime, please contact SIIA Washington Counsel Chris Condeluci
Additional ACA regulatory updates will be provided at SIIA's upcoming
National Conference & Expo,
scheduled for October 18-20, 2015 in Washington, DC.
A United Front Against the Cadillac
MyHealthGuide Source: Mike Nesper, 7/29/2015,
Employee Benefit News
Both the public and private sectors, as well as Democrats and Republicans,
have joined together in an effort to repeal the Affordable Care Act's excise
tax on high-cost group plans. Set to take effect in 2018, the so-called "Cadillac tax" would force employers to pay a 40% tax on plans exceeding
$27,500 for a family or $10,200 for an individual.
While the intent of the tax is to target only high-end plans, many plans
that cover middle-class Americans will trigger the Cadillac tax, Jim Klein,
president of the American Benefits Council, said Tuesday during a press
conference that announced the creation of the Alliance to Fight the 40, a
coalition of public and private employers, unions and other organizations
dedicated to repealing the tax. Average plans would trigger the tax because
it fails to consider factors such as age, gender and location, he said.
"This is not a tax on high-end health plans," said Terry O'Sullivan, general
president of the Laborers' International Union of North America, "and it
will lower the quality of health care for working families."
The Cadillac tax gives public employers with fixed budgets three poor
choices, said Brian Marshall, the superintendent of San Diego, Calif.-based
La Mesa-Spring Valley School District. He said his district would have to
decide between reducing benefits, raising employee contributions or
decreasing student services.
In Congress, there is bipartisan support -- both Reps. Frank Guinta
and Joe Courtney (D-Conn.) have bills calling for a repeal of the tax.
Guinta said he wants a standalone bill so no one has a reason to vote
against it. "We want it to be as simple as possible," he said.
The Cadillac tax has been controversial since its inception, Courtney said,
and many ACA supporters, like him, understand that "this is not an integral
part of the law."
Courtney also questioned the Congressional Budget Office's scoring of the
Cadillac tax, calling it "highly speculative." The CBO estimated the tax
will raise $87 billion over a decade -- with a quarter of the revenue coming
from the tax and three-quarters from higher income-tax revenue based on the
assumption that employers who reduce benefits will increase wages. "That is
a very unstable analysis," Courtney said.
Because of the faulty CBO score, Guinta said he hasn't encountered the
problem of finding a way to make up the projected revenue that would be
lost. It's logical to talk to the CBO and get an amended score, he said. The
lower that score is, the less concerned Congress will be about a pay-for,
The coalition is united behind a full repeal and isn't interested in fixing
the Cadillac tax, Klein said. "We think it's fundamentally flawed both in
theory and in construction," he said.
Use of On-site
Health Clinics Points to Reduced Overall Health Costs
MyHealthGuide Source: Christopher Conover, PhD, etc., 7/28/2015,
American Journal of Managed Care: Nick Otto, 7/30/2015,
Employee Benefit News
SAS and Duke University recently
published data from a Phase I study on the connection between on-site health
care clinic usage and claims costs, with some surprising savings results for
on-site clinic users.
The study, recently published in The American Journal of Managed Care,
focused on three categories of SAS employees and their dependents:
users (who designate the on-site clinic as their primary care),
- Casual users
(designated primary care providers outside the clinic, but used other clinic
services at least once), and
- Nonusers of the on-site clinic.
- Primary care users of the clinic saved SAS close
to $600 each in health plan claims costs over three years and had 2.7 fewer
external encounters than casual users and had 1.2 fewer external
encounters than nonusers.
- Primary care user dependents had 3.5 fewer external encounters than
casual users and 1.9 fewer external encounters than non-users.
- Annual monetized use of the health plan for employees and dependents
was highest for HCC casual users relative to HCC major users (employees:
$482 greater; dependents: $598 greater).
"Our goal was to find out if our primary care patients used fewer SAS health
plan dollars than employees and dependents that use other providers," said
Gale Adcock, chief health officer at SAS. "The answer was a resounding
Medical Stop-Loss Providers
Ranked by Annual Premium Survey (last updated 4/4/2015)
Editor's Note: The following is a recurring article.
This Newsletter is often asked by readers for a list of medical
stop-loss providers and their respective premiums. Below the first of a recurring
article that attempts to lists stop-loss providers and annual premiums.
Sources includes press releases, AM Best reports, conference presentations
Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and correction is
Sources will be cited. Please send updates /
changes to Info@MyHealthGuide.com
Years Providing Stop
Associated Carriers /
Annual stop-loss Premium
CIGNA Financial Supplement 2014, P.5 12/31/2014
||Sun Life Financial
Sun Life 2/12/2015 Management Discussion of "13%
stop loss growth over 2013" of 2013 premium of $915.2M
provided by Scott Beliveau, Sun Financial
||HCC Life Insurance Company
(A.M. Best Rated: A+)
(A.M. Best Rated: A+)
||HCC Insurance Holdings, Inc.
||HM Insurance Group
||HM Insurance Group
(A.M. Best Rated: A-)
Rhenish, President & COO, 2/16/2015
||Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
4Q 2014 Financial Supplement;
Medical Risk Managers, Inc.
Voya Employee Benefits
||> 35 Years
(A.M. Best Rated: A)
Lead Financial Analyst, Voya Employee Benefits,
||> 20 Years
||Philip Gardham, Vice President,
||Independence Holding Company
||Standard Security Life Insurance
Company of New York,
Madison National Life,
Independence American Insurance Company
Independence Holding Company,
Form 10-K, page 30.
||National Union Fire Insurance
Company of Pittsburgh
||AIG Benefit Solutions
Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
||Zurich North America
Joseph Byers, Zurich North America.
||Munich Re Stop Loss, Inc.
||Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
Union Labor Life Insurance Company (ULLICO)
(A.M. Best Rated: B++)
Second Vice President, Actuarial Operations.
||Markel Insurance Company
||Markel Insurance Company
(A.M. Best Rated: A-)
Mark Nichols, Managing
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
- Amalgamated Life
- American Fidelity Assurance Company
- American National Life Insurance Company of Texas
Accident and Health
- BEST Re
- Blue CrossBlue Cross Blue Shield (various regions)
- Gerber Life Insurance Company
- International Insurance Agency
- Lloyd's of London
- Nationwide Life Insurance Company
- Pan American Life
- QBE Insurance Company
- Trustmark Insurance Company
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:
Should reader interest indicate such measures are important, this
Newsletter will attempt to collect and report.
- Ratings from Best, S&P, Moodys and others
- Capital size of the insurance company
(data collection began
- 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
Reader response and correction is encouraged. Sources will be cited.
Please send updates / changes to Info@MyHealthGuide.com.
The Value of
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
August 6, 2015
Economic Capital and ORSA - A Case Study
presented by Actuarial Society of Greater New York. This Continuing
Education / Economic Capital session explores the development of Economic
Capital models using the work done at Guardian Life Insurance Company of
America as a case study. Presenters: Prabhdeep Singh, FSA,
CERA, MAAA, and James Bryant, FSA, MAAA, Guardian
Life Insurance Company.
• Leverage CFT models to develop Economic Capital models;
• Explore some of the important considerations in developing economic,
insurance, and operational risk scenarios;
• Discuss issues related to aggregation across risks and businesses;
• Understand the challenges in attribution analysis and developing a
• Learn how Economic Capital results are incorporated into the ORSA.
Location is Guardian Life, 7 Hanover Sqr, Floor 15, Room F3, 2pm - 4pm.
Register by July 31st, 2015: Cost: $25 for paid-up members and
subscribers, $30 for other attendees.
Registration and information..
September 14-16, 2015
Self-Insurance Executive Summit in London with Special Lloyd's Tour
presented by Self-Insurance Educational Foundation (SIEF). Join senior industry executives from the United States, the United Kingdom
and other major insurance marketplaces to share knowledge and facilitate
important professional connections in London.
.Apex City of London Hotel. Conference information: 800-851-7789 and
September 14-16, 2015
2015 MCRA Annual
Conference presented by Managed Care Risk Association.
Terranea Resort, Palos Verdes Peninsula, California-overlooks the
Pacific Ocean and Catalina Island. Early bird conference fee is $650
through May 18, $750 afterwards. Hotel number is (866) 802-8000 and
mention "Managed Care Risk Association". See
www.mcraweb.org. The mission of
the Managed Care Risk Association is to support the health care
excess of loss reinsurance and provider excess markets by
facilitating information exchange between reinsurers, underwriters,
brokers, and cost containment providers.
September 28-30, 2015
SPBA Fall Meeting
Scottsdale, AZ. Society of Professional Benefit Administrators
October 18-20, 2015
National Educational Conference & Expo
presented by Self-Insurance Institute
• The Rise of Private Equity and Venture Capital in the
• Your Company and Its Future - Preparing for a Major Financial
• How does direct provider contracting work in the context of
medical travel arrangements;
• What hospital executives think about self-insured employer payment
• What has been the actual self-insured employer experience with
on-site health clinics;
• How self-insured health plans should start preparing for the ACA
• What venture capital and private equity firms are looking for when
considering acquisitions of companies active in the self-insurance
• Where all of the "big" health care claims have been coming from;
• The latest ACA compliance news;
• What to do if your plan becomes subject to a DOL audit;
• How do you determine whether reference-based pricing is right for
- Additionally, the schedule will include a "mock mediation" session
where attendees will have a front row seat to see what happens when
a self-insured group, a TPA and a stop-loss carrier have a serious
claims payment dispute. This promises to an extremely entertaining
and interactive session.
The health care sessions are part of a larger educational program
that includes nearly 40 general and breakout sessions related to the
broader self-insurance marketplace. This top-notch educational
program will be supplemented by the industry's largest exhibit hall
and incredible networking opportunities throughout the event.
Washington, DC. Call 800-851-7789 and visit
February 9-11, 2016
presented by Health Care Administrators Association (HCAA).
Caesars Palace, Las Vegas, NV.
March 30-April 1, 2016
SPBA Spring Meeting
Washington, DC. Society of Professional Benefit Administrators
July 13-15, 2016
TPA University 2016
presented by Health Care Administrators Association (HCAA). Renaissance Dallas, Dallas,
October 17-19, 2016
SPBA Fall Meeting
Minneapolis, MN. Society of Professional Benefit Administrators
February 8-10, 2017
Executive Forum 2017 presented by Health Care
Administrators Association (HCAA). Bellagio, Las Vegas, NC.
March 15-17, 2017
SPBA Spring Meeting
Washington, DC. Society of Professional Benefit Administrators
September 13-15, 2017
SPBA Fall Meeting
Cincinnati, OH. Society of Professional Benefit Administrators
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
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