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Healthx and CieloStar Partner
To Launch Enrollment Solution to Reduces Costs and Streamlines Operations
MyHealthGuide Source: CieloStar, 4/26/2016,
www.cielostar.com and www.healthx.com
INDIANAPOLIS -- Healthx, Inc., the leader in cloud-based
digital engagement solutions for healthcare payers and other stakeholders,
and CieloStar, a leading nationwide healthcare benefits distribution and
payment technology company, announced a partnership to offer CieloStar's
enrollment capabilities on the Healthx member engagement platform. Healthx
officials state this is part of a larger integrated partner solution
strategy to bring more robust, comprehensive solutions to its customers.
The Healthx Enrollment Solution is pre-integrated on the Healthx platform. TPAs and commercial health plans that purchase
this solution can expect to see significant cost reductions while
streamlining operations, according to Sean Downs, CEO of Healthx.
"Managing eligibility and the entire benefits administration process can be
an administrative nightmare when dealing with medical claims, flexible
spending accounts, COBRA and other offerings. This is now simplified with a
seamless system that ties these benefits together in a unified tool to
manage employee benefits from hire to separation."
Downs said employees and members will also value the solution. "Trying to
navigate through multiple benefits systems and programs can be downright
confusing for the member," said Downs. "We simplify this by automating the
benefit administration process into a single platform with all the tools the
member needs, such as their payer medical plans, COBRA, flexible spending
account, health spending account, and so on. It can be a real challenge, but
by unifying these functions into a single-source tool, we're making
healthcare easier for the member."
CieloStar says the partnership is a natural fit with their capabilities.
"The demands on payers to increase member engagement while reducing costs
and improving the overall health of their members are increasing every day,
and Healthx is literally a pioneer in unifying information for payers,
members and providers," said William Mehus, chairman and CEO of CieloStar.
"The objective of unifying systems into a seamless experience is at the core
of our capabilities, and we're excited to partner with a like-minded
This partnership marks the first in several new offerings Healthx is
planning to roll out this year. "CieloStar fits perfectly into our
integrated partner solutions strategy," said Downs. "We recognize that TPAs
and commercial health plans need to provide more robust self-service tools
for their members to manage their own healthcare. To that end, we have set a
course to partner with some of the most innovative engagement providers and
wrap these capabilities into one very powerful solution to empower people to
improve their own healthcare while making our customers more efficient and
competitive." Downs concluded, "We are very excited about our relationship
with CieloStar, and to share more offerings in the coming months, which will
be a game changer in member engagement."
About Healthx, Inc.
Healthx provides the healthcare industry's leading digital engagement
platform connecting our payer customers to their consumer, provider,
employer and broker constituents. As an innovator in cloud-based technology,
Healthx supports over 170 payers representing 20 million members and 600,000
providers. Our engagement expertise enables us to guide customers to achieve
their business objectives by driving online portal and mobile app
utilization and producing measurable ROI. The platform can integrate with
over 150 third party applications, customized into a seamless user
experience across the consumer engagement ecosystem including shop and
enroll, managing benefits, cost transparency, payment processing, wellness,
health education and other specialty content. Healthx is a proven and
trusted partner, led by healthcare and technology experts passionate about
delivering engagement solutions that drive outcomes.
Contact Ron Wozny, Vice President of Marketing, at 317-550-3244,
www.healthx.com and follow Healthx on Twitter, LinkedIn and Facebook.
CieloStar has been helping employers and employees nationwide navigate the
ever-changing world of benefits since 1988. The company's expanding suite of
products and services includes web-enabled and mobile high-tech, high-touch,
integrated EDI and SaaS based solutions, sophisticated decision support and
benefits administration technology, private exchanges, enrollment solutions,
health and wellness tools, consolidated billing systems with auto
reconciliation, and an automated marketing, enrollment, rating, quoting,
underwriting, onboarding and eligibility management solution for the
self-funded marketplace. CieloStar, headquartered in Minneapolis, Minn., is
privately-held and employee-owned. Visit www.cielostar.com for more
information. Contact Paul Walther, President, at 612-436-2721,
and visit www.cielostar.com.
Companion Life Announces
Austin Scott as Director of Marketing in the Specialty Markets
MyHealthGuide Source: Companion Life, 5/20/2016,
Companion Life is pleased to announce that Austin Scott, Director of
Marketing in the Specialty Markets division since 2010, has been promoted to
Assistant Vice President of Sales and Marketing. In his new position Scott
will continue to be responsible for managing current client relationships as
well as helping Companion Life in its growth strategy across all product
"Austin has done a great job over the last 6 years in helping Specialty
Markets grow and diversify our portfolio," said Phil Gardham, Chief
Operating Officer of Companion Life. "This promotion is well deserved and
his new role going forward will be key to Companion Life's continued
Scott, a native of Columbia, has helped diversify the specialty markets
product portfolio as well as manage some of Companion's key client
relationships. Before coming to Companion Life, Scott was in sales at a
reinsurance intermediary company where he began his career in the insurance
About Companion Life
Headquartered in Columbia, S.C., Companion Life has
specialized in employee benefits since 1971. The company markets life,
dental, disability, accident and specialty health plans including medical
stop loss, limited benefit health plans and group supplemental retiree
prescription drug plans, as well as other insurance programs through a
network of independent agents and brokers, general agents and managing
general underwriters. Companion Life is licensed in 49 states and the
District of Columbia. It holds an A.M. Best Rating of A+ (Superior).
Lucent Health Hires Lorrie Lacko as Senior Account Executive
MyHealthGuide Source: Lucent Health, 5/17/2016,
Nashville TN -- Lucent Health, the leading
Healthcare Risk Management, Administration and Advisory Services company,
announced the hiring of Lorrie Lacko as a Senior Account Executive.
Effective immediately Lorrie will lead the relationship management, delivery
of services and ongoing support of strategic accounts within the Texas
region and across the nation. Before joining Lucent Health, Lorrie was an
Account Executive at MHBT and Director of Employee Benefits with TexCap
Concord Insurance Services where she led account teams in consistently
delivering innovative and high-care services.
Lorrie's background includes an impressive 20 year career in employee
benefits. She has a tremendous success record from dedicating her career to
serving the complex healthcare needs of employers and aligning each client's
unique needs with the best-fit solutions that drive down the cost of
"Lorrie has built strong and lasting relationships with industry leaders in
Healthcare including, insurance providers, claims & risk managers,
underwriters, and related service partners; she will consistently provide
the most competitive and high-value service options to Lucent Health
clients," said Clay Timmons, Senior Vice President of Sales for Lucent
Lorrie will be based out of Lucent Health's Irving Texas office. She resides
near Irving with her husband and teenage children.
About Lucent Health
Lucent Health, based in Nashville, dramatically reduced
employer healthcare risks and costs while improving employee access to
innovative healthcare services. Lucent Health developed the most advanced
risk-reduction solution for self-funded healthcare groups and continues to
lead the industry revolution with its innovative e2 MEC/MVP, reference based
pricing and captive services while serving over 140,000 members and
processing $600 million in claim value annually. Follow Lucent Health on
Twitter, LinkedIn and Facebook. Subscribe to the latest Lucent Health news.
Mark Stephen Ware,
Senior Vice President,
Corporate Marketing, Branding and Strategic Alliances, at
and visit www.lucenthealth.com.
INETICO Appoints Ray Longo as
Sales Executive, Eastern US, and April Tomberlin as Marketing and Sales
MyHealthGuide Source: INETICO, 5/18/2016, www.Inetico.com
Tampa, FL -- INETICO Care and Claims Management is pleased to announce that
Ray Longo, Sales Executive and April Tomberlin, Marketing and Sales Support
Manager have joined the firm to further expand INETICO's portfolio of
regional and national accounts.
Raymond Longo has over twenty years of healthcare experience in sales and
operations, including medical benefits, insurance, TPA, employee assistance
programs, work life, wellness, human resources solutions, and behavioral
health. Ray works as a strategic partner to understand the needs of clients,
brokers, and consultants to develop and implement innovative, engaging, and
Ray said, "I am excited to be a part of the Inetico team. Inetico's
innovative healthcare products and solutions are a game changer in the
market place. I am proud to advocate the great solutions which help plan
members to control costs and improve their health."
April Tomberlin joins the INETICO team as Marketing and Sales Support
Manager, with 20+ years in the financial services and healthcare industry.
April most recently worked with Florida Hospital West Region, a division of
the Adventist Health System, supporting the marketing department. In
addition to her healthcare experience, she also has knowledge of the
financial services industry. During her tenure with OMNI Tax & Financial
Advisors, she coordinated marketing efforts to enhance the firm's high
net-worth client relationships and develop new client relationships. She is
a Lee University Alumni, and a proud mother of two children.
April said, "It is an honor to have the opportunity to work at INETICO and
be a part of an entrepreneurial company that is innovative and has
integrated solutions. I am excited to collaborate with a passionate group of
people that are conscious of the financial wellness of healthcare plans, and
strive each day to be accountable, insightful, and interactive with clients
Linda Ludwick, COO of INETICO, said, "We are excited to
continue our expansion in the market place and amplify our Innovative
platform! Ray and April are both dynamic people and will be great team
Established in 2004, INETICO provides healthcare cost containment services
to self-funded, fully insured and various health care entities across all of
the United States. INETICO has developed its products and people with a
mission: INETICO is committed to strengthening the fiscal health of the Plan
while improving the clinical health of the Plan Members. Contact
Linda Ludwick, Chief Operations Officer, at 877-601-2200,
LLudwick@Inetico.com and visit
BridgeHealth Announces Mark Stadler as CEO and Jeff Waggoner as COO
MyHealthGuide Source: BridgeHealth Medical, Inc., 5/18/2016,
DENVER, CO -- Representatives of BridgeHealth Medical, Inc.
("BridgeHealth"), the country's leader in lower cost, high-quality, bundled
surgical case rate benefit plans, announce a new executive management
team to lead the company as it continues to grow and expand its operations
| Mark Stadler
Chief Executive Officer
|| Jeff Waggoner
Chief Operations Officer
On June 1, 2016, Mark Stadler will join BridgeHealth as Chief Executive
Officer (CEO) and will be responsible for the strategic direction of the
organization. Jeff Waggoner will become President and Chief Operations
Officer (COO). Together, they will be responsible for the overall management
and growth of the company.
BridgeHealth is a bundled medical services benefit management company that
offers a suite of products for self-insured group health plans to improve
the quality and outcomes of surgery, reduce costs, and positively affect the
rate of unnecessary surgery. In 2015, BridgeHealth was named No. 812 on the
prestigious Inc. 5000 list as one of the fastest growing private companies
in America, with three-year sales growth of 546 percent.
"We are excited to continue BridgeHealth's rapid growth under the leadership
of such a talented executive team," said David Calone, chairman of the Board
of Directors for BridgeHealth. "This management team has the experience to
help BridgeHealth reach an even larger base of organizations offering
self-insured health plans, while at the same time expanding our top-rated
provider network. Our company has grown so quickly because we are committed
to delivering high-quality outcomes at lower costs," Calone said.
Stadler, who comes to BridgeHealth from HealthSmart Holdings, Inc., where he
served as Chief Marketing Officer, said he is excited to join the
BridgeHealth family. "This company is truly unique, offering clients
real-cost savings and excellent medical care," he said. "Creating a network
of the most qualified providers across the country helps our members receive
the best clinical outcomes at a lower cost, while eliminating complicated
billing procedures. With the help of some of the most strategic thinkers in
the business, I look forward to guiding BridgeHealth on its continued path
During his nearly 40-year career, Stadler has served in multiple executive
positions that include Senior Vice President for the U.S. Markets for
Great-West Healthcare, Chief Growth Officer for Optum Health, and Chief
Sales Officer for American Enterprise Group. Additionally, he has an
extensive background in health care consulting, where he spent nearly 18
years with Mercer Human Resource Consulting.
Waggoner, who recently served as interim Chief Executive Officer of
BridgeHealth, said, "BridgeHealth is a leader in the health benefits
industry, and because of the value delivered to sponsors, members, and
providers through our high-quality, lower-cost bundled medical service
offerings, and facilitated process, the company continues to grow at a rapid
pace," he said. "This is a testament to our employees, plan sponsors, plan
members, and providers. I am committed to working with Mark to oversee the
continued success of BridgeHealth today and in the future."
Waggoner brings nearly 30 years of experience in the structuring and
development of high-performance organizations to create technology and
market disruptive solutions in the defense, aerospace, telecommunications,
health insurance, financial services, media and advertising, and health care
fields. He brings expertise in scaling organizations at all stages from
pre-Angel concept to Fortune 10, managing sustainable rapid growth in a wide
variety of functional managerial and senior executive roles.
Founded in 2007, BridgeHealth is a bundled medical services benefit
management company that offers a suite of products for self-insured group
health plans to improve quality and outcomes of surgery, reduce costs and
positively affect the rate of unnecessary surgery. Through decision support,
a high-quality narrow network, care coordination and other strategies,
clients get real savings in cost and high-quality outcomes while providing
an outstanding patient experience through a facilitated process. Clients
achieve very quantifiable results for themselves and their employee/plan
members in a manner that integrates with their full suite of health plan
benefits. BridgeHealth is headquartered in Denver, Colo., with offices in
Chicago, Ill. Contac Susan Lavenski at 304-545-8006,
email@example.com and visit
Foundation for Complex Healthcare Solutions
Todd Hancock as Newest Board Member
MyHealthGuide Source: Foundation for Complex Healthcare Solutions, 5/16/2016,
INDIANAPOLIS -- Todd Hancock was announced as the newest board
member of the Foundation for Complex Healthcare Solutions.
Mr. Hancock is the President of International Medical Group. IMG is a leader
in the global medical and travel insurance market. Headquartered in
Indianapolis, IMG also has offices in the United Kingdom and Dubai. Being
responsible for the administration of IMG's global insurance operations Mr.
Hancock has been a core leader for the company.
Mr. Hancock over the years has demonstrated his skills and his efficiency by
managing the operational integrity of numerous reputable insurance and
multicultural healthcare organizations across several continents. With a
focus at each continent on global health and benefits plan design,
cross-cultural employee development, and the optimization of high
performance and organizations.
Doug Stratton, the Foundations Chairman of the Board, stated, "It has been
a pleasure to getting to know Todd. His leadership qualities and passion for
finding innovative solutions for complex healthcare conditions, makes him a
perfect fit for our Board."
Todd Hancock added, "I am excited to be a part of an organization that is
working to change the dynamic of healthcare by providing individualized care
and prevention models that achieve better outcomes."
About the Foundation for Complex Healthcare Solutions
The Foundation is a not-for-profit 501(c)3 organization with the purpose of
developing and supporting innovative healthcare programs for individuals
with chronic, complex, and complicated conditions living in the State of
Indiana. The Foundation works with self-funded employers, provider
organizations, research organizations, other non for profits and commercial
payers in Indiana to support the care of individuals who can benefit from
Foundation programs and to research alternative methods of health and
wellness approaches. All programs result in quality study outcomes. Contact
Eric Banter, COO, at
and visit www.foundation-chs.org.
HIIG Accident & Health Has an Immediate Opening for Senior Stop Loss
MyHealthGuide Source: HIIG Accident & Health, 5/17/2016,
Join HIIG Accident & Health's growing team! Be a part of a rapidly expanding
company that values your expertise and contributions.
This position is responsible for determining acceptability of insurance
risks and appropriate premium rates for large, complex stop loss renewals /
prospect employer groups in accordance with underwriting guidelines and
The role can be located in any of the following regional offices: Malvern,
PA, Indianapolis, IN, Wakefield, MA, Atlanta, GA, Dallas, TX, Scottsdale, AZ
Essential Duties and Responsibilities
- Relies on experience and judgment to review risk, set pricing, negotiate,
and accomplish goals.
- Independently provides detailed explanations to sales regarding conditions
and requirements of quotes, rating decisions and underwriting guidelines.
- Analyzes stop loss claims experience; combines with manual in accordance
with credibility factors to determine appropriate rate levels for new
business and renewal accounts using a variety of pricing and funding
- Reviews plan design and calculates rates for requested or recommended plan
- Composes, prepares, and generates correspondence, proposals, and other
reports as needed or required.
- Develops and communicates new business or renewal rate recommendations and
decisions in accordance with level of underwriting authority.
- Processes sold accounts and/or confirmed renewals following established
- Manages new business or renewal accounts to balance profitability and
- Monitors performance of assigned book of business and initiates actions to
improve performance when needed.
- Develops and maintains relationships with clients, producers, and sales
representatives to support Company's production goals and persistency.
- Provides competitive feedback on rates, products, pricing and marketing
- Makes presentations to peers, producers, and leadership as necessary.
- Acts as a mentor to lower level underwriters by answering questions,
reviewing accounts that exceed their authority level, and offering
- Manages projects as assigned.
- Carries out stop loss training on simpler concepts as assigned.
- Other duties as assigned.
Essential Requirements for Education and/or Experience
- Bachelor's Degree and 5 years of related experience and/or training; or
equivalent combination of education and experience.
- 5-7 years of progressively complex medical stop loss underwriting
Specialized Knowledge/Beneficial Skills and Experience
- Professional certifications (HIAA, CEBS, etc.) beneficial.
- Strong understanding of stop loss industry concepts, practices and
- Proficient in Microsoft Office Suite (Outlook, Word, Excel ).
- Excellent written and verbal communication and presentation skills.
- Strong analytical skills and the ability to pay attention to details.
- Ability to carry out assignments within parameters of instructions given,
prescribed routines and standard accepted underwriting practices.
HIIG A&H offers
- A competitive base salary with performance based commissions
- Leadership development through individualized support and mentoring
- Medical benefits, STD/LTD, Life, Dental, Vision, 401k, PTO
- Background check including drug screen
Interested candidates should email their resume to
HIIG is a Houston based, fast expanding insurance group that provides
creative solutions for our clients' specialized needs. HIIG writes business
throughout the USA and Internationally through its underwriting divisions
that include Accident & Health, Construction, Energy, Professional,
Transactional Property, and other Specialty business. Visit
OneBeacon Insurance Group Seeks HMO Reinsurance and Provider Excess of Loss
MyHealthGuide Source: OneBeacon Insurance Group, 5/18/2016,
The Underwriting Consultant will develop and execute strategic initiatives
that contribute to the growth and profitability for a book of business in an
assigned territory. This includes the selection and rejection of new and
renewal business for the most complex, specialty accounts within the highest
underwriting authority levels.
Focus is typically on new business production and large account management.
Viewed as a senior resource and may act as a technical expert for a
particular line of business. Position can sit in any OneBeacon office or
- Maximizes opportunities for underwriting profitable new and renewal
business, as appropriate based on market conditions, by leveraging business
relationships, product knowledge and underwriting acumen. Develops and
maintains an active target account list tracking prospects and account
rounding and/or missed opportunities. Manages financial performance of all
assigned products in assigned territory including: accident year loss ratio,
premium plans (including new business, retention, and rate/exposure
increases), and commission targets.
- Underwrites a book of business. Manages underwriting quality and book
management. Executes underwriting strategy, including portfolio management,
self-audits of new and renewal business and well documented approvals of
underwriting edits. Ensures compliance with standards and assigned
- Demonstrates a strong understanding of exposures and key coverage issues.
Makes underwriting decisions to accept, decline, or modify risks within the
highest production underwriter authority levels. Implements underwriting
decisions in compliance with state laws.
- Develops superior working relationships with producers to successfully
promote achievement of mutual growth and profitability goals and to supply
the appropriate products and services. From a sales perspective, has the
ability to identify gaps in coverage and/or services, understands where
OneBeacon can make a difference based on those gaps and uses that
information to help retain or obtain a customer. Works closely with and
establishes strong business partnerships with other OneBeacon departments,
including claims, actuary, and risk control staff in an effort to better
service producers and accounts.
- Regularly travels to key producers/accounts and remains highly visible in
the marketplace. Anticipates the needs of the agency plant, analyzes trends,
and implements proactive strategies that best position the business.
Understands and communicates the OneBeacon underwriting appetite and
generates qualified business in support of that appetite. Monitors agency
action plans and participates in agency planning and marketing meetings to
best position the business for the future.
- Gathers and analyzes competitor information and producer specific reports
on assigned producers' new business flow, retention, profitability and
potential, to support territorial rate reviews. Works with other
underwriting staff to determine and make recommendations for marketing,
pricing, products and systems.
- Expert knowledge of HMO Reinsurance and Provider Excess of Loss technical
underwriting, pricing, and coverage issues. Must be a proven self-starter
with strong multi-tasking and relationship management skills. Must have
superior negotiation, marketing and sales skills.
- Must maintain strong professional knowledge of legislative issues,
industry trends and marketplace issues for the line of business within the
territory. Must be able to work in a fast pace and rapidly changing
- Must be able to act as coach and mentor to junior members of the
department. Must possess a high and extensive level of technical knowledge
and skills including product and industry.
Education and Experience
- Bachelor's degree or equivalent experience.
- 7-10 years of progressively more complex, specialty lines underwriting
- Professional insurance designation is preferred (AICPCU, RPLU).
To apply, please visit www.onebeacon.com/careers - Refer to Job #411BR
OneBeacon Insurance Group is a specialty company that focuses on the unique
risks faced by certain industry groups that we believe would benefit from
specialized expertise, tailored products and an intense commitment to
At OneBeacon, we believe that specialized expertise matters. Through our
underwriting companies, we offer a broad range of specialty insurance
products and services sold through independent agencies, regional and
national brokers, wholesalers and managing general agencies. Each OneBeacon
business is managed by an experienced team of specialty insurance
professionals focused on a specific customer group or industry segment they
know well. Visit www.onebeacon.com.
Tokio Marine HCC Seeks
Vice President Marketing and
Senior Underwriter in Southeast Regional Office
Tokio Marine HCC, 5/13/2016,
Tokio Marine HCC -- Stop Loss Group, a leading provider of medical stop loss
insurance, has the following open positions:
Senior Underwriter -- Southeast Regional Office -- Kennesaw, Georgia
As a Senior Underwriter for the Southeast Region, you'll establish and
maintain producer relationships while making underwriting recommendations
and decisions to protect the financial assets of the company. The geographic
territory of the region includes Alabama, Arkansas, Florida, Georgia,
Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee,
Virginia, West Virginia.
Qualified candidates will possess a four-year degree, and 5-7 years previous
experience and success in health insurance underwriting, and excellent
analytical, organizational, and communication skills.
Vice President, Marketing -- Southeast Regional Office -- Kennesaw, Georgia
As the Vice President of Marketing for the Southeast Region, you'll
establish and maintain producer relationships while making underwriting
recommendations and decisions to protect the financial assets of the
company. The geographic territory of the region includes Alabama, Arkansas,
Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South
Carolina, Tennessee, Virginia, West Virginia.
Qualified candidates will possess a four-year degree, and 8 years previous
experience and success in health insurance marketing, and excellent
analytical, organizational, and communication skills.
Interested individuals should email a current resume to
About Tokio Marine HCC -- Stop Loss Group
For more than 35 years, HCC Life Insurance Company, operating as Tokio
Marine HCC -- Stop Loss Group, has been leading the way in medical stop loss
insurance for employers and plans who self-fund their benefit plans. Rated
A+ (Superior) by A.M. Best Company, Tokio Marine HCC -- Stop Loss Group is
backed by the financial stability of its parent company, Tokio Marine HCC.
Tokio Marine HCC
Tokio Marine HCC -- Stop Loss Group delivers competitive coverage through
exceptional customer service. Our team of underwriters, claim specialists,
actuaries and medical professionals provides personal service and
professional expertise to a network of producers and third party
administrators (TPAs) across the United States. Visit
Lucent Health Seeks Vice President of Underwriting/Sales Support
MyHealthGuide Source: Lucent Health, 5/13/2016,
Lucent Health Seeks Vice President of Underwriting/Sales Support
with location in Nashville, TN or Dallas, TX
The Vice President, Underwriting/Sales Support manages all aspects of sales
and proposal support for Lucent's self-funded solutions including stop-loss
partnerships, staff management, proposal development, and adherence to
Essential Job Functions
- Manage all aspects of sales and proposal support for Lucent's self-funded
- Manage stop-loss partnerships
- Assure competitive stop-loss pricing for clients and prospects
- Assure timely delivery of competitive proposals to brokers and
- Assist company to meet and exceed growth and profitability goals
- Ensure adherence to Underwriting standards, compliance, and internal audit
- Maintain operational process and workflows
- Develop organizational and operational metrics to contribute information
and analysis for strategic plans and reviews
Qualifications & Skills
- Bachelor's Degree required
- MUST HAVE 5 or more years of experience managing a sales support team
- MUST HAVE 10 or more years of stop-loss underwriting experience
- Experience with developing and implementing sales strategies
- Ability to effectively negotiate sales contracts and proposals
- Detail oriented, organized and able to meet tight deadlines
- Strong understanding and experience utilizing Sales Force (SFDC)
How to Apply
Interested persons may apply on LinkedIn at
https://www.linkedin.com/jobs/view/132369591 or email their MS Word resumes
to Alex Arnet, firstname.lastname@example.org.
About Lucent Health
Lucent Health, based in Nashville, empowers US employers by
dramatically reducing healthcare risks and costs while improving employee
access to innovative healthcare services. Lucent Health developed the most
advanced risk-reduction solution for self-funded healthcare groups and
continues to lead the industry revolution with its advanced referenced based
pricing, e2 MEC/MVP, and captive solutions while serving over 140,00 members
and processing $600 million in transactions annually. Follow us on Twitter,
LinkedIn and Facebook. Subscribe to the latest Lucent Health news.
Market Trends, Studies, Books & Opinions
The OPEC of Healthcare
MyHealthGuide Source: Mike Dendy, MBA, MHA, Vice Chairman
and CEO of Advanced Medical Pricing
Solutions, Inc., 5/21/2016
Healthcare costs for employers continue to skyrocket. According to the
Kaiser Family Foundation, family premiums are up from approximately $10,500
in 2005 to over $17,000 in 2015. This increase occurred in spite of hundreds
of new companies and services being created to contain healthcare spending
over the last 10 years with ObamaCare blended in for good measure as well.
Hardly a day goes buy that I don't hear someone touting "a breakthrough"
that will assist employers in keeping cost trends in check and some even
dare to suggest maintaining "flat" cost levels. The problem with the host of
utilization management, wellness, on-line provider options etc. is that they
are all working around the periphery of the healthcare cycle and thus have
no real opportunity to truly assist an employer in reducing healthcare
costs. If you are thinking that the PPOs have the answer, think again, since
PPOs came into existence about 25 years ago healthcare costs are up by
nearly 4x (Kaiser). According to the Peter G. Peterson Foundation, US per
capita spending on healthcare is more than twice the average of other
developed countries. PPOs are a big part of the problem by the way as their
models are only intended to perpetuate their middle-man cost escalating and
opacity inducing existence.
So, what is the problem and how does an employer truly start to reign in
healthcare spending? The problem is easy and here is the breakdown:
- Hospitals: Makes Own Pricing, Unregulated Utilities
- Physicians: Greater Utilization = More Income
- Insurance Concerns: Higher The Cost, Greater The
Profit (Even W/Fixed Margins)
- Brokers: Mostly, Higher The Cost Greater Their
- Pharmacy: Unabated Greed, No governors On Price Or
- Ancillary Services: Greater The Turmoil, The
Greater The Need
- Employee/Members: Have little to no financial
interest in their purchase decisions
Who Loses? Employers, Employees and General Public
Is there a breaking Point?
In the aggregate, these healthcare players are healthcare's OPEC.
Like the oil producing cartels that for many years controlled the
cost of the world's energy in unencumbered fashion, there is absolutely no
catalyst for healthcare providers to reduce their costs or for an employers
covered members to be concerned whatsoever with their spending. I know of no
CEO or company that is willing to raise their hand and ask that fees or
salary paid to them be reduced so that they can provide their crucial
services at a more affordable level.
OPEC laughed at the US and the rest of the world when we complained
that $120 per barrel oil was choking the life out of business and the public
in general around the world. Rather, they built ski mountains in their
deserts out of the rest of the world's money and threatened to drive oil
prices even higher.
Until it ended. OPEC's strangle-hold on the world ended
when other countries, led by the U.S. and Canada started finding alternative
ways to produce oil themselves (fracking) and started to initiate aggressive
efforts in alternative energy. Note if you will that just a few months ago,
the OPEC countries were willingly and aggressively pumping oil and selling
all that they could for less than $30 per barrel. Since it only costs the
OPEC countries about $10 per barrel to extract oil, there is still a
significant margin in the pricing of oil at $30 per barrel.
- Like OPEC's weakening, a similar metamorphosis is available for
healthcare costs but such will require an external catalyst in the form
of employer righteous indignation with a bit of help from the
Let's start with hospitals.
A well run hospital can make money from Medicare payment schedules. The
problem is that most hospitals are not financially well managed and have no
reason to be when they can pretty much charge for services at will. Through
commercial payer sources (the PPOs), hospitals around the country are
collecting on average about 260% of what Medicare would pay for the same
Look at that number, 260%, closely, a hospital can make
a profit on Medicare yet they are collecting 2.6 times that amount from
commercial (employer) payers. While there are some markets where the average
commercial payment is below the 260% of Medicare number, there are many more
where that number is significantly greater going as high as 1,000% of
Medicare at times. It is stunning to think that an area of cost for many
companies that represents as much as 15-20% of the total cost of a business
is spent in such a clouded and non-transparent way. Providers and the large
health insurance companies have hidden this incredibly crucial data from
employers for the last 25 years and continue to do so. An employer not
having transparency into this information is beyond preposterous.
So, where does the excess money go within a hospital, many claim to be
financially insolvent at some level. According to a study first reported in
Health Affairs September 2014 edition, U.S. hospitals have
administrative costs that are significantly greater than their counterparts
in other countries.
- Administrative costs account for 25% of total US Hospital expenses
according to the study.
- The US has the highest administrative expense of all countries
studied and US hospital expenses are twice those of Canada and Scotland.
- The Netherlands had the second highest administrative expense ratio
coming in at 20%.
The article continues that were US Hospital expenses reduced to the level
of those of Canada, US hospitals would have saved $158 billion in 2011. In a
well-vetted interview with CBS News 60-Minutes, the CEO of the
University of Pittsburgh Medical Center admitted to having a base salary of
$8,000,000 annually. I also understand from well-informed sources that
Sutter Medical Center in California has over 30 executives on staff that are
paid more than $1,000,000 annually. Seems a bit much when hospitals are
protected like utilities yet have the ability to set their own pricing
levels to support poor management and potentially overpaid executives. For
what it's worth, the study reported no apparent link between higher
administrative costs and better quality care.
Physicians are much less of an issue but still need to be considered.
"Managed care" supposedly took care of physician cost escalations by
creating reasonable and customary tables for every possible physician
directed procedure. In many cases, managed care and Medicare and Medicaid
don't pay physicians enough for procedures to allow them to adequately cover
their costs and make a reasonable profit. So, the logical answer for the
physicians who can't be paid enough on a single visit to cover their costs
is to just increase utilization via second and third visits many of which
are absolutely unnecessary.
It is ironic to consider the fact that an average physician's salary in
the US ranges from $174,000 to $413,000 according to a recent study
published by Medscape when comparing to the pay level of at least some
hospital executives. Another issue that should raise the ire of
employer/payers is the fact that hospitals are buying physician practices
hand over fist to first control referral patterns and second become a new
profit center. These purchases are almost always accompanied by significant
increases in the pricing of the physicians' services.
Health Insurance Companies
Health insurance and administrative services are mostly a commodity and thus
must be price sensitive. The large insurers seek to maintain a steady margin
of somewhere between 4% and 8% but of course, as the cost of insurance goes
up their revenues go up even with a fixed margin. So, as the cost of medical
service payments to providers goes up, the insurance company's profits go up
We have already reviewed the fact that the PPOs negotiated rates often
pay 2x to 4x what Medicare would pay. So for an insurer/PPO to push
providers for more reasonable reimbursements of a smaller margin over
Medicare would mean they would be negotiating their own revenues downward as
- In another note of irony, employers entrust their health-plans
and share fiduciary responsibility with large health insurers that, as
we have shown, have the absolute opposite financial objective as the
employer. How can an administrative service only (ASO) provider that
owns a PPO, which intentionally overpays to perpetuate their own
existence, operate to protect an employer's plan assets?
Remember that these same organizations hide the data necessary for an
employer to understand and then act upon this illusion of partnership and
Most quality brokers are now working off of a very transparent fee basis and
don't have their incomes tied to an employers' overall spend. However, I
recently visited with an employer in Texas that has about 300 employees and
a broker that is paid over $300,000 annually on their account. I hear of
such egregious over compensation occasionally and wonder if the employer
does not know what their broker is being paid or does not care. I would
suggest that it is a breach of an employer's fiduciary responsibility to
their plan members to make gross overpayments to brokers (or anyone else for
that matter) as healthcare funding is typically co-mingled funding from both
the employer administrative cost and employee/members health spend.
Pharmacy costs are beyond outrageous due to greed and government negligence.
Seemingly due to effective pharmacy lobbying efforts, the U.S. government
has not instituted favored nations pricing caps similar to other developed
nations. That one item could save 8-10% of overall healthcare spend in our
current economy and would appear to be a relatively simple adjustment to the
paradigm that does not affect access to services and could significantly
improve quality of services provided.
Cost Containment and Wellness
Due to the inadequacies of cost containment on all the above mentioned
elements of healthcare, employers are forced to employ multiple services
that work around the periphery of healthcare to try and reign in costs as
best they can. Programs are expensive, fragmented add-ons to the health
plan, and some are just unnecessary which adds to the cost burden for
employers. For example, many health plans employ wellness services which
encourage annual health assessments, wellness checks, and promote health and
wellness overall. While the services are valid, they tweak the overall cost
structure vs. making fundamental strides to change the approach to
healthcare delivery and financing.
Finally, we have to consider the role we play in these overcharges as
employed consumers of healthcare. For the most part, an employer covered
member of a group healthcare plan can purchase all the healthcare they care
to consume, whenever and wherever they care to consume it with absolutely no
concern for the cost of those services. Somehow, we have allowed ourselves
to believe that such is a birthright and anything less is penal and unfair.
Consider this within the context of data provided by the government on
multiple levels and private reports as well that show that oftentimes had a
member consumer just altered their purchase patterns by walking a couple of
blocks down the street, they could have reduced by half or more the cost of
that service. Were that same consumer spending their own money for a
service, they would consider it reprehensible to have not vetted the best
value for their money. Until this paradox is addressed, employers will be
forever saddled with significant overpayments on group healthcare plans.
Defined Contribution Healthcare Plans are the only Answer
An employer can spend all the time they want utilizing peripheral options
for controlling healthcare spending but, until they address how they allow
their members to purchase healthcare, nothing is going to change the cost
curve for the better.
- The solution for employers is incredibly simple, just budget
what a health plan will pay for a service and push the consumer to make
financially reasonable choices. This is not as ridiculous as it sounds.
CALPERS did exactly that with a handful of services for their California
based employees. They announced what they were willing to pay for
commonplace events like knee or hip replacements and asked providers to
raise their hands if such were not sufficient. The handful of hospitals who
initially would not accept the CALPERS payment levels quickly changed their
minds and acquiesced when they saw the volume of business they were losing.
Eliminating the "healthcare payment fairy" from the purchase equation would
force the buyers of services and the sellers of services to meet on neutral
ground and find common value.
Insurance is intended to indemnify against loss that we can't afford. That
concept can stay in place while allowing U.S. healthcare costs to come under
control through appropriate use of defined contribution healthcare programs.
The step beyond the CALPERS model noted above is for an employer to
determine a financial ratio payable for all healthcare services within their
own sponsored plans. In a well managed plan, payments to providers take into
account unique overhead (such as for teaching hospitals) and geography. A
quality plan would seek to be fair to both the provider and the payer of
healthcare services and the data to make that determination is readily
- Assume for example that 70% of hospitals in the country would
agree to provide the services of a standard baby delivery for $16,000
(the same service is delivered in Europe for about $3,000 by the way),
why would we allow payment to a hospital of $20k, $30k, or even $50k,
just because a member chose, without any consideration for cost, to have
their baby at one of the more expensive hospitals.
If that same employee were traveling on behalf of the employer a budget
would be provided as to what would be reimbursed relative to airline, hotel,
and food/ beverage charges during the sponsored trip. Few employers would be
accepting of that employee flying first class, staying at The Ritz Carlton,
or eating caviar and lobster constantly during the trip. Rather, a
reasonable budget would be provided taking into account that while hotels
are more expensive in New York than in Omaha there are plenty to choose from
and at multiple levels of expense. Controlling travel expenses are a
critical cost management item for most company's yet those same companies
take no interest whatsoever in trying to control their healthcare
expenditures in a similar way even though the bottom line effect would be
significantly greater for doing so.
There is more than amble data available to allow an employer to provide a
well-vetted defined contribution healthcare plan for their members. Hundreds
of employers are now providing such an option for their group healthcare
plans through Reference Based Reimbursement or Cost Plus programs and those
employers are being rewarded with cost reductions to their overall
healthcare spend of 20% to 40% annually. Those savings accrue to both the
employer and their employee/members alike of course ultimately increasing
take home pay and the profitability and sustainability of the organization.
The defined contribution options are also superior to the newly manufactured
narrow network program concoctions of the large insurance companies in that
they allow members to utilize any provider of their choice rather than have
a very limited provider, HMO, type of option.
The cost of healthcare in the US is financially choking our businesses and
our employees the same way high oil and gasoline prices choked us all just a
few years ago. Like with oil, the answer to reducing healthcare costs
without affecting healthcare services, quality, and outcomes is immediately
available to employers once they dutifully consider the option of defined
contribution as their delivery model.
About the Author
Mike Dendy is the Vice Chairman and CEO of
Advanced Medical Pricing Solutions,
Inc., one of America's premier healthcare cost management companies.
Mike is the former Chairman/CEO of HPS Paradigm Administrators a Third Party
Administrative services company managing group healthcare benefit plans for
commercial and government agencies. Mike has a Master of Business
Administration and a Master of Healthcare Administration degree as well as
dual undergraduate degrees in Journalism and Social Psychology and has
served employers as a healthcare consultant for the past 26 years.
Legislative & Regulatory News
Final ADA Wellness Rules: 5 Important Changes for Employer Wellness
MyHealthGuide Source: Lindsey Surratt, 5/19/2016,
Healthcare Reform Digest Article
On Monday, May 16, the Equal Employment Opportunity Commission (EEOC)
released its final rule to amend regulations under Title I of the Americans
with Disabilities Act (ADA). This final rule provides guidance about the
extent to which employers may pay incentives or provide rewards to encourage
employees to participate in a wellness program that involves a
disability-related inquiry (like a health risks assessment (HRA) or a
medical examination (like a biometric screening)).
The final rule is
effective prospectively as of the first day of the first plan year beginning
on or after January 1, 2017, for the health plan used to determine the
wellness program incentives.
In April 2015, the EEOC published a Notice of Proposed Rulemaking, giving
industry stakeholders their first look at how the EEOC might address the
ADA's voluntary requirement for wellness programs, and whether that guidance
would be consistent with HIPAA's wellness regulations and incentive limits.
The final rule made few changes to the big-ticket items addressed in the
Notice of Proposed Rulemaking.
Keep in mind that the final rule applies to "employee health programs" – in
other words, all wellness programs that include disability-related inquiries
or medical examinations, regardless of whether the wellness program is
connected to an existing group health plan. Not all wellness programs
include disability-related inquiries or medical examinations. For example,
lunch-and-learn programs or seminars on nutrition or weight loss, or
activity-based programs that require employees to exercise or walk, may be
exempt from the final rule depending on the program's design.
5 important changes for wellness programs
- No Gateway Plans: The EEOC is aware of a trend in the marketplace used by
some employers to base eligibility for a particular plan or cost-sharing
structure on the completion of an HRA or participation in a biometric
screening. The EEOC made clear that the ADA prohibits "the outright denial
of access to a benefit available by virtue of employment" and concluded that
such plan designs discriminate against the employee in violation of 42
U.S.C. 12112(d)(4). Employers that currently utilize gateway plans should
prepare to align their wellness program structure with the requirements of
the final rule.
- New Notice Requirement: For a wellness program to be considered voluntary,
employers must meet certain conditions. One of these conditions is a new
notice requirement. Employees participating in wellness programs that
involve disability-related inquiries or medical examinations must be given a
notice that describes
- (a) the type of information to be collected,
- (b) the
purpose for which the information will be used,
- (c) the restrictions on
disclosure of the information,
- (d) any employer representatives or other
parties with whom the information will be shared, and
- (e) the methods used
to ensure the information will not be improperly disclosed.
- To the extent
employers already provide communication pieces to employees that include the
required information, an employer may continue to do so. If the required
information is not provided in existing communications, the employer must
revise current communications or develop a new communication that addresses
the required information. The EEOC plans to publish a sample notice on its
website in the next 30 days.
- Incentive Limitations -- Not Tobacco Related: The final rule retains the 30%
cap on incentives from the Notice of Proposed Rulemaking, but clarifies how
the limitation must be calculated. The limitation is based on the cost of
self-only coverage. The calculation methods in the final rule address four
- (1) incentives provided to employees when participation in the
wellness program is limited to employees enrolled in the plan;
incentives provided to employees when the employer offers only one group
health plan and participation in the wellness program is offered to all
employees regardless of enrollment;
- (3) incentives provided to employees
when the employer offers only one group health plan and participation in the
wellness program is offered to all employees regardless of enrollment; and
- (4) incentives provided to employees when the employer does not offer a
group health plan. Employers with wellness programs that involve an HRA or
biometric screening are encouraged to consult with legal counsel or their
benefits adviser to determine which calculation method applies and whether
the incentive or penalty currently offered is consistent.
- Incentive Limitations -- Tobacco Related: The 30% incentive limitation
referenced above applies to programs that offer both a non-tobacco related
incentive and a tobacco related incentive. This is a significant difference
between the HIPAA nondiscrimination regulations for wellness programs and
the EEOC final rule.
- Under HIPAA, employers may provide an incentive of up
to 50% of the cost of coverage for participation in a program designed to
prevent or reduce tobacco use.
- However, under the EEOC final rule, such a
program would be subject to a total incentive cap of up to 30% of the cost
of self-only coverage.
- This limitation applies if the program involves a
medical examination, like a cotinine test administered as part of a
biometric screening or on a stand-alone basis.
- A wellness program that
merely asks an employee whether or not they use tobacco is not subject to
the lower 30% limitation, as the EEOC clarifies that such a program does not
involve a disability-related inquiry or medical examination. Employers with
programs designed to prevent or reduce tobacco use should evaluate the
design of the tobacco component of their to determine the appropriate
- Confidentiality: The final rule reiterates the ADA's confidentiality
protections for medical records. Generally, wellness programs that are
connected to a group health plan or wellness programs that meet the
definition of a group health plan are subject to HIPAA's privacy and
- The EEOC's interpretive guidance states that it is
likely wellness programs that must comply with HIPAA's Privacy Rule will
also be compliant with the ADA's confidentiality protections.
- However, for
wellness programs that are not subject the HIPAA, the EEOC's final rule
clarifies the confidentiality protections that apply to such a program.
Under these protections, employers offering wellness programs subject to
this final rule are only permitted to receive information collected as part
of the wellness program in aggregate form that does not disclose, and is not
reasonably likely to disclose, the identity of specific individuals except
as necessary to administer the plan or as permitted by the regulations.
ADA's confidentiality protections also prohibit employers from requiring an
employee to waive the ADA's confidentiality protections, or agree to the
sale, transfer, or other disclosure of their medical information as a
condition for participating in the wellness program or receiving an
incentive for participation.
- The publication of this final rule, together
with Phase 2 of the HIPAA Audit Program, indicate a renewed focus on
compliance with the confidentiality, privacy, and security measures designed
to protect employee medical records and other health information.
So what does this mean for employer wellness programs?
- Employers with
wellness programs involving health risks assessments, medical
questionnaires, or biometric screenings should familiarize themselves with
the requirements under the rule.
- Employers with calendar year plans are
encouraged to act quickly to work with their legal counsel and benefits
consultant, as the work necessary to renew the plan and handle both Form W-2
and Form 1094-C and 1095-C reporting by the end of January 2017 will make
for a busy third and fourth quarter of 2016.
Reactions to New
EEOC Wellness Program Changes from Senator, Business, Lawyers and Others
MyHealthGuide Source: Senator Lamar Alexander (R)
Tennessee, 5/16/2016 and Jayne O'Donnell, 5/16/2016,
USA TODAY and Thomas
Reuters Practical Law
WASHINGTON, DC -- The Senate health and labor committee chairman
today said the Equal Employment Opportunity Commission's (EEOC) final rules
on workplace wellness programs released "will make it harder for
employees to choose healthy lifestyles and to save money."
"Wellness programs are the only part of ObamaCare that everyone agreed
on--everyone except the EEOC," said Sen. Lamar Alexander (R-Tenn.). "Congress
was clear in its support of workplace wellness programs in the health care
law--just about the only provision in the law with bipartisan support--and the
Departments of Health and Human Services, Labor, and Treasury were clear in
their regulations implementing the law. It seems the EEOC is the only one
missing the mark."
"The EEOC is taking away authority that Congress gave the administration and
overruling the actions of the Departments of Health and Human Services,
Labor and Treasury," Alexander said. "Today's rules contradict the law and
continue the confusion the agency has caused, so Congress will need to act
to help employees seeking to improve their health, while bringing down their
Alexander said he will push his bicameral legislation, The Preserving
Employee Wellness Programs Act, to reaffirm existing law. He said he is
considering introducing resolutions of disapproval under the Congressional
Review Act to overturn the rules by a majority vote in the Senate and the
House of Representatives.
Bryce Williams, CEO of HealthMine, a data analytics company for wellness
plans, doesn't think the new rules will discourage wellness programs and
instead thinks they could now become more common among smaller companies.
The rule requires enough disclosures to address concerns and is "measured
and appropriate" given the large investment employers are making in workers'
health, he says.
An employer's wellness program has to be designed to improve an employee's
health or prevent disease.
Companies should meet the rules if they help workers understand health
risks, says Seth Perretta, co-chair of Groom Law Group's health practice
group. Problems could arise if an employer makes a financial incentive
payable if an employee achieves a certain health goal, such as a lower body
mass index, without providing more ways to help the employee meet those
goals, he says.
The Affordable Care Act clearly makes these plans legal by saying financial
incentives could be worth 30 to 50% of health insurance costs, says James
Gelfand, senior vice president for health policy at the ERISA Industry
Megan Garcia, who works at JFK Hospital in Edison, N.J., says she wouldn't
have known husband Michael had severe hypothyroidism if he hadn't been
pushed to get a blood screening test under the program. After treatment, he
feels much better, lost 20 pounds and avoided what his doctor said could
have turned into cancer within four years.
Thomas Reuters Practical
HHS expressly declined to exclude TPA services from the final regulations.
As a result, regarding an insurer that receives federal financial assistance
and is principally engaged in providing health insurance but also provides
TPA services, the insurer's TPA services are subject to Section 1557 in
addition to its health insurance functions.
HHS acknowledged commenters' concerns that a TPA that administers a
self-insured plan could be held liable for benefit plan design features that
are discriminatory under Section 1557, but over which the TPA has no
control. In this situation, HHS will assess whether responsibility for an
alleged discriminatory decision or action rests with the TPA or the
employer. If the TPA is responsible, HHS will process the complaint against
Therapy that Uses Patient DNA
to Guide Drug Selection Seems Superior to Standard Chemo
MyHealthGuide Source: Maria Schwaederle, Pharm.D., Center
for Personalized Cancer Therapy, University of California, San Diego School
of Medicine, et al., 5/19/2016,
National Institute of Health HealthDay Article
"Precision" cancer treatment that's guided by genetic clues from the
patient's own tumor appears to outperform traditional chemotherapy, a new
research review finds.
Researchers analyzed 346 phase 1 clinical trials published between 2011 and
2013 involving 13,200 patients. Those trials included 58 treatment
arms that employed precision medicine, using tumor data to select patients
for treatment, and 293 that did not.
- Patients given precision -- or personalized -- treatment experienced
a tumor shrinkage rate six times that attained by regular chemotherapy.
- Achieved tumor shrinkage rates of about 31 percent, compared to
about 5 percent in those that did not match a person's cancer to the
drug being tested.
- Patients in precision medicine arms also had nearly twice the
progression-free survival -- time spent on medication before their
cancer resumed progression -- with an average of 5.7 months compared
with 2.9 months.
- Basing therapy on a patient's DNA indicators outperformed use of
protein indicators, 42 percent to 22.4 percent.
Researcher Maria Schwaederle will present these results
at the American Society of Clinical Oncology's annual meeting in Chicago
scheduled June 2016. But until they're published in a peer-reviewed medical
journal, data and conclusions presented at meetings are usually considered
About DNA Mapping
Precision medicine aims to treat cancer by targeting the unique DNA
mutations that allow tumors to grow and spread, according to the U.S.
National Cancer Institute.
Drugs developed under this approach might help the immune system better find
and destroy cancer cells; block cancer-cell division; stop signals that form
new tumor-feeding blood vessels; or order the cancer cells to commit
suicide, the cancer institute says.
Medical Stop-Loss Providers
Ranked by Annual Premium Survey (last updated 4/16/2016)
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 update 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 2015, P.5
||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
Tokio Marine HCC
Tokio Marine HCC Life
(A.M. Best Rated: A+)
|$29,700 as part of Tokio Marine Group
Ketrice Williams, 5/6/2016
Voya Employee Benefits
||> 35 Years
(A.M. Best Rated: A)
Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
||HM Insurance Group
||HM Insurance Group
(A.M. Best Rated: A-)
||Source - Matt Rhenish, President & COO, 2/19/2016
||Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
4Q 2014 Financial Supplement;
Medical Risk Managers, Inc., 2/9/2015
||> 20 Years
||Source - Philip Gardham, Vice President,
Specialty Markets, 10/8/2014
||Swiss Re Corporate Solutions
||Standard Security life Insurance Company of New York, Westport Insurance
Corporation and Independence American Insurance Company
Swiss Re Corporate Solutions Accounting Department
||National Union Fire Insurance
Company of Pittsburgh
||AIG Benefit Solutions
FSA, FCA, VP, Stop Loss Products, AIG
Benefit Solutions, 2/1/2016
||Zurich North America
Joseph Byers, Zurich North
||Munich Re Stop Loss, Inc.
Insurance Company (AAIC),
||Source - Travis Micucci, the Chief
Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
||United States Fire Insurance Company
Lauren Woods, VP Marketing Fairmont Specialty,
Union Labor Life Insurance Company (ULLICO)
(A.M. Best Rated: B++)
Second Vice President, Actuarial Operations.
||Gerber Life Insurance Company
||Gerber Life Insurance Company
Gerber Life Insurance Company Stop Loss Director Job Description. 4/11/2016
||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 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
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
Video Highlighting Captive Solutions for Mid-market Companies
MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF),
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
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 email@example.com or 800-851-7789 for more
information about private labeling.
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501 c 3
non-profit organization affiliated with the Self-Insurance Institute of
America, Inc. (SIIA). Its mission is to raise the awareness and
understanding of self-insurance among the business community, policy-makers,
consumers, the media and other interested parties. Visit
ICD-10 Readiness Tools
MyHealthGuide Source: Industry Study Group (ISG), 9/19/2015
In the early 2000s a group of industry professionals collectively known as
the Industry Study Group ("ISG") created a Standard Disclosure Notification
form and a standardized list of ICD-9 diagnosis codes, known as the Trigger
list. On October 1, 2015, our industry transitions to the new ICD-10 coding
system. The ISG has once again undertaken the development of a new Trigger
list based on the ICD-10 diagnosis codes. Please find links to the ISG White
Paper on the process and to the new ICD-10-CM Trigger list
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.
May 23-26, 2016
WEDI 25th Annual National Conference
presented by Workgroup for Electronic Data Interchange. This forum is designed
to facilitate the groundwork underlying the future of healthcare information
WEDI provides multi-stakeholder leadership and guidance to the nation's
healthcare system on how to use and leverage the industry's collective
technology, knowledge, expertise and information resources to improve the
administrative efficiency, quality and cost effectiveness of healthcare
information. Grand America Hotel, Salt Lake City.
Information and Registration
May 24-25, 2016
Self-Insured Workers' Compensation Executive Forum
presented by Self-Insurance Institute of America.
The educational program weaves together a collection of compelling topics
including "big data" applications for claims management, how wellness
programs can help control workers' comp costs, alternatives to statutory
workers' comp, medical "over-diagnosis," SIG tax updates, and developments
contributing to the erosion of exclusive remedy.
Rounding out the program, a variety of hot topics will be addressed as part
of an "Out Front Ideas" session, and also during a separate
"Battle of the
Bloggers" session, featuring several of the leading workers' compensation
industry commenters. These sessions promise to spark lively discussions that
you will not want to miss.
May 25-26, 2016
12th Annual Canadian Captives and Corporate Insurance
Summit presented by Captive Insurance.
Sheraton Centre, Toronto, ON. Event for current and prospective captive
owners, captive managers and other professionals working in risk management
and corporate insurance. Information and registration:
June 13, 2016
Predict Suite Subscribers Workshop, an interactive forum for subscribers to
the Predict Suite of on-line diagnosis, RX, and implant management tools,
presented by Advanced Medical Strategies at Mohegan Sun, Uncasville, CT.
Contact Adria L. Garneau, CEBS,
firstname.lastname@example.org and visit
June 13-15, 2016
AMS Claims Symposium, a 2-day educational seminar for medical excess,
underwriting, and medical management professionals, presented by Advanced
Medical Strategies. Join top-industry experts at Mohegan Sun, Uncasville,
CT, for this unparalleled educational opportunity. Contact Adria L. Garneau,
CEBS, email@example.com and visit
July 13-15, 2016
TPA University 2016
presented by Health Care Administrators Association (HCAA). Renaissance Dallas, Dallas,
July 19-21, 2016
MCIA Eleventh Annual Conference
presented by The Montana Captive Insurance Association, Inc. (MCIA).
This year's program will feature key captive regulators, captive owners and
leading service providers addressing a variety of timely educational topics.
The conference also serves as the premier networking event for those doing
captive insurance business (or would like to) in the growing Montana captive
domicile. Lodge at Whitefish Lake, Montana. (www.lodgeatwhitefishlake.com).
Block of reserved rooms released on May 18, 2016. Contact Shane Byars
866/388-6242, or firstname.lastname@example.org. Visit
June 23-24, 2016
Medicare Secondary Payer Master
Class presented by Healthcare Conferences. San Diego, CA.
Self-insured identities must be able to manage
the complexity of medical and pharmacy claims while handling Section 111
reporting, conditional payments, and settlements that follow. Join us to get all of your
questions answered and ensure you have a handle on the complexities of MSP!
Information and Registration: Call 704-341-2445, email
email@example.com and visit
September 25-27, 2016
36th Annual National Educational Conference & Expo
presented by Self-Insurance Institute of America.
Austin, TX. www.SIIA.org
October 17-19, 2016
SPBA Fall Meeting
Minneapolis, MN. Society of Professional Benefit Administrators
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:
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
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