MyHealthGuide Newsletter
News for the Self-Funded Community

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



General & Company News

People News

Market Trends, Studies, Books & Opinions

Legal, Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

Guardian Life Insurance Co. Becomes SIIA Gold Member

MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 8/24/2014,

The Self-Insurance Institute of America, Inc. (SIIA) today announced that Guardian Life Insurance Company has upgraded to Gold member status.

This latest upgrade announcement is part of a strategic initiative to increase membership support of the association so that it is better positioned to protect and promote the business interests of organizations involved in the self-insurance/alternative risk transfer marketplace.

Upgraded members (Silver, Gold and Diamond) receive a variety of additional membership benefits. Details can be accessed on-line at, or by contacting SIIA Membership Director, Jenn Ivy at

About Guardian Life Insurance Company

At Guardian, we know that promises matter. We've been keeping ours for over 150 years. We've maintained our financial strength for more than a century and a half, despite the countless ups and downs of the economy, so we can meet our future obligations to the people and businesses that put their trust in us. See how our strength, vision, and values make Guardian a company you can rely on. Guardian provides stop loss for self-funded employers and other products and services.  Visit

About SIIA

he Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally.  Visit


Sun Life Financial Leverages Big Data to Help Brokers and Employers Design More Effective Employee Benefits Solutions

MyHealthGuide Source: Sun Life Financial Inc. (NYSE: SLF, TSX: SLF), 8/28/2014,

WELLESLEY, Mass. -- The U.S. business group of Sun Life Financial Inc. has launched the Benefit Profile, a powerful data analytics decision-support tool that helps brokers and employers design and deliver competitive, appealing employee benefits plans customized to meet the diverse needs of the American workforce.

As one of the leading stop-loss providers in the U.S., Sun Life is also developing a stop-loss analytical tool to help brokers support self-funded employers, and employers that are considering becoming self-funded.

The Benefit Profile uses employer-specific demographics and robust industry benchmark data to develop insights enabling brokers to design and recommend optimal benefits plans and enrollment strategies to employers.

"Rising health care costs are forcing employers to find new ways to maintain an attractive benefits package without breaking the bank," said Tom Gilligan, vice president of Sun Life U.S. Distribution Operations. "The Benefit Profile provides brokers a new level of analytical sophistication to help employers adopt the best benefits plan design given the various demographic profiles within their workforce."

How it works

The Benefit Profile's big data technology synthesizes an employer's own census data and a broad range of industry benchmarks to provide a straightforward graphic analysis that compares gender, age, and income to benchmarks based on buying patterns reflected in Sun Life policy records, and complemented by well-known industry resources such as Group MarketShare, LLC.

Key Features of the Sun Life Benefit Profile:

  • Analyzes the demographic composition of a workplace by gender, age, and income.
  • Correlates such demographics to incidence rates for medical issues.
  • Displays typical demographic buying patterns of relevant insurance solutions; for example, the average life insurance coverage men or women each choose to buy.
  • Illustrates typical benefits offerings of competing employers in the same industry and region to help employers gauge how a plan design could support cost containment or recruitment and retention.

"The Benefit Profile turns a wealth of data into actionable insight that is presented in a dashboard format, empowering brokers to deliver a highly customized, versatile benefits plan designed for each employer," said Sun Life's Bilal Kazmi, AVP, Analytics and Innovations Marketing. "It's a way for employers to assess demographic risks and provide employees with a customized range of protection options. This innovation helps employers fine tune what's working, adapt to changes in their industry and region, protect their employees, and stay competitive year after year," added Kazmi.

Hypothetical insights

  • The Benefit Profile confirms that a fictional metal employer in a Midwestern state offers long term disability benefits plan with a higher salary replacement percentage than the industry and regional average. This insight allows the employer to either promote that detail to current and prospective employees or adjust the plan to create a more affordable option for employees that remains in line with industry peers.
  • A broker may know that 30% of an employer's overall workforce is enrolled in optional life insurance. However, the broker may not know whether a particular demographic of that workforce remains underserved. Segmenting employee participation by age, gender, and income, the Benefit Profile helps identify such a potential group, for example workers earning less than $30,000 annually. This insight could lead to a more focused enrollment and communications strategy targeting certain segments of the employee population.
  • A hospital in the Southeast is considering adding new benefits to its benefits program, but is unsure which product to add next. The demographic analysis in the Benefit Profile determines that the workforce contains a high proportion of women and employees over age 40. After reviewing incidence data for a variety of voluntary products within the Benefit Profile, the employer decides that critical illness coverage would be a good fit for its employee population.

To learn more about the Benefit Profile, visit for a brief video describing five ways a Benefit Profile can help brokers and employers build more competitive benefits packages.

About Sun Life Financial

Sun Life Financial is a leading international financial services organization providing a diverse range of protection and wealth accumulation products and services to individuals and corporate customers. Sun Life Financial and its partners today have operations in key markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Malaysia, Vietnam, and Bermuda. Sun Life Financial Inc., the holding company for the Sun Life Financial group of companies, is a public company. It is not an insurance company and does not offer insurance products for sale in the United States or elsewhere, and does not guarantee the obligations of its insurance company subsidiaries. Sun Life Financial Inc. trades on the Toronto (TSX), New York (NYSE), and Philippine (PSE) stock exchanges under the ticker symbol SLF.

In the United States and elsewhere, insurance products are offered by members of the Sun Life Financial group that are insurance companies. In the United States, Sun Life Financial provides a range of products and services to employers and their employees, including Group and Voluntary Life, Disability, Dental, Critical Illness, Accident, and Stop-Loss insurance products. Product offerings may not be available in all states and may vary depending on state laws and regulations. Visit


H.H.C. Group Certified by New Hampshire as an External Review Organization

MyHealthGuide Source: H.H.C. Group, 8/29/2014,

The State of New Hampshire Insurance Department has approved H.H.C. Group as an External Review Organization.

External Review Organizations provide external peer review services when insurers deny health insurance claims. The purpose of these reviews is to determine if a service is medically necessary, medically appropriate, experimental or investigational. The Affordable Care Act requires insurance companies to contract with at least three Independent Review Organizations that are nationally accredited.

H.H.C. Group is a URAC accredited Independent Review Organization (IRO) providing both internal and external peer reviews. URAC (formerly the Utilization Review Accreditation Commission) is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations. URAC's IRO standards "assure that organizations that perform this service are free from conflicts of interest, establish qualifications for physician reviewers, address medical necessity and experimental treatment issues, {and} have reasonable time periods for standard and expedited reviews, and appeals processes."

H.H.C. Group provides Internal and External Independent Peer Reviews for insurance companies, health maintenance organizations, self-insured companies and ERISA plans. The team overseeing the review process utilizes its combined 125 years of healthcare experience to ensure that every review fully answers all questions being asked, cites the appropriate medical guidelines, and is clearly written and grammatically correct.

In addition to being approved to conduct reviews in New Hampshire H.H.C. Group's Health Insurance Adjusters (H.I.A.s) are licensed in Florida, New York, North Carolina, and Oregon. H.H.C. Group is a Utilization Review Agency in Alabama and is a Licensed\Certified Independent Review Organization in Arkansas, Georgia, Hawaii, Idaho, Iowa, Kentucky, Mississippi, Nevada, Oklahoma, South Dakota, Utah, Washington and Wyoming, an External Independent Review Organization in the States of Illinois, Ohio, Tennessee, and Virginia, a Private Review Agent in the Commonwealth of Virginia, and a Licensed Medical Claims Review Agency in the State of Indiana.

About H.H.C. Group

H.H.C. Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. H.H.C. Group utilizes a combination of highly skilled professionals and advanced information technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.

H.H.C. Group's services include Claims Negotiation, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), Claim Repricing, Claims Editing, Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Predictive Modeling, Disease Management and Pharmacy Consulting. H.H.C. Group is one of forty-six URAC accredited Independent Review Organizations. Contact Bob Serber at , 301-963-0762 ext. 163, and visit


ECHO Earns Third Straight Spot on Prestigious Inc. 500 List

MyHealthGuide Source: ECHO Health Inc., 8/28/2014,

Westlake, OH -- ECHO Health Inc., a leading innovator of healthcare payment solutions, was honored as a 2014 Inc. 500 Fastest Growing Companies recipient, marking the third consecutive year ECHO has been recognized. ECHO joins an exclusive group of alumni, including Microsoft, Patagonia, Oracle and Timberland, to be selected for this honor.

"It is an honor to be recognized by Inc. 500 as one of the fastest growing companies in the U.S. for a third year," said Bill Davis, ECHO Chairman and CEO. "Our goal is to provide the most cost-effective and efficient healthcare payment solutions possible for our clients and to help them succeed. Making this year's Inc. 500 list is a testament to our team's ability to deliver on that goal and provide our partners with the only complete settlement option in the electronic healthcare payment marketplace."

The primary criterion to qualify for the Inc. 500 was to grow more than 942 percent from the start of 2011; the average growth across selected companies was 3,313 percent. ECHO Health, Inc. earned an impressive 162 ranking on the list.

About ECHO Health, Inc.

ECHO Health, Inc. is a leading provider of electronic healthcare payment solutions. Serving more than 50,000 ERISA health plans and fully insured groups, ECHO processes more than $9 billion in payments annually to providers and members through industry-leading payers. Founded in 1997, ECHO is a privately held company located in Westlake, Ohio. Call 440.835.3511, ext. 123 and visit


Wellcentive Named to Inc. 500|5000 List of Fastest Growing Private Companies

MyHealthGuide Source: Wellcentive, 8/25/2014,

ATLANTA, GA -- Wellcentive, the industry forerunner in end-to-end population health management (PHM) for healthcare organizations, announced today that it has been named to the 2014 Inc. 500|5000 list, an exclusive annual ranking of the fastest growing private companies in America. This prestigious list has become the hallmark of entrepreneurial success recognizing innovation, leadership and revenue growth.

Ranked 1,624 nationally, the Alpharetta, Georgia-based company reported a three-year revenue growth of 262 percent from 2010 to 2013 and more than doubling its staff, adding 57 new jobs. This substantial growth garnered Wellcentive the 124th place ranking in healthcare and 55th place ranking in Georgia. For more information about Wellcentive's ranking on the 2014 Inc. 500|5000 list, visit

The dramatic shifts brought on by health reform, incentive-based quality programs, and the rising rates of chronic care conditions and costs drove rapid adoption of Wellcentive's PHM solutions. Wellcentive enables healthcare organizations - health systems, physicians, accountable care organizations, health information exchanges, employer groups and payers - to drive improved financial, clinical, and human outcomes, by aggregating data across the continuum of care, applying analytics to identify and risk-stratify patients, and delivering action based workflow to proactively manage patient health and aggressively forecast and manage outcomes and costs for populations.

"This incredible honor of being named to Inc. 500|5000 list is solid validation of Wellcentive's value to the healthcare industry," said Tom Zajac, Wellcentive's CEO. "Our co-founders Mason Beard and Dr. Paul Taylor predicted the need for proactive population health management when launching the company in 2005. Since then, Wellcentive has remained committed to its mission delivering solutions, services and insight to help our customers manage the complexities of today's environment, including the shift from a volume-based to a value-based business."

Wellcentive received industry recognition as a leader in population health management in reports by IDC Health (2014), KLAS (2013) and Chilmark (2013). The company's growth includes:

  • Managing over 200 million clinical events per month, resulting in approximately 165 million value-based reimbursement transactions across their client base
  • Aggregating disparate data from nearly 3,000 interfaces
  • Affecting over 30 million patients through its customer base of 9,000 providers

About Wellcentive

Built from the ground up to help customers improve clinical, financial and human outcomes, Wellcentive's population health management technology is cloud-based, scalable, and customized to meet the needs of providers, health organizations and payers. Wellcentive's technology, insight and services help care teams measure and report performance and implement actionable workflow to drive value-based reimbursement and the transition from volume to value. Wellcentive has gained recognition as a leader in population health management in reports recently released by IDC Health, KLAS and Chilmark. Wellcentive aggregates data from more than 3,000 interfaces, and its solutions improve outcomes for over 30 million lives. Call 877-213-8456 and visit

About Inc.

Founded in 1979 and acquired in 2005 by Mansueto Ventures, Inc. is the only major brand dedicated exclusively to owners and managers of growing private companies, with the aim to deliver real solutions for today's innovative company builders. Total monthly audience reach for the brand has grown significantly from 2,000,000 in 2010 to over 6,000,000 today. Visit


Benaissance Recognized in Top 20% of America's Fastest Growing Companies

MyHealthGuide Source: Benaissance® , 8/26/2014,

OMAHA, NB -- Benaissance® announces it has been recognized in the top 20% of the Inc. 5000 list of America's Fastest Growing Companies. This prestigious award honors the privately-held provider of financial management technology solutions for America's health benefits for performance in 2013.

Benaissance contributes its growth to the explosion of health insurance exchanges and the heightened focus on consumerism in the US health insurance industry. In 2013, the company launched its ExchangePoint SaaS platform--the premier financial management system for public and private health insurance exchanges. ExchangePoint was critical in the successful launch of two state-based health insurance marketplaces, and is today powering the exchange-based premium billing needs of health plans in 18 states supporting hundreds of thousands of American families.

ExchangePoint delivers one, easy-to-read and understand consolidated bill for health benefits to consumers and provides convenient online and traditional ways for them to pay. The solution transparently manages detailed billing and payment data through a web-based system of portals, and is a central system of record for exchanges, offering a variety of consumer tailored offerings ranging from major medical plans to dental, vision, life, and other products. ExchangePoint is also designed to manage Medicaid and SCHIP programs for state governments with exchanges.

John B. Jenkins (CEO) said, "This past year was amazing for Benaissance. As the health insurance industry has evolved, we've found a receptive market ready for our services. With our background in COBRA and retiree premium billing, our business was already experienced in regulatory compliant, transparent, and timely consolidated billing. Powering the financial management needs of health insurance exchanges is a natural transition for our business. We were able to apply our COBRA expertise to create a new cloud-based solution (ExchangePoint) and empower our exchange customers to deliver turnkey and compliant health benefits programs in the new marketplaces.

I have never been more proud of our team here at Benaissance. This award is not only a reflection of our business, but is a testament to the strong work ethic, dedication, and commitment our staff shares to deliver our very best. We are leading the enterprise technology segment of our industry and our goal is to continue learning and growing from our momentum. Together, we are building a better Benaissance and impacting access to healthcare for millions of Americans.

About Benaissance

Benaissance is the trusted financial management partner for health benefits administration. We pioneered the industry's leading ExchangePoint and COBRApoint Software as a Service ("SaaS") solutions for individual single-point and consolidated group premium billing. Together, these two solutions deliver highly efficient and scalable billing and payment solutions with easy-to-understand billing and convenient payment options--for tens of thousands of US employers and millions American families through private exchanges, state based marketplaces, and over 100 health plan and TPA customers. Contact Carrie Messinger, at (402) 991-3947, and visit


People News

The Phia Group LLC Announces Exclusive U.S. Relationship with Jason Davis

MyHealthGuide Source: The Phia Group LLC, 8/30/2014,

Braintree, MA -- The Phia Group LLC, one of the health benefit industry's leading cost-containment service providers, announced that they have agreed to a U.S. exclusive consulting agreement with Jason C. Davis. Mr. Davis will assist The Phia Group with sales and product development.

"We have grown so quickly in the last few years; we want to invest in both our existing products as well as business development infrastructure; with an eye toward future offerings," stated Adam Russo, CEO of The Phia Group. "Jason is here to help us reach the next level."

Prior to becoming an independent consultant, Jason Davis was Vice-President US Markets for Global Excel Management, where for nearly 10 years he contributed at various levels of claim settlement, dispute resolution, R&D, product development, and sales.

"Though I consult in other markets, I wanted one exclusive, long-term strategic partnership in the United States; and Phia's innovative, forward thinking attorneys -- with their energy, market presence, and industry know-how -- just seemed like a good fit for me," stated Jason Davis. "I look forward to collaborating with The Phia Group and their clients to help build products and services that are uniquely valuable, and distinctly Phia."

About The Phia Group, LLC

The Phia Group, LLC, headquartered in Braintree, Massachusetts, in an experienced provider of health care cost containment techniques, offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. The Phia Group's overall mission is to reduce the cost of plans through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service. The Phia Group has become one of the most innovative and fastest growing cost containment firms in the nation, and is a pioneer; setting the highest standards in the heath care marketplace. Contact Ron Peck, Esq., Sr. Vice President & General Counsel, at 781-535-5617, and visit


Eldorado Announces Mike Blosser as a Vice President of Sales

MyHealthGuide Source: Eldorado, 8/26/2014,

PHOENIX, AZ -- Eldorado, a division of Mphasis, an HP company, is proud to announce the hiring of Mike Blosser as a Vice President of Sales.

Blosser brings over 28 years of success in healthcare IT and healthcare solutions sales. His vast experience with enterprise payer solutions, MCO, TPA and PPO marketed products and services, including implementation, consulting, BPO and hosting, make him a dynamic and valuable addition to the Eldorado team.

"Hiring Mike represents Eldorado's commitment to growth and innovation for our payer product line," says President Sally Else. "He is an extremely talented executive with an uncanny ability to understand a customer's problem and lead them to the appropriate solution. He will be a great complement to our Javelina sales team."

"As an experienced member of the healthcare payer community, I am excited to join this long-standing innovator in the market," said Blosser. "In Eldorado's Javelina system, I see the modern platform that health plans are seeking to meet the challenges of today's changing markets -- either as a full core system replacement or for components to assist in their go-to market plan. I like what I see and I am pleased to be joining an established organization with such forward-thinking vision and know how. My goal is to make sure that more healthcare organizations are introduced to these great products and great company."

About Eldorado

Based in Phoenix, Arizona, Eldorado, a division of MphasiS, an HP Company, specializes in health insurance application development, business process outsourcing services, information technology engineering and operational consulting. The company serves the full spectrum of organizations engaged in managing health benefit plans including third party administrators, health plans, employers and self-insured organizations. Together, Eldorado customers manage five million lives and handle 35 million claims annually. Contact Sally Else at 602.604.3100, and visit

About Mphasis

Mphasis (an HP Company) enables chosen customers to meet the demands of an evolving market place. Mphasis fuels this by combining superior human capital with cutting edge solutions in hyper-specialized areas. Visit


Bardon Insurance Group hires Andrew Milesky as National Director of Sales

MyHealthGuide Source: Bardon Insurance Group, 8/26/2014,

Scottsdale, AZ -- Bardon Insurance Group announces that Andrew Milesky will be joining the team as National Director of Sales. With his previous solid, successful experience in sales and marketing to Third Party Administrators he will be responsible for maintaining our national operation as well as expanding Bardon Insurance Group's clientele to include TPAs that we have not previously worked with.

"Andrew has a solid reputation in the industry and we are very happy to have him join our team. We are anticipating a very busy 4th quarter of 2104 and first quarter of 2015 and look forward to his contribution." said Adam Thaler, Senior Vice President and Chief Operating Officer. "Andrew's extensive background along with his proven track record for generating results will insure that Bardon maintains the same high level of success as we have experienced in the past." commented Donald Thaler, President of Bardon Insurance Group. "He exemplifies the principles that Bardon established and we are excited to have him join the team."

As of September 1st, Andrew can be reached at 480-682-1414 and

About Bardon Insurance Group

Bardon Insurance Group is a managing General Underwriter of medical excess loss coverage for single employer groups with 25 to 5,000+ employee lives. Bardon operates on the principles of honesty, integrity and excellence. It is Bardon's goal to form long term partnerships with medical Third Party Administrators which share these same values. This business model has produced stability for Bardon and many of their clients in an often unstable environment. Bardon's principle operations are located in Scottsdale, Arizona with an additional location in Boston, Massachusetts.

Bardon represents American National Insurance Company rated A (Superior) by the A. M. Best Company. Bardon is a member of the Self-Insurance Institute of America (SIAA), Health Care Administrators Association (HCAA), Texas Association of Benefit Administrators (TABA) and is a Stop Loss Service Partner of the Society of Professional Benefit Administrators (SPBA). Call (888) 550-4961 and visit


Benefitfocus Announces Ray August as Chief Operating Officer and Andy Howell Named Chief Commercial Officer

MyHealthGuide Source: Benefitfocus, Inc. (NASDAQ: BNFT), 8/27/2014,

CHARLESTON, SC -- Benefitfocus, Inc. (NASDAQ: BNFT), a leading provider of cloud-based benefits software solutions, has announced that Ray August has joined the company as Chief Operating Officer (COO). In the role of COO, August will oversee all operational functions and customer support efforts to drive seamless scaling as the organization grows. Over the course of a sixteen-year tenure, August held multiple roles at CSC, a multi-billion dollar company with over 10,000 employees around the world. Most recently, he held the position of General Manager for CSC's Financial Services Group. Prior to CSC, Mr. August was Chief Technology Officer at Great Plains Software, a solution provider of middle market accounting software that was acquired by Microsoft.

Andy Howell has been named Chief Commercial Officer (CCO) at Benefitfocus. In this new role, Howell will oversee all sales and marketing functions as well as ecosystem partner relationships to help continue significant and sustainable long-term growth. Howell has been with Benefitfocus since 2007, serving in various roles during his tenure including Senior Vice President (SVP) and General Counsel; SVP and General Manager of the insurance carrier business unit; and, most recently, COO.

"Ray is joining us for the next chapter in the Benefitfocus story," remarked Benefitfocus President and CEO Shawn Jenkins. "He will build on Andy's success in the role and position our company for continued sustainable growth and expansion of our operations. Our dedication to providing anticipatory service will be further strengthened by having an expanded leadership team. Andy will leverage his great experience with customers and partners to generate success in this exciting new role."

With more than 1,000 associates, Benefitfocus is currently expanding its headquarter's campus footprint from 13 to 40 acres with space for 1,200 additional associates. A new 145,000 square-foot Customer Success Center is scheduled to open in January. Jenkins recently discussed the growth of Benefitfocus and his vision for the benefits industry in a cover story for the August issue of the magazine Benefits Selling. In the interview, he describes the growth of the company from a small start-up in 2000 to a leading cloud-based benefits software provider.

"As Benefitfocus continues to scale to meet the needs of our customers, these two senior management changes will help us to grow more quickly," Jenkins continued. "Their presence will allow me to focus more of my time working on our future product roadmap. We want to take full advantage of the momentum we're experiencing to bring product innovation and expansion of our partner ecosystem. We are developing great products and a great team at Benefitfocus -- I like to say that we're just getting started."

About Benefitfocus

Benefitfocus, Inc. (NASDAQ: BNFT) is a leading provider of cloud-based benefits software solutions for consumers, employers, insurance carriers and brokers. Benefitfocus has served more than 23 million consumers on its platform that consists of an integrated portfolio of products and services enabling clients to more efficiently shop, enroll, manage and exchange benefits information. With a user-friendly interface and consumer-centric design, the Benefitfocus Platform provides one place for consumers to access all their benefits. Benefitfocus solutions support the administration of all types of benefits including core medical, dental and other voluntary benefits plans as well as wellness programs. Visit


Brentwood Services Administrators Inc Employs Sandra Gordon as Senior Claim Representative

MyHealthGuide Source: Brentwood Services Administrators Inc, 8/26/2014,

BRENTWOOD, TN -- Brentwood Services Administrators Inc. (BSA)., headquartered in Brentwood, Tenn., recently employed Sandra Gordon, of Nolensville, Tenn., for its Occupational Accident Department team as a senior claim representative, according to Jeff Pettus, president and chief executive officer of BSA.

In her new position, Gordon is responsible for reviewing, processing and handling occupational accident claims, as well as determining the claims coverage and extent of liability. She communicates directly with clients, employers, injured workers, physicians, and attorneys to manage claims in a timely and economic manner.

Prior to joining BSA, Gordon worked for Jupiter, MGA, in Brentwood, as a senior claim adjuster and was honored with its Jupiter Hall of Fame Award. She also was employed with Alfa-Vision Insurance and F. A. Richards & Associates, both in Brentwood. When working for Travelers Insurance in Franklin, Tenn., she received the In-Synch Service Award. Previously, she was a paralegal for 10 years.

Involved in the community, Gordon has served on the board of directors and as treasurer for the Columbia Girl's Fast-Pitch Softball league along with coaching girls softball for 15 years. Sandra was head coach of a girls' fast-pitch travel team that came in third place in the World Series and their team was placed in the NSA Hall of Fame.

Gordon attended Columbia State Community College in Columbia, Tenn., for two years majoring in accounting business, and also completed certification as a Realtor and certification in drafting. She later attended Nashville College of Medical Careers, completing a certification and passing the state board as a Registered Medical Assistant (RMA). She completed an internship with Columbia Pediatric Clinic and graduated as RMA with high honors.
Sandra Gordon is married to James Gordon, mortgage software developer, with six children and three grandchildren. Her hobbies include bowling and attending Titans' football games.

About Brentwood Services Inc.

Brentwood Services Inc., an independent employee-owned company headquartered in Brentwood, Tenn., specializes in structuring and managing alternative market solutions for employers and insurance providers. Call John Smitherman, vice president of sales, at (800) 524-0604 or (615) 263-1300, and visit

About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers' compensation and other casualty lines. BSA's aggressive coordinated approach to claims administration and loss control has a proven track record of reducing the cost of claims for its clients. BSA also provides underwriting, policy management and accounting services to association-sponsored pools and mutual insurance companies.

About Brentwood Reinsurance Intermediaries Inc.

Brentwood Reinsurance Intermediaries Inc. (BRII) provides insurance and reinsurance brokerage services encompassing self-insurance, guaranteed cost and deductible insurance with a focus on workers' compensation, excess liability lines, and accident and health reinsurance.


Magellan Health Names Dr. Karen Amstutz as Chief Medical Officer

MyHealthGuide Source: Magellan Health, Inc., (NASDAQ: MGLN) via Business Wire, 8/26/2014,

AVON, CT -- Magellan Health, Inc. announced that Dr. Karen Amstutz has been named as the company's chief medical officer, responsible for setting the strategic roadmap and vision for Magellan's clinical strategy and policy. Amstutz, who will report to Barry M. Smith, chairman and chief executive officer, will begin on September 15, and will be based in Scottsdale, Ariz.

"Karen has significant experience developing and leading clinical strategy, as well as managing care management programs which have delivered clinical effectiveness and quality," said Smith. "Her background as a practicing physician with active involvement in data analytics and the management of chronic diseases, as well as her experience successfully leading clinical strategy and operations for Medicare Advantage and Medicaid members at a national healthcare company will serve her well in this role. I look forward to working with Karen as Magellan continues to offer industry-leading programs and solutions across all of our lines of business."

"Joining Magellan Health at this point in the company's history is an exciting opportunity, as it further invests in innovative delivery models, cutting-edge technology and enhanced data analytics to drive improved outcomes and high-quality care for its members," said Amstutz. "Magellan's behavioral health, pharmacy and specialty solutions offerings provide compelling solutions to the marketplace to address many of the industry's fast-growing, complex and high-cost areas of healthcare."

Amstutz comes to Magellan from Evolent Health, where she was vice president of medical affairs, responsible for clinical effectiveness and operations for population health implemented in large health systems across the country. Amstutz developed quality improvement and clinical intervention strategies for partner health systems, and provided strategic direction to enterprise clinical program development, reporting and analytics functions, among other areas. Prior to her time at Evolent Health, Amstutz served as the vice president of medical affairs and senior medical director at xG Health Solutions, a healthcare start-up which assists health systems committed to value-based care succeed under value- and performance-based payment models. Amstutz also served as the vice president, medical director, care management and quality at WellPoint, where she was accountable for clinical strategy and operations, quality and medical cost management for managed Medicaid and Medicare Advantage, as well as for 33 million commercial members of large and small group plans nationally.

About Magellan Health

Headquartered in Avon, Conn., Magellan Health, Inc. is a healthcare management company that focuses on fast-growing, complex and high-cost areas of healthcare, with an emphasis on special population management. Magellan delivers innovative solutions to improve quality outcomes and optimize the cost of care for those we serve. Magellan's customers include health plans, managed care organizations, insurance companies, employers, labor unions, various military and government agencies, third party administrators, consultants and brokers. Visit


International Medical Group Hires Kristin Ash as Director of Group Development

MyHealthGuide Source: International Medical Group®, Inc. (IMG®), 8/18/2014,

(INDIANAPOLIS -- International Medical Group®, Inc. (IMG®), an Indianapolis-based insurance group, announced that Kristin Ash joined the company on August 6, 2014 as Director of Group Development. She will be responsible for new business acquisition, strategic planning, management of key accounts, and oversight of the employer group distribution channel.

Ash brings over 20 years of experience in client relationship management and international benefits. Ash has trained clients and brokers on international risk identification, management, and mitigation for the International Foundation of Employee Benefits. In her previous work as an MGA, Kristin was a top producer and a charter member of United Healthcare's Global Solutions Advisory Council. She has been published in Employee Benefit Advisor and Acquisition International and has received nominations and awards from the Forum for Expat Management.

"Kristin is another great addition to the IMG team and she brings excellent industry experience to our organization," said Vice President of International Sales, Amanda Winkle. "We are very excited about the best in class sales team we have assembled. Kristin brings a lot of insurance knowledge and has a proven track record of new business development. We expect great things from her in the international employer group segment."

About International Medical Group, Inc. (IMG)

As a leader in the international medical insurance market, IMG has provided Global Peace of Mind® to over a million people worldwide in more than 170 countries. For over 20 years, IMG has been providing top-tier global medical insurance benefits and has developed a reputation of excellence in the international community. With its around-the-clock medical management services, multilingual claims administrators and highly trained customer service professionals, IMG is confident in its ability to provide the products international travelers need, backed by the services they want. IMG is based in Indianapolis, Indiana USA. Its companies include IMG Europe Ltd, Akeso Care Management®, iTravelInsured®, and IMG-Stop LossSM. IMG's family of companies is committed to being with its international clients wherever they happen to be.  Contact 866.368.3724, and visit


Indigo Insurance Services is Looking for a Stop Loss Sales Executive

MyHealthGuide Source: Indigo Insurance Services, 8/19/2014,

As an Indigo Stop Loss Sales Executive you'll have the support of one of the nation's leading insurance companies and the flexibility and growth potential of running your own business.

You'll solve clients' needs through consultative and solution based selling, by building relationships with contacts in your territory to identify, develop and close sales opportunities.

Main Responsibilities

  • Sell Indigo Insurance Services Medical Stop Loss product through insurance brokers, third party administrators and consultants.
  • Build and establish relationships with key sources to market our product to some of the nation's leading employers.
  • Construct and maintain a business plan for your designated territory based on sales and strategic initiatives.
  • Call on existing and potential customers to not only prospect new customers but also to develop a book of business.
  • Meet annual targets and individual sales goals.
  • Develop internal relationships with underwriters and internal support partners who will assist you in creating specialized plans to meet your clients' needs.


  • Bachelor's Degree preferred. Two to three years previous experience selling the Stop Loss product required.
  • Commitment to attaining state required Life and Health agent license.
  • Proven relationships with underwriting and technical product expertise.
  • Strong organizational skills.
  • Strong networking and relationship management skills.
  • Excellent listening, presentation, negotiating and communication skills
  • A passion to succeed and challenge yourself while building a book of business
  • A winning attitude and interested in a career that offers independence, professional growth, and high income potential.
  • The successful candidate is driven, self-motivated, consultative and a great problem solver.

To apply: click here for Blue Cross Blue Shield of Massachusetts career site.

About Indigo Insurance Services

At Indigo, we believe that employees' needs are unique, so their insurance coverage should be too. Indigo Insurance Services is a full-service insurance agency that offers a comprehensive array of specialty insurance including; life, disability, critical illness, cancer care, stop loss, and more. Indigo Insurance Services, LLC is a subsidiary of Blue Cross and Blue Shield of Massachusetts, Inc. Visit


Market Trends, Studies, Books & Opinions

Senior Execs Increasingly More Hands-on in Medical Stop-Loss Decisions: Study

MyHealthGuide Source: Matt Dunning, 8/29/2014, Business Insurance Stop-Loss Article

As high-cost medical claims continue to rise among employers that self-insure their group health benefits, the number of senior executives, financial officers and risk managers involving themselves in their company's decisions regarding stop-loss insurance is also increasing.

Alexandria, Virginia-based Aegis Risk L.L.C.'s 2014 "Medical Stop-Loss Premium Survey" polled 244 employers.

Study findings

  • 69% said their company's chief financial officer had been directly involved in stop-loss reviews and coverage decisions in 2014, compared with 63% in 2013 and 52% in 2012.
  • 40% said one or more of their company's senior executives played a role in stop-loss decisions, a slight increase from 39% in 2013 but more than double the 18% reflected in 2012.
  • 19% of employers bringing their risk management departments into stop-loss discussions in 2014, compared with 12% in the prior year's survey.
  • 23% said they had incurred at least one medical claim in excess of $1 million within their last two policy periods, up from 14% in 2013.

"Formerly a rare event, claimants in excess of $1 million are more and more common," Ryan Siemers, Aegis Risk's founder and principal, said in a statement released Thursday alongside the report.

As a result, the report indicated that individual stop-loss premiums have increased annually by 7% to 10% over the last few years, depending on the contract type and deductible.

"The drivers may be several, including removal of dollar limits, specialty drug therapies and more aggressive provider billings," Mr. Siemers said. "It's important to note that claimants of this size create notable risk to not just the benefit plan, but organizationally to the employer or plan sponsor as well."


Legal, Legislative & Regulatory News

6th Circuit's Decision in SIIA v. Snyder Has Significant Implications for Self-Insured Plans, TPAs, and Stop Loss Carriers

MyHealthGuide Source: Thomas A. Croft, Esq., 8/29/2014, The Self-Insurer "From the Bench"

On August 4, 2014, the U.S. Court of Appeals affirmed the U.S. District Court's decision of September 7, 2012, throwing out SIIA's ERISA pre-emption challenge to the Michigan Health Insurance Claims Assessment Act, MCL 550.1731, et seq. ("the Michigan Act") on the face of SIIA's Complaint. The trial, and now appellate, federal courts determined that SIIA's position on the pre-emption issue "failed to state a claim upon which relief could be granted" under Fed.R.Civ.P. 12(b)(6). In other words, these courts concluded that SIIA was just plain wrong as a matter of law, even if everything it alleged in its Complaint about the nature and effect of the Michigan Act was true.

In general terms, The Michigan Act imposes a tax (or assessment) (currently 0.75%) on "paid claims" by "carriers" and TPAs up to a maximum of $10,000 per insured individual annually. "Carriers" include health insurers generally, and ERISA Plan Sponsors in particular. The assessment only applies to services rendered within the state of Michigan to persons who "reside" in Michigan. The regulations promulgated under the Michigan Act state that the home address of an individual as maintained in the ordinary business records of a carrier or TPA establishes a "rebuttable presumption" that that address is the domicile (residence) of the individual for purposes of the tax.

Court Makes No Inquiry into Real World Facts Alleged by SIIA

I am no ERISA pre-emption expert, although I will admit to more than a passing familiarity with the jurisprudence concerning it and its development over the past twenty years. In any event, I make no judgments about the propriety of either the District Court's or the Court of Appeal's pre-emption analysis, though I question whether this wasn't a much closer case than either court appreciated under applicable pre-emption law.

Regardless of the merits of these Courts' decisions on the pre-emption issues, I question the procedural propriety of their disposition of this case on the face of the pleadings, without any inquiry into the real world facts alleged by SIIA in its Complaint, and any evidence about the effect of the Act on the administration of ERISA Plans, both within and without the State of Michigan.

Closer to home, for me, however, are the specifics of the Michigan Act as they purport to apply to stop loss carriers, which are contradictory and frankly baffling in several respects. The tax is expressly imposed on "carriers" and TPAs for "paid claims" as defined in the Act. Before delving into what exactly is a "paid claim" under the Act, we need to examine Section 3(3) of the Act in detail:

  • "(3) All of the following apply to a group health plan that uses the services of a third party administrator or excess loss or stop loss insurer:
  • (a) A group health plan sponsor is not responsible for an assessment under this section for a paid claim if the assessment on that claim has been paid by a third party administrator or excess loss or stop loss insurer, except as otherwise provided in section 3a(2).
  • (b) Except as otherwise provided in subdivision (d), the third party administrator is responsible for all assessments on paid claims paid by the third party administrator.
  • (c) Except as otherwise provided in subdivision (d), the excess loss or stop loss insurer is responsible for all assessments on paid claims paid by the excess loss or stop loss insurer.
  • (d) If there is both a third party administrator and an excess loss or stop loss insurer servicing the group health plan, the third party administrator is responsible for all assessments for paid claims that are not reimbursed by the excess loss or stop loss insurer and the excess loss or stop loss insurer is responsible for all assessments for paid claims that are reimbursable to the excess loss or stop loss insurer."

What in the name of all that is rational (much less holy), do these provisions mean?

  •  Subdivision 3(a) tells us that a Plan Sponsor doesn't owe the assessment if the TPA or stop loss carrier has paid it….This much makes sense--if someone else has paid a tax for you, it seems only logical that you no longer owe the tax. But then we have the phrase "except as otherwise provided in section 3(a)(2)." The problem here is that section 3a2 does not "otherwise provide." It simply declares that Plan Sponsors and TPAs shall develop a methodology for collecting the assessment from groups with uninsured or self-funded coverage as a percentage of "actual paid claims." See Section 3(a)(2)(d). The interplay between these provisions is simply unclear.
  • Subdivisions 3(b) and 3(c) tell us that the TPA owes the assessment on all its "paid claims," "except as provided subdivision d," and that the stop loss carrier owes the assessment on all its "paid claims," except as provided in subdivision d. So subdivision d seems quite important.
  •  Instead of clarifying, subdivision d obfuscates and confuses things further. It says that, where there are both a TPA and a stop loss carrier (quite a typical scenario), the TPA is responsible for the assessment on "paid claims" not reimbursed by the stop loss carrier, and the stop loss carrier is responsible for the assessment on "paid claims" that are….[wait for it….] "reimbursable to" the stop loss carrier.

Subdivision d might make more sense if the word "by" had been used in lieu of the word "to," thus purporting to impose the tax on the TPA up to the specific deductible and on the stop loss carrier to the extent of the reimbursable excess. But that's NOT what the statute says. One has to strain to imagine where a "paid claim" would be "reimbursable to" a stop loss carrier. Truth is, I can't think of one. A refund to the stop loss carrier by the group/TPA on an overpaid claim would be something "reimbursable to" the stop loss carrier, but why should the stop loss carrier be taxed on such an adjustment?

Maybe the key to understanding the above-quoted provisions is the phrase "uses the services of a third party administrator or excess loss or stop loss insurer" in Section 3(3) quoted above. Does being insured by a stop loss carrier constitute "using the services of" the stop loss carrier? Perhaps subsection 3 contemplates a situation where the lines between providing excess loss insurance become blurred with the processing of underlying claims by stop loss carriers acting in a dual capacity as a TPA processing claims under the Plan and also as a stop loss carrier. I have criticized such arrangements elsewhere on conflict of interest grounds, but it is possible that the Michigan legislature recognized this blending of functions exists with some carriers, and wrote the Act with that aspect in mind. Insuring groups with stop loss insurance alone cannot fairly be characterized as "providing a service" in my view, and thus the entirety of section 3(3) may be inapplicable in most cases to stop loss carriers.

Stop Loss Carriers Never 'Pay Claims' within the Meaning of the Act!

Additionally, insofar as potential stop loss carrier liability is concerned, we must look closely at the Act's definition of a "paid claim." In pertinent part, it states:

"'Paid claims'" means actual payments, net of recoveries, made to a health and medical services provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier…." Real world fact: STOP LOSS CARRIERS DO NOT PAY PROVIDERS OR INDIVIDUALS. [Please excuse me for raising my voice]. Ergo, stop loss carriers never "pay claims" within the meaning of the Act, and are therefore not subject to the assessment unless they do something completely outside the norm of industry custom, practice, and common sense, like cutting a check to a provider directly or, God forbid, paying a stop loss claim directly to a Plan beneficiary.

SIIA raised such arguments in its briefs, but neither court's opinion addressed them. Indeed, neither the District Court nor the Court of Appeals' opinions ever even mention the words "stop loss" or "excess loss."

Act Cannot Apply to Stop Loss Carriers

In my opinion, the Act simply does not and cannot apply to stop loss carriers, the references in the Act to such carriers quoted above notwithstanding. But that is only my opinion based on my reading of the statute itself in its current form, and cannot and should not be taken as formal legal advice without further study. Perhaps the addition of language to policy forms might address any uncertainty in this regard, and clearly provide for indemnification from stop loss insureds for any such assessments levied now by Michigan or by other jurisdictions in the future.

TPAs Have To Pay Michigan's Tax ... and Recoup from Clients

So, where does this leave us? It leaves TPAs to pay the tax and to recoup it from their clients, including self-insured clients subject to ERISA. It imposes onerous reporting requirements on them, for which they will likely charge. This is a problem for TPAs both inside and outside Michigan, insofar as Michigan residents receiving treatment within the state will be covered by self-insured Plans sponsored by employers everywhere, and hence Plan Sponsors/TPAs will technically be subject to the assessment and reporting requirements as far as Michigan is concerned.

Perhaps the most ominous aspect of the Courts' validation of the Act is expressed in footnote 2 of the Court of Appeals' opinion:

  • "We recognize that each of the fifty states might enact similar taxes and multiple states could potentially claim and individual, perhaps a student, as a resident. This scenario could be burdensome to ERISA-covered entities. This state of affairs, however, is hypothetical and not before us at this point. We prefer to rule based on concrete facts rather than a blind appraisal of future events…."

Indeed. The validation of this Act will invite similar legislation elsewhere. One can only hope that another federal circuit will come to the opposite conclusion, one that is informed by the development of a factual record on the implications of such legislation on the self-funded community. 

About Tom Croft

Thomas A Croft is a magna cum laude graduate of Duke University (1976) and an honors graduate of Duke University School of Law (1979), where he earned membership in the Order of the Coif, reserved for graduates in the top 10% of their class. He returned to Duke Law in 1980 as Lecturer and Assistant Dean (1980-1982) and as Senior Lecturer and Associate Dean for Administration (1982-1984). He also taught at the University of Arkansas-Little Rock law school, where he was an Associate Professor of Law (1990-91), earning teacher of the year honors.

Until 2004, when he specialized in medical stop loss litigation and consulting, Tom practiced general commercial litigation. He was a partner in the litigation section of a major Houston firm in the late 1980s, and moved to the Atlanta area in 1991. He has been honored as a Georgia "Super-Lawyer" by Atlanta Magazine for the last eight years running, and holds an AV® Preeminent rating from Martindale-Hubble®.
Tom currently consults extensively on medical stop loss claims and related issues, as well as with respect to HMO Excess Reinsurance, Medical Excess of Loss Reinsurance, and Provider Excess Loss Insurance. He maintains an extensive website analyzing more than one hundred cases and containing more than fifty articles published in the Self-Insurer Magazine over many years. See He regularly represents and negotiates on behalf of stop loss carriers, MGUs, Brokers, TPAs, and Employer Groups informally, as well as in litigated and arbitrated proceedings, and has mediated as an advocate in many stop-loss related mediations. Tom can be reached at


Medical News

Brain Benefits from Weight Loss Following Bariatric Surgery

MyHealthGuide Source: 8/26/2014, Endocrine Society's Journal of Clinical Endocrinology & Metabolism, JCEM Article

Washington, DC--Weight loss surgery can curb alterations in brain activity associated with obesity and improve cognitive function involved in planning, strategizing and organizing, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

The study followed 33 women paired by age and level of education made up of two groups: 17 severely obese women and 16 lean patients.  The patients studied prior to and 24 weeks after bariatric surgery using neuropsychological tests and positron emission tomography. The study was conducted in a reference center for the treatment of obesity of a Brazilian public university.  The main outcome measure was comparison of performance in neuropsychological tests and cerebral metabolism of the obese women before and after bariatric surgery was measured. The results found at the two moments were compared with those of the women of normal weight.

Study findings

  • Obese individuals face a 35% risk of developing Alzheimer's disease compared to normal weight people.
  • Women with a mean age of 40.5 years and mean body mass index of 50.1 kg/m2 when compared with women with mean body mass index of 22.3 kg/m2 showed increased cerebral metabolism, especially in the posterior cingulate gyrus.
  • Following surgery, there was no evidence of this exacerbated brain activity. Their brain metabolism rates were comparable to the activity seen in normal weight women.
  • After surgery, the obese women also performed better on a test measuring executive function -- the brain's ability to connect past experience and present action -- than they did before the procedures.

"When we studied obese women prior to bariatric surgery, we found some areas of their brains metabolized sugars at a higher rate than normal weight women," said one of the study's authors, Cintia Cercato, MD, PhD, of the University of São Paolo in São Paolo, Brazil. "In particular, obesity led to altered activity in a part of the brain linked to the development of Alzheimer's disease -- the posterior cingulate gyrus. Since bariatric surgery reversed this activity, we suspect the procedure may contribute to a reduced risk of Alzheimer's disease and other forms of dementia."

About Endocrine Society

Founded in 1916, the Endocrine Society is the world's oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, the Endocrine Society's membership consists of over 17,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Washington, DC. Visit


Recurring Resources

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 6/30/2014)

Source: MyHealthGuide

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

Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter

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

  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
Capital /Equity
1. CIGNA     $1,907
  CIGNA 2013 10-K, page 46 2/27/2014
2. Sun Life Financial     $915.2
  Scott Beliveau, Sun Financial 4/28/2014
3. HCC Life Insurance Company >35 Years HCC Life
(A.M. Best Rated: A+)
Perico Life
(A.M. Best Rated: A+)
  HCC Insurance Holdings, Inc. Release,
4. HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
Mike Sullivan, President & COO
5. Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $475M
MRM - $255M)
Michael Fry, Executive Vice President, Symetra;
Mike McLean, Chairman Medical Risk Managers, Inc.
6. ING Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
Joe Keller, Lead Financial Analyst, ING Employee Benefits,
7. Companion Life > 20 Years   $310
  Philip Gardham, Vice President, Specialty Markets,
8. National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
9. Independence Holding Company   Standard Security Life Insurance Company of New York,
Madison National Life, Independence American Insurance Company
$200   Roy T.K. Thung, CEO, Letter to Stockholders
10. Zurich North America     $130   Tracey Brennan, Zurich North America.
11. Munich Re Stop Loss, Inc.   AIC, TransAmerica $110
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
12. The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
  Victor Moran, Second Vice President, Actuarial Operations.  3/12/2014
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $$3,388
Mark Nichols, Managing Director.

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

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

Stop-loss Premium Volume is not the Whole Story

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

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

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


Upcoming Conferences

September 18-19, 2014
The Nevada Business Group on Health Annual Health Care Summit. "Empowering Employers to Build Better Benefits", is this year's theme. Thought leaders from across the country including Sander Domaszewicz, Principal, Mercer, Karl Alrichs, Gregory and Appel, Scott Foster, WellCo, Dr. Suart Tousman and C.M. Yarborough, MD will be presenting on topics ranging from Population Health Management to Using the ACA as a catalyst for organizational change. Hyatt Regency Lake Tahoe.  Contact Terri Lightfoot, Executive Director, at and 775.329.8007.  Information on registration:

September 25, 2014 - Webinar - 10:00 am PT/12:00 pm CT/1:00 pm ET
"Pay or Play" Rules under 4980H: Planning for 2015 presented by Health Care Administrators Association (HCAA).  Speakers Ashley Gillihan and John Hickman, Alston & Bird LLP.  The ACA Employer Shared Responsibility (Pay or Play) final regulation includes complex rules for identifying full-time employees for purposes of determining which employees need to be offered coverage to avoid penalty taxes. HCAA Members: $25
Non-Members: $100.  Contact HCAA (888) 637-1605, and visit

October 15, 2014
Health Insurance Exchanges Forum hosted by America's Health Insurance Plans. An ongoing series to provide the latest and most critical exchanges information on the business of the exchanges, including best practices and how business processes have changed. Hear from the leadership implementing exchanges at the state and federal levels. Enjoy early registration rates before September 5, 2014. Contact: 202-778-3200 or . See

October 15, 2014
Lloyd's Meet the Market in Chicago. Spend half a day (1:30pm -- 6:30pm) with Lloyd's underwriters and London brokers learning how our market's solutions remain viable 326 years after its humble beginnings in Edward Lloyd's coffee shop. Opening remarks from Inga Beale, Lloyd's CEO and Vincent Vandendael, Lloyd's International Markets Director. Information: Contact David Stirling, Director, Crispin Speers & Partners Ltd, at University Club of Chicago, 76 East Monroe Street, Chicago, Illinois 60603. Registration.

October 16-17, 2014
The State Health Issues Conference hosted by America's Health Insurance Plans. Brings together the leading authorities and thought leaders to discuss the state legislative and regulatory issues challenging health plans. Enjoy early registration rates before September 5, 2014. Contact: 202-778-3200 or . See

October 16, 2014
Clearwater HIPAA Compliance BootCamp™.  Designed for busy professionals, this event distills into one action-packed day, the critical information leaders need to know about the HIPAA Privacy and Security Final Rules and the HITECH Breach Notification Rule. The Clearwater HIPAA Compliance BootCamp™ has helped hundreds of professionals learn HIPAA-HITECH fundamentals in a highly interactive classroom setting. Los Angeles, CA.  Contact Clearwater Compliance at 800-704-3394 and

November 5-12-19, 2014 -- Web Event
Clearwater HIPAA Compliance Virtual BootCamp™.   Designed for busy professionals, this event is a series of three, 3-hour web sessions delivering an action-packed HIPAA-HITECH curriculum This virtual workshop series provides critical information leaders need to know about the HIPAA Privacy and Security Final Rules and the HITECH Breach Notification Rule. The Clearwater HIPAA Compliance Virtual BootCamp™ has helped hundreds of professionals learn HIPAA-HITECH fundamentals in a highly interactive, online classroom setting. Contact Clearwater Compliance 800-704-3394 and

November 10-12, 2014
4th Annual IHC FORUM West presented by Institute for HealthCare Consumerism.  Join employers, brokers, health plans, TPA's, consultants and solution providers to LEARN, CONNECT and SHARE HealthCare Consumerism trends, challenges and solutions including:
Learn next steps and best practices in HealthCare Consumerism, Compliance issues with health care law in 2015 and beyond, Access latest health and benefit innovations and trends, Look into real time open enrollment statistics, Perspectives on election results, Analyze benefit models, including defined contribution and exchanges, Network with your peers and other industry stakeholders, Receive top quality education, more.  Red Rock Resort & Spa. Las Vegas, NV. Free registration for first 25 to register by September 15, 2014 using the registration code is MYHEALTHGUIDEVIP. Information and registration:

November 17-19, 2014
The Ops/Tech Forum, hosted by America's Health Insurance Plans, gathers industry experts to discuss critical issues such as: consumer engagement, exchange implementation, cost drivers, data analytics, and innovative technologies. Gain insights on the strategies, tools, and solutions you need to guide you into 2015 and beyond. Register today! Contact: 202-778-3200 or .

October 5-7, 2014
National Educational Conference & Expo presented by Self-Insurance Institute of America (SIIA). The event typically attracts more than 1,700 attendees from throughout the United States and from a growing number of countries around the world.  The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions. Highlights:

  • Click here for speaker listing
  • Self-insured group health plans from every angle
  • Plan design and cost containment
  • Financial risk transfer
  • Broker involvement
  • ACA compliance
  • Stop-loss captive programs
  • 831(b) captives
  • Workers' Comp self-insured funds (SIGs)
  • Over 150 Exhibitors
  • SIG Roundtable Discussion
  • Sessions Provide Unique Learning and Industry Collaboration Opportunities
  • Featured speaker: Dr. Richard Pimentel, senior consultant with Milt Wright & Associates, Inc., His presentation focus will be Updating Yesterday's Disability Management Solutions to Address Today's Workers' Compensation Dilemmas.

J.W. Marriott Desert Ridge, Phoenix, AZ. contact Justin Miller at 800/851-7789, or  Information and Registration:

October 15-17, 2014
SPBA Fall Meeting (members only). Nashville, TN. Society of Professional Benefit Administrators (SPBA).

December 4-5, 2014
IHC Forum West presented by the Institute for HealthCare Consumerism. Las Vegas, NV. Contact Joni Lipson at and visit


January 18-20, 2015
The 2015 Taft-Hartley Benefits Summit presented by Financial Research Associates, LLC.
Caesars Palace in Las Vegas. Contact Jennifer Clemence at  Information and registration: and visit

January 25-27, 2015
AAPAN 2015 Annual Forum presented by American Association of Payers Administration & Networks.  The theme for this year's forum is "Thinking Forward -- Rethink, Retool, Realign." This will be your opportunity to join industry leaders and an exciting lineup of speakers as we examine how best to position our businesses in this fundamentally changed healthcare environment. You will hear firsthand from experts and colleagues about challenges and opportunities at the state and federal level that are unique to TPAs, PPOs, and Workers' Comp professionals. Information: and (502) 403-1122.  Ritz-Carlton, Laguna Niguel in Dana Point, CA.

February 10-11, 2015
2015 Executive Forum presented by Heath Care Administrators Association (HCAA).  Encore at Wynn Las Vegas. Las Vegas, NV.

March 4-6, 2015
Self-Insured Health Plan Executive Forum presented by Self-Insurance Institute of America.  J.W. Marriott Camelback, Scottsdale, AZ. 

March 18-20, 2015
SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA).

April 13-15, 2015
International Conference presented by Self-Insurance Institute of AmericaHilton Panama, Panama City, Panama.

April 29-30, 2015
Self-Insured Taft-Hartley Plan Executive Forum (NEW EVENT!) presented by Self-Insurance Institute of America. Marriott Metro Center, Washington, DC

May 6-8, 2015
Northshore's 26th Annual Claims Conference.  Salem, Massachusetts. This is an invitation only event. If you are interested in attending or presenting at next year's conference, you may contact Steve Murphy at

May 12-14, 2015
Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance Institute of America. Windsor Court Hotel, New Orleans, LA

October 18-20, 2015
National Educational Conference & Expo presented by Self-Insurance Institute of America. Marriott Marquis, Washington, DC  

September 28-30, 2015
SPBA Fall Meeting (members only). Scottsdale, AZ. Society of Professional Benefit Administrators (SPBA).


March 30-April 1, 2016
SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA).

October 17-19, 2016
SPBA Fall Meeting (members only). Minneapolis, MN. Society of Professional Benefit Administrators (SPBA).


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

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


Editorial Notes, Disclaimers & Disclosures

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

    •  Is the Newsletter email in your junk or spam folder?
    •  Have your IT team "whitelist" sender (
    •  Provide another email address.
    •  Access the Newsletter online at

    Our email servers inactivate an account (email address) after three successive failed attempts to deliver the Newsletter. Failures to deliver occur when your email server "bounces" our Newsletter because your server views our email as spam because of anatomical terms often referenced in our "Medical News" section and for other reasons.


Clevenger Ernie Clevenger
President & Publisher
MyHealthGuide, LLC