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TABLE OF CONTENTS
Symetra's President and CEO Tom Marra on A.M.BestTV: Medical Stop-Loss 'Sweet Spot'
MyHealthGuide Source: 10/23/2014, A.M. BestTV Video
OLDWICK -- In this A.M.BestTV episode, Tom Marra, president and chief executive officer at Symetra Financial (Symetra), examines how the medical stop-loss insurance for employers that self-insure their employees' health benefits has emerged as a growth area.
Marra said his company's strategy is to be a national player in each of the company's three divisions: life insurance, retirement and employee benefits. He also notes that medical stop-loss continues to be at the core of Symetra's benefits division.
"Symetra has been in the medical stop-loss insurance industry for more than 40 years; thus, we have expertise that has built up steadily. Since the medical stop-loss product is a pure insurance, its risk dynamics are good," said Marra.
Marra addresses how medical stop-loss gets a lot of coverage, but also competition. "Symetra, along with four or five companies, dominate this industry," said Marra. "And due to the product being typically sold by the largest brokers, it is a niche product that is tied to a core benefit strategy, which gives it a lot of coverage."
Marra discusses the opportunities that the post health reform era has created for the industry. He said, "One opportunity is that most employers in the 500 to 2,000 'sweet spot' for medical stop-loss will look at all their options and going self-insured is one of them, and whenever a company becomes self-insured it covers catastrophic claims that might emerge. Hence, the company needs medical stop-loss coverage."
About A.M. Best
A.M. Best Company is the world's oldest and most authoritative insurance rating and information source. Visit www.AMBest.com.
Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation (NYSE: SYA), a diversified financial services company based in Bellevue, Wash. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent agents and advisors. Visit www.symetra.com.
Teladoc Adds Senator William Frist, M.D. and David Snow to Board of Directors
MyHealthGuide Source: Teladoc, Inc., 10/21/2014, www.Teladoc.com
DALLAS -- With the expansion of health insurance to an estimated 8 million new patients through the Affordable Care Act, innovations are needed to meet the primary care needs of all Americans. Dallas-based Teladoc, the nation's largest telehealth provider, has proven that telemedicine is an exceptional way to deliver high-quality, cost effective care.
Underscoring its industry leadership, Teladoc CEO Jason Gorevic announced the addition of two preeminent health care leaders to the company's board of directors: former U.S. Senator William Frist, M.D. and former Medco Health Solutions chairman and CEO David B. Snow.
"Senator Frist and David Snow are ideal Teladoc board members. These men have successfully navigated the complexities of Wall Street and the halls of Congress. Their commitment to Teladoc brings an added level of experience and success that will be invaluable to us as we continue our explosive growth and navigate the changing landscape of health care," said Gorevic. "Both Senator Frist and Dave Snow have numerous opportunities to sit on boards and they chose Teladoc. Their joining our board is not only an endorsement of Teladoc, but also of the telehealth industry."
Senator Frist is a world-renowned cardiothoracic transplant surgeon and a leading authority on health care policy. During his tenure on Capitol Hill, he served on both the Health and Finance Committees, where he was instrumental in passing health care reform legislation and ultimately served as Senate Majority Leader. Senator Frist brings to Teladoc decades of experience in providing top quality patient care, driving health care policy and reform, and a reputation for championing innovations that deliver improved health care outcomes.
"The implementation of the Affordable Care Act has infused an additional 8 million patients into the health care system, and this number is expected to grow significantly in the coming years. The increased demand will further tax our already overburdened primary care system, resulting in even longer patient wait times," said Senator Frist. "Teladoc is an innovative and effective solution for addressing the current access barriers to primary care. The Teladoc model has shown what we have believed to be true: that many of the everyday health care needs of patients can safely and efficiently addressed remotely using technology. It is exactly the type progressive and forward-thinking company we need in the health care industry today. As a Teladoc board member, I want to ensure our country's legislative groups understand the benefits Teladoc can bring to the health care system as a whole, but most specifically, the need it fills for the patients it serves."
David B. Snow, Jr., is a health care industry veteran, innovator and entrepreneur who has created and implemented solutions to manage the rising costs of health care. Most recently, he served as the chairman and chief executive officer of Medco Health Solutions, one of the nation's largest pharmacy benefit managers. Under his leadership, Medco's revenue grew from $34 billion to more than $70 billion. Prior to joining Medco, he served as president and chief operating officer at Empire BlueCross BlueShield. Currently, Snow serves as the chairman and CEO of Cedar Gate Technologies, a health care information technology data analytics company.
"There is a clear need in our country to create greater access to physicians. Teladoc is a change agent for the way consumers want to access primary care," said Snow. "As more and more companies look for efficient and cost-effective means for providing health care to their employees, telehealth -- and Teladoc -- are critical to fixing what is broken within our health care system today. Teladoc's outstanding technology, scalable business model and phenomenal year-over-year growth is evidence of the value it brings to its members and clients. The company's growth continues to be strong and I look forward to helping Teladoc accelerate its growth trajectory."
Teladoc recently announced it secured $50 million in funding, one of the single largest investments in a telehealth company. "Teladoc is in a significant position of strength; we have outstanding growth momentum, stellar leadership and we are financially strong. The
combination of the infusion of capital and addition of these industry icons to our board of directors will accelerate our growth strategy and further cement our foothold as the dominant leader in telehealth," added Gorevic.
Founded in 2002, Teladoc is the nation's leading telehealth provider with 8 million members and more than 250,000 consults annually. Teladoc provides 24/7 access to affordable, high-quality medical care for adults and children experiencing non-emergency medical issues via phone, secure online video, mobile app or HealthSpot™ Station -- a private, walk-in kiosk. Through a directly-managed network of U.S.-based, board-certified physicians, Teladoc delivers a 95 percent patient satisfaction rate with an average response time of 16 minutes. Teladoc is the first and only telehealth provider to receive certification from the National Committee for Quality Assurance (NCQA) for its physician credentialing process, scoring 100 percent. Recognized by Fast Company as "One of World's Most Innovative Companies in Health Care" in 2013, Teladoc partners with health plans, corporations, organizations and patients that seek accessible and affordable high-quality medical care. Contact Bill Fryling, Director of Sales, at (704) 776-6106, firstname.lastname@example.org and visit www.Teladoc.com.
QBE North America names William Kronenberg III to Board of Directors
MyHealthGuide Source: QBE North America, 10/23/2014, www.qbena.com
New York, NY -- QBE North America has announced the appointment of William Kronenberg III to its Board of Directors. With nearly 40 years of experience in the insurance industry, Kronenberg is well suited to assist in enhancing QBE’s North America results.
"We’re proud to have someone of Bill’s caliber join the Board. We look forward to drawing on his keen understanding of the Property & Casualty market, leadership experience in a global insurance organization, and extensive knowledge of the Specialty and Program business models in the US as we continue to transform QBE North America," says Dave Duclos, President and CEO.
Kronenberg currently serves as the principal owner of Fresh Start Development Co., LLC and is a director of Glatfelter Insurance Group. Previously, Kronenberg served as CEO and principal owner of Professional Underwriters, a program administrator specializing in the Public Entity market segment that was acquired by Glatfelter Insurance Group in 2008. From 1999 to 2002, Kronenberg served as CEO of XL Environmental, Inc. (formerly ESCS) and as a Director of XL America, Inc. Until its acquisition in 1999 by XL Capital, Kronenberg served as owner, CEO and President of ECS, Inc. a company specializing in integrated environmental risk management solutions. Kronenberg’s early insurance career began with AIG, including several casualty-oriented underwriting positions, concluding as the officer in charge of AIG’s program unit.
QBE North America is part of QBE Insurance Group Limited, one of the largest insurers and reinsurers worldwide. QBE NA reported Gross Written Premiums in 2013 of $5.855 billion. QBE Insurance Group’s 2013 results can be found at www.qbena.com. Headquartered in Sydney, Australia, QBE operates out of 43 countries around the globe, with a presence in every key insurance market. The North America division, headquartered in New York, conducts business through its property and casualty insurance subsidiaries. QBE insurance companies are rated "A" (Excellent) by A.M. Best and "A+" by Standard & Poor’s. Contact Deidra Parrish Williams, V.P., US Communications, at 212.805.9750 Ext: 828750, Deidra.ParrishWilliams@us.qbe.com and visit www.qbena.com.
One Call Adds Greg Roth To Board of Directors
MyHealthGuide Source: One Call Care Management (One Call), 10/14/2014, www.onecallcm.com
JACKSONVILLE, FL -- One Call Care Management (One Call), the nation's leading provider of specialized services that add value throughout the continuum of workers' compensation care, has named healthcare executive Greg Roth to its Board of Directors.
"Greg's experience as a leader and innovator in healthcare will be a tremendous asset to One Call's Board of Directors and to our leadership team," stated Buddy Gumina, Partner with Apax Partners and Chairman of One Call Care Management.
"As One Call moves forward in its mission to improve workers' compensation outcomes by delivering market-leading specialty services, innovative leakage capture solutions, and enhancing efficiencies across the continuum of care, Greg's insights and leadership will be a welcome addition," commented Joe Delaney, President and CEO of One Call.
"One Call brings an inspiring vision to workers' compensation combined with the commitment to deliver on what customers need today while innovating for their needs tomorrow," observed Mr. Roth. "It is the first and only company to bring together the industry's top experts in specialty services across the continuum of care, along with the financial strength and stability to truly transform workers' compensation results. I look forward to being a part of One Call's journey toward that vision."
Mr. Roth's career spans three decades of introducing innovation to transform and improve healthcare. Most recently he spent 10 years with TeamHealth, a leading national healthcare company offering permanent outsourced physician staffing solutions for 860 healthcare companies in 46 states. At TeamHealth, Mr. Roth held the positions of Chief Executive Officer, President and Chief Operating Officer, and also served as a member of the Board.
Previously, Mr. Roth served as an executive for HCA - Hospital Corporation of America for 10 years as President of the Ambulatory Surgery Division, Senior Vice President of Operations for the Western Region, and the Division's Chief Financial Officer.
Prior to these leadership roles, Mr. Roth held a variety of financial and operational positions in the healthcare industry. He holds a Master's Degree in Health and Hospital Administration from Xavier University and a B.S. in Allied Health Professions from Ohio State University. He is a Certified Public Account (CPA) and a Registered Respiratory Therapist.
About One Call Care Management
One Call Care Management (One Call) is the nation's leading provider of specialized solutions to the workers' compensation industry. One Call's solutions enable faster, more efficient and more cost-effective claims resolution. One Call provides reliable, consistent connections to care with expertise in high end diagnostics, physical therapy and transportation services, post-discharge home care and durable medical equipment, dental and doctor specialty services, complex care management, and the language services required for today's multicultural workforce. With a focus on injured workers' needs across the continuum of care, One Call enables maximum medical improvement and superior outcomes. Visit www.onecallcm.com.
HM Insurance Group Names Mark Nave as SVP, Strategy & Marketing
MyHealthGuide Source: HM Insurance Group, 10/23/2014, www.hmig.com
PITTSBURGH -- Mark Nave has joined HM Insurance Group (HM) as senior vice president, strategy & marketing. Mark follows Matt Rhenish, who was named president & COO of the company earlier this year. In his role, Mark will lead strategic planning, product development, market research, marketing and communications, events, project management and business analytics for HM.
"We are excited to have Mark on the leadership team at HM," Rhenish said. "With his strong background in strategic development and business transformations, he brings excellent business analysis and problem-solving capabilities that can build on our success."
Mark comes to HM from the management consulting firm McKinsey & Company, where he most recently held the role of engagement manager. There he led teams of consultants and worked with leading organizations from the health and financial services sectors on solving their toughest problems and developing practical solutions. Prior to McKinsey & Company, Mark held various leadership roles in sales, marketing and product management in the high tech sector -- specifically with RF Micro Devices and Robert Bosch GmbH. He also served as a Naval Flight Officer in the United States Navy and deployed to various duty stations around the world.
Mark received his MBA from the University of Maryland, after earning a bachelor’s degree in Systems Engineering from the United States Naval Academy.
Headquartered in Pittsburgh, HM Insurance Group is a recognized leader in risk management. HM's product portfolio features employer stop loss and managed care reinsurance. The company also offers workers' compensation in Pennsylvania.
About HM Life Insurance
HM Life Insurance Company, HM Life Insurance Company of New York, HM Casualty Insurance Company and Highmark Casualty Insurance Company have "A-" (Excellent) ratings from A.M. Best Company. Through its insurance companies, HM Insurance Group holds insurance licenses in 50 states and the District of Columbia and maintains 23 regional sales offices across the country. Visit www.hmig.com.
Athens Administrators Expands Program Insurance Market Focus, Names Executive Vice Presidents Raffy Daghlian And Guy Mastrangelo
MyHealthGuide Source: PRNewswire, 10/20/2014, www.athensadmin.com
CONCORD, CA -- Athens Administrators, a third-party claims administration services provider since 1976, has actively participated in the Program Insurance market segment on a regional basis for several years. Program Insurance is a critical area of focus for Athens and a unique segment for TPAs, requiring a highly specialized approach. To lead Athens' efforts in the Program Insurance space, we are proud to announce the appointment of Raffy Daghlian and Guy Mastrangelo as executive vice presidents. Both will continue to operate from the East Coast, and will be critical components of our continued expansion throughout the U.S.
In recent years Athens has achieved significant growth, delivering the highest-quality claims administration services. The addition of industry veterans Raffy Daghlian and Guy Mastrangelo will aid our continual expansion and help us provide outstanding Program Insurance services. Both executives bring a unique and valuable set of skills to the company, with a tremendous level of hands-on expertise in the Program Insurance claim administration space.
Athens' success is predicated on exceptional claims service and high-quality data and information from the TPA. We are proud to include Raffy and Guy on our industry-leading team. With over 50 years of combined experience in the claims and commercial insurance arena, they will lead the company's Program Insurance initiatives, and provide account management services for our valued program partners and clients.
Athens is a privately held company that provides property and casualty workers' compensation claims administration and managed care services. We are accustomed to operating in the most complex insurance markets. Our clients include managing general agencies, insurance carriers, retail insurance brokers, private and public sector self-insured entities, high-deductible captives and self-insured groups. Visit www.athensadmin.com.
United Claim Solutions (UCS) Welcomes Tobey Busch to its Information Technology Department
MyHealthGuide Source: United Claim Solutions (UCS), 10/24/2014, www.unitedclaimsolutions.com.
PHOENIX, AZ -- United Claim Solutions (UCS), an innovative Medical Cost Reduction and Claims Flow Management firm has again expanded its IT department to manage the increase in new business and service offerings.
"We are pleased to announce the addition of Tobey Busch to our Information Technology Department. Tobey's title is Software Developer II, and will be working with us to enhance the functionality of our UCX system, among other projects. He brings a diverse level of experience that will complement our current staff", said Ryan O’Mahoney, VP of Operations at UCS.
United Claim Solutions is an innovative Medical Cost Reduction and Claims Flow Management company providing cutting edge and customizable programs for payers, employers, unions, reinsurers, accountable care organizations and health plans. UCS offers end to end services including Bill Review, Out-of-Network Bill Repricing, Bill Edits, Medicare Plus Repricing, PPO Administration, Medical Management, Clearinghouse Services, Data Warehousing, OCR/Scanning, and Plan Modeling. We provide solutions for Group Health, Workers’ Compensation, and Auto Liability. Contact UCS if you are looking for:
• A partner that puts Service first
• Industry leading Savings on medical bills
• Flexible Solutions that reduce administrative costs
Contact Corte Iarossi, VP of Sales & Marketing at 866-762-4455 x 120, email@example.com and visit www.unitedclaimsolutions.com.
Few Self-Insured Plans Will Escape Paying Reinsurance Fees
appears few will qualify.
Nov. 15 is the deadline for submitting information and scheduling
payments for the fee. The payments are not due on Nov. 15, but
employers must upload their information by that date.
the Policy Period Does Not Necessarily Relieve Stop Loss Carrier
Florida Co-op filed suit against Nationwide and RMTS in April
2014, alleging, among other things, that Nationwide breached its
stop loss contract, not only as to the original $534,394.97 which it
had paid during the policy period, but also as to the additional
amounts that were not paid until 2012, after the policy period
expired (hereinafter the "Late-Paid Claims"). Florida Co-op sought
damages from Nationwide for breach of contract and under other
theories. The claim against RMTS was based on alleged tortious
interference with Florida-Co-op’s rights under the stop loss policy3.
Anticipatory Breach of Contract
The Court observed that
The Court interpreted Florida Co-op’s Complaint to allege that
the denial of the first claims for "TC" on disclosure grounds
constituted an advance notice that all claims relating to "TC" in
the future would be denied on these same grounds. As a practical
matter, that seems sensible--once a stop loss claim has been denied
on disclosure grounds, it is highly unlikely that future claims
would be honored, as the disclosure issue that lead to the initial
denial cannot be "cured" by subsequent action on the part of the
Late-Paid Claims May be Reimbursable under the
Stop Loss Contract
In short, Florida-Co-op was not tossed out on its ear just
because the claims at issue were paid late. The propriety of the
denial of all the claims on disclosure grounds remains an issue for
trial, as does Florida Co-op’s ability to have paid the Late-Paid
Claims within the policy period.
About the Author
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.
The Transitional Reinsurance Program -- Reinsurance Contributions
MyHealthGuide Source: CMS, The Center for Consumer Information & Insurance Oversight, CMS Article
The ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form will be available via www.pay.gov on Friday, October 24, 2014 in time for the 2014 benefit year's annual enrollment submission deadline of November 15, 2014. Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form Availability.
Section 1341 of the Affordable Care Act established a transitional reinsurance program to stabilize premiums in the individual market inside and outside of the Marketplaces. The transitional reinsurance program will collect contributions from contributing entities to fund reinsurance payments to issuers of non-grandfathered reinsurance-eligible individual market plans, the administrative costs of operating the reinsurance program, and the General Fund of the U.S. Treasury for the 2014, 2015 and 2016 benefit years.
Who Makes Contributions?
Health insurance issuers and certain self-insured group health plans offering major medical coverage that is part of a commercial book of business are contributing entities. For the purpose of reinsurance contributions, "major medical coverage" is defined in 45 CFR 153.20 as a catastrophic plan, an individual or a small group market plan subject to the actuarial value requirements under 45 CFR 156.140, or health coverage for a broad range of services and treatments provided in various settings that provides minimum value as defined in 45 CFR 156.145. A contributing entity must make reinsurance contributions on behalf of its enrollees in plans that provide "major medical coverage," as defined under 45 CFR 153.20, unless one of the exceptions provided under 45 CFR 153.400 applies to such coverage.
Although a contributing entity is responsible for the reinsurance contributions, it may elect to use a third party administrator or administrative services-only contractor for submission of enrollment data and the transfer of the reinsurance contributions.
How Does a Contributing Entity Make Reinsurance Contributions?
HHS is implementing a streamlined approach to complete the contributions process through Pay.gov. To successfully complete the reinsurance contribution process, contributing entities, or third party administrators or administrative services-only contractors on their behalf, must register on Pay.gov.
Using Pay.gov, the contributing entity (or third party administrators or administrative services-only contractors on their behalf) will access the "ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form" to enter the annual enrollment count. The ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form will auto-calculate the annual contribution amount to be remitted based on the annual enrollment count and the contributing entity will then schedule payment for the calculated reinsurance contributions on the payment page.
We note that HHS will offer contributing entities the option to pay: (1) the entire 2014 benefit year contribution in one payment no later than January 15, 2015 reflecting $63.00 per covered life; or (2) in two separate payments for the 2014 benefit year, with the first remittance due by January 15, 2015 reflecting $52.50 per covered life, and the second remittance due by November 15, 2015 reflecting $10.50 per covered life.
PPOs Pay Higher
Prices for Office Visits Where Competition Among Physician Practices
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 10/8/2014)
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
Reader response and correction is
encouraged. Other stop-loss leaders include the following list. However, we await
reader response providing stop-loss premium volume (and additional carriers)
so that each could be added to the table above. Stop-loss Premium Volume is not the Whole Story Industry executives question the purpose of a chart reporting only
stop-loss premium without additional information such as: October 30, 2014 - Webinar 1 PM Eastern November 5, 2014 - Webinar at 2:00 pm
Eastern November 10-12, 2014 November 17-19, 2014 December 1-3, 2014 December 4-5, 2014 January 18-20, 2015 January 25-27, 2015 February 10-11, 2015
March 18-20, 2015
May 6-8, 2015
July 21-23, 2015 September 28-30, 2015 March 30-April 1, 2016 October 17-19, 2016 March 15-17, 2017 September 13-15, 2017 Should you stop receiving the Newsletter, here
are some items to check: • Is the Newsletter email in your junk or spam folder?
Reader response and correction is
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
October 30, 2014 - Webinar 1 PM Eastern
November 5, 2014 - Webinar at 2:00 pm
November 10-12, 2014
November 17-19, 2014
December 1-3, 2014
December 4-5, 2014
January 18-20, 2015
January 25-27, 2015
February 10-11, 2015
March 18-20, 2015
May 6-8, 2015
July 21-23, 2015
September 28-30, 2015
March 30-April 1, 2016
October 17-19, 2016
March 15-17, 2017
September 13-15, 2017
Should you stop receiving the Newsletter, here are some items to check:
• Is the Newsletter email in your junk or spam folder?