MyHealthGuide Newsletter
News for the Self-Funded Community
5/12/2008

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


TABLE OF CONTENTS

General & Company News

AmWINS Acquires Beacon Risk Strategies

Presidio Acquires Vespasian Management

HealthEdge Receives $13 Million Investment Commitment from Psilos

TriZetto Constituent Software Differentiates Payers and Improves Coordination of Care Across Healthcare System

Mutual Assurance Administrators Enhances Services with Benefit Informatics Data Analysis and Reporting

NCPDP Launches dataQ to Provide Real-Time Pharmacy Access and Customized Reporting

MedSolutions’ Call Center Operation Achieves J.D. Power and Associates Recognition

Claimsnet.com 2008 Q1 Results Show Increased Revenues and Losses from Operations

TPA Acquisition Sought By Louisiana-Based TPA

People News

PHX Announces Kim Elliott as Strategic Account Manager

RGA Announces Steve Abood As Senior Vice President of its newly formed division, US Healthcare Reinsurance

Gen Re Promotes John Cholnoky to President

RenaissanceRe Names Dan Eudy as Senior Vice President

Market Trends, Studies & Books

Employees Without Access to Health Coverage Outside Work Defer Retirement

Workers Comp Market Has Slim 1% Underwriting Profitable for 2007

PPOs Must Collaborate Among Non-traditional Allies

Legal, Legislative & Regulatory News

ERISA Preempts Doctor's Claims of Breach of Contract and Fraud

Medical News

Patient Knowledge is Lacking on Newly Prescribed Medication After Hospital Discharge

Arthritis Can be a Barrier for Adults Seeking to Manage Diabetes through Physical Activity

Folic Acid and Vitamin B Use Does Not Reduce Risk of Heart Attack or Death Among Women at High CHD Risk

Resources

Standard Stop Loss Employer Disclosure Form Endorsed

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News


AmWINS Acquires Beacon Risk Strategies

MyHealthGuide Source: AmWINS Group, Inc., 5/7/08, www.amwins.com and www.beaconrisk.com

CHARLOTTE, N.C.--(BUSINESS WIRE)--AmWINS Group, Inc., one of the nation’s largest and most diversified wholesale insurance distribution firms, announced the acquisition of Beacon Risk Strategies, a Seattle-based managing general underwriter of excess-loss benefits insurance.

"The addition of Beacon Risk Strategies is a continuation of our initiative to strategically grow and diversify our Group Benefits Division,” said Steven DeCarlo, AmWINS Group’s CEO. "Beacon’s stop-loss capabilities represent a new product offering for our company and will strongly complement our existing capabilities.”

"We’re excited to have found another firm that fits so well into our company and enhances our strong portfolio of benefits services,” said Sam Fleet, President of AmWINS’ Group Benefits Division. "The synergies between Beacon and AmWINS Group Benefits will provide immediate benefit and opportunities to our broker customers.”

"Joining AmWINS makes terrific sense,” said Wright Dickinson, Beacon Risk Strategies’ President. "Combining our underwriting expertise and long-standing carrier relationships with AmWINS’ national retail client network and existing product solutions allows us to instantly build new relationships and bring new services to our existing customers. We are excited about this transition and look forward to becoming part of AmWINS.”

About Beacon Risk

Founded in 1999, Beacon Risk Strategies is a full-service managing general underwriter focusing on medical excess loss insurance.  The company provides customized products and services to protect companies and their health plans from unexpected catastrophic claims. Beacon represents several carriers and can offer products in all 50 states, giving them the unique ability to provide innovative and tailored packages to large self-funded employers and Blue Cross/Blue Shield plan markets.  Visit www.beaconrisk.com.

About AmWINS Group, Inc.

AmWINS is a wholesale distributor of specialty insurance products dedicated to serving retail agents throughout the United States by providing property and casualty, group life and health, and program administration services. Based in Charlotte, NC, the company operates through more than 35 offices across the United States and handles premium placements in excess of $3.3 billion dollars annually.  Visit www.amwins.com.

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Presidio Acquires Vespasian Management

MyHealthGuide Source: Presidio Reinsurance Group, Inc. (Presidio Re), 5/6/08, www.pxis.com and www.vespasiangroup.com

SAN FRANCISCO, CA -- Presidio Reinsurance Group, Inc. (Presidio Re) is pleased to announce the acquisition of Vespasian Management, Ltd. (Vespasian), of London, UK. Vespasian provides accident and health reinsurance solutions and products to support insurance companies, employers, affinity groups and financial institutions worldwide. The transaction was completed last week. Vespasian will be renamed Presidio Reinsurance Management, Ltd. Presidio Reinsurance Group is the parent company of Presidio Excess Insurance Services, Inc.

Dennis Heinzig, President and CEO of Presidio Re said, "In 1999 we opened our first office in London with this same team which later became Vespasian. Now we are pleased to welcome them back into the group. Under Craig Tyrell’s leadership as its Managing Director and our combined effort within the group, we will comprehensively expand our international accident and health programs and build on the success we have had together in the past.”

Craig Tyrell, Managing Director of Vespasian stated, "We are delighted to become part of Presidio Re. Their vision for international accident and health insurance and reinsurance is exciting, progressive and complements our current lines of business wonderfully. As part of Presidio Re, we will now be able to broaden our accident and health business, expand our underwriting operation, and enhance service for the benefit of our brokers and clients.”

About Presidio Re

Presidio Re is a market leader providing accident and health insurance and reinsurance products and services addressing the opportunities and challenges experienced by insurance companies, HMOs, managed care organizations, healthcare systems, hospitals, medical groups and employers. Since 1994, Presidio Re has provided management solutions for clients assuming all forms of medical risk exposures. Presidio Re writes over $150 million of medical reinsurance in North America. The company has offices in San Francisco, Minneapolis and Kansas City, and has clients throughout North America.  Contact: Dennis Heinzig, CEO at  (415) 354-1555 and visit www.pxis.com.

About Vespasian

Vespasian Management Ltd provides accident and health reinsurance solutions and products to support companies worldwide. Clients include insurance companies, employers, affinity groups and financial institutions. Vespasian focuses on a range of accident and health reinsurance coverages including catastrophe PA, general PA programs, key man, credit card, sports, passive war and terrorism, excess of loss medical reinsurance and certain proportional medical contracts. Vespasian has offices in London, UK and New York, NY. Contact: Craig Tyrell, CEO at 011-44-20-3008-6646 and visit www.vespasiangroup.com.

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HealthEdge Receives $13 Million Investment Commitment from Psilos

MyHealthGuide Source: 5/6/08, www.healthedge.com and www.psilos.com

Burlington, MA — HealthEdge, the leading provider of next-generation claims and benefit administration, business intelligence and portal software products for healthcare payors, announced that it has secured a $13 million investment commitment from Psilos Group, a leading healthcare venture capital and private equity firm.

"We believe that HealthEdge’s HealthRules is the only software platform that meets the needs of today’s healthcare marketplace,” said Dr. Albert Waxman, senior managing member of Psilos Group. "The legacy systems currently in use at most health plans cannot respond to the evolving consumer-focused healthcare economy which demands support for personalized benefits and complex financial transaction management. HealthEdge is uniquely positioned to provide payor organizations of all sizes the ability to quickly offer the kinds of innovative products that the market demands and to make long overdue reductions in administrative overhead. Psilos is excited to extend our support of HealthEdge as it continues to expand its products and services.”

"We are seeing unprecedented demand for our products,” remarked Rob Gillette, CEO of HealthEdge. "The healthcare payor community has now realized that a contemporary software platform, built with the next generation of healthcare in mind, is no longer a luxury, but a necessity. We are extremely pleased to have Psilos Group as our investment partner.”

HealthEdge will use the funds to increase the size of its business and to continue to invest in advanced product capabilities.

About HealthEdge

HealthEdge provides health plans, TPAs, PPOs and insurers of all sizes unique software products that enable them to compete in the new healthcare market. Payor organizations are able to pursue innovative, new strategies focused on increasing revenue, decreasing costs and improving the quality of healthcare. HealthEdge provides HealthRules®, a next-generation, patented software platform for core administrative processes, business intelligence, and web self-service. The company is headquartered in Burlington, Massachusetts.   Visit www.healthedge.com.

About Psilos Group

Psilos Group has been a successful healthcare venture capital and private equity firm since its founding in 1998. With over $500MM under management, Psilos focuses its investments across the healthcare services, healthcare information technology, and medical technology sectors. Psilos invests nationwide in businesses that are poised to create enduring market value by fundamentally improving the U.S. healthcare system. Our portfolio companies are sustainable and high-value businesses that have a demonstrated ability to reduce the costs of healthcare delivery, improve clinical quality and advance the alignment of payer, patient and provider incentives. Psilos has offices in New York, the San Francisco Bay Area and Santa Fe, New Mexico.  Visit www.psilos.com.

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TriZetto Constituent Software Differentiates Payers and Improves Coordination of Care Across Healthcare System

MyHealthGuide Source: TriZetto (NASDAQ: TZIX), 5/5/08, www.TriZetto.com

NEWPORT BEACH, CA -- The TriZetto Group Inc. announced a suite of applications that can provide health plans with advanced, Web-based services to enable members, providers, employers and brokers to make more informed decisions and improve the coordination of healthcare services across the U.S. healthcare system.

TriZetto's Constituent Web Solutions Features

"Our Constituent Web Solutions will help take our customers to a new level as strong service organizations. By enabling better transparency and information sharing, our applications can assist constituents across the healthcare system in conducting business with health plans more easily and make better informed decisions," said Dave Pinkert, TriZetto's senior vice president, constituent web solutions. "These unique capabilities help make our payer clients more competitive and differentiated when responding to RFPs for new cases and renewals."

Other benefits of TriZetto's Constituent Web Solutions, according to Pinkert, are that these Web-based systems can reduce a health plan's call center expenses and increase satisfaction of health plan constituents. Constituent Web Solutions directly support the payer's consumer-driven plans, help improve service quality in more traditional insurance products and lay the groundwork for a next-generation consumer retail platform. And by obtaining all of these applications from TriZetto, added Pinkert, the payer can present a common look and feel online with applications that integrate with TriZetto's back-office core administration and care management systems.

"Getting the right information to health care consumers, at the right time, and in the right format is healthcare's 'last mile,'" Pinkert said. "By securely distributing this information, our applications will enable a whole new experience in health insurance, which we call Integrated Healthcare Management (IHM), which will lead to more informed and engaged members, more efficient and effective healthcare providers, all supported by payers that see and manage the big picture, working with employers who see healthier, more satisfied employees.

In a recent research report, industry analyst firm Gartner Inc. wrote, "The relative immaturity of health insurance portals, when compared to other industries, and lack of consistent portal strategy within an insurer's site make investment in market differentiation possible and profitable."*

About TriZetto

TriZetto is Powering Integrated Healthcare Management™. With its technology touching nearly half of the U.S. insured population, TriZetto is uniquely positioned to drive the convergence of health benefit administration, care management and constituent engagement. The company provides premier information technology solutions that enable payers and other constituents in the healthcare supply chain to improve the coordination of benefits and care for healthcare consumers. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company's payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Call 949-719-2200 and visit www.trizetto.com.

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Mutual Assurance Administrators Enhances Services with Benefit Informatics Data Analysis and Reporting

MyHealthGuide Source: Benefit Informatics, 5/9/08, www.benefitinformatics.com and www.maa-tpa.com

TULSA, OK – Mutual Assurance Administrators (MAA), one of the most recognized Third Party Administrators in the Midwest, recently signed an agreement to implement the proven data analysis, reporting and distribution services of Benefit Informatics, a leading healthcare data warehouse provider for payers serving the self-insured health plan market.

Mutual Assurance Administrators will implement and offer the Benefit Analyzer® service to analyze healthcare utilization for self-insured clients, which includes the ability to drill-down to provider, procedure and payment information at the individual EOB level. MAA will distribute standard, ad-hoc and scheduled reports to clients and broker/consultants utilizing the Connect Edition.

"Partnering with Benefit Informatics strengthens our commitment to aggressively initiate and invest in additional programs and services to control rising healthcare costs for our clients,” said Todd Archer, President and CEO of Mutual Assurance Administrators. "Benefit Informatics is user friendly and at the same time delivers in-depth analysis capabilities for both our clients and consultant partners.”

Through proprietary applications that transform raw claim data into actionable management information, Benefit Informatics provides clients such as Mutual Assurance Administrators the ability to enhance their service offerings and better communicate with their self-funded clients, health plan participants and consultants.

"We are excited to be working with a nationally recognized payer such as Mutual Assurance Administrators,” said Philip Kurtz, President and CEO of Benefit Informatics. "MAA is a leading TPA in the industry and is growing to meet the needs of the self-insurance market. Our two companies share a common goal of increasing transparency to all stakeholders in the health insurance process to help control costs.”

About Benefit Informatics

Benefit Informatics Inc. enables the efficient planning, management and analysis of employee benefit plans through the delivery of online proprietary applications and services to insurance companies, Third Party Administrators, brokers and employers. Through its clients, Benefit Informatics currently serves more than 3,600 businesses, managing health benefits for nearly 2 million members. Benefit Informatics works closely with customers to provide solutions that help attract new customers, retain current clients and operate more efficiently. Please contact us to see how we can help your organization Sell, Keep and Do More™. Call (888) 802-INFO (4636) and visit www.benefitinformatics.com.

About Mutual Assurance Administrators

Mutual Assurance Administrators, a nationally recognized TPA founded in 1975, remains focused on delivering excellent customer service, controlling costs and providing professional support to employers and brokers. MAA is headquartered in Oklahoma City, OK and has division offices in Bartlesville, OK; Dallas, TX; Little Rock AR; Memphis, TN; and Springfield, MO. MAA continues to lead in developing practices and investing in resources that assist employers in providing quality benefits to their employees while keeping costs under control. In addition to providing Medical Administration, FSA Administration and URAC accredited Medical Management programs; MAA’s broad scope of services includes a fully integrated Disability Management program including Workers’ Compensation Administration. Call 800-825-3540 and visit www.maa-tpa.com.

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NCPDP Launches dataQ to Provide Real-Time Pharmacy Access and Customized Reporting

MyHealthGuide Source: The National Council for Prescription Drug Programs (NCPDP), 5/6/08, www.ncpdp.org

SCOTTSDALE, AZ — The National Council for Prescription Drug Programs (NCPDP), announced the launch of dataQ™, a next generation pharmacy data solution that provides healthcare stakeholders with the most up-to-date and in-depth pharmacy information available. dataQ enables PBMS, health plans, pharmacies and other stakeholders improved pharmacy database accuracy and streamlined electronic claims processing for faster reimbursement of prescription drug claims. It is also used for pharmacy network development and credentialing, data validation, drug utilization monitoring and product recalls, along with market research and analysis.

Available with varying subscription and administrative levels, the new resource expands functionality to include optional real-time web access to pharmacy data, extensive custom reporting and file download capabilities. dataQ’s industry-leading accuracy and integrity is based NCPDP’s on deep data validation, verification and documentation processes, which have been trusted for decades.

The launch reflects a natural evolution of the Standard Pharmacy Database v2.1 product containing almost 75,000 pharmacies, which will continue to be available. Originally developed to provide NCPDP Provider ID enumeration, the unique identifier for pharmacies, it now contains the new National Provider Identifier (NPI) on pharmacies and has grown to be the industry’s most comprehensive database of consistently updated pharmacy information.

"Using a time-tested method of assigning "intelligent” identification codes to data fields, dataQ provides more than just raw data; it is a way to identify, sort and categorize that data in a nimble manner previously unavailable in the industry,” stated NCPDP President Lee Ann Stember. "It is an invaluable data tool for payers and other drug claims processors, pharmacies, pharmaceutical and biotech manufacturers, informatics companies, pharmacy practice management system vendors, list procurement vendors and more. The new solution will allow pharmacies to have more access and control over their own information, with the ability to update their data via any web-based browser and view their data in a real-time environment.”

Added Stember, "With the new real-time look-up option for subscribers, we anticipate that dataQ will become an indispensable troubleshooting tool that empowers healthcare organizations to enhance productivity, reduce costs and improve the bottom line.”

About NCPDP

Founded in 1977, the National Council of Prescription Drug Programs (NCPDP) is an ANSI-accredited non-profit organization that creates and promotes consensus-driven standards for the transfer of data from and to the pharmacy services sector of the healthcare industry. A long-time and trusted player in the industry, NCPDP has been named in ground-breaking federal legislation, including HIPAA (the Health Insurance Portability and Accountability Act) and the MMA (Medicare Modernization Act). NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry.  Call (480) 477-1000 and visit www.ncpdp.org.

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MedSolutions’ Call Center Operation Achieves J.D. Power and Associates Recognition

MyHealthGuide Source: MedSolutions, 5/5/08, www.medsolutions.com

NASHVILLE, TN / WESTLAKE VILLAGE, CA -- MedSolutions, providing radiology management services for 20 million individuals nationwide, announces that it has been recognized for the second consecutive year for "An Outstanding Customer Service Experience" under the esteemed J.D. Power and Associates Certified Call Center Program (SM). MedSolutions was the first and currently the only radiology management companies to be recognized with this distinguished award, an outstanding achievement in light of the fact that there are 75,000 call centers in North America and to date only 40 have been certified with this award.

"Our call center exemplifies the highest professional standards, with professional first-level responders, and specialist reviewers including registered nurses as well as medical directors who are actively practicing physicians and currently board certified in an area of clinical pertinence to the review request," says Chris Crabtree, vice president of operations. "With increased Web technology improvements, we are currently expecting 40% of our volume to be coming through our web site, and have made improved efficiencies to lower our call volume, improve customer satisfaction, and increase turn around times on our cases."

J.D. Power and Associates certified the operations division both in Tennessee and Florida, following an exhaustive external audit which involved an independent third party satisfaction survey assessing customer ratings for MedSolutions' courtesy, knowledge, and concern for customer needs. Auditors also examined policies and procedures for each call, evaluating MedSolutions' commitment to enhancing the customer experience and confirming its delivery of world class services. MedSolutions call center operations handle about 2,840,920 calls annually from more than 200,000 physicians nationwide.

"Every member of the MedSolutions organization was honored to receive this esteemed award last year, and we are again gratified by this recognition," states Curt Thorne, CEO of MedSolutions. "This distinction is testament to our dedication to meeting customer expectations for service."

"This independent and unprecedented validation of our dedication to excellence in radiology management again punctuates MedSolutions' position as an ideal partner to the nation's leading healthcare payers and government programs," says Thorne.

About MedSolutions

MedSolutions specializes in managing radiology services for national and regional health plans as well as federal and state government agencies, maintaining management contracts for nearly 25 million individuals nationwide. The company leverages sophisticated analytics, personalized call center operations and extensive radiology care management experience to provide the most innovative, cost-effective radiology management solutions in the industry. Visit www.medsolutions.com.

About J.D. Power and Associates

Headquartered in Westlake Village, Calif., J.D. Power and Associates is an ISO 9001-registered global marketing information services firm operating in key business sectors including market research, forecasting, consulting, training and customer satisfaction. The firm's quality and satisfaction measurements are based on responses from million of consumers annually. J.D. Power and Associates is a business unit of The McGraw-Hill Companies.  Visit www.mcgraw-hill.com.

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Claimsnet.com 2008 Q1 Results Show Increased Revenues and Losses from Operations

MyHealthGuide Source: Claimsnet.com inc. (OTCBB: CLAI.OB), 5/5/08, www.claimsnet.com

DALLAS – Claimsnet.com inc., a leading provider of Internet-based business-to-business solutions for the healthcare industry, reported its results for the first quarter of fiscal 2008, which ended March 31, 2008.

Financial Highlights

"While we are pleased with the 18% growth in sales, our loss from operations increased compared to last year. This primarily resulted from extra efforts that were expended to upgrade our ASP server operations, providing updated hardware and software and increased capacity." commented Don Crosbie, chief executive officer of Claimsnet.

"Our expectation is that going forward we will benefit from this upgrade as our efforts in sales growth continue to increase our sales, and expenses again return to more normal levels. In connection with these efforts, the Company hired a new Vice President of Sales to focus on the payer industry and a sales representative to improve our penetration of the provider community. The results of these efforts seem promising, based on initial results in the first month. In addition, we have substantially completed the integration of the operations of Acceptius into our operations, and as a result we have further options in our sales efforts for paper conversion of claims and medical claims repricing opportunities. We believe these things taken together, along with continued cost controls, will move us towards profitability by the end of this calendar year," added Crosbie.

About Claimsnet.com inc.

Claimsnet.com inc. is a leading provider of Internet-based claim processing solutions for the healthcare payer industry, including distinctive, advanced ASP technology. Headquartered in Dallas, Texas, Claimsnet offers systems that are distinguished by ease of use, customer care, security and measurable cost advantages.  Contact Don Crosbie at (972) 458-1701 Ext. 112, dcrosbie@claimsnet.com and visit www.claimsnet.com.

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TPA Acquisition Sought By Louisiana-Based TPA

MyHealthGuide Source: Richard T. Wickert, Managed Care Strategies, 865-300-3925 or rtwickert@hotmail.com, 5/10/08 (rerun from 3/13/08)

Louisiana based workers compensation TPA, with offices in Louisiana, Texas, California and Washington, DC, is interested in acquiring a benefits TPA in any of the following States, Louisiana, Texas, California, or Florida. Key products should include, but not limited to, self-funded health benefits and consumer driven health plans. Please contact Richard T. Wickert, Managed Care Strategies, at 865-300-3925 or email: rtwickert@hotmail.com.

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People News


PHX Announces Kim Elliott as Strategic Account Manager

MyHealthGuide Source: PHX, 5/9/08, www.phx-online.com

Bedminster, NJ -- PHX, the leader in advanced cost management services, is pleased to announce the addition of Kim Elliott to the position of Strategic Account Manager.

Elliott has 24 years experience in the healthcare industry working in both Carrier and Third Party Administration environments. Additionally, Elliott has held various positions on the Payor side ranging from various functions such as Claims Analyst, Claims Training Specialist, Claims Manager, and most recently, Director of Account Management.

"We are proud to have Kim Elliott join our team to help lead PHX as Strategic Account Manager. She will collaborate with our clients to ensure their expectations are being exceeded. Mrs. Elliott is the caliber of professional we will continue to seek out, with talent and experience levels unsurpassed in the industry, to join our management team. With Kim's strong background and experience in the healthcare marketplace, combined with the unique suite of claims management services we offer, PHX undoubtedly remains the leader in the cost management arena. We will continue to lead the industry by uncovering every opportunity available in order to guarantee our goals and mission – to offer our clients superb service that translates into the best value in the healthcare cost management marketplace," stated Robert C. Malone, PHX President and CEO.

PHX is excited to add this position to its organizational structure. Strategic Account Management will immediately become a value added service to PHX clients. Elliott will coordinate PHX's stewardship efforts while gauging and reporting performance metrics. This role will also include discussing new programs, ideas, and solutions PHX will bring to market to demonstrate our clients' value in an increasingly competitive environment. Elliott will be located in PHX's Regional Office in Dacula, GA.

About PHX

PHX delivers advanced cost management solutions for health plans. The company combines claim processing automation with professional services to deliver a centralized approach to cost management, increasing savings in both the near and long term while dramatically reducing errors and turnaround time. The firm's solutions are used by a number of the industry's leading insurance companies, Health Maintenance Organizations, and Third Party Administrators. Services included in the PHX offering include bill review and audit, secondary network re-pricing/claims negotiations, claims editing, fraud and abuse detection, and health benefits trend analysis and reporting. All services are handled in-house for maximum privacy and legal and regulatory compliance. PHX also supplies full technology implementation, training and support for quick, seamless integration into any organization. Visit www.phx-online.com.

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RGA Announces Steve Abood As Senior Vice President of its newly formed division, US Healthcare Reinsurance

MyHealthGuide Source: Reinsurance Group of America, Inc (RGA), 5/8/08, www.rgare.com

Reinsurance Group of America, Inc. (RGA) announces that Steven J. Abood, FSA, MAAA, joined RGA on April 21, 2008, as Senior Vice President, US Healthcare Reinsurance, a newly formed division at RGA.

"Steve is known throughout the industry and we are excited to have him as part of the RGA family, " said Paul A. Schuster, FSA, MAAA, Senior Executive Vice President, U.S. Division, RGA Reinsurance Company.  "Steve will be responsible for building our US Healthcare Reinsurance line of business."

Abood has over 25 years of group insurance experience where most recently he was 8 years at Munich Re America.  He is a Fellow in the Society of Actuaries and a Member of the American Academy of Actuaries. He is a graduate of Rutgers University with a BA in Mathematics and Economics.

Steve Abood is located in New Jersey and can be contacted at 732-604-4775 or sabood@rgare.com.

About RGA

Reinsurance Group of America, Incorporated is a leader in the global life reinsurance industry, with more than $2.1 trillion of life reinsurance in force and assets of more than $21 billion. RGA serves clients from 24 offices around the world, delivering expert solutions in life reinsurance, facultative underwriting, risk management, product development, and capital-motivated reinsurance services. Visit www.rgare.com.

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Gen Re Promotes John Cholnoky to President

MyHealthGuide Source: General Re Corporation, 4/29/08, www.genre.com

Stamford, CT -- General Re Corporation announced that I. John Cholnoky has been promoted to President of General Reinsurance Corporation and Manager of Gen Re’s global direct Property and Casualty operations. Mr. Cholnoky’s responsibilities will include General Re’s direct treaty, both marketing and underwriting, facultative and claims divisions.

In addition, Mr. Cholnoky has been elected to the Board of Directors of General Re Corporation, the parent of General Reinsurance Corporation. Also elected to the General Re Board: Patricia H. Roberts, Steven J. Mannik and Winfried Heinen who join current Board members, Tad Montross, Peter Lütke-Bornefeld, William G. Gasdaska and Damon N. Vocke.

Commenting on the organizational changes, Tad Montross, Chairman and CEO of Gen Re, said, "I’m very excited about these changes. They will bring a sharper focus to our different businesses and help us navigate a challenging operating environment. John Cholnoky has been with Gen Re for 28 years. He has extensive reinsurance experience, in-depth knowledge of the business and significant client contacts around the world.”

About Gen Re

General Re Corporation, a subsidiary of Berkshire Hathaway Inc., is a holding company for global reinsurance and related operations. As one of the leading property/casualty and life/health reinsurers in the world, Gen Re is represented globally by a network of 45 branch and subsidiary offices in key reinsurance markets.  Visit www.genre.com.

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RenaissanceRe Names Dan Eudy as Senior Vice President

MyHealthGuide Source: RenaissanceRe (NYSE: RNR), 5/8/08, www.renre.com

PEMBROKE, Bermuda -- RenaissanceRe Holdings Ltd. announced that Dan R. Eudy has joined the Company as Senior Vice President of the Glencoe Group, which conducts the organization’s Individual Risk business. Mr. Eudy, who will report to William J. Ashley, Glencoe Group Chief Executive Officer, is expected to be based in Hartford, CT.

Neill A. Currie, President and Chief Executive Officer of RenaissanceRe Holdings Ltd., said: "I am very pleased to welcome Dan to the RenaissanceRe team. Dan is a seasoned and respected insurance professional. The breadth of his experience and his expertise in managing complex commercial risks will be of immense value as we continue to build upon our capabilities in this area.”

Mr. Eudy most recently served as Chief Executive Officer of Industrial Risk Insurers, which he joined in 1996 as Chief Underwriting Officer before being promoted to Chief Operating Officer in 2000 and CEO in 2001. Prior to this time, Mr. Eudy held a number of increasingly senior positions in underwriting, operations and marketing at Hartford Insurance Group. He has a BSBA in business and economics from Appalachian State University, and an MBA from Rensselaer Polytechnic Institute.

About RenaissanceRe Holdings Ltd.

RenaissanceRe Holdings Ltd. is a global provider of reinsurance and insurance. Our business consists of two segments: (1) Reinsurance, which includes catastrophe reinsurance, specialty reinsurance and certain joint ventures and other investments managed by our subsidiary RenaissanceRe Ventures Ltd., and (2) Individual Risk business, which includes primary insurance and quota share reinsurance. RenaissanceRe is traded on the New York Stock Exchange under the ticker symbol 'RNR'. Visit www.renre.com.

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Market Trends, Studies & Books


Employees Without Access to Health Coverage Outside Work Defer Retirement

MyHealthGuide Source: Watson Wyatt (NYSE, NASDAQ: WW), 5/7/08, www.watsonwyatt.com

WASHINGTON, DC — Older workers without other health care insurance options are more likely to defer retirement to stay covered under their employer’s plan, according to an analysis by Watson Wyatt Worldwide, a leading global consulting firm. Other factors, such as whether an employee has a pension, also contribute to decisions on when to retire.

Watson Wyatt analyzed data collected from 1992 to 2004 as part of the University of Michigan’s Health and Retirement Study, a biannual survey of 22,000 older U.S. workers.

Analysis Highlights

Retirement Influencers for Workers Over 50 Years Old

"Retirement is the result of a complex decision-making process that is influenced not only by employees’ benefit packages but also by environmental factors,” added Kevin Wagner, senior retirement consultant at Watson Wyatt. "When the market booms, DC plan participants might retire just when companies need to add workers, and when there are market busts, DC plan participants might stay at work just when companies want to reduce the size of their workforce. To effectively predict and manage workers’ exit from the workforce, employers need to take a comprehensive view of their benefit programs and tailor their retirement programs to meet both employee and employer needs.”

Read more information about the factors affecting workers’ retirement behavior at www.watsonwyatt.com/retirementtiming

About Watson Wyatt

Watson Wyatt is the trusted business partner to the world’s leading organizations on people and financial issues. The firm’s global services include: managing the cost and effectiveness of employee benefit programs; developing attraction, retention and reward strategies; advising pension plan sponsors and other institutions on optimal investment strategies; providing strategic and financial advice to insurance and financial services companies; and delivering related technology, outsourcing and data services. Visit www.watsonwyatt.com.

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Workers Comp Market Has Slim 1% Underwriting Profitable for 2007

MyHealthGuide Source: National Council on Compensation Insurance, Inc. (NCCI) , 5/8/08, www.ncci.com.  Slides: www.ncci.com/ncci/media/pdf/AIS-2008-SOL-Complete.pdf

Boca Raton, FL -- NCCI Holdings, Inc. released its annual "State of the Line” workers compensation market analysis. This year’s report indicates that the workers compensation calendar year combined ratio stands at 99%—the second consecutive year that the line has realized an underwriting profit, albeit a 6-point deterioration from 2006.

"We are pleased to report solid overall results for the workers compensation line in 2007,” NCCI President and CEO Steve Klingel said. "However, NCCI continues to observe that a low interest rate environment, combined with the modest performance of the equity markets, have left the line with post-tax returns on surplus that are far below record levels—and these results barely return the industry’s cost of capital after the significant payments of federal income taxes.”

"Given the positive 2007 results, our short-term view of the market is optimistic,” added NCCI Chief Actuary Dennis Mealy. "However, our long-term outlook is cautionary due to the myriad of uncertainties that continue to face the business.”

Analysis Highlights

About NCCI

National Council on Compensation Insurance, Inc. (NCCI) is the largest provider of workers compensation and employee injury data and statistics in the nation.   Visit www.NCCI.com.

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PPOs Must Collaborate Among Non-traditional Allies

MyHealthGuide Source: American Association of Preferred Provider Organizations (AAPPO), 5/8/08, www.aappo.org

Washington, DC – Collaboration among a broad set of industry stakeholders is vital to tackling many of the largest issues facing the health care and preferred provider organization (PPO) industries, according to a report released today by the American Association of Preferred Provider Organizations (AAPPO).

The annual report, Outlook Connect – 2008 Market & Industry Trend Report, found that while competition, consolidation and consumerism are trends that continue to be prominent in the PPO industry, the focus in the next several years needs to be on collaboration. The report is based on interviews with key industry stakeholders as well as data from AAPPO’s research partner, Mercer.

"Our report found that stakeholders believe the PPO industry is at a pivotal point where issues demand profound and potentially uncomfortable solutions – and that these solutions require us to work with nontraditional allies in order to improve the flow of needed information among preferred provider networks, payers and providers in order to improve the health care experience for all consumers,” said Karen Greenrose, CEO and president of AAPPO. "I am proud of the work AAPPO has accomplished to forge relationships with groups like the American Medical Association, and believe similar collaborations will only benefit consumers and the health care industry as a whole.”

Key findings

"PPOs are chosen by more than 165 million Americans, which represents nearly 67% of all insured Americans,” said Allen Karp, AAPPO chairman and vice president for Health Care Delivery for Aetna . "The popularity of PPOs, we believe, is due to our industry’s dedication to preserving the hallmarks of the PPO delivery system for consumers and employers – choice, quality and flexibility.”

About the AAPPO

Founded in 1983, AAPPO is the leading national association of preferred provider organizations (PPOs). PPOs put control for medical decisions in the hands of the physician and patient, resulting in easy access to the right care, provided by the right doctor, at the right time. AAPPO creates a forum for discussion and dissemination of PPO best practices.   Visit www.aappo.org.

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Legal, Legislative & Regulatory News


ERISA Preempts Doctor's Claims of Breach of Contract and Fraud

MyHealthGuide Source:  Bureau of National Affairs, Inc. (BNA), Legal News, Volume 08 Number 89, 5/8/08, www.bna.com

Case: Gianetti v. Blue Cross and Blue Shield of Connecticut Inc., D. Conn., No. 3:07cv01561 (PCD), 5/2/08. Court's Ruling

Article recommended by John H. Eggertsen, john@jhelaw.com, Eggertsen & Associates, P.C., www.jhelaw.com

ERISA preempts a doctor's state law claims seeking reimbursement for reconstructive plastic surgery he performed on a health plan participant's child, the U.S. District Court for the District of Connecticut ruled in the above case.

Case Background

Dr. Charles D. Gianetti performed reconstructive plastic surgery on SR, a minor covered by an employer-sponsored health care plan operated by Anthem Health Plans Inc., Anthem Insurance Companies Inc., and Blue Cross and Blue Shield of Connecticut Inc.

The court said Rose and her mother, Cynthia Bellamy, signed a statement that they would pay for all fees regardless of insurance. The agreement also provided that Gianetti would not send Bellamy a statement of his charges until Anthem paid him.

According to the court, Anthem paid only $3,019 of the $7,695 Gianetti sought in medical expenses. Anthem said it paid a portion of the amount owed directly to Bellamy and Rose, and denied coverage for another portion of the medical expenses. Bellamy and Rose denied ever receiving Anthem's payment and refused to make any payments to Gianetti, the court said.

Gianetti subsequently filed a lawsuit in state court against Anthem, Bellamy, and Rose, alleging breach of contract, quantum meruit, and unjust enrichment. Gianetti also alleged fraud, misrepresentation, and violations of CUTPA against Anthem. Anthem then removed the action to federal court on the basis of ERISA preemption.

Court's Ruling

Dismissing all of the doctor's claims, Judge Peter C. Dorsey said the doctor was a plan beneficiary because the participant and her child assigned their rights to him. In so finding, the court said the doctor's state law breach of contract claim derived from the administration of the ERISA plan, and thus was preempted by the federal statute.

According to the court,

Standing to Bring Lawsuit Under ERISA

The court found that Gianetti's claims derived from the existence and administration of the ERISA plan because recovery of the value of his services required an initial determination of the nature and extent of his benefits under the plan. "Plaintiff's benefits under the ERISA-regulated plan dictate both the value of the services and, as a result, the amount due for those services," the court reasoned.

Thus, liability would exist only because of Anthem's administration of the plan, the court said.

ERISA Preempts Claims of Breach of Contract, Unjust Enrichment

Noting that the court had supplemental jurisdiction over Gianetti's breach of contract, quantum meruit, and unjust enrichment claims against Bellamy and Rose, the court also found those claims were preempted by ERISA. In so finding, the court said Gianetti did not have a claim against Anthem without Bellamy's and Rose's assignment, and Gianetti would not have a claim against Bellamy and Rose without Anthem's denial under the plan.

ERISA Preempts Claims of Fraud, Misrepresentation

The court went on to find that Gianetti's fraud, misrepresentation, and CUTPA claims against Anthem were also preempted by ERISA. According to the court, the denial of charges, the alleged lack of timely review of the denied charges, and the alleged purging of Rose's records from Anthem's files all related to Anthem's management of the plan and had a large impact on Gianetti's benefits under the plan.

The court noted that ERISA's savings clause did not save Gianetti's claims from preemption because they were not specifically directed at the insurance industry, but rather were laws of general application. Furthermore, Gianetti's claims did not transfer or spread the policyholder's risk, constitute an integral part of the policy relationship between the insurer and insured, and the laws were not limited to entities within the insurance industry, the court said.

The court similarly ruled that the doctor's claims of misrepresentation, fraud, and violation of the Connecticut Unfair Trade Practices Act (CUTPA) concerned the existence and extent of benefits owed under the plan, and also involved the management of the plan. As such these claims also were preempted by ERISA, the court held.

About BNA

The Bureau of National Affairs, Inc. (BNA) is the largest independent publisher of information and analysis products for professionals in law, tax, business, and government.   BNA publishes daily, weekly, monthly, and up-to-the-minute news covering the full range of legal, legislative, regulatory, and economic developments that impact the business environment.  Visit www.BNA.com.

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Medical News


Patient Knowledge is Lacking on Newly Prescribed Medication After Hospital Discharge

MyHealthGuide Source: Mayo Clinical Proceedings, 2008;83(5):554-558, Abstract

There is an unacceptable functional health literacy and understanding of medications by the patient following hospital discharge according to a study published in the Mayo Clinical Proceedings.

Researchers reviewed the charts of 172 patients who were discharged from February 1, 2006, through April 25, 2006, from the internal medicine residency service at a community-based teaching hospital with prescriptions for 1 or more new medications. Between 4 and 18 days after discharge, patients were contacted by telephone and asked about the name, number, dosages, schedule, purpose, and adverse effects of the new medication(s) and whether they could name their medical contact person. Researchers recorded the number of correct answers, patient age, and years of education.

Study findings

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Arthritis Can be a Barrier for Adults Seeking to Manage Diabetes through Physical Activity

MyHealthGuide Source: Centers for Disease Control and Prevention (CDC), 5/8/08, Article

More than half of adults with diagnosed diabetes also have arthritis, a painful condition that can be a barrier to physical activity according to a study released by the Centers for Disease Control and Prevention.

The study, "Arthritis as a Potential Barrier to Physical Activity among Adults with Diabetes: United States, 2005 and 2007,” analyzed data on the prevalence of physical inactivity among adults with arthritis and diabetes in all 50 states, the District of Columbia, and U.S. territories.

Study findings

"These findings suggest more needs to be done to help people with diabetes and arthritis get physically active to improve their health,” said Chad Helmick, M.D., a CDC medical epidemiologist and co-author on the study. "Engaging in regular physical activity and maintaining a healthy weight can help alleviate the pain and disability that often accompany arthritis.”

Adults with arthritis and diabetes have unique barriers to being physically active such as concerns about pain, aggravating or worsening joint damage, and not knowing how much or what types of physical activity are safe for them. These concerns must be addressed for adults with both conditions to become more physically active.

About Arthritis and Diabetes

Nationwide, 46.4 million adults have arthritis and 20.6 million adults have diabetes, with nearly 7 in 10 having had diabetes diagnosed by a health professional. Research shows that engaging in joint-friendly activities such as walking, swimming, biking can help manage both conditions.

Disease self-management classes, including exercise programs that address arthritis-specific barriers, may help adults with arthritis and diabetes better manage their disease. Programs proven to be effective in managing arthritis, such as the Chronic Disease Self-Management Program, the Arthritis Foundation′s Exercise Program, and Enhance Fitness, are available in many local communities nationwide. For more information, visit CDC′s Arthritis Web site at http://www.cdc.gov/arthritis/intervention.

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Folic Acid and Vitamin B Use Does Not Reduce Risk of Heart Attack or Death Among Women at High CHD Risk

MyHealthGuide Source: Journal of the American Medical Association, 2008;299(17):2027-2036, 5/7/08, Abstract

After 7 years of treatment and follow-up, a combination pill of folic acid, vitamin B6, and vitamin B12 did not reduce risk of cardiovascular events among high-risk women according to a study published in the Journal of the American Medical Association.  However, there was significant homocysteine lowering.

The study followed 5,442 women who were US health professionals aged 42 years or older in a randomized double-blind, placebo-controlled trial of antioxidant vitamins.  Each woman either a history of CVD or 3 or more coronary risk factors.  Participants received a combination pill containing folic acid, vitamin B6, and vitamin B12 or a matching placebo, and were treated for 7.3 years from April 1998 through July 2005.   Researchers measured a composite outcome of myocardial infarction, stroke, coronary revascularization, or CVD mortality.

Study findings

Researchers concluded that randomized trials among patients with preexisting cardiovascular disease (CVD) failed to support benefits of B-vitamin supplementation on cardiovascular risk. 

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Resources


Standard Stop Loss Employer Disclosure Form Endorsed

MyHealthGuide Source: Self-Insurance Institute of America (SIIA, www.SIIA.org), Society of Professional Benefit Administrators (SPBA, www.SPBATPA.org), Recurring article

Self-Insurance Institute of America ( www.SIIA.org ) and Society of Professional Benefit Administrators (www.SPBATPA.org) have endorsed a standardized stop-loss disclosure form, which also includes ICD-9 codes. The documents are intended to help facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting.

Stop Loss Carriers and MGUs Adopting  the Standardized Form

The list below represents an estimated $3 Billion in stop loss premium.  Assuming a medical self-funded community stop loss market of $4 Billion, then over 75% of the market has adopted the form.

If you are a stop loss carrier or MGU that has adopted the standard disclosure form, please let us know at Info@MyHealthGuide.com.

Latest Survey Results Recommending Adoption

Respondents from the self-funded community have voted 86% in favor of adoption of the standard form for stop loss disclosure.  For all survey results, see www.MyHealthGuide.com/disclosures.htm.

Standard Form Adoption May Not Mean Standardization

While surveyed members (n=112) from the self-funded community voted 86% in favor of adoption of the standard form for stop loss disclosure and a majority of the stop loss market has adopted the form, complete standardization is still a goal.

LaRea Albert of Health First TPA (Tyler, TX ) complains, "The Standard Stop Loss Employer Disclosure Form is not standard, we are getting a different standard from various MGUs and carriers."  Another colleague at Health First, said, "Each stop loss source requires enough 'extras' that Health First concludes the form should not be called, "Standard."

"These comments show that, at least down at the operating level, many underwriters and their managers 'don't get it'! If the form is 'approved', but insist on the unique information carrier by carrier, then that's not accepting the standard, "  says John Lord, Vice President-Specialty Zurich Specialty Health, and a member of the Industry Study Group which developed the Standard Disclosure Form.  "Clearly we have work to do to get the message out to all the right people."

Disclosure Form, Codes, White Paper, Available

The following draft documents may be downloaded and viewed at www.myhealthguide.com/disclosures.htm

About Employer Disclosure

The Employer Disclosure, required by most stop loss carriers and MGUs, has grown in sophistication and use. Today, most stop loss sources require an employer disclosure before a new or renewal quote is offered. Ideally, the Employer Disclosure lists all known high cost claims, claims that have exceed a given dollar threshold, or patient/employees with certain diagnoses. Failure to disclose these individuals can later lead to claim denials.   For the past several years, an industry study group has worked on "standardizing" the reporting process with the objective that all insurers would come to accept the reporting system/form as an industry standard.

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Upcoming Conferences


May 12-14, 2008
10th Annual Self-Insured Workers’ Compensation Executive Forum presented by presented by Self-Insurance Institute of America (SIIA).  Compensation programs, including group self-insured Workers’ Compensation funds, consistently attracts more than 150 senior-level executives from across the nation.  Features:

Conference is for self-insured Workers’ Compensation programs, including group self-insured Workers’ Compensation funds. Excess insurance and risk management strategies.  SIG-specific Educational. Newport Beach, CA. Conference registration is $750 for SIIA members and $995 for others. Registration: Michiale Machado, mmachado@siia.org, 800-851-7789.  www.SIIA.org

May 19-22, 2008
17th Annual WEDI National Conference presented by Workgroup for Electronic Data Interchange (WEDI).   Contact Patti Brown at pbrown@wedi.org.   www.WEDI.org

June 10-12, 2008
SIIA International Conference presented by presented by Self-Insurance Institute of America (SIIA). Keynote speakers: Tom Sackville, CEO of the International Federation of Health Plans, and Ernst Csiszar, renowned expert on global financial services. World's leading companies involved in the self-insurance/alternative risk transfer marketplace will be featured including Willis Re, Mercer Human Resource Consulting, Aspen Re, Aetna Global, Swiss Re, Towers Perrin, Generali International and National Insurance Academy, India. Risk managers and professional service providers will be introduced to self-insurance/ART strategies and coverage concepts, markets and service resources available in other countries.  Hilton Barcelona Hotel, Spain.  Registration: Michiale Machado, mmachado@siia.org, 800-851-7789.  www.SIIA.org

July 16-18, 2008
HCAA 6th Annual TPA University presented by Health Care Administrators Association. Hotel Nikko, San Francisco.  Hotel reservations: (800) 248-3308 or (415) 394-1111. Reference "Health Care Administrators Association" to receive the group rate of $245. Information: Jaime Nolan, CAE, Executive Director, (888) 637-1605, hcaainfo@hcaa.org and www.hcaa.org.

June 17-18, 2008
Fifth Annual Mid-Year Executive Forum presented by The South Carolina Captive Insurance Association, Inc. (SCCIA). Education sessions on South Carolina captive insurance industry. Westin Poinsett Hotel in downtown Greenville, SC.  Contact Tonya Severance at 888-267-2296, tseverance@sccia.org and visit www.sccia.org.

August 19-21, 2008
Third Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA).  Grouse Mountain Lodge.  Whitefish, MT.  Contact Tonya Severance at 866-388-6242, tseverance@mtcaptives.org and visit www.mtcaptives.org.

September 8-9, 2008
TABA Annual Fall Conference & Exhibition presented by Texas Association of Benefit Administrators. Dallas Marriott Solana Hotel, Westlake, TX (Just west of DFW Airport). Contact Laura Firestone at laura.firestone@worldnet.att.net. Registration: www.tpbaa.com.

October 5-8, 2008
SIIA’s 28th Annual National Educational Conference & Expo presented by Self-Insurance Institute of America (SIIA).  Features: World’s largest event dedicated exclusively to the self-insurance/alternative risk transfer industry. Educational programs.  Networking opportunities.  World-class tradeshow of industry product and service providers.  JW Marriott Desert Ridge Resort & Spa, Phoenix, AZ.  Registration: Michiale Machado, mmachado@siia.org, 800-851-7789.  www.SIIA.org

October 27-29, 2008
SPBA Fall 2008 Meeting - Members Only presented by Society of Professional Benefit Administrators, Minneapolis, MN – Hyatt Regency, www.SPBATPA.org

November 17-20, 2008
WEDI 2008 Fall Conference presented by  Workgroup for Electronic Data Interchange (WEDI).  Topics will cover HIPAA Implementation, including Transactions, NPI, Attachments, Privacy and Security; Interoperability issues; Health Savings Accounts; EHRs; HIE and more.  Renaissance Esmeralda Resort and Spa (800-446-9875), Indian Wells, CA.  Contact Patti Brown at pbrown@wedi.org.   www.WEDI.org

December 8-10, 2008
The National Conference On Health Care Consumerism presented by Consumer Health World.  Features: Employers' Best Health Care Practices, Wellness & Prevention Strategies to Improve Employees' Health & Corporate Performance, the Next Generation of Health Web Based Applications and the Connection of U.S. and International Health Care Stakeholders in the Global Marketplace. Hyatt Regency Crystal City in Arlington, Virginia. Registration: Gary Karp, Director of Sales, 804-266-7422 ext. 7407and www.consumerhealthworld.com.

December 10-12, 2008
9th Annual Executive Educational Conference and Membership Meeting
presented by The South Carolina Captive Insurance Association, Inc. (SCCIA). Education sessions on South Carolina captive insurance industry. Charleston Place Hotel in Charleston, SC.  Contact Tonya Severance at 888-267-2296, tseverance@sccia.org and visit www.sccia.org.

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Editorial Notes, Disclaimers & Disclosures


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Ernie Clevenger
President & Publisher
MyHealthGuide, LLC
Clevenger@MyHealthGuide.com