MyHealthGuide Newsletter
News for the Self-Funded Community
7/21/2014

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

People News

Market Trends, Studies, Books & Opinions

Legal, Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News


Simplicity Health Plans®'s StayFit™ Plan Introduces Health Index Calculator™ to Motivate Health Behavior Change

MyHealthGuide Source:  Simplicity Health Plans®, 7/14/2014, www.thestayfitplan.com

CLEVELAND, OH -- Simplicity's patent-pending Health Index Calculator™ (HIC) is a major breakthrough in motivating health behavior change. The StayFit Plan, a national health and wellness company, announced the launch of their online Health to Wealth Challenges in conjunction with the HIC. These challenges build upon their financial wellness solutions and leverage existing challenge platform technology. They are designed to help individuals track personal savings that can be achieved through health behavior change and embrace the concept of "Personal Economics" as a motivator.

These simple and easy to use challenges reinforce how incremental changes in lifestyle and health behaviors can assist individuals with accumulating personal wealth. The challenges work hand- in- hand to reinforce the outcome data individuals receive from the Health Index Calculator.

"StayFit knows the importance of Financial Wellness in the workplace and our early adopter clients are enjoying the benefits and value that the Health Index Calculator provides to them and their employees. Helping people connect health to wealth is a step in the right direction, but challenging them to track their actual savings is the next logical move." said Lisa Holland, RN, MBA, and President of The StayFit Plan.

Almost every individual, with a few exceptions, can do something about their health and personal finances. StayFit' s unique Savings Tracker allows participants to track money saved from discrete categories such as food, alcohol, tobacco and many other behaviors.

Participants select the type of spending behaviors that helped them to improve their personal wealth from a drop down menu in the challenge platform. Visualization of these savings can help participants feel more confident about setting aside actual cash which can then be directed to a defined "pre-tax" savings plan. All collected data is analyzed to provide employers with optimal aggregate reporting.

StayFit' s financial wellness solutions address the new paradigm shift in workplace wellness. The Health Index Calculator is endorsed by Dee Edington, PhD and serves the following purposes in an employer wellness program:

  1. Serves as an educational and awareness tool for individuals. It helps participants understand the health to wealth connection and how simple, incremental behavior change can transform good health habits into wealth. It shows the realistic costs associated with behaviors and then computes them over time to retirement. It then shows the savings as the user adjusted their behaviors.
  2. Provides a platform that allows employers to link and integrate all aspects of their health benefits, wellness and wealth management programs for easy access and improved participant engagement. It provides content and links to pertinent information that helps users achieve their behavior change goals.
  3. Aggregate data reporting allows employers to address specific health risks and identify financial risk among the population in order to address programming and education gaps with targeted interventions as well as provide a measurement of program success from year to year.
  4. Can replace the Health Risk Assessment (HRA) since it also records, tracks and manages the crucial health metrics that may lead to 75% of chronic disease. The tool provides instant links to pertinent content via the users mobile device or desk top computer.

StayFit' s preliminary data shows members use the Health Index Calculator as many as 4-5 times in a year and receive at least three self-directed mobile reminder Alerts with fresh content daily! The tool is superior to the HRA in every way including engagement since the Calculator talks less time to complete and provides a higher level of integration to employer sponsored resources that help participants achieve their health to wealth goals.

The Health Index Calculator and the Health to Wealth Challenges are available as stand-alone products to Employers, TPAs, Brokers, Wellness Companies, Carriers and Financial companies. The products can also be purchased in combination with the StayFit Plan suite of wellness services.

About The StayFit™ Plan a division of Simplicity Health Plans

The StayFit Plan is a national health and wellness company that uses Simplicity Health Plans superior proprietary technology platform and patent pending products to impact the health and wealth of employee populations. As a strategic partner and trusted wellness advisor, we create a comprehensive wellness program that focuses on the key health and wealth factors that drive 75% of illness and claims cost. Contact Lisa Holland at (877-747-1113 option 7 then option 3) stayfitinfo@simplicityhealthplans.com and visit www.thestayfitplan.com .

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GPA's Nurse Navigator Presented at MCG Client Forum Conference

MyHealthGuide Source: Group & Pension Administrators, Inc., 7/17/2014, www.GPATPA.com

Dallas, TX -- GPA leadership recently presented at the annual MCG Client Forum Conference in Orlando, Florida. The focus of the conference, "Delivering High--Value Care," highlighted the innovative ways the GPA Nurse NavigatorSM team helps clients, members and providers through enhanced patient access to appropriate care. The GPA HealthWatchSM Executive Director, Barbara Derlein, RN, CCM, CDMS, AATMC, and Manager of the Nurse Navigator program, Rosie Fields, RN, CCM, spoke to attendees from large insurance carriers, federal government representatives and third party administrators. The GPA program delivers high value care tailored specifically to meet each client's individual needs based upon their unique employee base.

The GPA Nurse Navigator patient concierge program continues to be recognized for successfully addressing rising healthcare costs, reducing questions about healthcare benefit plans and providing quality and cost effective patient options for medical care. The program is designed to serve as a standardized tool that is built on a foundation of evidence-based guidelines to proactively educate members regarding their benefits, healthcare options, and the costs variations of care. The Nurse Navigator program effectively collaborates with other internal GPA programs such as Corporate Care Clinic, Wellness, Disease Management, Utilization Review and Care Management to provide members an innovative and comprehensive solution meeting their healthcare needs.

This unique GPA approach to medical cost containment and patient empowerment has earned the Nurse Navigator program the national recognition this forum offers.

About Group & Pension Administrators, Inc.

Group & Pension Administrators, Inc. (GPA) is the largest independently owned third-party administrator (TPA) in the Southwest, providing high-quality and custom healthcare benefit management solutions to self-insured employers. For over 40 years, GPA has combined its value of service excellence with a commitment to clients. They combine industry-leading technology and tools with "high-touch" patient care to deliver the healthiest employees and the "healthiest" bottom line.  Contact Barbara Derlein at 972.744.2466, BarbaraD@gpatpa.com and visit www.GPATPA.com .

About MCG

Care guidelines from MCG provide fast access to evidence-based best practices and care-planning tools across the continuum of care, supporting clinical decision-making and documentation and enabling efficient transitions between care settings. Eight of the 10 largest U.S. health plans and more than 1,200 hospitals use our evidence-based guidelines and software to help drive effective care for 70% of commercially insured Americans, resulting in better outcomes and contained costs.

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Risk Solutions Captive, Inc. Featured on Radio Program Inside Healthcare: Critical Thinking for Turbulent Times

MyHealthGuide Source: Risk Solutions Captive, Inc., 7/17/2014, www.risksolutionscaptive.com

Hendersonville, TN (July 17th, 2014): Bill Beeler, President of Risk Solutions Captive, Inc. (RSC), was recently featured on the radio program Inside Healthcare: Critical Thinking for Turbulent Times. Beeler and the host of the show, Robert Chamberlain, discussed how American businesses today have different options related to their healthcare, specifically in the self-funding arena, one of which is the new captive product offered by Risk Solutions Captive.

Beeler explains, "Employers have become more aware of the health benefits they provide to their employees because of the mandated benefits that are part of ACA as well as the penalties and fines associated for employers that do not provide the minimum benefits as well as the affordable benefits. This has made employers pay more attention to their plan, want more information about their plan, and try to find out what drives the cost of their plan. Until now they have not had this information. All they've had from a carrier is a set of rates and a premium increase. Those days have come to an end…Employers want more knowledge. They want more data that they can act upon."

Partnering with Health Cost Solutions and a highly-rated reinsurance carrier, Risk Solutions Captive provides employers and benefit consultants with ACA compliant options designed specifically for their employees.

"Risk Solutions Captive is basically an insurance company; we have our certificate of authority in the State of Tennessee, we market to employers with 50 employees and above, down to 25 if they have a favorable population, and we allow those groups to participate in our captive, RSC, but we also set up a separate captive cell for that employer group below RSC and they're responsible for a portion of the risk on the front end. Anything over a certain dollar amount cedes to RSC and then over a certain dollar amount it goes to the reinsurance carrier. It allows those employers to get into the self-funded environment and not experience those peaks and valleys of a self-funded plan," Beeler said.

Click here to hear the complete interview and learn how Risk Solutions Captive is addressing the growing cost of healthcare coverage through affordable self-funding options.

About Risk Solutions Captive, Inc.

Risk Solutions Captive, Inc. (RSC) provides innovative solutions for companies with 50 or more employees in the self-funded arena. RSC's partnership with Health Cost Solutions (HCS), the TPA, provides the foundation for RSC with a variety of services including claims payment, cost containment, billing, reporting, COBRA and HIPAA services. By partnering with a highly rated reinsurance carrier and Health Cost Solutions, Risk Solutions Captive offers risk protection from high-dollar claims exposure and the highest quality TPA services.  Contact Bill Beeler at bbeeler@risksolutionscaptive.com, 800.526.3919 and visit www.risksolutionscaptive.com .

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Pay-Plus® Solutions Launches New Web Destination

MyHealthGuide Source: Pay-Plus® Solutions, Inc. (PPS), 7/14/2014, www.ppsonline.com

Clearwater, FL -- Pay-Plus® Solutions, Inc. (PPS), a leading provider of electronic payments to healthcare Providers, is proud to announce the launch of its new web destination, www.ppsonline.com. The website focuses on Pay-Plus' service offerings and also expands upon PPS's mission to provide world class customer service while building customer value through innovation and technology. The new site provides clients and visitors with an enhanced user experience, featuring multi-media elements, greater content detail and easier navigation. Other enhancements to the site enable visitors to easily register for Pay-Plus services, access live helpdesk support and watch a video overview of Pay-Plus' payment processing solution.

"Our website & member portals have become a daily destination which allow our customers to conveniently and securely manage their businesses and are great examples of the innovation we continue to bring to the healthcare payment market," stated Jay Ver Hulst, President of Pay-Plus® Solutions. "With the launch of our new website and commitment to future enhancements, we continue to introduce leading technologies that allow us to keep our products focused and tailored to the needs of our customers."

About PPS

Pay-Plus® Solutions, Inc. (PPS), a PHX Company, delivers easy, fast and reliable electronic payments and explanation of payments to healthcare providers upon adjudication of valid and payable medical claims and reconciliation. The PPS system utilizes a patent pending process to deliver funds electronically via ACH and EOPs directly to healthcare providers via its web-based portal www.ppsonline.com. PPS is the only system designed exclusively for healthcare that combines banking functions, claim payments and remittance and integration with traditional paper processes.  Contact Leo J. Garneau III, Chief Marketing Officer, SVP, at lgarneau@phx-online.com, (888) 311-3505 ext. 296 and visit www.ppsonline.com .

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People News



Advanced Medical Strategies Adds Alice Jamba as Vice President of Clinical Services

MyHealthGuide Source: Advanced Medical Strategies, 7/18/2014, www.mdstrat.com

LYNNFIELD, Mass. -- Advanced Medical Strategies, the vanguard firm of physician-led claim specialists to health care payors, and publishers of the PredictDx diagnosis cost prediction software, has expanded its staff to include Alice Jamba, RN, as Vice President of Clinical Services. Her role will be to assist the company with clinical research and product development. Jamba joins as AMS continues to solidify its status as the premier clinical review organization.

Jamba adds more than 40 years of medical experience to the AMS underwriting support and clinical review team, having cut her teeth as an RN at New York Presbyterian Medical Center before slowly transitioning into medical review and research in 2003. Her un-paralleled breadth lies in having served as both a healthcare provider and an insurance specialist. Since her transition to the business side she has lent her expertise to a number of companies including Greenwood International insurance and Healthmarket.

"I am personally very excited to have an acquisition like Jamba on board," says Stacy Borans, MD, Founder and Chief Medical Officer at AMS, "I know how invaluable it is to balance that clinical experience with solid business acumen, and we're confident that her skills and experience will help AMS to continue its growth and product development goals.

Jamba joins the AMS team to help accommodate growing industry demand for AMS' core medical review and claim auditing services, and to provide an additional expert eye for clinical review. Among other duties, Jamba will assist AMS with expanding its database of catastrophic diagnoses, available through AMS' PredictDx subscription. Currently PredictDx can accurately predict the total long-term costs of more than 160 catastrophic diagnoses, including 95% of all cancers. Jamba also will assist with AMS' claim auditing and independent medical review processes to ensure speed and accuracy of service.

"I admire AMS as a physician-led organization. That level of detail is reflected in an 'each-case-is-unique' approach to claims auditing and review, and I really think that philosophy leads to maximized cost-savings for healthcare payors," says Jamba. "I'm excited to get started."

AMS is continuing to grow going forward as PredictDx is enhanced and as AMS adds to its growing list of healthcare payors and third party administrators looking to augment their stop-loss initiatives for catastrophic claims with more thorough medical review.

About Advanced Medical Strategies

Advanced Medical Strategies is a physician-lead company specializing in advancing the most innovative and proactive solutions for healthcare payors looking to provide excellent care with cost-effective methods. AMS aims to provide peace of mind when dealing with all facets of medical claims. Contact Danae Lambeth, National Sales Director, at (781) 224-9711 x107, Danae@mdstrat.com and visit www.mdstrat.com .

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EmployerDirect Promotes Joni Guerrero to Vice President of Operations

MyHealthGuide Source: EmployerDirect, 7/17/2014, www.edhc.com

AUSTIN, TX -- EmployerDirect, a leader in value-based healthcare that helps large, self-insured employers provide transparency for the quality and cost of their employees' planned medical procedures, announced that it promoted Joni Guerrero to Vice President of Operations. Joni has more than 20 years of management experience and has been EmployerDirect's Senior National Account Manager since February 2013. In her new position, she will provide direction and guidance to the operational activities of the company, as well as assist in maximizing growth and profitability.

Prior to EmployerDirect, Joni provided analytical and technical support as a government contractor for Vinculum Solutions. She was also Vice President of Operations for NuVANTE, Inc. In addition, Joni worked for EverydayWealth and the Internal Revenue Service. She holds a bachelor's degree in Government from the University of Texas, where she also received former Vice President Al Gore's Hammer Award for her re-engineering efforts toward making government work better and cost less.

"Joni's leadership has helped increase the utilization of our SurgeryPlus benefit," said Thomas Johnston, CEO of EmployerDirect. "She has also been instrumental in fostering an environment of innovation at EmployerDirect, and we look forward to her input as a member of our executive team."

"I'm honored to be recognized for my contributions and am further energized to continue playing a pivotal role in the growth of the company," said Joni Guerrero. "My focus will be to manage both the Personal Medical Concierge Services and Client Relations management teams. Our mission is to provide our clients and their employee members a superior experience by facilitating the entire placement for the members, beginning with our selective group of surgeons of excellence. We also shepherd the members through the rest of the medical process via our care coordinators, all while providing both the client and member great savings."

About EmployerDirect Healthcare

EmployerDirect, a leader in value-based healthcare, transforms the way self-funded employer health plans purchase healthcare for their members, saving 30-50 % on planned medical procedures with the potential to reduce total plan cost by 6-10 %. The company also offers a unique medical concierge service called SurgeryPlus that assists covered members with selecting a provider, scheduling a procedure, transferring medical records, coordinating travel logistics and negotiating surgery costs BEFORE the surgery occurs. Call (888)241-8537 and visit www.edhc.com .

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Brentwood Services Administrators Adds Theodore Roose, Susan White, and Promotes LaTronya Roberts

MyHealthGuide Source: Brentwood Services Administrators, 7/17/2014, www.bwood.com

Theodore Roose, Senior Claim Representative

BRENTWOOD, TN -- Brentwood Services Administrators recently has named Theodore Roose, of Hoover, Ala., to the position of senior claim representative, according to Jeff Pettus, president and chief executive officer of Brentwood Services Administrators Inc. (BSA).

Mark Sparks, regional claim manager for BSA in Birmingham, Ala., points out, "Brentwood is delighted to bring Ted aboard. With over 40 years of experience in our industry, Ted's knowledge will be invaluable to our clients as well as our staff. I don't think we could have found a more suitable candidate."

In his new position, Roose is involved with reviewing, processing and handling workers' compensation claims. He determines the compensability of the claim and extent of liability, as well as communicates directly with clients, employers, injured workers, physicians and attorneys to manage claims in a timely and economic manner.

Before joining BSA, Roose was employed as a multi-line claims supervisor for American Mining Insurance Co. in Birmingham, Ala. Professionally, Roose is an associate member of the Alabama Self-Insured Association, and a past president and member of the Alabama Workers Compensation Organization. He also organized and served as president for Workers Compensation Association of Alabama and the Mid-South Workers Compensation Association in Memphis, Tenn.

Roose graduated from the University of Alabama with a bachelor of science in finance from the College of Commerce and Business Administration.

Susan White, Claim Specialist

The Company employed Susan White, of Freeport, Ill, as a claim specialist, according to Pettus.

Luca DeVecchi, AIC, SCLA, BSA claims manager, explains, "Ms. White brings to BSA more than 20 years of experience in workers' compensation claims handling, most recently serving as senior claim specialist for Sedgwick Claims Management. She has multi-jurisdiction experience with an emphasis in Illinois, Iowa, Missouri and Kansas."

In her new position, White is responsible for reviewing, processing and handling workers' compensation claims, as well as determining the compensability of claims 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, she began in the insurance industry as a claim adjuster for Western States Insurance in Freeport, Ill., where she was employed for 10 years. White also previously worked for General Casualty/QBE Insurance for 17 years. 
 
White graduated from Highland Community College in Freeport, Ill, with a degree in education She also holds a Texas claims license. White holds an INS Certificate, as well as an associate in claims and associate in insurance designations.

LaTronya Roberts, Claim Examiner II

The Company promoted LaTronya Roberts, of Mt. Juliet, Tenn., on its Tennessee Claims Department team to the position of claim examiner II, according to Pettus.

Shirley Mahorney, BSA claims supervisor, reports, "LaTronya is handling medical-only claims for several Georgia accounts, and is working exceptionally well on her own." 

In her new position, Roberts is responsible for reviewing, processing and handling workers' compensation claims. In addition, she determines the compensability of the claim and extent of liability, and communicates directly with clients, employers, injured workers, physicians and attorneys to manage claims in a timely and economic manner.

Prior to her promotion, Roberts had served as a claim assistant in the BSA Occupational Accident Department since April 2013. Previously, she worked for Amerigroup as a customer services representative.

Roberts received her associate of applied science (AAS) degree, with a paralegal studies major, from Volunteer State College in Gallatin, Tenn.

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. 

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. Contact John Smitherman, vice president of sales, at bsiinfo@bwood.com, (800) 524-0604 or (615) 263-1300, and visit www.bwood.com .

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benefitsCONNECT Announces Megan Chiarello as Integrated Sales and Marketing Strategist

MyHealthGuide Source: benefitsCONNECT via inShare, 7/17/2014, www.benefitsCONNECT.net

Rancho Cordova, CA -- benefitsCONNECT, a leader in online benefits enrollment and administration, is pleased to announce the hiring of Megan C. Chiarello as the new Integrated Sales and Marketing Strategist. After years of increasing responsibility and exceptional performance in the health insurance benefits industry, Ms. Chiarello has taken on this new role to lead strategy initiatives at benefitsCONNECT. Ms. Chiarello will lead new sales focused marketing strategies to increase broker participation in benefits administration technology platforms especially with new ACA requirements driving adaption within the industry.

In addition to broker initiatives Ms. Chiarello will also work with both core and voluntary carriers to strategize ways to drive employee enrollment participation through cutting edge technology partnered with broker level service. She also works closely with the Media Department at benefitsCONNECT to deliver creative multimedia campaigns integrating video, avatars, and 2D-3D motion graphics into broker centric employee benefits enrollment campaigns.

Never one to sit still, Ms. Chiarello is also part of the active sales team. She educates brokers on the value of both large group and small group enrollment technologies, broker agency management systems, enrollment communication and value to carriers of a technology centric enrollment and communication solution. She will also perform a significant role in rolling out the benefitsCONNECT and Marketplace Private Exchange Platform to brokers and enrollment firms wanting to offer their own Private Exchange.

Ms. Chiarello attended the University of North Florida where she majored in Political Science with a minor in Communications and English.

benefitsCONNECT, a web-based benefits administration and enrollment system, provides HRIS functionality to the employer and employee, payroll and vendor data integration, consolidated billing, employee benefits and statements, employee self-service and communications, manager self-service and communications, broker commission tracking, as well as COBRA and FSA/HRA tracking. Enrollment and eligibility data is exchanged electronically though an advanced, EDI-enabled, Software as a Service (SaaS) platform.

About Transcend Technologies Group, Inc.

Founded in 2001, Transcend Technologies Group, Inc. (dba benefitsCONNECT) is a privately held company that specializes in Internet-based software applications for the health insurance and benefits industry. Transcend licenses benefitsCONNECT for benefits administration and online enrollment and agencyMANAGER for agency management functionality, and has established clients across the Unites State who entrust their book of business to benefitsCONNECT products.  Contact Sales at 916-421-4000, sales@benefitsCONNECT.net and visit www.benefitsCONNECT.net .

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Integro Appoints Ruth Kilduff as Chairman and Anne Anderson as President of US Operations

MyHealthGuide Source: Integro via inShare, 7/16/2014, www.integrogroup.com

New York, NY -- International insurance brokerage and risk management firm Integro Insurance Brokers announced the appointment of Ruth Kilduff as Chairman, and Anne Anderson as President of its United States operations, Integro USA.

Both Kilduff and Anderson are Integro veterans. Kilduff leads the firm's Healthcare practice and its Boston operations, while Anderson leads the firm's New York operations. Both are also members of the firm's Operations Committee.

The Kilduff and Anderson appointments follow a recently announced management reordering to better accommodate the firm's rapid growth, improve segmentation and enhance collaboration. Marc Kunney, formerly President of Integro USA, had been named President of Integro's North America operations.

"Ruth and Anne are proven and respected leaders," Kunney said. "They represent Integro at its finest and I'm delighted to welcome them to their new leadership roles. I'm confident their passion, expertise and creativity will assist us through our growth as we continue to deploy Integro's client-centric business model and personalized service."

Ruth Kilduff brings more than 30 years of experience in healthcare, as well as healthcare insurance, to her new role as Chairman of Integro USA. She has specific expertise in professional liability, alternative risk financing and risk consulting. Prior to joining Integro in 2006, Kilduff served as a Managing Director at Marsh. She is a Registered Nurse and a graduate of Massachusetts General Hospital School of Nursing and received her Clinical Nurse Specialist designation from Boston University.

Anne Anderson has more than 30 years of experience in risk management account design, placement and service implementation with a background in underwriting, facultative reinsurance and brokerage. She joined the firm in 2005. Previously, Anderson served as Integro's Property & International Practice Leader, as well as in similar roles at Palmer & Cay and at Marsh. She is a graduate of Cornell University, and a member of the Sponsor Board of the American Bankers Association.

About Integro USA

From offices in Atlanta, Boston, Chicago, New York and San Francisco, Integro USA provides quality broking services to US clients facing complex risks.

About Integro

Integro is an insurance brokerage and risk management firm focused primarily on serving organizations with complex risks. Clients credit Integro's superior technical abilities and creative, collaborative work style for securing superior program results and pricing. The firm's acknowledged capabilities in brokerage, risk analytics and claims are rewriting industry standards for service and quality. Launched in 2005, Integro and its family of specialty insurance and reinsurance companies, some having served clients for more than 150 years, operate from offices in the United States, Canada, Bermuda and the United Kingdom. Its U.S. headquarter office is located at 1 State Street Plaza, 9th Floor, New York, NY 10004. 1-877-688-8701. Visit www.integrogroup.com .

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Beacon Risk Strategies Seeks Stop Loss Underwriter

MyHealthGuide Source: Beacon Risk Strategies, 7/3/2014, www.beaconrisk.com

Job Title: Stop Loss Underwriter
Department: Underwriting
Reports To: President, Beacon Risk Strategies
Location: Seattle, WA or Atlanta, GA
Direct Reports: None
FLSA Status: Salary -- Exempt
Salary: Commensurate with Experience

Part of the Group Benefits division of AmWINS Group, Inc., Beacon Risk Strategies is a specialty underwriter, distributor and program manager of medical stop loss and other niche A&H products. As part of AmWINS, our vision is to create, distribute and service innovative insurance solutions that provide our employees, clients and markets with a first class experience.

Position Overview

This position will be responsible for underwriting medical stop loss quotes for new and renewal business. The successful candidate will have an in-depth understanding of underwriting principles and methodologies, the ability to analyze risk experience, ability to creatively problem solve and work well under pressure. Collaborating with other team members and meeting all internal and external deadlines are essential to this position.

Essential Duties

  • Review prospective clients for Stop Loss coverage and underwrite according to current underwriting and pricing guidelines to ensure that reinsurer standards for new business are met.
  • Renew business with existing clients based on current characteristics of the group, multi-year experience analysis, profitability or loss performance, future claim risk and liability to block of business.
  • Perform large claim analysis; research diagnosis and treatment plan.
  • Review plan change and legislative changes for impact to pricing and future claim risk.

Education/Experience

  • Qualified candidates will have a 4-year degree and a minimum of 3-5 years previous experience in successful stop loss underwriting, strong focus on detail, and excellent analytical, communication and time management skills. Experience underwriting other product lines is a plus (e.g. small group stop loss, voluntary or limited benefit products, etc.).

Skills & Qualifications

  • Demonstrate industry knowledge, applied experience
  • Exemplary internal and external communication skills, team and can-do attitude.
  • Solid understanding of underwriting operations and processes
  • Good time management skills

Contact Information

Interested candidates can email resumes to careers@beaconrisk.com .

About Beacon Risk Strategies

Beacon Risk Strategies is an AmWINS Group Company with offices in Seattle and Atlanta. Beacon understands that relationships matter. Our customers trust our expertise to deliver a competitive advantage in everything we do. Brokers, administrators and reinsurers expect a higher standard that comes from working with Beacon. We have a thoughtful approach to underwriting and a tenacious focus on delivering superior cost containment, claims administration and customer service.  Visit www.beaconrisk.com .

AmWINS Group, Inc. is among the largest and most diversified wholesale insurance distributors in the United States. AmWINS has expertise across a diversified mix of property, casualty and group benefits products. We also offer value-added services to support some of these products, including product development, underwriting, premium and claims administration and actuarial services. With over 3,200 employees located in 106 offices across 17 countries, our firm handles over $9.5 billion in premium annually through our four divisions: Brokerage, Underwriting, Group Benefits and International.  Visit www.AmWINS.com.

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Market Trends, Studies, Books & Opinions


Litigation Might Trump Arbitration in Stop Loss Contracts

MyHealthGuide Source: Thomas A. Croft, Esq., 8/1/2014, Advance Copy, "From the Bench", The Self-Insurer Magazine

Editor's Note: While I have experienced reasonable and fair judgments in arbitration cases, after serving as an expert witness, arbitrator or umpire in over 20 cases, I now have increased appreciation of litigation in courts over arbitration. Arbitration can cost more than litigation, rules of evidence are more dependable and consistent in litigation, and litigated judgments rarely simply "split the baby" when clearly a 50/50 ruling is not in order.


Many, but by no means all, carriers subscribe to the conventional wisdom that having a stop loss policy form clause requiring that all disputes between the insured group and the carrier be arbitrated and therefore not litigated in the courts is a distinct and near-universal advantage for the carrier. The thinking is that the playing field is tilted in favor of the carrier by such clauses, that arbitration is a superior and much more cost-effective means of resolving disputes, and that it results in quicker outcomes than the traditional means of dispute resolution in the U.S. court system. Well, maybe yes, maybe no.

In my anecdotal experience, there are several reasons why including standard stop loss policy arbitration clauses is not necessarily such an unequivocal "no-brainer."

Enforceability

As an initial matter, such clauses are simply unenforceable in a significant number of states. One might think that the overriding policy favoring arbitration expressed in the Federal Arbitration Act, 9 U.S.C. § 1, et seq. ("FAA") would pre-empt or "trump" any state statute restricting the enforceability of agreements to arbitrate, at least insofar as the transaction involves "interstate commerce," which most every stop loss contractual arrangement would.

But not so fast. Several reported decisions have upheld anti-arbitration acts in the face of challenges under the FAA. The rationale of these cases is that, while the FAA clearly mandates arbitration in most instances and would otherwise pre-empt the state law, the McCarran-Ferguson Act "reverse pre-empts" the FAA in the insurance context. In essence, McCarran-Ferguson says that no federal law--unless it relates specifically to the business of insurance--can pre-empt a state law that does. These cases hold that the FAA does not specifically relate to the business of insurance (it doesn't--it applies to arbitration agreements generally in all aspects of interstate commerce), but that the state anti-insurance arbitration statues do, and thus control over the FAA. The bottom line for our purposes is that a stop loss policy arbitration clause may not be enforceable in many states.

I should note that some the state anti-insurance arbitration statutes contain exceptions for "contracts between insurance companies." See, e.g., Kan. Stat, § 5-401(c). This begs the obvious question in the stop loss context: are employers sponsoring self-insured ERISA plans "insurance companies" for purposes of such statutes, such that a stop loss contract is exempt from the state's anti-arbitration statute?

  • ERISA's renowned "deemer clause," 29 U.S.C. § 1144(b)(2)(B), states that "Neither an employee benefit plan...nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies."

No cases I have seen have considered whether the deemer clause operates to render a self-insured ERISA plan exempt from an exception under a state anti-insurance arbitration statute for "contracts between insurance companies." Compare Scott v. Louisville Bedding Co. (Ky. App. 2013), available at StopLossLaw.com, pages 13-14 of the Court's opinion, where the court essentially punted on the even more basic issue of whether the stop-loss insured was an insurer at all.

Wolves in the Thicket

In any event, enough esoterica, and back to some more musings. Most every (and I think actually every) stop loss policy form I have seen states somewhere that the law of the state of the insured's principal place of business or state of incorporation controls. I suspect that this is a regulatory requirement imposed by the various state DOIs, as it seems odd that a carrier would choose to subject itself to the vagaries of the laws of whatever state its insured happened to reside in voluntarily. The validity of an arbitration clause will, therefore, depend on the law of the jurisdiction in which the policy is issued.

Wholly apart from the issue of whether the state involved has an anti-insurance arbitration statute, there is another wolf lurking in the thicket that could threaten the enforceability of the stop loss arbitration clause in many states--including those without any restrictions on arbitration of insurance disputes. A goodly number of states have deceptive trade practice, unfair settlement practice, bad faith or other statutorily based remedies that can be invoked in the insurance context, often providing for double or treble damages in an appropriate case. Cases from the U.S. Supreme Court and several of the federal Courts of Appeal have cast considerable doubt on the enforceability of arbitration agreements that limit an arbitrator's ability to award other than "compensatory damages" or "contractual damages." Such language very commonly appears in one form or another in many stop loss contract arbitration clauses, and may affect statutory rights, either expressly or by implication.

The "hot" issue in these cases seems to be not whether the limitation clause on remedies in the arbitration clause is per se unenforceable, but rather whether the entire arbitration agreement should be voided because it operates to nullify specific statutory rights under the guise of procedure (the arbitration). See, e.g., Paladino v. Avnet Computer Technologies, Inc., 134 F.3d 1054 (11th Cir. 1998)(nullification of rights to damages under Title VII, motion to compel arbitration denied).

Similarly, in Pacificare Health Systems, Inc. v. Book, 538 U.S. 401 (2003), the U.S. Supreme Court considered whether arbitration clauses limiting the arbitrators' ability to award "punitive or exemplary damages" or "extra-contractual damages of any kind" were enforceable where the group of plaintiffs asserted various claims, including claims under the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. § 1961 et seq. ("RICO"). The Supreme Court concluded that the matter of the enforceability of the arbitration clause under these circumstances was for the arbitrator in the first instance, and thus ordered the case to arbitration for a decision on the issue of arbitrability itself. See Suskin & Badnya article, below at note 2, for further details on the splits among the federal circuits on these types of issues generally.

To return to the "wolf" in the stop loss context, because many states have statutorily based remedies for a variety of insurer misconduct, even an otherwise valid arbitration clause might well be subject to attack on the grounds that it unconscionably interferes with important state public policy. This kind of assault might be particularly problematic where the state has a separate "bad faith" statute directed at insurers providing for other than contractual damages, as opposed to a simple common law doctrine supporting bad faith damages under certain circumstances.

Losing the 'Advantage' of Arbitration

If the arbitration clause in the policy form is unenforceable for some reason, then so be it. If we don't include one at all, we lose the "advantage" of arbitrating (no jury, limitation of remedies, unlevel playing field) for sure.

  • The simple and short answer: the existence of an unenforceable arbitration clause is itself grounds for more complicated and expensive litigation/arbitration. Indeed, an aggressive/creative plaintiff's lawyer might file a pre-emptive strike in court for a declaration that a particular arbitration clause is invalid, causing the carrier to litigate (or at least force arbitration of the threshold question of arbitrability) before starting the process of addressing the dispute on the merits.

This just adds another lawyer of issues to litigate or arbitrate about.

Personal Experience on Arbitration Proceedings

And now my closing editorial thoughts, based on my anecdotal and hearsay experience in the stop loss world over the years:

  • Most arbitrators only rarely seriously consider granting summary judgment/motions to dismiss thereby obviating the need for a formal arbitration hearing, which may well take days or even weeks. Unlike federal or state court judges, arbitrators get paid by the hour. Their economic incentive is to keep cases on their dockets, ultimately requiring a hearing. State and federal judges have exactly the opposite incentive--getting unmeritorious cases off their dockets as soon as possible. My experience is that most stop loss cases are won or lost at the pretrial motion stage. Moreover, even if the motion is non-dispositive, in the sense that it does not decide all the issues in the case, even limited rulings have an uncanny way of readjusting the parties' relative assessments of the strength of their cases, and quite often lead to successful mediation or outright direct settlement of the dispute. As noted above, arbitrators are generally not prone to provide such kind of pre-trial guidance to the parties.
  • Judges, especially federal judges, have more sophistication with legal principles than most arbitrators, as well as law clerks to assist with the legal research and analysis necessary to come to a proper decision.
  • Discovery is severely limited under the rules of most of the major arbitration service providers. It may be limited to an exchange of a narrow class of documents (thus effectively excluding important and relevant evidence from the decision-making process), and depositions, if permitted at all, are limited to a very few key witnesses. The discovery rules of the several states and the Federal Rules of Civil Procedure are premised on the notion that broad discovery leads to the truth. The scope and extent of such discovery can be limited by either party upon motion for cause shown. An arbitration without adequate pre-hearing discovery is a "trial by ambush." And the ambushing party can easily be as often the plaintiff, rather than the defendant carrier.
  • The rules of evidence generally do not apply. This means all manner of hearsay, otherwise inadmissible "expert" opinion, and other improper evidence can and usually is admitted and considered by the arbitrators.
  • Arbitration proceedings are typically confidential, not of public record like court proceedings. As a result, the development of the law relating to stop loss and other arbitrated insurance proceedings remains hidden from public view, and there is no foundation to establish precedent for future cases. Thus, arbitration deprives the entire industry and the public from legal evolution. The very same issues may get re-arbitrated over and over between different parties without good reason.
  • As a practical matter, THERE IS NO APPEAL from an arbitration award. The grounds for getting a court to set aside an arbitration award are so severely circumscribed, that they can only be invoked in egregious circumstances. While any judicial process can be fairly characterized as a "dice roll," an arbitration only provides a single throw. In court, errors can be corrected on appeal. There is a second chance for a party where error by the trial court harmfully affected the outcome.

I am not opposed to arbitration generally. It is often a superior means of dispute resolution. What I am opposed to is the knee-jerk preference that many insurance executives (and not necessarily their in-house counsel) have for the inclusion of arbitration clauses in their policies--a preference that seems more informed by myth than fact.

Footnotes

  1. For a discussion of this reverse pre-emption issue, see § 5.02[C] of "Arbitration Clauses in Insurance Policies", pp. 231-233 by E. Kneisel and R. Dolder.  See undated list of state-by-state restrictions on arbitration provisions in insurance policies. The author has not verified the accuracy or completeness of the latter-cited article, and therefore cannot vouch for it.
  2. H. Suskin & M. Badyna, Enforceability of Arbitration Agreements that Restrict Statutorily-Mandated Rights: the Sharpening Split Among the Circuits

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®.
Clevenger
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 www.stoplosslaw.com. 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 tac@xsloss.com..

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Legal, Legislative & Regulatory News


SIIA Updates on New York and Washington

MyHealthGuide Source: Self-Insurance Institute of America, 7/17/2014, www.SIIA.org

New York: Expanded Grassroots Advocacy Campaign Takes Shape

The Self-Insurance Institute of America, Inc. (SIIA) today held a special briefing in New York City for about 50 members and other stakeholders concerned about a looming threat to the self-insurance marketplace in the state of New York.

As previously reported by SIIA, unless the New York Legislature modifies a section of its insurance statute, the sale of stop-loss insurance will be prohibited to organizations with up to 100 workers effective as of January 1, 2016 - effectively eliminating this segment of the self-insurance marketplace.

The association spearheaded an initiative to get the necessary "fix it" bill passed during the 2014 legislative session, but this effort fell short. Today's briefing provided a re-cap on what happened in Albany over the last few months, and more importantly participants were provided specific guidance on how they can help support SIIA's re-tooled lobbying campaign going forward.

Washington: Key Business Trade Associations Focus on Self-Insurance Issues

The Self-Insurance Defense Coalition (SIDC) held its quarterly meeting in Washington, DC where the group discussed a variety of legislative, regulatory and litigation developments affecting self-insured organization.

The purpose of the SIIA-led coalition is to share information and coordinate lobbying efforts. In addition to SIIA, coalition members include:

  • United State Chamber of Commerce
  • National Association of Manufacturers
  • Council of Insurance Agents and Brokers
  • National Association of Wholesalers-Distributors
  • National Retail Federation
  • National Association of Health Underwriters
  • National Franchisee Association
  • National Electrical Contractors Association
  • Heating, Air-Conditioning and Refrigeration Distributors International

Specific developments covered during today's meeting included the Self-Insurance Protection Act (SIPA), state insurance exchange assessments and implications of the recent U.S. Supreme Court Ruling in the Hobby Lobby case.

About SIIA

The 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. Contact SIIA State Government Relations Director, Adam Brackemyre at abrackemyre@siia.org or SIIA Government Relations Coordinator Kevin McKenney at kmckenney@siia.org and visit www.SIIA.org .

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DOL Provides FAQ on ACA, ERISA and Contraceptive Coverage

MyHealthGuide Source: US Departments of Labor, Health and Human Services (HHS), and the Treasury 7/17/2014, DOL FAQ

Below is Frequently Asked Question (FAQ) regarding implementation of the Affordable Care Act. This FAQ has been prepared by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/), this FAQ answers a question from stakeholders to help people understand the law and benefit from it, as intended.

Disclosure with respect to Preventive Services

Q: My closely held for-profit corporation's health plan will cease providing coverage for some or all contraceptive services mid-plan year. Does this reduction in coverage trigger any notice requirements to plan participants and beneficiaries?

Yes. For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage.

Specifically, the Department of Labor's longstanding regulations at 29 CFR 2520.102-3(j)(3) provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan.

Accordingly, if an ERISA plan excludes all or a subset of contraceptive services from coverage under its group health plan, the plan's SPD must describe the extent of the limitation or exclusion of coverage.

For plans that reduce or eliminate coverage of contraceptive services after having provided such coverage, expedited disclosure requirements for material reductions in covered services or benefits apply. See ERISA section 104(b)(1) and 29 CFR 2520.104b-3(d)(1), which generally require disclosure not later than 60 days after the date of adoption of a modification or change to the plan that is a material reduction in covered services or benefits. Other disclosure requirements may apply, for example, under State insurance law applicable to health insurance issuers.

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Medical News


Telecare Intervention Improves Chronic Pain

MyHealthGuide Source: Kurt Kroenke, M.D., et al, Journal of American Medical Association, 7/15/2014, JAMA Article

A telephone-delivered intervention, which included automated symptom monitoring, produced clinically meaningful improvements in chronic musculoskeletal pain compared to usual care, according to a study published in the Journal of American Medical Association.

Pain is the most common symptom reported both in the general population and patients seen in primary care, the leading cause of work disability, and a condition that costs the United States more than $600 billion each year in health care and lost productivity. Musculoskeletal pain accounts for nearly 70 million outpatient visits annually in the United States each year. Telemedicine strategies for pain care have been proposed but not rigorously tested to date, according to background information in the article.

The study randomly assigned 250 patients with chronic musculoskeletal pain to an intervention group (n = 124) or to a usual care group whose members received all pain care as usual from their primary care physicians (n = 126). The intervention group received 12 months of telecare management that included automated symptom monitoring with an algorithm-guided approach to optimizing pain medications.

Study findings

  • Patients in the intervention group were nearly twice as likely to report at least a 30 % improvement in their pain score by 12 months (51.7 % vs 27.1 %);
  • The intervention was associated with clinically meaningful improvements in pain and a greater rate of improvement (56 % vs 31 %);
  • Patients in the usual care group were almost twice as likely to experience worsening of pain by 6 months compared with those in the intervention group (36 % vs 19 %);
  • Few patients in either group were started on opioids or had escalations in their opioid dose during the study period;
  • Patients in the intervention group were also more likely to rate as good to excellent the medication prescribed for their pain (73.9 % vs 50.9 %) as well as the overall treatment of their pain (76.7 % vs 51.6 %).

Researchers concluded that the intervention was effective, even though most trial participants reported pain that had been present for many years, that involved multiple sites, and that had been unsuccessfully treated with numerous analgesics.  The improvement in pain with minimal opioid initiation or dose escalation is noteworthy, given increasing concerns about the consequences of long-term opioid use.

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Recurring Resources


Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 6/21/2014)

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 Info@MyHealthGuide.com

  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital /Equity
(Millions)
Source
1. CIGNA     $1,907
2013
  CIGNA 2013 10-K, page 46 2/27/2014
2. Sun Life Financial     $915.2
2013
  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+)
$818
2013
  HCC Insurance Holdings, Inc. Release,
2/11/2014
4. HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$762.4
2013
$507
12/31/2013
Mike Sullivan, President & COO
2/4/2014
5. Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $475M
MRM - $255M)
$730
2012
$3,195
3/31/2014
Michael Fry, Executive Vice President, Symetra;
Mike McLean, Chairman Medical Risk Managers, Inc.
1/7/2014
6. ING Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$560
2013
$1,942
12/31/2013
Joe Keller, Lead Financial Analyst, ING Employee Benefits,
3/18/2014
7. Companion Life > 20 Years   $310
12/31/2013
  Philip Gardham, Vice President, Specialty Markets,
11/20/2013
8. National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
5/2014
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
6/20/2014
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
3/31/2014
10. Zurich North America     $130   Tracey Brennan, Zurich North America.
7/22/2011
11. Munich Re Stop Loss, Inc.   AIC, TransAmerica $110
2012
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
4/25/2013
12. The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$96
2/2014
  Victor Moran, Second Vice President, Actuarial Operations.  3/12/2014
13.
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $$3,388
12/31/2011
Mark Nichols, Managing Director.
7/20/2012

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
    (IIS)
  • 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 Info@MyHealthGuide.com.  

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Upcoming Conferences


July 22-24, 2014
MCIA 9th Annual Conference presented by Montana Captive Insurance Association, Inc. Montana is one of the country's top captive domiciles and is one of the country's fastest growing captive domiciles.  MCIA is the premier educational and networking event for those doing captive business in the state. This conference features faculty consisting of key state captive insurance regulators, national industry leaders and experts service providers to bring you the most up-to-date and valuable information on industry trends and niche opportunities.  Lodge at Whitefish Lake.  Contact Shane Byars at 866/388-6242, sbyars@mtcaptives.org and visit www.mtcaptives.org.

July 23, 2014  Webinar 2:00 p.m. - 3:30 p.m. EST
The Transitional Reinsurance Program: Contributing Entities and Counting Methods recommended by HCAA and presented by The Department of Labor's Employee Benefits Security Administration.  This webinar will focus on reinsurance contributions including who is a contributing entity and how a contributing entity can calculate its annual enrollment count for the purpose of determining reinsurance contribution amounts. The intended audience for this webinar is health insurance issuers, self-insured group health plans, third party administrators (TPAs) and administrative services-only (ASO) contractors.

To register for this webinar and to obtain additional information visit www.REGTAP.info. Registration for either webinar will be on a first-come, first-serve basis, limited to three (3) participants per organization. Note: The same material will be presented during these webinars, so registration will be limited to selecting only one of the event dates.

If you are new to REGTAP, visit www.REGTAP.info and select "Register as a New User." You will receive an email to confirm your account.

  • Click on the link in the email to complete the process of creating a user account.
  • Log in to your account.
  • Select the "Training Events" icon from "My Dashboard."
  • Select the event(s) for which you wish to register.

You will receive a separate email notice indicating your confirmation or waitlist status for each event. Questions can be submitted on www.REGTAP.info using "Submit an Inquiry" and note the "Reinsurance Program" in your question text. 

July 25, 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. Boston, MA. Contact Clearwater Compliance at 800-704-3394 and info@clearwatercompliance.com.

August 13-20-27, 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 at 800-704-3394 and info@clearwatercompliance.com.

August 18-20, 2014
Healthcare Information Security, Privacy Training presented by Clearwater Compliance, a designated Official Training Provider (OTP).  This official HCISPP training seminar is the most comprehensive, complete review of healthcare security and privacy concepts and industry best practices. The training specifically covers each element of the HCISPP common body of knowledge (CBK®), including foundational information on:

• The Healthcare Industry
• The Regulatory Environment
• Privacy and Security in Healthcare
• Information Governance and Risk Management
• Information Risk Assessment
• Third Party Risk Management

Comprehensive preparatory training for healthcare information security professionals who are working to earn the HealthCare Information Security and Privacy Practitioner (HCISPP) credential from (ISC)².  Nashville, TN. 

Cost of the Clearwater HCISPP training is $1,595. Click here to register.  Contact Helene Cuddeback at helene.cuddeback@clearwatercompliance.com and visit www.clearwatercompliance.com

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 info@clearwatercompliance.com.

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 info@clearwatercompliance.com.

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 jmiller@siia.org.  Information and Registration: www.siia.org/i4a/pages/index.cfm?pageid=6300

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

December 4-5, 2014
IHC Forum West presented by the Institute for HealthCare Consumerism. Las Vegas, NV. Contact Joni Lipson at jlipson@theihcc.com and visit www.www.theihccforum.com/2014-ihc-forum-and-expo/

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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 jjclemence@frallc.com.  Information and registration: www.frallc.com/register.aspx?ccode=B940 and visit
www.frallc.com

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: aseiler@aapan.org 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. www.HCAA.org.

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

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 smurphy@niis.com

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

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

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

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

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

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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®

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