MyHealthGuide Newsletter
News for the Self-Funded Community

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General & Company News

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Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

Berkley Accident and Health and ProSential Group Announce the Launch of ProSential Cap

MyHealthGuide Source: Berkley Accident and Health, 10/18/2016, and

Hamilton Square, NJ and Marblehead, MA -- Berkley Accident and Health, a W. R. Berkley Company®, and ProSential Group have announced the launch of ProSential Cap, a Stop Loss Group Captive designed to give employers transparency, stability, and control over their rising employee health care costs. ProSential Cap allows employers to move from buyers to owners of their health plans, and gain the opportunity to benefit from good health risk management.

ProSential Group is a national alliance of independently owned employee benefit brokers who have joined forces to offer expanded capabilities and expertise, and a broader range of products and services. Starting January 1, 2017, ProSential Group's brokerage firms will gain access to ProSential Cap, a turnkey solution that combines the full support of ProSential Group with the risk expertise of Berkley Accident and Health.

"Stop Loss Group Captives have become an important risk-management tool for small and mid-size companies. This agreement gives our brokers a Group Captive solution developed specifically for their clients and supported by Berkley Accident and Health, one of the largest and most experienced providers in the market," said Dean Rowe, Vice President, Carrier Relations, ProSential Group.

"We are excited about our agreement with ProSential Group," explained Christopher Brown, President and CEO, Berkley Accident and Health. "The scale and quality of its network, combined with its health risk management capabilities, creates tremendous opportunity for its clients to benefit from this solution."
ProSential Cap seeks to enable small- to mid-size companies to replicate the size and stability of a large employer's health plan. Rather than purchasing traditional health insurance, ProSential Cap's members self-fund their health benefits, buy Stop Loss insurance to protect themselves from high-dollar claims, and then join ProSential Cap to share risk. ProSential Cap reinsures the Stop Loss policies of multiple employers, in an effort to create a more diverse, balanced risk profile than that of a single employer.

Best of all, ProSential Cap serves as an incubator for innovative ideas. When several employers come together in a Group Captive, they can create a more stable risk and buy less Stop Loss insurance. They also are incented to manage health care costs, because they can benefit financially if the Captive's claims are lower than expected. As a result, Captive members share best practices and data as they put positive health initiatives in place, whether it is biometric screenings or onsite health clinics. These changes can improve the health and wellness of employees, while keeping costs down for everyone.

For more information about ProSential Cap, contact Dean Rowe at

About Berkley Accident and Health

Berkley Accident and Health is a member company of W. R. Berkley Corporation, a Fortune 500 company. Berkley Accident and Health provides an innovative portfolio of accident and health insurance products. It offers four categories of products: Employer Stop Loss, Group Captive, Managed Care (including HMO Reinsurance and Provider Excess), and Specialty Accident. The company underwrites Stop Loss coverage through Berkley Life and Health Insurance Company, rated A+ (Superior) by A.M. Best. Visit and

About ProSential Group

ProSential Group, one of the country's largest benefit brokerage organizations, is transforming the marketplace with innovative HR, benefits, and payroll solutions for small- to mid-sized companies. It brings clients a unique combination of best-in-class technology, employee engagement, HR, compliance, and population health management resources partnered with localized service and support via the ProSential network of benefits brokers. Headquartered in Marblehead, MA, ProSential Group has a growing base of expert brokers and satisfied customers throughout the U.S. Visit


QBE North America Releases New Podcast: Self-funded Employee Health Plans - An Effective and Efficient Way to Stabilize the Rising Cost of Healthcare

MyHealthGuide Source: PRNewwire, 10/20/2016

NEW YORK -- QBE North America has released a two-part podcast -- Self-funded employee health plans: an effective and efficient way to stabilize the rising cost of healthcare.

For all employers -- particularly small to medium-size private enterprises -- one of the single largest costs to businesses is providing health care to their employees. In a new two-part podcast, Steve Gransbury, President, Accident & Health, QBE Specialty Insurance, provides risk managers, brokers and employers with a comprehensive overview of the self-funded health insurance market and discusses the options available for reducing and stabilizing healthcare costs. He also gives insight into medical stop loss captives, an alternative risk financing option that is gaining popularity, and shares important considerations and requirements.

"For many employers, self-funding is generally thought of as the most efficient form of alternative risk transfer in terms of providing insurance capacity, increasing control and reducing overall cost of risk," said Gransbury. "At no time has the use of self-insurance been more prevalent than when an employer is self-funding their employee healthcare coverage. This has proved to be one off the most effective ways of managing the cost of providing health insurance coverage for employees."

"Our team at QBE recognizes this, and we are responding with practical solutions for our clients. It is also the reason I have created this podcast, so that we can easily share our deep expertise and insight with risk managers, brokers and employers," continued Gransbury.

The two-part podcast is available on the QBE Videos and Podcasts page of QBE North America's website:

  • Part One discusses how and why the rising cost of health insurance is driving increased interest among companies of all sizes in self-funding their health insurance plan. It also covers the importance of medical stop loss coverage for self-funded plans and describes the products and services QBE offers to help companies evaluate, structure, and manage their health insurance program.
  • Part Two focuses on the types and benefits of medical stop loss captives, including single parent captives for large companies and group captives for mid-size and small companies. It reviews the factors companies should consider in deciding what type of captive structure is most appropriate and QBE's unique approach to helping companies design and manage captives along with the rest of a self-funded health insurance program.

"This podcast is another example of how we are leveraging our intellectual capital to provide thought leadership to our producers and policyholders," said Jeffrey S. Grange, President, Specialty Insurance, QBE North America. "Costs for healthcare delivery continue to inflate faster than the growth in GDP. This, coupled with accompanying social inflation caused by proliferating and complex regulation, poses everyday challenges to employers. The QBE A&H team provides a robust set of solutions to employers to tackle the challenges they face when providing healthcare to their employees."

About QBE Specialty Insurance

QBE Specialty Insurance underwrites risks and provides exemplary coverage and services to support the specialized needs of customers across a wide variety of segments and industry sectors. These include Accident & Health, Aviation, Cyber, Healthcare, Inland Marine, Management Liability and Professional Lines, Media & Entertainment, Surety, Trade Credit and Transactional Liability for appointed retail and wholesale producers.

About QBE

QBE North America is part of QBE Insurance Group Limited, one of the largest insurers and reinsurers worldwide. QBE NA reported Gross Written Premiums in 2015 of $4.6 billion. QBE Insurance Group's 2015 results can be found at Headquartered in Sydney, Australia, QBE operates out of 37 countries around the globe, with a presence in every key insurance market. The North America division, headquartered in New York, conducts business through its property and casualty insurance subsidiaries. QBE insurance companies are rated "A" (Excellent) by A.M. Best and "A+" by Standard & Poor's. Visit and follow QBE North America on Twitter.


HMA Innovates to Increase Savings for Self-Funded Tribal Health Plans

MyHealthGuide Source: Healthcare Management Administrators (HMA), 10/20/2016,

Bellevue, WA -- Healthcare Management Administrators (HMA) has expanded the scope of their Tribal Health Plan product to provide clients additional savings.

Self-Funded Tribal Health Plans have the opportunity to leverage the Indian Health Service's Purchased/Referred Care (P/RC) program to pay for certain types of care at Medicare-like rates, resulting in significant healthcare cost savings. In May, the U.S Department of Health and Human Services implemented a regulation that gives Indian Health Service (IHS) and Tribal programs the ability to cap payment rates at a "Medicare-like rate" (MLR) to physicians and other non-hospital providers who provide services through the P/RC program. Previously, only facility claims were eligible for this special treatment.

This new regulation means that there is even greater opportunity for healthcare savings for Tribal Health Plans who can navigate the complexities of the regulations and find a good partner to help them administer their health plan. HMA's expanded product offers a flexible solution to do just that.

"We are extremely excited about being one of the first benefits administrators in the nation to develop a product that allows Tribal Health Plan clients to use P/RC for professional services and achieve substantial health plan savings." Lindsay Harris, HMA's Director of Strategy and Product Management said.

HMA is deeply experienced in administering Self-Funded Tribal Health Plans. HMA has administered both P/RC for facilities and CHEF since 2009. HMA's enhanced product, which launched on October 1st, is one more way that HMA is helping Tribal Health Plans manage healthcare costs.

About HMA

HMA is one of the nation's largest third party healthcare benefits administrators, and is headquartered in Bellevue, Washington. With offices across the Pacific Northwest, HMA has made it their mission to create a healthier future -- each client, every time. Through the latest industry technology, customizable plan designs and skilled staff, HMA is committed to meeting group healthcare coverage needs.  Contact Courtney Bowman, MBA, Marketing Specialist, at and visit


Lucent Health and Kemper Align to Serve Self-Funded Benefits Market

MyHealthGuide Source: Lucent Health, 10/17/2016,

Nashville, TN -- Lucent Health (@LucentHealth), the leading Healthcare Risk Management, Administration and Advisory Services company, announced that it has entered into a partnership with Kemper Benefits, the voluntary business of Kemper Corporation (@kemperinsurance). The relationship between the two companies will provide the foundation for an ongoing strategic alliance and go-to-market strategy serving Lucent Health Employer Groups and their members.

"We're very pleased to have Kemper join us in providing world-class service to our clients across the nation. Kemper's expertise and reputation for hospital indemnity insurance, critical illness insurance and accident expense coverage ensures our clients will continue to receive the highest level of care, accountability and service innovation," said Alex Arnet, Chief Commercial Officer for Lucent Health.

"The Kemper Benefits team is pleased to announce and promote our ongoing partnership with Lucent Health," said Tracy Berwick, Vice President, Kemper Benefits. "We recognize a significant distribution opportunity by collaborating with Lucent Health. Their reach and knowledge in today's dynamic market will integrate well with our sales strategy as we help brokers adapt, innovate and grow their benefits business."

About Lucent Health

Lucent Health (@LucentHealth), based in Nashville, empowers US employers by dramatically reducing their healthcare risks and costs while improving employee access to innovative healthcare services. Lucent Health developed a highly advanced risk-reduction solution for self-funded healthcare groups and continues to lead the industry revolution with its reference-based pricing, e2 MEC/MVP, and captive products, while serving over 140,000 members and processing $600 million in transactions annually. Contact Mark Stephen Ware, Senior Vice President, at and visit

About Kemper

The Kemper family of companies is one of the nation's leading insurers. With $8 billion in assets, Kemper is improving the world of insurance by offering personalized solutions for individuals, families and businesses. Kemper's businesses collectively:
• Offer insurance for home, auto, life, health and valuables
• Service six million policies
• Are represented by 20,000 agents and brokers
• Employ 6,000 associates dedicated to providing exceptional service
• Are licensed to sell insurance in 50 states and the District of Columbia

Contact Deborah Buck at and visit


Alacura Network Advisory Group Launched to Help Grow the Medical Transportation Benefits Management (MTBM) Industry

MyHealthGuide Source: Alacura, 10/17/2016,

Dallas, TX -- Alacura, the nation's first comprehensive Medical Transportation Benefits Management (MTBM) company, announced the formation of the Alacura Network Advisory Group. Donna Miller, CEO of Lifeguard International; W. Ashley Smith Jr., President of Jet Logistics; and Clay Hobbs, Director of Operations of Pafford EMS; have been selected to serve along with Alacura CEO David Boone; Semra Treece, Alacura's Director of Provider Development; and Dr. Matt Bush, Alacura's Medical Director.

The Alacura Network Advisory Group will help develop and expand the market presence of Alacura's network of credentialed medical transportation providers. The Advisory Group will serve as industry advocates and provide guidance through their perspectives on clinical issues, logistical expertise, and business insights into the growing MTBM industry. The Advisory Group will help Alacura structure best practices for credentialing medical transportation providers; share information regarding clinical policy and quality standards for ambulance providers; shape the composition, scale and distribution of the network; optimize transportation and associated logistics; and strengthen provider relations.

"We formed the Alacura Network Advisory Group in order to strengthen the MTBM industry," CEO Boone said. "Our goal with the Advisory Group is to expand the MTBM model to better serve patients, providers, and payors while simplifying a complex process. Additionally, we strive to improve safety and clinical quality and reduce costs throughout the system to the benefit of all stakeholders."

In an industry that has no central core of coordination, Alacura is the first and only MTBM company with the largest air transportation network in the U.S. As a way of demonstrating the highest standards of quality and safety, Alacura has established rigorous credentialing standards for medical transportation providers, who receive the Alacura Certified Medical Transportation seal once they complete the approval process (see certified badge as part of this release). The combination of Alacura's Network Advisory Group and commitment to excellence through credentialing standards assures that Alacura delivers the highest quality and safety in medical transportation services.

"The need for medical transportation often hits patients and their families at a very difficult time in their lives," said Alacura Provider Development Director Treece. "By streamlining the coordination of medical transportation and benefits, Alacura takes the burden off of the patient, payors can offer reliable quality services to their members at a lower cost, and providers can grow their business with increased access to transports. The Alacura Network Advisory Group will help us expand the reach of our services and deliver a win for everyone."

About Alacura

Alacura is the first and only medical transportation benefits management company dedicated to simplifying bedside-to-bedside non-emergent medical transportation for patients. Alacura manages the nation's largest fixed-wing transportation provider network ready to help patients 24/7/365 with one-call-does-it-all convenient, personal service. Alacura seeks to improve financial, operational and clinical performance for healthcare payors and administrators, their member patients, and transportation providers. Visit


SPBA's Fall Meeting Covers Top Issues Affecting Self-Funded Health Plans

MyHealthGuide Source: prweb, 10/20/2016

Chevy Chase, MD -- Hosting its Fall Meeting in Minneapolis this week, the Society of Professional Benefit Administrators (SPBA) conducted three days' worth of informational sessions and workshops. These focused on the operational side of running a third party administrator (TPA) firm, as well as information and solutions to help TPAs position themselves as leaders in new approaches to employee benefits.

The annual conference was held October 17-19 and brought TPA members together from across the United States to discuss some of the biggest topics they face in the self-funding industry.
After hearing opening remarks from David Rubenzahl, SPBA chairman of the board, members attended presentations on everything from specialty prescriptions and reference-based pricing to TPA leadership and stop loss partnerships.

Cyber security was a focal topic at the Fall Meeting as TPA members were educated about ways to effectively reduce their cyber risk exposure. In an overview session and series of supplemental workshops directly targeting TPAs' IT professionals, attendees learned about the different types of attacks happening today, the threats posed and the tools and advanced controls for preventing them. A roundtable talk gave TPA members the chance to share strategies and techniques for handling cyber risks, too.

"One of the best parts about our Fall Meeting is the peer-to-peer exchange that happens," said Anne Lennan, SPBA president. "The way panels and workshops are structured really encourages TPA members to share ideas and learn from each other's experiences."

Regulatory topics were also part of the agenda as things like HIPAA security audits, Free Market health care coverage and NAIC/state stop loss developments were covered. On top of that, participants heard about the latest issues related to the Affordable Care Act (ACA), including employer plan reporting, wellness rulings and stop loss training.

"The agenda for these meetings is developed in large part from the feedback our TPA members provide," Lennan said. "We cover the topics that they want to hear about and are most relevant to the day-to-day operations of their TPA firms. I think this explains why turnout is always so high."

About SPBA

SPBA is the national association of Third Party Administration (TPA) firms that manage client employee benefit plans. It is estimated that over 70% of U.S. workers and their dependents in non-federal health coverage are in plans administered by TPAs. The clients of TPA firms include every size and format of employment, including large and small employers, state/county/city plans, union, non-union, collectively bargained multiemployer plans, as well as most industries and professions.  Visit


Equian Ranked among the Nation's Fastest-Growing Healthcare Companies by Inc. 5000 for Six Consecutive Years!

MyHealthGuide Source: Equian, 10/20/2016,

INDIANAPOLIS -- Inc. magazine, the only major business magazine designed for CEOs of fast-growing, private companies, unveiled its annual list of fastest-growing companies in America to include Equian for the sixth year running. Equian has ranked among the top private healthcare companies by Inc. 500|5000 and in the overall ranking of all industries from 2010-2015. Equian's innovative approach to payment integrity solutions continues to drive savings in the healthcare and property and casualty industries. Equian's profile for the past 6 years can be found on

"Our accelerated growth is a reflection of the focus we place on ensuring the right party is paid the right amount at the right time throughout the payment spectrum," said Scott Mingee, CEO of Equian. Mike Morrison, CRO adds, "The use of our proprietary content, enabling technology, and highly responsive customer service is an important factor in our growth and in our ability to return hard dollar savings to our clients."

About Equian

Equian is a leading end-to-end payment integrity organization. The company manages over $250 billion in claims data annually on their innovative platform designed to assist clients by avoiding, identifying, pricing, analyzing clinical codes, and ultimately recovering inaccurate transactions in the complex environments of healthcare, workers compensation, and property & casualty markets. Equian acts on data to pay the right party, the right amount, at the right time delivering over $1.3 billion in actionable savings throughout the payment spectrum. Contact Mike Morrison, CRO, at 317-806-2128, and visit


People News

Symetra Names Matthew Heiberger Underwriting Regional Group Manager, Stop Loss

MyHealthGuide Source: Symetra, 10/19/2016,

BELLEVUE, WA -- Matthew Heiberger has joined Symetra Life Insurance Company as an underwriting regional group manager for medical stop loss insurance, with responsibility for Iowa, Minnesota, Nebraska and the Dakotas markets. He will be based out of Symetra's West Des Moines, Iowa, office.

Heiberger was most recently senior marketing underwriter for stop loss and group life products at HCC Life Insurance Company in Minnetonka, Minnesota. His 15-year background in medical stop loss underwriting also includes roles at United Health Care and ING.

Heiberger received a Bachelor of Science degree in business administration from Southwest Minnesota State University in Marshall, Minnesota.

About Symetra

Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation, a diversified financial services company based in Bellevue, Washington. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent agents and advisors. Contact Diana McSweeney, Media Relations Manager, at and visit


Job News

Pareto Captive Crosses $100m Mark; Seeks New Team Members

MyHealthGuide Source: Pareto Captive Services, October 19, 2016;

Philadelphia, PA -- Pareto Captive Services, LLC ("Pareto Captive") is pleased to announce that its captive programs topped $100m in stop loss premium at October 1st.

"Pareto would like to thank our partners, including consultants, stop loss carriers, and TPAs, and most importantly, we'd like to thank our clients. While this top line achievement is great, we take even more pride in the fact that our renewal ratio exceeds 95% and our programs are saving employers significant amounts of money," said Andrew Cavenagh, Managing Director of Pareto Captive.

"Our growth, both in terms of the number of participating employers and the corresponding premium levels, confirm that captives can provide a better option to medium-sized employers than traditional insurance products."

To keep pace with its current volume and its anticipated growth, Pareto Captive is seeking additional team members. Pareto Captive has a strong company culture and boasts a team-first environment. Successful applicants will be committed to quality and detail and have a strong desire to achieve and lead the industry.

Pareto seeks to fill the following positions:

  • Chief Operating Officer. The COO is responsible for implementing the company's vision, and integrating Sales & Marketing, Program Management, Underwriting, and Administration. The successful applicant will have a strong background in process management, technology, and/or accounting. A background in health insurance is not required.
  • Vice President/Sales & Marketing. The VP/Sales & Marketing is responsible for implementing the company's sales strategy. This includes creating and maintaining relationships with our distribution partners, and adding clients to existing group captives. The individual is responsible for oversight of the sales team, including setting overall team and individual goals, monitoring plan progress, and marketing. Experience in sales in a supervisory capacity is required for this position.
  • Underwriting Manager. The Underwriter Manager is responsible for both new and renewal underwriting and supervises a team of underwriters. The position also liaises with the underwriting departments of our stop loss carrier partners. Key experience necessary for this position includes:
    •  Experience underwriting accounts leaving the fully-insured market
    • Experience underwriting traditional stop loss
    • Managing a team of underwriters

About Pareto Captive

Pareto Captive's mission is to help medium-sized employers reduce both the cost and volatility of health insurance, while helping our distribution partners achieve significant growth. We create and manage employee benefit group captives that make self-insurance an option for medium-sized employers, allowing us to work collaboratively to reduce the cost of healthcare.

Pareto Captive offers a full suite of benefits, including health insurance, life & disability, free gym memberships, and a 401k program. All positions are based in Philadelphia and working remotely is not an option, although relocation packages are available.

If you are interested in one of the above positions, please send an email and resume to


HM Insurance Group Seeks Senior Underwriter

MyHealthGuide Source: HM Insurance Group (HM), 10/19/2016,

PITTSBURGH -- HM Insurance Group (HM) has an immediate opening for an experienced Senior Underwriter for its stop loss product line.

The Senior Underwriter will analyze risk factors for new enrollment, annual renewals and amendments of group insurance contracts or of self-funded plans in conformance with established underwriting policies, practices and standards. He or she also will analyze associated policies, guidelines and market data to continuously improve risk management and gain appropriate enrollment or manage existing membership.

In addition, the Senior Underwriter may analyze data such as financial conditions of the organization, participation percentage, type of industry, characteristics of employee groups or past claim experience to determine what benefits can be offered and to set the rates. He or she also will prepare a variety of reports and provide rationale and support to other areas within the organization, clients and possibly producers regarding one or more of the following: underwriting results, rate computations and financial activity. The responsibilities also include providing expense estimates and accurate analysis of financial exhibits. This position can be based in the Pittsburgh office or be work from home.

Qualifications include

  • Bachelor's degree in mathematics, actuarial science, finance, business, computer science or other quantitative analysis discipline
  • 7 years of relevant, progressive experience in underwriting

Preferred characteristics include

  • Actively pursuing a professional designation related to the healthcare industry with a willingness to complete one course within twelve months
  • Where applicable, a PA Producer's License in Accident and Health or a willingness to pursue and obtain it within six months

Knowledge & Skills

  • Ability to skillfully and knowledgeably interact with various internal departments and external stakeholders
  • Ability to use applicable computer systems, electronic tools and applications
  • Ability to work independently and assume responsibility for projects across a continuum from routine to highly complex
  • Understanding and support of corporate and departmental goals and initiatives
  • Use of ethical business practices with adherence to all privacy and confidentiality policies and regulations

Interested candidates can learn more or apply online.

About HM Insurance Group

HM Insurance Group (HM) works to protect businesses from the potential catastrophic financial risk associated with health care costs. The company provides reinsurance solutions that address risk situations confronting employers, providers and payers. A recognized leader in Employer Stop Loss, HM also offers Managed Care Reinsurance nationally.

HM Life Insurance Company, HM Life Insurance Company of New York and Highmark Casualty Insurance Company are rated "A-" (Excellent) by A.M. Best Company, one of the country's oldest and most respected rating agencies. HM also consistently has been named to Ward's 50 top life and health carriers based on financial performance. Through its insurance companies, HM Insurance Group holds insurance licenses in 50 states and the District of Columbia and maintains sales offices across the country.  Visit


HM Insurance Group Seeks Director of Underwriting & Administration

MyHealthGuide Source: HM Insurance Group (HM), 10/19/2016,

PITTSBURGH -- HM Insurance Group (HM) has an immediate opening for an experienced Director of Underwriting to manage a team of stop loss underwriting professionals in the company's Eastern region.

The Director of Underwriting has full responsibility for stop loss profitability results and adherence to underwriting guidelines by the underwriting staff and/or external parties on behalf of the company.

Major managerial duties include development of the staff, management of the unit's budget, establishment and monitoring of the production standards, monitoring and intervention of staff's training needs, support of staff in underwriting decisions, oversight of the interaction between sales and underwriting staff and the development of working relationships with external producers and internal business partners.

In addition, the director of underwriting is expected to actively participate in departmental and companywide projects and assume a support role to the Senior Vice President of Underwriting or other senior management as directed. This position can located be in Pittsburgh or Omaha.

Qualifications include

  • Bachelor's degree in business administration, mathematics, actuarial science, finance or other quantitative discipline or the equivalent experience
  • 7 to 10 years of underwriting group insurance products
  • 10 years of management or team leader experience

Additional preferred characteristics include

  • Management skills
  • Motivational skills
  • Problem solving
  • Team building skills
  • Negotiation skills
  • Organizational skills
  • CEBS
  • Advanced degree or other advanced certification in the underwriting field

Interested candidates can learn more or apply online.

About HM Insurance Group

HM Insurance Group (HM) works to protect businesses from the potential catastrophic financial risk associated with health care costs. The company provides reinsurance solutions that address risk situations confronting employers, providers and payers. A recognized leader in Employer Stop Loss, HM also offers Managed Care Reinsurance nationally.

HM Life Insurance Company, HM Life Insurance Company of New York and Highmark Casualty Insurance Company are rated "A-" (Excellent) by A.M. Best Company, one of the country's oldest and most respected rating agencies. HM also consistently has been named to Ward's 50 top life and health carriers based on financial performance. Through its insurance companies, HM Insurance Group holds insurance licenses in 50 states and the District of Columbia and maintains sales offices across the country.  Visit


The Phia Group Seeks Attorney

MyHealthGuide Source: The Phia Group, 10/18/2016,

Braintree, MA -- The Phia Group, LLC seeks to further grow its team in response to client demand, and is looking to recruit an attorney to help combat rising healthcare costs and empower health plans.

The Phia Group, LLC -- a service-oriented company assisting health plans nationwide -- provides its clients with innovative cost-cutting solutions and constantly expanding service offerings. It continues to enjoy growth thanks to its most valuable resource -- its capable and committed team. Now, The Phia Group seeks to add another talented attorney to that team.

The Phia Group is currently seeking a full time attorney to solve a wide range of issues presented by employers, their health plans, and those that service them -- such as analyzing appeals, drafting and explaining health plan terms, reviewing agreements, and resolving disputes between various industry entities, and much more -- all in an effort to protect the integrity of the self-funded health care model, as well as to protect plan members their employers.

As the industry is called upon to introduce interested individuals to The Phia Group, referrals are welcome, via an emailed cover page, resume, and salary requirements, to be sent to No phone calls please.

About The Phia Group

The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets. To reduce the cost of healthcare through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward thinking methodology, The Phia Group boasts an all encompassing cost containment program for the ever-changing healthcare industry. Visit


The Phia Group Seeks Senior Account Manager

MyHealthGuide Source: The Phia Group, 10/18/2016,

Braintree, MA -- The Phia Group, LLC seeks to further grow its team in response to client demand, and is looking to recruit a Senior Account Manager to provide ongoing support for The Phia Group's valued clients and customers.

The Phia Group, LLC -- a service-oriented company assisting health plans nationwide -- provides its clients with innovative cost-cutting solutions and constantly expanding service offerings. It continues to enjoy growth thanks to its most valuable resource -- its capable and committed team.

The Phia Group is currently seeking a Senior Account Manager to help coordinate implementations and other client-facing matters. The Senior Account Manager will have the opportunity to be a centralized point of contact and a valued resource for inquiries, issues, and various needs of certain clients of The Phia Group.

As the industry is called upon to introduce interested individuals to The Phia Group, referrals are welcome, via an emailed cover page, resume, and salary requirements, to be sent to No phone calls please.

About The Phia Group

The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets. To reduce the cost of healthcare through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward thinking methodology, The Phia Group boasts an all encompassing cost containment program for the ever-changing healthcare industry. Visit


Market Trends, Studies, Books & Opinions

EEOC Re-evaluates Wellness Rewards

MyHealthGuide Source: Norbert Kugele and Kent Sparks, Warner Norcross & Judd LLP, 10/21/2016, Employee Benefit News (EBN)

If your company's health and welfare plan includes a wellness program, you will want to review your reward system soon to make sure that it does not run afoul of new restrictions under the Equal Employment Opportunity Commission's (EEOC) recent wellness program regulations. The new rules are intended to make sure that employees are not coerced to participate in wellness programs, including through rewards that are so high that individuals feel compelled to participate or share their medical history information.

Prior EEOC regulations

Wellness programs are subject to a number of laws, including laws prohibiting discrimination on the basis of a health condition or a disability and laws restricting an employer's collection and use of genetic information. The Departments of Health and Human Services, Labor and Treasury have on numerous occasions published regulations on wellness programs, most recently in 2014.

  • These regulations set limits on wellness program rewards, generally capping them at 30% of the cost of the coverage (but at 50% for programs aimed at tobacco use).
  • But employers only had to count rewards toward the cap if the rewards affected the health plan--such as discounted premiums or lower deductibles--and were tied to some kind of health standard.
  • As a result, rewards that individuals received simply for participating in the wellness program, or that were provided separately from the health plan, didn't have to be counted at all.

New EEOC regulations

The new EEOC regulations, however, change all of this. The EEOC is concerned that the total amount of rewards offered through wellness programs has grown to the point where individuals feel coerced to take health risk assessments or biometric screenings.

  • To make sure that rewards are not coercive, the EEOC is setting a cap at 30% of the cost of individual coverage on all rewards--financial, in kind, or otherwise--offered to employees for wellness programs that include disability-related inquiries or medical examinations.
  • The EEOC is also applying the 30% cap to incentives offered to spouses participating in the wellness program who provide information about their current or past health status. In that case, the incentive offered to the employee and the spouse each cannot exceed 30% of the cost of individual coverage.
  • Even rewards that are offered outside of the health plan or that are provided for simply participating in the wellness program are included in this 30% calculation.

To ensure that your company's wellness program complies with these new requirements, you will want to consider all rewards--no matter the value--that are available to employees and their spouses under any and all wellness programs you operate, including where the value of the awards may vary for employees based on utilization, such as reduced co-pays or deductibles.

In addition to the new restrictions on rewards, the regulations require an employer to provide a notice to participants that's easily understandable and that explains what medical information will be collected, how it will be used, who will receive it and the restrictions on its disclosure.

 The EEOC created a model notice for employers, which is available on its website. If this information is already covered in your company's wellness program materials, then you do not have to issue a separate notice. The EEOC has also clarified that collecting health information through risk assessments, biometric screenings or other methods is only reasonable if the employer uses that information to alert individuals about health risks and/or to design programs to treat conditions prevalent in the employer's workplace.


Legislative & Regulatory News

Refusal to Pay Claims to Gain Negotiating Leverage Is Abuse of Discretion Under ERISA

MyHealthGuide Source: Martin J. Bishop, Thomas C. Hardy, 10/13/2016, ReedSmith Client Alerts

Case: North Cypress Medical Center Operating Company v Cigna Healthcare, No. 12-20695, United States Court of Appeals for the Fifth Circuit. Civil Action NO. 4:09-CV-2556 (S.D. Tex. Sep. 28, 2016)  Court Ruling compliments of CaseText

A federal district court found that Cigna Healthcare abused its discretion, and thus was liable under section 502(a)(1)(B) of ERISA, when its primary motivation for refusing to pay a hospital's claims was to enhance its leverage in negotiations to bring the hospital into its provider network.

While Cigna argued that it had a valid justification for refusing to pay the hospital's claims because of the hospital's practice of forgiving balances owed by Cigna's members, the court found that Cigna's interpretation of its plan language was legally incorrect, and that the evidence demonstrated that refusing to reimburse the hospital was part of Cigna's plan for bringing the hospital in-network.

The decision underscores that reliance on legal authority (here, a Seventh Circuit decision) may not shield a payor from liability under section 502(a)(1)(B) if there is evidence that the administrator favored one interpretation of plan language for reasons that amount to bad faith.

Given the number of lawsuits addressing fee forgiveness that have been filed by both providers and payors in recent years, this highlights the potential danger that payors may find themselves in if outside factors, such as contract negotiation leverage, influence reimbursement policies with providers. While payors may incentivize out-of-network providers to come in-network, this case illustrates that certain conduct--such as refusing to pay a provider's claims without a solid legal justification--may cross the line and subject payors to ERISA liability.


North Cypress Medical Center Operating Company ("North Cypress") sued Cigna Healthcare ("Cigna") in the United States District Court for the Southern District of Texas, alleging that Cigna violated section 502(a)(1)(B) of ERISA when it refused to pay anything to North Cypress, as assignee of its patients' benefits. Cigna justified its refusal to pay North Cypress, an out-of-network hospital, on the basis of plan language stating that "payment for the following is specifically excluded:...charges for which you [patients] are not obligated to pay or for which you are not billed." Because North Cypress generally did not bill the patients any amount (a practice commonly known as "fee forgiveness"), Cigna asserted that it was not obligated to pay anything to North Cypress under the terms of its members' plans. Cigna therefore implemented what it called a "Fee-Forgiving Protocol" under which it either paid nothing, or drastically reduced its payments to North Cypress and other providers who engaged in fee forgiveness.

In addition to claims seeking benefits based on ERISA and breach of contract theories, North Cypress sued for breach of fiduciary duty under section 502(a)(3) of ERISA, failure to provide full and fair review under section 503 of ERISA, and failure to provide requested plan documents under section 502(c) of ERISA. Cigna asserted a counterclaim under section 502(a)(3) of ERISA, alleging that North Cypress' artificial inflation of its claimed medical costs breached duties owed by North Cypress to Cigna.

After the court initially granted summary judgment in favor of Cigna on North Cypress' ERISA and breach of contract claims, the Fifth Circuit, finding that North Cypress had not established its standing to sue as an assignee of the patients' benefits, overturned the judgment and remanded in March 2015. North Cypress Med. Ctr. Operating Co., Ltd. v. Cigna Healthcare, 781 F.3d 182, 187 (5th Cir. 2015).

The Fifth Circuit also affirmed dismissal of Cigna's counterclaim as time-barred. In June 2016, another district court in the Southern District of Texas found that Cigna's Fee-Forgiving Protocol was based on an incorrect interpretation of the plan language, and that Cigna abused its discretion in refusing to pay a hospital's claims despite its provision of medical services to Cigna's members. Connecticut Gen. Life Ins. Co., et al. v. Humble Surg. Hosp., LLC, No. 4:13-cv-3291, 2016 WL 3077405 (S.D. Tex. Jun. 1, 2016) ("Humble").


Because of the Humble decision, a principal issue at summary judgment was whether it had preclusive effect on Cigna and, if so, to what extent. The court found that the Humble court's ruling that the Fee-Forgiving Protocol was based on a flawed interpretation of the plan language was entitled to collateral estoppel effect. However, the court found that whether Cigna abused its discretion in applying the Fee-Forgiving Protocol to North Cypress was a factual inquiry that was not subject to collateral estoppel.

In resolving the abuse-of-discretion issue, the court looked at whether Cigna had a conflict of interest, whether the plan was internally consistent, the factual background of Cigna's determination, and whether it could infer bad faith on Cigna's part. On conflict of interest, the court found that there was a genuine issue of material fact because, while evidence showed that Cigna's cost containment program might provide a basis for finding a conflict, there was no evidence that the claims at issue were subject to the cost containment program. Accordingly, it did not weight conflict of interest in the analysis. The court found that Cigna's plan language was internally consistent, a factor that favored Cigna.

However, the court found that the final two factors strongly favored North Cypress.

  • Specifically, the court pointed to internal communications that established that Cigna's motivation in applying the Fee-Forgiving Protocol to providers in general and to
  •  North Cypress in particular was to pressure North Cypress to join Cigna's networks on more favorable terms.

While Cigna claimed that its Fee-Forgiving Protocol was motivated by its concerns about fee forgiveness and was supported by a 1991 Seventh Circuit decision, the court found that the evidence suggested otherwise. Accordingly, it found that Cigna abused its discretion in violation of section 502(a)(1)(B). The court reserved determination of damages, given the lack of summary judgment evidence.

The court's decision is important to payors for other reasons as well.

First, the court found that North Cypress' inability to produce an assignment of benefits from each member on whose behalf it claimed to sue was not critical, given that Cigna established a genuine dispute of material fact by submitting an affidavit stating that it routinely has patients sign assignments upon admission.

  • The court granted summary judgment to Cigna on North Cypress' claims under ERISA sections 502(a)(3), 502(c) and 503.
  • The court found the section 502(a)(3) claim impermissibly duplicated North Cypress' ERISA benefits claim.
  • It also found that North Cypress could not sue under section 502(c), because it could not establish that it was a plan participant or beneficiary, and that
  • North Cypress failed to show that Cigna failed to provide notice of the reasons for its denials or to provide an adequate administrative review process.


Cigna abused its discretion because it implemented its Fee-Forgiving Protocol to exert leverage in contract negotiations with providers. Though courts in some jurisdictions have been more favorable to arguments similar to Cigna's, this case, along with the Humble decision on which it relies, follows a trend in the Fifth Circuit and elsewhere, of courts taking a hard look at the motivations of ERISA payors in denying claims based on fee forgiveness, particularly when the plan language does not support the administrator's determinations.

The decision especially highlights the potentially adverse consequences a payor may face if it allows outside factors, such as contract negotiations with a provider, to influence its reimbursement policies toward that provider. Given the prevalence of fee forgiveness programs among providers and the proliferation of lawsuits involving the practice, this opinion may have wide-ranging implications for payors.


Medical News

Mothers with a Previous Bariatric Surgery Increases Prematurity and other Risk for Their Infants

MyHealthGuide Source: Brodie Parent, MD, et al, 10/19/2016, JAMA Surgery

In women of childbearing age, a prior bariatric operation is associated with risks for perinatal complications according to a study published in JAMA Surgery.

The study examined the risk for perinatal complications in women with a history of bariatric surgery (postoperative mothers [POMs]) by comparing them with mothers without operations (nonoperative mothers [NOMs]) and examining the association of the operation-to-birth (OTB) interval with perinatal outcomes.

Researchers investigated 10,296 individuals, average age was 29 years.  The individuals were a part of a population-based retrospective cohort study (January 1, 1980, to May 30, 2013) at hospitals in Washington State. Data were collected from birth certificates and maternally linked hospital discharge data. Participants were all POMs and their infants (n = 1859) and a population-based random sample of NOMs and their infants frequency matched by delivery year (n = 8,437).

The primary outcomes were prematurity, neonatal intensive care unit (NICU) admission, congenital malformation, small for gestational age (SGA), birth injury, low Apgar score (≤8), and neonatal mortality. Poisson regression was used to compute relative risks (RRs) and 95% CIs, with adjustments for maternal body mass index, delivery year, socioeconomic status, age, parity, and comorbid conditions.

Study findings

  • Mothers with prior bariatric surgery had infants with significantly higher risks for prematurity, small-for-gestational-age status, and intensive care unit admission.
    • Compared with infants from NOMS, infants from POMs had a higher risk for prematurity (14.0% vs 8.6%)
    • NICU admission (15.2% vs 11.3%)
    • SGA status (13.0% vs 8.9%), and
    • Low Apgar score (17.5% vs 14.8%)
  •  Operation-to-birth intervals of less than 2 years were associated with the highest risks for prematurity and intensive care unit admission.


Recurring Resource

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 8/8/2016)

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 update is encouraged. Sources will be cited. Please send updates / changes to
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
1 CIGNA     $2,701
  Source - CIGNA Financial Supplement 2015, P.5 12/31/2015
2 Sun Life Financial > 30 Years   $1,155
  Source - Sun Life Financial, Financial Planning and Analysis department (8/8/2016)
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A+)
$29,700 as part of Tokio Marine Group
  Source - Ketrice Williams, 5/6/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $253
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
10 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
11 Munich Re Stop Loss, Inc.   American Alternative Insurance Company (AAIC),
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
  Source - Lauren Woods, VP Marketing Fairmont Specialty, 1/4/2016
13 The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
  Source - 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 Cross Blue Shield (various regions)
  • International Insurance Agency Services, LLC (IIS)
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan-American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • 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  


The Value of Self-Funding

MyHealthGuide Source:  The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, The Self-Insurance Educational Foundation, Inc. (SIEF has published The Value of Self-Funding.

Self-funding is an important contributor to the financial and physical health of America's wellness future. Self-funding is more than processing claims and receiving premiums, it provides quality coverage and proactive healthcare management for employers of all sizes and industries.

About the SIEF

The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501(c)(3) non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). The foundation's mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit


Video Highlighting Captive Solutions for Mid-market Companies

MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF), 5/11/2016,

The Self-Insurance Educational Foundation (SIEF) announced that it has released a new video highlighting captive insurance solutions for mid-market companies, including stop-loss captive programs, enterprise risk captives, and property & casualty group captives. Please click here to access the video.

The video can be accessed through the Foundation's web site at or by clicking here.  The video includes a separate video focused on self-insured group health plans. Both videos can be private labeled by individual companies interested in using them for their own purposes. Contact Justin Miller at or 800-851-7789 for more information about private labeling.

About SIEF

The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501 c 3 non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). Its mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit


ICD-10 Stop Loss Trigger Diagnosis Tools

MyHealthGuide Source:  Industry Study Group (ISG), 9/19/2015

In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list. On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. The new ICD-10-CM Trigger list is endorsed by SIIA and HCAA and supported by SPBA.  

Below are useful links for members of the self-funded community including TPAs, stop-loss carriers, MGUs, and others.


Upcoming Conferences

October 27, 2016 - Webinar 1:00 PM (EST) to 2:00 PM
How Low Can You Go? Managing Specialty Drugs, Reducing Overall Pharmacy Spend, and Unraveling the Mystery Behind PBMs presented by The Phia Group. Pharmacy Benefit Managers, or PBMs, are an important factor in the cost and value of self-funding - yet many TPAs, brokers, and plan sponsors feel it is impractical to even look into changing the status quo. Self-funded plans and those who service them, however, should be constantly on the lookout for effective alternatives to their current procedures - especially in this aggressive economic and legal climate.  The Phia Group's legal team analyzes the processes and agreement terms offered by PBMs - and help you make the decision regarding whether or not your current PBM is the best choice for you, your employees, and your clients.  Registration:

December 1-2, 2016 - A Hybrid Conference and Internet Event
Population Health Colloquium Special Edition: Pop Health Policy & Strategy Under the New Administration.  Speakers: Sheila Burke, MPA, RN, FAAN, Chair, Government Relations & Public Policy, Baker, Donelson, Bearman, Caldwell & Berkowitz, Faculty Research Fellow, Stephen K. Klasko, MD, MBA, President and Chief Executive Officer, Thomas Jefferson University and Jefferson Health, Donato J. Tramuto, President and Chief Executive Officer, Healthways, Founder, Health eVillages, Nashville, TN.  Hyatt Regency on Capitol Hill, Washington, DC.  Information and registration: 


January 29-31, 2017
2017 AAPAN Annual Forum!.  This year's forum features session tracks tailored to group health, workers' compensation and specialty health markets. Keynoters will challenge attendees to think outside the box and offer insights into healthcare public policy under the new administration. And we've expanded the number of opportunities for quality networking.  Ritz-Carlton, Dove Mountain, Tucson, AZ at the  resort January 29 - 31, 2017. Early bird registration runs through September 30, 2016. Information and registration:

January 30-February 1, 2017
26th Annual National Health Benefits Conference & Expo.   Real-world education with numerous sessions focusing on case study evaluations and addressing many of today's hottest topics and issues from the latest ACA regulations to wellness program trends. To assist you in continuing your education, we are also pleased to provide CE credit for numerous designations including PHR/SPHR/GPHR, CIMA, CPA, CHES/MCHES, CEBS CPE and more! And because we understand that education goes beyond the classroom, this three-day program is designed to give attendees numerous opportunities to network with peers, speakers and exhibitors. ​Clearwater, FL.  Registration and information:  

February 8-10, 2017
Executive Forum 2017
presented by Health Care Administrators Association (HCAA). Bellagio, Las Vegas, NC. Kicking off just 19 days after our country's new president is sworn into office, you can bet we'll have plenty to talk about. We've lined up what may be our most impressive slate of presenters ever to:

  • Examine the impact on the self-funding industry of the electorate's choice of a new administration,
  • Explore tech and social communication changes that may well disrupt your current strategies, and
  • Expose you to new and unique ways for your business to thrive in in this Brave New World.

Schedule and registration:

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

March 27-29, 2017 -  A Hybrid Conference and Internet Event
17th Population Health Colloquium.  The Leading Forum on Innovations in Population Health & Care Coordination Academic Partner: Jefferson College of Population Health. Loews Philadelphia Hotel, Philadelphia, PA. Information and registration:

March 28-30, 2017
Self-Insured Health Plan Executive Forum presented by The Self-Insurance Institute of America. JW Marriott Tucson Starr Pass Resort & Spa, Tucson, AZ.

April 18-19, 2017
SIIA 2017 International Conference presented by The Self-Insurance Institute of America, Inc. Focus on Latin America and self-insurance-related business opportunities emerging within the region. Condado Vanderbilt Hotel. San Juan, Puerto Rico.  Visit

May 3-4, 2017
SIIA Legislative Conference presented by The Self-Insurance Institute of America, Inc. Washington Marriot Metro Center Hotel. Washington, DC.  Visit

May 16-18, 2017
Self-Insured Workers' Compensation Executive Forum presented by The Self-Insurance Institute of America. The Omni Grove Park Inn. Asheville, NC.

July 17-19, 2017
HCAA TPA Summit 2017 presented by Health Care Administrators Association.  Hilton Hotel at the Ballpark. St. Louis, MO

October 8-10, 2017
37th Annual National Educational Conference & Expo presented by The Self-Insurance Institute of America. JW Marriott Phoenix Desert Ridge Resort & Spa. Phoenix, AZ.

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


Editorial Notes, Disclaimers & Disclosures

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