MyHealthGuide Newsletter
News for the Self-Funded Community
4/21/2014

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



Advanced Medical Strategies Partners with The Phia Group on Innovative NetworkDx

MyHealthGuide Source: Advanced Medical Strategies, 4/18/2014, www.mdstrat.com and www.phiagroup.com

Lynnfield MA -- Two powerhouse healthcare cost containment firms, The Phia Group, LLC, and Advanced Medical Strategies, have combined to create NetworkDx, a new, patent pending software as a service (SAAS) subscription-based offering that provides healthcare payors comprehensive analysis of the provisions in PPO contracts.

One of the most frequent struggles that any healthcare payor faces is PPO contract analysis. The larger the network, the more labor intensive the contract review process. With the Affordable Care Act substantially increasing the number of businesses that self-insure, more companies will be directly providing for their employees' healthcare, thus increasing an already ubiquitous need for cost assessment. Knowing what the contract specifies for coverage is imperative.

Before NetworkDx, contract and network analysis was performed individually, with some analyses taking as long as six months. NetworkDx drastically reduces this time, making accurate analyses quickly available to any subscriber with internet access (including smart-phones).

Without using specific contractual language, comprehensive summaries inform subscribers of the extent of their contractual rights for in-network claims. NetworkDx analyzes and summarizes payors' audit rights, usual and customary charge definitions, dispute resolution procedures, and miscellaneous provisions with a direct, user-friendly interface.

"Many benefit plans are bound by contracts they either don't understand or have never seen. Examining the network agreements compiled by this new NetworkDx software makes a problematic task significantly less daunting," explains Adam V. Russo, Esq., Chief Executive Officer of The Phia Group, LLC. "Advanced Medical Strategies, a Massachusetts based firm, has taken advantage of our expertise and a decade's worth of contractual review, and created a clear, concise, and useful feedback tool that users can access through on-line software."

NetworkDx subscribers will be able to utilize the database to evaluate networks prior to signing a PPO contract; accessing NetworkDx's review of applicable contract terms, without divulging any propriety information. Only NetworkDx offers this cross-network, convenient and comprehensive service with contract information added to the database regularly.

"Our clients, old and new, have supported AMS by subscribing to PredictDx; verifying their desire for innovative, data driven products based on real time claims experience. We couldn't be more pleased to have developed NetworkDx with another excellent company, The Phia Group. We anticipate our clients will value NetworkDx and they can look forward to an even faster pace of innovation from us. We plan to introduce more useful new products to support them in their daily efforts to remain competitive and profitable," states Peter Borans, President of Advanced Medical Strategies.

About Advanced Medical Strategies

Advanced Medical Strategies is a physician-lead organization bringing innovative solutions to the healthcare payor industry. Based in Lynnfield, MA, Advanced Medical Strategies has been offering world-class claims review and cost containment services since 2003. Contact Danae Lambeth, National Sales Director, at (781)-224-9711 x107, danae@mdstrat.com and visit www.mdstrat.com .

About The Phia Group

The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. The Phia Group’s overall mission is to reduce the cost of plans through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service.  Visit www.phiagroup.com .

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Planwatch and HealthCare Strategies Inc. Ensure Healthier Employees & Save Money

MyHealthGuide Source: ProServe Health Informatics (Planwatch), 4/18/2014, www.plan-watch.com and www.hcare.net

Stow, OH -- ProServe Health Informatics (Planwatch) and HealthCare Strategies Inc. (HCS) are joining forces to integrate financial and plan modeling with clinical Risk Stratification reporting to provide one of healthcare's most comprehensive reporting and data analytics  tools.

Both companies are answering a demand in the marketplace for data transparency, trend analysis, budgeting, and health and wellness effectiveness. It is estimated that data analytics will save over $300 billion in health care costs in the US. Health care reform has changed the landscape of health care and understanding the trends and health of a population has never been more important.

"HealthCare Strategy's clinical dashboard and Medical Management services offer the tools to improve member health while reducing healthcare costs. By marrying our two analytic products, clients will benefit from seeing the financial details of today while forecasting clinical outcomes for tomorrow," says Georgeann Seuffert, Vice President of Sales, Planwatch.

Jan Albert, HCS' CEO and Founder adds, "When it comes to healthcare, data-driven solutions save money and allow you to make solid decisions. Working together, we'll identify opportunities to maximize clients' healthcare investment. It's a synergy that promises to bear great savings and long-lasting favorable outcomes through clinical and financial reporting."

About Planwatch

Planwatch is a product of ProServe Health Informatics. It was developed in 2005 by company co-founders who recognized both the need and the solution for an economical, user-friendly, high level data analysis and reporting system for Third Party Administrators, Insurance Companies, Self-Administered Employer Groups, Stop Loss Carriers, Cost Containment Companies and Claim Adjudication Systems. This web based product allows Third Party Administrators to gain a thorough understanding of the needs of an employer population and helps make sense of ACA mandates and changes. By streamlining the reporting process, TPAs are able to share this valuable detailed claim information to assist their broker partners in proper claims management. Planwatch reporting packages include on demand reporting, comprehensive analysis, data exploration, historical plan modeling, benchmarking and disclosure reporting. Contact Georgeann Seuffert, Vice President of Sales at (888) 275-2242 ext. 303, gseuffert@proservehealth.com and visit  www.plan-watch.com .

About HealthCare Strategies

Founded more than three decades ago, HCS has substantially reduced costs and improved the health of hundreds of employee populations nationwide. HCS's flagship program, HealthReach Predictive Care Management, an early entrant into the predictive modeling and healthcare data warehousing field, along with member and provider outreach, has reduced clients' healthcare trends to single digits, resulting in hundreds of millions of dollars in savings. HCS provides a combination of technology and clinical solutions that include provider and member technology platforms, Utilization Management, Large Case Management and a maternity program, MaterniCare. Email sales@hcare.net and visit www.hcare.net .

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People News



EmployerDirect Welcomes Jeff Gary as Executive Vice President of Business Development

MyHealthGuide Source: EmployerDirect, 4/14/2014, 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, is pleased to welcome Jeff Gary as Executive Vice President of Business Development. Mr. Gary has more than 20 years of experience in the healthcare industry and has served in executive positions with a variety of managed healthcare organizations.

Jeff's responsibilities at EmployerDirect are to create and lead internal and external strategic business development initiatives as well as lead strategic alliance and partnership opportunities.

"Over the past 12 years, Jeff has worked with many successful companies while running his own consulting company," said Thomas Johnston, CEO at EmployerDirect. "He brings a wealth of knowledge and experience in strategic business development that will prove invaluable as we expand our employer and provider networks nationwide."

Jeff was the founder and president of The JMG Group in Austin, Texas, a strategic healthcare consulting company that focuses on innovation, revenue growth, medical spend and cost containment solutions. He is an active advisor and consultant to numerous healthcare and insurance organizations. In 2008, he formed Stratabex, LLC, a healthcare business development company that he later sold to Prescription Benefits Inc. Throughout his career, he has held leadership positions with companies including Blue Cross and Blue Shield, Humana, and UnitedHealth Group.

"At a time when healthcare costs continue to escalate, EmployerDirect offers a proven and innovative alternative for self-insured employers to generate substantial hard cost savings," said Jeff Gary. "The company's mission of improving accessibility to quality healthcare and offering an unmatched level of service is in parallel with the goals that I have been working toward."

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 percent on planned medical procedures with the potential to reduce total plan cost by 6-10 percent. 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)241-8537and visit www.edhc.com .

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United Claim Solutions (UCS) Grows with Linda Myrick as Claims Editing and Special Project Manager

MyHealthGuide Source: United Claim Solutions (UCS), 4/18/2014,  www.unitedclaimsolutions.com

PHOENIX, AZ -- United Claim Solutions (UCS), an innovative Medical Cost Reduction and Claims Flow Management firm has further expanded its Operations Department to manage the increase in new business and service offerings.

"We are pleased to announce the addition of Linda Myrick to our Operations Department.  Linda will assume the new role of Claims Editing and Special Project Manager. She will manage our bill editing solution, and will also be responsible for managing and implementing new products and services", said Ryan O'Mahoney, VP of Operations at UCS.

Ms. Myrick has over 15 years' experience in medical coding principles and guidelines, including the ability to read and interpret notes and charts and assign appropriate diagnostic and procedural codes. She worked daily with all specialties of medical claims including anesthesiology, cardiology, physical therapy, skilled nursing, General Surgery, OB/GYN pathology, diagnostic testing, ER, DME coding and evaluation & management. She has an in depth knowledge of reimbursement (OPPS, 3M DRG, HHC, SNFI) as well as a complete understanding of ASC Guidelines, multiple surgery billing and bundling following CCI Edits. Most recently, she worked as Pricing and Coding Lead /Supervisor-Claims Support with TriWest Healthcare Alliance in Phoenix, AZ. There she was responsible for all functions for both the Claims Field Support Team and the Recoupment Team.

About UCS

United Claim Solutions is an innovative Medical Cost Reduction and Claims Flow Management company providing cutting edge and customizable programs for payers, employers, unions, reinsurers, accountable care organizations and health plans. UCS offers end to end services including Bill Review, Out-of-Network Bill Repricing, Bill Edits, Medicare Plus Repricing, PPO Administration, Medical Management, Clearinghouse Services, Data Warehousing, OCR/Scanning, and Plan Modeling. We provide solutions for Group Health, Workers' Compensation, and Auto Liability. Contact UCS if you are looking for:

  • A partner that puts Service first
  • Industry leading Savings on medical bills
  • Flexible Solutions that reduce administrative costs

Contact Corte Iarossi, VP of Sales & Marketing at 866-762-4455 x 120, ciarossi@unitedclaim.com and visit www.unitedclaimsolutions.com .

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Pan-American Life Insurance Group Appoints Alex Rizo as Vice President, Accident and Health

MyHealthGuide Source: Pan-American Life Insurance Group via Business Wire, 4/14/2014, www.palig.com

NEW ORLEANS -- Pan-American Life Insurance Group (PALIG), a leading provider of insurance and financial services throughout the Americas, announced the appointment of Alex S. Rizo as Vice President, Accident and Health. The newly created position reflects Pan-American Life's intent to expand its Accident and Health product offering in both domestic and international markets.

"These lines of business are an important part of our strategy to solidify Pan-American Life as a partner of choice for the insurance needs of individuals and businesses across the Americas"

"These lines of business are an important part of our strategy to solidify Pan-American Life as a partner of choice for the insurance needs of individuals and businesses across the Americas," said José S. Suquet, Chairman of the Board, President and CEO of Pan-American Life. "From that standpoint, it was vital for us to recruit an experienced individual whose knowledge and expertise will drive the growth of our Mass Marketing and Personal Accident businesses in Latin America and the Caribbean and at the same time support our U.S. GWI Group Accident, Blanket Accident and Occupational Accident business."

As Vice President, Accident and Health, Rizo's key responsibilities will be to oversee operations, sales and product development for the Accident and Health lines of business in all of the jurisdictions that Pan-American Life currently operates in.

"Alex is a great fit for this position and for Pan-American Life," Suquet added. "I am extremely confident that with him on board in this capacity, we will strengthen our ability to deliver best in class life, health and accident solutions to clients in all of the markets where we have presence."

Rizo's previous professional experience includes his 22-year tenure with American International Group (AIG), during which time he worked across Latin America, notably in Chile, Colombia, Panama and Uruguay. Most recently he served as the Executive Director and Vice President, Consumer Division Head in Mexico. In that capacity, he managed a US$100 million division comprised of several lines of business including Accident and Health.

Rizo obtained a Bachelor of Business Administration in Accounting from Xavier University in Cincinnati, Ohio and a Master of International Management- Marketing and Finance from Thunderbird, The American Graduate School of International Management in Glendale, Arizona. He is fluent in both English and Spanish and will be based in Pan-American Life's Miami office.

About Pan-American Life

The Pan-American Life Insurance Group is a leading provider of insurance and financial services throughout the Americas. New Orleans-based Pan-American Life Insurance Company, the Group's flagship member, has been delivering trusted financial services since 1911, employing more than 1,400 worldwide, providing top-rated life and health insurance, employee benefits and financial services in 47 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands. The Group's member companies offer individual and/or group life and health insurance throughout Latin America and the Caribbean. The Group has branches and affiliates in Costa Rica, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, and 15 Caribbean markets, including Barbados, Cayman Islands, Curacao and Trinidad and Tobago. Contact Marta C. Reeves at 504-566-3112, MReeves@panamericanlife.com and visit www.palig.com .

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Assist America Welcomes Mark Fiechter as Vice President of Sales

MyHealthGuide Source: Assist America, Inc., 4/17/2014, www.assistamerica.com

Princeton, NJ -- Assist America, Inc. is pleased to welcome Mark Fiechter as Vice President of Sales in the US, effective immediately.

Mr. Fiechter brings a proven track record of more than 23 years in the insurance industry, having worked for several major Accident and Health insurance companies as well as a several Managing General Underwriters. In addition to developing and managing sales teams that have continuously delivered outstanding results, he has expertise in P&L management and improvement, team building and leadership, relationship management and product development.

Prior to joining Assist America, Mr. Fiechter most recently held the position of National Sales Manager for the Insurance team at Europ Assistance USA where he managed a significant block of business, and a national sales team. While delivering profitable growth he exceeded new business goals, and managed client relationships with EA's key accounts.

"Mr. Fiechter is a key addition to the Assist America team and we are very pleased to have him head our sales efforts in the US," said Brian Mulligan, President and CEO of Assist America. "Mr. Fiechter's strong sales and insurance background is a perfect combination for us and we are proud to have him on board."

Mr. Fiechter holds a Bachelor of Science in Finance from St. Johns University as well as insurance licenses in Life, Accident and Health.

About Assist America, Inc.

Founded in 1990, Assist America, Inc. provides global emergency assistance services in partnership with various benefit plans. The company, headquartered in Princeton, New Jersey, serves more than 30 million members and over 300,000 enterprises through programs from the world's most prominent group benefit providers. Visit www.assistamerica.com .

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Indigo Insurance Services Seeks Stop Loss Sales Executive (Southeast Region)

MyHealthGuide Source: Indigo Insurance Services, 4/14/2014, www.indigo-insurance.com

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

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

Main Responsibilities

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

Requirements

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

Send resumes to Richard Greenhalgh, CLU, ChFC, Vice President, Specialty Benefits, at richard.greenhalgh@bcbsma.com, (617) 246-7331. 

About Indigo Insurance Services

Indigo Insurance Services is a full-service insurance agency that offers a comprehensive array of specialty insurance including; stop-loss, life, disability, critical illness, cancer care and more. Employers can buy financial accounts, COBRA, FMLA, and ERISA administrative services, as well as Employee Assistance Plans. We offer customized stop-loss coverage options for employer groups headquartered outside of Massachusetts. Our underwriting partners help us to provide employers and employees with the highest degree of customer service and care.   Visit www.indigo-insurance.com/products-services/stop-loss/stop-loss.html .

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Market Trends, Studies, Books & Opinions



Should We Have Expected Obamacare's 8.2 Million Big Surprise on Employer Health Insurance?

MyHealthGuide Source: Jason Millman, 4/10/2014, The Washington Post Blog and Rand Corp. Survey

Article referred by John H. Eggertsen, Attorney at Law, Eggertsen Consulting, Inc.

There's one Obamacare number that stands out above the rest this week -- 8.2 million. That's how many people have taken up employer-sponsored insurance since September, and most of them were previously uninsured, according to a Rand Corp. survey issued Tuesday.

The Rand survey, which naturally comes with limitations, attributes the drop in the uninsured rate over the past six months mostly to gains in employer coverage. For all the predictions of employers dumping coverage for health insurance exchanges, this was a pretty surprising finding. Obamacare was actually driving millions of uninsured Americans to sign up for employer insurance.

But maybe that shouldn't have been surprising?

The Rand survey reminded me of another survey I wrote about just last week. Large employer members of the HR Policy Association, who laid out expected costs from the Affordable Care Act, said they expected the law's individual mandate will add pressure to their budgets. (The one really big caveat: HR Policy Association's report didn't account for cost savings the ACA would create.) In other words, these large employers said the Obamacare requirement for people to get insurance -- the individual mandate -- would drive more of their workers to sign up for their coverage.

"The RAND study validates large employers' projections that the individual mandate would increase take up rates, and the costs associated with those additional take ups," said Tevi Troy, president of the American Health Policy Institute, the think tank founded by the by HR Policy Association

Timothy Jost, a professor at Washington and Lee University School of Law, and a supporter of the health-care law, also said the survey from Troy's group supports the idea that the individual mandate will increase the number of those signing up for employer coverage. "This is a factor that must be considered in the lively debate about whether Obamacare is covering the uninsured," he said.

We still need some hard data before we can project enrollment in employer plans with greater confidence. The Rand survey, which was based on a nationally representative sample of 2,500 adults surveyed each month for the past few months, comes with a margin of error of 3.6 million and a 95 percent confidence rate. So that means researchers are still pretty sure at least 4.6 million gained new employer coverage since September.

The Rand report stands in contrast to the Congressional Budget Office, which in February predicted no major change in employer plan enrollment for 2014 because of the health-care law. The CBO also predicted employers would cover 2 million fewer people in 2015, 6 million fewer in 2016 and eventually flattening out at 7 million fewer people in employer plans.

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Legal, Legislative & Regulatory News



State Legislative/regulatory Developments Update

MyHealthGuide Source: Self-Insurance Institute of America, 4/14/2014, www.SIIA.org

Connecticut- Assessment Update

SIIA continues to urge the Connecticut Legislature to eliminate a new assessment on self-funded health plans and met with a key senator this week to reinforce industry objections.

Last Thursday, SIIA members Dave Follansbee and Rick Parrett of Diversified Group Brokerage joined SIIA Government Relations Director Adam Brackemyre for an important meeting with Senate Beth Bye, co-chair of the Joint Appropriations Committee. Businesses, health insurance plan and their respective trade associations also had representatives in this important meeting.

Strong concerns were expressed about the proposed assessment is likely preempted by ERISA and that it serves as a disincentive for employers to voluntarily provide health coverage for their workers. Senator Bye appeared to take the input seriously and advised she and her colleagues will give the matter additional consideration.

SIIA will continue to work with stakeholders in Hartford and encourages additional association members to get involved. Stay tuned for additional updates. In the meantime, if you have Connecticut clients or business partners who want to oppose this new assessment, contact Adam Brackemyre right away.

New York - Stop-Loss Legislation

SIIA is ramping up lobbying efforts to pass legislation (S. 6917) that will protect the self-insurance market in that state for groups with 51-100 employees.

As previously reported, New York currently restricts the sale of stop-loss insurance to small groups (currently defined as 2-50 employees). In accordance with the Affordable Care Act, the small group definition changes to 2-100 employees effective January 1, 2016. So without a legislative "fix" before that date, self-insurance will effectively no longer be an option.

One immediate objective is to identify current 51-100 self-insured group health plan sponsors (private employers and unions) that would be willing to participate in a grassroots advocacy campaign. Please contact Adam Brackemyre right away should you be able to assist with this effort.

SIIA's Legislative/Regulatory Conference

If you have not already done so, make plans to attend SIIA Legislative/Regulatory Conference scheduled for April 23-24, 2014 in Washington, DC. Conference details, including registration forms, can be accessed on-line at SIIA Legislative/Regulatory Conference or by calling 800-851-7789.

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 Adam Brackemyre, Director of State Government Relations directly at 202/463-8161, abrackemyre@siia.org and visit www.SIIA.org .

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Medical News


Aspirin in Patients Undergoing Noncardiac Surgery Increases Major Bleeding

MyHealthGuide Source: P.J. Devereaux, M.D., Ph.D. el al, New England Journal of Medicine, 4/17/2014, NEJM Abstract

Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding according to a study published in the New England Journal of Medicine.

There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not.

The study randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5,628 patients) or they were already on an aspirin regimen (continuation stratum, with 4,382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days.

Study findings

  • In the aspirin group, there were 351 of 4,998 patients (7.0%) who died or experienced nonfatal heart attack.
  • In the placebo group, there were 355 of 5,012 patients (7.1%) who died or experienced nonfatal heart attack.
  • However, major bleeding was experienced by 230 patients (4.6%) in the aspirin group compared to 188 patients (3.8%) in the placebo group.

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Recurring Resource


Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 3/31/2014)

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     $839.9
2012
  Sun Financial Release,
5/2/2013
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
$2,174
12/31/2012
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. 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
33/31/2014
9. National Union Fire Insurance Company of Pittsburgh   AIG Benefit Solutions $188
4/2013
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions.
5/17/2013
10. Zurich North America     $130   Tracey Brennan, Zurich North America.
7/22/2011
11. International Insurance Agency Services, LLC
(IIS)
>10 Years Standard Life and Accident Insurance Company
(A.M. Best Rated: A)
$115
3/1/2014
  David Haddad, CEO, IIS
3/25/2014
12. Munich Re Stop Loss, Inc.   AAIC, TransAmerica $110
2012
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
4/25/2013
13. 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
14.
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
NA United States Fire Insurance Company
(A.M. Best Rated: A)
NA IOA Re, Vista Underwriters NA $1,000+ AAM Best, MGU Websites
1/22/2013

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
  • 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


April 24, 2014
Clearwater HIPAA Compliance BootCamp™.   Designed for busy professionals, this session 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. San Francisco, CA.  Contact Clearwater Compliance at 800-704-3394 and info@clearwatercompliance.com.

April 23-24, 2014
Legislative Conference presented by Self-Insurance Institute of America (SIIA). Features important members of Congress, key federal regulators and other policy-influencers who can affect the business interests of the companies involved in the self-insurance/alternative risk transfer marketplace and the popular "Walk on the Hill" activity, where attendees will have the opportunities to meet with their elected representatives on Capitol Hill to discuss self-insurance industry issues. Washington, DC. Information: www.SIIA.org and 800-851-7789.

April 30, 2014 11:00AM - 12:00PM EDT
The Growing Role of Molecular Pathology in Determining Cancer Therapy
presented by INTERLINK CancerCARE.  Featured is Christopher Corless, MD, PhD, Chief Medical Officer at Knight Diagnostic Laboratories and Professor of Pathology at Oregon Health & Science University.  "There have been rapid developments in our understanding of the mutations that drive the growth of many types of cancer and these mutations are being targeted with an ever-growing list of new therapies. This talk will review how molecular pathology is used to identify targets for personalized cancer treatment." - Dr. Corless.  Reserve your Webinar seat now at: https://www2.gotomeeting.com/register/325431770

May 6-9, 2014
Benefitfocus One Place presented by Benefitfocus.  Annual event that brings together leading healthcare, benefits and technology professionals from around the country. Attendees have the opportunity to select from different conference tracks, participating in those that apply to their area of interest or expertise. Topics include Healthcare Reform Readiness, Preparing for Open Enrollment, Smarter Technology -- Creating a Better Way to Manage Benefits, Private Exchange Marketplaces -- Designing the Shopping Experience, Strategies for Enhancing Overall Benefits Package.  Charleston, S.C.  Visit www.benefitfocus.com

May 7-9, 2014
NiiS 25th Annual Medical Excess Claims Conference presented by Northshore International Insurance Services, Inc.'s.  Hawthorne Hotel in Salem, Massachusetts. Information: MECCinfo@niis.com

May 7, 2014
2014 Spring Conference presented by The Actuarial Society of Greater New York.  The Spring Conference will be a ½ day conference focusing on timely topics that benefit actuaries and other insurance professionals. They include:

  • General Session: Current Professionalism Topics at the Academy
  • Breakout Sessions 1
    •  How to Talk to the CEO
    •  Healthcare Reform: Two Pieces of the Puzzle
    •  Principal Based Reserves
  • Breakout Sessions 2
    • The Analyst's View of the US Life Insurance Industry
    •  Long Term Care Updates
    •  The New Face of Regulation

The conference will end with a Networking Reception. Early bird registration begins now. Regular registration begins on May 1. Visit www.goasny.org.

May 7-9, 2014
IHC Forum & Expo presented by The Institute for HealthCare Consumerism. Titled, "HealthCare Consumerism: The Solution for HealthCare Reform". 100% Dedicated to HealthCare Consumerism Progress, Collaboration and Education. Cobb Galleria Centre in Atlanta, GA. Use Promo Code MYHEALTHGUIDE for $100 off Registration Rates.  Contact Joni Lipson at jlipson@theihcc.com and visit www.theihccforum.com/2014-ihc-forum-and-expo/ and visit www.theihccforum.com.

May 7-9, 2014
25th Annual Northshore Medical Excess Claims Conference presented by Northshore International. Since 1989, Northshore International has provided a forum for medical excess claims professionals to meet with their peers and industry experts to discuss current and emerging topics impacting medical claims and excess coverages.  The 2014 conference topics will include changes in hospital reimbursement practices, catastrophic medical costs trends, Medicare based reimbursement models, surgical implants, and innovative approaches for controlling case management/vendor costs. The conference will also include sessions discussing challenges in specific excess claims and concludes with a roundtable discussion led by founder and Chief Executive Officer, David W. Ives, CPCUConference information and registration. Contact Stephen V. Murphy, Chief Operating Officer. The  will be held  at the historic Hawthorne Hotel in Salem Massachusetts. Visit www.niis.com/conference.asp.

May 12-15, 2014

23rd Annual WEDI National Conference  presented by Workgroup for Electronic Data. Focus is on the next steps for implementation of the recommendations presented in the 2013 WEDI Report. This event is expected to attract more than 500 of health information management leaders to learn the latest in Health IT. Join us for 4 days of sessions focused on ICD-10, Transactions, Privacy & Security, and Emerging Trends, as you share your expertise, success stories and ideas. Interchange (WEDI) Loews Hollywood Hotel, Hollywood, CA.  Contact Amy Verd, CMP at averd@wedi.org and visit www.wedi.org

May 14-21-28, 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.

May 20-21, 2014
Workers' Compensation Executive Forum presented by Self-Insurance Institute of America, Inc.  Eden Roc Hotel (near South Beach) in Miami Beach, FL. Information: www.SIIA.org and 800-851-7789.

July 16-18, 2014
TPA University presented by Health Care Administrators Association (HCAA). Omni Nashville Hotel, Nashville, TN. Contact Carol Berry at (818) 340-7668 and cberry@hcaa.org. Registration: www.hcaa.org/tpa/tpa_Register.html

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 22-24, 2014
MCIA Ninth Annual Conference presented by The Montana Captive Insurance Association, Inc.  Features key captive regulators, captive owners, leading service providers addressing a variety of timely educational topics, and premier networking.  Lodge at Whitefish Lake.  Whitefish, MT.  Contact Shane Byars at 866/388-6242, or via e-mail at sbyars@mtcaptives.org and visit www.mtcaptives.org .

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.

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 5-8, 2014
National Conference presented by Self-Insurance Institute of America (SIIA). , J.W. Marriott Desert Ridge, Phoenix, AZ. www.SIIA.org.

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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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.

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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