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TABLE OF CONTENTS
AMPS Acquires Claims Delegate Services
MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 12/13/2014, www.advancedpricing.com
Advanced Medical Pricing Solutions (AMPS) announced their acquisition of Claims Delegate Services (CDS), Inc.
"We are pleased to report our acquisition of CDS which was completed late last night, said Mike Dendy, President and CEO of AMPS. This is the perfect ending to a year in which our growth rate topped 60% and our national footprint expanded dramatically, Dendy continued.
"Along with CDS, AMPS launched our Reference Based Reimbursement (RBR) program three years ago as an alternative to the value eroding PPO networks", said Dendy. From day one of implementation our clients have seen dramatic reductions in their healthcare spending as we eliminate the partnership for overpayments that the PPOs and many of the nations hospitals have created together, continued Dendy.
"Our clients are often speechless when we document what they are paying for hospital services after what they believe are the PPOs discounts, said Jim Delaney, Chief Operating Officer of AMPS". On average we find payment levels of over 260% of Medicare and many times we find post PPO payments greater than 400% of Medicare continued Delaney. "The problem for employers is that they don't know what they are paying for services and if they ask the PPO network to benchmark what they are paying they just refuse citing proprietary contracts and relationships", continued Delaney.
CDS, which is currently based in Boca Raton, Florida will be moving operations to Atlanta, Georgia in early 2015. Rick Hirsch, the current CEO of Claims Delegate Services will remain with the company as President and Chief Legal Council of the organization reporting to Mike Dendy, AMPS' CEO/President.
AMPS has become the preeminent supplier of healthcare claim review and verification services over the past eight years. Our charge of excellence has now expanded to wellness, dependent verifications, and progressive re-pricing models. Our direction is to bring the same level of professionalism and leadership within these segments of cost management that we have delivered previously with our established claim services. Visit www.advancedpricing.com.
H.H.C. Group Launches Cost Charge Ratio Reference Based Pricing Service
MyHealthGuide Source: H.H.C. Group, 12/12/2014, www.hhcgroup.com
H.H.C Group, a leading healthcare insurance consulting company, today announced the launch of its Cost Charge Ratio Based Pricing Service, designed to help payors of all sizes reign in ever increasing provider related costs.
"PPO discounts have been only partially successful in controlling spiraling provider costs. Many larger insurers have already made the switch to Reference Based Pricing or are considering doing so, putting all who compete with them at a serious disadvantage", said Dr. Bruce Roffé, President and CEO of H.H.C Group.
"Like our Medicare Based Pricing Product, Cost Charge Ratio Based Pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Both eliminate excess charges due to providers artificially inflating their prices for services delivered. They also ensure similar payment for the same or similar services", stated Dr. Roffé.
For Cost Charge Ratio or Medicare Based Pricing to be successfully implemented, payors will need to garner provider acceptance and minimize balance billing. Providers will have to be willing to accept prompt and reasonable payment as payment in full for their services. H.H.C Group also offers a service to secure agreements with key providers.
It will take time to convert to Cost Charge Ratio or Medicare/DRG Based Pricing. However, those presently paying based on DRGs can start using H.H.C. Group's DRG Validation immediately to ensure that claims are being properly coded and payment is appropriate for the services provided. As Medicare/Medicaid Recovery Audit Contractor audits have shown, miscoding and up-coding errors are extensive and the potential for savings huge.
About H.H.C. Group
H.H.C. Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. H.H.C. Group utilizes a combination of highly skilled professionals and advanced information technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.
H.H.C. Group's services include Claims Negotiation, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), Claim Repricing, Claims Editing, Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Predictive Modeling, Disease Management and Pharmacy Consulting. H.H.C. Group is one of forty-six URAC accredited IROs. Contact Bob Serber at email@example.com, 301-963-0762 ext. 163 and visit www.hhcgroup.com.
Auxiant Continues Indiana Expansion
MyHealthGuide Source: Auxiant, 12/10/2014, www.auxiant.com
Auxiant, the largest privately owned TPA for self-funded benefits plans located in Wisconsin, and the longest existing TPA in Iowa, announced the expansion of its TPA services to the state of Indiana in late 2013.
This expansion has produced immediate results, and Auxiant now has expanded its client base to include employer groups from across the state of Indiana. Auxiant's longstanding focus and expertise in Third Party Administration and unique, forward-looking approach are expected to continue to drive rapid growth throughout the state in 2015. Using a variety of cost management tools, Auxiant health plans are consistently beating the state and national average. One of the key components of Auxiant's success has been an innovative product called 'FocusHealth'. FocusHealth is now in its 4th year of growth, and is producing impressive results across the Midwest.
How FocusHealth Works:
FocusHealth's methodology combines the most accurate and reliable cost and quality data for inpatient and outpatient hospital procedures -- even hospital comparisons. FocusHealth then combines the cost and quality scores to provide a composite value score. Creative plan designs incentivize members to use the highest value facilities.
Auxiant is an Independent Third Party Administrator (TPA) of self-funded benefit plans, specializing in customization, technological tools for clients, cost-control and health management. Auxiant is known for its innovation and technology, constantly evolving to meet the needs of its clients.
From their offices located in Cedar Rapids, IA, Madison, WI, and Milwaukee WI, Auxiant provides administration for over 245 clients covering in excess of 95,000 member lives. Auxiant works with a very diverse group of clients, all having customized benefit plans. Each client is given unmatched personalized service by a dedicated service team, and Auxiant's strength in the marketplace provides a powerful advantage to any self-funded employer group. Contact John Holt, Auxiant National Sales Executive for Indiana at 1-800-682-0795, firstname.lastname@example.org and visit www.auxiant.com.
Livongo Health™ Signs Iron Mountain Self-Funded Employer to Implement Livongo Ecosystem to Improve Lives of Employees with Diabetes
MyHealthGuide Source: Livongo Health™ via PRNewswire, 12/12/2014, livongo.com
PALO ALTO, CA -- Livongo Health™, a consumer digital health company that is focused on using technology to empower people with chronic conditions to live better, announced an agreement with Iron Mountain Incorporated. They wanted to improve the health and productivity of their employees with diabetes while reducing the cost of care. Today, this cost ranges from $8,000-$20,000 per person per year and can represent up to 25% of an employer's total health care costs.
Livongo for Diabetes™ provides an end-to-end ecosystem that empowers people with chronic diseases to live better, starting with diabetes. It starts with a smart cloud that captures information from a variety of devices (numbers, behavior, activity), analyzes it in combination with other data about the individual and provides that information in real time to the complete care team -- the person with diabetes, their care team, and their care managers. Today, for diabetes, it starts with the industry's first interactive, cellular-enabled blood glucose meter.
Iron Mountain, a leading provider of storage and information management services headquartered in Boston, MA, knew they needed to find a better way to keep their employees healthy while containing rapidly rising healthcare costs. They spend nearly $13,000 per year on each of their employees with diabetes.
"Livongo Health provides the perfect marriage of technology and high touch," said Director of Benefits Strategy, Scott Kirschner. "With such a large employee population, it's incumbent on us to provide the very best care available to help them maintain a healthy lifestyle. We are convinced that their unique approach will have a dramatic impact on both the health of our employees and the cost of their care."
"This innovation company recognized the need to do something different and have embraced Livongo's approach to disease management. Livongo brings the most powerful technology and real-time data available today so people with diabetes can focus on their life, not their disease," said Glen Tullman, Chief Executive Officer of Livongo Health™. "We're redefining the experience for people with chronic diseases and also the way leading employers can support their workforce."
Iron Mountain will launch Livongo for Diabetes™ to their employees in the next 4 weeks.
About Livongo Health
Livongo Health™ is reinventing the way people manage chronic conditions, beginning with diabetes. We are focused on improving the experience for people with diabetes, the people who care for them (family, friends, physicians), and the people who pay for their care. By offering the right information, tools and support, at the right time, we empower people with diabetes to live better and improve their health while reducing the cost of care. Contact Catherine Riedel at email@example.com, 312.209.0250 and visit livongo.com.
Bravo Wellness Solutions Receive Praise
MyHealthGuide Source: Bravo Wellness, 12/9/2014, www.bravowell.com
Cleveland, OH -- Bravo Wellness, the leader in outcomes-based incentives, is pleased to announce that several of its clients and partners have been named 2014 IHC Superstars. The Institute for HealthCare Consumerism (IHC) Superstar awards were created to recognize those individuals who go above and beyond in executing innovative health and benefit management programs or who provide those solutions to organizations.
Congratulations to Dennis Clark--Valeo, Chad Thies--Union Bank & Trust, Charlie Leatham--Hays Companies, and Kent Grathwohl--Group Associates (currently with Gallagher Benefit Services).
"We've been humbled with many great accolades for our company growth and success, but there's nothing more gratifying than seeing our clients and business partners earn recognition for the successful impact their wellness programs are having," said Jim Pshock, Bravo Wellness founder and CEO. "It's a true honor to be associated with these winners and to be a part of their award-winning strategies."
Dennis Clark, U.S. Human Resource Director at Valeo, Most Innovative Benefit Plan Design & Implementation Award. Dennis and his team's focus on reducing healthcare cost trends has been a tremendous success. Implementing outcomes-based wellness, along with frequent communication to employees and the availability of tools for health improvement, has helped drive 97% participation. Another Valeo business unit of similar size and demographics was not offered the wellness plan, allowing for the development of a natural control group. The difference was an 11% (control group) vs. a 2.5% claims cost trend over the five year period they've been working with Bravo! The participating population is slowing and reversing the national trends in obesity, elevated blood pressure, and nicotine usage.
Chad Thies, First Vice President of Human Resources at Union Bank & Trust, Most Effective Employee Communication & Education Award. UBT has created an array of unique benefits in the pursuit of associates' optimal health. And because of this pursuit, these benefits are made available to all employees, not just to those on the health plan. In addition to onsite health screenings and flu vaccinations, they hold educational meetings, provide access to free fitness memberships, health coaches, resource materials, and even offer free, healthy meals. They also created a Wellness Passport booklet, containing important information and resources for participants to utilize as they log their progress and personal journeys towards health.
Charlie Leatham, Vice President at Hays Companies, Most Innovative Partner/Consultant Award. Charlie recognizes the value of outcomes-based incentive programs and the impact they can have on employees' lives. He has helped multiple clients find success with these programs and understands the unique challenges each face in the delivery of their programs to employees. With his ability to naturally align the HR and benefits teams' goals with solutions that deliver results, Charlie works strategically with clients to meet their wellness needs and increase engagement towards good health.
Kent Grathwohl, Vice President at Group Associates, Most Innovative Broker Award. Kent has been a pioneer in introducing biometric-based wellness programs to his clients, guiding them to wellness solutions that are proven to maintain or even reduce corporate costs. Staying current on innovative and cutting edge applications in wellness has allowed Kent to provide unsurpassed support to his clients. With a strong understanding of, and involvement in his clients' philosophies, Kent is able to bring wellness initiatives that best fit each culture and effectively work for all employees.
About Bravo Wellness
Bravo Wellness has been a disruptive force in the wellness industry since its inception in 2008. Bravo pioneered the outcomes-based wellness incentive space and carefully designs compliant incentives that result in unprecedented engagement levels. Bravo's case studies prove and demonstrate sustained health improvement and reduced claims spending--all while equipping individuals to make better choices and providing thoughtful alternatives to those for whom special exceptions are warranted. With roots in data management, compliance and technology, Bravo recognizes that it's rarely the lack of activities that makes a program unsuccessful, it's often the lack of motivation and engagement--a problem that can be solved. Call 877.662.7286 and visit www.bravowell.com.
Health Catalyst Collaborates with Microsoft on Data Warehouse and
Analytics for Healthcare Industry
Unlike traditional "early-binding" EDWs, which typically require up
to 18 months and longer to begin delivering value, Health Catalyst's
Late-Binding platform offers rapid time-to-value - often within a
few months, if not weeks, according to the January, 2014 report
Healthcare Analytics: Making Sense of the Puzzle Pieces by the
respected healthcare research firm KLAS. Rather than binding source
data to schemas, business rules and vocabulary when that data is
first streamed into the data warehouse (as happens with typical
EDWs), data in a Health Catalyst data warehouse is bound as it is
needed by the analytic use case. This innovative design ensures that
the data retains its original, unchanged and granular form, allowing
the data to be constantly repurposed to support a multitude of use
cases, providing the flexibility required in an industry where new
uses cases and new data sources are constantly being defined.
HeaHealth Catalyst is a mission-driven data warehousing and analytics company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 30 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. Faster and more agile than data warehouses from other industries, the Health Catalyst Late-Binding™ EDW has been heralded by KLAS as a "newer and more effective way to approach EDW." Visit www.healthcatalyst.com.
HCAA Announces 2015
Executive Forum - 'Spotlight on Self-Funding'
All HCAA members, as well as non-member TPAs are invited to attend
this conference. Registration and more information is now available
on the HCAA website.
The Health Care Administrators Association is the nation's most prominent nonprofit trade association that supports the advocacy, networking and educational needs of TPAs, insurance carriers, managing general underwriters, audit firms, physician hospital organizations, brokers/agents, human resource managers and health care consultants. For nearly 35 years, HCAA has taken a leadership role in legislative advocacy, working to increase its influence with policymakers and other stakeholders in order to transform the self-funding industry and expand its role within healthcare. Visit www.hcaa.org and connect with us at @HCAAinfo, HCAA LinkedIn or HCAA YouTube.
Symetra's Ratings Affirmed by Fitch
MyHealthGuide Source: Fitch via Business Wire, 12/12/2014, www.Symetra.com and Fitch
CHICAGO -- Fitch Ratings has affirmed the 'A+' Insurer Financial Strength (IFS) rating on Symetra Life Insurance Company (Symetra Life) as well as all ratings for Symetra Financial Corp. (Symetra), including the Issuer Default Rating (IDR) at 'A-' and all outstanding debt issues. The Rating Outlook has been revised to Negative. A full list of rating actions follows at the end of this release.
Key Rating Drivers Includes Stop Loss
Fitch's affirmation of Symetra's ratings reflects the company's strong balance sheet, consistent and diversified earnings, moderate financial leverage and lower-risk products. Additional strengths include the company's good competitive position in the group medical stop-loss market and fixed annuities sold through banks.
The ratings also consider Symetra's lack of significant scale compared to other highly rated life insurers and the company's reliance on its niche group medical stop-loss business, which generates a significant but sometimes volatile source of earnings, and moderate profitability compared to similarly rated peers.
The Outlook is revised to Negative based primarily on Symetra's high exposure to the continuing low interest rate environment and the effect on profitability, GAAP based fixed charge coverage and additional statutory reserving related to asset adequacy testing over the next 12 to 18 months. Longer-term, Fitch is concerned with the earnings implications of a prolonged low interest rate environment as spreads between earned rates and credited rates narrow. Given its liability mix, Symetra is more exposed to this risk than peers.
Symetra's risky asset ratio is in line with life industry levels, declining to 84% at Sept. 30, 2014 from 91% at year-end 2013. Symetra takes its equity exposure in the form of greater weighting of commons stocks and carries a lower exposure to private equity. Symetra's bond portfolio has normally carried a greater than industry allocation of 'BBB' rated bonds and an average exposure to below investment grade bonds (BIGs). The company's bond portfolio has avoided concentrations in troubled asset classes.
The company's investment portfolio has higher than average exposure to commercial mortgages than the life insurance industry as this asset class has grown to over 15.5% of invested assets. Mortgage credit quality is considered high and mortgage performance has been very good with 99.9% of mortgages in good standing at Sept. 30, 2014.
Fitch Group is a global leader in financial information services with operations in more than 30 countries. Fitch Group is comprised of: Fitch Ratings, a global leader in credit ratings and research; Fitch Solutions, a leading provider of credit market data, analytical tools and risk services; Fitch Learning, a provider of learning and development solutions for the global financial services industry; and Business Monitor International, a provider of country risk and industry analysis specializing in emerging and frontier markets. Visit www.fitchratings.com.
Data Dimensions Welcomes Mark Golino as New Chief Information Officer
MyHealthGuide Source: Data Dimensions, 12/12/2014, www.datadimensions.com
JJANESVILLE, WI -- Data Dimensions is pleased to announce the addition of Mark Golino to its executive leadership team as Chief Information Officer, where he will direct all technology for the company.
Golino brings more than 25 years of data center management and senior-level technology experience with him to Data Dimensions. He has worked extensively in technology management and has designed, built and deployed high-capacity data centers, OCR solutions and natural language processing solutions. Golino has managed multiple teams of employees and several projects simultaneously, and he has extensive experience in application development, research and design.
"I'm very excited to welcome Mark to our executive leadership team," says Jon Boumstein, Data Dimensions President and CEO. "He brings a wealth of knowledge and experience to Data Dimensions, and he will help us reach new levels of growth and success in the coming years."
The addition in December of Mark Golino winds up a busy year for Data Dimensions. In November, HealthEdge completed its investment in Data Dimensions, enhancing growth opportunities for both companies. Earlier that month, Data Dimensions completed its acquisition of Olim Technologies Group, a long-valued partner. This summer, the company hired its 1000th employee and announced plans to open a new facility in Mt. Sterling, KY. And in August, Data Dimensions earned a spot for the second time on Inc. Magazine's exclusive Inc. 5000 list of the nation's fastest growing private companies.
About Data Dimensions
Since 1982, Data Dimensions has been helping clients better manage business processes and workflows by bridging the gap of automation, technology, and physical capabilities. As an innovative leader in the area of information management and business process automation, we provide a complete range of outsourcing and professional services including mailroom management; document conversion services; data capture with OCR/ICR technologies; physical records storage and electronic retrieval services through our state of the art Tier III data center. Call 800-782-2907 and visit www.datadimensions.com.
Data Dimensions is a portfolio company of HealthEdge Investment Partners, LLC. HealthEdge is an operating-oriented private equity fund founded in 2005. HealthEdge's investment team has over 100 years of combined operating experience as operators and investors. Visit www.healthedgepartners.com.
Magellan Health Appoints Dr. John Agwunobi to Board of Directors
MyHealthGuide Source: Magellan Health (NASDAQ: MGLN) via Business Wire, 12/11/2014, www.MagellanHealth.com
SCOTTSDALE, AZ -- Magellan Health, Inc. announced that Dr. John O. Agwunobi has been appointed to the Magellan Health board of directors, for a term ending at the 2015 annual meeting of shareholders. In connection to the appointment of Agwunobi, the board increased its membership from nine to ten members.
"Dr. John Agwunobi's experience includes direct patient care, government service and advisory roles, as well as private sector health leadership and innovation," said Barry M. Smith, chairman and chief executive officer of Magellan Health. "As Magellan continues its work in population health management, his intimate understanding of state and federal health programs, coupled with his work bringing healthcare to consumers where they can most easily and efficiently access it, will be a valuable addition to our company's board. I look forward to working with him in this new capacity."
From September 2007 to April 2014, Agwunobi served as the senior vice president and president of health and wellness of Wal-Mart Stores, Inc., where he was responsible for all health related businesses for the company in the United States and Puerto Rico. He previously served as the assistant secretary for health in the U.S. Department of Health and Human Services from 2005 to 2007, where he was a principal advisor to the secretary on matters related to health and science. From 2001 to 2005, Agwunobi served as the secretary of health for the State of Florida, where he reported directly to the governor and was a member of the governor's cabinet. Agwunobi is a board certified pediatrician and holds both a Master of Public Health and a Master of Business Administration degree. He previously served as the chair of the U.S. African Development Foundation and as an interim executive board member of the World Health Organization.
About Magellan Health
Headquartered in Scottsdale, Ariz., Magellan Health, Inc. is a healthcare management company that focuses on fast-growing, complex and high-cost areas of healthcare, with an emphasis on special population management. Magellan delivers innovative solutions to improve quality outcomes and optimize the cost of care for those we serve. Magellan's customers include health plans, managed care organizations, insurance companies, employers, labor unions, various military and government agencies, third party administrators, consultants and brokers. Visit www.MagellanHealth.com.
A New Type of ERISA-Based Hold-Up: The Rise of Out-of-Network Provider Suits Against Self-Funded Health Care Plans
MyHealthGuide Source: Michael T. Graham and Amy Gordonon, McDermott Will & Emery LLP, BNA Pension & Benefits Daily™, 10/27/2014, The Bureau of National Affairs, Inc. (800-372-1033), www.bna.com
Over the past decade, there has been a significant increase in the number of physicians who have dropped out of PPO and HMO networks and attempted to negotiate their own financial reimbursement with insurance companies and self-funded health care plans related to medical treatment provided to participants whose plan are governed by ERISA.
These moves have led to a corresponding increase in the number of health care benefit suits brought by out-of-network physicians and treatment centers seeking to gain through litigation that which they could not get through direct negotiations with insurers and plan administrators-- higher reimbursement amounts for health care treatment from ERISA-governed medical plans.
Many of these suits first centered on the transparency provided by insurance companies and ERISA plans in determining the UCR for which out-of-network physicians would be reimbursed.
The physicians argued that the insurance companies and plan administrators were hiding the true basis for how they would determine the objective reimbursement rates for the physician's out-of-network services, while the insurance companies and plans argued that the physicians unreasonably inflated their treatment fees in an effort to receive increased out-of-network reimbursement.
From these larger theoretical fights, individual physicians and treatment centers have entered the fray--with the individual physicians or groups looking to recover for allegedly undervalued UCR determinations on a participant-by-participant basis.
These relatively new out-of-network provider suits are now filling the federal district courts and ERISA plan administrative claim dockets with cookie-cutter lawsuits seeking to re-write the rules by which out-of-network treatment is reimbursed.
About the Authors
Michael T. Graham (firstname.lastname@example.org) is a partner in the law firm of McDermott Will & Emery LLP and is based in the firm's Chicago office. His practice specializes in employee benefits litigation and controversy matters, advising plan administrators and fiduciaries on proper compliance with ERISA's claims and appeals procedures and litigating benefit matters in state and federal courts around the country.
Amy Gordon (email@example.com) is a partner in the law firm of McDermott Will & Emery LLP and is based in the firm's Chicago office. Her practice focuses on welfare benefits compliance; specifically, she advises clients on issues related to the Health Insurance Portability and Accountability Act (HIPAA), the Public Health Service Act, the Affordable Care Act (ACA), ERISA, and the Code.
Court Rejects Group's and Carrier's Cross-Motions for Summary Judgment on Eligibility Issue, Remands Case for Trial
MyHealthGuide Source: Thomas A. Croft,
Esq., 12/12/2014, www.StopLossLaw.com
Based on these provisions, the Court of Appeals concluded that the carrier was bound by the Plan administrator's decision as to eligibility, "absent an abuse of discretion." In other words, the Court of Appeals applied an ERISA-type "abuse of discretion" deference to the Plan's decision-making. In doing so, the Court of Appeals principally relied on three Ninth Circuit cases (see footnote 6 of the opinion), all of which were ERISA cases involving claims for benefits by Plan beneficiaries, and none of which involved a stop loss contract. If there were any "anti-discretion" provisions in the stop loss contract at issue, the Court of Appeals did not refer to or discuss them.
Stop Loss Carrier Arguments
About the Author
Thomas A Croft is a magna cum laude graduate of
Duke University (1976) and an honors graduate of Duke University
School of Law (1979), where he earned membership in the Order of the
Coif, reserved for graduates in the top 10% of their class. He
returned to Duke Law in 1980 as Lecturer and Assistant Dean
(1980-1982) and as Senior Lecturer and Associate Dean for
Administration (1982-1984). He also taught at the University of
Arkansas-Little Rock law school, where he was an Associate Professor
of Law (1990-91), earning teacher of the year honors.
TRIA Moves Closer to Renewal
MyHealthGuide Source: Willis Group Holdings plc, 12/9/2014, www.willis.com
Editor's Comment: The SIIA is a supporter of TRIA.
Reports from Washington, D.C. today indicate that Capitol Hill may be finally closing in on a potential compromise to renew the Terrorism Risk Insurance Program Reauthorization Act of 2007 or TRIPRA.
As we have previously reported, the US Senate on July 17th, in a vote of (93-4), passed a bill (S.2244) sponsored by Senator Charles Schumer (D-NY) to extend TRIPRA, with minor modifications. However, no similar legislative proposal was moved through the House due to firm opposition to the continuation of the program by key members of the House Financial Services Committee.
With Chairman Jeb Hensarling (R-Texas) stating as recently as this week that program extension would "violate House spending rules," a compromise seemed unlikely. He further went on to say that "if Senate Democrats continue to insist on their 'my way or the highway' approach … a long-term reauthorization may have to wait until the next Congress."
With Congress adjourning on the 11th of December, many have predicted a temporary, short-term extension which would achieve just that.
Now, initial reports of discussions held today between Chairman Hensarling, Senator Schumer, House Majority Leader Kevin McCarthy and other key members seem to indicate that a deal may be close to finalization, extending TRIPRA for six years, incrementally increasing the program threshold to $200 million (from the current $100 million) and the coinsurance percentage to 20% (currently 15%).
Many other provisions have yet to be negotiated, and it is not apparent how the dispute over the funding of the bill will be resolved. There may also be a bifurcation between program thresholds for nuclear, biological, chemical and radiological events and those deemed as "conventional terrorism."
While these encouraging signs signal movement away from the determined position of key House leadership, we caution that negotiations are still ongoing. While agreement on the key points may be imminent, there is still the possibility that the extension could not ultimately be finalized before the end of the current session.
Willis Group Holdings plc is a leading global risk adviser, insurance and reinsurance broker. With roots dating to 1828, Willis operates today on every continent with more than 18,000 employees in over 400 offices. Willis offers its clients superior expertise, teamwork, innovation and market-leading products and professional services in risk management and transfer. Our experts rank among the world's leading authorities on analytics, modeling and mitigation strategies at the intersection of global commerce and extreme events. Visit www.willis.com..
Lowering Statin Does Not Reduce Bone Fractures
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 11/1/2014)
Editor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
January 18-20, 2015
January 25-27, 2015
February 4-5, 2015
February 9-11, 2015
March 18-20, 2015
• Evolving regulatory environment for self-insured health plans in
Panama City, Panama. Call
800/851-7789 and visit www.SIIA.org
May 6-8, 2015
July 21-23, 2015
September 28-30, 2015
March 30-April 1, 2016
October 17-19, 2016
March 15-17, 2017
September 13-15, 2017