MyHealthGuide Newsletter
News for the Self-Funded Community
8/3/2015

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.comClick here if Newsletter stops arriving.

TABLE OF CONTENTS

 

General & Company News

People News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News


RxResults Unveils MemberChoice to Combat Rising Drug Costs for Self-Funded Employers and Their Employees

MyHealthGuide Source: RxResults, 7/30/2015, www.rxresults.com

Little Rock, AR -- Pharmacy costs are expected to rise by 16% between 2013 and 2016, and to continue to rise at that rate through the end of 2023. In addition, the rising cost of drugs has contributed to patients not taking their drugs as prescribed or not at all, resulting in $290B annually in healthcare costs. Employers must begin to implement risk management tools in order to control company health plan costs and lower costs for their employees (plan members).

RxResults, a Little Rock based pharmacy risk management company, believes MemberChoice is a smart option for employers who want to help their health plan members save money and feel better, and also improve the company's bottom line.
 
"MemberChoice is being introduced to market at the right time. Employers and insurers are seeing unsustainable increases in pharmacy spending and some are left with no choice but to shift cost to employees who are company health plan members. MemberChoice puts members in charge by providing them with lower cost options to expensive brand medications based on unbiased, clinically sound recommendations from the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy", says Tery Baskin, President and CEO.

MemberChoice Offers

  • Prescription claims analysis by unbiased UAMS College of Pharmacy experts
  • Targeting high cost drugs and providing lower cost alternatives that provide the same or better patient benefit
  • Immediate savings for the employer (5-10% of total pharmacy spending) and the members
  • Member friendly communication and incentives designed to motivate plan members
    Freedom for plan members to make the change and save through a completely voluntary program
  • Frequent communications with members, their physicians and pharmacists to educate and inform, and a call center for one-on-one consultation

Baskin states that, "Employers are torn between managing the cost of providing health care benefits and being able to retain talent in the workforce. They are faced with getting members more engaged in spending medical cost dollars wisely. We have put an incentive program in place along with education to help keep your members engaged and making the right decisions about pharmacy spending."

About RxResults

RxResults is a next-generation Pharmacy Benefits Risk Management company started by Tery Baskin in 2009 has grown into a talented team of pharmacists, physicians and industry experts. RxResults continues to see ever-rising pharmacy costs putting unnecessary strain on employers. In an effort to reduce wasteful pharmacy spending, while providing access to medications proven safe and most effective to members, RxResults focuses on:

  • A comprehensive suite of evidence-based products to help employers and employees manage their pharmacy costs
  • Easy to understand, customized reporting for help employers make better decision when planning benefits
  • A high level of customer service to inform and educate employers and employees of their cost saving options

Visit www.rxresults.com.

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6 Degrees Health, Inc. and Indiana University Health agree to an Exclusive Transplant Network Agreement for the State of Indiana

MyHealthGuide Source: 6 Degrees Health, Inc., 07/31/2015, www.6degreeshealth.com

Beaverton, OR -- 6 Degrees Health is proud to announce the addition of Indiana University Health to OURproviders™.

Indiana University Health (IUH) is one of the few hospitals in the country to be Medicare certified to perform all major solid organ transplants, including liver, kidney, pancreas, intestinal and multivisceral, heart and lung transplants. Combine the exceptional solid organ program with the IUH Melvin and Bren Simon Cancer Center and the Riley Hospital for Children, and you truly have a destination transplant solution.

"As the 5th largest transplant center in the U.S., Indiana University Health (IUH) is centrally located and a big draw for many of our clients. When 6 Degrees approached IUH, we came at the deal with the desire to partner on a very unique and strategic level. 6 Degrees is entering an extremely busy couple of months, with a number of substantial network deals being finalized. The IUH network agreement is a landmark deal for 6 Degrees, and a great way to kick off some of the most significant hospital additions in our history … stay tuned," states Scott Ray, 6 Degrees Health's CEO & General Counsel.

About 6 Degrees Health, Inc.

6 Degrees Health is a Specialty Network focusing on mitigating the risks with transplants, cancer, cardiac and other complex high-dollar care. OURsolutions™ is designed for Insurers, Third Party Administrators, Stop Loss and Reinsurance carriers, Self-Insured Employee Health Plans, Health Maintenance Organizations, and Government Health Plans. OURsolutions™ promotes improved patient outcomes, optimizes Payor savings, and delivers the incremental volume to OURproviders™. The keystone of 6 Degrees Health's solutions is its proprietary analytics platform (VeritasDx™) … there is no equal in the market executing the transparency necessary to achieve a win-win for Patient, Payor and Provider. Contact David Vizzini, President, 6 Degrees Health, Inc., at davidvizzini@6degreeshealth.com, 503-640-9933 ext. 102 and visit www.6degreeshealth.com.

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PHX Highlights Its Seventh Annual Forum

MyHealthGuide Source: Premier Healthcare Exchange (PHX), Inc.,7/27/2015, www.phx-online.com

Bedminster, NJ -- Premier Healthcare Exchange (PHX), Inc., a leading provider of healthcare cost management services recently hosted 250 healthcare stakeholders at its seventh annual Forum at the St. Regis Monarch Beach. The theme of this year's 3 day event was "Making Tomorrow Today".

"These are truly fast moving times in our industry. We are starting to hear words like; consumerism, transparency and digital marketing", stated Todd Roberti, CEO, PHX. "In the past we would all wait it out and we would all think it's just another FAD. Not this time, technology is far more advanced compared to the past. Our seventh annual Forum is an ideal platform to come together for collaboration, strategizing, and to embrace the trend of acting now upon the many opportunities which will make our industry stronger, more productive and ultimately, sustainable."

Highlights of this year's event included discussions on future company initiatives, panel sessions spotlighting vendor partner value-added business opportunities, as well as, topics focused on future technologies within the healthcare industry. Additionally, PHX stressed the importance of embracing the innovative trends of tomorrow, today. As one Forum attendee commented, "As always PHX has delivered a first class event that not only provided information that will help us better prepare for the future, but also network with fellow attendees and share information and ideas that can help us better serve our clients."

Speakers at this year's Forum included: Robert Herjavec, Shark Tank, "The Will to Win"; Scientist and Entrepreneur, Daniel Kraft, M.D. "The Future of Healthcare and Medicine: Where can Technology Take Us?"; Deputy Administrator & Director of CMS, Dr. Shantanu Agrawal, "Bending the Cost Curve of Medicine at the Centers for Medicare and Medicaid"; Leanne Gassaway, Vice President of State Affairs, AHIP, "Creating an Affordable, Stable and Accessible System for Consumers"; Marlon Dungo, Vice President of Commercial Acceptance and Rob Rydell, Vice President of Healthcare, MasterCard, "ePayments in a B2B World"; and Mike Ferguson, President of SIIA, "Legislative/Regulatory Update for the Self-Insurance Industry".

About PHX

Premier Healthcare Exchange (PHX) was incorporated in 2001. The company provides advanced network and cost management solutions for health plans that combine claim processing automation with professional services to deliver a timely, centralized approach to healthcare cost management. This approach results in a significant reduction in payment errors, appreciable improvement in the time needed to bring claims to resolution and in savings that substantially reduce the healthcare costs of its clients. PHX solutions are utilized by industry leading insurance companies, Taft-Hartley Funds, Health Maintenance Organizations (HMOs) and Third Party Administrators (TPAs).  Visit www.phx-online.com.

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Rockport Benefits, LLC's Extends Gratitude for Support

MyHealthGuide Source: Rockport Benefits, LLC, 7/28/2015, www.rockportbenefits.com
 
Beverly, MA -- As the fateful 4th quarter faces us all in the not so distant future, Rockport Benefits, LLC would like to extend our gratitude to all of you who have already demonstrated your support.

"We have had a great start and are looking forward to a fulfilling 4th quarter," says Amy K. Argeros, Managing Director. "To our Business Partners, stay tuned for upcoming cost saving offerings, which will be rolled out shortly. We are hopeful that our new strategies are both easy to implement and their savings potential is quickly realized."

"To our Market Peers, we plan to join you in maintaining the underwriting integrity necessary to promote this business, creating more opportunity for those desiring to join the self- funded arena. Best of luck with your 4th quarter goals."

About Rockport Benefits

Offering 20+ years of medical stop loss expertise combined with the strength of an A+ rated Carrier and full suite of Underwriting, Claims and Risk Management Services, Rockport Benefits balances its rich historical perspective with a newly energized approach to today's industry. Contact Amy Argeros at aargeros@rockportbenefits.com, 978-969-0658 and visit www.rockportbenefits.com.

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People News



American Specialty Health Appoints Jerome Bonhomme as Chief Technology Officer

MyHealthGuide Source: American Specialty Health, 7/27/2015, www.ashcompanies.com

SAN DIEGO  -- Jerome Bonhomme has joined American Specialty Health Incorporated (ASH) as chief technology officer, effective immediately. Bonhomme will lead ASH's new consumer technology department, focused on developing, maintaining and expanding the company's consumer-facing web site capabilities and innovative applications, and enhancing internal systems and platforms.

Bonhomme has a broad background as a software technology executive, with substantial experience in developing ecommerce platforms, applications and architecture to support customer engagement, product launches and marketing outreach.

"As consumers demand more customized and personalized health and wellness offerings to keep them actively engaged in staying fit and healthy, American Specialty Health will be a premier provider of that technology," said ASH Chairman and CEO George DeVries. "By offering individuals the responsive programs they want on the platforms they prefer, we will continue to sustain our mission to empower individuals to live healthier and longer. We are thrilled to have Jerome on board as we continue to pursue excellence in technology innovation."

Bonhomme previously was vice president of software engineering at Lytx in San Diego. There, he was responsible for all software engineering and product development, delivering a next generation platform and implementing new software engineering processes. While at Lytx he also filed several patents in the domain of geo-spatial data processing.

In 2004, Bonhomme joined Sony Electronics to develop the architecture and launch Store.Sony.com, Sony's online store. Later he became part of Sony's global technology team as director and chief architect for the Global eCommerce Platform. He led the creation of a single cohesive platform to serve each country with its own language and fulfillment capabilities.

Bonhomme is a graduate of the University Sorbonne in Paris, where he earned a MS in electrical engineering and a MS in computer science. He worked in several technology positions in France and San Diego before settling at BroadVision in San Diego as a technical manager in 2000. In this role, Bonhomme developed new generations of their platforms and helped launch four products.

About American Specialty Health
 
American Specialty Health Incorporated (ASH) is one of the nation's premier independent and privately-owned specialty health services organizations, offering specialty health provider networks and programs, fitness and exercise programs, and population health solutions for health plans, insurance carriers and employer groups. Operating from offices in Carmel (Indianapolis), Ind., San Diego, Calif., Southlake (Dallas), Texas, and Columbia, S.C., ASH has more than 1,200 employees and administers services for more than 34 million members nationwide. Additional products offered through ASH and its subsidiaries include Healthyroads®, FitnessCoach™, Active&Fit®, Silver&Fit® and others. Call 800-848-3555 and visit www.ashcompanies.com. Follow us on LinkedIn or Twitter at @ASHCompanies.

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QBE Accident & Health Announces Mike Millea as Assistant Vice President

MyHealthGuide Source: QBE Accident,  7/31/2015, www.qbena.com

New York, NY -- QBE North America announces an addition to its Accident & Health Division's Medical Stop Loss Underwriting team.

Mike Millea has joined QBE Accident & Health as Assistant Vice President - Lead Underwriter. Mike has more than 15 years of experience in the medical stop loss industry and comes to QBE from HCC Life where he most recently served as Senior Consulting Underwriter. His background includes significant business development and account management experience.

We are very happy and excited to have Mike join QBE Accident & Health, said Steve Gransbury, President of QBE A&H. Mike's knowledge and experience provides additional expertise and depth to our rapidly expanding stop loss team and will contribute greatly to our growth.

Mike will work out of QBE's Marblehead, Massachusetts office and can be reached at: michael.millea@us.qbe.com .

About QBE

QBE's North America operations are part of QBE Insurance Group Limited, one of the top 20 insurers and reinsurers worldwide. Headquartered in Sydney, Australia, QBE operates out of 38 countries around the globe, with a presence in every key insurance market. The North America operation, headquartered in New York, conducts business through various property and casualty insurance subsidiaries. QBE insurance companies are rated "A" (Excellent) by A.M. Best and "A+" by Standard & Poor's. Contact Phillip C. Giles, Vice President -- Sales & Marketing, Accident & Health, at 910.420.8104, phillip.giles@us.qbe.com and visit www.qbeah.com.

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Brentwood Services Administrators Hires Irma McCoy as a Claim Representative and Selects Peggy Mellentine as Claim Examiner

MyHealthGuide Source: Brentwood Services Administrators Inc. (BSA), 7/31/2015, www.bwood.com

Irma McCoy, Claim Representative

BRENTWOOD, TN -- Brentwood Services Administrators Inc. (BSA)., headquartered in Brentwood, Tenn., recently hired Irma McCoy as a claim representative in the General Liability Department in the corporate office in Brentwood, according to Jeff Pettus, president and chief executive officer of BSA.

As a claim representative, McCoy is responsible for reviewing, investigating, assessing negligence, evaluating and negotiating settlements of general liability claims as assigned by her general liability claims supervisor, Teresa Jenkins. She assesses comparative negligence of the parties involved, as well as communicates directly with clients, claimants and attorneys to manage claims in a timely and economic manner.

Previously, McCoy was a claim adjuster for Nationwide/HIC in Nashville, Tenn., assigned to investigate, evaluate and negotiate claims. She also has been employed by C.N.A. and Aetna Life & Casualty.

With diverse experience in handling claims including special accounts, she has held licensing in multiple states and has a strong commitment to customer service. McCoy graduated from Southeastern University of Hammond, La., with a bachelor of arts degree.

Peggy Mellentine, Claim Examiner

BSA also selected Peggy Mellentine for the position of claim examiner in the Champaign, Ill., office, according to Pettus, president and chief executive officer of BSA.

In her new position under the supervision of Luca DeVecchi, claims manager, Mellentine will be processing and handling workers' compensation claims as assigned by her claims supervisor. In addition, she determines the compensability of the claim to the extent of liability, and communicates directly with clients, employers, injured workers, physicians and attorneys to manage claims in a timely and economic manner.

Prior to joining BSA, Mellentine served as a workers' compensation claim representative investigating and managing claims for QBE Insurance in Freeport, Ill.

With 13 years of claim handling experience and 24 years in the insurance industry, Mellentine has earned her INS designation. She attended Highland College in Freeport for one year where she obtained her certification in clerical business studies.

About Brentwood Services Inc.

Brentwood Services Inc. is an independent employee-owned company headquartered in Brentwood, Tenn., and specializing over the past 25 years in structuring and managing alternative market solutions for employers and insurance providers. Contact John Smitherman, senior vice president of sales for Brentwood Services Inc., at (800) 524-0604 or (615) 263-1300, bsiinfo@bwood.com  and visit www.bwood.com.
 
About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers' compensation and other casualty lines. BSA's aggressive coordinated approach to claims administration and loss control has a proven track record of reducing the cost of claims for its clients. BSA also provides underwriting, policy management and accounting services to association-sponsored pools and mutual insurance companies.

About Brentwood Reinsurance Intermediaries Inc.

Brentwood Reinsurance Intermediaries Inc. (BRII) provides insurance and reinsurance brokerage services encompassing self-insurance, guaranteed cost and deductible insurance with a focus on workers' compensation, excess liability lines, and accident and health reinsurance.

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HCC Life Has Two Immediate Openings for an Underwriter or Senior Underwriter in Plano, TX and Minnetonka, MN Offices

MyHealthGuide Source: HCC Life Insurance Company, 7/17/2015, www.HCCLife.com

HCC Life Insurance company has two immediate openings for an Underwriter or Senior Underwriter in our Plano, TX and Minnetonka, MN offices.

The Underwriter/Senior Underwriter establishes, maintains, and develops producer relationships, and has expanded underwriting authority and business development responsibility. This position reports to the Senior Vice President.

Responsibilities include, but are not limited to:

Relying on experience and judgment, the Senior Underwriter is responsible for accomplishing the following assignments. These assignments are broad in nature and work can be difficult.

  • Meet annual company goals for profitability, renewal retention, revenue growth, and new business production.
  • Evaluates risk acceptability within established guidelines and set appropriate rates and factor levels.
  • Analyze proposed plan changes to acceptability and cost.
  • Work in conjunction with the Marketing department to follow-up on quoted cases.
  • Communicates with TPA/Broker's to answer questions, explain decisions, deal with problems, build, and maintain productive relationships. Respond appropriately and in a timely manner to service requests.
  • Complete RFP's timely and follow-up for status and competitive numbers.

Position Knowledge, Skills, and Requirements

Education

  • Bachelor's degree in Business Administration, Accounting or Finance or a related field or the equivalent education and/or experience
  • Prefer work towards CEBS, FMLI, or CLU certification

Experience

  • Minimum of five years of medical stop-loss underwriting experience

We offer a competitive base salary and benefits package, including bonus potential and a 401k plan with 6% company match.

Any offer of employment will be contingent upon positive criminal background and credit checks. EEO Employer.

Interested individuals should send resume to Tracy Creekbaum, Marketing Specialist, at TCREEKBAUM@hcclife.com.

About HCC Life

HCC Life Insurance Company (HCC Life) is an Indiana-domiciled life insurance company with an extensive product portfolio including medical stop loss, group term and short term medical insurance. HCC Life has consistently held an A+ (Superior) rating for financial strength by A.M. Best Company as well as AA (Very Strong) ratings by Standard & Poor's and Fitch Ratings.

HCC Life has more than 35 years of experience and is a leading provider of medical stop loss insurance through brokers, consultants and third party administrators. Guided by an 8-person executive management team whose members have an average of more than 20 years of insurance experience, the entire HCC Life staff works together with third-party administrators and brokers to find the best solution to managing risk for our mutual clients. Our commitment to medical stop loss enables HCC Life to remain a stable partner for producers in a constantly changing marketplace. Unlike many providers of medical stop loss, HCC Life assumes 100 percent of the risk, and is therefore responsible for all underwriting, claims and administrative decisions. Visit www.HCCLife.com.

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WellSystems and Continental Benefits Seek Stop Loss Managers, Underwriters, IT Analysts and More

MyHealthGuide Source: WellSystems and Continental Benefits, 7/24/2015, www.wellsystems.com

WellSystems and Continental Benefits, partner companies located in Tampa, Florida are actively recruiting for several positions, including:

  • Manager of Stop Loss Marketing
  • Stop Loss Underwriters
  • Account Managers
  • IT Business Analysts (Including those with clinical and care management experience, vendor integration, data integration and system set-up)
  • Plan Builders
  • Health Care EDI Analysts
  • Health Care Data Analysts
  • TPA Sales Professionals in Midwest and Northeast

We are the fastest growing administrator of health benefits in the United States, offering a completely integrated technical platform, access to multiple carrier networks and the full complement of industry-leading cost control, service and analytics.

We are very forward thinking in our compensation and benefits programs and are led by a team of the top experts in the TPA and group health benefits industries. For information on any of these positions, please send an e-mail to Glenn McLellan, President at gmclellan@wellsystems.com.

About WellSystems

WellSystems provides services to various types of payers including carriers, health plans, TPAs and provider-sponsored networks and community health plans. Visit www.wellsystems.com.

About Continental Benefits

Continental Benefits is a full-service TPA operating on a national basis and providing services to Plan Sponsors ranging from 100 to 25,000 covered employees. In our first two years of operation we have surpassed 750,000 covered participants.

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IHC Risk Solutions (IHCRS), Seeks Regional Sales Executive for the Mid-Atlantic Region

MyHealthGuide Source: IHC Risk Solutions (IHCRS),  7/23/2015, www.ihcrisksolutions.com

IHC Risk Solutions (IHCRS), a national direct writer of medical stop-loss, is seeking a highly motivated and energetic Regional Sales Executive for the Mid-Atlantic region of the United States. Candidates must be able to develop, grow, and maintain a profitable block of business, with a special emphasis on maintaining and growing existing partnerships.

Candidates are required to have the following

  • Medical stop-loss sales experience or related industry with a good knowledge of self-funding and stop-loss. Captive and organ transplant products knowledge helpful.
  • Existing contacts with key distribution channels (brokers/ third-party administrators/consultants) beneficial.
  • Knowledge of key industry factors including health care reform and reinsurance trends
  • Excellent communication skills enabling proper interaction with prospects/clients as well as internal underwriters
  • Strong presentation skills for individual, board room, and conference level events
  • Ability to represent IHCRS at industry events, affiliations, associations, sponsored outings
  • Willingness to travel as required (50%) and manage budget
  • Goal oriented with ability to follow defined business plan
  • Exhibits excellent time management skills
  • Capable of using current technology systems including Salesforce, DY, and Outlook
  • Ideal candidate would be located in the Baltimore/DC Metro Area
  • Ability to comply with IHC's corporate practices and procedures

Compensation

  • Compensation commensurate with experience
  • Comprehensive Benefits package including medical benefits and 401K

Interested candidates should forward their resumes to humanresources@ihcrisksolutions.com today! We are motivated to fill this position so do not delay. 

About IHSCRS

IHC Risk Solutions (IHCRS) offers medical stop-loss, group stop-loss captives, and an Organ Transplant Solution program. IHCRS is a full service direct writer for self-insured employer groups in all 50 states and is a member of the IHC Group, an insurance organization composed of Independence Holding Company (NYSE:IHC) and its operating subsidiaries. Coverage is underwritten by Standard Security Life Insurance Company of New York, also a member of the IHC Group. The IHC Group is built on financial strength and stability of IHC which has over $1 billion in assets as of June 2013 and over 25 years in the stop-loss business. Visit www.ihcrisksolutions.com.

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Market Trends, Studies, Books & Opinions


Why the ACA Creates a Golden Ticket for TPAs

MyHealthGuide Source: Bob Carlson,, Healthx, 7/31/2015, www.healthx.com

In Charlie and the Chocolate Factory, highly sought-after Golden Tickets gave a lucky few entry into the wonders of Willy Wonka's facility. In a similar fashion, the Affordable Care Act is providing new opportunities for TPAs. While its full economic ramifications probably won't be determined for a few years, or maybe even a generation, it's clear that the ACA has completely re-energized an industry that feared fading into the sunset just a few years ago.

New opportunities: Handling ACA Challenges and Complexity

Many of the new opportunities for TPAs result from challenges and complexity associated with the ACA. For example:

Small and mid-size employers who wanted to continue providing employees with health insurance were uncertain of what the changes would mean or how to document compliance. Others realized they needed to offer a plan for the first time to avoid fines. In both cases, they turned to TPAs for guidance.

Accountable care organizations (ACOs) found they needed help managing new administrative tasks that accompany moving to a pay-for-performance model.

Niche players like hospitals and municipal groups found greater incentive to continue offering self-funded health insurance. TPAs With their deep expertise in insurance administration, their understanding of how to drive member participation, and their flexibility to tailor programs to suit the specific needs of groups from 25 covered lives and up, the changes brought about by the ACA are directly in the TPAs' wheelhouses. In fact, they are proving better suited to the ACA than the large, full-insurance carriers for the self-funded employer market.

Additional Opportunities: Increasing Business from Bread-and-Butter Clients

While self-funded employers have always been the bread-and-butter of TPAs, many have recently been able to expand that market downward as a result of two primary forces:

  • Changes brought about by Reinsurance carriers make it more attractive to self-fund (such as creation of coverages with smaller specific and aggregate stop-loss limits).
  • Reinsurance carriers have also begun offering coverages where claims reimbursement takes place immediately and claims auditing takes place afterwards, helping employers manage risk more effectively.

The requirement for employers to offer some form of health insurance to employees or face significant government fines.

The result is more small employers are now looking into what types of affordable health plans they can offer. This is where TPAs shine.

Added bonus: Flexibility to Tailor Plans and Programs

Unlike large carriers who only offer a handful of off-the-shelf options, TPAs have the flexibility to tailor their self-funded plans to the specific needs of each employer. They also have the administrative capacity to manage the entire program for employers -- including complex, ACA-specific requirements such as calculating and reporting on the number of covered employees based on hours worked.

Once programs are set up, TPAs are also in a better position than large carriers to drive employee engagement with it. For example, they can:

  • Build portals that match the employer's website in terms of design, branding, and language. This is important because employees -- especially those with less insurance literacy -- are far more likely to feel good about and trust a portal that looks like it's from their employer rather than an insurance company.
  • Set requirements that drive usage of the portal, such as making the portal the only option for enrollment or requiring an employee to complete an online HRA to be eligible for the company contribution to health insurance (with the employer's approval, of course). Engaging employees through the portal, rather than sending information such as explanations of benefits (EOBs) through regular mail, can help TPAs bring their administrative costs down further, making it more affordable for employers to offer health insurance.
  • Incorporate other services into the portal with one-click access, such as health risk assessments and wellness programs. By doing so, employers make it easier for employees to become and remain healthier. In addition, reports generated through those services can help brokers and TPAs develop new programs, such as rewards for smoking cessation and exercise, which address specific health concerns of that group. These programs not only help employers lower claims; they also contribute to reducing time lost due to avoidable illnesses, improving productivity.

TPAs across the country are already seeing results. One that already had a small business program in place has doubled its revenue in the last two years by adding new, smaller self-funded employers. Others that have added this capability have created new markets for themselves and established a position as the dominant player in their area. And the surface has only been scratched.

About Healthx

Healthx is the healthcare industry’s leading digital engagement platform for connecting payers, providers, consumers, employers and brokers. Visit www.healthx.com.

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National Health Expenditure Projections, 2014--24: Spending Growth at 5.8% Faster Than Recent Trends

MyHealthGuide Source: Nathaniel Weixel, 7/29/2015, Sean P. Keehan, et al, CMS, 7/15/2015, Health Affairs and Nathaniel Weixel, 7/29/2015, CMS

Health spending is projected to grow to nearly $5.5 trillion in the next 10 years, spurred on by the Affordable Care Act's coverage expansions, an aging population and a stronger economy, according to a July 28 report from the CMS.

In the report, published in the journal Health Affairs, actuaries at the Centers for Medicare & Medicaid Services projected

  • spending on hospitals, drugs and insurance will grow 5.8 percent per year from 2014 to 2024 -- just over 1 percentage point faster than the gross domestic product over that same period.
  • As a result, the health spending share of the economy is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024.

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Legislative & Regulatory News


Latest Regulatory 'Cadillac Tax' Guidance Raises Concerns for TPAs & Employers

MyHealthGuide Source: Self-Insurance Institute of American, 7/31/2015, www.SIIA.org

The U.S. Treasury Department issued its much-anticipated "second" Notice providing suggestions on how the Department intends to implement the so-called Cadillac Tax - officially referred to as the Excise Tax on High Cost Employer-Sponsored Health Coverage (the "Excise Tax").

In the "first" Notice released on the Excise Tax - Notice 2015-16, issued on February 23, 2015 - Treasury sought public feedback on

  • (1) what "type" of health coverage should be counted for purposes of the Tax,
  • (2) how to "value" the health coverage that must be included in the Tax's calculation, and
  • (3) how to determine the Tax's annual dollar thresholds (which if exceeded, triggers the Tax).

This recently released Notice - Notice 2015-52 - supplements Notice 2015-16 by addressing additional issues such as

  • (1) identifying the entity liable to pay the Excise Tax liability,
  • (2) describing how the Tax liability may be allocated among these entities, and
  • (3) explaining how actual payment of the Tax may be made to the Internal Revenue Service ("IRS"). Comments on Notice 2015-52 are due October 1st.

Please note, after Treasury considers the public comments submitted on both Notices, the Department intends to issue proposed regulations implementing the Excise Tax. It is unclear when these proposed regulations will be issued, but there is a good chance that proposed regulations could be released by the end of this year or early 2016, and final regulations following on in mid- to late-2016.  

Key provisions of the notice are as follows:

 A. Treasury Suggests Two Different Approaches When It Comes to Determining What Entity Pays the Excise Tax In the Case of Self-Insured Benefits

According to the statute, the Excise Tax is imposed pro rata on insurance companies and administrators of self-insured arrangements, and also the employer in certain cases. Notice 2015-52 confirms that the Excise Tax is payable by an insurance company in the case of a fully-insured employer plan. The Notice also confirms that the employer is liable to pay a portion of the Excise Tax attributable to employer contributions to a health savings account ("HSA"), along with employee contributions made to an HSA through a Code section 125 cafeteria plan. Unfortunately, in the case of self-insured benefits, however, Treasury did not confirm that the Excise Tax is payable by a third-party administrator ("TPA") or, alternatively, the employer sponsoring the self-insured plan. Instead, Treasury said that the Department is considering two approaches for determining "who the administrator" is for purposes of the Tax.

  1. Under the first approach, the entity liable for paying the Excise Tax would be the entity "responsible for performing the day-to-day plan administration functions, such as receiving and processing claims for benefits, responding to inquiries, or providing a technology platform for benefits information." Treasury went so far as to say that the Department anticipates that this entity would be the TPA for the self-insured benefits, except in "rare circumstances" where the employer administers its own plan (or owns a TPA performing these functions).
  2. Under the second approach, the entity liable for paying the Excise Tax would be the entity "that has the ultimate authority or responsibility under the arrangement with respect to the administration of the plan benefits (including final decisions on administrative matters), as well as authority or responsibility over eligibility determinations, claims administration, and arrangements with service providers (including the authority to terminate service provider contracts)." Treasury stated that the Department anticipates the entity with such ultimate administrative authority or responsibility under the arrangement would be identifiable based on the terms of the plan documents, and often would not be the person that performs the day-to-day routine administrative functions under the plan. In other words, it would appear that the employer would be responsible for paying the Excise Tax if the second approach were adopted.

B. Other Noteworthy Matters Addressed By Treasury

1. The Period for Determining the Amount of the Tax Payable

Treasury confirmed that the Tax would be determined based on the calendar year. Treasury also confirmed that the Tax liability would be determined by the employer soon after the end of the calendar year (so the employer can then notify the entities responsible for paying the Tax as soon as possible to ensure that these entities can pay the Tax liability in a timely manner). Treasury highlighted specific instances where it may be difficult for an employer to sufficiently calculate the Tax liability soon after the end of the calendar year (e.g., in cases where self-insured plans use different methods for the determination of the COBRA applicable premium, or in the case of experience-rated arrangements). Treasury has requested comments on how to address these issues.

2. Exclusion of the Cost of the Tax from the Tax's Calculation

Treasury recognizes that in cases where the Excise Tax is payable by an insurance company or an administrator of self-insured benefits, the Tax liability will be passed through to the employer. In this case, Treasury does not want these passed-through liabilities in the form of, for example, administrative fees that may be included in determining the COBRA applicable premium or a premium load, to be counted when determining if the aggregate cost of health coverage exceeds the Tax's dollar thresholds for the year. But, Treasury is concerned that excluding these amounts may not be administrable, and therefore, the Department is requesting comments on this point.

3. Requirement To Notify the Entities Responsible for Paying the Excise Tax

According the statue, after the employer determines the amount of the Excise Tax liability that is payable by a particular entity, the employer is required to notify that entity (along with the IRS) of the amount of the Tax owed. Treasury is in the process of considering both the form in which the information must be provided, and the time at which the information must be provided. The Department requested comments on administrative issues raised by this notice requirement.

4. Actual Payment of the Excise Tax Liability

Treasury suggests that the Department may add the Excise Tax liability otherwise payable by an insurance company, an administrator, and/or the employer on the Form 720, which is currently used to pay excise taxes for violations of certain other group health plan requirements.
What Does All of This Mean?

TPAs and self-insured employers should be concerned about Treasury's suggestion that entities that provide various administrative services for self-insured plans should pay the Excise Tax. In the case of TPAs, these entities do not want to be saddled with the Tax liability. For self-insured employers, these companies would like to avoid the administrative complexities associated with ultimately paying the Tax as it is passed through by the TPA. The employer community has already petitioned Treasury to eliminate this "tax-within-a-tax" and simply impose the Tax on the employer. For this reason, it was surprising that Treasury so clearly articulated that the Department was considering to impose the Tax on TPAs as one of its approaches.

SIIA Response Preview

SIIA intends to submit public comments on this issue, as well as other issues discussed in the Notice. Association lobbyists have already communicated to Senate Finance Committee staff the concern the self-insurance community should have over imposing the Excise Tax on the actual administrator of self-insured benefits. Additional updates will be forthcoming. Should you have any questions regarding this notice in the meantime, please contact SIIA Washington Counsel Chris Condeluci at ccondeluci@siia.org.

Additional ACA regulatory updates will be provided at SIIA's upcoming National Conference & Expo, scheduled for October 18-20, 2015 in Washington, DC.

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A United Front Against the Cadillac Tax

MyHealthGuide Source: Mike Nesper, 7/29/2015, Employee Benefit News

Both the public and private sectors, as well as Democrats and Republicans, have joined together in an effort to repeal the Affordable Care Act's excise tax on high-cost group plans. Set to take effect in 2018, the so-called "Cadillac tax" would force employers to pay a 40% tax on plans exceeding $27,500 for a family or $10,200 for an individual.

While the intent of the tax is to target only high-end plans, many plans that cover middle-class Americans will trigger the Cadillac tax, Jim Klein, president of the American Benefits Council, said Tuesday during a press conference that announced the creation of the Alliance to Fight the 40, a coalition of public and private employers, unions and other organizations dedicated to repealing the tax. Average plans would trigger the tax because it fails to consider factors such as age, gender and location, he said.

"This is not a tax on high-end health plans," said Terry O'Sullivan, general president of the Laborers' International Union of North America, "and it will lower the quality of health care for working families."

The Cadillac tax gives public employers with fixed budgets three poor choices, said Brian Marshall, the superintendent of San Diego, Calif.-based La Mesa-Spring Valley School District. He said his district would have to decide between reducing benefits, raising employee contributions or decreasing student services.

In Congress, there is bipartisan support -- both Reps. Frank Guinta (R-N.H.) and Joe Courtney (D-Conn.) have bills calling for a repeal of the tax. Guinta said he wants a standalone bill so no one has a reason to vote against it. "We want it to be as simple as possible," he said.

The Cadillac tax has been controversial since its inception, Courtney said, and many ACA supporters, like him, understand that "this is not an integral part of the law."

Courtney also questioned the Congressional Budget Office's scoring of the Cadillac tax, calling it "highly speculative." The CBO estimated the tax will raise $87 billion over a decade -- with a quarter of the revenue coming from the tax and three-quarters from higher income-tax revenue based on the assumption that employers who reduce benefits will increase wages. "That is a very unstable analysis," Courtney said.

Because of the faulty CBO score, Guinta said he hasn't encountered the problem of finding a way to make up the projected revenue that would be lost. It's logical to talk to the CBO and get an amended score, he said. The lower that score is, the less concerned Congress will be about a pay-for, Guinta said.

The coalition is united behind a full repeal and isn't interested in fixing the Cadillac tax, Klein said. "We think it's fundamentally flawed both in theory and in construction," he said.

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Medical News


Use of On-site Health Clinics Points to Reduced Overall Health Costs

MyHealthGuide Source: Christopher Conover, PhD, etc., 7/28/2015, American Journal of Managed Care: Nick Otto, 7/30/2015, Employee Benefit News

SAS and Duke University recently published data from a Phase I study on the connection between on-site health care clinic usage and claims costs, with some surprising savings results for on-site clinic users.

The study, recently published in The American Journal of Managed Care, focused on three categories of SAS employees and their dependents:

  • Major users (who designate the on-site clinic as their primary care),
  • Casual users (designated primary care providers outside the clinic, but used other clinic services at least once), and
  • Nonusers of the on-site clinic.

Study findings

  • Primary care users of the clinic saved SAS close to $600 each in health plan claims costs over three years and had 2.7 fewer external encounters than casual users and had 1.2 fewer external encounters than nonusers.
  • Primary care user dependents had 3.5 fewer external encounters than casual users and 1.9 fewer external encounters than non-users.
  • Annual monetized use of the health plan for employees and dependents was highest for HCC casual users relative to HCC major users (employees: $482 greater; dependents: $598 greater).

"Our goal was to find out if our primary care patients used fewer SAS health plan dollars than employees and dependents that use other providers," said Gale Adcock, chief health officer at SAS. "The answer was a resounding ‘yes.'"

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Recurring Resource


Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/4/2015)

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     $2,318
2014
  CIGNA Financial Supplement 2014, P.5 12/31/2014
2. Sun Life Financial     $1,034.2
2014
  Sun Life 2/12/2015 Management Discussion of "13% stop loss growth over 2013" of 2013 premium of $915.2M provided by Scott Beliveau, Sun Financial 4/28/2014
3. HCC Life Insurance Company >35 Years HCC Life
(A.M. Best Rated: A+)
Perico Life
(A.M. Best Rated: A+)
$876.5
$3,903 HCC Insurance Holdings, Inc. Form 10-K
4. HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$792.9
2014
$550.7
12/31/2014
Matt Rhenish, President & COO, 2/16/2015
5. Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
$728
2014
$3,360.6
12/31/2014
Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc.
2/9/2015
6. Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$681
2014
$1,945
12/31/2014
Joe Keller, Lead Financial Analyst, Voya Employee Benefits,
3/9/2015
7. Companion Life > 20 Years   $440
10/8/2014
  Philip Gardham, Vice President, Specialty Markets,
10/8/2014
8. Independence Holding Company   Standard Security Life Insurance Company of New York,
Madison National Life, Independence American Insurance Company
$240.9
12/31/2014
  Independence Holding Company, Form 10-K, page 30.
9. National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
5/2014
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
6/20/2014
10. Zurich North America     $150   Joseph Byers, Zurich North America.
4/6/2015
11. Munich Re Stop Loss, Inc.   AIC, TransAmerica $110
2012
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
4/25/2013
12. The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$104
12/2014
  Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
13.
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
Mark Nichols, Managing Director.
7/20/2012

Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above. 

  • ACE America
  • Aetna
  • Amalgamated Life
  • American Fidelity Assurance Company 
  • American National Life Insurance Company of Texas
  • Berkley Accident and Health
  • BEST Re 
  • Blue CrossBlue Cross Blue Shield (various regions)
  • Gerber Life Insurance Company
  • International Insurance Agency Services, LLC
    (IIS)
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • UnitedHealthcare

Stop-loss Premium Volume is not the Whole Story

Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:

  • Ratings from Best, S&P, Moodys and others (data collection began 6/2012)
  • Capital size of the insurance company (data collection began 6/2012)
  • Reinsurance purchased and from whom
  • Length in the business (data collection began 6/2012)
  • Number of open litigation claims
  • Is stop-loss a core business or ancillary business?
  • % age of risk retained vs. ceded
  • Average stop-loss claim processing turn-around time
  • % age of claims denied
Should reader interest indicate such measures are important, this Newsletter will attempt to collect and report.  

Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.  

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The Value of Self-Funding

MyHealthGuide Source: The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, www.SIEFOnline.org 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 www.SIEFOnline.org.

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Upcoming Conferences



August 6, 2015

Economic Capital and ORSA - A Case Study presented by Actuarial Society of Greater New York.  This Continuing Education / Economic Capital session explores the development of Economic Capital models using the work done at Guardian Life Insurance Company of America as a case study.  Presenters: Prabhdeep Singh, FSA, CERA, MAAA, and James Bryant, FSA, MAAA, Guardian Life Insurance Company. 

• Leverage CFT models to develop Economic Capital models;
• Explore some of the important considerations in developing economic, insurance, and operational risk scenarios;
• Discuss issues related to aggregation across risks and businesses;
• Understand the challenges in attribution analysis and developing a rollforward;
• Learn how Economic Capital results are incorporated into the ORSA.

Location is Guardian Life, 7 Hanover Sqr, Floor 15, Room F3, 2pm - 4pm.  Register by July 31st, 2015: Cost: $25 for paid-up members and subscribers, $30 for other attendees.  Registration and information..

September 14-16, 2015
Self-Insurance Executive Summit in London with Special Lloyd's Tour presented by Self-Insurance Educational Foundation (SIEF). Join senior industry executives from the United States, the United Kingdom and other major insurance marketplaces to share knowledge and facilitate important professional connections in London. .Apex City of London Hotel. Conference information: 800-851-7789 and http://www.siia.org/i4a/pages/index.cfm?pageid=6844.

September 14-16, 2015
2015 MCRA Annual Conference presented by Managed Care Risk Association. Terranea Resort, Palos Verdes Peninsula, California-overlooks the Pacific Ocean and Catalina Island. Early bird conference fee is $650 through May 18, $750 afterwards. Hotel number is (866) 802-8000 and mention "Managed Care Risk Association". See www.mcraweb.org. The mission of the Managed Care Risk Association is to support the health care excess of loss reinsurance and provider excess markets by facilitating information exchange between reinsurers, underwriters, brokers, and cost containment providers.

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

October 18-20, 2015
National Educational Conference & Expo presented by Self-Insurance Institute of America. Program Addresses:

  • The Rise of Private Equity and Venture Capital in the Self-Insurance Marketplace
    Your Company and Its Future - Preparing for a Major Financial Transaction
    How does direct provider contracting work in the context of medical travel arrangements;
    • What hospital executives think about self-insured employer payment practices;
    • What has been the actual self-insured employer experience with on-site health clinics;
    • How self-insured health plans should start preparing for the ACA "Cadillac" tax;
    • What venture capital and private equity firms are looking for when considering acquisitions of companies active in the self-insurance marketplace;
    • Where all of the "big" health care claims have been coming from;
    • The latest ACA compliance news;
    • What to do if your plan becomes subject to a DOL audit;
    • How do you determine whether reference-based pricing is right for your plan;
  • Additionally, the schedule will include a "mock mediation" session where attendees will have a front row seat to see what happens when a self-insured group, a TPA and a stop-loss carrier have a serious claims payment dispute. This promises to an extremely entertaining and interactive session.

The health care sessions are part of a larger educational program that includes nearly 40 general and breakout sessions related to the broader self-insurance marketplace. This top-notch educational program will be supplemented by the industry's largest exhibit hall and incredible networking opportunities throughout the event. Marriott Marquis, Washington, DC. Call 800-851-7789 and visit www.SIIA.org

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February 9-11, 2016
Executive Forum 2016 presented by Health Care Administrators Association (HCAA). Caesars Palace, Las Vegas, NV. www.HCAA.org

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

July 13-15, 2016
TPA University 2016 presented by  Health Care Administrators Association (HCAA). Renaissance Dallas, Dallas, TX. www.HCAA.org

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

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February 8-10, 2017
Executive Forum 2017
presented by Health Care Administrators Association (HCAA). Bellagio, Las Vegas, NC. www.HCAA.org  

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

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

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Editorial Notes, Disclaimers & Disclosures


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