MyHealthGuide Newsletter
News for the Self-Funded Community

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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

The Healthcare Savings Quarterly Releases 3rd Qtr. 2015 Edition: Establishing Healthy Companies

MyHealthGuide Source: United Claim Solutions, 9/30/2015,

PHOENIX, AZ -- The Healthcare Savings Quarterly (HSQ) has released the 3rd Quarter 2015 edition of its growing educational publication. This edition focuses on Establishing Healthy Companies, and includes articles from industry leaders.

  • You can access a FREE copy of this e-magazine, review past editions, and sign up to receive future editions via email by clicking on:
If you are a Self-Insured Employer, Payer, Labor or Trust Organization, Stop-loss Company, Health Plan, CO-OP, ACO, or a business that services this market, this publication can be a useful source of information and guidance.

About The Healthcare Savings Quarterly

The Healthcare Savings Quarterly (HSQ) is a unique electronic publication designed to provide useful, timely and actionable information on a host of topics impacting the health insurance and healthcare markets. Each quarter we identify a "hot topic" in the market, and solicit articles from industry leaders to provide varying perspectives on issues and opportunities. Currently, HSQ reaches over 5,500 contacts nationwide.

HSQ is powered by United Claim Solutions (UCS), an innovative Medical Cost Reduction and Claims Flow Management company providing cutting edge and customizable cost-containment programs for payers, employers, unions, accountable care organizations, stop-loss companies, CO-OPs, ACOs and health plans.

About United Claim Solutions (UCS)

UCS offers end to end services including Bill Audits, Out-of-Network Bill Repricing, Bill Editing, Specialty Claim Negotiations, Medicare Plus Repricing, PPO Administration, Medical Management, Clearinghouse Services, Data Warehousing, OCR/Scanning, and Plan Modeling. We provide solutions for Group Health, Workers' Compensation, and Auto Liability. Contact Corte B. Iarossi, VP of Sales & Marketing at 866-762-4455 (x120), and visit


Relevant Healthcare Becomes Preferred Vendor For National Alliance Of State Health Co-Ops (NASHCO)

MyHealthGuide Source: Relevant Healthcare, 8/17/2015,

Chicago, IL -- Relevant Healthcare, a national healthcare cost containment company, was recently nominated and added to the NASHCO Preferred Vendor Program as a valuable savings tool for the state self-funded health cooperatives across the country, and their combined membership that now exceeds 1 million people.

Over the past 10 months, Relevant has been working very closely with one of the NASHCO member CO-OPs where it has been successful in saving more than $1.5 million dollars on only a handful of claims for dialysis treatment - an area where all of the cooperatives are experiencing the same challenges. As a result of that success and global interest, as well as the many other areas in which Relevant can save significant healthcare dollars, Relevant was nominated to participate in this program.

"We are extremely excited about this opportunity. We have had the desire for some time to help the state CO-OPs in any way that we can, and are grateful to have been given the chance to prove our ability to do just that. We look forward to establishing a long term relationship with NASHCO and in working with each CO-OP to develop valuable programs that help them to grow and remain a successful component of our healthcare system," said Scott Fuqua, President. 
Relevant's robust offering of savings solutions will provide NASHCO's membership with a valuable tool and resource. Combining the savings opportunity of all of its products, and depending on the size of the individual CO-OP, Relevant has estimates of savings that reach into the range of $50,000,000+ per year. With most products carrying a Contingency Model (no savings, no fees) and its National Radiology Network which involves no fees what-so-ever, Relevant is also able to offer NASHCO risk-free solutions that also include complimentary savings analysis and an extremely measurable ROI.

"We are proud to welcome Relevant Healthcare to our Preferred Vendor Program. Cost containment is a key goal for CO-OPs and all insurers, and Relevant Healthcare has the tools and resources to help our member CO-OPs achieve significant cost savings. We look forward to working with Relevant Healthcare in the coming months and years, and encourage CO-OPs to explore their range of services," said Kelly Crowe, President of NASHCO.

About Relevant Healthcare

Relevant Healthcare Cost Containment is a minority owned (MBE), and union affiliated organization that provides savings solutions in high cost areas of Healthcare for Employee Benefits and Workers' Compensation. Our services benefit self-funded employers, insurance carriers, CO-OPs and Medicaid Plans seeking to control healthcare costs, Third Party Administrators needing to carve out expensive procedures for their clients, workers' compensation insurance carriers/TPAs looking to lower costs, and any Broker or Consulting Firm that is looking to bring more value to their self-funded clients. Our solutions focus on specific areas of healthcare treatment that continue to drive the major increases in costs and utilization: Dialysis, Diabetes, Surgery, Large Dollar Claims, Pharmacy, Fraud/Waste/Abuse, and our flagship, FREE Advanced Radiology Network that offers significant discounts on procedures such as MRIs, CT Scans, and PET Scans while also providing a Concierge Service for the patient.  Contact Scott Fuqua at 855-328-5100, and visit


INTERLINK CancerCARE Partners with McKesson Specialty Health's Clear Value Plus

MyHealthGuide Source: INTERLINK COE Networks & Programs, 10/1/2015,

Hillsboro, OR -- INTERLINK COE Networks & Programs is pleased to announce the addition of McKesson Specialty Health's Clear Value Plussm technology as a fully integrated tool within its CancerCARE® initiative dedicated to improving the value and outcomes of cancer care across the United States.

Built upon the evidence-based NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Clear Value Plus technology utilizes information from a patient to determine regimens geared toward determining treatment with least toxicity and better cost-effectiveness for an overall better outcome. CancerCARE's clinical personnel then work with the community-based physicians in support of improved quality and patient satisfaction, lowered costs, and overall patient outcomes - the "Triple Aim" applied to cancer population management.

Combined with its diagnostic second opinion program (PathologyDiagnosticCOE), CancerCARE brings key components together to craft a value-based, optimized, accurate, and timely plan for each patient. Since the program collects patient-specific clinical information at care decision points, CancerCARE is recommending that Clear Value Plus courses of care be approved in their entirety in lieu of each individual component, further reducing administrative burden at all levels. Additionally, in this relationship INTERLINK continues its licensing and support of National Comprehensive Cancer Network® (NCCN®) efforts, and further improves those capabilities through McKesson Specialty Health's Clear Value Plus technology.

"Value-Based Purchasing is important to our clients, so it's important to us" says John Van Dyke, INTERLINK's CEO. "Clear Value Plus technology enables CancerCARE to share patient specific low risk/highly effective care options to physicians as they plan care. This technology creates a solid community management program, which compliments our highly effective COE ACCESS, Second Opinion and Clinical Trial programs currently in place."

Dr. Ron Potts, Chief Medical Officer for INTERLINK adds, "This opportunity to incorporate the outstanding leadership of the NCCN Guideline panels in evidence-based guidelines development with the highly-developed expertise of McKesson's Specialty Health gives us a unique set of tools to positively influence the care of patients enrolled in our CancerCare program".

Leading the Clear Value Plus implementation within CancerCARE, will be Kris Atkins, RN, CCM, Ronald G. Potts, MD and Tara Metzner, National Director of CancerCare Client Relations. Functions will include collection of essential clinical information by the Triage Center, communications with the physician offices, and treatment compliance notices to the plan. Included in this program is an itemized drug and biologics list for the agreed upon Clear Value Plus treatment program, thus enhancing the efficiency of client authorization and bill payment processes.

"The addition of Clear Value Plus to our already robust program will allow us to guide those members receiving care from local providers with the information they need to make informed decisions to obtain the best quality, patient-centric, value based care I have ever seen available in my 30 years of oncology nursing," says Kris Atkins, RN, VP of CancerCARE Quality Programs.

Benefit plans are evolving to include specific sections for cancer, transplants, dialysis and other high cost/low frequency care. With cancer costs now the #1 reinsured and plan claim for most, INTERLINK's program featuring Centers of Excellence networks and guideline management will play an important role.

About INTERLINK® COE Networks & Programs

INTERLINK® has 20 years of experience as an outcomes management company based in Hillsboro, Oregon. INTERLINK® builds Centers of Excellence networks for high-cost, low frequency medical procedures which are used by health plans all across the nation. Two of INTERLINK's seven COE networks have Affordable Care Act (ACA) adjusted benefit language, member education materials and fully integrated case management programs. INTERLINK® is well known for its transplant capabilities, which enables large plans to build their own COE network in our TransplantCUSTOM program, and a turn-key, narrowed TransplantELITE performance network for smaller plans. CancerCARE is our comprehensive cancer management program, using three custom built COE networks, NCCN Guidelines®, McKesson Specialty Health's Clear Value Plus Program, ACA adjusted cancer benefit language and fully integrated case management.  Contact Tara Metzner at 877-640-9610, tara.metzner@interlinkhealth and visit


Xchange Group Celebrates Fifth Anniversary, 4th October 2015

MyHealthGuide Source:  Xchange Group, 9/30/2015,

The Xchange Group and its main subsidiary Xchange Benefits are very proud to be celebrating fives year of delivering excellent service and high quality outcomes to our clients.

Peter McGuire President and CEO stated, "We are here today and thriving because of the loyalty of our clients and business partners who have supported us over the past five years. Our clients can continue to expect and receive un-rivaled service in the industry because of the dedication of our exceptional team members. We wish to express a huge thank you to all of our clients".

Over the past five years Xchange Group has diversified its brands to include; Xchange Affinity; Xchange Benefits; Xchange Consulting; Xchange Intermediaries; Xchange Specialty and Xchange Travel.

The Xchange Group looks forward to providing industry leading service and innovation to our current clients and to our future clients for many years to come. The Xchange Group management team also looks forward to welcoming new colleagues who share our passion and vision and who have an uncompromising drive to deliver only the very best outcomes to clients.

About The Xchange Group

Founded in 2010, The Xchange Group is a diverse Group of Business Units focused on the Global Insurance and Reinsurance Industry.  Led by a Team who have industry leading experience; Xchange Group: Underwrites, Consults, Creates Products, Creates Retail Distribution, Structures Risk, Transacts Reinsurance, Advises on Capital Deployment and most importantly Listens to our Clients. Contact Peter Mcguire at, 914.437.7360, and visit


NAEBA Releases Video, Discover The Benefits of Self-Funding

MyHealthGuide Source: The National Association of Employee Benefit Administrators (NAEBA), 9/24/2015,

Editor's Note:   This article is being published again this week with corrected website address (URL) for the video link below.

Burr Ridge, IL -- The National Association of Employee Benefit Administrators (NAEBA) has produced a new animated video, entitled Discover The Benefits of Self-Funding. Featuring a bold, fresh white board format, the program is brief, emphasizing the advantages of self- insured health benefit plans in under two minutes.

Produced by Barcelona Creative Group and licensed to the NAEBA, the video was created to serve as a marketing tool for Third Party Administration firms participating in the NAEBA. To view the program or to obtain information about the NAEBA, visit

About the NAEBA

The National Association of Employee Benefit Administrators is a cooperative marketing association dedicated to helping member TPA firms market employee benefits administration in very innovative ways. By combining traditional media with new digital and social media tools, members are better able to convey the importance of self-funded health benefit plans, expert administration and the cost control strategies that set independent TPAs apart. Contact Thomas Barcelona, NAEBA Executive Director at 630/320-6424 ext. 1300, and visit

About Barcelona Creative Group

Barcelona Creative Group is a strategic marketing and branding firm, specializing in insurance and employee benefits administration. Based in Chicago and established in 1990, the agency serves as the creative resource team for the NAEBA and leading, independent Third Party Administrators throughout the U.S.  Visit


People News

Reinsurance Group Of America (RGA) Names Dan Carlson as Senior Vice President and Head of Business Development, U.S. Group Re

MyHealthGuide Source: Reinsurance Group Of America, Inc., 10/1/2015,

Reinsurance Group Of America (RGA) has named Dan Carlson Senior Vice President and Head of Business Development for its U.S. Group Re team. Dan comes to RGA from Marsh and McLennan, where he was Managing Director and National Team Leader for Health Plan Reinsurance and Provider Excess Loss Insurance.

Dan will coordinate business development activities throughout the group reinsurance division at RGA, and build relationships with clients and brokers across all group lines of business, including Life, Health, Disability, and Special Risk.

Prior to his 18-year tenure at Marsh, Dan held leadership roles at MMI Companies and The Travelers. Dan is currently a board member of the Managed Care Risk Association and Chairperson of the Colorado Healthcare Executive Forum.

About RGA

Reinsurance Group of America, Incorporated is one of the largest global life and health reinsurance companies in the world. The company provides clients with individual life reinsurance, individual living benefits reinsurance, group reinsurance, health reinsurance, financial solutions, facultative underwriting and product development. RGA and its subsidiaries serve clients from operations in Australia, Barbados, Bermuda, Canada, China, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Malaysia, Mexico, the Netherlands, New Zealand, Poland, Singapore, South Africa, South Korea, Spain, Taiwan, Turkey, the United Arab Emirates, the United Kingdom, and the United States. Worldwide, RGA has approximately $2.9 trillion of life reinsurance in force and assets of $47.5 billion.  Contact Lynn Phillips, Executive Director, Public Relations, at 636.736.2351, and visit


PartnerRe Health Announces Addition of Trevor Miller

MyHealthGuide Source: PartnerRe Health, 10/1/2015,

San Francisco, CA -- PartnerRe Health announced the addition of Trevor Miller to the Employer Programs team as Assistant Vice President, Business Development Manager.

Trevor will be a member of the team responsible for client development and retention for PartnerRe Health's products and services in the Employer market. He brings over 15 years of experience including expertise in self-funding and employer stop loss; in particular working with large brokerage firms, consultants and TPA's.

"We are very pleased to have Trevor join our team. Working with Adam Gottesman and Elizabeth Denne, his experience and knowledge will support the continued business outreach efforts and growth of our Employer Group," stated Matthew Leming, Vice President, Director, Employer Programs Health. "Trevor will play an integral role as we introduce and provide unique solutions to our stop loss clients."

About PartnerRe

PartnerRe Ltd. is a leading global reinsurer, providing multi-line risk management solutions around the world. Risks reinsured include property, casualty, motor, agriculture, aviation/space, catastrophe, credit/surety, engineering, energy, marine, specialty property, specialty casualty, multiline and other lines, mortality, longevity, health, and alternative risk products.

PartnerRe Health, the global Health Division of PartnerRe, is an acknowledged leader in providing risk management solutions to accident and health markets. Our team of experienced professionals develops innovative, client-specific solutions by thoroughly understanding our clients' goals, market, risk tolerance and exposures. Using a suite of proven proprietary financial and analytical tools, we design an effective risk management program with extensive support services.  Ranked #1 on "America's 50 Most Trustworthy Financial Companies" -- Forbes, 2015.  Contact Ali Duerr, Marketing Manager, at 415.354.1584, and visit


Berkley Accident and Health Seeks to Add 3 New Positions

MyHealthGuide Source: Berkley Accident and Health, 10/2/2015,
Berkley Accident and Health is growing again, and is looking to add 3 new positions to its team.

Berkley Accident and Health (Berkley) is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk.

We offer a broad range of products, including employer stop loss; benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk -- our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W.R. Berkley Corporation (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States.

We have immediate openings for the following positions: Employer Stop Loss Product Director, EmCap Product Director, Underwriter I .

Employer Stop loss (ESL) Product Director
Berkley Accident and Health is seeking a full time ESL (Employer Stop Loss) Product Director in our Marlborough office. Reporting to the SVP, Product Management and Development, this role will be integral to the further development and innovation of our ESL product offering. A solid insurance background, with 3-5 years of progressive experience will set a good backdrop to take on the challenges of this position. We are looking for self-starters who have either directly managed a program or been involved in the management of a program or product line in a hands- on capacity. The job summary and its qualifications are outlined at :

EmCap Product Director

 Berkley Accident and Health is seeking a full time EmCap Product Director to be located in our Marlborough MA office. The ideal candidate will have the proven ability to be innovative and strategically focused. He or she will be integral to the development and market positioning of our next generation EmCap product . A Job Summary and its qualifications are outlined at:

Stop Loss Underwriter I

Berkley Accident and Health is seeking a full time, highly motivated entry level Underwriter looking to advance in a Stop Loss Underwriting career. This position will be located in our Marlborough Ma office. The ideal candidate will support a team of underwriters by preparing terms, census, benefit s, and experience information into a quoting system completely, accurately, and in a timely fashion. This position will also support underwriters by performing miscellaneous items to help meet sales and profitability goals. As the candidate gains experience he /she will start to evaluate risk and price new business and renewal accounts up to an assigned authority level. A Job Summary and its qualifications are outlined at:

About Berkley Accident and Health

Berkley Accident & Health is a wholly owned subsidiary of W.R. Berkley Corporation (NYSE: WRB) which was founded by William R. Berkley in 1967. The Company has been widely known for its entrepreneurial culture and unique decentralized corporate structure, having been recognized as the best managed insurance company in 2007 by Forbes Magazine. Our unique entrepreneurial approach focuses on customer needs for transferring risk and controlling costs. Our unique technical understanding of the medical marketplace, combined with our proprietary medical management capabilities, allows us to achieve superior results for our customers. Visit


Integro Re Enhances Managed Care Expertise With Addition Of Gary Cellini

MyHealthGuide Source: Integro Re, 10/1/2015,

San Francisco, CA and New York, NY -- Integro Re, the reinsurance division of Integro USA Inc., announced the addition of Gary Cellini, an expert in renal disease coverage and specialty pharmaceuticals, as a consultant within the firm's rapidly expanding Managed Care (HMO reinsurance and Provider Excess) and Accident and Health reinsurance offerings.

"Healthcare risk financing is undergoing a sea change of activity, particularly as it impacts insurers, provider-based health plans and other healthcare provider entities," said Peter Robinson, head of Integro Re's specialty practice. "Based on his impressive record of successes in the development of Medicare Advantage Special Needs Plans, CMS Demonstration Projects, and population health management in the renal and specialty pharmacy industries, we are confident Gary will help Integro Re's clients realize the best terms, high quality analytical modeling and innovation from the reinsurance markets nationally relating to population health, renal disease and specialty pharmaceuticals."
Cellini held CEO and senior leadership positions with several firms, including Satellite HealthCare, DaVita HealthCare Partners, Baxter International and Gentiva. He has developed nine Medicare Advantage health plans in eight states and the District of Columbia. He was responsible for two CMS ORDI demonstration projects that were instrumental in the early development of integrated care and medication management systems, bundled medical payments, and accountable care shared saving programs later implemented by the Centers of Medicare and Medicaid Innovation.

Cellini holds a Doctor of Pharmacy degree from the University of the Pacific's Thomas Long School of Pharmacy and a Master of Business Administration from the University of California Los Angeles's Anderson Graduate School of Management.

About Integro Re

Integro Re, a division of Integro USA Inc., is a full service reinsurance broker with particular expertise in healthcare, developing and implementing reinsurance strategies for a client base that includes insurance companies, alternative risk entities such as captives and risk retention groups, managing general agencies and third party administrators. Integro Re has locations in New York, London, San Francisco, Chicago, Denver and Boston.

About Integro

Integro is an insurance brokerage and risk management firm. Clients credit Integro's superior technical abilities and creative, collaborative work style for securing superior program results and pricing. The firm's acknowledged capabilities in brokerage, risk analytics and claims are rewriting industry standards for service and quality. Launched in 2005, Integro and its family of specialty insurance and reinsurance companies, some having served clients for more than 150 years, operate from offices in the United States, Canada, Bermuda and the United Kingdom. Its U.S. headquarter office is located at 1 State Street Plaza, 9th Floor, New York, NY 10004. 1-877-688-8701. Contact Betsy Van Alstyne at, 212.295.5445 and visit


Top Marketing Company, Ocozzio, Seeks Top Talent to Join Leadership Team

MyHealthGuide Source: Ocozzio, 10/1/2015,

Augusta, GA -- The self-funded space's leading marketing company is looking for the best talent in the country to fill two senior leadership positions.

Ocozzio, based in Augusta, Ga., is a rapidly growing, cutting-edge marketing company providing an "out-source marketing department" solution primarily serving healthcare clients.

Because of our growing client base, Ocozzio is consistently in the market for top marketing talent.

Currently, Ocozzio is looking for:

  • An additional Vice President of Marketing Strategy
  • An additional Vice President of National Accounts
  • These positions report to Executive VP positions

Visit to learn more about these openings and information on how to apply. You may also stop by our booth at SIIA. We would enjoy meeting you in person.

About Ocozzio

The healthcare marketing pros! We are a one-stop strategy, planning, design and execution marketing company. We specialize in the healthcare space with 12 years of hands-on experience serving more than 50 healthcare service provider companies. Our mission is to help our clients grow their business.  Visit


IHC Risk Seeks Regional Sales Executive for Western Region

MyHealthGuide Source: IHC Risk Solutions (IHCRS), 9/24/2015,
IHC Risk Solutions (IHCRS), a national direct writer of medical stop-loss, is seeking a highly motivated and energetic Regional Sales Executive for the Western region of the United States.

The position will be located in our Phoenix, AZ office. 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 experience 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 Phoenix, AZ area
  • Ability to comply with IHC's corporate practices and procedures


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

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

About IHC Risk Solutions (IHCRS)

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 December 2013 and over 25 years in the stop-loss business. Visit


Market Trends, Studies, Books & Opinions

D.W. Van Dyke & Co. Announces 2015 Stop Loss Industry Persistency and New Business Survey

MyHealthGuide Source: D.W. Van Dyke & Co. Inc., 9/30/2015,

Chris Koehler, President of D.W. Van Dyke & Co. Inc., announced this past week that results from its just completed 2015 Stop Loss Industry Persistency and New Business Survey were sent to the 27 participating Stop Loss organizations representing over $5 Billion of annualized Stop Loss premium.

"DW Van Dyke and Company appreciates the ongoing support of the many Carrier and MGU survey participants as it continues to regularly provide them detailed Stop Loss industry data measurements through its ongoing survey analysis," says Koehler.

Growth trends continue as measured in our 2015 survey:

  • Premium growth: 6.3%
  • Number of cases growth: 5.1%

About D.W. Van Dyke & Co. Inc.

D.W. Van Dyke & Co., Inc. is a privately held reinsurance intermediary with a 30+ year history of designing risk transfer programs and providing solutions for its clients. All of the intermediaries at D.W. Van Dyke & Co., Inc. have insurance and/or reinsurance underwriting backgrounds in a myriad of Life, Accident, Health, Financial, and Casualty product lines, and as a result, are able to provide unique solutions for their clients.  Visit


Legislative & Regulatory News

SIIA Submits Cadillac Tax Comment Letter Why Tax Should Not Be Levied on TPAs

MyHealthGuide Source:  The Self-Insurance Institute of America, Inc. (SIIA), 9/28/2015,

The Self-Insurance Institute of America, Inc. (SIIA) submitted a formal comment letter in response to the latest regulatory guidance issued by the Treasury Department (Treasury) and the Internal Revenue Service (IRS) regarding the proposed implementation of the Excise Tax on High-Cost Employer-Sponsored Health Coverage, more commonly known as the "Cadillac Tax."

The association's comments explaining why the Tax should not be levied on third party administrators as contemplated in the regulatory guidance. Leading employer-specific trade associations have also articulated this position - if there is going to be a tax, Treasury and IRS should minimize administrative complexities and eliminate creation of a "tax-within-a-tax" by imposing the Tax on self-insured employers directly.

Please click here to access the full text of the association's comment letter. SIIA expects to meet with key Treasury/IRS officials in Washington, DC before the end of the year to share additional technical expertise supporting the points incorporated in the letter. Watch for additional regulatory updates as developments warrant.

In the meantime, more information about the Cadillac tax will be provided at SIIA's National Conference & Expo, scheduled for October 18-20 in Washington DC. Specifically, Richard (Rick) Johnson, senior vice president with Segal Consulting, will present the following session.

Preparing Self-Insured Plans for the Cadillac Tax

The ACA 40% Excise Tax, AKA the "Cadillac" tax is slated to become effective for 2018, imposing a ceiling on the amount of health benefits employers can provide their employees and retirees on a pre-tax basis. Many self-insured group health plans are rich compared to the minimum requirements and a growing number are likely to hit the 40% Excise Tax threshold quickly. So in practice, this tax will soon become a major design consideration for self-insured employers and their TPA partners. This session will explore:

  • What the 40% Excise Tax is and how it is calculated
  • Why employers might have to limit cafeteria plan (Section 125) health care spending accounts in the future
  • How the Excise Tax will affect self-insured health benefit plans now and into the future
  • Changes self-insured employers will need to consider to avoid or delay this tax
  • Options available to employers sponsoring self-insured plans to maintain compensation equity
  • Case studies illustrating the growing impact of the Excise Tax after 2018

About SIIA

The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally.  Call 800.851.7789 and visit


Justice Changes Stance, Asks for Contraceptive Mandate Ruling

MyHealthGuide Source: Matt Dunning, 10/1/2015, Business Insurance Article

The Obama administration has asked the U.S. Supreme Court to decide if religious nonprofit groups should be exempted from the federal health care reform law's so-called contraceptive mandate.

In a brief filed Wednesday, the Justice Department asked the high court to accept the Roman Catholic Archbishop of Washington's petition to hear its challenge of the health care reform law rule. The rule requires religious nonprofit employers to offer their employees cost-free prescription contraceptives or, under an accommodation finalized in July, pass the obligation to their health insurers or third-party health plan administrators.

  • The request reverses the Justice Department's previous stance opposing the Washington archbishop's request for a hearing, as well as petitions to review of six other federal appeals court rulings -- all of which upheld the government's accommodation for religious nonprofits.
  • In its brief, the Justice Department said its change was due to the 8th U.S. Circuit Court of Appeals' recent ruling siding with the religious charities. The 8th Circuit's ruling created "a circuit conflict on an important question of federal law that should be resolved by this court," the Justice Department said in its brief.
  • "This court should resolve the circuit conflict over the viability of the challenges to the accommodation, but the pending petition in (the archbishop's case) is a more suitable vehicle in which to do so," according to the Justice brief. "The (archbishop's) petition presents all of the health coverage arrangements that have given rise to (Religious Freedom Restoration Act) challenges to the accommodation."

The Washington archbishop case also addresses both key tests of the federal religious freedom law, which the plaintiff charities have argued protects them from participating in any activity that violates their religious beliefs, the Justice Department said.


Court Nixes Participant's Claims in Subrogation Dispute

MyHealthGuide Source: Bloomberg Law, 9/25/2015

Case: Cleveland v. Cent. States Se. & Sw. Areas Health & Welfare Fund.  2015 BL 310542, W.D. La., No. 5:14-cv-03350-SMH-MLH, 9/24/15.  Court's Ruling

Article referred by
John H. Eggertsen, Attorney at Law

Central States, Southeast and Southwest Areas Health & Welfare Fund properly denied benefits to a fund participant, who had sustained injuries in a car accident, based on its conclusion that the participant interfered with its subrogation rights under the plan, a federal judge in Louisiana ruled.

In a Sept. 24 order, Judge S. Maurice Hicks Jr. of the U.S. District Court for the Western District of Louisiana found it was within Central States's discretion to deny Joffrey Cleveland's claim for benefits because he filed a lawsuit in state court seeking to recover money from his and the other driver's auto insurance policies, which conflicted with Central States's subrogation rights under the plan.


Medical News

Lifestyle-Focused Text Messaging Improves Risk Factors in Patients With Coronary Heart Disease

MyHealthGuide Source: Clara K. Chow, MBBS, PhD, 9/22-29/2015, Journal of American Medical Association (JAMA) Abstract

Using lifestyle-focused mobile phone text messaging helps coronary heart disease patients lower LDL-C cholesterol level and improves other cardiovascular disease risk factors according to a study published in the Journal of American Medical Association.

The randomized clinical trail (The Tobacco, Exercise and Diet Messages (TEXT ME)) recruited 710 patients (mean age, 58 years; 82% men; 53% current smokers) with proven coronary heart disease (prior myocardial infarction or proven angiographically) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia.

Patients in the intervention group (n = 352) received 4 text messages per week for 6 months in addition to usual care. Text messages provided advice, motivational reminders, and support to change lifestyle behaviors. Patients in the control group (n=358) received usual care. Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerized message management system. The program was not interactive.

The primary outcome was low-density lipoprotein cholesterol (LDL-C) level at 6 months. Secondary end points included systolic blood pressure, body mass index (BMI), physical activity, and smoking status.

Study findings

  • At 6 months, levels of LDL-C were 5 mg/dL lower in intervention participants.
  • Other risk factors improved:
    • Systolic blood pressure reduced average 7.6 mm Hg,
    • BMI reduced average 1.3,
    • Physical activity increased 293 metabolic equivalent task min/wk,
    • Reduction in smoking (26% vs 44%), and
    • The majority reported the text-message program to be useful (91%), easy to understand (97%), and appropriate in frequency (86%).

Researchers conclude that patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors. The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.


Recurring Resource

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 8/8/2015)

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

  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
Capital /Equity
1. CIGNA     $2,318
  CIGNA Financial Supplement 2014, P.5 12/31/2014
2. Sun Life Financial     $1,034.2
  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+)
$3,903 HCC Insurance Holdings, Inc. Form 10-K
4. HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
Matt Rhenish, President & COO, 2/16/2015
5. Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc.
6. Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
Joe Keller, Lead Financial Analyst, Voya Employee Benefits,
7. Companion Life > 20 Years   $440
  Philip Gardham, Vice President, Specialty Markets,
8. Independence Holding Company   Standard Security Life Insurance Company of New York,
Madison National Life, Independence American Insurance Company
  Independence Holding Company
9. National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
10. Zurich North America     $150   Joseph Byers, Zurich North America.
11. Munich Re Stop Loss, Inc.   AIC, TransAmerica $110
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
12. The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
  Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
Mark Nichols, Managing Director.

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
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • UnitedHealthcare

Stop-loss Premium Volume is not the Whole Story

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

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

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


The Value of Self-Funding

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

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

About the SIEF

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


ICD-10 Readiness Tools

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

In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list.

On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. Please find links to the ISG White Paper on the process and to the new ICD-10-CM Trigger list.

The original ICD Trigger list  was endorsed by SIIA and SPBA.  The updated ICD-10-CM is now endorsed by HCAA.

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


Upcoming Conferences

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


February 9-11, 2016
Executive Forum 2016 presented by Health Care Administrators Association (HCAA). Senator Tom Daschle is opening keynote! Senator Daschle will present "An Insider's View on President Obama's Health Care Policy and Its Future" on Wednesday 2/10/16 from 9:00am - 10:30am.  Caesars Palace, Las Vegas, NV. Room rates: $220 / night plus tax (through 1/15/16).  Call 866-227-5944 and reference Health Care Administrators Association or SCHCA6.

March 7-9, 2016
The Sixteenth Population Health Colloquium presented by HC Conference. Philadelphia, PA and WEBCAST.  Featuring Special Medical Home Track.  Presenters include: Troyen Brennan, MD, MPH, Executive Vice President and Chief Medical Officer, CVS Health, Former Chief Medical Officer, Aetna Inc., Woonsocket, RI.  Bill Copeland, MBA Vice Chairman and US Life Sciences & Health Care Industry Leader, Deloitte LLP, Philadelphia, PA.  Peter R. Orszag, Vice Chairman, Citigroup, Former Director, OMB (Obama), Former Senior Economist, Council of Economic Advisers (Clinton), New York, NY Information and Phone: (800) 503-7439, and 

March 21-23, 2016
Self-Insured Health Plan Executive Forum presented by Self-Insurance Institute of America.  New Orleans, LA.

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

April 5-7, 2016
SIIA International Conference presented by Self-Insurance Institute of America. San Jose, Costa Rica.

May 4-6, 2016
15th Annual Health Literacy Conference
presented by The Institute for Healthcare Advancement's (IHA).  Anaheim, CA. One-day and Two-day conferences presents practical and effective solutions to health literacy challenges, ranging from how to write and design effective communication, to tools for addressing low health insurance literacy skills.  Emphasis on ACA-related programming. The conference will attract health educators, health insurance agents, physicians and nurses, hospital representative, academics, writers, researchers and public health workers among others interested in the health literacy field. The conference also offers up to 20 continuing education credits to attendees.

May 18-19, 2016
Self-Insured Taft-Hartley Plan Executive Forum  presented by Self-Insurance Institute of America. Chicago, IL.

May 24-26, 2016
Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance Institute of America. Scottsdale, AZ. 

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

September 25-27, 2016
36th Annual National Educational Conference & Expo presented by Self-Insurance Institute of America. Austin, TX. 

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


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

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

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


Editorial Notes, Disclaimers & Disclosures

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