MyHealthGuide Newsletter
News for the Self-Funded Community
9/26/2016

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

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News



ELMC Group, LLC Acquires Leading Medical Stop-Loss Underwriter IOA Re, Inc., Expanding Capabilities in Self-Funded Healthcare Market

MyHealthGuide Source: ELMC Group, LLC, 9/22/2016, elmcgroup.com

NEW YORK -- ELMC Group, LLC, a manager of premier, full-service managing general underwriters (MGUs) specializing in underwriting medical stop-loss insurance, announced that it has signed an agreement to purchase IOA Re, Inc., a longstanding, highly-reputable MGU headquartered in East Norriton, PA.

In connection with the acquisition of IOA Re, J.C. Flowers & Co. LLC, a leading private investment firm dedicated to investing globally in the financial services industry, will acquire a controlling interest in ELMC.

"The acquisition of IOA Re will allow ELMC to expand its reach in the self-funded healthcare market and offer new opportunities for growth," said Richard Fleder, co-founder and CEO of ELMC. "The addition embodies our commitment to providing a best-in-class platform for delivering smart, straightforward medical stop-loss solutions to our carrier, broker, TPA and client partners," said Fleder.

"We are pleased to combine our strengths to meet the demands of the rapidly-changing marketplace," said John Parker, president of IOA Re. "The ELMC platform enables us to reach a larger audience as well as strengthen our risk positions and capture profits through its offshore captive strategy," Parker said.

Eric Rahe, a Managing Director of J.C. Flowers, added, "We believe this is an ideal time to invest in the medical stop-loss insurance sector, as more businesses are choosing to self- insure. Not only is this a sector we know well, but by partnering with the highly respected ELMC and IOA Re teams, we feel confident we can further enhance the company's standing in the industry."

IOA Re entered the medical stop-loss business in 1982 and remains a well-regarded organization. Beyond its key medical stop-loss product, IOA Re's lines of business include managed care (HMO and provider excess insurance), and workers' compensation catastrophe reinsurance; all lines of business which ELMC remains firmly committed to supporting.

IOA Re's affiliated holding, Insurance Resources and Auditing Services (IRAS), provides  professional auditing and insurance services for external MGUs, insurers, reinsurers, managed care organizations, TPAs and self-insured employers.

The acquisition of IOA Re represents a strong complement to ELMC's existing operations, including Midwest Reinsurance Underwriters, RxReins and DiversitySL. The breadth and depth of IOA Re's underwriting and operating platform provides an ideal springboard which will enable the organization to expand its reach in the self-funded healthcare market as well as the reinsurance space as a whole.

About ELMC

ELMC owns, manages and seeks to acquire premier MGUs across the nation that specialize in underwriting medical stop-loss insurance for self-funded health plans. ELMC provides a best-in-class platform for delivering medical stop-loss solutions to brokers, carriers and clients. Contact Mary Ann Carlisle at mcarlisle@elmcgroup.com and visit elmcgroup.com.

About J.C. Flowers

J.C. Flowers is a leading private investment firm dedicated to investing globally in the financial services industry. Founded in 1998, the firm has invested more than $15 billion of capital in 45 portfolio companies in 16 countries across a range of industry subsectors including banking, insurance and reinsurance, securities firms, specialty finance, and services and asset management. With approximately $6 billion of assets under management, J.C. Flowers has offices in New York and London. Visit jcfco.com.

About IOA Re

IOA Re is a managing general underwriter based in East Norriton, PA, with offices located throughout the United States. While medical stop-loss is IOA Re's largest product line, IOA Re enjoys a strong reputation and client following in managed care, special risk, workers' compensation and other associated lines of business. Its affiliated holding, IRAS, provides professional auditing and insurance services for external MGUs, insurers, reinsurers, managed care organizations, TPAs and self-insured employers.  Visit www.ioare.com.

Top


Health Care Administrators Association (HCAA) Announces 2017 Executive Forum

MyHealthGuide Source: Health Care Administrators Association (HCAA), 9/22/2016, www.HCAA.org

MINNEAPOLIS, MN -- The Health Care Administrators Association (HCAA), a leader in education, networking and advocacy for the self-funding industry, announces its 2017 Executive Forum to be held February 8-10, 2017 at the Bellagio in Las Vegas. The one-and-a-half-day event will feature educational sessions on a variety of pressing self-funding topics impacting the industry following the United States presidential election.

"The platforms of the U.S. presidential campaigns have focused heavily on foreign policy, economic growth, domestic security and civil freedoms, but there is another major story that hasn't been getting nearly enough press - the outcome of November's election and its fundamental impact on the way healthcare is administered in our country," said HCAA Chief Executive Officer Carol Berry, CSFS. "Our conference focus will be on the disruptions coming to our industry from all sides - from new payment models that offer radical ways of measuring value to social communications changing how we market our businesses; from cognitive computing's impact on the future to clinical and financial data mining changing how we use our data; and from integrated behavioral health strategies to captives that can extend their reach beyond risk management. Further complicating the picture will be how the possibility of a Congressional shakeup and the selection of a new Supreme Court Justice may affect the future of our industry. All this and more will be dissected by an expert lineup of TPA, self-funding and health care industry experts at our 2017 Executive Forum."

In addition to a number of networking sessions and receptions, the educational lineup of the conference will include the following general session topics and speakers:

  • Art, Assassination, and America: How Transparency Disrupts an Industry and Changes a Nation - Martin A. Makary MD, MPH, Professor of Surgery for Johns Hopkins University School of Medicine
  • Health Care Marketing in 140 Characters - Russ Krueger, John Scott, Taylor Guido and Chris Robinson of Ocozzio, Inc.
  • How Will Millennials Disrupt Customer Engagement? - Lynn Kesterson-Townes, worldwide commerce marketing leader for IBM
  • Health Psych: Brain Hacks, Opioid Epidemic, Behavioral Economics and Predatory Treatment Facilities - Robert Mines, PhD, CEO and psychologist of Mines & Associates
  • Held Captive - The Benefits Extend Beyond Risk Management - Mike Meloch, president of TPAC Underwriters; Park Eddy, president of Active Captive; and Kevin Larson, president of EBMS
  • Now that the Dust Has Settled - The Political Landscape in Washington - Steven Hayes, senior writer at The Weekly Standard and a Fox News contributor
  • How to Leverage the Intersection of Financial and Clinical Data - Rod Reasen, CEO of Springbuk Analytics
  • The Impacts of Value Based Care Market Transitions on TPA Service Offerings - Jim Giordano, principal and president of Managed Transitions

All HCAA members, as well as non-member TPAs are invited to attend this conference. Early-bird registration and conference room rate discounts are available through November 18, 2016. For more information on registration, or to view the full schedule of session descriptions and speaker bios, visit the HCAA website.

About HCAA

The Health Care Administrators Association is the nation's most prominent nonprofit trade association that supports the education, networking, resource and advocacy needs of third-party administrators (TPAs), insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers and health care consultants. For nearly 35 years, HCAA has taken a leadership role in legislative advocacy, working to increase its influence with policymakers and other stakeholders in order to transform the self-funding industry and expand its role within health care.  Visit www.HCAA.org, connect at @HCAAinfo, HCAA LinkedIn or HCAA YouTube.

Top



Advanced Medical Pricing Solutions (AMPS) Launches Interactive Margin Erosion Calculator and Broker Tool Kit

MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 9/23/2016, www.advancedpricing.com

ATLANTA, GA -- Advanced Medical Pricing Solutions (AMPS), a Physician Led, Technology Driven healthcare cost management company has launched its newest tools for brokers and payers to deliver critical information and solutions to the self-funded market.

AMPS leads the cost-containment industry by delivering dramatic savings to self-funded employers and their members through its Medical Bill Review (MBR) and Reference Based Reimbursement (RBR) programs. They've now made available two new interactive tools to assist brokers and payers to help guide their Clients to solutions that will have the biggest impact on their medical spend. These dynamic resources are located on the AMPS website, www.advancedpricing.com.

The AMPS Margin Erosion Calculator allows users to visualize the erosion of profit margins as benefits increase over time. Just plug in real data including annual revenue, benefit expense (including pharmacy), pre-tax margin, and estimated tax rate. Users can also choose the default assumptions for revenue and expense growth. The tool will chart the estimated impact of healthcare costs on company margins over 5 years and create a pdf report sent to you via email. The Margin Erosion Calculator provides a powerful analysis when talking to self-funded employers about the importance of considering proven alternatives to the standard PPO options.

The Broker Tool Kit provides brokers with multiple informational resources including white papers, email blasts, and other useful information to discuss the impact of medical spend on a self-funded Health Plan, and options to mitigate the negative trend line.

"We're very excited about the launch of these new services. They're designed to empower brokers and payers by providing additional tools to help them manage the impact of increasing healthcare costs on their Clients' bottom line. And because these tools are online they can be accessed at any time", said John Powers, Executive Vice President of Sales, at AMPS.

About AMPS
 
Advanced Medical Pricing Solutions is a cutting edge healthcare cost management company providing unique solutions to dramatically reduce Health Plan medical spend and employee out-of-pocket costs. Focusing on aggressive alternatives to traditional PPOs, this Physician Led, Technology Driven company offers industry leading savings through Reference Based Reimbursement (RBR) solutions, Medical Bill Review services, Direct Provider Contracting, and flexible Out-of-Network Repricing options.  Contact John Powers, Executive VP, Sales, at 630-361-2525, jpowers@advancedpricing.com and visit
www.advancedpricing.com.

Top



Health Payer Consortium (HPC) Expands The "Paid Claim Refund" Program

MyHealthGuide Source: Health Payer Consortium, 9/23/2016, www.healthpayerconsortium.com

St. Louis MO -- Through the "Paid Claim Refund" program, Health Payer Consortium (HPC) identifies trends and noncompliant charges, per federal billing guidelines, on large in and out of network claims. After these noncompliant charges have been identified, HPC works with the Provider to procure a refund check. This program is successful for almost every Payer, Network, and Claim Type.

"Some claims will have a few thousand in savings while others will have a few hundred thousand in savings. You never know until after we review your claims with our proprietary solutions," says Patrick Crites, President of HPC. "Since we perform these services on large paid claims, the refunds can be substantial and we have procured refunds on claims that were a year old."

"Many cost containment solutions miss large errors and there are also noncompliant billing trends that do not become widely known until after large claims have been paid. Reviewing large claims after they have been paid should become a part of every payers cost containment efforts," says Jason Nau, VP of Operations at HPC. "These are charges that should not have been billed for in the first place."

If you would like more information about getting a refund on your paid claims or any of our other services, please see Patrick Crites, Patrick.crites@hpcmembers.com, at SIIA this week or send an email to Jason Nau at jason.nau@hpcmembers.com and he will schedule a convenient time for a confidential discussion.

About Health Payer Consortium

HPC is designed to be a member-owned innovation company that combines the benefits of in-sourcing, outsourcing, and innovation management for Healthcare Payers. Our mission is to utilize our unique business model to deliver industry-leading services and savings while eliminating third party profit stacking. The ultimate goal is to shift profits back to Payers and their clients. We offer refunds on paid claims, compliance audits, medical bill review, negotiations, editing, network repricing, and reference based repricing. We also have a separate case management division which provides a full suite of case management and utilization review services. Check us out at www.healthpayerconsortium.com.

Top



The Phia Group's Plan Appointed Claim Evaluator® (PACE) Celebrates First Anniversary

MyHealthGuide Source: The Phia Group, 9/22/2016, www.phiagroup.com

The Phia Group's Plan Appointed Claim Evaluator® (PACE) service will celebrate its first anniversary in October. As the premier fiduciary transfer and final, internal appeals handling service on the market, PACE has quickly become a game changer for TPAs, brokers and self-funded groups, alike.

Tim Callender, a Staff Attorney with The Phia Group and Phia's Lead PACE Counsel commented on the service's anniversary, "It's incredible to see how our involvement in a difficult appeal can avoid litigation and assure the governing plan document is properly followed. Time and again we are handling appeals that involve extremely complex exclusions or medical necessity issues that would have been interpreted incorrectly without PACE. It feels good to know that PACE is protecting plan fiduciaries, helping TPAs and brokers avoid litigation, and assure proper outcomes. It's good for the industry."

Over the past year, The Phia Group's PACE service has seen adoption in all regions of the nation and is set to eclipse 100,000 employee lives.

About The Phia Group

The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets.  Contact Tim Callender, Esq., attcallender@phiagroup.com, 781-535-5631 and visit www.phiagroup.com.

Top



VRx byMail Delivers for Employers and Members

MyHealthGuide Source: Veridicus Health (VRx), 9/23/2016, www.veridicushealth.com

Veridicus Health (VRx) opened its own, state-of-the-art mail order pharmacy, VRx byMail, on July 1st of this year. VRx byMail delivers maintenance medications straight to your door or office with deeper discounts than retail pharmacy outlets. The additional savings realized from mail order helps reduce both member and employer healthcare costs while giving members more convenient access to their medications.

VRx byMail is located in Salt Lake City, Utah and services members across the United States. VRx byMail's integration with other Veridicus Health offerings, including VRx pharmacy benefit management (PBM) and clinical services, means members have one point of contact for all pharmacy inquiries.

Pharmacist In Charge (PIC), Dr. Justin Bryner, Pharm D. clarified a major difference on how VRx byMail will operate versus other mail order pharmacies:

"Traditionally, mail order pharmacies have been viewed as lacking the personal touch that comes with your neighborhood pharmacy. We wanted to change that. It's exciting to know that we give members the convenience of mail order delivery for maintenance medications while maintaining a neighborhood pharmacy feel."

In speaking to the importance of VRx byMail, Veridicus Health President, Doug Burgoyne, said, "By establishing an internal mail order pharmacy, our clients experience substantial savings opportunities and more control over their pharmacy benefits. At the same time, members can take advantage of the convenience and savings of mail order while still experiencing the same level of customer service they've come to expect from Veridicus Health."

Many PBMs require mandatory mail order, taking control away from employers and members while bolstering profit margins. Veridicus Health and its PBM, VRx, maintain a more client- facing position of true transparency and plan control by allowing the employer to choose how to utilize mail order services in a way that serves their benefit goals.

Veridicus Health provides guidance and education around benefit designs and plan options, but clients always have the freedom to choose whether or not to participate in mail order, without any penalties or additional administrative fees.

Veridicus Health has also announced the opening of a specialty pharmacy in the coming months to help address the rising costs and impacts of specialty medications. Watch for more news from Veridicus Health in the coming weeks and months.

About Veridicus Health

Veridicus Health provides transparent, pass-through pharmacy benefit management services to clients and members throughout the United States. Located in Salt Lake City, Utah, VeridicusHealth uses a lowest net cost pharmacy benefit model to help employer groups and members manage the rising pharmacy costs and avoid waste.  Contact Joyce Canning, VP Client Development, at 801.990.9967, jcanning@myvrx.com and visit www.veridicushealth.com.

Top



Cayman Captives Boosted by Stop-Loss

MyHealthGuide Source: Cayman News, 9/22/2016

So far, 2016 has been a very active year for new captive insurance formations, with 23 new licenses granted over the first six months of the year, according to the Cayman Islands Monetary Authority. This number exceeded the issuance of licenses in the whole of 2015.

"Historically, November and December are the busiest months in terms of new captive formations, and if the same applies to 2016, the year will be another phenomenal year for the jurisdiction in terms of new captive/(re)insurance company formations," said Ruwan Jayasekera, Head of Insurance Supervision at CIMA.

"CIMA is seeing a shifting trend in new captive/(re)insurance company formations, with more and more companies being formed to assume unrelated and non-traditional risks," he added. Changes made to the main insurance law, supporting regulations and the regulatory framework within the last five years to accommodate sophistication and innovation have had a positive impact on the insurance industry, with insurance groups, intermediaries and hedge-funds in particular choosing Cayman to house their (re)insurance subsidiaries."

"Even with consolidation taking place throughout the healthcare system in the United States by way of mergers and acquisitions, it is encouraging to see the formation of new healthcare captives to write traditional med-mal liability insurance, as well as non-traditional risks, such as cyber risks and medical stop loss," Jayasekera said.

About Cayman Islands Monetary Authority

The Cayman Islands Monetary Authority began operations on 1 January 1997. It was established as a body corporate under the Monetary Authority Law, which was brought into force on that date.  Visit www.cimoney.com.ky.

Top


People News



Tokio Marine HCC Stop Loss Group Announces Johnny Banks as Vice President of Marketing in the Southeast Region

MyHealthGuide Source: Tokio Marine HCC, 9/21/2016, www.tmhcc.com/life

Tokio Marine HCC -- Stop Loss Group is pleased to introduce Johnny Banks as Vice President of Marketing in the Southeast Region.

Johnny Banks brings over 30 years of insurance experience including the last nine years working with Brokers and Administrators placing Medical Stop Loss in the Southeast. Johnny is a graduate of Virginia Tech.

In his new position, Johnny will be responsible for maintaining and enhancing producer relationships, renewing existing business, generating new business and facilitating proposal activity. His territories include Tennessee, Arkansas, Kentucky, as well as parts of Georgia and North Louisiana.

If you have any questions or need additional information, please contact Johnny directly at (770) 693-6423 or jbanks@tmhcc.com. Please send all RFPs and information related to RFPs torfp_southeast@hcclife.com.

About Tokio Marine HCC - Stop Loss Group

A member of the Tokio Marine HCC group of companies. Tokio Marine HCC is the marketing name used to describe the affiliated companies under the common ownership of HCC Insurance Holdings, Inc. Tokio Marine HCC's products are underwritten by American Contractors Indemnity Company, HCC International Insurance Company PLC, HCC Life Insurance Company, HCC Specialty Insurance Company, Houston Casualty Company, Lloyd's Syndicate 4141, United States Surety Company and U.S. Specialty Insurance Company. Contact Tracy Creekbaum at tcreekbaum@tmhcc.com, 770-693-6507, and visit www.tmhcc.com/life.

Top



Cypress Benefit Administrators Expands TPA Team with Laurie Molle, Director of Client Services

MyHealthGuide Source: Cypress Benefit Administrators, 9/7/2016, www.cypressbenefit.com

Appleton, WI -- A third party administrator (TPA) headquartered in Appleton, Wisconsin, with  four additional locations across the United States, Cypress Benefit Administrators has hired Laurie Molle to serve as its Director of Client Services.

Molle's 12-plus years of professional business experience in the health care industry includes her most recent role as Vice President of Operations for a national TPA.

Working from Cypress's Appleton location, Molle will focus on managing the TPA's fast-growing book of business and its internal operations, including heading up the Group Administration, Vendor Relations and Compliance departments at the company.

"Laurie will be an important asset to the Cypress team as we continue to grow throughout the country," said Tom Doney, president and CEO of Cypress. "We are excited to welcome her as she brings such a great base of knowledge and real-world experience in self-funding," he shared. "She is well-known among her previous clients and throughout the industry for her expertise in TPA operations."

Having established her versatile skillset in business over the years, Molle has led the efforts of multiple teams in her previous employment and also has expertise in a wide variety of TPA functional areas, including claim operations, vendor relationships, compliance and client and broker relations.

"I am excited to be part of a firm that is a recognized leader in the TPA industry," Molle said. "I look forward to working with a world-class team of employee benefits professionals at Cypress and contributing to the ongoing growth of the company."

About Cypress Benefit Administrators

A privately held company headquartered in Appleton, Wis., Cypress Benefit Administrators has been pioneering the way toward cost containment in self-funded health benefits since 2000. The TPA is the country's first to bring claims administration, consumer driven health plans and proven cost control measures together into one package for companies ranging from 50 employees to thousands of employees. It serves employer-clients across the U.S. with additional locations in Portland and Salem, Ore., Omaha, Neb. and Denver, Col. For more information on Cypress Visit www.cypressbenefit.com.

Top


Job News


Zurich Seeks Business Development Manager to sell Medical Stop Loss Solutions

MyHealthGuide Source: Zurich Insurance, 9/20/2016, www.ZurichNA.com

Zurich Insurance is currently seeking a skilled and experienced Business Development Manager to sell Medical Stop Loss Solutions for our Specialty Division in our South Region.

As a professional Zurich BDM, you will identify and target specific brokers/consultants and gain a greater depth of business from them across specific product lines. You will partner with the Specialty Health underwriting team to identify strategies for achieving specific sales and retention targets, and in many cases serve as the primary point of contact for escalation of business issues and questions regarding products and services.

This position requires extensive, proven sales experience with Stop Loss and benefit-focused brokers who offer Medical Stop Loss solutions. You must have a strong ability to develop an intimate knowledge of your broker's business model and proposition and be able to create a business plan to assist your brokers in meeting their goals. The nature of this position requires the ability to sell internally as well as externally, which carries with it the demand of superb client service skills, and excellent written and verbal communication skills.

Location of the position is flexible with candidates preferably located within Zurich's Dallas or Houston office locations.

Our Business Development Manager is responsible for:

  • Establishing strong professional relationships with agents/brokers and customers to assure profitable sales production, excellent service, repeat sales and referrals for other customer contacts and production.
  • Collaborating with distribution partners to develop opportunities for Medical Stop Loss coverage and grow our book of Medical Stop loss business.
  • Identifying new sales opportunities.
  • Producing monthly activity/call reports addressing agency visitations, customers meetings, quotations, prospects, leads, sales, field relationships, concerns, issues or problems and monthly sales production reports addressing Sold accounts, renewal activity and lost opportunities.
  • Successfully integrating company products into the distribution network within the region/territory to achieve maximum market penetration and obtain the goals and objectives for the business unit.
  • Works closely with the regional offices, other Zurich Business Units and Profit Centers to develop leads and contacts for business opportunities and cross marketing or product density initiatives.
  • Follows up on calls and/or quotations that have been made to agents/brokers/customers to answer any questions or to close the sales.
  • Acting as a territorial and technical resource for the business unit.

Basic Qualifications

  • 6+ years of sales (OR Underwriting) experience with Medical Stop Loss Coverage
  • Time and Territory Management Skills
  • Ability to travel 50% within the assigned territory including overnight stays

Preferred Qualifications

  •  Bachelor's Degree Preferred
  • Demonstrated ability to execute effective sales strategies.
  • Possess outstanding presentation, negotiation, oral and written communication skills.
  • Demonstrated ability to facilitate critical business relationships with both internal and external stakeholders.
  • Strong understanding of insurance industry from a market and underwriting perspective.
  • Ability to build relationships (external and internal) that can deliver on the Brand Promise, new business sales and retention targets.
  • Strong knowledge of Underwriting parameters, concepts, risks, and hazards.
  • Ability to analyze and understand financial and performance metrics.
  • Ability to identify business trends, changes in market conditions, and competitor activity.
  • Excellent planning and organizational skills.
  • Must be goal oriented and driven by meeting specific performance (goals) expectations.

Qualified applicants may apply @: https://zurich.taleo.net/careersection/zurich_ext_cs/jobdetail.ftl?job=160007C0&lang=en&sns_id=mailto#.V-A7veYO_eM.mailto

EEOE disability/vets.

About Zurich Insurance

Zurich is a Swiss insurance carrier with over 140 years serving businesses worldwide, including 100 years in the United States. We have proven our commitment to delivering reliable and comprehensive insurance solutions to our customers. All of our passion goes into helping understand, manage and minimize risks. Visit www.ZurichNA.com.

Top


IMG Stop Loss Seeks Underwriter Trainee -- Stop Loss

MyHealthGuide Source: International Medical Insurance Companies (IMG), 9/15/2016, www.imglobal.com

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves Global Peace of Mind®

We are looking to grow our team with a qualified Underwriter Trainee -- Stop Loss who shares our energy and enthusiasm.

The Stop Loss Underwriter Trainee will learn to underwrite new and renewal stop loss clients and to work closely with producers to provide excellent service by meeting deadlines, providing accurate quotes, and providing  timely correspondence. In addition to outside producers, this position requires interaction with stop loss marketing, administration, and claims.

Duties and Responsibilities

  • Learn risk assessment and pricing of new business and renewals
  • Learn effective communication with producers and internal marketing staff
  • Learn to develop and maintain strong relationships with outside producers
  • Adherence to company guidelines and polices
  • Learn to evaluate plan documents and amendments

Knowledge Skills and Abilities

  • Background in stop loss insurance
  • Strong risk analysis and mathematical skills
  • High level of accuracy
  • Ability to work with and assist others when needed
  • Ability to communicate effectively
  • Ability to use Excel and Word applications

Preferred Skills

  •  Knowledge of Stop Loss Underwriting
  • Enhanced knowledge of medical conditions and costs

Additional Notes

  • Occasional overtime may be needed especially during the fall busy season.

Perks

  • On site fitness center
  • Casual dress
  • 401k with a 2 year vesting period
  • Short and Long term Disability after one year of employment

Qualified candidates can send their resumes directly to HR@imglobal.com.

About IMG

For more than 25 years, International Medical Insurance (IMG) has dedicated its efforts to providing international medical insurance, travel insurance and impeccable service to the international community.  It's our specialty.  We realize that traveling abroad can be an exciting experience.  We also know that anything can happen while you're away from home - whether visiting short-term or living abroad indefinitely.  It's important to be prepared for any unexpected illness, injury or medical emergency.  Many traditional medical plans simply are not designed for international travel. Visit www.imglobal.com.

Top


IMG Stop Loss Seeks Stop Loss Underwriter

MyHealthGuide Source: International Medical Insurance Companies (IMG), 9/15/2016, www.imglobal.com

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves Global Peace of Mind®

We are looking to grow our team with a qualified Stop Loss Underwriter who shares our energy and enthusiasm.

Duties and Responsibilities

Our Stop Loss Underwriter underwrites new and renewal stop loss clients, and works closely with producers to provide excellent service by meeting deadlines, providing accurate quotes, and providing timely correspondence. In addition to outside producers, this position requires interaction with stop loss marketing, administration, and claims.

  • Risk assessment and pricing of new business and renewals.
  • Effective communication with producers and internal marketing staff.
  • Develop and maintain strong relationships with outside producers.
  • Adherence to company guidelines and polices.
  • Maintain a profitable block of business.

Knowledge Skills Abilities

  • A minimum of 2 years stop loss underwriting experience.
  • Strong risk analysis and mathematical skills.
  • High level of accuracy.
  • Ability to work with and assist others when needed.
  • Ability to communicate effectively.
  • Ability to use Excel and Word applications.

Preferred Skills

  • 5+ years stop loss underwriting experience.
  • Enhanced knowledge of medical conditions and costs.

Perks

  • On site fitness center
  • Casual dress
  • 401k with a 2 year vesting period
  • Health Benefits (Medical, Dental, Rx, Short and Long Term Disability)
  • Tuition reimbursement

Qualified candidates can send their resumes directly to HR@imglobal.com .

About IMG

For more than 25 years, International Medical Insurance (IMG) has dedicated its efforts to providing international medical insurance, travel insurance and impeccable service to the international community.  It's our specialty.  We realize that traveling abroad can be an exciting experience.  We also know that anything can happen while you're away from home - whether visiting short-term or living abroad indefinitely.  It's important to be prepared for any unexpected illness, injury or medical emergency.  Many traditional medical plans simply are not designed for international travel. Visit www.imglobal.com.

Top


Market Trends, Studies, Books & Opinions


Closest Hospital Is Rarely the Best Choice for Price or Quality, Report Shows

MyHealthGuide Source: FairChex, 9/13/2016, FairChex White Paper (full text with graphics)

SHERBROOKE, QUEBEC -- FairChex, a health care provider value measurement tool offered by Global Excel Management, has released a new white paper spotlighting the large differences in cost and quality among hospitals operating in the same regions, sometimes within just a few miles of each other.

"The U.S. health care system has never provided patients the information on cost and quality needed to make informed decisions, which is why we continue to see tens of thousands of patients each year going to more expensive, lower-quality hospitals when there may be far better options operating virtually next door," said Benjamin Tabah, managing director, FairChex.

Without objective data, patients blindly follow the recommendations of their primary physicians, their co-workers -- or even billboards. These practices continue despite broad awareness that preventable hospital errors kill tens of thousands of people each year and that hospitals can charge very different prices for the same procedures.

Particularly large variations in costs can crop up in densely-populated urban areas, where higher costs of living are accepted as a fact of life. But while no one will leave the city to save a dollar on a gallon of milk, the difference in cost for some elective surgeries can be tens of thousands of dollars -- even among facilities that have equal (or better) measured quality outcomes.

The FairChex report, "Closest Hospital Is Rarely the Best Choice," focuses on three common procedures in three different areas of the United States:

  • Coronary bypass (New York) -- Costs to Medicare for this procedure, the most commonly-performed heart surgery, vary by more than $20,000 between high-quality facilities located within New York City and several, such as St. Francis Hospital in Roslyn, NY, and Englewood Hospital and Medical Center in Englewood, NJ, that are within 25 miles of the city.
  • Joint Replacement (San Francisco) -- In contrast to New York City, patients in the Bay Area seeking more affordable treatment options need to go substantially inland for their procedures. However, within 100 miles of the San Francisco city center, three facilities in the Modesto-Stockton corridor offer high levels of quality and cost savings in excess of $5,000 -- potentially large savings for individuals with high co-insurance requirements.
  • Mastectomy (Montana) -- Unlike the first two case studies, Helena, MT, is not a densely-populated place. There is only one option for treatment within the city and it offers some of the lowest quality outcomes for this type of cancer care anywhere in the United States. However, within 100 miles there are two other facilities that offer outstanding care (quality outcomes above the 80th percentile) at virtually the same price.

"Across the U.S. health care system, one of the easiest ways to reduce costs would be to redirect patients from low-quality/high-cost facilities to high-quality/low-cost alternatives," said Tabah. "In the short term, we could save $100 per year per person -- or $25 billion annually -- with that one simple switch. In the long term, the dynamic effects of competition on hospital leadership would lead to better quality and cost of care."

FairChex's quality ratings are based on a comprehensive evaluation of the process of care, patient satisfaction and clinical outcomes. Quality data examines hospitals at the department / clinical category level, to avoid masking low-value departments operating within hospitals with higher values. Cost data examines hospitals at the procedure level based on diagnoses-related group (DRG) codes using the best available data on Medicare reimbursements (inpatient) and/or CPT codes for outpatient procedures.

About FairChex

FairChex meets a profound need for transparency in healthcare by rating hospitals based on their price and quality outcomes -- down to the level of an individual procedure. A subscription-based software platform gives health plan administrators the tools needed to help patients make informed decisions about where they choose to have planned procedures. Each patient who chooses an A/A+ hospital over a C-grade facility (or below) can save a plan more than $10,000 -- while receiving an equivalent or better level of care. Visit www.FairChex.com.

About Global Excel Management Inc.

Global Excel is a full-service cost containment, claims management and medical assistance company located in Canada. It offers a complete range of services to over 300 international, Canadian and U.S. domestic clients located in more than 40 countries around the world. Global Excel manages approximately 105,000 inpatient, outpatient and non-medical cases per year and processes in excess of $850 million in healthcare claims annually. Contact Benjamin Tabah at Benjamin.Tabah@globalexcel.com and visit www.globalexcel.com.

Top


Legislative & Regulatory News



Employer Groups See Mixed Bag in EEOC Wellness Plan Ruling

MyHealthGuide Source: Carmen Castro-Pagan, 9/22/2016, BNA Pension & Benefits Daily

Case: EEOC v. Orion Energy Systems, Inc. Case 1:14-cv-01019-WCG. Court's Ruling (Compliments of BenefitsLink.com)

Employer groups are at odds over what a recent decision by a federal court in Wisconsin on the EEOC's wellness plan regulation will actually mean for the rule and future lawsuits.

A Sept. 19 decision by the U.S. District Court for the Eastern District of Wisconsin allows Orion Energy Systems Inc. to require employees who want to enroll in the company's health-care plan to undergo medical examination or pay full premium coverage. Some are calling it a win for the Equal Employment Opportunity Commission and others are claiming a partial victory for the employer side.

The decision in EEOC is the first to weigh in on a new regulation by the agency that allows employers to offer limited financial incentives to encourage employees to participate in wellness programs without violating federal law.

This is a "mixed result" for employers, Kathryn Wilber, senior counsel for the American Benefits Council in Washington, told Bloomberg BNA Sept. 22. Orion won on the voluntary standard issue, but there should be a concern about the court's application of the safe harbor provision in the Americans with Disabilities Act, Wilber said.

Frank C. Morris, an employee benefits attorney at Epstein Becker Green in Washington, D.C., agrees. "This is a classic split decision," Morris said. Orion "scored a big win" since the court found that its wellness program didn't violate the ADA because it was voluntary despite the fact that not participating in it would mean that an employee would have to pay 100 percent of the health-care premiums, Morris told Bloomberg BNA Sept. 22.

ADA's Safe Harbor Provision

The ADA includes a safe harbor provision related to the insurance industry, which employers have successfully used to contest the EEOC's challenges to the medical examinations they require as part of their wellness programs.

Another federal court in Wisconsin held last year in EEOC v. Flambeau, Inc. (W.D. Wis. 2015) ruled that the safe harbor provision allows employers to design insurance plans that require otherwise-prohibited medical examinations and inquiries as a condition of enrollment in a plan. That case is currently on appeal to the U.S. Court of Appeals for the Seventh Circuit, but it may be dismissed on jurisdictional grounds.

After Flambeau was decided, the EEOC issued regulations on employer-sponsored wellness plans. The regulations provide, among other things, that the ADA's safe harbor provision doesn't apply to medical examinations taken in connection with a wellness program like the ones at issue in this case and Flambeau.

The Orion court said that the EEOC's take on the ADA's safe harbor provision was a "permissible interpretation" of the statute and could be applied retroactively.

Employers' Take on the Safe Harbor Ruling

The EEOC is "no doubt thrilled with the decision--they got almost everything they wanted," James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington, told Bloomberg BNA Sept. 22.

The Orion decision is "the first that really comes from a court that gives some perspective as to the regulation and how the safe harbor applies to these set of facts," Wilber said.

Employers have taken a position that the safe harbor applies and the court essentially ruled that out in this case, she said. The deference the court is giving to the safe harbor provision isn't what employers were hoping for, Wilber said.

Employers that want to assert the safe harbor defense should make sure that their wellness plan is really part of their health plan and that there is evidence that it is used to assist in underwriting, classifying and administering risk under the statutory language and as demonstrated in Flambeau, Morris said.

Voluntary Standard

Medical examinations that are voluntary and part of a health plan don't violate the ADA. This was the rationale used by the court in ruling for Orion.

Some employer groups see this as a win for their side. The Orion decision is a "very strong rebuttal" to the EEOC's final regulation that the limited incentives that employers can provide to participants in wellness plans can't go over 30 percent, Mark Wilson, chief economist at the HR Policy Association in Washington, told Bloomberg BNA Sept. 21.

The EEOC's final regulation provides that if an employer wishes to incentivize or penalize employees' participation, the program remains voluntary if the employer provides a financial incentive at or below 30 percent of the total cost for self-only coverage.

In Orion, the court said that the EEOC didn't argue that this part of the regulation applied retroactively. The EEOC, instead, argued that Orion's program wasn't voluntary, but compulsory, because it shifted 100 percent of the premium cost to an employee who opted out.

The court wasn't persuaded by this argument. "Even a strong incentive is still no more than an incentive; it is no compulsion," the court said. "Orion's wellness initiative is voluntary in the sense that it is optional," the court added.

The Orion court didn't rule on the 30 percent incentive cap in the EEOC's regulation. Moving forward, employers should carefully review the risks of using more than a 30 percent incentive for health plans as this limit is consistent with the Affordable Care Act rules for health-contingent plans, Morris said.

More Lawsuits and Appeals?

The Orion decision is significant because it may be the only one of a trio of cases brought by the EEOC that gets resolved on the merits. Late in 2014, the EEOC brought lawsuits challenging wellness programs at Honeywell International Inc., Flambeau Inc. and Orion Energy.

The case against Honeywell ended when a federal court in Minneapolis denied the EEOC's request to block the company from penalizing workers who didn't participate in a corporate wellness program.

The Flambeau court relied on the Eleventh Circuit decision in Seff v. Broward County, 691 F.3d 1221 (11th Cir. 2012), to uphold the medical examinations required in the employer's wellness plan. In that case, the appeals court said that Broward County, Fla.'s wellness program fit within the ADA's safe harbor provision for insurance plans.

Employer groups believe that more lawsuits will follow. The EEOC will likely ignore the court's decision and will keep bringing lawsuits against other employers, Wilson said.

Asked whether he believed that the EEOC would likely wait until its regulation become effective in January 2017 to bring more lawsuits challenging employers' wellness programs, Morris said yes.

"I think they will wait until 2017 unless they see a case where they allege special circumstances," Morris said.

If Orion is appealed, and upheld on the circuit level, then there is a disagreement between the Eleventh and Seventh circuits, which would be a good reason for the Supreme Court to take up the case, Gelfand said.

The EEOC didn't immediately respond to Bloomberg BNA's request for comments.

Top


Medical News


Getting Pharmacogenomics Into the Clinic

MyHealthGuide Source: Jennifer Abbasi, 9/21/2016, JAMA

Regarding Pharmacogenomics, "Clinical implementation unfortunately has been lagging behind," said Edith A. Nutescu, PharmD, MS CTS, associate professor and director of the Center for Pharmacoepidemiology and Pharmacoeconomic Research at the University of Illinois at Chicago College of Pharmacy.

  • In the results of a nationwide survey by the American Medical Association released in 2012, only 13% of more than 10 000 responding physicians had ordered a pharmacogenomic test in the previous 6 months, although almost all of them--98%--agreed that drug responses may be influenced by genetic variations.

Genotype-guided prescribing--also referred to as pharmacogenetics, or PGx--is expected to become routine as genetic profiling becomes more commonplace.

"[I]t is likely that a time will come in the near future where patients will start to demand the use of such information during care--that they will ask of their physician, ‘Have you considered my genomics?' before accepting a prescription," said Peter H. O'Donnell, MD, associate director for clinical implementation at the University of Chicago's Center for Personalized Therapeutics.

In the meantime, major efforts are under way to prove that pharmacogenomic tests have clinical utility and to make it easier for physicians to choose these tests and interpret and act on the results, translating them into better outcomes for their patients.

How Does Pharmacogenomics Work?

"Genetic variability affects essentially every single gene in the human genome and sometimes it's going to affect genes whose proteins are critical for drug response," said Mary V. Relling, PharmD, chair of the pharmaceutical sciences department at St Jude Children's Research Hospital.

Most so-called pharmacogenes encode drug-metabolizing enzymes, and each individual's genotype for a particular gene can be categorized into 1 of 5 phenotypes that describe the enzyme's activity--ultrarapid metabolizer, rapid metabolizer, normal metabolizer, intermediate metabolizer, and poor metabolizer--Nutescu explained.

Other genes encode the enzymes that are the site of action where drugs exert their effects; patients with variations in these genes may be more sensitive or resistant to certain drugs than normal.

Knowing this information can help clinicians choose the right medication or dose for a patient.

A patient who has a genetic variant associated with slow metabolism of the drug thinner warfarin, for example, might experience major bleeding on a standard dose. In contrast, a patient with a variant associated with fast warfarin metabolism might not get any benefit from the standard dose, putting them at greater risk of a major stroke or thromboembolism.

"Warfarin is consistently among the top 10 medications that leads to hospitalizations due to adverse events," Nutescu said. "Drugs that are more prone to side effects, complications, hospitalizations, [and] resource use, clearly should be on the radar."

By screening for variants in the 2 genes that influence warfarin metabolism and sensitivity, CYP2C9 and VKORC1, respectively, a physician can adjust the dose to optimize treatment and prevent an adverse event.

"The goal is to avoid trial and error, to make patients safer, and to increase the chance for effectiveness when they start a medication," O'Donnell said.

Advocates of pharmacogenomics say the field is an emerging resource for improving patient safety. Since 2012, more than 1 million adverse drug events have been reported each year to the US Food and Drug Administration (FDA), "many of which might be preventable using PGx testing," Geoffrey S. Ginsburg, MD, PhD, director of the Center for Applied Genomics and Precision Medicine at Duke University Medical Center, said in an email.

Pharmacogenomics may also help inject more science into the art of prescribing. Mark A. Frye, MD, professor and chair of the department of psychiatry and psychology at the Mayo Clinic, believes the technology has the potential to transform antidepressant treatment for major depressive disorder, multiple anxiety disorders, and some chronic pain conditions.

  • Up to a third of patients with major depression do not fully respond to antidepressant treatment, Frye said, and many experience serious adverse effects. In a recent article on psychiatric pharmacogenomics published in Mayo Clinic Proceedings, Frye and coauthors wrote that "[i]t is increasingly recognized that genetic variation may contribute to this differential risk to benefit ratio."

Frye added that clinical research is needed to better understand what level of value genetic testing adds for patients seeking treatment for depression. "Value added can mean many things--getting better faster, complete remission of symptoms, less side effect burden, better quality of life, [and] less hospital cost are only a few examples," he said.

Building A Case

According to a 2015 Nature review article that Relling coauthored, drugs currently known to be affected by "actionable" inherited pharmacogenes represent around 7% of FDA-approved medications and 18% of US outpatient prescriptions. In addition to antidepressants and blood thinners, these drugs include, antivirals, chemotherapy agents, immunosuppressants, pain relievers, and statins, among others, making the field of pharmacogenomics relevant for precision medicine in a variety of medical specialties.

"It is my view that someday--probably not far in the future--we will look back on the idea of treating all patients who have the same ‘disease' with the same drug as a simply archaic practice," O'Donnell said in an email.

Despite the promise of pharmacogenomics, physician uptake has been slowed by a lack of implementation guidance and clinical and outcomes data.

The FDA has included pharmacogenomic information on the labels of more than 150 medications. But some of these do not translate the genetic test results into specific prescribing actions, Relling said.

To help advise physicians, the international, nonprofit Clinical Pharmacogenetics Implementation Consortium (CPIC) has written guidelines for gene-drug pairs that the group believes have sufficient evidence from randomized controlled trials and other clinical studies to influence prescribing.

The CPIC--a joint project between the National Institutes of Health's Pharmacogenomics Research Network and the online Stanford-hosted Pharmacogenetics Knowledge Base (PharmGKB)--has identified more than 300 gene-drug pairs of interest. Relling, who coleads CPIC, said that about half of those will have actionable prescribing based on genetics. So far, the group, which focuses on inherited genomic variations, has released clinical practice guidelines for 13 genes affecting the response to more than 30 drugs.

A handful of clinical research institutions in the United States have begun implementing pharmacogenomics testing. "These demonstration projects are creating a path for more widespread implementation and a toolbox for the broader community to use," Ginsburg said.

In 2010, Vanderbilt University launched blood panel-based preemptive pharmacogenetic testing to screen patients for a group of actionable genetic variants based on the likelihood of needing the information in the future. A study of Vanderbilt's current testing panel found that 91% of almost 10 000 genotyped patients had at least 1 of 14 variants associated with 5 gene-drug interactions.

Nevertheless, Muin J. Khoury, MD, PhD, director of the Office of Public Health Genomics (OPHG) at the Centers for Disease Control and Prevention, said that for most gene-drug pairs, more outcomes data are needed to justify routine testing outside of a research setting.

His office has identified a handful of non--cancer-related pharmacogenomic tests that have enough synthesized evidence to support routine clinical implementation. These include tests for gene variants associated with the HIV drug abacavir, the epilepsy drug carbamazepine, and the cystic fibrosis drug ivacaftor, for example.

However, for most pharmacogenomic tests, clinical utility--the balance of benefits and harms in practice--hasn't been sufficiently established yet, Khoury said. As an example, pharmacogenomic tests for gene variants associated with warfarin responsiveness fell among those OPHG concluded did not have enough evidence to support routine use in clinical practice.

Although some experts in the field say OPHG's standards for evidence are too high, a push is under way to develop more outcomes evidence to support broader pharmacogenomic testing.

"Within the pharmacogenetics community we're really trying to focus on… build[ing] the evidence for that last step that proves the clinical value of doing these things," said Julie A. Johnson, PharmD, dean and distinguished professor at the College of Pharmacy at the University of Florida.

Johnson leads a project in the NIH-funded Implementing Genomics in Practice (IGNITE) network. Out of 6 IGNITE projects--all based in academic medical centers--3 are focused on pharmacogenomics implementation. Johnson's team is tracking implementation metrics, such as test adoption rate and drug therapy changes initiated after test results, as well as clinical outcomes.

Last year, she presented data from University of Florida's IGNITE project at the annual American Heart Association (AHA) meeting showing that genotype-guided clopidogrel therapy reduced cardiovascular events after angioplasty and stent placement. Among patients with a loss-of-function genotype that leads to reduced clopidogrel effectiveness after these procedures, those who switched to a different antiplatelet therapy after the procedure had a reduced risk of major adverse cardiovascular events compared with patients who continued taking clopidogrel.

Data on a approximately 4500 patients from a larger multicenter trial that includes the University of Florida cohort will be presented at this year's AHA meeting in November. "If those data turn out the way our data turned out in the cohort at University of Florida, that has a potential… to be the kind of evidence that might be needed for more people to embrace that approach," Johnson said.

Barriers To Entry

Additional challenges stand in the way of pharmacogenomics implementation. Physicians say they need tools to help them understand and use the tests.

"Just because you make the test available, it doesn't mean that your providers are able to interpret the test results and are able to integrate it at the bedside," Nutescu said.

O'Donnell added, "Decision-support--in other words, guidance about how to use genomic information--is needed for prescribers who will be increasingly encountering pharmacogenomic results for their patients, because most clinicians in practice have not been formally trained in genomics."

To that end, the IGNITE website offers a toolbox of resources for health systems and clinicians, such as example clinical decision support alerts for electronic health record (EHR) systems and test result decision tables.

The CPIC is currently updating the existing guidelines to provide more computational tables and data that can be directly uploaded into EHR systems to facilitate implementation of genetic testing. Relling was part of a CPIC group that recently published standardized pharmacogenomics terms in Genetics and Medicine that can be interpreted exactly the same way across all EHR systems.

Pharmacogenomics leaders say that a lack of reimbursement for genetic tests is another huge challenge that cannot be underestimated. The Centers for Medicare & Medicaid Services does not cover panel-based testing, which Johnson said is often the most cost-effective and logical approach to pharmacogenetics-guided treatment.

"Even though the cost of genetic tests is coming down all the time, somebody has to bite the bullet and pay for that test, and we just don't have a health care system that's geared toward doing that at this point," Relling said. Johnson believes that clearing up reimbursement issues would be one of the fastest ways to get doctors to embrace pharmacogenomic testing.

Some say the change can't come soon enough. "PGx is the leading edge of genomic medicine," Ginsburg said. "Providers who are not at least thinking about how to incorporate PGx into their practices might find themselves behind the curve in the next 3 to 5 years as the evidence accumulates and practice guidelines adopt this area [of] genetics in the clinic."

Top


Recurring Resources



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

Source:  MyHealthGuide

Editor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.
Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and update is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital/Equity
(Millions)
1 CIGNA     $2,701
2015
 
  Source - CIGNA Financial Supplement 2015, P.5 12/31/2015
2 Sun Life Financial > 30 Years   $1,155
2015
 
  Source - Sun Life Financial, Financial Planning and Analysis department (8/8/2016)
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A+)
$907
2015
$29,700 as part of Tokio Marine Group
  Source - Ketrice Williams, 5/6/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$807
2015
$396
12/31/2015
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$751.4
2015
$588
12/31/2015
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
$728
2014
$3,360.6
12/31/2014
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
10/8/2014
 
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
3/31/2016
 
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $253
2/1/2016
 
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
10 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
11 Munich Re Stop Loss, Inc.   American Alternative Insurance Company (AAIC),
TransAmerica
$147
2015
 
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
2015
$1,200
  Source - Lauren Woods, VP Marketing Fairmont Specialty, 1/4/2016
13 The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$104
12/2014
 
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
2016
$6,800
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
15
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
  Source - Mark Nichols , Managing Director.  7/20/2012

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

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

Stop-loss Premium Volume is not the Whole Story

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

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

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

Top



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.

Top



Video Highlighting Captive Solutions for Mid-market Companies

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

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

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

About SIEF

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

Top


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. The new ICD-10-CM Trigger list is endorsed by SIIA and HCAA and supported by SPBA.  

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

Top


Upcoming Conferences


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

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

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

Top


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

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

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

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

Schedule and registration: www.hcaa.org/?page=2017EFSchedule

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

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

March 28-30, 2017
Self-Insured Health Plan Executive Forum presented by The Self-Insurance Institute of America. www.SIIA.org

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

May 16-18, 2017
Self-Insured Workers' Compensation Executive Forum presented by The Self-Insurance Institute of America. www.SIIA.org

October 8-10, 2017
37th Annual National Educational Conference & Expo presented by The Self-Insurance Institute of America. www.SIIA.org

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

Top


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®
  • Should you stop receiving the Newsletter, here are some items to check:

    •  Is the Newsletter email in your junk or spam folder?
    •  Have your IT team "whitelist" sender (Clevenger@MyHealthGuide.com)
    •  Provide another email address.
    •  Access the Newsletter online at www.MyHealthGuide.com/news.htm.

    Our email servers inactivate an account (email address) after three successive failed attempts to deliver the Newsletter. Failures to deliver occur when your email server "bounces" our Newsletter because your server views our email as spam because of anatomical terms often referenced in our "Medical News" section and for other reasons.

Top


Clevenger Ernie Clevenger
President & Publisher
MyHealthGuide, LLC
Clevenger@MyHealthGuide.com