MyHealthGuide Newsletter
News for the Self-Funded Community
7/6/2015

Published weekly by MyHealthGuide, LLC (www.MyHealthGuide.com). This Newsletter is for personal, non-commercial use only.  This weekly newsletter is FREE OF CHARGE to subscribers.  Subscribe free. Send news, press releases and announcements to mailto:Info@MyHealthGuide.comClick here if Newsletter stops arriving.

TABLE OF CONTENTS

 

General & Company News

People News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News



Global Excel Management Acquires Olympus Managed Health Care

MyHealthGuide Source: Global Excel Management Inc., 6/30/2015, www.globalexcel.com

Global Excel Management Inc. is pleased to announce our recent acquisition of Olympus Managed Health Care Inc., and its associated companies, Olympus Healthcare Solutions México SA, ChoiceNet International México SA and Healthcare Concierge Services Inc.

With this acquisition, Global Excel reinforces its position as the leading supplier of cost containment, claims management and medical assistance services in the industry. Both organizations feel that the synergies experienced with this fusion will bring benefits on domestic and international levels.

According to Steven W. Jacobson, Chairman, CEO and Founder of Olympus, "In the process of planning strategic position we considered a sale of the company. The only way we would consider a sale was upon the condition that the buyer would need to be in a position and have the ability to continue, not only the aggressive growth, but also sustain the values we had created. Ironically it was in a key competitor that we found the capacity and drive that would satisfy these significant conditions. The combination of our network management, our strength in the destination and expat markets and our position as market leader in Latin America market along with Global Excel’s history of experience in complementary skills and markets, made it evident they were an ideal purchaser. I am confident and pleased that we have been acquired by a company who will ensure the legacy of Olympus continues for its clients and employees."
 
Reg Allatt, CEO of Global Excel, adds, "Olympus was a very natural fit for Global Excel. Each organization has strengths which will complement each other perfectly. The response from clients and employees from each group has been overwhelmingly positive. We were very pleased that Olympus, CNI and HCS trusted our reputation for being client oriented, innovative and performance focused. We’re very confident that together we’ll be able to provide significant added value to existing and new clients. More importantly, we found that the core values in Olympus were the same as ours, and that included a very strong focus on our respective employees. In the future, Global Excel will continue to concentrate on our corporate objective of both horizontal and vertical expansion, both through profitable organic growth and qualified targeted acquisitions."

"Over the next few months the goal of both management teams will be to continue providing the highest level of service to our respective clients. We’ll be focusing on identifying those synergies which will bring added value to existing clients and allow both Olympus and Global Excel to extend their service offering to new markets and clients. We look forward to a long and mutually beneficial relationship with our new colleagues at Olympus, CNI and HCS.
If you have any questions or comments, please don’t hesitate to contact us, " says David O’Connor, President, Global Excel Management Inc.

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 John Spears, VP Business Development and Marketing, at john.spears@globalexcel.com and visit www.globalexcel.com.

About Olympus Managed Health Care Inc.

Olympus Managed Health Care Inc. is the leading independent provider of health care claims administration and cost containment services. Since its inception in 1994, Olympus has focused exclusively on facilitating access to health care on behalf of its health care clientele. Olympus' products and services focus on bringing value to the payer, medical provider, and health care consumer. Olympus is an ISO 9001:2008 Certified Company, has over 60 clients located in 90 countries, and will process approximately $415 million in healthcare claims annually.

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Self-Insurance Educational Foundation Presents Self-Insurance Executive Summit in London with Special Lloyd's Tour - Sept 14-16

MyHealthGuide Source: Self-Insurance Educational Foundation (SIEF), 7/1/2015, SIEF London Conference

London has long been the center of the global insurance marketplace, so the Self-Insurance Educational Foundation (SIEF) is pleased to use this location for a special educational and networking event designed to help attendees better understand how self-insurance strategies continue to be shaped by trends and developments on a worldwide basis.

Join senior industry executives from the United States, the United Kingdom and other major insurance marketplaces as we share knowledge and facilitate important professional connections in this historic city.

Scheduled for September 14-16, 2015, the event features top industry speakers, multiple networking events and special tour of Lloyd's of London.

Conference Agenda

  • Monday, September 14, 2015
    • Welcome Reception
  • Tuesday, September 15, 2015
    • Networking Breakfast
    • The State of the London Market - Colin Bird, Chairman & CEO, Besso Insurance Group Limited
    • The Future of Health Care Reform in the United States - Michael Ferguson, President & CEO, Self-Insurance Institute of America, Inc.
    • Captives and Their Growth in the Work Comp and HealthCare Market - Gary Osborne, President, USA Risk Group
    • PPACA/US Health Market -- Opportunities for Risk Takers - Tony Plampton, President, Re-Solutions, LLC
    • Going Globally Medical - Jason Woods, Business Development Manager of International Accident & Health, Advent Underwriting Limited -- Syndicate 780
    • Solvency II -- What It Is and Why it Matters to Companies on Both Sides of the Atlantic - Ciarán Healy ACCA, ARM, Willis Captive Practice, Willis Group, Willis (Ireland)
  • Wednesday, September 16, 2015
    • Tour of Lloyds

The host hotel for the SIEF Self-Insurance Executive Summit is Apex City of London Hotel. Hotel reservations must be made directly with the hotel. The SIEF group rate is £255.00 Single. Rate includes full English breakfast and 20% VAT. Early reservations are strongly advised. The room block for the special group rate ends July 15, 2015. Reservations made after July 15, 2015 will be made on space and rate availability basis only.

About SIEF

The Self-Insurance Educational Foundation (SIEF) is affiliated with the Self-Insurance Institute of America, Inc. (SIIA).  Call  800-851-7789 and visit www.siia.org.

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People News



EBMS Seeks Director of Account Management for Billings, MT Office

MyHealthGuide Source: EBMS, 6/24/2015, www.ebms.com

EBMS is an industry leader providing administrative services to corporate employee benefit plans throughout the United States. We are currently seeking a Director of Account Management to oversee the strategic and operational direction of the Account Management team. Key responsibilities include coaching staff in achieving revenue growth targets and client retention goals while ensuring a high quality customer experience. The ideal candidate will demonstrate a high level of expertise in leadership and third party administration to deliver a high level of service, quality performance and production.

Ideal candidate must have a Bachelor's degree in a related field with a minimum of eight years of experience in management and third party administration account management experience. The position requires travel up to 50% of the time. Qualified, interested candidates are encouraged to apply online at www.ebms.com

EBMS is an EEO/AA/M/F/Vet/Disability Employer

About EBMS

EBMS is one of the nation's premier industry leaders in health risk management and third party administration of self-funded health benefit plans, designing strategies to transform the health and wellbeing of individuals, organizations and communities. Throughout the past 33 years, EBMS has thrived and excelled within the very challenging landscape of change in the healthcare marketplace. In contrast to insurance companies, ASO carriers, and other third party administrators, EBMS creates unique solutions that can be tailored to meet the specific needs of our clients, including your organization, allowing for greater flexibility and customization.  Visit www.ebms.com.

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Market Trends, Studies, Books & Opinions



Beating Medical Trend - Managed Care vs Reference Based Pricing

MyHealthGuide Source: Bill Rusteberg, 7/2015, RiskManagers.us White Paper

The Problem

Medical inflation continues to rise. Facing rate increases year after year, plan sponsors, with their financial backs to the wall, have historically resorted to cost shifting. These continued failed attempts to control costs have driven some to seek alternate means to restore pricing sanity to health care. To many, the cost of health insurance can mean the difference between profit and loss.

Understanding the cost of health care is directly related to what we agree to pay; more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time. Secretive contracts between health care givers and third party intermediaries contain provisions that guarantee continuous and systematic cost increases. Shared savings side agreements and other schemes found in the health industry economic chain help fuel raging health insurance costs.

Known as medical trend, cost increases have proven to be consistent and predictable. The expected rise in the cost of medical services over time is expressed as an annual percentage increase and is an important element in underwriting future risk. Medical trend is a dominant cost driver in rate making. The annual compounding effect can double or triple health care costs over time.

"For managed care plans, the medical care inflation part of trend is a function of the changes in provider reimbursement rates that are negotiated. To the extent that such negotiations entail factors such as outliers and provider bonuses, the trend rate may be materially more than simply the weighted average increase in fees." Kevin Gabriel, MBA, FSA, MAAA, Chief Actuary of Sierra Berkshire Associates, Inc.

The Solution

Moving away from managed care contracts, more and more employers are embracing a myriad of reference based pricing models. These models can vary in scope and reach; however all share certain common characteristics in conformance with prudent business practices. Price transparency and claim benchmarking are key elements.

In 2007 -- 2008 we approached several of our clients to suggest something different to control costs. The concept was simple. Eschew managed care contracts in lieu of claim benchmarking off multiple data points such as Medicare reimbursement rates. Removing managed care contracts, i.e, PPO, and paying providers quickly, fairly and directly had an immediate impact on claim costs.

After 15 months we performed a study by running 100% of claims back through the prior PPO network reimbursement rates. This exercise proved a net savings of 43% above and beyond the PPO discounts we would have otherwise experienced. Instead of doing the same thing year after year, our client did something different and it worked.

It has been seven years since our first client exited the managed care world. Subsequently more clients have embarked on the same journey, most with equally good results. None have returned to the world of managed care.

The Evidence

Skeptics may ask "How have your clients fared over time? Have they won the battle against medical trend?" The answer may be found by reviewing the experience of four of our clients who have been on a reference based pricing model for five years or more.

Our study is based on actual paid, mature medical claims through succeeding plan years starting in the first year on reference based pricing benchmarked off the prior year under a managed care plan. All claims above stop loss levels have been excluded.

This abbreviated analysis does not recognize changing demographics and plan changes. For example the leveraging effect of higher deductibles will increase trend factors. Of particular importance it should be noted that plan changes occurred in each case through improved benefits supported by prior year claim savings. This study includes medical claims only.

One must understand that medical trend is just one of the factors used to calculate renewal rates for health plans and stop loss insurance. Each year carriers set their own trend level based on various factors, including the current health care inflation rate, analysts’ forecasts and their own experiences. However, our clients are self-funded and thus bear most risk with actual trend directly affecting costs without the benefit of pooling to any significant degree.

"Over the past several years, trend rates have consistently run 8-10% nationally, though certain regions have seen significantly higher or lower figures. Prescription drug trends (which are a component of this) have been more volatile. In the early 2000’s these trends were above 15%. They then fell back to single digit levels. But they have now returned to the teens,"  said Gabriel.

In comparing our client’s experience with average medical trend, we relied upon Heffernan Benefit Advisory Services -- 2013 Trend Report; Historical Trend Factors. Based on this report, we are using 9.615% as average annual medical only trend factor.

Political Subdivision -- 400 Employee Lives

This case has been on RBP for 7 years. They experienced poor claim years in 2010 and 2012. In 2012, for example, there were 14 large claims that approached or exceeded $125,000. Medical PEPM for 2014 and 2015 (to date) is less than 2008. Benefits have been improved; no deductible or co-insurance features with all benefits subject to co-pays only. Funding increase over seven years has been 15.6% or 2.23% per year.
Political Subdivisoin

Public School District -- 900 Employee Lives

This case has demonstrated a consistent downward claim trend. Current PEPM (2015) is less than 2008-2009. No benefit reductions. Some benefit improvements. Plan funding has remained essentially static for the past five years.

Public School District

Medical Industry -- 280 Employee Lives

Plan year 2012-2013 experienced an outlier year with several large claims and 34 pregnancies. Current medical PEPM is 16% higher than under managed care plan in 2008-2009, representing a 2.66% increase per year (sans outliers). This illustrates that higher utilization and outlier claims will result in increasing cost which would occur under either managed care or RBP model. However, RBP trend factor continues below industry benchmarks.

Medical Industry

Retail Business -- 818 Employee Lives

This case has consistently been well below medical trend. Current medical PEPM is significantly lower than plan year 2008-2009. This case has not raised plan contributions in seven years.
Retail Business

Conclusion

Managed care has failed. Medical costs continue to soar. Providers are charging more and we continue to agree to blindly pay up through secretive contracts negotiated by vested interests. Medical trend has, and continues to be, consistently at double digits or close to it.

Cost plus insurance / reference based pricing is a proven method to maintain and even improve comprehensive coverage while at the same time keeping costs reasonable, predictable and consistent. Industry sources estimate reference based pricing plans represent 10% market share and rising. An east coast hedge fund, seeking opportunities in reference based pricing models, predicts reference based pricing will gain 60% market share within the next five years.

"What moves things is innovation. But it's not easy to innovate in stagnant, hyper-regulated, captured sectors" - Max Borders ( www.fee.org ) Cost shifting under the Affordable Care Act will continue to fail to control costs.

Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market.

Plan sponsors can reasonably expect to reduce their health care costs below medical trend without benefit reductions or cost shifting of any kind.

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Self-funded Health Plans: A New Challenge for Hospitals

MyHealthGuide Source: Emily M. Scott, 6/29/2015, Hirschler Fleischer Attorneys at Law

Editor's Note:  A view of self-funding from the perspective of a hospital advocate.

Hospitals should be on the lookout for a new trend in the continuing battle over healthcare costs: employers with self-funded health plans who simply refuse to pay the hospital’s charges.

These self-funded plans typically do not have a provider contract with the hospital to set the price of goods and services--and employers are leveraging third-party administrators (TPAs) to tell the hospitals what the employer will pay.

The rise of the self-funded employer plans

Traditionally, employers offer health care coverage through a commercial insurance company, which collects insurance premiums and pays members’ bills for covered services. Because of their size and bargaining power, insurance companies can secure more favorable rates for the goods and services hospitals provide to their members.

Some midsized employers, however, are opting to establish self-funded plans in lieu of contracting with commercial insurers. Rather than paying premiums to an insurance company, employers set aside funds to pay employees’ medical bills themselves.

The role of third-party administrators

Issues arise when it comes time to determine the price for hospital goods and services. Lacking a contractual agreement, hospitals routinely charge patients enrolled in these self-funded plans according to the prices listed on the hospital’s chargemaster--the hospital-specific, comprehensive price directory of goods, services and procedures that can be billed by the facility. Because chargemaster rates are higher than most negotiated contract rates, employers with self-funded plans often hire third-party administrators (TPAs) to analyze hospital bills and assign re-priced costs--much lower than the chargemaster rates--to each service and supply. The employer then pays the hospital at the re-priced cost determined by the TPA, calling it "reasonable" payment for the hospital’s services.

These payments typically cover only a fraction of the patient’s total hospital bill. Hospitals then find themselves in the position of billing the employer, the patient, or both, to recoup the balance of the patient invoice. When the patient refuses to--or cannot--pay the balance, the delinquent bills are turned over to collections agencies. Notably, many TPAs also assist balance-billed employers or employees with collections activity and/or the resulting lawsuits. These lawsuits can be costly for hospitals in terms of reputational damage and legal expenses.

How hospitals can protect themselves

Hospitals can--and should--take steps from the beginning of the clinical encounter to manage billing and collection for patients with self-funded health plans. These include:

  • Make sure hospital admission paperwork is clear regarding the patient’s financial responsibility and that admission personnel are well versed in advising patients of their responsibility.
  • Ask patients if they have a self-funded health insurance plan--and be able to explain what that means.
  • Keep a list of area employers with self-funded plans.
  • When possible, give patients who may be balance-billed a preliminary, non-binding cost estimate.
  • Allow affected patients the opportunity to view the chargemaster if requested.

About the Author

Emily M. Scott is a partner in Hirschler Fleischer’s Richmond office. Her commercial litigation practice focuses primarily on assisting healthcare providers with contract matters, business torts, employment disputes, and hospital staffing issues, including credentialing, peer review and bylaw compliance. She can be reached at 804.771.9593 or escott@hf-law.com.

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Legislative & Regulatory News


Supreme Court Will Rule Whether ERISA Preemption Shields a Self-funded Health Plan from Vermont's Requirements to Report Health Claims Data

MyHealthGuide Source: Todd Leeuwenburgh, 7/1/2015, Thompson Blog and Supreme Court Certiorari

The U.S. Supreme Court will decide whether ERISA preemption shields a self-funded health plan from state requirements to report health claims data. The court agreed June 29 to hear Gobeille v. Liberty Mutual Ins. Co. (2015 WL 2473478).

The state of Vermont is appealing the 2nd U.S. Circuit Court of Appeals’ ruling in Liberty Mutual v. Donegan, 746 F.3d 497 (2nd Cir., 2014), that the state law could not be applied to compel Liberty Mutual to report its plan data. The High Court granted certiorari to address the following question: Whether ERISA preempts Vermont’s reporting mandates insofar as they require self-insured plans governed by ERISA to submit data about claims paid under the terms of the plan.

Starting in 2008 under the Vermont Health Care Uniform Reporting and Evaluation System, Vermont required health care providers and all public and private health care payers (including insurers, government programs and TPAs) to provide claims data and related information to the State’s health care database.

The statute creates, and provides for the maintenance of a unified health care database containing claims data and other health care-related data. The state uses the data to: evaluate health resource capacity; identify health care needs; develop programs to improve patient outcomes; rein in costs; and promote quality and affordability of health services in the state. Penalties for knowing and willful failure to comply can be as much as $10,000 per violation.

Do State Assessments Conflict with Core ERISA Goals?

Liberty Mutual is litigating in its role as sponsor of a self-insured health plan for its employees in the state. It sued after Vermont subpoenaed its TPA for the required records.

In February 2014, the 2nd Circuit ruled that ERISA preemption applied because:

  1. the Vermont law created a new complex state requirements for ERISA plan administrators;
  2. the plan sponsor suffered an injury-in-fact as a result of Vermont’s reporting law and rules; and
  3. the state’s law and rules had "connection with" ERISA plans, because "reporting" is a "core" ERISA competency.

Alfred Gobeille, chairman of the Green Mountain Care Board (the state agency that takes care of the health care database’s responsibilities), filed a writ of certiorari in August 2014 to overturn the appeals court’s ruling. Liberty Mutual filed a brief in opposition, to which Gobeille replied in November 2014.

In the reply brief, Gobeille argued that the 2nd Circuit’s ruling was drastically out of step with other circuits, and failed to give proper weight to an amicus brief arguing against preemption filed by the U.S. Department of Labor, the federal agency that administers ERISA. DOL argued in its brief that the state’s reporting and evaluation system "does not relate to ERISA plans in any way that dictates benefit choices or interferes with plan administration or structure."

"The federal government, seven states, another court of appeals, and the dissenting judge below all disagree with the 2nd Circuit’s sweeping expansion of ERISA preemption. Nothing short of clarification by this Court will resolve this confusion," Gobeille argued in his reply.

Sixteen states are developing similar databases to which all payers must report, and the 2nd Circuit’s holding creates "a gaping hole" in those databases, by cutting out data for tens of millions of Americans covered by self-insured plans, according to Gobeille’s brief. Because most Americans who receive health insurance coverage from their employers are covered by self-insured plans, "an all-payer claims database that omits self-insured plans cannot be considered accurate or comprehensive."

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Medical News


Trauma, PTSD May Raise Women's Odds of Heart Attack, Stroke

MyHealthGuide Source: Jennifer A. Sumner, epidemiologist at Columbia University's Mailman School of Public Health in New York City, et al,  6/29/2015, Circulation Abstract and Steven Reinberg, 6/29/2015, HealthDay Reporter

Women who have been through a traumatic event or developed post-traumatic stress disorder (PTSD) face an increased risk of heart attack or stroke according to a study published in the journal, Circulation.

The study reviewed data from 49,978 women who took part in the Nurses' Health Study II. Trauma exposure and PTSD symptoms were assessed using the Brief Trauma Questionnaire and a PTSD screen.

Study findings

  • For women with severe PTSD, there is a 60 percent higher risk of heart attack or stroke compared to women who hadn't experienced any trauma.
  • The risk was increased 45 percent for women who experienced a traumatic event but didn't develop PTSD.

Researchers advise that while this study found an association between trauma and a higher risk of stroke and heart attack, it wasn't designed to prove a cause-and-effect relationship. It's possible that other factors may explain the increased risk.

Symptoms of PTSD include: avoiding reminders of the trauma; having nightmares or flashbacks of the trauma; having trouble sleeping; being irritable; or startling easily.

PTSD is twice as common in women as in men. Approximately one in 10 women will develop PTSD in their lifetime," researchers noted. "Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men."

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Recurring Resource


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

MyHealthGuide Source: MyHealthGuide

Editor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.

Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter

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

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

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

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

Stop-loss Premium Volume is not the Whole Story

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

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

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

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The Value of Self-Funding

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

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

About the SIEF

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

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Upcoming Conferences


July 15-17, 2015
TPA University 2015 presented by Health Care Administrators Association (HCAA). HCAA's 2015 TPA University.  Theme  is "Self Funding: Winds Of Opportunity." Opening Keynote on Wednesday, July 15th - Michael Hoffman, Being #1 On Purpose - How to be a Catalyst for the Winds of Opportunity.  With much of health care is still manual (We still rely on FAX MACHINES!), approaches and attitudes toward the quality of communication must be updated.  Learn game changers to be the catalysts of progress in the winds of opportunity. Swissotel Chicago.  Information and registration: www.hcaa.org/?2015TPAU

July 21-23, 2015
MCIA Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA). Features key captive regulators, captive owners and leading service providers addressing a variety of timely educational topics. The conference also serves as the premier networking event for those doing captive insurance business (or would like to) in the growing Montana captive domicile. Lodge at Whitefish Lake in Whitefish, MT. Sponsors: Shane Byars at 866/388-6242, or via e-mail at sbyars@mtcaptives.org. Contact mcia@mtcaptives.org and visit www.mtcaptives.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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Editorial Notes, Disclaimers & Disclosures


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