MyHealthGuide Newsletter
News for the Self-Funded Community

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General & Company News

People News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

Symetra Celebrates 40th Consecutive Year as Medical Stop-Loss Leader

MyHealthGuide Source: Symetra Life Insurance Company, 1/25/2016,

BELLEVUE, WA -- In 2016, Symetra Life Insurance Company is celebrating its 40th anniversary as a medical stop-loss provider. A stop-loss pioneer and industry leader, Symetra has built one of the largest medical stop-loss operations in the country.

To help mark the historical milestone, Symetra created a dedicated anniversary website -- 40 Years of Stop Loss -- which includes a timeline of key events in the employer-sponsored health care industry, educational tools and resources for benefit brokers and employers, and a section inviting self-funding industry participants to share their stories. In late spring, the company will expand its digital Benefits administrative platform, GroupOnline (GO), to include stop-loss services in addition to existing group life and disability capabilities. The new enhancement will improve the ease of doing business with Symetra for benefits brokers, third party administrators and employers via a secure online experience.

"At Symetra, we are very proud of our legacy of doing business with integrity and transparency. We entered the medical stop-loss market in 1976 in response to ERISA, which allowed groups to self-fund their medical plans for the first time. Our product was designed as a creative, cost-effective solution that provided financial peace of mind for these new, self-funded groups," said Michael Fry, executive vice president of Symetra's Benefits Division. "Forty years later -- with a demonstrated service, underwriting and claims management expertise -- we remain committed to helping employers meet the challenges of a complex and evolving health care environment."

Medical stop-loss insurance protects companies that self-fund their health insurance plans against large or catastrophic claims. Employers with stop-loss insurance are reimbursed for individual employees' medical costs above a certain pre-determined dollar amount. Stop-loss insurance also protects against unexpectedly large amounts of total medical claims. Symetra also offers group life and disability, absence management, critical illness and accident insurance as well as supplemental medical and gap insurance that can be paired with administration for self-funded minimum essential coverage (MEC) plans.

About Symetra

Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation (NYSE: SYA), a diversified financial services company based in Bellevue, Wash. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent agents and advisors. Contact Diana McSweeney, Media Relations Manager, at and visit


HMA Unveils New Website and Member Portal

MyHealthGuide Source: Healthcare Management Administrators (HMA), 2/1/2016,

Bellevue, WA -- Healthcare Management Administrators (HMA) proudly revealed creative and strategic improvements to their website and member portal. The new website features: a Pacific Northwest look and feel, user-friendly navigation, responsive design for easy viewing on smartphones, tablets, and computer screens of any size, and a strong member focus.

In addition to updating the overall design of the website, several enhancements were made to the member portal. As a Third Party Administrator, HMA works with a variety of vendors to offer comprehensive benefits and services. To keep members better connected, HMA created a member dashboard where a variety of services are linked and available through a single user name and password.

"We are extremely excited about our new website and enhanced member portal. We have worked hard to create an integrated, seamless experience for our members," Lindsay Harris, HMA's Director of Product Management said.

Healthcare is embracing the digital age and seamless website enhancements will continue to be a focus for HMA through 2016. Continual advances in technology and member satisfaction set HMA apart as one of the most innovative and reliable TPAs in the Pacific Northwest.


HMA is one of the nation's largest third party healthcare benefits administrators, and is headquartered in Bellevue, Washington. With offices across the Pacific Northwest, HMA has made it their mission to create a healthier future -- each client, every time. Through the latest industry technology, customizable plan designs and skilled staff, HMA is committed to meeting group healthcare coverage needs.  Contact Courtney Bowman, MBA, Corporate Marketing and Project Coordinator, at, 800.869.7093 ext 5266 and visit


Data Dimensions Moves Florida Software Division to Expanded High-tech Facility

MyHealthGuide Source: Data Dimensions, 1/26/2016,

JANESVILLE, WI -- With the upcoming launch of its new Dimensions360 Electronic Content Management system, Data Dimensions is poised for strong growth in 2016 and beyond. To facilitate that growth, Data Dimensions is expanding its office space in Lake Mary, Fla., with the leasing of a new, high-tech facility.

The 6,400-square-foot center, scheduled to open March 1, will feature a technologically advanced working environment for more than 32 software developers working on Dimensions360 and other SaaS-based initiatives. The building also will be home to a 24-7-365 call center.

Data Dimensions' new Lake Mary facility has been designed with technology in mind, featuring a floor plan that promotes worker productivity in a collaborative environment. The space will be flexible and include interconnecting and scalable offices, impromptu collaboration spaces and a fully equipped conference room with a state-of-the-art video-communication system.

The building will also feature a call center with a wall of monitors allowing for real-time views of the products and services Data Dimensions offers its clients, enabling employees to provide quick and precise responses to issues that arise. The new facility will also have a robust and scalable infrastructure, with a private and secure network, advanced real-time monitoring, burstable fiber-based internet connectivity and advanced voice telecommunications.

Mark Golino, Data Dimensions Chief Information Officer, said Data Dimensions' new facility will position the company's software division for continued expansion and improvement.

"Our new Lake Mary location enables Data Dimensions to accelerate development of our flagship product, Dimensions360, along with other software and technology initiatives by giving us more space to expand our technology team," Golino said. "We're excited to provide our team members with a more technically advanced, visually appealing, effective and flexible office space."

Jon Boumstein, President and CEO of Data Dimensions, said the new facility is another sign of Data Dimensions' dedication to its mission.

"With the release of Dimensions360, Data Dimensions continues to bring leading-edge content management software to our clients," Boumstein said. "Our new Florida office, with its technological focus and features designed to maximize client service, will help Data Dimensions reach new levels of success."

About Data Dimensions

Since 1982, Data Dimensions has been helping clients better manage business processes and workflows by bridging the gap of automation, technology, and physical capabilities. As an innovative leader in the area of information management and business process automation, we provide a complete range of outsourcing and professional services including mailroom management; document conversion services; data capture with OCR/ICR technologies; physical records storage and electronic retrieval services through our state of the art Tier III data center. Contact Will Pfeifer, Marketing Coordinator, at, 800-782-2907 and visit

Data Dimensions is a portfolio company of HealthEdge Investment Partners, LLC. HealthEdge is an operating-oriented private equity fund founded in 2005. HealthEdge's investment team has over 100 years of combined operating experience as operators and investors. Visit


Ventanex Sponsors '
Clean the World' Hygiene Kit at upcoming HCAA Executive Forum in Las Vegas

MyHealthGuide Source: Ventanex, 1/27/2016,

Ventanex, a single-source, full-service provider of document services and payment processing, is pleased to announce their sponsorship of the inaugural Clean the World hygiene kit project initiative. This is part of the upcoming HCAA Executive Forum event Feb 9-11, being held at Caesars Palace in Las Vegas. Ventanex will sponsor and maintain the kit-building area where attendees can help prepare the goal of three hundred kits which will benefit the local Vegas area community following the conference.

Toby Magill, President at Ventanex stated, "Being the first sponsor of the Clean the World hygiene kit project at the HCAA event allows Ventanex to contribute to an extremely worthy cause while also allowing us to promote our company to the HCAA executives in attendance. We are pleased to be part of such a positive initiative."

About Clean the World

Clean the World's objective is to collect and recycle soap and hygiene products that are discarded every day by the hospitality industry and other sectors that generate environmental waste. By distributing these products to impoverished people, Clean the World hopes to prevent millions of hygiene-related illnesses and resulting deaths each year.

Since 2009, Clean the World has established 4,000+ hotel partners across 3 continents and has distributed over 30 million soap bars an 1 million hygiene kits in the US, Canada and Asia, while diverting 4,000 metric tons of waste from landfills. For more information, go to

About Ventanex

Established in 2000, Ventanex is a software as a service (SaaS) business process outsourcing provider focusing on document and payment processing including turn-key print and mail operations. Our proprietary platform enables users to access all documents related to a claim - from submission right through to payment and deposit - in realtime and in one platform. By owning and operating the entire process from claim submission through provider payments, Ventanex is able to provide a more cost-effective solution to TPAs and self-insured companies. The company is VISA Certified and is registered with the US Treasury as a non-depository financial institution. Contact Mike Fagan, EVP of Sales, at, 888-321-3249, and visit


Rite for you Corporate Wellness Changes Name to Alyfe Wellbeing Strategies

MyHealthGuide Source: Alyfe Wellbeing Strategies, 1/18/2016,

Columbus, OH -- Rite for you Corporate Wellness recently changed its name to Alyfe Wellbeing Strategies. The rebranding was in response to changing market realities and signifies the evolution and growth of the company and its shift in focus to total wellbeing. The new brand is expanding its services into non-traditional areas of wellness, enhancing current services and strategically leveraging over 20 years of expertise in nutrition as a crucial part of its programming. The goal is to offer clients an increased set of integrated services.

Workplace wellness programs are popular among employers as a means of lowering healthcare costs. In fact, more than two-thirds of U.S. employers currently offer corporate wellness programs as part of employee benefits, according to a 2015 study by the Society for Human Resource Management. Traditionally, these programs have been directed at improving the physical health of employees.

There is however growing evidence, supported by surveys and studies from Gallup, The World Economic Forum, and other independent organizations that when employers care about the overall well-being of employees as opposed to just physical health, it results in increased productivity and greater financial impact to the company bottom line. Often, this requires employers to offer many different types of programming that would not be included in a traditional health and wellness plan.

Alyfe is leading the way in providing non-traditional offerings to employers in order to increase the employee's overall satisfaction with their life. By providing a diverse set of services that focus on physical, emotional, social, career and fiscal aspects of well-being, Alyfe will steer companies towards taking a more comprehensive whole-person approach. The result will be a happier, healthier, more cohesive organizational culture, employees who have increased tenure at their organizations, and ultimately, an increase in productivity.

When asked to comment on Alyfe's new shift in focus, Nikki Hudsmith, who led the research and development efforts for the Gallup-Healthways Well-Being Index and is currently the Vice President of Operations at Performance pH, an advisory firm that helps companies improve operational performance, said, "The most current research shows that employees who achieve higher overall well-being are more engaged at work, report fewer unscheduled absences, and have lower healthcare costs. We now know that employers can substantially impact their employees' health and performance by expanding their workplace wellness programs to include a more comprehensive approach to overall well-being. Alyfe's approach to well-being will provide the framework that employers need to take their wellness strategies to the next level."

The new name ‘Alyfe' signifies the transformation that happens when one finds the ‘Y' in life. The new name and butterfly logo will better reflect the company and its services in the years ahead.

About Alyfe Wellbeing Strategies

Alyfe Wellbeing Strategies is a woman-owned minority business based in Columbus, Ohio. The company successfully serves the corporate wellness needs of businesses across the Midwest. With over 20 years of experience in healthcare, Ms. Kay Lakhi is the driving force behind the company's steady growth. She was named ‘Small Business Person of the Year 2012' and has served as the chairperson of the Worthington Area Chamber of Commerce and as the President of the Columbus Dietetic Association. Ms. Lakhi is not only an experienced and qualified healthcare professional, but also an extremely successful visionary. She is the Founder, President and CEO of Alyfe Wellbeing Strategies, Dietary Solutions, and Rite For You Nutrition Center.  Contact Isabelle Raja, Marketing Coordinator, at and visit


MED Group Announces Expansion of Payer Network with Addition of America's Choice Provider Network

MyHealthGuide Source: America's Choice Provider Network (ACPN).1/26/2016,

LUBBOCK, TX -- The MED Group, a Managed Health Care Associates, Inc. (MHA) Company, announced further expansion of its payer network with the signing of a new agreement with America's Choice Provider Network (ACPN). MED Group Members will now have access to an additional 22+ million covered lives through its agreement with ACPN, an independent, multi-specialty National Provider Network.

The MED Group is the leading group purchasing and member services organization in the home medical equipment industry. The MED Group strives to offer HME providers innovative, value-added programs in addition to a competitive GPO portfolio, such as specialized clinical networks, MED U, which provides HME industry-specific education, and the MED Suppliers Network, which promotes and advertises the services of MED Members. The MED Group's comprehensive payer network is another example of this commitment and functions as a cost saving, revenue generating program that offers MED Members access to more than 175 million lives.
ACPN, through their proprietary network and technology, offers providers access to lives beyond traditional group health by contracting with clients in worker's compensation and auto liability. Its payer clients primarily consist of third party administrators (TPAs), insurance carriers, health and welfare funds, employer groups, and self-insured health plans.
"We are confident this agreement will provide our members a great opportunity to continue to grow their business," said Jeff Woodham, Senior Vice President and General Manager, The MED Group. "With ACPN's established network of healthcare providers, our members will now have access to more than 175 million covered lives."

About The MED Group

The MED Group, a wholly owned subsidiary of Managed Health Care Associates, Inc. (MHA), is a Group Purchasing, Business Solutions and Network Management Organization that serves its Home Care Customers (Provider Members, Suppliers and Referral Sources) through a unique model that delivers value for each.

MED Members are market-leading Home Medical Equipment (HME) Providers that consistently deliver quality patient care through clinical and business based best practices. Through MED smart purchasing economic models, members make cost effective purchasing choices for products available through MED Business Partner agreements. MED also helps members improve efficiencies in education and training, reimbursement, accreditation, certification, technology and other operational areas - to help maintain their status as market leaders. MED's Network includes market leading HME providers that cover 1900+ locations.
Contact Seth Breeden, COO, ACPN, at and visit


Armune BioScience Secures Contract for Apifiny with America's Choice Provider Network to Expand Access to Apifiny

MyHealthGuide Source: America's Choice Provider Network (ACPN).1/26/2016,
KALAMAZOO, MI -- Armune BioScience, an emerging leader in break-through cancer diagnostics, has secured a contractual agreement for Apifiny with America's Choice Provider Network (ACPN), a leading preferred provider organization (PPO). Under the terms of the agreement, Armune is established as a preferred provider, and its Apifiny test will be covered by over 1,700 payers in North America covering over 22 million lives. Armune continues to expand patient access to Apifiny through a growing number of insurance providers and reference laboratories.

Launched in the United States in April of 2015, Apifiny is the only cancer specific, non-PSA blood test designed to aid clinicians in the detection of prostate cancer. Apifiny order volume exceeded 3,000 tests in 2015. Primary care physicians and urologists have utilized Apifiny to help move beyond PSA based testing to assess prostate cancer risk.

"We are very much looking forward to having an innovative provider such as Armune BioScience in our national provider network. Contracting with providers such as Armune BioScience ensures that our members have access to the best care," said Seth Breeden, chief operating officer of ACPN. "It is with great excitement that we can now offer our members access to Apifiny to help in the detection of prostate cancer detection."

"Securing a contract with ACPN is another example of the potential game-changing clinical and economic value that Apifiny offers," said David A. Esposito, President and CEO of Armune BioScience. "Given the current concerns of PSA testing throughout the world, Apifiny is well positioned to offer clinicians additional information in the assessment of prostate cancer risk. In addition, we are confident that Apifiny will help to address our healthcare system's demand for improved outcomes at lower costs."

Apifiny was developed based on innovative research into the immune system's response to cancer conducted at the University of Michigan. Armune is currently expanding testing throughout the United States and preparing to launch Apifiny in several markets worldwide. Armune recently retained Mavericks Capital as the Company's advisor and investment bank.

About America's Choice Provider Network

Founded in 2012, ACPN is an independent, multispecialty national provider network. Through its proprietary network and technology, ACPN offers access to providers, payers and patients in all 50 States, Canada, the Dominican Republic, Guam, Mexico, and Puerto Rico. ACPN's products include Individual and Group Health, Workers Compensation, Auto Liability, and Medicare Advantage. Its client base consists of Insurance Carriers, Third Party Administrators, Health and Welfare Funds, Self-Administered Employer Groups, Student Plans, Travel Plans, etc. ACPN's mission is to achieve consistency in healthcare transactions, simplify claims adjudication processes, create reasonable reimbursement arrangements, and establish reliable healthcare access for all parties--providers, payers and patients.  Contact Seth Breeden, COO, ACPN, at and visit

About Mavericks Capital

Mavericks Capital LLC and its licensed broker dealer, Mavericks Capital Securities LLC, specializes in advising companies on M&A, capital raises and strategic partnerships across the healthcare sector. With a senior team having deep medical perspectives, core scientific knowledge and proprietary analytics, we help construct and facilitate innovative and lucrative solutions for our clients. Our practice areas include therapeutics, devices, diagnostics, services and digital health.  Visit

About Armune BioScience

Armune BioScience, Inc. is a medical diagnostics company that develops and commercializes unique proprietary technology exclusively licensed from the University of Michigan for diagnostic and prognostic tests for prostate, lung and breast cancers. Armune was incorporated as a Delaware Corporation in 2008 with corporate headquarters in Kalamazoo, MI and a research and commercial laboratory in Ann Arbor, MI.  Contact Sue Crookston, Chief Financial Officer, at and visit


OptumRx Acquires Workers Comp Specialist PBM Helios

MyHealthGuide Source: Sheena Harrison, 1/27/2016, Business Insurance

OptumRx Inc., the pharmacy benefit management unit of UnitedHealth Group Inc., has acquired workers compensation PBM Helios, spokespeople for the companies confirmed Wednesday.

Terms of the deal, which took place Jan. 15, were not disclosed. A spokeswoman for Memphis, Tennessee-based Helios said that Helios' current leadership and account management teams will remain in place after the acquisition.

A spokesman for Minnetonka, Minnesota-based OptumRX said that Helios will be folded into Optum's existing workers comp and auto no-fault PBM business.

"Helios' proven track record of solving the unique and complex challenges of managing workers' compensation health care expenses supports our continued focus on supporting the evolving needs of our customers and members," the OptumRX spokesman said in an emailed statement to Business Insurance on Wednesday.

"Working together, Helios will be better positioned to effectively serve the current and future needs of clients by accessing the expertise and breadth of the OptumRx organization and as a result provide more comprehensive solutions and more aggressively manage expenses," Helios' spokeswoman said in an emailed statement Wednesday. "Leveraging the scale of the organization will also help Helios provide clients with enhanced products and services, including access to broader networks and greater pharmaceutical purchasing power."

The deal between OptumRX and Helios follows mergers and acquisitions by both firms in the recent past. In July, OptumRX acquired Catamaran Corp. for $12.8 billion, making OptumRX the third-largest PBM based on prescription volume.

Helios was created in August 2014 following the merger of two workers comp PBMs, Progressive Medical Inc. and PMSI Inc.


SIIA's International Conference in Costa Rica April 5-7, 2016

MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 1/28/2016,

SIIA will be in Costa Rica April 5-7, 2016 for its increasingly popular International Conference. For those of you thinking about attending, now is the time to start making your arrangements.

Start first by signing up for the conference as the discounted early bird registration expires TOMORROW. You will then be able to reserve your sleeping room at the host hotel.

The conference program is focused on helping U.S.-based companies identify and understand potential business opportunities related to self-insurance/captive insurance markets in key countries throughout Latin America and the Caribbean. In addition, the event will provide a truly unique networking environment designed to connect U.S. attendees with attendees from Latin America for the purpose of exploring partnership and/or business development opportunities.

For those attendees interested in medical travel opportunities, one of our conference sponsors has organized an optional no-cost tour of local medical facilities. This tour, which is scheduled on the backside of the conference, promises to be especially useful for TPAs and consultants who would like to be better informed to advise self-insured employers on medical travel options.

The conference will be held at the Costa Rica Marriott, conveniently located near the San Jose Airport. Please click on the link for more information about the hotel.

For those who have not traveled to Costa Rica before, there is one important thing to know - it's really easy to get there with a flight time of only about three to four hours from most major U.S. airports. While Costa Rica may seem like an exotic location, it's really no more difficult or expensive than traveling between coasts in the U.S.

And for early arrivals, we've arranged an optional group tour to see a popular tourist attraction. We'll take everyone to La Paz Waterfall Gardens, which is the most visited ecological attraction in the country, featuring the best hiking trails near San Jose, incredible waterfalls, and a wildlife reserve with more than 100 species of animals. Learn more at

For those companies interested in promoting their corporate brands in connection with this event, a limited number of sponsorship opportunities are now available. Contact Justin Miller at for immediate assistance.

Detailed event information, including registration forms, can be accessed on-line at
or by calling 800/851-7789. This promises to be a truly unique educational, networking and travel experience so why wait? Make plans today to join SIIA in Costa Rica in 2016.

About SIIA

The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally. It is a single association that meets all the information, educational, networking and legislative/ regulatory representation that a company needs.  Visit


People News

HCAA Announces Steve Rasnick as its New Vice President for 2016

MyHealthGuide Source: Health Care Administrators Association (HCAA), 1/28/2016,

MINNEAPOLIS, MN -- The Health Care Administrators Association (HCAA), a leader in advocacy, education and networking for the self-funding industry, announced Steve Rasnick, a seasoned TPA veteran with more than 35 years' experience in the private insurance sector as its new Vice President. Currently President of Self Insured Plans, LLC, Rasnick has been appointed to this new role by the 2015-2016 Board of Directors, and will be responsible for strategic planning and leadership, as well as contributing to the future growth of the association.

"I am excited about my new role with HCAA, and look forward to continuing to grow the HCAA as the ultimate resource for the self-funding industry," said Rasnick. "My goal is to help make HCAA become unique in a world of lookalikes, identify and strengthen the relationships with current and future business partners, and maintain a close working relationship with other industry organizations."

Rasnick also commented on HCAA's most anticipated event, the HCAA Executive Forum:  "This is always an exciting time of year for the industry as our TPA, broker and other members gear up for what will prove to be another outstanding Executive Forum." Often setting the tone for the year in self-funding, this year's 2016 HCAA Executive Forum will be held February 9-11 at Caesar's Palace in Las Vegas. Senator Tom Daschle will serve as this year's keynote speaker, presenting, "An Insider's View on President Obama's Public Policy and Its Implications on the 2016 Election."

Rasnick's broad insurance background includes previous positions as President of Gem Insurance Company, President of Foundation Health National Life Insurance Company, managed care organizations covering more than 800,000 members; Chairman of ProAmerica, a national PPO organization; President of The Travelers Plan Administrators, the third largest national benefits administrator, covering more than 1,000,000 members; and President and Founder of Claims Administration Services Inc., at the time, the largest TPA in Illinois.

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 and connect with us at @HCAAinfo, HCAA LinkedIn or HCAA YouTube.


Creative Risk Underwriters Welcomes Vince Butler as Senior Vice President of Client Relations

MyHealthGuide Source: Creative Risk Underwriters (CRU), 1/29/2016,

MARIETTA, GA -- Creative Risk Underwriters (CRU), a growing managing general underwriter, announced that Vince Butler has joined the organization as Senior Vice President of Client Relations.

In his new role, Butler will direct client development activities and support ongoing relationships with brokers, TPAs, and employer groups in Florida, while also contributing to the CRU leadership team in marketing and strategic planning capacities.

Prior to joining CRU, Butler spent the past 35 years building an extensive background in the financial and insurance sector, having most previously worked as an Account Executive in the Employee Benefits division of Hunt Insurance Group, LLC., in Tallahassee, Fla. He also held a leadership role for more than 11 years at Alliance Underwriters in Lake Mary, Fla., where he developed and spearheaded all business relationships with various clients as Chief Operating Officer and Chief Financial Officer. Butler holds a Bachelor of Business Administration degree from Florida Atlantic University.

"Vince brings tremendous service and client development credentials to the CRU team," said Executive Vice President, Val Flowers. "We are committed to selecting the best talent in the marketplace and Vince is another example of CRU further implementing that strategy."

Butler may be contacted via phone at (678) 661-4635 or via email at

About Creative Risk Underwriters, LLC

Creative Risk Underwriters (CRU) is a full-service managing general underwriter providing medical stop loss insurance to employer groups and Taft-Hartley plans. Under the management of proven industry leaders with over 50 years combined stop loss insurance experience, CRU is dedicated to providing professional analysis of the needs of its clients, as well as excellent customer service, custom underwriting solutions and competitive pricing. CRU is partnered with two A rated carriers to offer stop loss coverage, while itself performing all underwriting, policy issuance, claims, premium administration and auditing functions. Headquartered in Marietta, Georgia, CRU is the trusted choice of brokers, third party administrators and policyholders throughout the U.S. Call (678) 671-4073 and visit


INETICO Appoints Art Hoath IV to Executive Vice President of Sales and Ronnie Brown as Vice President of Client Services

MyHealthGuide Source: INETICO, 1/26/2016,

Tampa, FL -- INETICO Care and Claims Management is pleased to announce that Art Hoath IV has joined the firm to provide executive sales leadership and further expand INETICO's portfolio of regional and national accounts. Art has over 20 year's sales leadership experience in the Healthcare space. He has successfully sold managed care, cost containment solutions and most recently lead the sales for a leading ePayment/compliance Healthcare Technology company out of Florida, with over 300% sales growth within the payer market since 2013.

Art has been active within the industry at SIIA, HCAA and SPBA events and looks forward to reconnecting with everyone at upcoming industry events. He holds a BS in Healthcare Science and currently resides in the Tampa area, with his wife and 3 children. "I am excited to join the INETICO team and look forward to working with clients and business partners. The exceptional people at INETICO truly care for their clients and patients alike, which is what makes this organization so special."

Ronnie Brown will rejoin INETICO as Vice President of Client Services. She has over 25 years of experience in employee benefits, with an emphasis on self-funding and payer/provider operations. Most recently, Ronnie served as Chief Operating Officer for a leading electronic payments company delivering services to payers and providers nationwide.

Ronnie is a licensed Health, Life and Variable Annuities agent in the state of Florida and has led the TPA community as the National Chairperson of the Society of Professional Benefit Administrators (SPBA). She holds a Marketing degree from New York Technical College. "I am very pleased to be returning to INETICO where the vision of providing a superior client experience with the gift of exceptional health mirrors my passion for this industry".

Linda Ludwick, COO of INETICO, said " What an honor to have Art and Ronnie. They are both dynamic people and will be great team additions."

Joseph Hodges, President/CEO of INETICO, said "We are very excited to have Art and Ronnie as part of our team, they are both well respected industry leaders. We are pleased they choose INETICO to further their career goals. This places INETICO in a superior position to continue our expansion in the market place and amplify our Innovative platform."


Established in 2004, INETICO provides healthcare cost containment services to self-funded, fully insured and various health care entities across all of the United States. INETICO has developed its products and people with a mission: INETICO is committed to strengthening the fiscal health of the Plan while improving the clinical health of the Plan Members."   Visit


Underwriting Management Experts Hires Matthew Kelley as New Director of Sales

MyHealthGuide Source: Underwriting Management Experts, 1/23/2016,

Lansdale, PA -- Matthew Kelley, former Managing Director of a Texas-based TPA, has been hired as the new Director of Sales for Underwriting Management Experts (UME).

Matthew Kelley previously served as the Managing Director, a senior-level executive, for a third-party administrator located in Texas, handling daily sales, communication with clients, and day-to-day operations of the company. Having spent the last ten years as a part of the healthcare industry, Kelley possesses extensive TPA experience. He graduated from Texas Tech University in 2005.

Anne Marie Chapman, Chief Executive Officer of UME, says that, "Kelley will be a great addition to the team. His TPA experience will allow us to better serve our clients, as he will understand what they truly need. With his knowledge and connections, he will add even greater diversity to our already extensive client base. We are thrilled to welcome him on as a part of our team."

Kelley's strengths include a relaxed personality, excellent listening skills, and the ability to positively interact with clients. In his new role as Director of Sales, Kelley will be responsible for helping form new partnerships so that UME can be available to offer stop-loss solutions wherever they are needed.

About Underwriting Management Experts

Underwriting Management Experts (UME), is a full service MGU. We provide flexible, innovative stop-loss, captives and life products that meet the unique needs of our partners. UME offers professional expertise, personalized service and creative solutions to an ever-changing market place.  UME is a managing general underwriter of employer stop-loss coverage. We provide a full range of services including underwriting, policy binding, contract issuance, premium collection and claims payment. We also offer captive solutions and student medical.  Contact Robert "Bobby" Glorioso, Executive Personal Assistant, at 855-315-5088, and visit


Brentwood Services Administrators Promotes
Nicole Brothers To Claim Representative I in Tennessee Claims Department

MyHealthGuide Source: Brentwood Services Administrators Inc. (BSA), 1/26/2016,

BRENTWOOD, TN -- Brentwood Services Administrators Inc. (BSA) has promoted Nicole Brothers to the position of claim representative I in the Tennessee Claims Department, according to Jeff Pettus, president and chief executive officer of BSA.

In her new position, Brothers' responsibilities include reviewing, processing and handling workers' compensation claims as assigned by Judy Betzold, AIC, claim supervisor in the Tennessee Claims Department. In addition, Brothers determines the compensability of the claim and extent of liability. She communicates directly with clients, employers, injured workers, physicians, and attorneys to manage claims in a timely and economic manner.

Brothers was employed by BSA in 2009 as a claim assistant, then was promoted to claim examiner II. Before joining BSA, she worked in positions providing clerical support.

About Brentwood Services Inc.

Brentwood Services Inc. is an independent employee-owned company headquartered in Brentwood, Tenn., and specializing over the past 25 years in structuring and managing alternative market solutions for employers and insurance providers.

About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers' compensation and other casualty lines. BSA's aggressive coordinated approach to claims administration and loss control has a proven track record of reducing the cost of claims for its clients. BSA also provides underwriting, policy management and accounting services to association-sponsored pools and mutual insurance companies. Call John Smitherman, senior vice president of sales for Brentwood Services Inc., at (800) 524-0604, (615) 263-1300, and visit

About Brentwood Reinsurance Intermediaries Inc. (BRII)

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


WEDI Announces Charles Stellar as Interim President and CEO

MyHealthGuide Source: WEDI, 1/20/2016,

RESTON, VA -- WEDI, the nation's leading authority on the use of health IT to create efficiencies in healthcare information exchange, announced that Charles W. Stellar, an executive leader with more than 35 years of experience in healthcare, association management and organizational leadership, has been named by the WEDI Board of Directors as WEDI's interim president and CEO after the resignation of Devin Jopp, Ed.D. In this role, Stellar will be responsible for strategic leadership and guidance of the organization, its staff and committees until a more-permanent replacement is named.

Stellar joins WEDI from his recently retired position as executive vice president of America's Health Insurance Plans (AHIP), the trade association representing the nation's health insurance industry, where he was the key liaison between AHIP's 350 plan and 400 affiliate members, ensuring consistency in messaging and shaping AHIP's membership strategy. At AHIP, Stellar's extensive portfolio included overseeing member services related to positioning the association and its diverse membership to a variety of national, state and local audiences.

"We are honored that Charles has agreed to serve in this role and propel our organization forward during this transitional period," said Jean Narcisi, chair of the WEDI board. "In addition to the close working relationships he shares with many of the member organizations on our board, he brings unparalleled domain experience in successfully bringing healthcare associations to national prominence. We expect he will continue our efforts to further WEDI's role as a recognized leader and advocate for healthcare IT."

Stellar also provided comments: "This year will be instrumental for WEDI as we continue to work closely with the industry to implement exciting new initiatives, drive awareness of healthcare's ongoing challenges, and collectively improve the quality and efficiency of healthcare IT. I want to take this opportunity to thank our dedicated board, executive workgroups, loyal sponsors and diverse membership base for placing its confidence in WEDI as we prepare for what will be an exciting Spring Conference and a year full of promise and progress."

Prior to his tenure at AHIP, Stellar was president and CEO of the American Managed Care and Review Association (AMCRA); executive director of Healthmaster HMO/IPA; deputy administrator of Charter Medical Services in Saudi Arabia; executive director of EyeCare Associates; associate executive director of the American Association of Foundations for Medical Care; and associate executive director of the American Association of the Professional Standards Review Association (PSRO). Stellar earned bachelor degrees in health administration and business administration at the University of North Carolina.

About WEDI

The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation's healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI's membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. Visit and connect with us on Twitter, Facebook and LinkedIn.


The Xchange Group Seeks Sales Executives

MyHealthGuide Source: The Xchange Group, 1/21/2016,

‪White Plains, NY -- As the Xchange Group continues to grow, we have openings for talented people to join our Medical Stop Loss agency - Xchange Benefits.

Our portfolio has grown significantly over the past five years and we now have openings for Self-Funded Medical Stop Loss Sales Executives across the US to be part of the next stage of our evolution. ‬

If you are interested in joining a growing company of talented self-starters who still know how to have fun and would like to be truly compensated for what you do then please contact Peter McGuire, President & CEO, at‬.

About The Xchange Group

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


InterRemedy Insurance Services Seeks Midwest Business Development Specialist (Sales Executive), Employer Stop Loss

MyHealthGuide Source: InterRemedy™ Insurance Services, 1/20/2016,

San Francisco, CA -- InterRemedy™ Insurance Services, provides stop loss solutions and services for brokers and consultants. As a centralized wholesale marketing resource, we pair all of our cases with the most cost-effective, "A-rated" stop loss insurance partner. We manage the stop loss placement process from start to finish by providing superior stop loss marketing solutions, account management, claims facilitation, premium accounting, and risk management services.

InterRemedy is expanding its sales department and seeking a Business Development Specialist. We are interested in speaking with qualified candidates who currently live in the Midwest. The position requires extensive sales experience with a proven track-record selling stop loss insurance and associated services. Candidate will need to be customer oriented, hold a current A&H Insurance License, have superior technical knowledge of stop loss insurance, and have the ability to manage a sizable territory with several accounts. Ideal candidate should have multiple contacts within the healthcare industry.

Position: Business Development Specialist

Compensation: Salary + Commission
Location: Midwest
Travel: Required within territory

General Responsibilities

  • Establish new business by planning and organizing daily work schedule to call on existing or potential prospects. Work with InterRemedy team to service, maintain and grow company portfolio of business.
  • Proactively self-manage all daily activities and travel as required to support and grow InterRemedy's sales and marketing efforts.
  • Address customer needs by investigating need, making recommendations and developing and delivering solutions.
  • Establish close relationships with insurance marketing, underwriting partners and broker management teams.
  • Keep management informed by sharing activity and results such as daily call reports and weekly or monthly work plans. Knowledge of systems is a plus.
  • Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional organizations.
  • Contribute to team effort by accomplishing related results and projects as needed. Maintain a high level of productivity, participation, and innovation. Interface effectively with all company departments and actively participate in company's best practices, values and philosophies.
  • Ensure that the Business Development Division meets or exceeds all growth goals efficiently and effectively.


  • 5+ Years of background in Employer Stop Loss Sales
  • College Degree Preferred
  • Licensed A&H Insurance Agent

Interested candidates should send resume to Debbie Canadas, at

About InterRemedy

InterRemedy™ Insurance Services provides stop loss solutions and services for brokers and consultants. As a centralized wholesale marketing resource, we pair all of our cases with the most cost-effective, "A rated" stop loss insurance partner.

We manage the stop loss placement process from start to finish by providing superior stop loss marketing solutions, account management, claims facilitation, premium accounting, and risk management services. Our goal is to provide a flexible and simplified process for brokers and consultants while maximizing profits and favorable results for their clients.  Visit


Market Trends, Studies, Books & Opinions

Premium Cost Trends in Medical Stop Loss

MyHealthGuide Source: Jessica Marabella, 1/19/2016, POMCO

According to a recent survey by Aegis Risk, the frequency, and cost of catastrophic claims is on the rise. One in five survey respondents reported filing a stop loss claim in excess of $1 million over the past two policy years. The survey also indicated that decisions on stop loss policies, individual and aggregate thresholds, and policy types are being accomplished on a collective basis. Renewal decisions are being made by human resource directors, finance managers, and CFOs, who are reportedly involved 66 percent of the time. In addition, executive leaders are involved in stop loss decisions 45 percent of the time -- a number that is increasing over the years.


When asked in 2015 if they anticipated an increase in their individual stop loss deductibles, the majority of respondents were uncertain:

  • No, prefer to keep at the current level 42%
  • Yes, will seek a moderate increase 8%
  • Uncertain, will review a range and make a determination 48%
  • None of the above 2%


According to survey respondents, average monthly premiums by deductible and contract type ranged from approximately $12.00 to approximately $96.00

Individual Deductible






























Other insights of note from the survey were as follows: 

  • 94% of surveyed plans cover pharmacy, demonstrating a slight increase compared to previous years
  • 94% of respondents do not have an annual stop-loss reimbursement maximum
  • 98% of policies offer unlimited lifetime maximums, representing at 13% increase from 2010
  • 27% of respondent policies include an aggregating specific deductible, with the average size being 54% of the underlying individual stop loss policy
  • 8% have considered a captive arrangement to further mitigate risk
  • 8% have considered dropping their stop loss policy entirely
  • 18%18% hold policies with at least one lasered claimant

Employers looking to reduce their annual stop loss premium costs should consider the following:

  • Partner with an experienced broker who can help you understand all of the variables that can impact your policy decision.
  • Confirm your broker has negotiated on your behalf and is marketing several options to ensure you are receiving the best policy options
  • Be sure your benefits administrator is accurately managing your claims disclosures to help avoid denials


Established in 1978, M.W. Pomfrey & Associates was a small benefits consulting firm that delivered on the promises it made to its clients – provide a cost-effective option to health insurance. Their staff of six began developing software for an enrollment and auditing computer system, enabling companies to own their claims data and therefore, make educated health benefit decisions – the paramount benefit of self-funded health benefit plans.  Visit


Legislative & Regulatory News

The ERISA Industry Committee Engages EEOC on Proposed GINA Regulations

MyHealthGuide Source:  ERISA Industry Committee (ERIC), 1/26/2016, ERIC Article

WASHINGTON -- The ERISA Industry Committee (ERIC) submitted comments to the Equal Employment Opportunity Commission on proposed rulemaking regarding Title II of the Genetic Information Nondiscrimination Act (GINA) and the impact on employer-sponsored wellness programs.

As the only national trade association advocating solely for the employee benefit and compensation interests of the country's largest employers, ERIC speaks for employers who sponsor some of the largest private group health plans in the country. ERIC members are dedicated to providing high-quality, affordable health care to employees, retirees, and their families across the nation. The promotion of wellness for workers and their families has become extremely important to ERIC members, as effective workplace wellness programs can provide significant benefits both inside and outside the workplace.

ERIC appreciates and supports the Commission's efforts to clarify how its rules will affect employer-sponsored wellness programs and is especially encouraged by its attempts to align the GINA Title II permissible reward limits with those of the Affordable Care Act (ACA). However, ERIC members continue to have serious concerns with respect to where these rules diverge. For instance, the EEOC would set limits on rewards paid in conjunction with Health Risk Assessments (HRAs), whereas the ACA rules do not limit incentives paid for HRAs or other "participatory" wellness programs.

"It cannot be emphasized enough how important it is that the rules from the different parts of the government concerning wellness programs be in alignment with each other," said Gretchen Young, Senior Vice President of Health Policy, ERIC. "Restricting an employer's flexibility, however, to best tailor wellness programs to their workforces discourages innovative approaches to health improvement and, ultimately, would serve only to force additional administrative and financial challenges on employers who strive to help their employees achieve better health outcomes."

ERIC's letter to the Commission
You can read ERIC's letter to the Commission in its entirety by clicking:
Selected Highlights
  • The Commission's inducement limits for HRAs are categorically inconsistent with the ACA rules, which do not impose incentive limits for participatory wellness programs, including HRAs. Moreover, the inducement limits for HRAs are simply not necessary to protect the "voluntary" nature of a wellness program, because the Commission's rules require such inducements to be paid whether or not an employee or the employee's spouse answers questions regarding genetic information
  • The ACA rules define participatory wellness programs as programs that either do not provide a reward that is, or do not include any conditions for obtaining a reward that are, based on an individual satisfying a standard related to a health factor. Examples in the final regulations include: A program that reimburses employees for all or part of the cost for membership in a fitness center; a program that reimburses employees for the costs of participating, or that otherwise provides a reward for participating, in a smoking cessation program without regard to whether the employee quits smoking; and a program that provides a reward to employees who complete an HRA regarding current health status, without any further action (educational or otherwise) required by the employee with regard to the health issues identified as part of the assessment.

About the ERISA Industry Committee

The ERISA Industry Committee (ERIC) is the only national trade association advocating solely for the employee benefit and compensation interests of the country's largest employers. ERIC supports the ability of its large employer members to tailor health, retirement and compensation benefits for millions of employees, retirees and their families. Visit


Medical News

Doctors Should Screen all Adults for Depression

MyHealthGuide Source: Albert L. Siu, MD, MSPH and the US Preventive Services Task Force (USPSTF): JAMA and Liz Szabo, 1/26/2015, USA TODAY

Primary care doctors should screen all adults for depression according to an expert panel recommendation published in Journal of American Medical Association.

In its previous recommendation, the U.S. Preventive Services Task Force, which advises the federal government on health, had recommended screening adults for depression only when mental health services were available.

New Recommendation

  • The task force for the first time said screening benefits specific groups, including older adults, pregnant women and new mothers. In the past, there wasn't strong enough evidence to weigh in on whether depression screening helps or hurts these groups.
  • Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.

In its new report, the task force said this limitation is no longer needed, because mental health services are more widely available today than in 2009, when its last recommendations were published. Federal law now requires that private insurers cover mental health and physical conditions equally.

"We're hoping that our screening guidelines are an impetus to increase awareness that depression is common, it's painful, it's costly and it's treatable," said Karina Davidson, a member of the task force and a psychologist in the department of psychiatry at New York Presbyterian Hospital/Columbia University Medical Center.

Davidson noted depression is often treated with medications, which could pose particular risks for developing fetuses or breastfeeding infants. Although research has found "potential serious fetal harms" from depression medications, the task force concluded that "the likelihood of these serious harms is low."

Newer types of antidepressant medications, such as selective serotonin re-uptake inhibitors, or SSRIs, also have risks, the task force said. SSRIs are associated with an increase in suicidal attempts in adults ages 18 to 29, as well as an increased risk of stomach or intestinal bleeding in adults over than 70.

About Depression

Depression also can be life-threatening. More than 41,000 Americans commit suicide each year, according to the Centers for Disease Control and Prevention. More Americans now die from suicide than from car accidents. About 90% of suicides are related to mental illness.

A 2015 study in the Journal of Clinical Psychiatry estimated that depression costs the United States $210 billion a year, with 40% of those costs related directly to depression, and the rest related to indirect costs, such as lost productivity.

People with chronic illnesses, such as diabetes and heart disease, should be screened at least once a year, wrote Thase, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. People in good health who see their doctors sporadically should be screened at every visit.


Recurring Resources

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 1/25/2016)

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 update is encouraged.
Sources will be cited. Please send updates / changes to
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
1 CIGNA     $2,318
  Source - CIGNA Financial Supplement 2014, P.5 12/31/2014
2 Sun Life Financial     $1,034.2
  Source - 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+)
$29,700 as part of Tokio Marine Group
  Source - Daniel Strusz, 1/25/2016
4 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
  Source - Matt Rhenish, President & COO, 2/16/2015
5 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
  Source - 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)
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/9/2015
7 Companion Life > 20 Years   $440
  Source - 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
  Source - Independence Holding Company
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
  Source - Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions, 6/20/2014
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),
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
  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++)
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
  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 CrossBlue Cross Blue Shield (various regions)
  • Gerber Life Insurance Company
  • International Insurance Agency Services, LLC
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • UnitedHealthcare

Stop-loss Premium Volume is not the Whole Story

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

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

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


The Value of Self-Funding

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

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

About the SIEF

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


ICD-10 Readiness Tools

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

In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list. On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. Please find links to the ISG White Paper on the process and to the new ICD-10-CM Trigger list.

  • The 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.


Upcoming Conferences

January 31 - February 2, 2016
2016 AAPAN Annual Forum: Today's Health Care System: What's Working and What's on the Horizon presented by AAPAN - AAPPO and TPAAA.  Ritz-Carlton, Laguna Niguel in Dana Point, California.  Registration:

February 2, 2016 - Webinar at 1:00pm (EST)
Take Your Money and Run! Montanile Changes Subrogation - How Will You Respond?
presented by The Phia Group. On January 20, 2016, The Supreme Court of the United States decided in favor of the plan participant in the case of Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan. The Supreme Court held that the Plan could not recover from Montanile, the plan participant, after he received a third party settlement and spent the money.  Third party recovery just got much more difficult.  If benefit plans don't have air-tight language, and if they fail to proactively intervene before a plan participant spends settlement proceeds, the Supreme Court has indicated that the benefit plan is left with no recourse. For this reason, those without substantial resources dedicated to the pursuit will have a much more difficult time ensuring that their clients' rights are enforced.  Please join The Phia Group for a free webinar on Tuesday, February 2nd, at 1:00pm (EST), where we will describe the Montanile case, its impact, and how it changes everything. Registration:

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

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

March 21-23, 2016
Self-Insured Health Plan Executive Forum presented by Self-Insurance Institute of America. 
The program's keynote speaker will be Dr. Martin Makary, professor of surgery at John Hopkins University School of Medicine and author of the widely-acclaimed book Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.  Breakout session highlights include:

  • Karen van Caulil, chairwoman of the National Business Coalition on Health describes how health care coalitions are starting to break the grip of health insurance monopolies in certain regions around the country.
  • Heather Lavallee, president of employee benefits distribution for Voya Financial will team up with Matt Rhennish, president & COO of HM Insurance Group, for an interactive discussion exploring what "Big Data" means for stop-loss underwriting.
  • The potential opportunity for TPAs to partner with provider sponsored health plans will be addressed by Karin Landry, managing partner of Spring Consulting Group, LLC.
  • Rick Raup, president & CEO of Business Administrators & Consultants, will lead a panel discussion focused on how TPAs, stop-loss carriers and other key industry players are adapting to the ICD-10 transition.
  • We'll preview the expected evolution of TeleHealth solutions for self-insured health plans with a presentation by Dr. Jeffrey Kesler, president & COO of Salus.
  • For the closing general session, the SIIA government relations team will provide a detailed report on important legislative and regulatory developments affecting companies involved on in the self-insurance marketplace.

For those companies interested in promoting their corporate brands at this event, a limited number of exhibiting and sponsorship opportunities are now available. We should note that exhibit space and sponsorships sell-out well in advance of the event each year, so it is suggested that you act fast to secure your preferred promotional opportunity. Contact Justin Miller at for immediate assistance. New Orleans, LA.  Registration and information: 

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

April 5-7, 2016
SIIA International Conference presented by Self-Insurance Institute of America. The conference program is focused on helping U.S.-based companies identify and understand potential business opportunities related to self-insurance/captive insurance markets in key countries throughout Latin America and the Caribbean. In addition, the event will provide a truly unique networking environment designed to connect U.S. attendees with attendees from Latin America for the purpose of exploring partnership and/or business development opportunities.
San Jose, Costa Rica. Costa Rica Marriott:  Information and registration: 800/851-7789 or

April 11-13, 2016
Health Care Management Conference presented by International Foundation of Employee Benefit Plans. This conference will take a closer look at private exchanges, cybersecurity, specialty drugs, and the abuse occurring in substance abuse treatments. It will also cover wellness, the importance of data and why health care literacy is essential for you and your participants. Use this smaller, more intimate setting to pack in the most information possible on health care plans, from both the presenters and fellow trustees.  View a full list of program details and register online. Register by February 29 and save $250 with the early registration discount. Pointe Hilton Squaw Peak Resort, Phoenix, AZ.  Information and registration: Call (888) 334-3327, option 2 and visit

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

May 18-19, 2016
Self-Insured Taft-Hartley Plan Executive Forum  presented by Self-Insurance Institute of America. Designed to help Taft-Hartley health plan administrators and trustees better understand all of the self-insurance strategies available to them that can help control costs while providing benefits to workers in the most efficient way. Speakers include Terry O'Sullivan, general president of the Labors' International Union of North America (LIUNA), Ed Smith, ULLICO CEO, Ed Kaplan, SVP and national health practice leader for The Segal Company, Adam Russo, CEO of the Phial Group, LLC, Cody Purdy, employee benefits consultant with IMA, Inc., Colleen Savoie, principal with Parker, Smith & Feek, Inc., David Chapman, president of Phoenix Benefits Management.  Sponsors contact:  Justin Miller at Information and registration: Chicago, IL. Call 800-851-7789 and visit

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

May 25-26, 2016
12th Annual Canadian Captives and Corporate Insurance Summit presented by Captive Insurance. Sheraton Centre, Toronto, ON. Event for current and prospective captive owners, captive managers and other professionals working in risk management and corporate insurance. Information and registration:

June 13-15, 2016
AMS Claims Symposium, an invitation-only event presented by Advanced Medical Strategies. Mohegan Sun, Uncasville, CT. Contact Adria L. Garneau, CEBS, and visit

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

July 19-21, 2016
MCIA Eleventh Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA). This year's program will feature 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, Montana. ( Block of reserved rooms released on May 18, 2016. Contact Shane Byars at 866/388-6242, or  Visit

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

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


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

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

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


Editorial Notes, Disclaimers & Disclosures

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