MyHealthGuide Newsletter
News for the Self-Funded Community

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General & Company News

People News

Market Trends, Studies, Books & Opinions

Legal, Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

Bravo Wellness, LLC Receives $22 Million Investment

MyHealthGuide Source: Bravo Wellness, LLC, 8/12/2014,

CLEVELAND, OH -- Bravo Wellness, LLC, a provider of innovative outcomes-based wellness programs, announced a $22 million Series A minority investment from ABS Capital Partners, a leading investor in later-stage growth companies. Bravo Wellness will use the proceeds to expand its sales and marketing efforts and to continue to innovate and expand its solutions. ABS Capital Partners Managing General Partner John Stobo will join the Company's board of directors and General Partner Mark Anderson will be an observer.

"Our solution has already had a huge impact in numerous organizations, but we wanted to keep innovating the product and reach even more customers," said CEO and Chairman Jim Pshock. "Bravo continues to see strong growth and an increased demand from companies and their employees trying to control increasing health care costs by employing innovative wellness solutions. We wanted to make sure that we found a partner who sees the exciting opportunities we have, and ABS Capital is the right fit."

Bravo, founded in 2008 and headquartered in Cleveland, Ohio, designs and administers outcomes-based wellness initiatives for companies, organizations, brokers and other wellness providers. Approximately 75 percent of all health care spending in the United States is lifestyle related and linked to individual behavior. Lifestyle choices significantly influence health care costs, and adding accountability through a wellness program can reduce these costs in both the short and long term. Bravo provides tailored solutions through a robust technology platform combined with deep domain expertise, particularly with regard to compliance and tracking personalized improvement goals. Unlike most wellness programs that are based on participation, activity and uncorrelated rewards, Bravo's solutions are based on biometric data (such as smoking habits, body mass index, blood glucose, blood pressure and cholesterol) that give the employee the opportunity to impact meaningfully his or her health as well as the associated insurance premiums. Bravo's proprietary technology platform provides employers with a solution for coordinating biometric screenings, tracking incentives and employee compliance, determining reasonable alternatives, resolving appeals and providing the tools for data-driven decision-making.

"We were impressed by the differentiated, outcomes-based solutions that the management team has built. They have positioned the company as an industry leader, and we look forward to working with the team through this next phase of rapid growth," said Stobo. "It is exciting to be backing Bravo as it continues its mission of simultaneously helping companies and employees save money while improving health and wellbeing."

Bravo provides a consultative and innovative approach in administering a program that works best for each client's culture and provides options for immediate cost savings. Bravo has had great success with a wide variety of customers such as Insurance Office of America, Valeo, Graco Inc., Southwest General Health Center and MasterBrand Cabinets, Inc., helping each organization to achieve its own unique program goals.

Brown Gibbons Lang & Company acted as the exclusive placement agent to Bravo Wellness for the financing.

About Bravo Wellness

Bravo Wellness has been a disruptive force in the wellness industry since its inception in 2008. Bravo pioneered the outcomes-based wellness incentive space and carefully designs compliant incentives that result in unprecedented engagement levels. Bravo's case studies prove and demonstrate sustained health improvement and reduced claims spending -- all while equipping individuals to make better choices and providing thoughtful alternatives to those for whom special exceptions are warranted. With roots in data management, compliance and technology, Bravo recognizes that it's rarely the lack of activities that makes a program unsuccessful, it's often the lack of motivation and engagement -- a problem that can be solved. Contact Rick Kjerstad, Senior Vice President of Business Development, at and visit

About ABS Capital Partners

At ABS Capital Partners, we have a simple mission -- to invest in the very best late-stage growth companies. Our singular focus has allowed us to cultivate a deep understanding of what it takes to get promising businesses to the next level. Our priority is finding the best growth companies -- not completing certain types of transactions or investing specific amounts of dollars. Our flexibility allows us to structure the right deal to support a company's growth trajectory and particular needs. We actively partner with CEOs to tackle the challenges of rapid expansion and create significant long-term value. Our partners are highly experienced at working with growth companies -- each having spent between one and three decades in their industry as C-level executives, investment bankers, consultants or investors.

ABS Capital Partners specializes in three growth sectors -- business and education services, information and communications technology and health care -- and has invested in over 100 growth companies over the past two decades. With over $2 billion raised since inception, including $500 million in its latest fund, ABS Capital continues to build on its strong reputation for teaming with CEOs and market leaders to deliver strong returns to investors. Visit

About Brown Gibbons Lang & Company

Brown Gibbons Lang & Company (BGL) is a leading independent investment bank serving the middle market. BGL specializes in mergers and acquisitions advisory services, debt and equity placements, financial restructuring advice, and valuations and fairness opinions, with global industry teams in Healthcare & Life Sciences, Consumer Products & Retail Services, Energy & Environmental Services, Industrials, Metals & Metals Processing, Plastics & Packaging, and Real Estate. BGL has offices in Chicago and Cleveland, and Global M&A partner offices in more than 50 countries across five continents, which allows us to deliver to our clients unparalleled access to corporations, investors and opportunities globally. Visit


Re-Solutions Offers New Whitepaper 'Opportunities in Self-Funding in Response to the ACA; Fueling your business growth in the emerging self-funded market'

MyHealthGuide Source: Re-Solutions Intermediaries, 8/5/2014,

Re-Solutions Intermediaries announces a new whitepaper entitled, 'Opportunities in Self-Funding in Response to the ACA; Fueling your business growth in the emerging self-funded market' in response to ACA. 

Increasingly, employers are addressing the uncertainty caused by the ACA by choosing private self-funded employee health plan options. Every insurer in the specific and aggregate stop loss market is assessing the risks and how to best take advantage of the growth in self-funding. This whitepaper provides insights into this trend towards self-funded employee health plans.

The whitepaper addresses:

  • The emerging self-funded market
  • The specific and aggregate stop loss opportunity
  • The risk of unlimited claims
  • How to mitigate that risk with reinsurance

Self-funding employee healthcare benefits helps employers of all sizes mitigate the uncertainty and cost of new requirements imposed by the Affordable Care Act (ACA), including:

  • Guaranteed Issue -- No more pre-existing conditions limitations will likely increase the cost of fully insured policies.
  • Coverage mandates -- The 10 essential benefits and other coverage mandates will also drive up the cost of fully insured group health plans.
  • Because self-funding offers fewer unknowns and other advantages, such as lower costs and greater flexibility in benefit design, it is becoming more attractive to employers of all sizes.

To access the whitepaper, please click

About Re-Solutions

Reinsurance is a global business and a constantly changing marketplace. At Re-Solutions we have seasoned professionals with the experience, entrepreneurial drive and worldwide industry connections you need. As an independent reinsurance intermediary, we access the right market for You, not one that works best for us because of some corporate obligation. We live and breathe life, accident and health business. We're not the A&H tail wagged by the P&C dog. Visit


Collective Health Introduces Cloud-Based Self-Insurance for Companies of All Sizes

MyHealthGuide Source: Collective Health via Business Wire, 8/13/2014,

SAN MATEO, CA -- Collective Health introduces a new solution for employer-sponsored health insurance. Collective Health provides companies with a simple solution to sponsor health care on their terms by extending the benefits of self-insurance to companies of all sizes, without the complexity or expense that is traditionally associated with the self-insurance process. The company has raised a series A venture investment led by Founders Fund with participation from Formation 8, the Social+Capital Partnership, and prominent angel investors including Scott Banister, Max Levchin, Jeremy Stoppelman and Amr Awadallah.

Health care spending, and health insurance premiums in particular, are increasing at an unsustainable rate, with spending on health care growing twice as fast as overall GDP. With over ninety percent of private health insurance paid for by employers, companies have borne the brunt of these increasing costs and have until now been held hostage to rapid and unpredictable increases in traditional health insurance premiums. Collective Health was created to offer companies a better way to control and manage health care costs, while offering superior health coverage uniquely tailored to the needs of American workers.

"While insurance is supposed to be a risk-sharing business, health insurance has increasingly become a middleman business ­ devised to generate profit for the health insurers above all else. As a result, there is a fundamental disconnect between the incentives of traditional health insurance companies and people's and organizations' health insurance needs," said Ali Diab, co­founder and CEO of Collective Health. "At Collective Health we have created a complete replacement for employer-sponsored health insurance: a replacement that is focused on people's and organizations' health and happiness, not on health insurer profits."

Collective Health's cloud-based self-insurance platform extends the benefits of self-insurance to businesses of all sizes, bringing technological innovation and efficiency to an industry infamous for its opaque business practices, antiquated technology and processes, and unpredictable price increases. Additionally, Collective Health's solution is underscored by a user experience that is built from the ground up for the people it was designed to serve -- employees and their dependents.

Delivered as a software-as-a-service (SaaS) solution with a flat-fee pricing structure, Collective Health provides employers of all sizes with a fully integrated health self-insurance platform -- including actuarial analysis, customized health plan design, legal and regulatory compliance, plan funding, claims administration, health provider network access and real-time data analytics -- all in one seamless package.

Self-insurance provides true transparency into the real costs of health care and substantial financial savings and cost control compared to traditional health insurance, as evidence by the ninety-four percent of large US employers that self-insure their employee health plans today. Yet, until today, self-insurance has not been a viable option for most businesses due to the complexity and high fixed costs associated with establishing a self-insured employer-sponsored health plan. Collective Health makes self-insurance easier than buying a fully-insured health plan, giving employers a clear path toward health insurance independence.

Through Collective Health, employers and employees have access to a single, unified platform to view and manage their health care activities and costs, direct access to real-time customer service, and health plan features and descriptions that are presented in clear, unambiguous language. Collective Health self-insured plans are optimized by employers to meet the unique needs of their employees and can be integrated with popular perks such as telemedicine, nutrition programs, gym memberships, free rides to doctors' appointments and more.

"Fundamental reform is long overdue in the health insurance industry," said Scott Nolan, Partner at Founders Fund. "Collective Health is challenging the status quo of the entire private health insurance industry, using technology to dramatically bring down costs for employers of all sizes while providing higher quality care to employees and their dependents."

About Collective Health

Collective Health was founded in late 2013 by Ali Diab, previously Vice President of Product Management and Business Operations at AdMob, acquired by Google in 2010, and by Dr. Rajaie Batniji, a physician and political economist on faculty at Stanford University. The company is headquartered in San Mateo, California. Collective Health is currently enrolling companies for a January 1, 2015, health plan coverage start date. Visit


TRICAST Launches New Version of Web-Based Pharmacy Benefits Surveillance and Analytics Software Tool

MyHealthGuide Source: TRICAST, 8/14/2014,

MILWAUKEE -- TRICAST, Inc. announced the availability of Reveal™ 2.0, its cutting-edge web-based software tool that leverages nearly two decades' worth of prescription drug benefit consulting expertise.

"We've baked all our knowledge into a product that delivers real-time surveillance and analytics (both retrospective and predictive) for comprehensive pharmacy benefit oversight. There's really nothing else like it in our industry," said TRICAST President Greg Rucinski.

The release of Reveal also marks TRICAST's entry into the software as a service (SaaS) market space. SaaS is a software and licensing delivery model in which the software is licensed on a subscription basis and is centrally hosted.

"Applying a SaaS model in the healthcare industry has the potential to significantly reduce our client's IT support costs as well as allowing Reveal™ to grow with the client without incurring additional IT capital expenditures," noted Director of Infrastructure Chris Favero.

Reveal enables TRICAST clients to monitor pricing, process, and formulary and rebate adherence. The tool also includes a full suite of Centers for Medicare & Medicaid Services (CMS) oversight products such as automated reject analysis, comparisons of source to PDE claims, and all other CMS oversight requirements.

"We've learned a lot about what's important to the healthcare marketplace in our two decades of consulting and we've built it into Reveal," said Director of Software Development Ken Ullsperger.

For example, many need an automated method of importing data that's integrated with fixed files such as Medi-Span® or First DataBank® pharmaceutical information, CMS watch list criteria, CMS gap discount information, taxonomy files, and other decision-support information.

"We want to be very clear: TRICAST is not abandoning our tried and true consulting offerings. What it really means is that we are empowering our clients by harnessing the benefits of our fifteen years of experience and making it available to them," concluded Rucinski. "Our Reveal clients benefit because their pharmacy benefit data is available for comparative analysis at a daily, hourly and even down to the minute frequency. Our Reveal clients can now focus on the road ahead instead of looking back at what has already transpired."


TRICAST is a pharmacy data analytics company utilizing industry expertise and powerful software tools to empower our clients to make decisions that lower their healthcare costs and efficiently manage their pharmacy benefit programs. TRICAST is headquartered in Milwaukee, Wisconsin. Contact Rob Shelley, Senior VP of Business Development, at 612-940-6390 and visit


Cornichon Healthcare Select, LLC Announces Two New September Releases for its Electronic HIPAA Safeguard Privacy and Security Rule and HITECH Act Breach Notification Rule policy

MyHealthGuide Source: Cornichon Healthcare Select, LLC, 8/15/2014, and

Cornichon Healthcare Select, LLC announces two new September releases for its electronic HIPAA Safeguard Privacy and Security Rule and HITECH Act Breach Notification Rule policy and procedure tool:

  • Risk Analysis Template,, written in plain, common sense language designed for step-by-step, comprehensive self-assessment of threats and vulnerabilities based on National Institute of Standards and Technology (NIST) protocols.
  • Safeguard Forms and Acknowledgements for HIPAA Security Administrative, Physical, and Technical implementation specifications and select HIPAA Privacy Administrative Requirements.

Each of these electronic releases will be sent via email at no cost to purchasers of HIPAA Safeguard from August 18-31, 2014.

When your organization implements HIPAA Safeguard, it will benefit from the following product attributes:

  • HIPAA Safeguard automatically embeds your organization's designated name in each required HIPAA/HITECH Act policy and procedure, eliminating potentially costly willful neglect-not corrected status once the policies and procedures are implemented.
  • HIPAA Safeguard is electronic, which facilitates instant download and access upon fulfillment--including secure access on IOS and Android smartphones and tablets via readable app--and provides a convenient "one-touch" table of contents that takes the user to the selected HIPAA/HITECH Act policy or procedure or Meaningful Use security criterion linked to HIPAA Security.
  • HIPAA Safeguard provides information on HHS Office for Civil Rights (OCR) guidance on safeguards, business associate agreements, breach notification, and compliance audit protocols, as well as URL links to NIST and Department of Health and Human Services (HHS) references.
  • HIPAA Safeguard ties each implementation specification to the appropriate OCR compliance audit protocol so your organization knows what an auditor will "inquire of management" with respect to compliance due diligence, and documentation an auditor will need to "verify" compliance implementation in the event of a forthcoming compliance audit or complaint or breach investigation.
  • HIPAA Safeguard includes over 800 guideposts for implementing safeguard policies and procedures and conducting workforce training.
  • HIPAA Safeguard has been legally vetted to ensure consistency with standards and implementation specifications, and is in use by attorneys and business consultants to help their clients achieve compliance.

"HIPAA Safeguard's downloadable privacy, security, and breach notification polices and procedures are understandable and affordable, and each included our corporate name for identification," said Robert Barbour, CEO of Advomas in Troy, MI. "This is a valuable and timely tool to help covered entities and business associates achieve HIPAA/HITECH Act privacy, security, and breach notification compliance."

HIPAA Safeguard is available for an affordable $449 for the first year, which includes email notification of any URLs for pertinent HHS regulatory, OCR guidance, OCR compliance audit protocol, or NIST updates, and $99 per year thereafter, which is optional, but includes maintenance and any updates via email. Purchase online at

Register now at for a free example of the HIPAA Safeguard content, and purchase HIPAA Safeguard now through August 31, 2014, for the free Risk Analysis Template and Safeguard Forms and Acknowledgements sent to you by email. Remember, OCR's compliance audits are expected to begin in several months.

About  Cornichon Healthcare Select, LLC

 Cornichon Healthcare Select, LLC. is managed by Edward Jones and is the author of the electronic guide "HIPAA SAFEGUARD". Edward is a leading authority on healthcare privacy and security, insurance, electronic remittance/payments, and electronic healthcare records. He was a founding commissioner of the Electronic Healthcare Network Accreditation Commission (EHNAC) and served as Chairperson of the Workgroup for Electronic Data Interchange (WEDI). Edward is the co-author of six books for the AMA, four on HIPAA and two on the implementation of EHR. He has also co-authored two books for the ADA, including the ADA Practical Guide to HIPAA Compliance: Privacy and Security Kit.  Contact Craig Maynard at 843-813-6567 or and visit and


Competitive Health Debuts a New Corporate Identity That Meets A Changing Marketplace

MyHealthGuide Source: Competitive Health, Inc., 8/12/2014,

Mission Viejo, CA -- After nearly 20 years of transformative work for healthcare network payment marketplace, Competitive Health, Inc., has a new dynamic corporate identity to match.

"We believe the complex healthcare network market is missing an opportunity to reduce costs by offering innovative network solutions. We help customers develop these solutions and we wanted to make sure our identity reflected that message," says Kimberly Darling, Competitive Health CEO and founder.

Competitive Health, Inc., was founded in 1996 and was one of the first companies to provide a proven automated patient payment responsibility and network real-time solution to the healthcare marketplace. Competitive Health excels in developing healthcare payment solutions, including the cost effective delivery of payments to the healthcare provider or to the patient. Virtual payments, reloadable debit cards, claimant cards, ACH/835 and check printing are a few of the services  Competitive Health's technology facilitates. In many cases clients have not only saved money, they added millions of dollars in new revenue to their bottom line.

The leadership of Competitive Health is devoted to finding unique payment solutions in the healthcare network space, and they find it personally satisfying to serve this niche marketplace.

Darling continues, "We're in the middle of transformative changes in the healthcare payment market -- some good changes, and some changes that will challenge the industry. Payors have to be ready to adapt, and our technology is a 'game changer'. It was time for our corporate identity to reflect the new opportunities and solutions available to our customers."

Competitive Health, Inc., can be found online at and the leadership will be actively engaged on LinkedIn identifying new and innovative ways to realize cost savings in healthcare payments.

About Competitive Health

Competitive Health, Inc. is an award-winning, privately held health network and program enhancement company providing patented technology-based, consumer-driven programs and payment solutions to clients throughout the United States. Led by Chief Executive Officer and founder, Kimberly Darling, Competitive Health has established itself as the preeminent supplier of healthcare network access with unique technology and fixed-cost strategies, which translates to hundreds of millions of dollars in savings for Insurance Carriers, Third Party Administrators, Affinity Groups and Exchanges. Corporate headquarters are located in Mission Viejo, California, with executive offices in Newport Beach, California, and provider referral services in Cleveland, Ohio. Visit


People News

PartnerRe Announces Timothy Ross Joins Health Team

MyHealthGuide Source: PartnerRe, 8/1/2014,

San Francisco, CA -- PartnerRe is pleased to announce that Tim Ross has joined as Senior Underwriter, Specialty Medical Programs. He brings over 20 years of experience in the health insurance field. Tim will join the Specialty Medical team led by Tasha Barbour and will operate out of our Kansas City office. He will work with our clients and brokers to build and underwrite our growing portfolio of business.

"By expanding our Specialty Medical team we can ensure that our clients have every resource available in managing their financial exposures in today's constantly changing healthcare environment" said Tasha Barbour, Vice President, Director, Specialty Medical Programs.
"Tasha has done an excellent job of establishing our Specialty Medical Program. Tim is a great addition to her team. He will be extremely valuable in underwriting and servicing our growing portfolio of specialty business, researching healthcare reform topics, assisting with new product development and building and maintaining our broker relationships. His expertise will enable us to further strengthen our leadership position in the Specialty Medical market," stated Richard Berve, Executive Vice President, Director, Underwriting.


Tim Ross
7101 College Blvd., Suite 200
Overland Park, KS 66210
Tel: 1 913 871 7211

About PartnerRe

PartnerRe Ltd. is a leading global reinsurer, providing multi-line reinsurance to insurance companies. The Company, through its wholly owned subsidiaries, also offers capital markets products that include weather and credit protection to financial, industrial and service companies. Risks reinsured include property, casualty, motor, agriculture, aviation/space, catastrophe, credit/surety, engineering, energy, marine, specialty property, specialty casualty, multiline and other lines in its Non-life operations, mortality, longevity and accident and health in its Life and Health operations, and alternative risk products. For the year ended December 31, 2013, total revenues were $5.5 billion. At June 30, 2014, total assets were $23.4 billion, total capital was $7.7 billion and total shareholders' equity attributable to PartnerRe was $6.9 billion.  Contact Ali Duerr, Marketing Manager, at 415 354 1584, and visit


INETICO Seeks Positions: Sales Executive, Software Engineer, Case Manager and UR Reviewer

MyHealthGuide Source: INETICO, Inc., 8/4/2014,

TAMPA, FL -- INETICO, Inc., a leading provider of medical management cost containment solutions, is seeking highly qualified, industry specialists to fill new positions:

  • Sales/Business Development Executive -- to target Central / Pacific Northwest Regions
  • Software Engineer II - .NET Developer -- based in our Downtown Tampa main office
  • Telephonic Case Manager RN -- training to be done in our Downtown Tampa office, then to transition to remote/work-from-home position
  • Utilization Management First Level Reviewer LPN -- based in our Downtown Tampa main office

For more information contact Maria King, Human Resources via email at .

About INETICO, Inc.

INETICO is a fast track industry leader providing medical and dental cost containment solutions to TPAs, self-funded plans, fully-insured plans, employer groups, MGUs and insurance carriers. INETICO's innovative and integrated approach to Care & Claims Management provides clients with cutting edge technology and access to information that are unparalleled in the industry today. Whether through our URAC accredited Utilization Management, Case Management, Disease Management and Maternity Management programs, our professional PPO and Claims Management Services, or our proprietary INETIPASS Care & Claims Management platform, INETICO is on the grow! We are looking for experienced, high energy, results driven individuals who are interested in a long-term commitment for success with a focus driven company.  Visit .


IHC Risk Solutions Seeks Actuarial Position for Enfield, CT Corporate Office

MyHealthGuide Source: IHC Risk Solutions, 8/8/2014,

IHC Risk Solutions, a growing direct writer of Stop Loss Insurance and a member of The IHC Group is seeking an individual interested in advancing their career in the Stop Loss Insurance Industry to fill an Actuarial position in our Enfield, CT Corporate office.


This position is responsible for working with a team of experienced Stop Loss Professionals to assist in the profitable on-going growth of a leading Stop loss Carrier. This position shares responsibility for all actuarial functions related to that growth.


  • Maintaining and updating Stop loss Rating manuals and pricing factors.
  • Experience and expense studies.
  • Product development and new product pricing.
  • Stop Loss Reserve analysis.
  • Consultant to Stop Loss Underwriters.
  • Analyze statistical information to estimate morbidity patterns.
  • Collaborate with programmers, underwriters, accounts, claims experts, and senior management to help develop plans for new lines of business or improving existing lines.
  • Pursue initiatives to capitalize on strengths and market opportunities and to counter competitive threats.
  • Assist with product changes and new product offerings
  • Ability to present concepts and results of work products to senior management
  • Analysis of risks and underwriting considerations


  • Ability to work as a constructive team player
  • ASA to new FSA Designation
  • Bachelor's degree in a related field preferred or equivalent experience
  • Five or more years of actuarial experience in healthcare products
  • Strong oral and written communications skills
  • Strong analytical skills and the ability to pay attention to details
  • Advanced level experience with Excel
  • Knowledge of Microsoft Office software suite
  • Stop Loss and small group fully insured medical experience a plus


  •  Salary commensurate with experience

Interested candidates should forward their resumes to today!

About IHC Risk Solutions (IHCRS)

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


Market Trends, Studies, Books & Opinions

'Coverage for Individuals Participating in Approved Clinical Trials' and How it Affects You, the Payer

MyHealthGuide Source: Caryn S. Wetmore, General Counsel and Bruce D. Roffé, President and CEO of Roffé Enterprises, Inc. t/a H.H.C. Group,

A little known and obscure section of the 2010 Patient Protection and Affordable Care Act (PPACA), Section 2709, titled "Coverage for Individuals Participating in Approved Clinical Trials", will have significant negative impact on payers large and small nationwide..

Under Section 2709, a group health plan and health insurance issuer offering group or individual health insurance coverage may not deny coverage of routine patient costs associated with items and services furnished in connection with approved clinical trials.

Pharmaceutical companies are only responsible for paying for the experimental medications themselves. Even if, after administering the experimental medication, an adverse reaction is seen in the patient and that patient requires further treatment, the pharmaceutical company bares no financial responsibility. Specifically, routine patient costs include all items and services consistent with coverage provided in the plan (or coverage) that is typically covered for a qualified individual who is not enrolled in a clinical trial. Routine patient costs, however, do not include the investigational item, device, or service, itself.

As defined in Section 2709, and mentioned above:

  • (i) "qualified individual" means an individual who is a participant or beneficiary in a health plan who currently is enrolled in or is eligible for a clinical trial to treat cancer or other life-threatening disease or condition;
  • (ii) "'life-threatening condition' means any disease or condition from which the likelihood of death is probable unless the course of the disease or condition is interrupted"; and
  • (iii) "'approved clinical trial' means a phase I, phase II, phase III, or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease or condition and…" is a federally funded trial (e.g., approved or funded by the National Institutes of Health), is conducted under an investigational new drug application reviewed by the Food and Drug Administration, or is a drug trial.

Section 2709 does not require a payer "to provide benefits for routine patient care services provided outside of the plan's (or coverage's) health care provider network unless out-of-network benefits are otherwise provided under the plan (or coverage)." This Federal law section does not preempt State law. In either circumstance, the stricter law applies.

Section 2709, therefore, obligates payers to pay for care associated with the approved clinical trial other than for the investigational item, device, or service, itself. As a result, payers are obligated to pay for the care, including any and all complications associated with the approved clinical trial. To read Section 2709 in its entirety, please visit the following website:

About H.H.C. Group

H.H.C. Group is a full-service health insurance consulting firm. Our staff of licensed health Insurance adjusters who are attorneys, nurses, pharmacists, physicians, and other health insurance professionals, will contact providers to negotiate/reprice your costly medical claims. Patients can submit/enter claims directly online for pricing reductions. Providers can use this site to electronically submit claims to health insurers.

H.H.C. Group's Health Insurance Adjusters (H.I.A.) are licensed in Florida, New York, North Carolina, and Oregon. H.H.C. Group is a Utilization Review Agency in Alabama and is a Licensed\Certified Independent Review Organization in Arkansas, Georgia, Hawaii, Idaho, Iowa, Kentucky, Mississippi, Nevada, Oklahoma, South Dakota, Utah, Washington and Wyoming, an External Independent Review Organization in the States of Illinois, Ohio, Tennessee, and Virginia, a Private Review Agent in the Commonwealth of Virginia, and a Licensed Medical Claims Review Agency in the State of Indiana.

Our service offerings include, but are not limited to, Claims Editing, Claim Negotiations, Claim Repricing, Medical Bill Review (Audit), Medical Peer Review, Case Management, Utilization Review, Data Mining, Claim Scrubbing, Disease Management, DRG Validation, Medicare Claim Repricing, Pharmacy Consulting, Transplant Networks, and we provide case review, analysis and reporting as a URAC Accredited Independent Review Organization.

Contact Robert Serber at, (301) 963-0762, x 163 and visit


Legal, Legislative & Regulatory News

SIIA NAIC Summer Meeting Report: Regulators Considers Policy Proposals Affecting Self-Insurance Marketplace

MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 8/16/2014.

The Self-Insurance Institute of America, Inc. (SIIA) participated on 8/16/2014 in two NAIC Working Group meetings where policy proposals affecting the self-insurance marketplace were discussed. This communication will serve to provide re-caps of each meeting.

The primary agenda item for the ERISA (B) Working Group was the recently-released white paper, entitled "Stop Loss Insurance, Self-Funding and the ACA."

The Chair, Christina Goe of Montana, called the meeting to order and outlined how industry stakeholders can provide feedback on the white paper within a 30-day public comment period commencing immediately. She noted that there will be at least one conference call in "mid-September" and possibly more after the white paper is edited. It is likely that a second draft would then be circulated with an additional comment period and at least one additional conference call. The meeting only lasted about 10 minutes.

SIIA expects to submit comments as part of its broader advocacy and communications campaign to educate policy-makers at the state and federal level about the importance of self-insured group health plans and how stop-loss insurance works. Some recent examples of the association's efforts include:

  • SIIA secured the introduction of federal legislation to prevent regulators from re-defining stop-loss insurance as health insurance based on attachment point levels;
  • The Self-insurance Educational Foundation (SIEF), which is affiliated with SIIA, released and updated report on stop-loss marketplace prepared by Milliman;
  • SIIA President & CEO Mike Ferguson has testified at two congressional hearings over the past 10 months on the subject of self-insurance;
  • Working with its members in Connecticut, SIIA was successful in killing aggressive stop-loss insurance regulation;
  • SIIA continues to spearhead a lobbying effort to pass legislation in New York to protect a segment of the self-insurance marketplace in that state, and
  • SIIA continues to spearhead a lobbying effort in the District of Columbia to block harmful stop-loss legislation.

Separately The NAIC's Financial Regulation Standards and Accreditation (F) Working Group considered a proposal to re-define a "multi-state" reinsurer, one that would affect virtually all captive insurance companies operating in multiple states. The definition has many problems including: the proposal would affect a broader range of insurance lines than intended, an unreasonably short period to come into compliance and the costs of compliance would compel many captives to move offshore.

Chairman John Huff, the Missouri Insurance Department Director, announced that the NAIC received 34 comment letters, most of which were critical of the proposal. SIIA submitted one of the letters of opposition.

After opening public comment for only those who did not already submit comments, he turned the microphone to Commissioner Joseph Torti of Rhode Island. Commissioner Torti, a proponent of the definition change, said that he did not intend to broadly affect captives, but there are legitimate concerns about guarantees without real financial collateral. This meeting also lasted only about 10 minutes.

The next step for this proposal is unclear. Before the next NAIC meeting, the committee could release a second draft of the definition with an open comment period of either 60 or 365 days. Or, all action could be deferred until the next NAIC meeting in November.

If this proposal is to advance within the NAIC, it will have to change significantly. In discussions with several regulators after the meeting regulators, SIIA confirmed that many doubt this proposal is needed and that insurance departments already have the tools to effectively regulate captives. SIIA will nonetheless continue to monitor developments and initiate advocacy efforts accordingly.

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.

Please contact SIIA State Government Relations Director Adam Brackemyre at should you have any questions regarding this report or would like to request the referenced white paper and/or reinsurance definition proposal.

Additional legislative/regulatory updates will provided at SIIA's upcoming National Conference & Expo, scheduled for October 5-7, 2014. Event details can be accessed on-line at, or by calling 800/851-7789.


Providers Are Not ERISA Beneficiaries

MyHealthGuide Source: Todd Leeuwenburgh, 8/8/2014, Thompson Blog

Case: DB Healthcare v. BCBS Arizona, 2014 WL 3349920 (D.C. Ariz., July 9, 2014).

In a decision sharply at odds with a recent Illinois ruling, a federal district court in Arizona held that health care providers cannot be characterized as plan beneficiaries who can sue to compel payment of ERISA benefits. The court rejected the view that a direct payment for services is an ERISA benefit that give providers the right to sue under ERISA -- such a right only comes from an assignment of benefits from a plan participant, it held. Characterizing beneficiaries as more than just a covered spouse or dependent would undermine ERISA, the court decided in the above DB Healthcare case.

Furthermore, plans' non-assignment language effectively blocked participants from assigning to providers their right to sue to enforce ERISA rules, the court decided.

These were the court's main conclusions in dismissing a case under which the providers alleged they were owed ERISA claims and appeals rights as ERISA beneficiaries.

The Facts

BCBS insured and administered the claims of several ERISA plans.

A group of health service providers including 10 nurse practitioners, had been billing allergy tests (ALCAT cytotoxic lab tests and attendant care) and getting paid for them since May 2011.

Sometime soon thereafter, the payer reversed its coverage policy on the tests, defining them as "investigational." The payer posted the change on the Internet, but the providers said the policy was not properly communicated to them. The providers also said that the fact Blue Cross paid hundreds of the claims was an acknowledgement that the tests were medically necessary and amounts billed and paid were proper.

In its provider agreements, BCBS reserved the right to adjust an adjudicated claim for up to a year after the date of payment if the claim was incorrectly paid or denied. (It also posted its policy of non-payment for investigational or experimental services.)

In April 2012, the payer sent the NPs demand letters saying that the claims had been paid in error and they needed to return $237,000. The providers alleged this reversal was an ERISA benefits determination, while the payer contended that it was an overpayment recoupment from future claims.

The providers refused to refund the money. In reply, Blue Cross alleged breach of contract, threatened to toss in-network NPs out of its network, and reject the credentialing applications of NPs who had pending applications to become in-network.

The providers sued to reverse the retroactive denial, saying the payer's demand letter violated ERISA and health care reform claim rules requiring adequate notice in writing within 30 days and the opportunity for full and fair review. Provider contracts that provided for unilateral offsets should be preempted by ERISA, they said.

Even under ERISA, they argued, their recoveries would not be equitable because they would rely on tracing that cannot be done.

They argued that the cancellation of the NPs' in-network status violated ERISA's prohibition on retaliation, and sought an order forcing Blue Cross to restore the provider agreements and the provider-network applications it had cancelled.

Blue Cross moved to dismiss the claims, saying the providers were trying to manufacture federal ERISA questions in order to avoid their contractual obligations.

Providers Said They Were Beneficiaries

The providers said they had standing under ERISA because they are ERISA beneficiaries, and the fact that they collected payments directly from the payer conveyed an ability to enforce ERISA.

They argued that providers become beneficiaries much in the same way that ERISA allows workers to designate beneficiary rights to spouses and dependents. But the court said that argument was "unpersuasive" and "contrary to the weight of authority."

The court rejected the idea that the providers should gain legal status as ERISA beneficiaries without an assignment of benefits. Other benefits, like vacation pay and fringe benefits, are unassignable, the court remarked.

And the mere fact of being directly paid by the plan does not make a provider into a plan beneficiary for ERISA standing purposes.

  • Note: The federal district court in DB Healthcare v. BCBS Arizona rebutted the federal court in Illinois' expansive definition of beneficiary in Penn. Chiro. Assn. v. Blue Cross Blue Shield Assn., 2014 WL 1276585 (N.D. Ill., March 29, 2014), which decided that providers were "beneficiaries" under ERISA by virtue of being paid directly by plans. As beneficiaries, the providers had to be afforded ERISA claims-processing and appeal protections. The court also barred the health plans from unilaterally recovering overpayments from the providers.

The court said the ruling in Penn. Chiro. Assn. v. Blue Cross Blue Shield Assn.: had no foundation in precedent; applied pension plan provisions to the health context; and was the "only case ever" to reach such a conclusion.

An ERISA plan may expand the definition of beneficiary, but the plans DB Healthcare was involved with limited the definition of beneficiary to the participant plus family members or dependents.

The plaintiffs cited cases where courts gave providers ERISA standing, but the providers in those cases had assignments. In contrast, DB Healthcare was trying to assert its rights as a beneficiary in the absence of any assignment. The court rejected that reading.

  • [Health care providers] are not beneficiaries. They may sue to enforce ERISA only with valid assignments.

The providers submitted no valid assignments of benefit forms to the court. They did submit four blank forms and one filled-out form that did not assign benefits to any of the NPs by name.

Non-assignment Clauses

Further, some, if not all of the plans, had valid non-assignment clauses, leaving no basis for providers to expect ERISA claims rules to be in effect. BCBS Arizona contended, and the court found nothing to contradict, that every ERISA plan contained this non-assignment language.

  • The benefits contained in this plan, and any right to reimbursement or payment arising out of such benefits, are not assignable or transferable, in whole or in part, in any manner or to any extent, to any person or entity. You shall not sell, assign, pledge, transfer or grant any interest in or to, these benefits or any right of reimbursement or payment arising out of these benefits, to any person or entity. Any such purported sale, assignment, pledge, transfer, or grant is not enforceable against [Blue Cross] and imposes no duty or obligation on [Blue Cross]. [Blue Cross] will not honor any such purported sale, assignment, pledge, transfer or grant.

A non-assignment clause prohibiting participants from signing away their rights to pursue ERISA benefits in court is not inconsistent with an arrangement under which the plan pays the provider directly -- for the convenience of the provider and participant, the court said.

As a result, the court barred the providers from suing as assignees. Further, the court denied the providers the opportunity of amending their complaint.

ERISA Exists to Defend Participants, Beneficiaries

The providers had promoted their case saying this was a classic "right to pay" as opposed to "amount of pay" situation (the former -- right to pay -- being an important hallmark of an ERISA case versus state-law case). But without an assignee, the court said that was moot.

The court ruled for BCBS Arizona, and dismissed DB Healthcare's complaint.


Medical News

Experiencing Atrial Fibrillation While Hospitalized For Surgery Associated With Increased Long-Term Risk of Stroke

MyHealthGuide Source: Gino Gialdini, M.D., of Weill Cornell Medical College, New York, et al., Journal of American Medical Association, 8/13/2014, JAMA Article

Experiencing atrial fibrillation (AF) while hospitalized was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery, according to a study published in the Journal of American Medical Association.

The study included 1,729,360 eligible patients with an average follow-up time of 2.1 years. Among these patients, perioperative AF was documented in 24,711 cases (1.43 percent).

Study findings

  • After discharge from the index hospitalization for surgery, 13,952 patients (0.81 percent) went on to experience an ischemic stroke.
  • At 1 year after hospitalization for noncardiac surgery, cumulative rates of stroke were 1.47 percent in those with perioperative AF and 0.36 percent in those without AF.
  • At 1 year after cardiac surgery, cumulative rates of stroke were 0.99 percent in those with perioperative AF and 0.83 percent in those without AF.

Analyses indicated that perioperative AF after noncardiac surgery was associated with twice the risk of stroke and a 30 percent greater risk after cardiac surgery.

Researchers said that results may have significant implications for the care of perioperative patients. The associations we found suggest that while many cases of perioperative AF after cardiac surgery may be an isolated response to the stress of surgery, perioperative AF after noncardiac surgery may be similar to other etiologies of AF in regard to future thromboembolic risk.

About AF

Atrial fibrillation (AF) and flutter affect more than 33 million people worldwide. The presence of chronic AF confers a 3-fold increased risk of stroke. Perioperative (around the time of surgery) atrial fibrillation may be viewed as a transient response to physiological stress, and the long-term risk of stroke after perioperative atrial fibrillation is unclear, according to background information in the article.


Recurring Resources

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 6/30/2014)

Source: MyHealthGuide

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

Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter

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

  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
Capital /Equity
1. CIGNA     $1,907
  CIGNA 2013 10-K, page 46 2/27/2014
2. Sun Life Financial     $915.2
  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+)
  HCC Insurance Holdings, Inc. Release,
4. HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
Mike Sullivan, President & COO
5. Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $475M
MRM - $255M)
Michael Fry, Executive Vice President, Symetra;
Mike McLean, Chairman Medical Risk Managers, Inc.
6. ING Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
Joe Keller, Lead Financial Analyst, ING Employee Benefits,
7. Companion Life > 20 Years   $310
  Philip Gardham, Vice President, Specialty Markets,
8. National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $215
  Jeff Gavlick, VP, Stop Loss Products, AIG Benefit Solutions
9. Independence Holding Company   Standard Security Life Insurance Company of New York,
Madison National Life, Independence American Insurance Company
$200   Roy T.K. Thung, CEO, Letter to Stockholders
10. Zurich North America     $130   Tracey Brennan, Zurich North America.
11. Munich Re Stop Loss, Inc.   AIC, TransAmerica $110
  Susan McGrath Bowman,
Chief Operating Officer, Munich Re Stop Loss, Inc.
12. The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
  Victor Moran, Second Vice President, Actuarial Operations.  3/12/2014
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $$3,388
Mark Nichols, Managing Director.

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

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

Stop-loss Premium Volume is not the Whole Story

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

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

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


Upcoming Conferences

August 18-20, 2014
Healthcare Information Security, Privacy Training presented by Clearwater Compliance, a designated Official Training Provider (OTP).  This official HCISPP training seminar is the most comprehensive, complete review of healthcare security and privacy concepts and industry best practices. The training specifically covers each element of the HCISPP common body of knowledge (CBK®), including foundational information on:

• The Healthcare Industry
• The Regulatory Environment
• Privacy and Security in Healthcare
• Information Governance and Risk Management
• Information Risk Assessment
• Third Party Risk Management

Comprehensive preparatory training for healthcare information security professionals who are working to earn the HealthCare Information Security and Privacy Practitioner (HCISPP) credential from (ISC)².  Nashville, TN. 

Cost of the Clearwater HCISPP training is $1,595. Click here to register.  Contact Helene Cuddeback at and visit

August 20-27, 2014 -- Web Event
Clearwater HIPAA Compliance Virtual BootCamp™.  Designed for busy professionals, this event is a series of three, 3-hour web sessions delivering an action-packed HIPAA-HITECH curriculum This virtual workshop series  provides critical information leaders need to know about the HIPAA Privacy and Security Final Rules and the HITECH Breach Notification Rule. The Clearwater HIPAA Compliance Virtual BootCamp™ has helped hundreds of professionals learn HIPAA-HITECH fundamentals in a highly interactive, online classroom setting.  Contact Clearwater Compliance at 800-704-3394 and

August 20, 2014
Best Practices in Reinsurance Administration Webcast presented by Society of Actuaries.  For those involved in reinsurance, administration or reporting.  Focused on helping grow competencies in external forces and industry knowledge as referred to in the SOA Competency Framework. Presenters, Tom Hartlett, Chief Administrative Officer, Aurigen U.S. and Paul M. Chapman, PMC Consulting LLC and Melinda G. Hubbard, ACS, ChFC, CLU, FLMI, ARA, Director, New Business, Ohio National Financial Services. Information and registration.

October 15, 2014
Health Insurance Exchanges Forum hosted by America's Health Insurance Plans. An ongoing series to provide the latest and most critical exchanges information on the business of the exchanges, including best practices and how business processes have changed. Hear from the leadership implementing exchanges at the state and federal levels. Enjoy early registration rates before September 5, 2014. Contact: 202-778-3200 or . See

October 16-17, 2014
The State Health Issues Conference hosted by America's Health Insurance Plans. Brings together the leading authorities and thought leaders to discuss the state legislative and regulatory issues challenging health plans. Enjoy early registration rates before September 5, 2014. Contact: 202-778-3200 or . See

October 16, 2014
Clearwater HIPAA Compliance BootCamp™.  Designed for busy professionals, this event distills into one action-packed day, the critical information leaders need to know about the HIPAA Privacy and Security Final Rules and the HITECH Breach Notification Rule. The Clearwater HIPAA Compliance BootCamp™ has helped hundreds of professionals learn HIPAA-HITECH fundamentals in a highly interactive classroom setting. Los Angeles, CA.  Contact Clearwater Compliance at 800-704-3394 and

November 5-12-19, 2014 -- Web Event
Clearwater HIPAA Compliance Virtual BootCamp™.   Designed for busy professionals, this event is a series of three, 3-hour web sessions delivering an action-packed HIPAA-HITECH curriculum This virtual workshop series provides critical information leaders need to know about the HIPAA Privacy and Security Final Rules and the HITECH Breach Notification Rule. The Clearwater HIPAA Compliance Virtual BootCamp™ has helped hundreds of professionals learn HIPAA-HITECH fundamentals in a highly interactive, online classroom setting. Contact Clearwater Compliance 800-704-3394 and

November 10-12, 2014
4th Annual IHC FORUM West presented by Institute for HealthCare Consumerism.  Join employers, brokers, health plans, TPA's, consultants and solution providers to LEARN, CONNECT and SHARE HealthCare Consumerism trends, challenges and solutions including:
Learn next steps and best practices in HealthCare Consumerism, Compliance issues with health care law in 2015 and beyond, Access latest health and benefit innovations and trends, Look into real time open enrollment statistics, Perspectives on election results, Analyze benefit models, including defined contribution and exchanges, Network with your peers and other industry stakeholders, Receive top quality education, more.  Red Rock Resort & Spa. Las Vegas, NV. Information and registration:

November 17-19, 2014
The Ops/Tech Forum, hosted by America's Health Insurance Plans, gathers industry experts to discuss critical issues such as: consumer engagement, exchange implementation, cost drivers, data analytics, and innovative technologies. Gain insights on the strategies, tools, and solutions you need to guide you into 2015 and beyond. Register today! Contact: 202-778-3200 or .

October 5-7, 2014
National Educational Conference & Expo presented by Self-Insurance Institute of America (SIIA). The event typically attracts more than 1,700 attendees from throughout the United States and from a growing number of countries around the world.  The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions. Highlights:

  • Click here for speaker listing
  • Self-insured group health plans from every angle
  • Plan design and cost containment
  • Financial risk transfer
  • Broker involvement
  • ACA compliance
  • Stop-loss captive programs
  • 831(b) captives
  • Workers' Comp self-insured funds (SIGs)
  • Over 150 Exhibitors
  • SIG Roundtable Discussion
  • Sessions Provide Unique Learning and Industry Collaboration Opportunities
  • Featured speaker: Dr. Richard Pimentel, senior consultant with Milt Wright & Associates, Inc., His presentation focus will be Updating Yesterday's Disability Management Solutions to Address Today's Workers' Compensation Dilemmas.

J.W. Marriott Desert Ridge, Phoenix, AZ. contact Justin Miller at 800/851-7789, or  Information and Registration:

October 15-17, 2014
SPBA Fall Meeting (members only). Nashville, TN. Society of Professional Benefit Administrators (SPBA).

December 4-5, 2014
IHC Forum West presented by the Institute for HealthCare Consumerism. Las Vegas, NV. Contact Joni Lipson at and visit


January 18-20, 2015
The 2015 Taft-Hartley Benefits Summit presented by Financial Research Associates, LLC.
Caesars Palace in Las Vegas. Contact Jennifer Clemence at  Information and registration: and visit

January 25-27, 2015
AAPAN 2015 Annual Forum presented by American Association of Payers Administration & Networks.  The theme for this year's forum is "Thinking Forward -- Rethink, Retool, Realign." This will be your opportunity to join industry leaders and an exciting lineup of speakers as we examine how best to position our businesses in this fundamentally changed healthcare environment. You will hear firsthand from experts and colleagues about challenges and opportunities at the state and federal level that are unique to TPAs, PPOs, and Workers' Comp professionals. Information: and (502) 403-1122.  Ritz-Carlton, Laguna Niguel in Dana Point, CA.

February 10-11, 2015
2015 Executive Forum presented by Heath Care Administrators Association (HCAA).  Encore at Wynn Las Vegas. Las Vegas, NV.

March 4-6, 2015
Self-Insured Health Plan Executive Forum presented by Self-Insurance Institute of America.  J.W. Marriott Camelback, Scottsdale, AZ. 

March 18-20, 2015
SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA).

April 13-15, 2015
International Conference presented by Self-Insurance Institute of AmericaHilton Panama, Panama City, Panama.

April 29-30, 2015
Self-Insured Taft-Hartley Plan Executive Forum (NEW EVENT!) presented by Self-Insurance Institute of America. Marriott Metro Center, Washington, DC

May 6-8, 2015
Northshore's 26th Annual Claims Conference.  Salem, Massachusetts. This is an invitation only event. If you are interested in attending or presenting at next year's conference, you may contact Steve Murphy at

May 12-14, 2015
Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance Institute of America. Windsor Court Hotel, New Orleans, LA

October 18-20, 2015
National Educational Conference & Expo presented by Self-Insurance Institute of America. Marriott Marquis, Washington, DC  

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


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

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


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®


Clevenger Ernie Clevenger
President & Publisher
MyHealthGuide, LLC