MyHealthGuide Newsletter
News for the Self-Funded Community

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General & Company News

People News

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

Summit Reinsurance Services Give Notice of Data Breach for Certain Self-funded Employer Groups

MyHealthGuide Source: Summit Reinsurance Services, Inc. via PRNewswire, 3/13/2017

FORT WAYNE, IN -- Summit Reinsurance Services, Inc. discovered an event that may affect the security of certain individuals' personal information. Summit provides reinsurance and employer stop-loss underwriting services to certain insurance companies and has individuals' information because of the services Summit provides.

What Happened?

On August 8, 2016, Summit discovered that ransomware had infected a server containing certain personal information. Summit immediately launched an investigation to determine the nature and scope of this event and to prevent the encryption of data contained on the server. Based on the forensic investigation, it appears that the unauthorized access to the server first occurred on or around March 13, 2016.

What Information Was Involved?

The information contained on the affected server may have included name, Social Security number, health insurance information, provider's name, and/or claim-focused medical records containing diagnosis and clinical information.

What We Are Doing.

To date, Summit has no direct evidence that data from the affected server has been used inappropriately. Nevertheless, in an abundance of caution, Summit, on behalf of certain affected health plans and self-funded employer groups, is notifying affected individuals of this incident. Summit is also providing information that can be used to better protect against identity theft and fraud, as well as access to one year of credit monitoring and identity restoration services at no cost to the individual. Summit is committed to the security of the personal information in its care and has worked, and will continue to work, to enhance the protections in place to protect data.
What You Can Do.

You can review the information Summit is providing on steps individuals can take to protect against identity theft and fraud.

For More Information.

If you believe you have been affected by this incident, please call (877) 215-9747, Monday through Friday, 9 a.m. to 7 p.m. EST (closed on U.S. observed holidays) and provide Reference Number 2996113016.


DWVD January 2017 Survey Announcement

MyHealthGuide Source: D.W. Van Dyke & Co. Inc. (DWVD), 3/15/2017,

Chris Koehler, President of D.W. Van Dyke & Co. Inc., announced that MGU and Carrier participation for its just completed January 2017 Stop Loss Industry Surveys (Premium increase, Persistency and New Business) was extremely successful. Survey results will be tabulated and sent to the 30+ participants representing almost $6.5 Billion in annualized Stop Loss premiums prior to the SIIA Conference in Tucson which begins March 27.
Organizations considering participation in future DWVD Stop Loss surveys should contact Chris at or Michelle Marzella at

About D.W. Van Dyke & Company

Founded in 1978, DWVD provides intermediary and advisory support for reinsurance placements, distribution, product development consulting and direct brokering services on behalf of institutional clients. DWVD works throughout the Life, Accident & Health space, most prominently in the stop loss business. DWVD's customers and markets include Insurance Companies, Reinsurers, TPAs, MEWAs, Cooperatives, MGAs, distribution companies and others. Contact Walt Roland at and visit


American Fidelity Receives Sixth Fortune Magazine and the Great Place to Work Institute Honor in a Year

MyHealthGuide Source: American Fidelity, 3/9/2017,

Oklahoma City, OK -- American Fidelity once again received national recognition as one of the 100 "Best Companies to Work For" as recognized by global research and consulting firm Great Place to Work® and Fortune Magazine. American Fidelity came in at number 89 on the list, and the only Oklahoma City-based company on the list.

"According to the survey, 98 percent feel great pride in what we accomplish together and 92 percent of Colleagues believe American Fidelity is a great place to work. Our Colleagues work diligently to care for our Customers across the country and really enjoy coming to work," said Dave Carpenter, executive vice president and chief operating officer. "Moving to our new headquarters has helped us grow our culture of collaboration and launching our new brand last year has helped renew our focus on making life easier for our Customers, which in turn has helped American Fidelity be an even better place to work."

How Colleagues rated American Fidelity according to a survey conducted by the Great Place to Work Institute:

• Great challenges: 96%
• Great atmosphere: 95%
• Great rewards: 96%
• Great pride: 98%
• Great communication: 94%
• Great bosses: 94%

American Fidelity helps Colleagues balance work and life with 70 percent of Colleagues working flexible schedules and 84 percent having the option to telecommute. Colleagues receive 26 days of paid time off for holidays, vacation and sick leave plus 20 hours of paid volunteer time. Colleagues can also get their car washed on-site, pick up prescriptions at the medical clinic or work with a personal trainer at the office gym. Pension plans, 401(k) and Health Savings Accounts matching contributions and bonuses help Colleagues feel like they are in it for the long term.

Learn more about the results and the American Fidelity culture:

American Fidelity currently has more than 50 positions open, many in the Oklahoma City area. Openings are currently available in actuarial, IT, auditing, Customer service, compliance, underwriting, benefits, administrative and sales. View all current openings and career information:

American Fidelity was selected among hundreds of companies vying for a place on the list this year. Applicant companies opt to participate in the selection process, which includes an employee survey and an in-depth questionnaire about their programs and company practices. Great Place to Work® then evaluates each application using its unique methodology based on five dimensions: credibility, respect, fairness, pride and camaraderie.

In January 2017, American Fidelity announced that Bob Lang and Steve Solomon had joined the team to develop a direct-to-market stop loss insurance program. Working together as a stop loss team, both as managed general underwriter (MGU) principals and later as insurance company executives, Lang and Solomon developed a client-focused business model based on long-term underwriting fundamentals. 

About American Fidelity

American Fidelity Assurance Company is a provider of stop loss medical protection for self-funded health plans and employers.  The Company also is a supplemental benefits provider with a focus on offering a different opinion for Customers in education, municipality, auto retail and healthcare. It serves more than 1 million Customers across 49 states. Visit


Society of Actuaries Present Webcast: ACA's Impact on Self-Insurance in the Small Group Market

MyHealthGuide Source: Society of Actuaries, 3/15/2017,

  • Webcast: April 4, 2017, Noon - 1:15 p.m. ET

Learn more about the ACA's potential impact on the composition of health risk in the small group market.

This webcast will discuss the results from a study evaluating the impact of community rating regulations on employer self-insurance across industries with varied health risk, using cross-state variation in pre-ACA small group market rating regulations and data from a nationally representative survey of employer health benefits.

It was found that lower risk employers subject to laws limiting allowable premium rating variation had a predicted probability of self-insurance that is about 18 percentage points higher than otherwise similar higher risk employers, suggesting that these selection concerns are warranted.

Presenters will discuss the implications of these findings for projecting the ACA's potential impact on the composition of health risk in the small group market, as well as how various other policies, including changes to the ACA, might impact the market.


Earn up to 1.50 CPD Credits


  • Erin Trish, Ph.D.
    Assistant Research Professor
    USC Schaeffer Center for Health Policy and Economics
  • Brad Herring, Ph.D.
    Associate Professor for Health Economics
    Johns Hopkins Bloomberg School of Public Health


  • Rebecca Owen, FSA, FCA, MAAA
    Health Research Actuary
    Society of Actuaries

About Society of Actuaries

With roots dating back to 1889, the Society of Actuaries (SOA) is the world's largest actuarial professional organization with more than 27,000 actuaries as members. Through research and education, the SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal challenges. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.  Visit


People News

PMGU Welcomes Bill Hoitt as VP of Sales

MyHealthGuide Source: Partners Managing General Underwriters, 3/13/2017

Scottsdale, AZ -- PMGU is excited to announce that Bill Hoitt has joined our team as VP of Sales, covering the Northeast region.

Bill has been in the employee benefits industry since 2005. He has worked for third-party administrators as well as one of the largest employer stop loss carriers in the country. His specialty and passion has always been for self-funding. He comes to Partners MGU from HM Insurance Group where he started the Boston sales office and was the director of sales for the New England region. Bill lives in Marshfield, MA with his wife and three young kids. He enjoys coaching youth sports, exercising, going to the beach and is a fan of all the major Boston sports teams.

Commenting on his new role, Bill said, "In a world of copy cats, it's rare to come across a company with such a unique value proposition like the one Partners MGU brings to the table. I'm excited about the opportunity to cut through spreadsheets and begin building truly solid relationships with our Producer-Partners."

Please feel free to contact Bill with questions about his new role, or about becoming a Producer-Partner with PMGU:, 508.631.8010.

About PMGU

Partners Managing General Underwriters is an entrepreneurial organization that underwrites medical Stop-Loss for the self-insured marketplace. This team is made up of seasoned professionals with a long history in employee benefits and insurance. Through its carrier partner, U.S. Fire Insurance Company, PMGU is approved in all 50 states. PMGU offers a unique opportunity for partnership among our Producer-Partners, PMGU and our Carrier. This opportunity is unlike anything else offered in the Stop Loss marketplace and is available only to our Producer-Partners.


Zelis™ Healthcare Announces Millie Tan as Chief Marketing Officer

MyHealthGuide Source: Zelis™ Healthcare, 3/8/2017,

BEDMINSTER, NJ and ATLANTA, GA -- Zelis™ Healthcare, a market-leading healthcare information technology company, is pleased to announce that Millie Tan is Chief Marketing Officer for Zelis Healthcare.

Ms. Tan will focus on accelerating market share and profit growth by enhancing Zelis' value proposition and building its brand with strategic vision for current and future offerings.

Ms. Tan is a proven marketing strategist well known for consistently delivering strong growth in market share and profit.

Ms. Tan served as Chief Marketing Officer for Quintiles, now Quintiles/IMS, a global leader in health information technologies and clinical research. She joined Quintiles from and Monster Worldwide, the global leader in connecting people with jobs online, where she was Chief Marketing Officer for Europe and Core Marketing Head for North America. Ms. Tan also held increasingly senior leadership positions in consumer marketing with Polaroid and Gillette, including assignments in Hong Kong and Tokyo.

Ms. Tan earned an MBA from the Tuck School of Business, Dartmouth College, an MA from Teachers College, Columbia University and a BA from Skidmore College.

"Millie has exceptional abilities as a strategic marketer," said Doug Klinger, CEO of Zelis Healthcare. "I look forward to her contributions as we grow the business and our market share."

"I'm very excited to be joining Zelis Healthcare at this time as it is well poised to continue its leadership in providing innovative solutions to address the needs of payers, providers and patients," said Ms. Tan.

About Zelis™ Healthcare

Zelis Healthcare is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payments solutions including network solutions, claims integrity and electronic payments serving healthcare payer clients, healthcare providers and healthcare consumers in the medical, dental and workers' compensation markets nationwide. Zelis Healthcare is backed by Parthenon Capital Partners.  Contact Heather Ingram, Director of Marketing, at (800) 860-1111 Ext. 1635, and visit  Visit us on Facebook, follow us on Twitter, or connect with us on LinkedIn.


Job News

Berkshire Hathaway Specialty Insurance Seeks Stop-Loss Medical Risk Consultant

MyHealthGuide Source: Berkshire Hathaway Specialty Insurance, 3/13/2017,

This might be just the opportunity you have been waiting for - Working for an ever-growing international company where your values matter, where you are asked to do the right thing for the right reason. If being part of a supportive team, where your contribution is valued, where "Simplicity of Complexity" is one of our guiding principles, then we are waiting for you to join us, as we continue to build a "Forever Company"

Medical Risk Consultant

Berkshire Hathaway Specialty Insurance is seeking a medical risk consultant to join their medical stop loss team. The ideal candidate will utilize professional and clinical knowledge to assess risk. These activities will provide BHSI medical stop loss underwriters, claim auditors and external clients with appropriate clinical assessment of the anticipated care needs and potential costs of identified claimants.

Essential Job Functions

  • Effectively explain complex clinical conditions to internal and external clients.
  • Build strong relationships with internal (UW's, Claims) and external clients (TPA's, external CM's) to communicate risk factors and projected cost of claims.
  • Evaluate and assess both new business and renewal large claims/disclosure, clinical and claims data to identify known and potential risks and make potential cost recommendations to the stop loss underwriting team.
  • Serve as the lead resource for underwriting in identifying potential large claims, and to project the expected cost of the potential claim.
  • Quickly, thoroughly, and correctly assess a potential/actual claim situation to successfully influence risk decision makers, resulting in meaningful clinical and/or financial outcomes.
  • Document and effectively communicate claim projections and rationale to stop loss underwriters.
  • Develop a tracking system of claim cost projections and their effectiveness in reducing stop loss claims costs.


  • Bachelor's Degree or equivalent combination of education and work experience.
  • RN license required.
  • Five years of relevant experience, preferably with stop loss carrier.
  • Prior clinical experience preferred.
  • Working knowledge of stop loss insurance policy and contract language.
  • Verified knowledge of ESL Office, particularly the Underwriting, Claims and Policy Administration modules.
  • Working knowledge of Microsoft Excel.
  • Excellent oral, written, and interpersonal communication skills to achieve positive outcomes.
  • Detail oriented.

Interested candidates should email their resumes to Ruth Weaver at

About Berkshire Hathaway Specialty Insurance

Berkshire Hathaway Specialty Insurance provides medical stop loss, commercial property, casualty, healthcare professional liability, executive and professional lines, surety, travel, programs, and homeowners insurance.  Visit


Sun Life Seeks Stop Loss Underwriting Risk Director

MyHealthGuide Source: Sun Life, 3/9/2017,

Job Description Summary

This position is responsible for advancing best practices and implementing management protocols and key risk decision guidelines. This encompasses identifying and addressing external threats including those related to competitive, legislative, regulatory, and new technology and developing a strategy to address these underwriting risks. This position will have management responsibility for all departmental training initiatives. Reporting into this position will be our Learning & Development Associate Director and our medical underwriting team.

Responsibilities (include, but are not limited to)

  • Setting a risk management framework that is industry leading, best in class and enables SLF to achieve superior business results.
  • Development, approval, communication and documentation of underwriting risk rules.
  • Annually assess all existing UW risk rules, procedures and tools to identify areas that are outdated, inaccurate, ambiguous, or need further assessment.
  • Driving process improvement initiatives impacting underwriting risk.
  • Assessing external market trends and evaluate the need to make changes to our risk assessment approach.
  • Lead assigned Strategic initiatives focused on improving underwriting results.
  • Ongoing management of QPS risk rules/warnings to ensure they are aligned with business goals and objectives.
  • Driving the development of business practices and approaches to existing and emerging unique risks (i.e. captives, health plans, FITO).
  • Support development, implementation, documentation and maintenance of Special Producer Programs.
  • Partner with Claims, Actuarial, Underwriting and Product Development to establish feedback and management process that will enable early identification of risk concerns and development of solutions to address these concerns.
  • Responsible for Stop Loss department training needs (Not limited to underwriting); AD direct report will have day to day responsibility. Director is responsible for setting strategic direction and collaborating with business areas to develop and implement annual training plans.
  • Managing team of large claim medical underwriters in support of UW assessments.
  • Development of staffing models and other potential variance modeling.


  • 7-10 years Medical ASO/Stop Loss underwriting experience
  • Deep understanding of the healthcare marketplace
  • Strong understanding of risk management principles
  • UW training experience
  • Evaluates advantages/disadvantages, along with industry and marketplace trends, when making recommendations and decisions
  • Assesses complex issues from multiple angles to get the complete picture
  • Able to resolve problems that don't have clear solutions or outcomes

Interested candidates should email resume to Margaret Peterson at

About Sun Life

Sun Life offers a variety of stop-loss insurance products and services that provide a great source of financial protection – allowing companies to limit their liability for claims and maintain the budget. You can depend on our excellent sales, underwriting, and claims service. Plus, we deliver opportunities for companies to save money through cost-containment resources that can help lower health care costs even before a stop-loss claim occurs.  Visit


Sun Life Seeks Associate Director, Stop-Loss Training and Learning Development

MyHealthGuide Source: Sun Life, 3/9/2017,

Role Summary

The Associate Director, Stop-Loss Training and Learning Development will drive the business unit's training and learning development strategy with the goal of increasing the expertise and talent across the collective organization. The Associate Director will work closely with stop-loss business leaders to assess learning and talent development needs across the business, and then develop and execute on a robust multi-year strategy to meet the identified needs aligned to our key business goals, imperatives, and initiatives. Initially, a key focus will be on underwriting training.

Primary responsibilities

  • Serve as the primary trainer and resource for UW, new hire, and general product training.
  • Work with SL leadership team to assess baseline and prospective learning and development needs.
  • Evaluate data from Employee Engagement Survey, Brighter Way Initiatives, and varying VoC collection activities to identify key areas of focus.
  • Collaborate with leaders to assess specific needs by functional area and identify expected resource commitment required to develop and deliver training content.
  • Develop and implement learning strategy aligned with overarching Stop Loss strategic plan and identified learning and development needs.
  • Drive plan for comprehensive learning and organizational development initiatives across Stop Loss.
  • Coordinate, design, and implement training across all facets of the stop loss business.
  • Design and develop new hire training curriculum.
  • Research and model best practices in learning in order to ensure innovative, best-in-class training and performance support for Stop Loss organization.
  • Partner with various subject matter experts to facilitate and deliver specific topic / expertise level training sessions
  • Schedule, coordinate, and ensure successful execution of planned training sessions
  • Create metrics and reports to evaluate and present findings related to training impact and effectiveness.
  • Establish a framework for continuously measuring success of learning initiatives.


  • Bachelor's degree
  • 7+ years of experience working with Stop-Loss product in UW, Claims, Product Pricing, Quality, or Stop-Loss Operations
  • Ability to define strategy, overall direction, and effectively communicate vision to key stakeholders
  • Experience in collaborating with business leaders, supporting evolving business strategies, and driving to a collective identified goal
  • Ability to create and build learning and training programs that are innovative, comprehensive, and repeatable
  • Demonstrated expertise in leading through influence / can manage without authority
  • Direct experience with training or coaching -- has developed learning and knowledge solutions for a variety of roles
  • Proficient facilitation skills
  • Experience in partnering with SME's to help facilitate or deliver training content
  • Can manage complexity -- distributed learners, centralized teams, and multi-site locations
  • Demonstrated ability to manage change throughout all levels of the organization

Interested candidates should email resume to Margaret Peterson at

About Sun Life

Sun Life offers a variety of stop-loss insurance products and services that provide a great source of financial protection – allowing companies to limit their liability for claims and maintain the budget. You can depend on our excellent sales, underwriting, and claims service. Plus, we deliver opportunities for companies to save money through cost-containment resources that can help lower health care costs even before a stop-loss claim occurs.  Visit


Sun Life Seeks Associate Director Stop Loss Renewals

MyHealthGuide Source: Sun Life, 3/9/2017,

Sun Life is a leading provider of Stop Loss Insurance with over One Billion Dollars in force. We have a great opportunity for you to join our dynamic team! The Renewal Associate Director role can be located in either Wellesley, MA or Windsor, CT

Role Summary

This management position is responsible for leading and managing a multi-site (Wellesley, Windsor and Remote) team of Stop Loss Renewal underwriters to achieve persistency, revenue and profitability targets in coordination with the Director of Stop Loss Renewal Underwriting. You will be expected to contribute to the development of product and pricing strategies for Sun Life's Stop Loss product at both the regional and national level. This requires the ability to apply a strong technical Underwriting knowledge base in addition to the ability to collaborate well with members of the Stop Loss Sales organization.


  • Accountable for leading a team responsible for underwriting and successfully renewing over $1B of Stop Loss business
  • Collaborate with Stop Loss Actuarial and Underwriting leadership to develop and execute sound renewal underwriting methodologies that support business objectives
  • Develop strong partnerships with the distribution organization in order to implement and promote successful business strategies
  • Hire, train, develop and retain seasoned underwriters with a focus on succession planning
  • Identify and implement best practices
  • Act as a technical underwriting resource on complex cases
  • Promote compliance, consistency and efficiency in underwriting practices
  • Effectively manage inventory through allocation of work, and sound renewal planning process
  • Meet with Sales and participate in broker meetings to help deliver Sun Life's value proposition
  • Focus on employee development and attainment of a high performance culture
  • Partner with training and QA staffs to continually assess and develop underwriting expertise
  • Create a strong environment of motivation, ownership and accountability among the renewal underwriting team


  • 5-10 years underwriting experience, preferably Stop Loss
  • Experience leading a team preferred
  • Bachelor's degree preferred and/or equivalent years of experience in the Stop Loss industry
  • Strong operational background
  • Strong relationship management, collaborative and influencing skills
  • Strong communication, presentation and interpersonal skills
  • Ability to negotiate effectively

Interested candidates should email resume to Margaret Peterson at

About Sun Life

Sun Life offers a variety of stop-loss insurance products and services that provide a great source of financial protection – allowing companies to limit their liability for claims and maintain the budget. You can depend on our excellent sales, underwriting, and claims service. Plus, we deliver opportunities for companies to save money through cost-containment resources that can help lower health care costs even before a stop-loss claim occurs.  Visit


LifeTrac, Inc. Seeks Assistant Vice President of Sales & Marketing

MyHealthGuide Source: LifeTrac, Inc., 2/27/2017,

LifeTrac, Inc. is a leading national transplant network offering clinical support and access to hundreds of transplant programs at a select group of the nation's leading transplant facilities. 

As an Assistant Vice President you will be responsible for new business through outside sales and marketing to Third Party Administrators, Health Maintenance Organizations, Stop Loss Carriers and Reinsurers, and other payers.

Key responsibilities

  • Retain and grow sales volume by building strong relationships with key influencers, selling new or additional services, or by identifying new business lines for existing service expansion.
  • Manage the client contracting and annual performance reporting within assigned key clients.
  • Develop and deliver sales presentations and written communications to client sales targets.
  • Attend industry conferences and trade shows to reinforce and expand company contacts and industry reputation.

Preferred qualifications

  • Bachelor's degree in Business Administration or a related field or the equivalent education and/or experience
  • Minimum of six years of relevant and progressive experience in health care sales, with experience preferred in selling network access for transplant or other complex health care services
  • Strong understanding of third party administrator and employer stop loss markets and products
  • Minimum of three years of leadership experience.

Interested individuals should email a current resume to

About LifeTrac® Network

The LifeTrac® Network (LifeTrac) is a national transplant network offering clinical support and access to hundreds of transplant programs at a select group of the nation's leading transplant facilities. LifeTrac serves HMOs, TPAs, employer benefit plans, health insurers, reinsurance and stop loss companies. LifeTrac provides clients access to transplant contracts focused on cost predictability and low unit cost. With over 850 programs under contract, LifeTrac has a contract where members need care. LifeTrac also helps when members need transplant adjacent therapies -- complex treatments they might require before, after, or in lieu of transplantation. LifeTrac Continuum leverages provider relationships to secure impressive discounts from network providers for conditions such as ventricular assist device implantation, congestive heart failure, leukemia, lymphoma, and more.  Visit


Windsor Strategy Solutions Seeks a Sales Associate

MyHealthGuide Source: Windsor Strategy Solutions, 3/1/2017,

Windsor Strategy Solutions is seeking a dynamic, self-motivated sales associate to join our rapidly growing company. Incentive based compensation with base salary and significant upside potential. Candidate should have a record of prior sales success, as well as working knowledge of health benefit plan design and underwriting.

Job responsibilities & requirements

  • Ability to manage the sales cycle including prospecting, proposing, closing, and further developing an account
  • Demonstrate the software product suite via webinar or in person
  • Ability to quickly learn new technology and translate it into solutions that address customer needs
  • Target market: health benefits consultants / advisors / brokers
  • Some travel required
  • Excellent communication skills

Preferred qualifications

  • 3+ years sales and/or underwriting experience
  • Bachelor's degree

Interested parties should submit their resume and cover letter to:

About Windsor Strategy Solutions, LLC

Windsor Strategy Solutions, LLC, based in Princeton Junction, New Jersey, develops cutting edge software for employee benefits professionals who want powerful and easy to use tools that deepen their understanding and consulting capabilities for their client's health benefits plans. Our Health Benefits Consulting Suite and Actuarial Advisor rating manual are used by consultants, brokers, TPAs, plan sponsors, actuaries, reinsurers and stop-loss carriers.  Visit


Auxiant Seeks Sales Consultant for Milwaukee Office

MyHealthGuide Source: Auxiant, 3/1/2017,

Be part of a growing and prospering and fast growing company as a Sales Consultant for our Milwaukee, WI office.

Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA and Madison and Milwaukee, WI. Auxiant is a fast-growing, progressive company offering an excellent wage and benefit package. The Sales Consultant position will be responsible for sales in Indiana and Ohio for Auxiant. Auxiant has experienced significant growth in these states and is looking to add another sales person.


  • Responsible for cold calling, networking, conducting needs analysis, and consultative selling to existing and prospective brokers/consultants and clients

Essential duties and responsibilities

  • Cold call prospective brokers and consultants
  • Maintain a superior relationship with existing agents/consultants
  • Maintain regular communication with brokers/consultants and clients
  • Conduct needs analysis and future needs forecasting
  • Have superior knowledge of how self funding works and knowledge of all self funding terminology
  • Educate clients and brokers/consultants on difficult to understand services
  • Using a consultative approach, sell services to brokers/consultants and their clients
  • Up-sell existing clients Auxiant services through the broker/consultant
  • Excellent knowledge of our competition and our vendors
  • Other duties as assigned or appropriate

Minimum qualifications

  • Proven outside sales experience in self funding is preferred
  • Excellent interpersonal, written/verbal communication and presentation skills
  • Proficient PC skills including e-mail, record keeping, routine database activity, word processing, spreadsheet, PowerPoint, etc.
  • Excellent time management and organizational skills with the ability to handle multiple projects, meet established deadlines and change as the business needs require
  • Previous sales experience is preferred

Education and/or experience

  • Bachelors Degree and 2-4 years related experience; or equivalent combination of education and experience.
  • Job Type: Full-time

Required experience

  • Sales: 1 year

Interested candidates should send resumes to Joseph Holt, Vice President Sales & Marketing Auxiant, at


CFA/ NCAS Seeks Manager of Stop Loss in Baltimore MD

MyHealthGuide Source: CFA/ NCAS, 2/20/2017,

CFA/ NCAS, a leading third party administrator in the Mid Atlantic area, is seeking a manager of stop loss marketing and claims operations. This position reports directly to the Vice President, Corporate Support. In this capacity the manager provides leadership to Stop Loss marketing and claims unit to support new business sales and account retention through the marketing of competitive stop loss products and industry best practices stop loss claims administration.

Essential Duties

  • Strategic planning, cultivation, development and management of preferred stop loss carrier relationships.
  • Marketing, analysis, negotiation and placement of stop loss coverage of new and renewal business.
  • Management of Medical Review Unit.
  • Plans, organizes and manages the Stop Loss claims operations.
  • Managing, mentoring and professional development of stop loss staff.
  • Training sales representatives and account managers on stop loss products and coverage.
  • Assisting Training department as Stop Loss Insurance subject matter expert for internal and external customers.


  • Bachelor's degree or equivalent work experience.
  • Five years or more of progressive responsibility with increasing levels of managerial expertise and responsibility in marketing and analysis of Stop Loss Insurance and Stop Loss claims administration.
  • Must be thoroughly familiar with current health insurance market trends, services, contracts and pricing procedures, alternative funding arrangements.
  • Ability to analyze and understand insurance contracts, terms, provisions, limitations and exclusions.
  • Strong organizational skills.
  • Established management of diverse operations and mentoring capability.
  • Ability to work collaboratively with internal and external constituents to assure timely and reliable data outputs.
  • Ability to successfully analyze and negotiate competitive and reliable Stop Loss product quotes on behalf of TPA and CF clients for new and renewal business.
  • Ability to develop and evaluate favorable strategic relations with Stop Loss Carriers, Reinsurers and Managing General Underwriters (MGUs).
  • Life & Health producer license for Maryland, District of Columbia and Virginia ( currently licensed or secured within the first 6 months in position)

Interested applicants should send resumes to


NCAS is an industry leader in providing self-funded employee benefit plan administration services. We have been delivering customer-centric, quality benefit administration services for over 30 years. As a third-party administrator, NCAS gives our employer groups the freedom to design products with high levels of customization and competitive pricing. We are based out of Baltimore, Maryland and offer employer groups the best of two worlds--the cost-effectiveness and flexibility of a locally operated TPA combined with the backing and innovation of a national organization.  Visit


Market Trends, Studies, Books & Opinions

Glenn McLellan's Thoughts from the TPA Front Lines: #5: To PPO or Not to PPO…That is the Question

MyHealthGuide Source: Glenn McLellan, McLellan Consulting Services,  4/14/2017,

Things are moving at light speed for TPAs with new technology, approaches to disrupting traditional use of PPOs, carriers seeing TPAs as sources of business, increasing interest in participant engagement and widespread investor interest. It is essential for TPAs to "get back to the basics" and build the foundation to successfully manage any or all of these trends.

In 25 years of consulting with TPAs of all sizes, locations and challenges, I have developed 13 steps or strategies TPAs should take to build a strong foundation. This is the next in a series to review the steps.

#5: To PPO or Not to PPO…That is the Question

This article has taken me a while to write because of the number of times I had to re-write it. I have never been the most politically correct Consultant but rarely do one's words have the potential to alienate so many people. I promise to be less long-winded in future articles. Controlling the unit cost of healthcare is just one of the topics I am most passionate about.

If anyone noticed, we have a health benefit crisis in the United States, with per employee per year cost increasing over 300% since 2000. If that isn't enough, there is so much finger-pointing going on it makes one's head spin…it's the Pharma companies fault…it's Hospital's fault…it's our inability to manage disease effectively at fault…it's lack of transparency…it's lack of information…it's the misalignment of benefit design with consumerism.
In fact, it is all these causes and more! In the words of Howard Beale in the movie Network from 1976, "I'm mad as hell and I'm not going to take it anymore". Since its inception, the TPA industry has pioneered many of the most forward-thinking risk management and cost control strategies seen in the benefits marketplace. The word "disruptors" is almost too cliché these days as everyone seems to use it, but TPAs committed to innovation and using their experiences from the "front lines" truly represent a positive disruption of the status quo.
Lately, however, I believe that we have slowed down our innovation and perhaps even lost sight of our delegated role of Administrator of Plans. I say this because I continue to observe a litany of poor strategies put into play relating to the unit cost of medical services:

Preferred Provider Organizations

Does anyone really think that a 20-year old idea which hasn't been significantly updated can really work? Providers aggressively bill with software that "maximizes revenue"; provide deceptive contracts that create the illusion of a great deal; then are saddled with collection of thousands of dollars in patient liability. Is there any alignment of purpose in that? If I'm a provider and only collect 75% of the amount due to me because of high deductibles and coinsurance, why would I agree to a better contract?
Forget about better deals, think about the pure logistics of it. Is it possible to keep 50 contracts with facilities up-to-date given the hundreds, if not thousands, of ways to "game the system"? Expand that to a regional or national network with hundreds or even thousands of hospitals.

Example of Audit Results

I think it is important to tell a little story about an audit I just completed for a health plan that has a self-funded operation.

  •  Over a 12-month period, they managed the heck out of several contracts with hospitals. Most impressive was use of DRG methodology on inpatient care and excellent case rates for outpatient services.
  • The outlier or stop loss provision wasn't bad either, increasing from $200,000 to $400,000 during the 12 months reviewed. Even if the outlier was exceeded, the allowed amount was to be calculated based on 35% of billed charges…that's right, a 65% discount!
  • On the surface, a great deal. Well, I looked at roughly 25 claims paid throughout the year and an interesting thing happened. The facility realized that it could still manipulate the outlier provision to their advantage. High cost drug and surgical implant cost surged. Once the outlier was increased I saw knee implants priced at $135,000 and implants for back surgeries spike to over $350,000! Oncology and other high cost drugs showed inflated billings of over 1,000% of AWP.

The moral here is that even the best intended PPO network has an insurmountable hill to climb. Because of that, their value is significantly diminished. It is also important to understand that a PPO's efforts to maintain a robust network from an access perspective conflict directly with a TPA's ability to enforce its obligation to fairly and equitably manage costs.

Rental of Carrier Networks

I can remember 8 years ago, when I gave several speeches to the TPA community with strategies to "Beat the BUCAs". Now it seems that TPAs believe that something has changed. Two or maybe even three of the BUCAs "lease" their networks to TPAs at a cost of $13-$20 per covered employee per month.

From my perspective, an extremely short-sighted "deal" only benefitting the carriers. Let's look at the business proposition offered:

  1. The networks have all the issues discussed above, but carrier protection of the provider relationship makes enforcement of standard TPA cost control impossible. In fact, carrier rental agreements forbid collecting any form of clinical or substantiation data.
  2. TPAs using the networks are evaluated on their operational effectiveness, which means claims turnaround and minimizing provider complaints. If you think about taking a claim off line to complete the cost control your client expects, your effectiveness results suffer.
  3. For the benefit of renting a carrier network, your clients get to experience the "ancillary" services available to them, like carrier stop loss, PBM services and care management. Let's think about this. If I manage a care management unit of a carrier tasked with controlling costs for an insured and carrier ASO business, I don't think my best people and best programs are likely to be focused where I have no risk.
  4. TPAs pride themselves on delivering creative, customized solutions to clients on things like plan design, direct contracting and care management. It doesn't work when using carrier networks because they don't want "provider partners" confused.
  5. From a business perspective, the situation is even worse. A TPA can't compete for any business where the carrier or even another TPA using the carrier network is involved, and I might be lucky enough to have minimum revenue requirements. At the same time, they can pursue my business all they want.
  6. The carriers don't lease TPAs their best networks. In one case, the few TPAs who have access pay 1% to 3% more than their ASO business pays and with the other network with a larger base of TPA users it's much worse. That carrier has a three-tier network system whereby their best TPA network (used by only two TPAs in the country) pays 2% to 3% more than their ASO business; and the easy to attain network pays double digit above the ASO version. Pandering to the big carriers just to have their name on your ID card is most often a stab in the back to your customer.

Forgetting about issues like those outlined above, there is even question about whether carrier networks without cost control meet "tests" for any fiduciary responsibility a TPA might have with their clients. I recently completed a data analysis on 2,500 facility claims where carrier networks were involved, and the average allowable amount compared to Medicare was 281%. I'm not sure what the right number is, but a range of 160% to 175% of the Medicare allowable would have saved $25-28 Million over the carrier discounts.

Out-of-Network Management

 I have been a little tough so far on unit cost control strategies but I don't want to forget about management of the 6-8% of claims for every Plan where the patient has used a non-contracted provider. Some of these occur due to emergencies, others are based on the patient desiring "the best care" and many are due to HREAP providers (Hospitalists, Radiologists, ER MDs, Anesthesiologists and Pathologists).

Here's the thing, I don't believe that most TPAs have ever had the time or energy to really focus on how they manage these claims. If PPOs have issues from a cost control perspective, what do we think about an industry of "PPO Aggregators", "Wrap Networks", "Supplemental Networks", or in its worst form "Blind Networks". These provide automated re-pricing based on multiple layers of contracts with various PPOs. It should be no surprise that providers "pad" their fees to allow for the discounts rather than spending the administrative time to track PPO contract provisions and appeal accordingly.

For the most part, TPAs see out-of-network as a service that must be provided and as a source of revenue. Most do not measure the quality of their efforts and ways in which savings and the resulting contingent fees can be increased. Be advised, there is a lot of data circulating among brokers, consultants, and in the media about abuse of OON services to embellish fees. Do you want to get caught with your hand in this cookie jar?

Solution Strategies

I think that I have "vented" my frustrations enough. Now is the time to identify some strategies that have tremendous potential for bringing TPAs back to being an innovative bunch:

Reference-Based Reimbursement (RBR) or "Cost Plus"

Nowhere is the ongoing battle between a client's C-Suite and Human Resources more visible than in consideration of RBR. The C-Suite needs operating cost savings and HR wants no ripples in the pool. I would argue that if RBR is implemented properly it will enhance a company's relationship with its employees. Delivering a "fair reimbursement" to providers generates enough savings to reduce payroll deductions for health benefits, eliminate the stratification of in-network and out-of-network benefits and even reduce deductibles and out-of-pocket amounts.

As I noted above, much of the success of RBR is based on how it is implemented and managed on an ongoing basis. There are several characteristics of RBR "done well" and there are significant variations in approach with the vendors currently supporting it.

  • On one end is an aggressive approach, with a relatively low "mark-up" on Medicare and a very high volume of participant disruption.
  • On the other end is a "prospective negotiation" model, where a hand-off from care management allows for negotiation of a reimbursement prior to or during an admission or encounter.

As you might expect, a lower "mark-up" on Medicare generates the greatest savings but a ravaged relationship with a medical community and covered participants. The "negotiation model" saves the least because the negotiation typically occurs with a representative of the provider with limited scope of authority. This is likely the same person who negotiates with PPOs, so that is a statement on its overall effectiveness.

So, the first characteristic of a strong RBR program is utilizing a highly "defendable" approach to determining a "fair reimbursement" for billed services. Keep in mind that the Medicare allowable is a benchmark established across all facilities and all geographic regions, and represents for the most part an "average". In my mind, the determination of an RBR allowed amount only begins with what percentage of Medicare is "fair". It should also take into consideration clinical variables that might justify a higher reimbursement or even the facility's cost-to-charge ratio. Credibility is instantly injected into the discussion with a provider if the process of determining reimbursement is thoughtful.

The second characteristic of a strong RBR program relates to the first, and is the recommended "starting point" for determining a fair reimbursement. I once heard a healthcare finance expert suggest that most reasonably run hospitals can earn a profit if revenue from commercial patients exceeds 140% of what it receives for Medicare patients.

  • Having studied many RBR programs, the right "starting point" involves balancing "pain" (disruption for participants and providers) with "gain" (savings).
  • Simply, the more aggressive the program approaches the calculation of the allowed amount, the higher the rate of appeals and balance billing.

Following are some reasonable expectations:

% of Medicare Appeal Rate Balance Bill Rate
125% 30% 20%
140% 15% 5%
150% 10% 3%
160% 5% 2%
175% 3% 1%

The characteristic of strong RBR programs, communication and advocacy, relates to the last two columns above.

  1. First, what foundation does the RBR program provide to help covered participants understand the difference in the way their benefits are now paid?
  2. Second, if the TPA receives an appeal or the participant receives a balance bill or other collection effort from the provider, what support is provided to them?

Communication and advocacy are all about confidence. The client's management (even HR) must recognize that an RBR program will cause minor disruption but they are confident that they are being fair to providers and covered participants. The covered participants must be confident that the program will protect their rights and even credit if necessary.

One important point about protection to covered participants. Ever watch TV and see advertisements for lawyers you can't imagine representing or defending you? The same is true for those involved in advocacy and legal representation…they must be well respected and credible with the providers. Look for multiple levels of legal protection and involvement from, well respected law firms.

  1. The final characteristic of strong RBR programs is recognition that RBR is only one component of an overall strategy to bring costs under control or reduce them. It must be paired with some of the other innovative approaches that follow, like care re-direction via navigation, direct contracting and community health.

Care Re-Direction Via Navigation

 I always wondered why so many Plans only differentiate between in-network and out-of-network providers, when one of the biggest drivers of cost is inappropriate use of healthcare resources.

Think in terms of the child's ear ache treated at the Urgent Care Center or ER versus a call to a telemedicine or video medicine program. Think about lab tests or high cost radiology done on an outpatient basis at the local hospital versus an independent lab or radiologist. Think about outpatient surgery at a hospital versus an ASC.

The excess cost is mind-blowing: 

Medical Service Inefficient Setting
Independent Option
Amount Allowed
Per Encounter
Metabolic Panel (Lab) $321.00/$144.45
(Hospital Outpatient Lab)
(Independent Lab)
MRI of Upper Body $3,245/$1,455 (Hospital/Excludes Prof.) $752.00
(Facility and Professional)
Knee Arthroscopy $16,780/$9,445
(Hospital, Surgeon, Anesthesia)
(Bundled ASC Cost)
MD Visit for Pediatric Earache $128.23/$89.76 (MD OV)
$184.50/$129.15 (UC)
$653.00/$457.10 (ER)
(Video Medicine)

So how do we re-direct care most effectively? Three strategies must be implemented.

  1. First, plan design financial incentives and employee communications must lead patients to question providers on where they are ordering care. Those who pursue less costly alternatives should be rewarded.
  2. Second, we must provide telephonic "navigation" resources and well-designed web tools to guide patients while being treated.
  3. Finally, most Plans include a "Medical Necessity" provision, excluding coverage for care which is not medically necessary. We must tighten this definition and enforce it, with as much focus on the setting of care as the need for care.

Direct Contracting and Community Health

One of the most effective ways to overcome Human Resource concern over RBR programs is to provide covered participants with at least some access to contracted providers. In exchange for contracts that are equal to or better than RBR-based reimbursement, these providers recognize the participants, accept the agreed upon reimbursement and are forbidden from "balance billing". This is NOT building a PPO. The goal is to reach out to the most utilized facility and top 50-100 providers used by the employee base and explain the resources we are using to re-direct care to them.

"Community Health" is a variation of direct contracting. It is an organized group of doctors and a facility which is willing to contract effectively as well as improving the delivery of care in the community. A partnership between the employers, providers and TPA in the community emerges, focused on health improvement, quality of care and cost of care.

Pursuit of "Carve-out" Products

The final step in the quest for innovation is the integration of "carve-out" products to enhance access to effectively contracted and managed care. I use the word integration purposefully. Products like lab networks, high cost radiology, tele- and video-medicine, medical tourism and bundled ambulatory surgery have been around for a while but adoption and penetration has been embarrassingly low. Each of the companies offering the services have great tools and experience to assist with building utilization and resulting savings. As an industry, we must recognize that our ability to use these solutions versus the cookie cutter approaches used by PPOs and carriers are what differentiate us.

About McLellan Consulting Services (MCS)

McLellan Consulting Services (MCS) offers all stakeholders in the self-insured health benefits market high quality consulting services. MCS is based in Tampa Bay, Florida and has provided consulting to well over 300 clients in its 30 plus years in business. Clients have included Plan Sponsors, Third-Party Administrators (TPAs), Stop Loss Carriers, Captives, Health Care entities and specialty vendors like PPOs, population health management companies, data warehouse and analytics companies and pharmacy benefit managers.

Glenn McLellan has delivered well in excess of 200 public speeches relating to all areas of self-funded health benefits in the last 10 years, including many for the Self Insured Institute of America (SIIA), Society for Professional Benefit Administrators (SPBA), Texas Association of Benefit Administrators and Health Care Administrators Association (HCAA).  Contact Glenn McLellan at, (860) 604-0410 and visit


Legislative & Regulatory News

State Legislative and Regulatory Update

MyHealthGuide Source: Self-Insurance Institute of America, 3/13/2017,

Connecticut: Stop-Loss Legislation Would Codify Bulletins

Sources close to the legislative process inform SIIA that Sen. Kevin Kelly has introduced SB 926 to take insurance department bulletins and place them into statute. As previously reported, Connecticut requires stop-loss policies to meet the NAIC Stop-Loss Model Act.

SB 926 was heard by the Insurance and Real Estate Committee on Tuesday March 7. It faced opposition from the insurance department, insurance carriers and business community. At this time, SIIA will be monitoring further developments.

Maine: Proposed Legislation Would Prohibit Small Employer Stop-loss Insurance Contracts

One of the latest proposals to restrict small employer health insurance options has been introduced in Maine. Two reliable sources report that that one of the licensed insurance carriers in the state requested the bill be introduced.

The legislative proposal, LD 608, would prohibit a stop-loss carrier from issuing a policy to a business fitting the statutory definition of a "small employer," 50 or fewer employees, in the state.

SIIA has contacted carriers and brokers on the ground and understands that there is significant opposition to the legislation from industry and employers - and one of the bill's co-sponsors will not support his legislation after a Maine small business owner told him that his legislation would take aware a health insurance option.

If you are located in Maine, have business associates in Maine, or have clients in Maine, you encouraged to help with opposition to this legislation. Please contact Adam Brackemyre at for talking points or should you have any questions. SIIA will send a letter of opposition to the bill sponsors.

New York: Stop-Loss Legislation Lobby Day

SIIA will host a lobby day in Albany on April 25 to support its legislation to protect the stop-loss market for groups of 51-100.

While details are being finalized, the day will begin with a breakfast at a nearby hotel conference room. We will then split into groups and walk to the Capitol to meet with legislators and urge them to support our legislation and industry. The event will conclude by early afternoon.

If you would like to participate, please contact Adam Brackemyre at

New Jersey: Proposed Regulation Would Expand Large Group Contract Options

The New Jersey Department of Banking and Insurance (DOBI) proposed regulations in January that would lower the minimum individual attachment point from $25,000 to $20,000 and aggregate attachment points for large group (greater than 50 members) from 125% to 110%.

The proposed rule comment period has closed, but a final regulation has not been approved. SIIA submitted a comment letter supporting the proposed changes that would lead to greater employer options and will keep you updated once any changes are finalized.

New Mexico: SIIA Legislation Advances Quickly

As previously reported, the state's unique statutory language that defines stop-loss as "health insurance" has caused some filing issues for many SIIA members. We believe the solution will be passed by the legislature this year.

Over the past two years, SIIA has been working with the Office of the Superintendent of Insurance, retained a lobbyist and introduced legislation that would allow stop-loss form and rate filings to be approved without a health insurance medical loss ratio test.

On Friday, February 24, SIIA Vice President of State Government Relations Adam Brackemyre testified as the expert witness for the legislation before the House Business and Industry Committee. After successful testimony, SIIA's retained lobbyist was able to have the bill placed on the Judiciary Committee's consent agenda, meaning the bill was non-controversial and expedited through committee.

We are now pleased to report that HB 336 passed the House on Friday, March 10. A larger, more complicated Senate bill, SB 367, contains the same language and passed the Senate about one hour later. In sum, the SIIA-supported language becomes law if either bill passes.

While in Santa Fe, Mr. Brackemyre spoke to a few Senators about the need for the legislation and to be watching for it when it came to their committee as well as thanking the Superintendent for working with the industry to get the insurance market working again. We are pleased that the department is supporting the legislative fix and are optimistic that this legislation will be signed into law. SIIA will continue pressing legislators to pass at least one of two bills.

Georgia: Captive Legislation

Some Georgia legislators have introduced legislation to make technical changes in that state's captive law.

Senate Bill 173 makes a number of technical and definitional changes to improve the state's captive insurance law. Several SIIA Members assisted in the drafting of the legislation.

Illinois- HICA Tax Reintroduced and New Captive Legislation

Rep. Greg Harris has reintroduced his Michigan-style health insurance claims assessment (HICA) as HB 1796.

As the state of Illinois has been unable to pass a budget in nearly two years, Rep. Harris has proposed a one percent claims tax as a solution to close the state's reported $6-8 billion annual deficit. The HICA was proposed last year in a large revenue-raising bill, HB 4300. According to very reliable sources in Springfield, the HICA was going to be dropped from that bill. To keep the idea alive, Rep. Harris introduced stand-alone HICA legislation as HB 5750. SIIA has been working with allies on the ground in Springfield to fight the HICA and will continue to do so.

Also of note to some SIIA members, Senator John Mulroe has introduced SB 1286, legislation that would make a number of technical revisions to the state's captive law, set minimum capital requirements, reduce filing fees and designate ten percent of all captive tax revenue to fund appropriate captive regulation by the insurance department. The bill has been heard once in the Senate Insurance Committee.

Please watch for ongoing exclusive SIIA reporting on these other important developments. SIIA lobbyists will provide a live legislative/regulatory update presentation as part of the association's upcoming Self-Insured Health Plan Executive Forum, scheduled for March 28-29 in Tucson. SIIA's Legislative/Regulatory Conference is scheduled for May 3-4 in Washington, DC.

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.  Contact Adam Brackemyre, Vice President of State Government Relations directly at 202/595-0641, or via e-mail at and visit


ERISA Civil Penalties Inflation Adjustment Act Annual Adjustments for 2017

MyHealthGuide Source: Paul D. Woodard, 3/17/2017, Butterfield Schechter Blog

Below are the DOL's penalties as they relate to ERISA violations pursuant to the Federal Civil Penalties Inflation Adjustment Act Annual Adjustments for 2017, which became effective on January 13, 2017.


Description of ERISA Violations Subject to Penalty

2016 Penalty Amount

2017 Penalty Amount

§ 209(b)

Failure to furnish reports (e.g., pension benefit statements) to certain former participants and beneficiaries or maintain records.

Up to $11 per employee

Up to $28 per employee

§ 502(c)(2)

• Failure or refusal to file annual report (Form 5500) required by ERISA § 104; and

• Failure of a multiemployer plan to certify endangered or critical status under ERISA § 305(b)(3)(C) treated as failure to file annual report.

Up to $2,063 per day

Up to $2,097 per day

§ 502(c)(4)

• Failure to notify participants under ERISA § 101(j) of certain benefit restrictions and/or limitations arising under Internal Revenue Code § 436;

• Failure to furnish certain multiemployer plan financial and actuarial reports upon request under ERISA § 101(k);

• Failure to furnish estimate of withdrawal liability upon request under ERISA § 101(1); and

• Failure to furnish automatic contribution arrangement notice under ERISA § 514(e)(3).

Up to $1,632 per day

Up to $1,659 per day

§ 502(c)(5)

Failure of a multiple employer welfare arrangement to file report required by regulations issued under ERISA § 101(g).

Up to $1,502 per day

Up to $1,527 per day

§ 502(c)(6)

Failure to furnish information requested by Secretary of Labor under ERISA § 104(a)(6).

Up to $147 per day not to exceed $1,472 per request

Up to $149 per day not to exceed $1,496 per request

§ 502(c)(7)

Failure to furnish a blackout notice under § 101(i) of ERISA or notice of the right to divest employer securities under § 101(m) of ERISA.

Up to $131 per day

Up to $133 per day

§ 502(c)(8)

Failure by a plan sponsor of a multiemployer plan in endangered status to adopt a funding improvement plan or a multiemployer plan in critical status to adopt a rehabilitation plan. Penalty also applies to a plan sponsor of an endangered status plan (other than a seriously endangered plan) that fails to meet its benchmark by the end of the funding improvement period.

Up to $1, 296 per day

Up to $1,317 per day

§ 502(c)(9)(A)

Failure by an employer to inform employees of CHIP coverage opportunities under ERISA § 701(f)(3)(B)(i)(I)- each employee a separate violation.

Up to $110 per day

Up to $112 per day

§ 502(c)(9)(B)

Failure by a plan administrator to timely provide to any State the information required to be disclosed under ERISA § 701(f)(3)(B)(ii), regarding coverage coordination - each participant/beneficiary a separate violation.

Up to $110 per day

Up to $112 per day

§ 502(c)(10)(B)(i)

Failure by any plan sponsor of a group health plan, or any health insurance issuer offering health insurance coverage in connection with the plan, to meet the requirements of ERISA § 702(a)(1)(F), (b)(3), (c), or (d); or § 701; or § 702(b)(1) with respect to genetic information.

$110 per day during non- compliance period

$112 per day during non- compliance period

§ 502(c)(10)(C)(i)

Minimum penalty for de minimis failures to meet genetic information requirements not corrected prior to notice from Secretary of Labor.

$2,745 minimum

$2,790 minimum

§ 502(c)(10)(C)(ii)

Minimum penalty for failures to meet genetic information requirements which are not corrected prior to notice from Secretary of Labor and are not de minimis.

$16,473 minimum

$16,742 minimum

§ 502(c)(10)(D)(iii)(II)

Cap on unintentional failures to meet genetic information requirements.

$549,095 maximum

$558,078 maximum

§ 502(c)(12)

Failure of CSEC plan sponsor to establish or update a funding restoration plan.

Up to $100 per day

Up to $102 per day

§ 502(m)

Distribution prohibited by ERISA § 206(e).

Up to $15,909 per distribution

Up to $16,169 per distribution

§ 715

Failure to provide Summary of Benefits Coverage under Public Health Services Act § 2715(f), as incorporated into ERISA § 715 and 29 CFR 2590.715-2715(e).

Up to $1,087 per failure

Up to $1,105 per failure

About the Author

Paul D. Woodard practices in the areas of Employee Benefits, Employee Stock Ownership Plans, Pension and Profit Sharing Plans, ERISA, ERISA Litigation, Business Law, Qualified Domestic Relations Orders (QDROs), and Estate Planning.

About Butterfield Schechter LLP

Butterfield Schechter LLP is San Diego County's largest firm focusing its law practice primarily on employee benefit plan matters.  Visit


Medical News

Mediterranean Diet Improves HDL (Good Cholesterol) Function

MyHealthGuide Source: Hernáez A, Castañer O, Elosua R, et al., MDedge, 3/1/2017 and Circulation, 2/15/2017, Hypercholesterolemia for March/April 2017

High cardiovascular risk individuals following a traditional Mediterranean diet (TMD) saw improved high density lipoprotein (HDL) atheroprotective functions, especially when enriched with virgin olive oil, according to a study published in Circulation.

The study followed a random sample of 296 volunteers from the PREDIMED Study after a 1-year intervention. The effects of 2 TMDs were compared:

  • 1 group consumed enriched with virgin olive oil (TMD-VOO; n=100) and
  • 1 group consumed nuts (TMD-Nuts; n=100),
  • with respect to another group consumed low-fat control diet (n=96).

The effects of both TMDs were assessed on the role of HDL particles on reverse cholesterol transport, HDL antioxidant properties, and HDL vasodilatory capacity.

Study findings

  • Both TMD (Mediterranean diets) increased cholesterol efflux (giving off) capacity relative to baseline.
  • (TMD-VOO) (Mediterranean diet with virgin olive oil) intervention decreased cholesterol effect and increased HDL (good cholesterol).
  • TMD adherence induced beneficial changes by improving HDL oxidative status.
  • The 3 diets increased the percentage of large HDL particles.

About Cholesterol, Good Kind and Bad Kind

Editor's Note

In contrast to majority public opinion that there is good cholesterol (High Density Lipoprotein/HDL) and bad cholesterol (Low Density Lipoprotein/LDL), in my lay opinion, both forms of cholesterol are good

Our cardiovascular system has piping (veins and arteries) that needs repair occasionally.  A nick, cut, hole or depression can occur inside the vascular walls.  LDL cholesterol is the soft putty or spackling carried by our blood to "fill" the hole, similar to the process for repairing dry-wall.  HDL cholesterol is the hard substances that "sand papers" away the excess LDL build-up.  So, both cholesterol forms are good and valuable.

However, when LDL is produced in excess from improper diet, exercise or sometimes DNA (our parents), the LDL can build a block or occlusion in the vascular pipe leading to reduced blood flow or stoppage.  Occasionally, the LDL build-up can break-off, flow to a narrow pipe, get stuck, and stop blood from flowing to other vital areas, causing a stroke. 

So, LDL gets a bad reputation for causing stroke and such.  However, we need LDL for vascular wall repair.


Recurring Resources

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 3/16/2017)

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     $3,082
  Source - CIGNA Financial Supplement 2016, P.5 12/31/2016
2 Sun Life Financial > 30 Years   $1,155
  Source - Sun Life Financial, Financial Planning and Analysis department (8/8/2016)
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A++)
$29,700 as part of Tokio Marine Group
  Source - David Grider, 11/11/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/16/2017
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
  Source - Matt Rhenish, President & COO, 3/1/2017
6 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
7 Companion Life > 20 Years   $440
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Group Solutions $302
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 3/1/2017
10 United States Fire Insurance Company >15 Years   $200
  Source - Lauren Woods, A&H Division Crum & Forster, 2/6/2017
11 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
12 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
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
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
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 Cross Blue Shield (various regions)
  • International Insurance Agency Services, LLC (IIS)
  • Lloyd's of London
  • Nationwide Life Insurance Company
  • Pan-American Life
  • QBE Insurance Company
  • Trustmark Insurance Company
  • UnitedHealthcare

Stop-loss Premium Volume is not the Whole Story

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

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

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


The Value of Self-Funding

MyHealthGuide Source:  The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, and  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


Video Highlighting Captive Solutions for Mid-market Companies

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

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

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

About SIEF

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


ICD-10 Stop Loss Trigger Diagnosis Tools

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

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

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


Upcoming Conferences

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

March 23, 2017 - Webinar 1:00 PM - 2:00 PM (EST)
Medical Bill Blues: Pre-Payment Contracting and Negotiation, Pricing Alternatives, and Post-Payment Recovery of Overpayments presented by The Phia Group, LLC. Analysis of various ups and downs we associate with "provider relations," including overpayments, claim negotiations, reference-based pricing, balance billing and more - and discuss some best practices for working within each of these domains. Registration:

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

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

  • Health care industry thought leader Dave Chase will deliver a TED-style talk on how self-insured employers are playing an increasingly important role in helping to save the country's dysfunctional health care system.
  • A panel of technology visionaries will discuss winning technology strategies for companies involved in the self-insurance marketplace.
  • SIIA lobbyists will provide updates on key legislative/regulatory developments at both the state and federal level, and detail the association's advocacy strategy for 2017.
  • As a follow-up to sessions held at SIIA's recent National Conference & Expo covering referenced-based pricing/Medicare-plus topics, we'll have a session focused specifically about how to best defend against balance billing.
  • Captive insurance experts will highlight business development opportunities for self-insurance industry service providers in connection with stop-loss captive programs.

For sponsorships, contact Justin Miller at The Forum will be held at the beautiful JW Marriott Tucson Starr Pass Resort and Spa. Information and Registration

April 4, 2017 - Webcast Noon - 1:15 p.m. ET
ACA's Impact on Self-Insurance in the Small Group Market presented by Society of Actuaries.  This webcast will discuss the results from a study evaluating the impact of community rating regulations on employer self-insurance across industries with varied health risk, using cross-state variation in pre-ACA small group market rating regulations and data from a nationally representative survey of employer health benefits.

It was found that lower risk employers subject to laws limiting allowable premium rating variation had a predicted probability of self-insurance that is about 18 percentage points higher than otherwise similar higher risk employers, suggesting that these selection concerns are warranted.


  • Erin Trish, Ph.D.
    Assistant Research Professor
    USC Schaeffer Center for Health Policy and Economics
  • Brad Herring, Ph.D.
    Associate Professor for Health Economics
    Johns Hopkins Bloomberg School of Public Health


  • Rebecca Owen, FSA, FCA, MAAA
    Health Research Actuary
    Society of Actuaries

Earn up to 1.50 CPD Credits.  Registration:

June 5-6, 2017
13th Annual Canadian Captives & Corporate Insurance Strategies Summit.  See Brochure. Speakers include:

  • Gary Pearce, Vice President Risk Management, Kelly Services Inc.
    Bruce Langille, Managing Director of Risk Management & Security Services, Province of Nova Scotia
    Cynthia Johansen, Registrar/CEO, College of Registered Nurses of British Columbia
    Zach Finn, Director, Davey Risk Management & Insurance Program, Butler University
    Dan Kugler, VP Enterprise Risk Management, REV Group

Toronto at One King West. Information and Registration.  Or Call: (866) 298-9343 ext. 200. Email: Website:

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

May 3-4, 2017
SIISIIA Legislative Conference presented by The Self-Insurance Institute of America, Inc.  Hear from key members of Congress, Trump Administration officials, and other policy-influencers on the latest legislative/regulatory developments affecting the self-insurance/captive insurance marketplace at both the federal and state level.  Participate in SIIA's "Walk on the Hill" and meet with your elected representatives in their DC offices to discuss important industry issues. Click here for registration and sponsorship forms or by call 800-851-7789.  Washington Marriot Metro Center Hotel. Washington, DC.  Visit

May 10-11, 2017
Roundstone Medical Captive Forum presented by Roundstone.  Forum brings employers, advisors and health care industry experts together designed to help make the most of their Medical Captive program. Topics including plan design, wellness programs and health improvement strategies.  Free event.  Employers will also receive complimentary hotel accommodations at the Hyatt Regency Cleveland at The Arcade.  Advisors are welcome to attend this free event with two or more employer clients in attendance. Information: Roundstone 2017 Forum Employer Brochure

May 10-12, 2017
Northshore's 28th Annual Medical Excess Claims Conference presented by Northshore International Insurance Services, Inc. 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 or Susan Arsenault at Salem, Massachusetts. 

May 15-18, 2017
WEDI 2017 presented by The Workgroup for Electronic Data Interchange (WEDI), the leading authority on the use of Health IT to improve healthcare information exchange.  WEDI is a coalition comprised of a cross-section of the healthcare industry: doctors, hospitals, health plans, laboratories, pharmacies, clearinghouses, dentists, vendors, government regulators and other industry stakeholders. Contact: Michael McNutt, Director, Events and Education, at (202) 618-8802,  Loews Hollywood, Los Angeles, CA.  Information and Registration.

May 16-17, 2017
Self-Insured Workers' Compensation Executive Forum presented by The Self-Insurance Institute of America, Inc.  Educational topics include:

  • Medical Marijuana Use And the Implications on Workers' Comp Programs
  • Medical Secondary Payer Developments & The Trump Administration
  • Why Current Medical Management Strategies are Failing - And What We Can Do About It
  • Does Workers' Comp Need Federal Oversight?
  • More

This year's forum will be held at the historic and beautiful Omni Grove Park, Ashville, NC.  Information and registration.

June 7-9, 2017
Institute & Expo 2017 presented by AHIP.  Essential discussions and essential decisions focused on strengthening our health care system.  Leading thinkers gather to share ideas, learn from each other, and tackle some of our industry's toughest challenges including quality of care, mounting health care costs, and building a sustainable system focused on value. You'll enjoy

  • A mix of long-term vision and laser focus on shorter-term priorities.
  • Industry best practices -- you'll discover what's working, and how to apply lessons learned to your organization
  • Idea sharing -- join thousands working together, sharing ideas and uncovering solutions in a host of interactive events and sessions

Known as the Essential Event for the Health Care Industry, Institute & Expo, get ready to join thousands in Austin in June. Information and Registration: AHIP Institute & Expo 2017

June 20-22, 2017
The 4th Annual AMS Claims Symposium presented by Advanced Medical Strategies. This educational and networking event will be attended by claims, underwriting, and clinical professionals representing reinsurers, carriers, MGUs, and other key players in the stop loss and managed care industry. Beauport Hotel in Gloucester, Massachusetts.  The Predict Suite Subscribers Workshop on Tuesday, June 20, 2017.  For information about this invitation only event, contact Adria L. Garneau, CEBS, at 781-224-9711, X106, or

July 11-13, 2017
MCIA 12th Annual Conference presented by The Montana Captive Insurance Association, Inc. Features key captive regulators, captive owners, leading service providers addressing a variety of timely educational topics, and networking.  Lodge at Whitefish Lake. For companies interested in promoting their corporate brand at the conference, contact Shane Byars at 866/388-6242, or via e-mail at  Information and registration:

July 17-19, 2017
HCAA TPA Summit 2017 presented by Health Care Administrators Association.  Hilton Hotel at the Ballpark. St. Louis, MO

October 2-4, 2017
Annual Self Funding Employer & Workers Compensation Conference hosted by The Self Funding Employer Association.  Los Angeles, CA.

October 8-10, 2017
37th Annual National Educational Conference & Expo presented by The Self-Insurance Institute of America. JW Marriott Phoenix Desert Ridge Resort & Spa. Phoenix, AZ.

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

November 28-30, 2017
Cayman Captive Forum 2017 presented by Cayman Islands Monetary Authority. The Ritz-Carlton, Grand Cayman. Visit

December 4-7, 2017
WEDI-Con 2017 presented by The Workgroup for Electronic Data Interchange (WEDI), the leading authority on the use of Health IT to improve healthcare information exchange.  WEDI is a coalition comprised of a cross-section of the healthcare industry: doctors, hospitals, health plans, laboratories, pharmacies, clearinghouses, dentists, vendors, government regulators and other industry stakeholders. Contact: Michael McNutt, Director, Events and Education, at (202) 618-8802,  Hyatt Regency Reston, Reston, VA.  Information and Registration.


April 4-6, 2018
SPBA Fall Meeting (members only). Capital Hilton, Washington DC. Society of Professional Benefit Administrators (SPBA). 

September 26-28, 2018
SPBA Fall Meeting (members only). The Peabody Memphis, Memphis, TN. Society of Professional Benefit Administrators (SPBA).


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Clevenger Ernie Clevenger
President & Publisher
MyHealthGuide, LLC