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

Tokio Marine HCC – Stop Loss Group Introduces Enhanced Proposal

MyHealthGuide Source: Tokio Marine HCC,  2/24/2017,

Tokio Marine HCC – Stop Loss Group, a leading carrier providing medical stop loss insurance and other specialty products to the self-funded marketplace, is excited to introduce an Enhanced Proposal as it continues to look for innovative ways to help its producers write and retain business.

With today's ever changing and evolving healthcare market, employers and plans are looking for ways to maximize their healthcare dollars. With Tokio Marine HCC's Enhanced Proposal, each group will have the opportunity to use analytics and benchmarking statistics from a leading stop loss carrier to make more informed decisions.

Tokio Marine HCC's goal is to provide its clients with tools and references to simplify the stop loss decision making process.

"Tokio Marine HCC has been an innovative stop loss carrier for many years. Our Enhanced Proposal offering is another way for us to differentiate ourselves from others in the market and provide a valuable resource to our producers and policyholders," said Daniel A. Strusz, President and Chief Executive Officer of Tokio Marine HCC – Stop Loss Group.

For more information about Tokio Marine HCC's Enhanced Proposal, please contact an underwriter, regional marketing representative or a member of our senior management staff.

About Tokio Marine HCC – Stop Loss Group

Tokio Marine HCC is a leading specialty insurance group with offices in the United States, the United Kingdom, Spain and Ireland, transacting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance. Tokio Marine HCC has achieved an outstanding record of growth and profitability, since its founding in 1974, through creative but careful underwriting, strong risk management practices, opportunistic expansion of existing lines of business and targeted acquisitions. Tokio Marine HCC is well capitalized and positioned to continue its success. Contact Tracy Creekbaum, Marketing Specialist, at, 770-693-6507 and visit


AMS Adds New Mental Health Module to PredictDx

MyHealthGuide Source: Advanced Medical Strategies (AMS), 2/10/2017,

LYNNFIELD, Mass -- Advanced Medical Strategies (AMS) has unveiled a new module within its Predict Software Suite. The subcategory of Mental Health is now an option in the PredictDx directory of medical diagnoses. Following quickly on the heels of the Pediatric subdirectory, this component is a further PredictDx expansion that addresses the need for information about a variety of complex illnesses with associated high dollar costs.

The PredictDx directory previously included many behavioral health diagnoses, such as Opioid Abuse and Eating Disorders, among others. These have been meticulously re-examined and refined for inclusion into Mental Health. An additional nine diagnoses were implemented specifically for this innovative module. The novel additions are:

  • ADHD
  • Alcohol/Sedative-Hypnotic-Anxiolytic Use Disorder
  • Anxiety Disorder
  • Bipolar Disorder
  • Depression/Depressive Disorders
  • Oppositional Defiant Disorder/Conduct Disorders
  • Personality Disorders
  • Schizophrenia/Schizoaffective Disorder/Psychotic Disorders
  • Traumatic Brain Injury

All the Mental Health diagnoses, including the nine new designations listed above, are seamlessly integrated within PredictDx, the web-based solution to predicting and managing catastrophic claims. As with the hundreds of other costly medical diagnoses, the ones pertaining to Mental Health include treatment descriptions and regimens, financial analytics & statistics, complications, and physician commentaries. In other words, valuable insight into the critical information needed to be effective in today's healthcare environment.

VP of Clinical Services for AMS, Alice G. Jamba, RN: "Having an extensive background in the field of Mental Health prior to joining AMS, working on this project has been personal for me. Providing the correct treatments, appropriate medical management, and accurate drug regimens for these behavioral diagnoses is imperative, especially now. Mental Health is the most expensive health condition. The US spends more than $200 billion on these disorders--that's $50 billion more than Heart Conditions, the second costliest medical ailment. I'm certain that this module will be beneficial to our clients. They rely on us to provide them with the cutting- edge data and analytics necessary to make informed choices when reviewing catastrophic claims, as well as delivering cost containment solutions. The new Mental Health breakout within PredictDx is one more way to earn and keep that trust…and maybe even surpass their expectations."

The module is currently active and easily accessible. Subscribers of PredictDx can search globally or they can type a search term and select from Adult, Pediatric, or Mental Health options via a drop down box to find the results within each.

No restrictions, special access and/or additional fees are involved. The Mental Health module is yet another value-add enhancement to the Predict Suite.

About AMS

Advanced Medical Strategies is a physician-led organization serving TPAs, Health Plans, HMOs, Worker's Compensation Payers, MGUs, Stop-Loss Carriers, Specialty Risk Insurers, Occupational Accident Insurers, A&H Insurers, and Self-Administered Group Health Plans. With thousands of hours saved in research, analysis and underwriting, AMS has leveled the playing field between the Administrator and Carrier resulting in superior premiums and increased revenue streams for payers. Contact Adria L. Garneau, CEBS, Chief Claims Officer, at, 781.224.9711 x106 and visit


McLellan Consulting Services Announces 2016 Third-Party Administrator Survey - TPA Participation Welcomed

MyHealthGuide Source: McLellan Consulting Services (MCS), 2/23/2017,

McLellan Consulting Services is pleased to announce that on Monday, February 27 that it will be releasing the data gathering tools for its comprehensive 2016 TPA Survey. This will be the 7th Survey completed, but the first since 2013 when 130 TPAs participated and contributed to over 300 benchmarks, metrics and industry standards critical to running a TPA.

  • To participate in the TPA Survey, please contact Glenn McLellan at, (860) 604-0410 and visit
  • Each TPA participating in the Survey will receive a Report Card no later than May 7, 2017 listing all benchmarks and the computed or reported results of the TPA.
  • Only survey participants the full series of benchmarks covering revenue, operating expenses, staffing, productivity, service standards, products, sales and account management.
  • One of the values of this Survey is the fact that many of the benchmarks and metrics are developed from raw data provided. MCS spends roughly 2-3 hours per response normalizing data so that comparisons are as accurate and consistent as possible.

For the 2013 Survey, Glenn McLellan presented high level results at HCAA, SPBA and TABA conferences.  

MCS will communicate with all TPAs where it has contact information. Each TPA will be provided with the Survey data gathering tool as an Excel document and a Survey Workbook. Included within the Workbook is a Confidentiality and Non-Disclosure Agreement that MCS would like executed with all participants. Only summarized information is presented, and no information is sold or distributed to any party outside the participants. If you have not received the Survey communication and would like to participate, contact Glenn McLellan at

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


Innovative Health Plan Extends Growth Into Florida

MyHealthGuide Source: Innovative Health Plan (IHP), 2/23/2017,
New Haven, CT -- Innovative Health Plan (IHP) is excited to announce their growth into Florida and welcomes John Knox Village of  Central Florida, a premier senior life care facility located in Orange City,  FL, into the IHP family.

John Knox Village of Central Florida is a 175-acre, not-for-profit Life Plan Retirement Community encompassing a full range of independent living, assisted living and skilled nursing care options for more than 750 residents. Since 1989, it has been a home to an eclectic mix of "realistic idealists," who believe in planning for an uncertain future while enjoying a fulfilling present.

John Knox Village of Central Florida employs over 600 employees and 60% of their employee base is now enrolled with IHP. Together, IHP and John Knox Village of Central Florida will implement programs and strategies designed to keep employees healthy and engaged, allowing them to focus on what they do best--care for residents.

"Innovative Health Plan provides the custom solutions and cost saving strategies we were looking for in health plan provider," Joseph Trainor, Executive Director at John Knox Village of Central Florida. "We're thrilled that with IHP, we can deliver quality health care benefits to our employees while meeting our company's financial goals."

"We are excited to be expanding the IHP footprint in Florida with the addition of John Knox Village to our growing client roster," said Allen Jackson, CEO of IHP, "We look forward to working with them to provide quality healthcare benefits and exceptional customer service to their employees."

About Innovative Health Plan, Inc.

As a leader in innovative pricing solutions and self-funded plan options, Innovative Health Plan (IHP) brings cost control and transparency to healthcare providers. Unlike traditional health plans, IHP provides its clients with custom benefits, evidence-based care management, performance measurements and online administration. They serve clients with 10-2000 lives across the country. Visit


People News

SIIA Chairman Jay Ritchie to Testify in Congressional Hearing

MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 2/23/2017,

The US House Committee on Education & the Workforce has scheduled a legislative hearing on Wednesday, March 1st, focusing on the Self-Insurance Protection Act. Specifically, the committee intends to examine the importance of self-insurance as part of the process of health  care reform.

The hearing will also focus on legislation to implement association health plans, long supported by SIIA and its members, in addition to wellness programs, often a key component of self-insured plans.

Jay Ritchie, current chairman of the SIIA Board of Directors and Executive Vice President of Tokio Marine HCC - Stop Loss Group, has been asked by Chairwoman Virginia Foxx (R-NC) to testify before committee members as an expert witness on self-insurance and stop-loss programs.

"I look forward to discussing with Congress the importance of self-insurance and stop-loss issues in the overall framework of the current health care reform debate," stated Ritchie.
"Promoting and protecting the self-insurance industry is paramount to ensuring that all employers, particularly the small and medium sized employers, have access to cost-effective and efficient delivery of health care options."

The hearing, "Legislative Proposals to Improve Health Care Coverage and Provide Lower Costs for Families," will begin at 10:00 AM EST on Wednesday, March 1st and live streamed at:

Mr. Ritchie's testimony will be available at once the hearing has begun.

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 Ryan Work, SIIA vice president of government relations, at and visit


Job News

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

High Satisfaction with TPA Services in the Areas of FMLA, STD, LTD

MyHealthGuide Source: Stephen Miller, CEBS, 2/22/2017, SHRM

The San Diego-based Disability Management Employer Coalition (DMEC) released initial findings from its 6th Annual Employer Leave Management Survey, conducted last year among 1,132 U.S. employers of all sizes.

Findings on a number of key leave-management trends are highlighted below.


Outsourcing of Family and Medical Leave Act (FMLA) administration continues
to increase, the survey found:

  • 34% of employers with 50 or more employees outsource FMLA leave to a third-party administrator (TPA).
  • 45% of employers with 1,000 and more employees do so.
  • 80% of employers that also outsource management of short-term disability (STD) and long-term disability (LTD) leave do so through the same TPA that manages FMLA leave on their behalf.

"Satisfaction with external vendors continues to be high--up to 86 percent," said Karen English, a partner at Spring Consulting Group in Boston, which partnered with DMEC in conducting the study.

"Compliance is really what drives outsourcing of leave administration and organizations lacking the internal resources to handle all of the obligations that they face today with leave management," said Terri Rhodes, CEO, Disability Management Employer Coalition (DMEC).


While LTD coverage is more commonly a fully insured benefit, STD is more commonly self-insured by employers that use the services of a TPA to administer the program:

  • 56% of respondents - LTD is fully insured
  • 69% STD is self-insured with a TPA
    • 40% - TPA cutting checks to employees, or
    • 29% - TPA is notifying the employer of the need to pay.

FMLA and Americans with Disabilities Act (ADA) leave management is increasingly being integrated with an employee assistance program (EAP). "A trend is to bring these programs together," English said. "When employees are taking disability leave, they're being referred to the EAP," which then helps with managing the employees' return to work.

Leave-Tracking Technology

Rhodes said that alternatives to outsourcing include using automated software systems and platforms, which can be helpful "given that the majority of employers are still managing their leave obligations internally."

Leave tracking and management systems can be integrated with, and draw data electronically from, HR information systems, time and attendance platforms, and payroll systems. "More flexible data feeds and functionality to upload reports can help" meet complex leave-tracking issues, English said.

The survey showed that the challenges respondents most often said were difficult or extremely difficult were:

  • 35% of respondents - tracking intermittent FMLA leave
  • 30% - managing FMLA and ADA leave-taking
  • 29% - transferring employees to alternative positions
  • 26% - denying leave requests

The survey found that top reasons for shifting from manual tracking to automated systems to manage FMLA and other leave-taking included the desire to lessen the HR staff's time burden, reduce errors and ensure regulatory compliance. "These activities can be made easier by implementing an automated tracking system to eliminate manual processes and to facilitate better recordkeeping," English said.

About SHRM

The Society for Human Resource Management (SHRM) is the world’s largest HR professional society, representing 285,000 members in more than 165 countries. For nearly seven decades, the Society has been the leading provider of resources serving the needs of HR professionals and advancing the practice of human resource management. Visit


Legislative & Regulatory News

SIIA Sends Strong Signal on Employer Based Plans/ House Leadership Issues Health Care Draft

MyHealthGuide Source: Self-Insurance Institute of America, 2/21/2017,

The House Republican leadership unveiled a draft outline of health care reform ideas to the GOP Conference. This policy outline to replace much of the Affordable Care Act (ACA), while not providing comprehensive details, does offer a glimpse in to the direction House Republicans are likely to take.

Among other things, the draft plan largely replaces the ACA individual subsidies in favor of fixed tax credits towards purchasing health insurance, in addition to fixed state funding or block grants towards Medicaid programs. The draft suggests the elimination of tax penalties for individuals without insurance, or employers who do not offer it, as well as the elimination of health insurance fees and medical device excise taxes initiated under ACA.

The House Republican framework also includes an unspecified amount of money for state grants, which can be used to help defray consumer out of pocket costs, or to establish high risk pools for those with chronic illness.

SIIA Strongly Supports Employer Sponsored Health Coverage

With Congress holding ongoing policy discussions on health care reform, SIIA continues to add its voice in the debate surrounding health care reform. Last week, SIIA joined 26 other industry associations in calling for the National Economic Council (NEC) to fully repeal the Cadillac Tax and protect the tax treatment of employer sponsored health coverage.

The letter urges the NEC, in its conversations with Congress, to continue the effectiveness of employer sponsored health coverage by fully and permanently repealing the 40% "Cadillac Tax" on health benefits. Such a tax on employer-provided benefits is largely a direct tax on individuals and businesses. While stating support for controlling health care costs, the letter argues that taxing health benefits, even within an exclusionary range, would hurt employers with higher costs and less affordable coverage.

SIIA Government Relations staff will continue to provide important updates on ACA reform across Congress. As we further advocate on your behalf, SIIA will be asking you, our members, to engage and be active on important issues impacting the future of our industry. One way to do so is by attending the upcoming SIIA Legislative & Regulatory Conference in Washington, D.C. on May 3 and 4, during which time SIIA members will be able to meet and hear from Members of Congress, policymakers and regulators.

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 Ryan Work, SIIA vice president of government relations, at and visit


Enforceability of Forum Selection Clauses In ERISA Plans

MyHealthGuide Source: Corey Schechter, Esq., 2/24/2017, ERISA Legal Blogs

Case: Clause v. U.S. District Court for the Eastern District of Missouri, 2017 U.S. Dist. LEXIS 719 (Jan.17, 2017).

On January 17, 2017, the Supreme Court of the United States declined to decide the issue of whether forum selection clauses contained in ERISA benefit plans are enforceable when it denied Certiorari in the above Clause case.

The Supreme Court's denial of Certiorari in Clause allows to stand an 8th Circuit decision upholding the enforceability of a forum selection clause contained in a benefit plan governed by ERISA which required the plan participant to litigate her claims in a particular forum.

ERISA itself provides that a participant or beneficiary may bring a claim for benefits, "in the district where the plan is administered, where the breach took place, or where a defendant resides or may be found." 29 U.S.C. § 1132(e)(2). Forum selection clauses in ERISA plans typically limit where such claims may be brought to where the plan is administered. Proponents of such clauses generally argue that limiting the forum in which a claim may be brought allows for some degree of uniformity in how claims will be handled, while opponents of such clauses generally state that they impose an increased burden on the claimant by requiring them to litigate in a distant forum.

While the only two U.S. appellate courts to rule on the issue of forum selection clause enforceability as it relates to ERISA benefit plans (i.e., the 6th and 8th Circuits) have upheld their validity, it is worth noting that several U.S. district courts within other circuits have found these clauses unenforceable (typically on grounds of public policy, as well as contradicting ERISA's own choice of forum clause contained at 29 U.S.C. § 1132(e)(2).

Perhaps a split of opinion among the circuits is what the Supreme Court is looking for before it will decide to take on the issue itself; however, given the rising use of forum selection clauses in ERISA-governed benefit plans, it is likely only a matter of time before that occurs.

It must be remembered that denial of Certiorari by the Supreme Court is of no precedential value. Therefore, while forum selection clauses within ERISA-governed benefit plans may continue to be enforced in the 6th and 8th Circuits, other circuits are still free to adopt the opinion that such clauses are invalid and thus unenforceable.

Butterfield Schechter LLP is San Diego's largest law firm focusing its practice on ERISA and employee benefits law.


Medical News

Exercise Prolongs Life Even When Started in Middle Age

MyHealthGuide Source: Cleveland Clinic Journal of Medicine, 2/21/2017

Change in maximal exercise capacity (MEC) in men and women referred for an exercise stress test is inversely related to risk of all-cause mortality, a recent study found.

The study followed 10,854 patients (average age 54 years; 43% women; 30% nonwhite) who completed 2 physician-referred exercise tests between January 2, 1991, and May 28, 2009, were included from the Henry Ford Exercise Testing (FIT) Project.

Study findings

  • Increasing from low to intermediate or high fitness was associated with 37% lower risk of death compared to patients with low fitness at both tests.
  • Each 1-MET increase in age- or sex-adjusted MEC between baseline and follow-up was associated with a 13% lower risk of death in men and 16% lower risk of death in women.

Comments by Neil Skolnik, MD, "We have known for at least 20 years that there is a relationship between fitness and a lower risk of hypertension, diabetes, cardiovascular disease, cardiovascular mortality and all-cause mortality.

"The remarkable study demonstrates that it is unlikely that it is just that healthy people exercise more, but rather it is the exercise that matters in keeping people healthy since an improvement in exercise level leads to better health outcomes.

"The results clearly show the significant benefit of improving fitness in middle age, a message that is important for our patients to hear.


Recurring Resources

Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 2/7/2017)

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, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
  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 Benefit Solutions $253
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
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

February 28, 2017 - Webinar 1:00 pm EST
Addicted America: The Opioid Crisis presented by Advanced Medical Strategies (AMS).  Registration:

March 1, 2017 - 10:00 AM EST
SIIA Chair Jay Ritchie  live stream of congressional testimony on Legislative Proposals to Improve Health Care Coverage and Provide Lower Costs for Families."  Jay Ritchie, current chairman of the SIIA Board of Directors and Executive Vice President of Tokio Marine HCC - Stop Loss Group, has been asked by Chairwoman Virginia Foxx (R-NC) to testify before committee members as an expert witness on self-insurance and stop-loss programs. Live stream:

March 8-9, 2017
National Health Policy Conference presented by AHIP.  AHIP's National Health Policy Conference delves deeply into our nation's top policy priorities as we work together to improve our health care system. Learn what's working now, and what's on the horizon for our health care system. The agenda will be filled with the expert speakers you want to hear from and the topics you need to know more about. You'll gain insight into ways to help your organization develop sound solutions to our industry's most challenging issues.  We're talking about value, innovation, outcomes, and accessibility. We're talking about successful collaborations that help increase the quality of care. Location: The Ritz-Carlton Washington, 1150 22nd Street, NW, Washington, D.C. 20037.  Registration: AHIP National Health Policy Conference

March 8-9, 2017
National Conference on Individual and Small-Group Markets presented by AHIP.  AHIP's National Conference on Individual and Small-Group Markets will deliver expert guidance from policymakers, scholars, thought leaders, and industry stakeholders on key policy and operational changes in serving the Individual and Small-Group markets.
The ACA will see significant changes in 2017. Stay abreast of the landscape as policymakers begin the revision process, and discover tactics to help support current customers while adapting to possible new mechanisms that may be used to provide coverage.  You'll uncover lessons learned from real-life experiences serving Individual and Small-Group markets. You'll gain insight into new opportunities as we explore market trends and uncover ways to develop consumer-focused strategies moving forward.  Find solutions that deliver short-term stability and long-term improvement. Be prepared for the possibilities. Location: The Ritz-Carlton Washington, 1150 22nd Street, NW, Washington, D.C. 20037. Registration: AHIP National Conference on Individual and Small-Group Markets

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

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 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 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

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