MyHealthGuide Newsletter
News for the Self-Funded Community
3/27/2017 

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

TABLE OF CONTENTS

General & Company News

People News

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News



Zurich North America Reshapes Medical Stop Loss Strategy

MyHealthGuide Source: Zurich North America and Spectrum Underwriting Managers, Inc., 3/24/2017, www.zurichna.com and www.spectrumhq.com

Zurich North America announces changes in its transactional underwriting approach and related administration for all case underwriting activities. Going forward those activities will be conducted by one of our highly experienced Program Administrators (Spectrum Underwriting Managers, Summit Reinsurance Services, or Beacon Risk Strategies).

For most Medical Stop Loss (MSL) business, Spectrum Underwriting Managers (Indianapolis, IN) will be the transactional underwriter. Spectrum has been successfully underwriting MSL business for more than 25 years, and Zurich has had a formal and successful relationship with these firms for over 10 years. In addition, our underwriting guidelines will reflect our revised risk appetite and risk selection criteria which will, among other things, place significant emphasis on the availability of current and quality claims data for each account.

All current producers will be directly contacted shortly to share go forward submission and contact details.

Zurich North America is making these changes as part of our ongoing goal to simplify our structure, strengthen our position and ensure we are in the best position to help meet the needs of its business, distributors and customers.

Zurich remains committed to the Group Specialty Health marketplace and will continue our twenty year presence in the Medical Stop Loss (MSL) segment for self-funded employers and for our Managed Care Organization (MCO) customers for whom we have more recently commenced the delivery of value-added products and services. There is no change in our MCO strategy and we look forward to continuing our growing relationship with Summit Reinsurance Services (Zurich Program Administrator) and our valued brokers and customers.

We also look forward to continuing to provide MSL solutions to our valued brokers and customers. We will continue to directly engage with our brokers and Zurich will continue to directly manage those relationships.

Zurich looks forward to continuing to provide solutions to the always evolving Group Specialty Health marketplace. Our go forward operating model combines highly experienced and focused expertise at the transaction level along with Zurich's financial strength, brand, producer relationship management and our continuing commitment to help our customers understand risk and provide solutions for the same.

About Zurich North America

In North America, Zurich is a leading commercial property-casualty insurance provider serving the global corporate, large corporate, middle market, specialties and programs sectors through the individual member companies of Zurich in North America, including Zurich American Insurance Company. Life insurance and disability coverage issued in the United States in all states except New York is issued by Zurich American Life Insurance Company, an Illinois domestic life insurance company. In New York, life insurance and disability coverage is issued by Zurich American Life Insurance Company of New York, a New York domestic life insurance company. Visit www.zurichna.com.

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Pomco Group to be Acquired by United Healthcare

MyHealthGuide Source: Rick Moriarty, 3/6/2017, Syracuse Business News

United Healthcare Group is acquiring Syracuse Pomco Group, an insurance administrator that hires almost 400 individuals at its headquarters in Eastwood.

Syracuse Pomco Group and United Healthcare released a statement Monday saying they have entered into a contract to "integrate their third-party administration businesses."

"In addition to further expanding access to health benefits in Central and Upstate New York, businesses and clients will have higher access to programs and services that can make better the health and well-being of people in the region," the statement claimed.

"We're excited to combine capabilities with Pomco and UnitedHealthcare," Matt Peterson, chief executive officer of ancillary and individual at United Healthcare, stated in the statement. "After decades of powerful performance with Pomco, we see further possibilities for growth with our combined businesses."

"United Healthcare is a proven market innovator that brings vast technological and capital resources to make sure investments in our clients, workers, providers and community," Robert Pomfrey, president and chief executive officer of Pomco, stated in the statement. "This collaboration will expand the products and service of United Healthcare while also bringing more cost-effective solutions to Pomco clients, members and the Central and Upstate New York regions."

Sources stated that workers at Pomco's headquarters on James Street were informed of the deal Monday morning and told that their jobs "will be safe." The sale is hoped to take about thirty days to close, one source claimed.

Inquired about the deal's affect on jobs, a United Healthcare representative said the contract is subject to regulatory approvals and that the company can't comment further at this time. However, she claimed that the company views the acquisition as "a growth opportunity."
Co-founded by Pomfrey in the year of 1978, Syracuse Pomco Group is one of the nation's greatest benefits administrators for self-funded health and risk management policies.

The company laid off more than 100 employees a year ago after Health Republic of New York, a financially troubled insurer POMCO processed claims for, was compelled to close by state and federal regulators.

In accordance to its website, United Healthcare gives health benefit programs for people, employers, military service members, retirees and their families, and Medicare and Medicaid beneficiaries, and contracts straightly with more than one million physicians and care experts, and 6,000 hospitals and other care facilities nationwide.

About POMCO

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

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The Phia Group Announces 'Leave of Absence' Reviews

MyHealthGuide Source: The Phia Group, LLC, 3/24/2017, www.PhiaGroup.com

Braintree, MA -- The Phia Group, LLC is pleased to announce the addition of "Leave of Absence" reviews.

Recognizing that employee handbooks are rarely compliant with applicable law, and promise employees extended health plan coverage contrary to health plan documents whose terms require termination of coverage, The Phia Group is pleased to provide a Leave of Absence review service. The Phia Group's team of plan document experts and attorneys will analyze the applicable plan document side-by-side with the employer's handbook and stop-loss policy, to ensure there are no gaps in coverage and that all are in compliance with applicable law.

"Too often we see employees -- and their employer -- caught unawares by limits existent in their own plan document." remarked The Phia Group's Vice President of Consulting, Jennifer McCormick, Esq., "Employers enact generous policies regarding leaves of absence, reflected in their handbooks, but totally forget to update their health plans accordingly."

For more information regarding The Phia Group's Leave of Absence Review, or to learn about any of The Phia Group's other services, please contact Tim Callender by email at tcallender@phiagroup.com or by phone at 781-535-5631.

About The Phia Group

The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, The Phia Group is truly Empowering Plans.  Visit www.PhiaGroup.com.

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Liberty Mutual Insurance Acquires Assets of Medical Stop Loss Provider TRU Services, LLC

MyHealthGuide Source: Business Wire, 3/21/2017

BOSTON -- Liberty Mutual Insurance has signed a definitive agreement to acquire the assets of TRU Services, LLC, a Beverly, Massachusetts based managing general agent (MGA) that specialized in providing Medical Stop Loss products to mid- and large-size medical plan sponsors. TRU underwrites both specific and aggregate stop loss coverage, administering approximately $65 million in premium in 2016.

Once the transaction is closed in Q2, the founders of TRU, Jerry and Anne Trupiano, along with the entire 38-member strong TRU team, will join Liberty Mutual's Specialty Lines-focused business unit Liberty International Underwriters (LIU) as employees. Once TRU becomes part of LIU, it will continue operating as an MGA throughout 2017 and will transition to directly writing Medical Stop Loss for LIU by January 1, 2018.

"As we look to expand our product offerings, medical stop loss offers an exciting opportunity for LIU, and the acquisition of an industry leader like TRU gives us a strong foothold in the market," said Jim Hinchley, President of LIU Americas.

Jerry Trupiano, co-founder of TRU, said: "Liberty Mutual provides a terrific platform for the TRU team to continue to grow and develop the business we've built up over the past two decades. Anne and I are thrilled to become part of the Liberty Mutual family."

About Liberty International Underwriters

Part of Liberty Mutual Insurance, Liberty International Underwriters (LIU) distributes global specialty lines products and services exclusively through the independent broker network worldwide to insure specialized risk in most countries in the world. From New York to Melbourne, LIU maintains underwriting consistency that leverages substantial global capacity while giving its underwriters broad local authority to deliver creative solutions that genuinely add value. Visit www.LIU-USA.com.

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Empire Life and Symbility Health Partner to Offer Stop Loss Insurance

MyHealthGuide Source: Insurance Journal, 3/21/2017

Symbility Health announced March 21 that it has signed an agreement for Empire Life to provide stop loss insurance to Symbility's third party administrator partners beginning April 1.

Stop loss insurance is purchased by employers who self-fund their employee benefit health plans and do not want to assume 100% of the liability for plan's claims.

"With their comprehensive stop-loss protection solution, Empire Life will help ensure the long-term viability and sustainability of our clients' benefit plans by balancing employee needs with plans' financial security," said Shannon McShane-Reed, President, Symbility Health in an announcement. "This is especially important in today's reality of escalating drug costs."

"We're excited to work with Symbility," said Steve Pong, Senior Vice-President, Group Solutions, Empire Life. "They're an innovative, world-class Canadian software company, and this partnership will help us grow our business outside of our regular channels. We look forward to expanding our partnership in 2017 and beyond."

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DWVD Completes January 2017 Survey

MyHealthGuide Source: D.W. Van Dyke & Co. Inc. (DWVD), 3/22/2017, www.dwvd.com

Chris Koehler, President of D.W. Van Dyke & Co. Inc., announced that MGU and Carrier results for its just completed January 2017 Stop Loss Industry Surveys (Premium increase, Persistency and New Business) were sent last week to the 33 organizations participating in the survey (MGUs (14), DIRECTs (19)). Total annualized survey premiums this year grew to almost $6.5 Billion.

One take away from this year's Persistency and New Business survey was the record January MGU growth resulting from strong MGU persistency and solid new business production.

Organizations considering participation in future DWVD Stop Loss surveys should contact Chris at ckoehler@dwvd.com or Michelle Marzella at mmarzella@dwvd.com 

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 wroland@dwvd.com and visit www.dwvd.com.

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People News



Brentwood Services Administrators Promotes Courtney Wall To Medical Only-Claims Representative

MyHealthGuide Source: Brentwood Services Administrators Inc. (BSA), 3/20/2017, www.BWood.com

BRENTWOOD, TN -- Brentwood Services Administrators Inc. (BSA), headquartered in Brentwood, Tenn., recently promoted Courtney Wall in February 2017 to the position of medical only-claims representative in the Brentwood office, according to Jeff Pettus, president and chief executive officer of Brentwood Services Administrators Inc.

Wall is responsible for reviewing, processing, and handling workers' compensation claims as assigned by Lisa Whitten, claims supervisor for BSA. Wall determines the compensability of claims, processes medical bills; and communicates directly with clients, employers, injured workers, physicians and attorneys to manage claims in a timely and economic manner. Wall was employed by BSA as a claim assistant in March 2014. Previously, Wall worked in customer service for Victory Childcare as a childcare teacher.

About Brentwood Services Inc.

Brentwood Services Inc. is an independent employee-owned company headquartered in Brentwood, Tenn., specializing over the past 26 years in structuring and managing alternative market solutions for employers and insurance providers. contact John Smitherman, senior vice president, sales, at John.Smitherman@bwood.com or Randy Chapman, vice president, sales, at Randy.Chapman@bwood.com. Both can be reached at by phone at (800) 524-0604 and visit www.BWood.com.

About Brentwood Services Administrators Inc.

Brentwood Services Administrators Inc. provides claims management and loss control services to employers and employer associations with self-insured and large deductible programs for workers' compensation and other casualty lines throughout the contiguous 48 states. BSA's aggressive coordinated approach to claims administration and loss control has a proven track record of reducing the cost of claims for its clients. BSA also provides underwriting, policy management and accounting services to association-sponsored pools and mutual insurance companies.

About Brentwood Reinsurance Intermediaries Inc.

Brentwood Reinsurance Intermediaries Inc. (BRII) provides insurance brokerage services encompassing self-insurance, guaranteed cost and deductible insurance with a focus on workers' compensation. Reinsurance intermediary services include workers' compensation, accident and health, general and automobile liability casualty and specialty coverages. Clients include corporations, governmental entities, insurance companies and captive insurance companies. Visit www.brentre.com.

About CompPoint Managed Care Inc.

CompPoint Managed Care Inc., a managed care provider and wholly owned subsidiary of BSI, offers medical case management, utilization review, medical bill review, pharmacy benefits management and other ancillary services designed to control claim costs. Visit www.comppointmc.com.

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Job News


Berkshire Hathaway Specialty Insurance Seeks Stop-Loss Medical Risk Consultant

MyHealthGuide Source: Berkshire Hathaway Specialty Insurance, 3/13/2017, www.bhspecialty.com

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.

Requirements

  • 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 Ruth.Weaver@bhspecialty.com.

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 www.bhspecialty.com.

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Sun Life Seeks Stop Loss Underwriting Risk Director

MyHealthGuide Source: Sun Life, 3/9/2017, www.sunlife.com/us/

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.

Qualifications/Competencies

  • 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  Margaret.Peterson@sunlife.com.

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 www.sunlife.com/us/.

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

MyHealthGuide Source: Sun Life, 3/9/2017, www.sunlife.com/us/

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.

Qualifications

  • 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  Margaret.Peterson@sunlife.com.

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 www.sunlife.com/us/.

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Sun Life Seeks Associate Director Stop Loss Renewals

MyHealthGuide Source: Sun Life, 3/9/2017, www.sunlife.com/us/

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.

Responsibilities

  • 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

Experience

  • 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  Margaret.Peterson@sunlife.com.

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 www.sunlife.com/us/.

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

MyHealthGuide Source: LifeTrac, Inc., 2/27/2017, www.lifetracnetwork.com

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 hr@lifetracnetwork.com.

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 www.lifetracnetwork.com.

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Windsor Strategy Solutions Seeks a Sales Associate

MyHealthGuide Source: Windsor Strategy Solutions, 3/1/2017, www.windsorstrategy.solutions

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: info@wspactuaries.com.

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 www.windsorstrategy.solutions.

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Market Trends, Studies, Books & Opinions


Self-Insured Companies Help Push Health Care Innovations

MyHealthGuide Source: Mike Ferguson, President and CEO, Self-Insurance Institute of America, Inc., 3/22/2017, Investor's Business Daily Politics

Self-funded companies have strong incentives to customize their health plans in ways that will improve health and reduce long-term spending for employers and employees alike.

New models like telemedicine and on-site clinics, as well as sophisticated data analysis, are empowering them to do so -- and revolutionizing employer-sponsored benefits in the process.

Self-insurance has long been the coverage model of choice for large companies.  According to Employee Benefits Research Institute (EBRI),

  • 80% of employers with more than 500 employees self-fund their health plans.
  • 60% percent of Americans with employer-sponsored health benefits are on self-insured plans.

Self-insured businesses also have considerable freedom to adopt innovative models for delivering care. That's great news for workers and their families, since many of these new approaches are much more convenient -- and effective.

Telemedicine

In many cases, telemedicine doctors' visits offer more sophisticated care than in-person consultations. Consider the electronic stethoscopes used to evaluate patients remotely. These devices amplify body sounds for easier listening, and can transmit and record the resulting data digitally for future reference -- a vast improvement over traditional stethoscopes.

Telemedicine also carries significant financial benefits, as it reduces the need for expensive trips to the hospital or clinic. By one estimate, 40% of emergency room visits and 70% of doctor visits could be dealt with remotely.

Less hemmed in by the restrictions of traditional coverage, self-insured plans are largely responsible for the growth of telemedicine.

In fact, when major insurers like Cigna and UnitedHealth first began covering telemedicine a few years ago, the change applied exclusively to the self-insured plans they administered.

On-site Clinics

Then there's the growth of on-site clinics, which allow companies to remove some of the barriers that keep workers from seeing a doctor -- including copays, deductibles, and the hassle of getting to the doctor's office.

At many self-insured firms, a visit to the doctor for workers and their dependents is as easy as a walk down the hallway, with little or no wait.

These clinics can pay for themselves. A Department of Health and Human Services study found:

  • Companies offering on-site clinics and wellness programs can cut health expenses up to 55%
  • Reduce short-term sick leave 32%, and
  • Increase productivity 52%.

One administrator of such clinics has seen 80% of its clients cut the growth rate of their health costs in half after offering on-site care for 18 months.

Data Analytics

Companies that self-fund also maintain complete ownership of their claims data -- a major advantage given today's sophisticated data tools.

Businesses can analyze trends in how employees use medical care, uncover new ways of reducing health costs, and even predict changes in their health care finances years in advance.

For instance, data analytics can help identify whether workers are taking their blood-pressure medication or getting regular preventive checkups.

Companies can respond to those findings by lowering out-of-pocket costs for prescription drugs or incentivizing specific healthy behaviors. Those interventions can save money in the long run by warding off costly -- and completely preventable -- complications.

By breaking free of the conventional coverage model, self-insured companies are finding innovative ways to improve the health of their workers, and at lower cost. Business leaders and policy-makers should take note.

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Legislative & Regulatory News


Cigna Barred From Recouping Self-Insured Plan Assets from Out-of-Network Medical Provider for not Collecting Out-of-Pocket

MyHealthGuide Source: M. Flores, 3/16/2017, AVYM

Case: Connecticut General Life Insurance Co. et al. v. True View Surgery Center One, LP et al. Case No.:3:14-cv-01859-AVC; US District Court Connecticut

On March 10, 2017 in the US District Court of Connecticut, Judge Alfred V. Covello ruled in favor of surgical center defendants and against Cigna, barring Cigna from recouping self-insured plan assets based on alleged "overpayments" which were predicated on Cigna's "legally incorrect" interpretation of ERISA plans "exclusionary language".

This decision offers clear guidance on critical issues such as cross-plan offsetting, Cigna's fee forgiveness protocol, SIU practices and ERISA disclosure requirements, confirming the profound shift in Out-of-Network benefits and claim processing for all health care providers and health plans in the nation.

The decision also further unwinds the payor initiated "out-of-network fraud" enigma and is one of a series of critical court decisions which address the typical scenario for out-of-network providers: payors refusal to pay claims which leads to "catch-all"  out-of-network lawsuits seeking total overpayment refunds of claims previously paid to providers, all based on broad and vague allegations of fraud.

Case Background

The case revolves around Cigna's fee forgiving protocol, whereby Cigna denies medical claims if its members don't pay their entire out of pocket cost up front. Based on this premise, Cigna is also seeking recovery of approximately $17 million in alleged "overpayments" made to providers that did not collect the full patient out of pocket liability up front.

In what may have been the impetus for a litigation tsunami, where over 100 Cigna administered health plans were sued for various ERISA violations including embezzlement, issuing "secret checks" and self-dealing, Cigna filed suit on 12/11/2014 against True View Surgery Center One and affiliated health care providers seeking declaratory and injunctive relief under ERISA  and essentially asking the court to declare that "no coverage is due" where medical providers "do not enforce the plans' cost-share requirements". Cigna also asked the court to order defendant medical providers to "submit to Cigna only claims containing charges that Defendants actually charge the plan member as payment in full". In other words, no medical coverage is available if the member does not pay their entire out of pocket liabilities  up front.

Cigna was also seeking the return of any benefit payments, as "overpayments" made to the medical provider where the member did not pay their entire out of pocket liability up front, specifically requesting the court to impose a "constructive trust on monies currently held by Defendants as a result of the overpayments made by Cigna…pursuant to an equitable lien".

Out of network provider True View Surgery Center One, argued that the issues were already resolved in a previous case litigated in Texas, and that Cigna was attempting to take multiple bites out of the same apple in order to wrongfully deny legitimate medical claims.

Court Ruling

The court focused on two main issues:

  1. Whether Cigna is barred by the doctrine of collateral estoppel from pursuing their claims on behalf of ERISA plans; and
  2. Whether Cigna has adequately alleged traceability in order to recover alleged "overpayments"

Ultimately, the court agreed with defendant True View Surgery Center One and ruled "Cigna is barred by the doctrine of judicial estoppel" in its attempt to have the courts validate its fee forgiving protocols, and in its attempts to recover alleged "overpayments"

In his decision, Judge Covello cited the Humble case (Connecticut General Life Insurance Co. et al. v. Humble Surgical Hospital, LLC, Case number 4:13-cv-03291) where Cigna was slammed with a $17 million penalty and opined that the district court in Texas had already "addressed the issue" regarding Cigna's fee forgiving protocols.

In citing the Humble case, the judge said "In Humble, the court held that Cigna's interpretation of this "exclusionary" language was "legally incorrect," and that "ERISA does not permit the interpretation embraced by Cigna."

The judge went on to say that the Texas court found

  • "because ‘[t]he average plan participant would not understand from the exclusionary language…that his/her coverage is expressly conditioned on whether Humble collects upfront, the entirety of his/her deductible, co-pay and co-insurance before Cigna pays,' Cigna's "exclusionary" language interpretation does not pass muster under the "average plan participant" test," which ERISA requires.".

The judge ultimately holds:

  • "Cigna is relying on the interpretation of its ERISA plans that the United States District Court for the Southern District of Texas held to be ‘legally incorrect' in order to effectively deny providers' benefit claims. Therefore, the doctrine of collateral estoppel bars Cigna from relitigating those [issues]."

As part of Judge Covello's ruling on Cigna's lack of traceability, in  dismissing Cigna's claim for "overpayments", we must again look to the Humble case for clarification.

According to the Humble court:

  • "Cigna is not entitled to equitable restitution of any alleged overpayments based on the "tracing" method, as it cannot identify any specific res separate and apart from Humble's general assets. See Health Special Risk, 756 F.3d at 366 (reasoning that "Sereboff did not move away from any tracing requirement; it distinguished between equitable liens by agreement--which do not require tracing--and equitable liens by restitution--which do."). As the Court explained in Knudson, the basis for petitioners' claim is "that petitioners are contractually entitled to some funds for benefits that they conferred. The kind of restitution that petitioners seek, therefore, is not equitable…but legal--the imposition of personal liability for the benefits that they conferred upon respondents."Knudson, 534 U.S. at 214."

Implications

All Out-of-Network providers and self-insured health plans should understand the implications of the court's rulings in order to protect members and beneficiaries from inappropriate medical debt and bankruptcy and to safeguard and protect self-insured health plan assets from possible conversion, abstraction or "hidden fees". Education and understanding of these concepts will bring peace, harmony and compliance to the healthcare industry, especially when health plans are determined to contain healthcare  costs and healthcare providers are dedicated to providing all patients with  high quality, affordable healthcare when exercising their freedom of choice and right to seek out-of-network care.

About Avym

For over 7 years, Avym Corp. has advocated for ERISA plan assets audit and embezzlement recovery education and consulting. Now with the Supreme Court's guidance on ERISA anti- fraud protection, we are ready to assist all medical providers and self-insured plans recover billions of dollars on behalf of  hard-working Americans. Visit avym.com.

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Medical News


Quality of Life Differences Following Various Prostate Cancer Treatments

MyHealthGuide Source: Ronald C. Chen, MD, MPH; Ramsankar Basak, PhD; Anne-Marie Meyer, PhD; et al, 3/21/2017, JAMA Networks

The study addressed the differences in quality of life are associated with radical prostatectomy, external beam radiotherapy, brachytherapy, and active surveillance after treatment for prostate cancer.

The study followed a cohort of 1,141 newly diagnosed prostate cancer enrolled from January 2011 through June 2013 in collaboration with the North Carolina Central Cancer Registry. Median time from diagnosis to enrollment was 5 weeks. 

Quality of life using the validated instrument Prostate Cancer Symptom Indices was assessed at baseline (pretreatment) and 3, 12, and 24 months after treatment. The instrument contains 4 domains--sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems--each scored from 0 (no dysfunction) to 100 (maximum dysfunction). Propensity-weighted mean domain scores were compared between each treatment group vs active surveillance at each time point.

Study findings

  • Of 1,141 enrolled men,
    • 314 pursued active surveillance (27.5%),
    • 469 radical prostatectomy (41.1%),
    • 249 external beam radiotherapy (21.8%), and
    • 109 brachytherapy (9.6%).
  • Radical prostatectomy was associated with worse sexual dysfunction and
  • Urinary incontinence compared with active surveillance, external beam radiotherapy and brachytherapy with worse short-term urinary obstruction and irritation, and
  • External beam radiotherapy with worse short-term bowel symptoms.
  • However, by 24 months, mean scores between treatment groups vs active surveillance were not significantly different in most domains.

Conclusion

Patients diagnosed with localized prostate cancer have to decide among treatment strategies that may differ in their likelihood of adverse effects.

In this cohort of men with localized prostate cancer, each treatment strategy was associated with distinct patterns of adverse effects over 2 years. These findings can be used to promote treatment decisions that incorporate individual preferences.

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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 Info@MyHealthGuide.com
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital/Equity
(Millions)
1 CIGNA     $3,082
2016
 
  Source - CIGNA Financial Supplement 2016, P.5 12/31/2016
2 Sun Life Financial > 30 Years   $1,155
2015
 
  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++)
$907
2015
$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)
$858
2016
$378
12/31/2016
  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-)
$837
2016
$594
12/31/2016
  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)
$728
2014
$3,360.6
12/31/2014
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
10/8/2014
 
  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
3/31/2016
 
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Group Solutions $302
3/1/2017
 
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 3/1/2017
10 United States Fire Insurance Company >15 Years   $200
2016
$1,200
  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),
TransAmerica
$147
2015
 
  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++)
$104
12/2014
 
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
2016
$6,800
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
15
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
  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 Info@MyHealthGuide.com.  

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The Value of Self-Funding

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

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Video Highlighting Captive Solutions for Mid-market Companies

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

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 www.siefonline.org 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 jmiller@siia.org 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 www.siefonline.org.

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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.

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Upcoming Conferences


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

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:
https://attendee.gotowebinar.com/register/2839458373568371457

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 jmiller@siia.org. 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.

Presenters

  • 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

Moderator

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

Earn up to 1.50 CPD Credits.  Registration: https://www.soa.org/prof-dev/events/2017/aca-impact/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 www.SIIA.org

April 30 - May 3, 2017
14th Annual World Health Care Congress.  Join Health Insurance, Third Party Administrators and Broker Executives. This year's meeting will focus on the future of health care under and connecting and preparing health care and business leaders for the transformation in the health care system that will happen over the next four years.  Focuses: Health Policy, Drug Pricing, Referenced Based Pricing, Employer-Health System Direct Contracting, On-Site Clinics, More.  Washington DC. Information and Registration

May 3, 2017
Launch Event sponsored by Downtown Chicago Association of Health Underwriters.  Keynote speaker: Janet Trautwein, CEO, NAHU. East Bank Club, 500 N. Kingsbury Ct, Chicago, IL.

May 3-4, 2017
SIIA 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 www.SIIA.org

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 smurphy@niis.com or Susan Arsenault at sarsenault@niis.com. 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, mmcnutt@wedi.org.  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 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: customercare@strategyinstitute.com. Website: www.captivesinsurance.com 

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 agarneau@mdstrat.com.

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 sbyars@mtcaptives.org.  Information and registration: www.mtcaptives.org.

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.  www.selffundingconference.com

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. www.SIIA.org

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

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

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, mmcnutt@wedi.org.  Hyatt Regency Reston, Reston, VA.  Information and Registration.

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

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

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Editorial Notes, Disclaimers & Disclosures


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