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The Merits


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balance Experts in coverage solutions for single entities, groups and public entities, our integrated approach gives self-insureds greater stability and control over their self-funded plan. Unparalleled underwriting expertise, innovative risk management and in-house claims management, work in sync and in perfect balance for best possible outcomes.

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APRIL 2020 VOL 138

W W W. S I P C O N L I N E . N E T






IN 2020 By Karrie Hyatt













The Self-Insurer (ISSN 10913815) is published monthly by Self-Insurers’ Publishing Corp. (SIPC). Postmaster: Send address changes to The Self-Insurer Editorial and Advertising Office, P.O. Box 1237, Simpsonville, SC 29681,(888) 394-5688

Self-Insurer’s Publishing Corp.

PUBLISHING DIRECTOR Erica Massey, SENIOR EDITOR Gretchen Grote, CONTRIBUTING EDITOR Mike Ferguson, DIRECTOR OF OPERATIONS Justin Miller, DIRECTOR OF ADVERTISING Shane Byars, EDITORIAL ADVISORS Bruce Shutan and Karrie Hyatt, 2018 Self-Insurers’ Publishing Corp. Officers James A. Kinder, CEO/Chairman, Erica M. Massey, President, Lynne Bolduc, Esq. Secretary

APRIL 2020



The Merits



raig Clemente wanted to be the next Derek Jeter or Eli Manning, having grown up a sports fanatic outside New York City where he imagined one day suiting up as a Yankee or Giant. But after working one summer for his dad’s reinsurance company at just 14, he embarked on a meandering career path. Stints as a Wall Street trader and hotel management trainee focused on operations and revenue proved to be detours. He’s now chief operating officer for Specialty Care Management, which former SIIA chairman Bob Clemente founded, and at age 36, he’s actively helping shape the self-insurance industry for newer generations. The younger Clemente has chaired SIIA’s Future Leaders Committee, the brainchild behind the upcoming Mentor Connection Forum where they’ll be paired with senior executives in the i ndustry as part of a “speed-mentoring” format. The event will help SIIA members ages 30 to 40 learn practical careeradvancement advice as well as network with peers.



The Merits of Mentoring Another noteworthy name to consider in recognition of this effort is Kari Niblack, CEO of ACS Benefit Services, a third-party administrator whose career path has racked up serious miles. Now in her 50s, she’s focused on succession planning to close generational gaps in her firm and has happily taken on the role of mentor. One such beneficiary of her thought leadership is Lauren Wu, a clinical recruiter at NuWest Group Holdings, LLC who was inspired by a talk she gave at SIIA’s national conference about four years ago. Wu, who had just graduated from college at that time, asked if she could buy Niblack a cup of coffee. They have since met at each of those annual events and are engaged in informal chats throughout the year.

“I think it’s beneficial for both of us,” Niblack says, “and it has been fun to see her move up in her career as a result of having the courage to tap me on the shoulder in the security line at the airport… I get pure enjoyment out of serving as a mentor to some younger folks in our industry. I think that you always look for people to mentor, or you look for mentors yourself who can help you grow, Kari Niblack because if you stop growing, then you’re not advancing.” TIES THAT BIND Mentoring makes perfect sense for Millennials who’d much rather have coaches than bosses and are leery of traditional hierarchies, according to a recent Forbes article that also suggested a meaningful corporate mission and purpose are vitally important to this age group. It’s critical for young people in the industry to verbalize to mentors what they want to derive from that relationship and leverage that resource to the hilt, Clemente believes. “You can learn from every interaction and piece of information that you get, whether it’s during the middle of a workday or over coffee or lunch,” he explains, referencing his father-son mentoring experience. “Health care is such a huge and complex

Tony Strazzara

industry, and I think we need to create not only a great organic dialogue, but effective and viable solutions that continue to bring great value to the lives that we are covering in this market,” he observes. Tony Strazzara, age 30, director of actuarial services for Actuarial Strategies & Tactics, Inc., marvels at the way two of his mentors conduct themselves in meetings and on phone calls. One is Bernie Erickson, the owner of his firm, who shines in seemingly intimidating environments with 20 to 30 people in a client’s meeting room where pressure mounts to deliver a killer presentation. “I was just captivated by how natural that was for him, how well versed he was in the industry and in his expertise,” he reports. “It inspired me to be like that; just get up there and make that presentation or be on that stage, don’t hold back and be confident.” There’s also Bill Ashley, CEO of Allied National, a TPA in Kansas City who’s a favorite client. Like Erickson, Ashley can easily captivate an audience and is always cool, collected and reflective when answering questions. He’s also

APRIL 2020



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The Merits of Mentoring a good listener. “It seems like there’s nothing that he doesn’t know about the industry,” according to Strazzara whose first Future Leaders Committee meeting was last fall in Boston.

WHAT MAKES A GREAT LEADER Great leaders are able to balance risk taking with the timing of decisions, according to Niblack. “The higher you go up in an organization, you’re not always going to get 100% of the information on any given topic,” she says, “so you’ve got to have the agility to have a particular topic and say, ‘okay, tell me pros and cons of this,’ and then not stall decision making.” When looking to hire future leaders, she seeks candidates who are adaptable and open to growing in areas that they wouldn’t normally be assigned to, as well

“I don’t think retirement’s as magical as it used to be for a lot of people,” says Peter Robinson, managing director of EPIC Reinsurance, who’s in his early 60s and still very much enjoys his work. “I see a lot of people staying on well past traditional markers of retirement age.” That’s why it makes sense to build a resilient multigenerational team whose younger employees are visible to clients, he suggests. This shows a clear signal that the company is thinking about its business over a longer term “and not just in the immediate relationship side of the business that’s so true around selfinsurance,” according to Robinson. He feels fortunate to work with people in their 30s and 40s who are looking ahead, “and so we sort of run our business as somewhat of a partnership.” As he edges closer to the twilight of his long and distinguished career, SIIA Chairman Dave Wilson Dave Wilson is delighted to learn new things, especially with recent work in the biopharma and genetics space. But the CEO of Windsor Strategy Partners also has been proactive about cultivating new leadership at his company. Paul Fallisi, who’s nearly a decade younger, was appointed president last year and will also assume the CEO role in due time. Wilson has helped groom him for more than 30 years. When bringing in a successor, Wilson warns that it’s critically important not to continually undercut that individual, which will only create distress and hasten their exit. “You need to bring in the right person, and you need to let that person run the firm,” he adds.

Peter Robinson

as their ability to take risks and perform at an exceptional level. As life expectancy increases and more people tie their identity to work, many of the nation’s estimated 73 million Baby Boomers may choose to stay in the workforce or ponder a career crossroad.

A core value of his is flexibility, which is important at any age. For example, Wilson sought to create an organization where executives could adapt work schedules to their lives rather than the other way around.

SELF-STARTERS AND SELF-LEARNERS Anyone who is a self-starter and self-learner, as well as motivated by their own aspirations, will have a running head start in terms of advancing their career in the self-insurance industry, Strazzara says. In his case, the doors of opportunity were opened, “but nobody was pushing me through those doors necessarily. I had to walk through them myself.”

APRIL 2020


The Merits of Mentoring

Other basic keys to success involve a willingness to bend and nurture client relationships. “We embrace changes every single week, and we don’t feel stuck on necessarily one way of doing something,” he notes. One of his firm’s chief missions is to visit clients face to face. “We could do a lot of our daily work from home or a coffee shop using our own laptops, but we don’t,” he explains. “We all come to the office every day, and I can see firsthand the benefit that has with the relationships that are fostered here.” When Niblack started out 30 years ago, business deals were consummated

“You would actually meet with people,”

with handshakes.

she observes, warning against replacing relationships with impersonal

“You would get to know them on a personal level. As technology has advanced, there is much




less of the, ‘let me sit down and have coffee with you.’ My expectation of our company and client, vendor or broker relationships is that we stay somewhat old fashioned; that we use technology for development of materials and webinars.” In spite of these pleas to preserve coveted facetime, younger generations are expected to chip away at the 9-5 mindset with more telecommuting. “I work from home full time,” reports Cassie Bachman, Esq., age 31, managing director of compliance for Elevate Risk Solutions. “Working at home is a growing trend, and I think people our age are asking for it while negotiating contracts.”

CONFIDENCE BOOSTERS In terms of getting promoted and noticed in the self-insurance industry, she believes confidence drives more than 80% of that success. This quality enables her peers to accommodate bigger or different types of work projects or opportunities, she adds. A second key component is to embrace lifelong learning, which Bachman says is enhanced by Cassie Bachman setting goals, such as specializing in certain areas or becoming president of a company, and acquiring valuable skills within a certain timetable. Bachman advises her young peers to look for mentors who have connections and will gladly make introductions that can advance careers. “There aren’t a lot of opportunities for people in our industry to find mentors who are not someone they work for,” she says, noting that the Mentor Connection Forum is a perfect venue for doing so.

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The Merits of Mentoring She hadn’t met anyone her age until attending a past SIIA Future Leaders event, which she describes as mind blowing. Bachman lunged at a chance to become part of that initiative and help her generation “make a difference in what we want our future to be in the industry.” Robinson finds it gratifying whenever younger people seek guidance from seasoned leaders in the industry. But since talent is in short supply, he says there’s always a danger that some are going to get poached through the mentorship process or they’re “drift away” from being over-scheduled or succumbing to distractions.

“My view with younger people is they have to put their own work into it,” he says, “but frequently, they don’t know how to create a network or personal board of directors, where to get information or how to expand their relationships to get a broader view of opportunity in their particular part of the experience.” His parting caveat:

Bruce Shutan is a Portland, Oregon-based freelance writer who has closely covered the employee benefits industry for more than 30 years.

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Celebrating 10 years of Employee Benefit Group Captives We’ve been innovating for a very long time. Ten years ago, Berkley Accident and Health was an industry pioneer with EmCap®, our employee benefit group captive program. Today, we are a market leader with an impressive track record of building and managing successful captives. For group captives, it’s a clear choice. Choose the team with a decade of experience and success. These statements are illustrative only and not indicative of actual past or future results. Stop Loss is underwritten by Berkley Life and Health Insurance Company, a member company of W. R. Berkley Corporation and rated A+ (Superior) by A.M. Best, and involves the formation of a group captive insurance program that involves other employers and requires other legal entities. Berkley and its affiliates do not provide tax, legal, or regulatory advice concerning EmCap. You should seek appropriate tax, legal, regulatory, or other counsel regarding the EmCap program, including, but not limited to, counsel in the areas of ERISA, multiple employer welfare arrangements (MEWAs), taxation, and captives. EmCap is not available to all employers or in all states.

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Captive Growth in 2020



READY FOR GROWTH IN 2020 Written By Karrie Hyatt


verall in 2019 captive growth showed mixed results. Of the domiciles that have reported numbers for 2019, only six had gains in captive numbers, while the rest had static results or lost more captives than they formed. While there were a few outliers, garnering captive formations in the forties and fifties, most domiciles showed a more reserved year with formations under twenty.

2019 got off to a slow start, but as the year went on and the economy began to change, domiciles saw more activity in the captive sector. Many jurisdictions reported an uptick in captive formations in the last two quarters of 2019, and several domiciles have reported a number of captive formations already this year. This increase in captive formation reflects the hardening insurance market, which will likely affect the industry for at least the next 18 months.



Captive Growth in 2020 Delaware had the most captive formations last year with 56. Followed by Utah (42) and Montana (40). Vermont retained its top spot as the largest U.S. domicile with 585 captives. Utah follows Vermont with 435, and Delaware is third with 359 captives. The remaining top ten are as follows: Nevada (298), Montana (293), North Carolina (235), Hawaii (231), South Carolina (179), District of Columbia (49), and Tennessee (140).

Vermont added 22 captives last year which is a little lower than average for the domicile. 559 of their captives are active while 29 are listed as inactive. Six of their new captives were redomiciled from other captive jurisdictions. In a statement released by Vermont's captive department, the new captives consisted of “14 pure captives, four sponsored captives, two risk retention groups (RRGs), one special purpose financial insurer, and one industrial insured captive.” The domicile has reported that it already has several captive applications in the pipeline to approval.

In April 2019, the Vermont legislature updated their captive law with a variety of small changes that ranged from dividends for nonprofit incorporated protected cells to NAIC required statutory accounting for a specific type of captive. Highlights of the updated legislation are that captives need to be examined every five years, it clarifies the definition of an independent director, and it offers captives more flexibility in their investments. Vermont usually tweaks its captive law each year to keep on top of changes in the industry.

However, so far in 2020, the state legislature has not introduced any changes.

The second largest captive domicile, Utah, added 42 captives, including eleven cell captives, to their roster in 2019, but retired more leaving their total number of captives slightly lower than the year before. Utah plans to make a minor change to its captive law in 2020 to allow some captives to reinsure pure third-party risk with prior approval from the state’s insurance commissioner.

Delaware’s large increase of 56 captives was offset by the 118 captives that closed their doors, so the domicile’s overall numbers were down for the year. Much of Delaware’s success in 2019 was due to the legislative update to their captive law in late 2018 that allows for “conditional licensing”—a form of licensing that lets certain captive owners to obtain a license on the same day as applying. This form of licensing proved very attractive to captive owners in 2019 with 52 of Delaware’s new captive forming through this process.

Montana added 40 new captives in 2019, according to a report by The domicile also retired 32 captives. Still, Montana saw a net increase in captives from 288 in 2018 to 293 at the end of 2019. The domicile also updated its captive law in 2019 to allow prospective captives to

APRIL 2020


Captive Growth in 2020 use letters of credit from banks outside of Montana to meet capital and surplus requirements. Prior to this update, captives were required to use a letter of credit from a Montana-chartered bank or one from a bank that has membership in the Federal Reserve system. As Montana had 26 new captives in 2018, the updated captive law may have provided further impetus for captives to domicile in the state.

North Carolina continues its steady growth adding 26 new captives in 2019, leading to a total of 298. This number is down slightly from 2018. North Carolina is also doing brisk business in cell and series captives, with 447 active, and 61 new cell or series captives added in 2019. The domicile reported at the end of January that it had already licensed two new captives and approved two cells, with three additional captive applications in the approval process.

Nevada added 21 new captives last year and closed 26, taking their total number down to 298. The District of Columbia had 149 captives at the end of the year, but despite 18 new captives, its total number of captives was down from 2018.

South Carolina also had 18 new captives last year which brought their year-end total from 171 in 2018 to 179 in 2019. Hawaii added eleven captives and had eleven withdraw leaving their total number at 231. Arizona added



nine captives and retired five taking their total number of captives to 128. Georgia, Texas, and Arkansas all had formations in the low single digits—five, four, and three respectively. However, for Arkansas, which is still trying to make its name as a captive domicile, three additional captives were a thirty percent increase in their total captive number. They now have nine captives.

Tennessee celebrated licensing its 200th captive in February, having already licensed four since the beginning of the year with six more captive applications already submitted. At the end of 2019, the domicile had 140 active captives. Last May, the governor signed into law Tennessee's latest update to its captive legislation. Tennessee was the earliest state to become a captive domicile—its original legislation became law in 1978—and its most recent updates are helping to keep it competitive in the captive marketplace. The updated law allows for protected cell captives to merge; allows premium payments and claims on insurance losses to be paid in foreign currency; and allows for the early licensing of captives among other small tweaks.

Illinois spent much of 2018 working to update its captive law. Originally passed in 1989, Illinois has not made much headway as a captive domicile. The state legislature passed the captive update during the middle of the year, but the governor vetoed the bill in August. The veto was overturned by a wide majority late November 2018 by both the House and Senate. The legislation was modeled on the captive laws of

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Captive Growth in 2020 some of the most successful domiciles and is meant to make captives as welcome in Illinois as they are in Hawaii or Vermont.

In early 2019, Texas updated their captive law, shoring up their original laws with clarifications and procedures. The law allows the commissioner to waive a captive’s annual report’s actuarial opinion for captives with less than $1 million of net premium or reinsurance; clarifies the DOI’s role in approving dividends; and provides guidance for determining qualified jurisdictions and rating agencies for reinsurance transactions, among other minutia.

In April of last year, Georgia passed updated captive law that allows for the formation of cell captives and provides new rules for captives that request to go dormant.

Connecticut last updated its captive law in 2018, allowing for the formation of agency captives. The domicile is looking to update its law again this year. Ned Lamont, the governor of Connecticut, wants to update the law with innovative captive regulations to help attract captives to the state. One aspect of the governor’s plan is to offer tax incentives to captive who chose to domicile, or redomicile, their captives in Connecticut. Legislation has not been introduced at this time.

While the state’s captive department hasn’t released numbers for 2019, Alabama’s legislature has already been busy this year. Alabama is the first state to update its captive law in 2020. The legislation, passed in February, revises branch captive requirements allowing them to more closely match those of pure captives, removes the requirement that coastal homeowner captives have fronting carriers, clarifies how domestic captives can insure risks in foreign jurisdictions, and codifies a formal dormancy statute.

Captive legislative updates have averaged around five over the last two years and no new states have become captive domiciles in over five years. While Washington state is looking to implement captive legislation this year, it seems that the U.S. may have reached a saturation point for domiciles. Karrie Hyatt is a freelance writer who has been involved in the captive industry for more than ten years. More information about her work can be found at: www.






ongress recently passed the first coronavirus response bill, the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020. This bill contained $8.5 billion in funding for small business loans, state departments of health, vaccine development and a ramp-up of now ongoing testing. Congress also passed the second phase of coronavirus response, the Families First Coronavirus Response Act, with a more focused policy angle. Highlights of this legislation include paid sick and family leave, SNAP programs for seniors, and insurer coverage mandates for COVID-19 testing.



INSIDE THE BELTWAY The bill requires private health plans, including both fully-insured and selfinsured plans, to provide coverage for COVID-19 diagnostic testing, including the cost of provider, urgent care center and emergency room visits in order to receive that testing and any related medical services during that time.

SIIA understands that some in Congress are also pushing to include language in this third response package to prohibit surprise medical bills. As you know, prohibiting surprise out-of-network medical bills has been a bipartisan priority since last year, though policymakers have disagreed on the correct approach to billing reimbursement, landing between a benchmark and arbitration approaches.

This coverage must be provided at no cost to the consumer, although the legislation as passed does not currently require coverage for treatment. However, as the virus continues to develop, Congress is likely to turn its attention to treatment and other medical services beyond just the initial testing scope.

SIIA continues to track COVID related policy and regulatory activities related to selffunded plans, employers and service providers. In addition, please watch for a number of topic specific webinars in the weeks to come.

While it is unknown at this time whether a congressional package will include surprise billing prohibitions, policymakers may at the very least prohibit surprise billing for COVID-19 related treatment, an approach that SIIA would support. Â

If you have questions about the recent impacts of COVID-19 legislation and selffunded plans or would like more information, please contact Ryan Work, SIIA vice president of federal government affairs, at

SIIA also understands that a number of self-funded service providers and employers are proactively and voluntarily offering coverage and waiving co-pays for certain testing and treatment. Both Congress and the Administration are now in negotiations over a third coronavirus response bill and economic stimulus package. Senate Majority Leader McConnell unveiled a comprehensive $1 billion package that offers financial assistance for individuals and families, small business relief, financial assistance for impacted industries such as airlines, hospitality and health care, and additional resources for state and local government response and recovery. In addition, this proposal would change the HSA rules to allow telehealth and primary care contracts before the deductible is met, and offset Medicare sequestration cuts.

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APRIL 2020



OUTSIDE the Beltway


elf-insurance, particularly self-insured employee health plans, continues to be targeted by an increasing number of states with restrictive laws, regulations or taxation schemes that trespass on ERISA protections. The threatening environment continues to test SIIA’s ability to fulfill its mission to protect and promote selfinsurance.

An ongoing state-by-state government relations process has taken SIIA staff and member activists to many state capitals as they advocate for beneficial measures or defend against those that could harm the self-insurance industry.




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SIIA continues to lead a coalition opposing small group stop-loss ban legislation, A.2213, and will be meeting with several legislators, urging them to keep the self-insurance option for small employer.

Recently, the governor’s office and key legislators discussed small group reform and stop-loss insurance. How the Legislature is planning to reform the small group market remains unclear but advancing stop-loss legislation was part of the discussion. The next time that stop-loss legislation could receive a hearing or move is in the May to June timeframe. SIIA is not aware of any commitments to advance A.2213 being made at the meeting.

SIIA has been fighting a TPA assessment for more than two years. Recently we learned that the other funding mechanisms are being considered, including a tax on hospitals and health insurance premiums. This would be welcome news, but until the Reinsurance Program legislation is amended and SIIA will continue to fight it.

Senator Kirk Talbott introduced individual market reinsurance legislation. Senate Bill 148 would create a Louisiana Health Reinsurance Association and be funded by health insurance policy and TPA covered lives fees of $2.50 per member per month.

TPAs with a Louisiana license should review this bill carefully, as the legislation may tie Louisiana licensure with Reinsurance Association membership. The legislation, as drafted, also gives the commissioner to audit a licensed TPA and fine it for noncompliance.

Connecticut Legislation codifying Connecticut Bulletin HC-126, including minimum $20K small group individual and 120 percent aggregate attachment points and small group lasering prohibition, is moving through the Connecticut legislature via House Bill 5018 and Senate Bill 328. Both bills were heard by their committees on March 2nd.

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OUTSIDE THE BELTWAY SIIA is monitoring the progress of both bills and is working with lobbyists in Hartford. At this time, there does not appear to be any legislative interest in modifying the text of the bulletin, which is the desired outcome.

• requiring a business to have 15 employees to be eligible for a policy

• prohibiting lasering in the small group market

Nevada SIIA has been actively engaged with the Nevada Department of Insurance (DOI) for the past three years, working to create more small employer health benefit options.

At the January 23rd Advisory Committee on Health Care and Insurance, staff announced it intends to issue a new draft of this regulation. The major changes in the regulation include:

SIIA’s last comments suggested clarifying that only paid claims are reimbursable, ensuring that some definitions of terminology like “lasering” and “expected claims” were consistent with industry standards and urging the department to withdraw a very small group contact ban.

• raising the minimum individual attachment point to $20,000 • deleting a $4,000 per-person aggregate requirement

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OUTSIDE THE BELTWAY The latest draft is available at SIIA’s latest comments are available at https://files.constantcontact. com/48f6ffcb701/ef75fab2-1260-4fdb-b4ac-2e85af620209.pdf .

It should be noted that the current regulations are still in force until new ones are effective.

Pursuant to Nevada law, the DOI will issue a new draft regulation and have another hearing to take in-person stakeholder feedback. SIIA understands that draft will have a two-year delayed implementation date and, according to a source, to allow the DOI to study level-funded issues with the intent of not inhibiting the product. Assuming regulations are approved this year, the earliest they would be effective is for the 2023 plan year.

SIIA will continue to work with the department, submit comments and, if possible, attend the next hearing to discuss the regulations.

Should you have any or if you would like to alert SIIA of new state legislative and regulatory activity (health care, workers’ compensation and/or captive insurance matters), please contact Adam Brackemyre, Vice President of State Government Relations directly at 202/595-0641, or via e-mail at

Do you aspire to be a published author? We would like to invite you to share your insight and submit an article to The Self-Insurer! SIIA’s official magazine is distributed in a digital and print format to reach 10,000 readers all over the world. The Self-Insurer has been delivering information to top-level executives in the self-insurance industry since 1984. Articles or guideline inquires can be submitted to Editor Gretchen Grote at ggrote@ The Self-Insurer also has advertising opportunties available. Pleae contact Shane Byars at sbyars@ for advertising information.

APRIL 2020





Written By Kevin Trokey


f you spend any time online at all, you have felt a level of industry energy that I’m not sure has ever existed before. The source of the energy is the confidence advisors have found in helping their clients finally take some control of their healthcare spend. Oh, and they’re also helping improve the quality of care! How are they doing this? By simply applying the time-proven benefits of Value-Based Insurance Design (VBID).



processed foods became the norm. Take all the processing out of the way, and it’s obviously a healthier way to eat. Is it a movement? Is it an evolution? Or is it simply a more common-sense way to eat? Does it really matter? It’s taking us back to the way we ate for thousands of years. Similarly, when we are able to take all of the damaging elements out of healthcare that networks have introduced and get back to a more common-sense approach, we know it will deliver better results and do so at a lower cost.

“HEALTHY” IS A LOT OF HARD WORK WHAT’S IN A NAME? Some call the re-emergence of VBID a "movement"; some call it an evolution; some simply call it common-sense. I don't really care what it's called, there is no doubt it will HELP solve many of our healthcare problems. But it won't solve all of them, nor will it be a fit for every employer. Regardless of the label you use, we should all find confidence in its ability to produce results, and you should find confidence in your own ability to execute, for one basic reason. The core ideas of VBID are not new at all. They take us back to the way healthcare used to be; to the way it was before it started spinning out of control. In fact, even the idea of building these ideas into partially self-funded plans (or as a friend of mine suggests calling them, “large dollar deductible” plans) has been around for decades. As one self-funded industry leader/veteran observed to me recently (paraphrasing), “We’ve been trying to get advisors to embrace these ideas for the past 24 years. We were all but ignored for the first 22 and now the bandwagon can’t hold everyone.”

WHAT’S OLD IS NEW AGAIN VBID is to BUCAH plans what the farm-to-table movement is to pre-packaged, processed meals. While the latter may both be convenient and marketed to imply they are good for you, they lack the nutritional density you need. They are literally and figuratively bringing you down. VBID and F2T are also similar in they take us back to our common-sense roots. Unfortunately, we allowed others to make us lazy and we have spent decades rationalizing ourselves through dangerous decisions. F2T is simply taking our diets back to what they were before pre-packaged,



The comparison between eating healthy and building a healthy benefit plan doesn’t end with the above analogy. If only it were as simple as avoiding prepackaged processed meals, we would be a lot healthier as a society. Unfortunately, even giving the up the convenience of such meals is a greater challenge than most are up for. The best some can aspire to is to simply make better (even if it’s “less bad”) pre-packaged, processed meal choices. And, even those who are able to give up the pre-packaged processed meals completely, have to face the reality that this step alone isn’t enough. You have to cut back on calories, get to the gym, take some personal time, have healthy relationships, etc. to be truly healthy. Building a healthy benefits program for your clients takes a similar, holistic effort. This is an especially important reminder for those of you overly excited that VBID is a “holy grail” of a solution for your prospects/clients and it has become your sole focal point. Even when VBID is the right solution for a client, it is only part of what they need.



How many of you have invested in other solutions for your clients? I’m guessing most of you have invested in compliance, technology, HR, and communication solutions to name a few. Do you think, because of the re-emergence of VBID, your clients need those solutions any less than they did the day you decided to invest in them? Of course not! In reality, they need them more than ever before.

Some of you are ahead of the industry in terms of putting VBID solutions into place. You feel you have a competitive advantage and maybe you do, for a brief moment.

I would argue that, because of the complexity of VBID plans, your clients face greater compliance challenges than ever before (certainly no fewer); need the operational efficiencies that only the right technology solution can deliver; and, there is no doubt, they need more help in effectively communicating these more complex plan designs to their employees. Don’t leave these critical ideas/ solutions back at the office.

I understand your passion and excitement about VBID but keep it all in perspective. Many of you are convinced it is THE answer. The answer for your clients' healthcare spend and, maybe even more for some of you, you feel it is the answer to your growth challenges. You may feel that taking these ideas to your clients is a sustainable advantage. Well, it may be a competitive advantage for the moment, but that won’t last. The rest of the market will catch up quickly. If you have become a one-trick VBID pony, you are going to find yourself out of the race for new business when up against industry thoroughbreds who don’t limit themselves to a single solution, but instead focus on the client and help them execute on what they truly need and want. Kevin Trokey is the Founding Partner of Q4intelligence, a marketing and sales enablement firm committed to the preservation and transformation of the independent agency system. He writes prolifically regarding the many challenges being faced by today’s agencies, providing guidance to overcome those challenges. He is a frequent industry speaker and was recognized by the National Association of Health Underwriters as their speaker of the year in 2016.

Kvein Trokey


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APRIL 2020


Written by Kelly E. Dempsey



he glory of self-funding is the flexibility an employer has to create a benefit plan that truly suits the individual employer. Employers with ERISA-governed selffunded plans have the opportunity to craft benefits and exclusions that align with the needs of their employee population, while implementing various cost containment solutions to assist the employer in offering a robust benefit plan, and, perhaps even more importantly, controlling the costs for the employees and the employer. But where does that flexibility stop? Flexibility can begin to taper off when it comes to determining which individuals are eligible for employer-sponsored coverage. In short, the relevant regulations mandate that only employees of the employer sponsoring the health plan should be eligible to participate. So the logical next question is: who qualifies as an employee?

APRIL 2020


In general, individuals that are issued a 1099 instead of a W-2 are independent contractors (“ICs”) and are accordingly not employees (“EEs”), and thus should not be offered employee benefits; to that end, the Internal Revenue Service (“IRS”) provides various resources to assist employers in appropriately classifying workers.

Interestingly, the IRS specifically lists “benefits” under the “type of relationship” category as a consideration for classifying a worker.

There is also a 20-factor (yes – 20) test found in Revenue Ruling 87-41 (19871 C.B. 296), but the IRS is aware that certain factors may not apply to every situation.

As states continue to develop employment-related laws to address various aspects that either directly relate to or at least tangentially effect employee benefits, one such development is of specific interest. New Jersey in particular has issued several new laws that took effect immediately in late 2019, related to independent contractor status and worker misclassifications. The New Jersey Department of Labor and Workforce Development now has the authority to issue monetary penalties for misclassification. If a labor contractor is involved, the employer and the labor contractor have joint liability for any violations and penalties.

The IRS looks at three areas of the relationship: (1) the behavioral control the employer has on the individual, (2) the level of financial control, and (3) the type or nature of the relationship.

While the considerations are a sliding scale rather than a hard-and-fast rule (as in, simply offering benefits does not necessarily make the individual an employee), it is certainly a factor.

Ultimately, misclassifying individuals may jeopardize the IC’s “IC” status, which leads to various complications for the employer, the IC, and the health plan.

In April 2020, New Jersey employers will also be required to post a notice regarding worker misclassification. The poster will include information about the prohibition on misclassification of workers, information on the differences between ICs and EEs, the benefits and protections employees are entitled to under state law, the remedies available to misclassified workers, and contact information for complaints or notification of alleged violations. These laws are the result of Governor Murphy issue Executive Order No. 25 in May of 2018 that established the Task Force on Employee Misclassification, making it a top priority to put guidelines in place to diminish work misclassification, which is believed to be widespread problem. If the State of New Jersey determines that individuals are being identified as ICs when they really are EEs (and vice versa), the State may issue specific penalties and even stop-work orders, in addition to other remedies or penalties found in other applicable law.

INNOVATIVE STOP LOSS AND ANCILLARY SOLUTIONS At BenefitMall, we know that employer groups benefit most from treating their health plan as an investment rather than an expense. Our team of self funded consultants can help you succeed by offering: • Reporting, Compliance Services and Plan Document Review • Billing and Premium Collection • Ancillary Products and Services

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There are two penalties that can be imposed. The first is an administrative penalty for misclassifying an employee. For the first violation, the administrative penalty is $250 per misclassified employee. Subsequent violations may increase the penalty up to a maximum of $1,000 per misclassified employee. The second penalty is structured a bit differently and the monetary amount is to be no more than 5% of the worker’s gross earnings over the past 12 months. The limitation applies to the earnings from the employer that actually misclassified the individual – meaning a new employer that has contracted to work with the IC cannot be held accountable for the prior employer’s mistake. The State may dictate that the penalty is paid directly to the misclassified workers, or the employer may be required to pay into a trust account for any applicable workers. Employers are to be provided with notice and given the opportunity to appeal by requesting a hearing with the Commissioner of Labor and Workforce Development. As with most laws, there is a good faith factor worked into the analysis. Ultimately the State must look to a variety of factors when applying penalties, including any previous violations by the employer, the seriousness of the violation, the employer size, and the good faith of the employer. You’re probably thinking: why does this matter to me? Over the last few years there has been an uptick in the number of self-funded plans that appear to want to include ICs as eligible, so if you’re a claims administrator, a consultant, or a broker, one of the plans you work with is likely impacted. Aside from specific state law penalties, there are a variety of considerations. Plan language is a major consideration (as it so often is). This may seem like the easiest piece of the puzzle, but as we dig in a bit, it becomes clear that it’s not so simple. Clear eligibility language is crucial to ensure compliance with ERISA Summary Plan Description requirements, so the first step is to modify the eligibility provisions of the document, including how a covered person or participant is defined. Again, determining when to offer coverage is usually simple, but the length of coverage and termination of coverage get a bit trickier. How long will the IC be eligible? Are ICS only covered when working on a project? Would the IC be terminated immediately when a project is over?  Would an IC be interested in such coverage if only offered for a limited period of time?



Benefits are usually offered when there is a permanency of the relationship between the employer and individual; generally, true employment relationships do not have defined end dates, while IC relationships usually have a more definite timeframe. That defined timeframe can make crafting the plan language offering coverage to ICs into a tedious process and could be difficult for a TPA to administer! Employers also need to consider whether they are inadvertently creating a MEWA – a multiple employer welfare arrangement. The offer of coverage to non-employees (i.e., the ICs) likely creates a MEWA. Generally speaking, a MEWA is created when one benefit plan is offered to two or more unrelated entities. Because each IC is a separate entity, it could create a de facto MEWA by including even one IC in the plan benefits. As the MEWA and Association Health Plan (“AHP”) space is another area of developing law, the company would need to properly form the MEWA or AHP first before modifying plan eligibility provisions, and an employer that forms a MEWA loses many of the coveted protections afforded by ERISA. If the employer still wants to continue down this path, the next consideration is tax consequences for both the employer and the IC. By classifying an individual as an IC, an employer avoids paying employment taxes; however, the IC is likely to be taxed on the benefits provided by the employer, since pre-tax protections generally do not apply.

Certain employers may be eligible for the IRS’ Voluntary Classification Settlement Program (“VCSP”), which allows employers to reclassify workers and receive some relief from federal employment taxes that the employer was not paying. Employers can also seek a proactive determination from the IRS regarding the proper classification of workers (although it’s not easy to estimate how long that might take to receive). Last, but not least, there are resources for individuals to calculate unreported taxes and report an apparent misclassification to the IRS. In addition to the above, stop loss is also a consideration; in order to ensure that these individuals’ claims will be covered under the stop loss policy, it need to be

underwritten accordingly and the policy must be written to include coverage for ICs. It generally goes without saying, but the stop loss carrier will need to sign off on the plan language modifications as well (generally before the changes go into place). With that said, will other states follow New Jersey’s lead? The answer to that question is unclear; however, since the passage of the Affordable Care Act in 2010, the United States Department of Labor is continuing to audit self-funded ERISA-governed plans on a regular basis, looking at a variety of things. Some audits are truly randomized, while others begin due to a complaint from a plan beneficiary. Employers should take a proactive approach to review their benefit offerings and assess whether the health plan’s actual eligibility exactly matches what is stated in the Plan Document, Summary Plan Description, and employee handbook, and update the documents accordingly (or correct any EE or IC statuses accordingly). In summary, it’s natural for an employer to want to offer benefits, including a robust health plan, to the individuals working for the benefit of the employer; however, if those individuals are not actual employees, things can go sideways quickly. Employers should proceed with caution when deciding to offer employer benefits to independent contractors.

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APRIL 2020


In this ever-changing industry, states are continuing to develop new rules for employers that bleed into the employee benefit space and can impact their selffunded health plan offerings. These new state laws, combined with existing federal guidelines, can be difficult to navigate, but with some careful planning, employers are given the tools they need to figure it all out!

Kelly E. Dempsey is an attorney with The Phia Group, LLC. As the Vice President of Phia Group Consulting, Kelly’s specialization is an interesting mix of compliance matters impacting self-funded plans (such as issues relating to ERISA, ACA, COBRA, FMLA, MHPAEA, and MSP) and “outside-the-box thinking,” finding creative and innovative ways to help plans, brokers, and TPAs achieve their various self-funding goals. Kelly is admitted to the Bar of the State of Ohio and the United States District Court, Northern District of Ohio.

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With all the uncertainty in the self-insurance marketplace given COVID-19 developments, I wanted to take this opportunity to deliver a message of certainty – SIIA will be there for its members.

We were of course disappointed that our events scheduled for this spring needed to be cancelled. But SIIA is much more than just a conference producer and we are pressing forward with important membership initiatives even in this challenging environment.

On the COVID-19 front, SIIA has positioned itself to be the best single source of industry specific information that is being delivered via webinars, e-mail updates and in-depth coverage in The Self-Insurer magazine.

APRIL 2020


ENDEAVORS While Coronavirus concerns are clearly top of mind for most members right now, SIIA’s leadership does anticipate that things will return to “normal” or some variation of normal in the coming months, so we are now re-setting the planning process for key initiatives that have been temporarily side-lined.

SIIA Drug Pricing Task Force meeting in February

We plan to update members soon on the work of a volunteer task force focused on developing strategies to Captive managers and advisors meet in Miami address rising costs in February associated with specialty drugs and We will also be re-engaging the SIIA gene therapy that are adversely Future Leaders Committee to continue affecting self-insured payers its very important work of developing and their stop-loss partners. strategies to encourage younger member involvement in our organization, which in turn benefits the overall industry.

Another task force will continue its work to identify ways to ensure that health claims data is more readily available for underwriting and cost management purposes.

And a third task force of SIIA TPA members will be resuming its work soon to develop best practices for working with reference-based pricing vendors.

SIIA members involved with captive insurance are being well-served by an ongoing SIIA members in Dallas discuss obtaining political advocacy effort necessary claims data in February designed to deter the potential of new regulations and IRS enforcement practices that would be harmful to the industry.



Finally, we are now finalizing the educational program and other event details for SIIA’s National Conference & Expo, scheduled for October 11-13, 2020 in Phoenix. And while I did just say that SIIA is more than just conference producer, we do produce amazing events. How great it will be to see all of our members together under one roof after the social distancing era comes to an end.

There’s even more activity I could report on, but I hope this summary demonstrates that SIIA is focused on helping its members even in the face of the current challenges and distractions.

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ENDEAVORS That’s all for now. On behalf of SIIA’s volunteer leadership and professional staff, we look forward to getting through these difficult times together and continuing our mission of protecting and promoting the business interests of companies involved in the self-insurance and captive insurance marketplace.


Michael W. Ferguson President & CEO

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2020 APRIL MEMBER NEWS SIIA Diamond, Gold & Silver Member News SIIA Diamond, Gold, and Silver member companies are leaders in the self-insurance/captive insurance marketplace. Provided below are news highlights from these upgraded members. News items should be submitted to All submissions are subject to editing for brevity. Information about upgraded memberships can be accessed online at For immediate assistance, please contact Jennifer Ivy at If you would like to learn more about the benefits of SIIA’s premium memberships, please contact Jennifer Ivy at APRIL 2020


NEWS DIAMOND MEMBERS BERKLEY ACCIDENT AND HEALTH APPOINTS REGIONAL MANAGING VICE PRESIDENTS TO LEAD ITS MEDICAL STOP LOSS SALES TEAM Berkley Accident and Health, a Berkley Company, has appointed three regional Managing Vice Presidents to lead its Medical Stop Loss sales team. Ron Brodeur, Matt Cooper, and David Frawley will lead the company's Eastern, Western, and Central regions, respectively. The newly created sales regions are designed to enhance the company’s distribution efforts and better service its clients. The Managing Vice Presidents will be responsible for growing existing distribu-

tion relationships, as well as identifying new opportunities. They will also provide overall direction to the Regional Sales Managers in their territory. “Our new regional structure will make us more agile,” said Lee Davidson, Senior Vice President, Stop Loss. “It will enable us to devote resources and adapt to changing market conditions with greater speed and agility,” continued Davidson. “In addition, Ron, David, and Matt have been an important part of the growth of our Stop Loss business, and I’m excited to have them drive our regional sales strategy.” This change complements the regional alignment in Berkley Accident and Health’s Group Captive segment and positions the company to best support its clients in all of its business segments.

About Berkley Accident and Health Berkley Accident and Health is a member company of W. R. Berkley Corporation, a Fortune 500® company. Berkley Accident and Health provides an innovative portfolio of accident and health insurance products. It offers four categories of products: Employer Stop Loss, Group Captives, Managed Care (including HMO Reinsurance and Provider Excess), and Specialty Accident. The company underwrites Stop Loss coverage through Berkley Life and Health Insurance Company, rated A+ (Superior) by A.M. Best. Contact Linda King, Director, Marketing, at lking@ and visit BerkleyAH. com.




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DARCEY DEARDEN JOINS VALENZ AS SENIOR SALES EXECUTIVE PHOENIX, AZ -- Valenz™, a leading innovator for data-driven solutions that reduce medical claim costs and promote quality healthcare, welcomes Darcey Dearden as Senior Sales Executive. An award-winning sales professional for more than 20 years, Dearden has a proven record of consistently exceeding performance goals and building strong relationships with clients and referral partners. Prior to joining Valenz, Dearden was Regional Vice President for Total Administrative Services Corporation, the nation’s largest privately held thirdparty benefits administrator. There, she elevated underperforming teams and established new standards to enhance accountability, collaboration and production. Her work experience also includes sales management positions at BenefitMall and Paychex.

“Darcey offers a winning combination of excellence in sales leadership, team building, and uncovering new solutions that maximize efficiency and reduce costs,” said Rob Gelb, Chief Executive Officer. “Her skill sets in strategic execution and effective communication make her well positioned to help our clients achieve smarter, better, faster healthcare. She is an outstanding fit for our team.” Dearden brings to Valenz a strong background in business-to-business sales, benefit administration and compliance. She says she is thrilled to join Valenz because, as the innovators behind the industry’s first complete health administrative ecosystem, Valenz embodies the future-focused, client-centric, data-driven vision necessary for lower-cost, higher-quality healthcare. “I look forward to meeting and exceeding our clients’ needs with the leading-edge data science and solutions that are unique to the Valenz ecosystem,” Dearden said. “I share this company’s dedication to managing costs and improving quality of care, and it is an honor to be part of such a vibrant, growing team.”

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NEWS About Valenz

VALENZ WELCOMES BRITTNEY PARRISH AS SENIOR CLIENT SERVICES EXECUTIVE Parrish comes to Valenz from Preferred Medical, where, as Regional Account Manager, she was responsible for managing sales, service and relationship-building. Her prior work experience also includes sales positions at Genex Services and Johnson & Johnson.

“I am excited to join this industry-leading team and support its data-driven vision of reducing costs for clients while enhancing quality of care,” Parrish said. “Through the complete Valenz health administrative ecosystem, I look forward to delivering solutions to clients that result in better health outcomes at lower costs.”

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. For more information, visit www.valenzhealth. com. Valenz is backed by Great Point Partners. Call Carol Dobies (816) 595-6720, Rob Gelb (866) 762-4455 ext. 377, and visit

About Great Point Partners Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds. com.

A graduate of the University of Richmond, Parrish’s skill sets include strategic sales planning, account analysis and development, client service, and negotiations – all key to her new role at Valenz, according to Tom Cox, Vice President, Client Services. “Brittney brings many strengths that support our ongoing commitment to growing our services and client base,” Cox said. “As we continue to expand our analytic and predictive capabilities to provide smarter, better, faster healthcare for our clients, we are proud to have her on our team.”

APRIL 2020




Previously, she served as a client relationship manager at Meritain Health.


I am thrilled to be part of a nationally growing company that is committed to successful relationships, outstanding service and innovation,” said Stetson. “I bring a wealth of knowledge to my client relationships, and my experience in working on all sides of the self-funded health plan industry will help take HPI to the next level.”

LYNN STETSON, NAMED NEW SENIOR ACCOUNT EXECUTIVE OF NATIONAL CLIENT MANAGEMENT AT HEALTH PLANS, INC. (HPI) Westborough, MA -- Springing forward after another successful year of growth, HPI has named Lynn Stetson as senior account executive of national client management. Lynn has spent over 25 years in the self-funded health plan industry and has dedicated her career to building trusting and lasting relationships with clients and their consultants. Her expertise will continue to fuel HPI’s development outside of New England as she provides exceptional service and educates customers about self-funding. “I am thrilled to welcome Lynn to HPI’s national team,” said Holly Weiske, vice president of national client management at HPI. “Lynn’s exceptional leadership and communication skills surely will have a great impact as we continue to cultivate our customer relationships throughout the country.” Stetson most recently served as a senior account executive at Lucent Health (formerly Cypress Benefit Administrators) for which responsibilities included client relations, renewals, and product and strategic consulting.



About HPI HPI redefines what is possible with self-funded health plans. As a third-party administrator, we partner with health plan brokers and employers to provide innovative self-funding strategies and customized plans tailored to each client’s needs and population. Our solutions give employers greater cost transparency and control, while elevating the member experience. It is our flexible approach, entrepreneurial spirit and commitment to quality, technology, and service that enable us to deliver premium value to our customers. Contact Su Doyle, Director of Strategic Marketing, at and visit www.

NEWS AMPS PROMOTES JONATHAN JEFFRESS TO CHIEF OPERATING OFFICER ATLANTA — Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, announced that Senior Vice President Jonathan Jeffress has been appointed Chief Operating Officer, assuming responsibility for operations, implementation and integration, client advocacy, adjudication and professional services, and information technology (IT) operations. “AMPS has been on an exciting, fastpaced growth trajectory, which is expected to accelerate as we continue to develop new ways of bringing value to our clients. We are expanding our team

and expertise, adding products and services, and gaining the honor to serve new clients,” says Kirk Fallbacher, Chief Executive Officer for AMPS. “I am excited to have Jonathan Jeffress leading our operations. His experience and success in the industry will bring much value to our clients.” Mr. Jeffress is a seasoned, operations executive with over 20 years’ experience in the healthcare and insurance industries, combined with in-depth expertise in organizational management, process improvement, implementation, integration, IT, and service delivery. He recently served as the VP of Operations and Client Delivery at Cotiviti, serving more than 40 Medicaid, Medicare, and commercial health insurance clients, resulting in $1.7 billion in annual net savings. Prior to that, he served as VP of Implementation Services leading the delivery and execution of between 60 and 70 project implementations and expansions annually. Jonathan has worked in numerous other leadership roles in the healthcare market focused on driving operational improvements, implementing scalable processes, developing high performance teams focused on delivering value for clients, and driving margin expansion and increased profitability.

APRIL 2020


NEWS “This is a great time to be part of AMPS as we work to disrupt the healthcare industry,” says Mr. Jeffress.

“To further increase the value we deliver to clients and bring new solutions to market, we are increasing our organizational capacity using tools and technology and a seamless integration of a global workforce. Maximizing the advantages of a global team enables an around the clock, 24-hour workday that accelerates our results and captures value for clients closer to the time of transaction. In addition to faster response time, this will improve our scalability and will enable AMPS to increase the scope of work and value we deliver for clients.” About AMPS Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers, TPAs, and reinsurers.



AMPS mission is to help clients attain their goals of reducing healthcare costs while keeping members satisfied with quality healthcare benefits. AMPS leverages 15 years of experience in auditing and pricing medical claims to deliver “fair for all” pricing both pre-care and post-care. AMPS offers innovative dashboards and analytics to provide clients with insights based on Plan performance. Learn more at

SILVER MEMBERS STRATEGIC RISK SOLUTIONS INTRODUCES MSL CAPTIVE SOLUTIONS Concord, MA -- Strategic Risk Solutions (SRS) announced the formation of MSL Captive Solutions Inc, a specialist underwriting, and consulting services firm focused on the use of captives in medical stop loss programs. The independent new entity will work closely with brokers, consultants and all captive managers to structure customized single-parent and group captive solutions to meet the specific risk and financial objectives of their clients. MSL Captive Solutions will be the industry’s only platform dedicated to the development and delivery of comprehensive services exclusively for single parent and group medical stop loss captives. In introducing the new venture, Brady Young, President and CEO of SRS commented

“we have been working in the MSL space since captives started participating in these programs, but I think there is a need for a more holistic approach to bring it all together to help captive owners and the various trading partners involved with captives. This new venture will fill the gaps and maximize the impact of the captive with the goal of helping drive down health insurance costs for employers”. Phil Giles, formerly of QBE North America, joins the firm as Managing Director and will lead MSL Captive Solutions’ business development initiatives. “I am truly excited to help build and position this new enterprise. Our operating agility, experience, expertise and exclusive focus on medical stop loss will allow us to deliver marketleading captive solutions to our clients”, stated Giles. “I have known Phil a long time and I am confident that he and the seasoned professionals we are adding to the team will be able to add a lot of value and take captives involved in MSL to the next level” said Young.

NEWS About Strategic Risk Solutions (SRS) SRS is the 5th largest captive management firm in the world and the leading independently owned manager. The company has representation in all major US captive domiciles, Barbados, Bermuda, Cayman and Europe. It provides financial reporting, regulatory compliance and program management services to existing and prospective captive insurance companies. Contact Phillip C. Giles, Managing Director , at, (910) 420.8104 and visit

HHC GROUP RECEIVES UNCONDITIONAL IRO COMPREHENSIVE (INTERNAL\EXTERNAL) URAC ACCREDITATION For the seventh time since 2004, HHC Group has received URAC accreditation as an Independent Review Organization (IRO): Comprehensive Review. The Comprehensive Review accreditation allows for HHC Group to conduct both Internal and External Reviews\Appeals.

URAC (formerly known as the Utilization Review Accreditation Commission) is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations, such as HHC Group. URAC's IRO standards "assure that organizations that perform this service are free from conflicts of interest, establish qualifications for physician reviewers, address medical necessity and experimental treatment issues, {and} have reasonable time periods for standard and expedited reviews, and appeals processes." Internal and External Reviews consist of first and second level appeals from the denial of an insurance claim on the grounds of medical necessity. In its

Mind over risk. That’s how we properly assess risk – enabling our clients to focus on their businesses. We provide innovative stop loss solutions to protect self-funded employers from potentially catastrophic losses. We offer flexible captive solutions to help control the severity risk of your self-insured program. We have developed medical stop loss solutions specifically dedicated to meeting the unique needs of Taft-Hartley union plans. Our Organ & Tissue Transplant policy is a fully-insured option to protect your self-funded plan from losses due to transplant exposures. Our clients have been benefiting from our expertise for over 40 years. To be prepared for what tomorrow brings, contact us for all your medical stop loss and organ transplant insurance needs.

Tokio Marine HCC - Stop Loss Group HCC Life Insurance Company operating as Tokio Marine HCC - Stop Loss Group A member of the Tokio Marine HCC group of companies TMHCC1112 - 01/20

APRIL 2020


NEWS capacity as an IRO, HHC Group reviews medical records, check references, and follows all applicable URAC guidelines to make a factual, independent determination as to whether or not a claim was medically necessary. HHC Group is currently licensed to conduct External Reviews in 29 states across the country.

priate medical guidelines, and is clearly written and grammatically correct.

HHC Group provides Internal and External Independent Peer Reviews for insurance companies, health maintenance organizations, self-insured companies and ERISA plans. The team overseeing the review process utilizes its combined 125 years of healthcare experience to ensure that every review fully answers all questions being asked, cites the appro-

HHC Group's services include Claim Negotiation, Claim Repricing, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), Claims Editing, Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Disease Management and Pharmacy Consulting. H.H.C. Group is one of 46 URAC accredited IROs. Contact Bob Serber at, 301-963-0762 ext. 163 and visit

About HHC Group HHC Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. HHC Group utilizes a combination of highly skilled professionals and advanced information technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.

Work with a company that makes connections.

Choose coverage that aligns you with experience, market insight, data-driven decisions and accessible experts.

When you work with HM Insurance Group, you can connect with thought leaders and smart ideas steeped in regional knowledge and backed by financial stability. We build relationships – nationwide and for the long-term – ever mindful of the evolving health care landscape and committed to protecting the financial well-being of our clients from the impact of catastrophic claims. Find more on



Coverage is underwritten by HM Life Insurance Company, Pittsburgh, PA; Highmark Casualty Insurance Company, Pittsburgh, PA; or HM Life Insurance Company of New York, New York, NY.

MTG-3258 (2/20)



NEWS About ACS Benefit Services Founded in 1982, ACS Benefit Services was formed on the realization that there needed to be better benefit solutions and health plans available in the marketplace. Since then, ACS has grown to be a leading third-party administrator by focusing on the future of the industry, creating long-term solutions and predicting the benefit administration needs of our employer groups. Contact Kari Niblack at KNiblack@ and visit

ACS BENEFIT SERVICES WELCOMES WES JONES AS NEW REGIONAL DIRECTOR OF SALES Winston-Salem, NC -- ACS Benefit Services announced that Wes Jones has joined the company as Regional Director of Sales. He will report to Joe Meyer, Vice President of Sales, and be responsible for generating new business and cultivating broker relationships as ACS expands into new markets. A seasoned sales executive with vast experience in the self-funding industry, Jones comes to ACS from HealthSCOPE Benefits, where he spent the past nine years as Vice President of Sales. Prior to that, he worked for 14 years in the financial services industry.

“I am very excited to join the dynamic team at ACS and look forward to bringing to market innovative solutions for the employer community,” Jones said in a statement. ACS President & CEO Kari Niblack praised Jones’ experience. "I am delighted to welcome Wes to ACS," Niblack said in a statement. "As ACS continues its rapid growth and focuses across the United States, Wes brings a deep channel experience that will accelerate ACS’ growth and help our clients navigate the product changes that are driving a renaissance in the industry. We are thrilled to have him onboard."

GILSBAR NAMES KIM RANDAZZO SENIOR DIRECTOR OF CLIENT SERVICES COVINGTON, LA -- Gilsbar is proud to announce a promotion for Kim Randazzo from Director of Client Services to Senior Director of Client Services. Ms. Randazzo oversees employees in Gilsbar's Client Services department, managing sales, account management, implementation and benefit analytics for Gilsbar's clients. "My mission is to align our client-facing teams with our operations teams to better meet the needs and expectations of our clients. It's important for Gilsbar's employees to understand our clients and the people we serve in order to develop unique solutions for the members and contacts we interact with daily," Ms. Randazzo shared. Gilsbar's Vice President and Chief Operating Officer, Judy Schott, stated, "Over the years, Kim has brought a level

APRIL 2020


NEWS of expertise and leadership to meeting the needs of our brokers, customers and operations. When it comes to implementing new clients and serving existing clients, Kim's level of experience is second to none. She comes out of our operations area, so she knows the details going on behind the scenes which uniquely qualifies her to serve our clients with excellence." About Gilsbar, LLC Established in 1959, Gilsbar, LLC® is one of the largest privately-held insurance services organizations in the country. Recognized as a catalyst for creating healthy businesses, Gilsbar, LLC® offers self-funded and fully-insured benefit plan management services, along with Wellness, Advocacy, and overall Population Health Management. Gilsbar, LLC's integrated delivery model improves the health and well-being of its members, resulting in significant health plan savings for its clients. Gilsbar, LLC® has been honored by Inc. magazine for its sustained growth, Modern Healthcare and Business Insurance magazines as a Best Place to Work, and WELCOA and the American Heart Association for its proven wellness methodology. Visit

Expect More from Your Underwriter At TPAC, we’ve raised the bar on what you get from your underwriter. We approach problems creatively, deliver transparency, build long-lasting relationships, and boast unrivaled turnaround times. Some may consider that unheard of—but that’s our standard. It’s time you got the underwriting you deserve. Contact us today to get started.



SIIA 2020 BOARD of directors & committee chair ROSTER




David Wilson President Windsor Strategy Partners, LLC Princeton, NJ

Kari L. Niblack, JD, SPHR CEO ACS Benefit Services Winston-Salem


Jeffrey K. Simpson Attorney Womble Bond & Dickinson (US) LLP Wilmington, DE

CAPTIVE INSURANCE COMMITTEE John R. Capasso, CPA, CGMA, PFS President & CEO Captive Planning Associates, LLC Medford, NJ


Peter Robinson Managing Principal EPIC Reinsurance San Francisco, CA

Mike Ferguson SIIA Simpsonville, SC

Robert Tierney President StarLine East Falmouth, MA

TREASURER AND CORPORATE SECRETARY* Gerald Gates President Stop Loss Insurance Services AmWins Worcester, MA *Also serves as Director

SIEF BOARD OF DIRECTORS Nigel Wallbank Chairman Heidi Leenay President

Thomas Belding President Professional Reinsurance Marketing Services Edmond, OK Laura Hirsch Co-CEO Aither Health Carrollton, TX Lisa Moody President & CEO Renalogic Phoenix, AZ

GOVERNMENT RELATIONS COMMITTEE Steven B. Suter President & CEO Healthcare Management Admtrs., Inc. Bellevue, WA CHAIR, INTERNATIONAL COMMITTEE Liz D. Mariner Ford Senior Vice President Re-Solutions, a Risk Strategies Company Minneapolis, MN CHAIR, SIIA FUTURE LEADERS COMMITTEE Brady Bizarro Director, Healthcare Attorney The Phia Group, LLC CHAIR, TPA BEST PRACTICES TASK FORCE Jerry Castelloe Principal Castelloe Partners, LLC CHAIR, WORKERS’ COMP COMMITTEE Shelly Brotzge Regional Underwriter, Group Self-Insurance Midwest Employers Casualty

Freda Bacon Director Les Boughner Director Alex Giordano Director

APRIL 2020




Edward Sotherden Partner Bulwark Healthcare Consultants LLC Newark, DE Dana Roberts ASO Product Analyst Dean Health Plan Madison, WI Kelly Wiler Senior Underwriter Exude Inc. Philadelphia, PA

Steve Parker President Reunion Health Services Ridgeland, MS Melody Terral Area Vice President Gallagher Covington, LA

Matthew Harrison VP Quality & Compliance Avande, Inc. Evans, GA

Catherine Ratcliffe COO/Partner Refined Benefits, Inc. dba Sullivan Riverview, FL

Pierre Guilfoile Director of Health Plan Analytics National Insurance Services Eden Prairie, MN

Clayton Farrell Chief Executive Officer Integrated Insurance Partners Inc. Lakeland, TN

Paul Aguilar Director nThrive Alpharetta, GA

Melissa Daniels Integrated Prescription Management Fresno, CA

Angela Giles Director of Marketing Objective Surgical Indianapolis, IN

Lucky Lippa President Lippa Insurance Services, Inc. Laguna Niguel, CA

Joseph Sweeney President Resolute Underwriting Strategies Radnor, PA

Maggie Beckley Director of Business Development MediBid Katy, TX


EMPLOYER CORPORATE MEMBER Debra Guidry Underwriting Manager FRSA-SIF Winter Park, FL CAPTIVE MEMBER Jeremy Noetzel Director of Finance, Tax & Strategic Implementation GL Risk Management, Inc. Mishawaka, IN

Monica Gruia Tribal-Care Insurance Crown Point, IN

Medicare Paid



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April 2020  

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