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August 2018


The World’s Leading Alternative Risk Transfer Journal Since 1984


Synergy What happens when corporate medical clinics are offered alongside exercise facilities? Clinical pathways intersect with fitness trails – widening the road to prevention, treatment and employee wellness.

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



Synergy What happens when corporate medical clinics are offered alongside exercise facilities? Clinical pathways intersect with fitness trails – widening the road to prevention, treatment and employee wellness.



Volume 118

INSIDE the Beltway: AHP Interest Heats Up After DOL Rule Finalization

24 ACA, HIPAA and Federal Health Benefit Mandates The Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other federal health benefit mandates

By Bruce Shutan

Editorial and Advertising Office P.O. 1237, Simpsonville, SC 29681 (888) 394-5688

2018 Self-Insurers’ Publishing Corp. Officers


James A. Kinder, CEO/Chairman Erica M. Massey, President Lynne Bolduc, Esq. Secretary

Catching the

Insurtech Wave


Much Needed Correction in the Second Circuit … Is Relief (Equitable, That Is) Around the Corner?


SIIA Endeavors

By Karrie Hyatt


Member News

August 2018 | The Self-Insurer




What happens when corporate medical clinics are offered alongside exercise facilities? Clinical pathways intersect with fitness trails – widening the road to prevention, treatment and employee wellness.


nsite medical clinics represent one meaningful way self-insured employers can deepen their control over clinical outcomes and costs. Onsite fitness facilities are another tactic. Imagine the potential that can be realized when these two areas are combined. “The synergy between any and all forms of health care delivery, intervention and prevention is enhanced when the coordination of an onsite program is inclusive of the resources,� says Mike La Penna, a principal with the La Penna Group, Inc., who has helped develop workplace health clinics that are considered industry models.

By Bruce Shutan

Self-insured employers can use onsite medical centers to treat and manage various conditions, while fitness facilities serve to delay or avoid these conditions, explains Ernie Clevenger, co-founder and president and CEO of CareHere, LLC, which provides patient-centered care and wellness centers. Fitness centers also can be used for physical therapy for existing conditions, he adds, while the combination of onsite


medical centers and fitness facilities is a natural integration of approaches to achieve better health. Any benefit that elevates the health status of employees and their beneficiaries will ultimately result in decreased costs to the self-insured employer, according to La Penna. He points to numerous cases and analyses that show a 5% to 14% range of savings from care management and coordination of primary and secondary care. “The larger savings for a large self-insured firm are generally due to efficiencies in employee access to care and the avoidance of unnecessary emergency department utilization and admissions,” he says. In later program stages, and with more mature populations for whom disease state management has been combined with prevention and wellness, La Penna notes that cost savings are gauged against the avoidance of employees or beneficiaries advancing form one risk level to the next. This scenario is most often charted with diabetics and pre-diabetic populations.

A provider of onsite and near-site health care services for LinkedIn, Microsoft, Intuit, Symantec and others, Crossover Health’s physical medicine service line tracks and measures therapy outcomes using an approach it calls Focus on Therapeutic Outcomes or FOTO. He says customers average four fewer visits per physical medicine episode compared to the community. FOTO, whose data involves 21 million clinical outcomes, is what Crossover Health uses to determine the most effective therapies for each patient, as well as assess per-employee charges. This data-driven trend has shown impressive results, including a 30% reduction in total medical spend, 35% reduction in pharmacy costs and 187% fewer opioid prescriptions.

Cisco’s comprehensive approach Cisco, a darling of Silicon Valley, is one example of a large self-insured employer that offers both onsite health and wellness centers. Its largest U.S. campus sites in Research Triangle Park, N.C., and San Jose, Calif., feature comprehensive multidisciplinary medical and fitness centers promoted under the Cisco LifeConnections brand. A 118,000 square-foot facility in the latter location has not only medical offices, but also a pharmacy, vision, dental center and fitness center under one roof. Employee fitness training data and preferences are all stored in the cloud, so employees can access the info whenever and wherever they like.

Self-insured employers that delve into care delivery, including onsite health and wellness centers, will see significantly better outcomes, as well as higher employee engagement and productivity, notes Daniel Lord, physical medicine senior program manager at Crossover Health. Cisco LifeConnections clinics

August 2018 | The Self-Insurer


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The LifeConnections Health and Fitness Centers represent an “integrated

approach for helping Cisco employees and their families be the best they can be at work and at home,” says Katelyn Johnson, Cisco’s senior integrated health manager for global benefits. “The

centers are world-class in design with high-touch and high-tech features. From primary care to acupuncture to personal training and group fitness, there is something for everyone.” Cisco has about 36,000 employees in the U.S. and another roughly 37,000 overseas where those employees have access to these onsite services in Bangalore, India, and a fitness center in Ottawa, Canada and Bedfon Lakes, U.K. LifeConnections Fitness Centers, which vary in size and scale, also are located in Boxborough, Mass., Lawrenceville, Ga., and Richardson, Texas.

being of Cisco families, she reports. In terms of measuring results, she would not provide details beyond saying Cisco has amassed “very strong financial performance measured by operational metrics, clinical measures, and cost avoidance and savings figures.” Managing complex or chronic specialty care visits is one strategy Cisco has employed to help bend the cost curve. For example, employees with back pain would go to a chiropractor, physiotherapist or acupuncturist in the Stanford Health Care network rather than start with a costly MRI. Cisco has convinced about 1,000 employees and their dependents to try its new health care plan, whose costs have fallen about 10% and is seen as a model for Amazon’s disruptive health care venture with JPMorgan and Berkshire Hathaway.

Mercedes-Benz: Steering in the right direction Another prominent U.S. multinational corporation that self-insures its employee health benefits also has integrated onsite health and wellness services at a key location in Middle America. More than 3,000 employees and 10,000-plus family members, as well as about 5,000 independent contractors, have access to an onsite medical clinic and adjoining fitness center at the Mercedes-Benz U.S. International manufacturing plant in Vance, Ala. “When we started our journey five years ago, I had no idea if this was going to work or not because we are really out in the middle of nowhere,” observes Jeff Burbank, manager of safety, security and medical in the Mercedes-Benz U.S. International HR department. “Five years later, it’s one of the best decisions we ever made.”

All U.S. full-time employees for Cisco are eligible for health insurance coverage and have the option to choose a self-insured national plan. In some states, Johnson says they can choose an HMO fully insured plan. These facilities represent “a strong tool to attract and retain top talent” that also contributes significantly to the well-

Cisco LifeConnections clinics

August 2018 | The Self-Insurer



Cisco LifeConnections clinics

Employees are able to visit a “top-notch” physician in a “world-class facility” in less than 25 minutes without incurring a co-pay, he notes, adding that the workforce considers it one of the best benefits the company offers. “When you walk in, it’s like wow, this is something that you hardly see out in public,” he enthuses. One critical component is a partnership with CareHere, which has helped reduce the automaker’s overall medical spend since the clinic opened in April 2013. The key to success is early diagnosis, testing and treatment of diabetes, hypertension and other chronic conditions, as well as making maintenance-type drugs available through mail order without co-pays.


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Combine those improved outcomes with the benefits of physical exercise in the fitness facility and the result has been healthier, happier and more productive employees who are costing much less to insure. Half of all Mercedes-Benz employees have visited the clinic. The monthly cost to the automaker of employees who had three annual visits was $829 between April 2017 and the end of March 2018 compared with $1,546 for those who did not. Mercedes-Benz saved more than $2 million from onsite clinical operations vs. claims cost in the market during this time frame. The figure includes office visit, lab and medication savings, while another $277,380 in productivity savings were identified. In addition, employees saved $854,560 in terms of lower out-of-pocket costs and $229,220 on prescription drugs, which translate into $542.98 in savings per employee. Within that same timeframe, projected savings per instance were seen across several categories, including a marker for prostate cancer ($42,570), diabetes ($10,683), hypertension ($7,428), obesity ($1,615) and high cholesterol ($944). The cost of care for a member diagnosed with diabetes engaged in the health center (i.e., had three annual visits) is $717 less than a member who seeks care outside of the health center. To bolster these results, CareHere has arranged for diagnostic testing at local facilities for X-rays, MRIs, mammograms and other tests without employee co-pays. Mercedes-Benz also decided to work closely with a local hospital on managing its workers’ compensation cases rather than steering injured claimants to the onsite medical center. Separating the two was necessary to stem employee anxiety or concerns about privacy over the possibility of comingled medical records from the group health and work comp sides.








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Clevenger says that the beauty of a self-funded health plan is that it can be customized by

“Claim experience is far more transparent in self-funded plans,” he adds, which enable

employee conditions, lifestyles, geography and other factors.

easier calculation of past and expected return on investment associated with a robust menu of onsite health and wellness services.

Bruce Shutan is a Los Angeles freelance writer who has closely covered the employee benefits industry for 30 years.

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Catching the

Insurtech Wave By Karrie Hyatt


nsurtech is rapidly advancing the insurance sector with new ways to work a longestablished business model. Innovative technology is creating faster transactions and improved customer interactions, but traditional insurance can be resistant to change. Captives, always innovators in the insurance space, are both in front of and behind the wave of change.

What is Insurtech? Insurtech is the advancement of insurance processes through technology. Whether it is reinventing data analytics or risk management, technology for the insurance sector is advancing at tremendous speed. Some of the advancements include cloud-based data, customer service and interaction automation, internet of things, and blockchain technology. It has become a hot topic in the last several years as venture capitalists and angel investors have moved beyond the broader category of fintech (financial technology) and have set their sights on insurance. There have even been start-up accelerators, such as Startupbootcamp in the UK


and Global Insurance Accelerator in the U.S., to foster insurtech innovators. The reason it’s getting so much attention recently is that the insurance sector seems primed to be disrupted and there is untapped revenue within its traditional systems. Insurance has a much longer history than most other businesses and has often been considered a dinosaur in its inability to adapt at a pace that more modern business models do. While new efficiencies in the industry have been occurring at an ever-faster rate, the fundamental idea of insurance transactions remains the same. And for a good reason: insurance knows how to help mitigate the risk in their customers’ lives and livelihoods. Venture capitalists, trying to squeeze a few more dollars out of an insurance transaction is not going to find the gold mine they are looking for in the insurance sector. Insurance companies have been successful because they know what they are doing and have been doing it for a long time.

Large insurance companies are investing heavily in proprietary technology. Smaller insurance companies and most captives generally will not have the capital to invest in developing their own technology. Insurtech development is costly. Yet captives have been at the forefront of change in the insurance industry during the last half century and with their flexibility of coverage and openness to try new things, captives might be the best place to implement start-up insurtech. According to Lynn Sheils, general counsel with EWI Re, Inc., “Captives seem ideal for launching new technology driven business models. Given that captives generally address risks unique to a specific group or group of related companies, a captive seems ideal to insure the risks around companies harnessing insurtech, risks that traditional insurance companies may not be comfortable with. Also, since captives have fewer insureds that have to give buy-in to new ideas, captives seem ideal for incorporating innovative products into the insurance process.” As much flexibility as captives enjoy, when it comes to insurtech developments in claims management, captives are likely to be following, not leading. Advanced claims management systems will likely be too expensive for most captives, even though using innovative claims management technology, that allows for sophisticated data analysis and risk modeling, can significantly lower the cost of claims handling and a reduction in fraud.

Traditional vs. Captive That is not to say that the insurance sector is not interested in innovations to their business. It’s just that the disruption seen in other business sectors is not going to be so radical in insurance. Big insurers are heavily investing in insurtech and every business in the insurance space has an eye to new developments. In a report titled “Global FinTech Survey” published by PWC in 2016, three out of four insurance companies believe that some part of their business is at risk of disruption by insurtech. August 2018 | The Self-Insurer



“It makes sense for large insurance companies to make the investment in systems with these new technologies because every improvement in the loss ratio of a billiondollar insurer results in a substantial improvement in the company’s bottom line,” said Sheils. “For most captives, when the cost benefit evaluation of a new system is performed, the captive is going to be priced out of these systems. Also, a captive is unlikely to have the volume of data needed for data mining, predictive modeling, or anomaly detection.”

Insurtech Applications and Blockchain

Even though most captives won’t have the resources to develop their own insurtech, coming onto the market are programs and products that could allow them to harness the potential of insurance technology. During the last year several large companies in the insurance space have launched insurtech programs for their clients. In 2017, Willis Towers Watson launched a program to automate claims using “decision engine” technology—also called smart technology or AI (artificial intelligence). The program is effective for handling a large volume of small claims—for example, parcel delivery. Earlier this year, Marsh partnered with IBM and ACORD (Association for Cooperative Operations Research and Development) to develop a proof of insurance blockchain for its client, ISN. To streamline money transfer capabilities for a client, Allianz Global Corporate & Specialty has developed a prototype using blockchain that will accelerate the process for its clients. Other established third-party vendors in the insurance sector are also developing their own insurtech products. This is great news for captives who will be able to take advantage of innovative technology through their captive manager and other TPAs without having the outlay of capital.

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“A third-party vendor, a captive manager or even reinsurers offering the use of insurtech products owned by the captive manager or reinsurer could be a value-added service and give a competitive advantage when attracting new clients. Captives may even seek out like captives to partner with to share the technology cost and to leverage their combined data and analytics.”

According to Sheils,

“There are companies targeting captives along with smaller insurance carriers, RRGs, and self-insured groups,” continued Sheils. “You are also seeing a lot of interest in the development of products in this space

around blockchain where there are multiple parties in the transaction all benefiting from the use of the technology.” The use of blockchain technology in insurance, and especially captives, is beginning to take off. Blockchain is the technology behind Bitcoin and other cryptocurrency. It’s essentially a digital database (ledger) that records data across a network of computers (nodes) allowing transactions to be verified and shared with no need for a central organization agency. Once the information becomes a “block” in the “chain” of data, it can’t be removed or changed and is visible to all parties involved, leading to increased transparency. Blockchain could be the disruptive force in insurance that venture capitalists have been looking for, if it can be harnessed effectively. Some applications for blockchain that are being considered are streamlining new

customer in-take and customer engagement; creating efficiencies in verifying policyholders, underwriting criteria, and claims handling through automation; fraud detection; and sharing risk and claims data. All applications that could rapidly advance how captives do business. Blockchain could be a solution for an individual captive’s lack of historical data. Using blockchain technology in conjunction with similar captives, could offer a way combine data for improved data mining and analytics.

Insurtech and Captive Regulation Insurance domiciles tend to react more to market forces than to lead them.Yet as technology is rapidly changing, regulators are picking up the pace by revising regulation to include these new processes. Bermuda, the world’s largest captive domicile, has opened its doors to blockchain technology and is positioning itself as the primary hub for blockchain business. Vermont, the top U.S. captive domicile, announced in May that they were experimenting using blockchain technology for new captives filing incorporation documents. Vermont has always been at the forefront of advancement in the captive sector, so it should come as no surprise that they are looking into tech innovation for regulating captives. However, most U.S. captive domiciles are not in a position to either make big changes to how


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Delaware Means Stability, Growth & ICCIE Trained Only one in four domiciles that is ICCE trained. Commitment to developing a professional captive insurance staff by having 80 percent of our financial analysts hold the Associate in Captive Insurance (ACI) designation. Annual captive insurance company premiums dramatically increased in 2017 to nearly $12 billion versus $4.4 billion in 2016. This increase reflects the re-domestications to Delaware by large captive insurers who recognize Delaware as a premier domicile. Consistent and stable leadership. Steve Kinion has been the captive insurance director for nine years.

“This recognition by the ICCIE reflects the education, experience, and professionalism of Delaware’s captive insurance staff. One of my objectives is to build upon a staff of highly competent regulators who know and understand how to regulate insurance for the benefit of my fellow Delawareans. I am proud of the hard work and dedication of the individuals in the captive bureau and heartily commend them.” Commissioner Trinidad Navarro

STEVE KINION, DIRECTOR Bureau of Captive & Financial Products Department of Insurance

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they regulate or in what they are regulating. Will captive regulators be able to keep up with the changes in the marketplace? According to Sheils, the answer is yes. “Domiciles are very competitive in attracting captives, so I think regulators will quickly start embracing insurtech.”

“In the beginning days of insurtech, it was the smaller, entrepreneurial firms that were welcoming technological innovation in the insurance industry,” she continued. “Once consumers expressed their interest and demand for technological conveniences in insurance, traditional insurance companies recognized that they had to embrace the new technology or otherwise it could destroy the industry. Much the same way, captive regulators will, and are, recognizing the necessity of accepting of insurtech.”

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.karriehyatt. com.

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the Beltway written by Dave Kirby

AHP Interest Heats Up After DOL Rule Finalization

Larry Thompson


he self-insurance industry’s appetite for federally-structured association health plans (AHP) has been whetted by the U.S. Department of Labor’s (DOL) recently released final rule that expands the definition of larger employer groups to allow small employers and selfemployed individuals to band together in offering health insurance to association members. Notably, self-insured AHPs would be treated as multi-employer welfare arrangements (MEWA) under state law. The new rules have stimulated an immediate spike of interest in AHPs according to Larry Thompson, chairman of SIIA’s Government Relations Committee and founding chairman of Inventavis. “Interest among our industry is very high because the AHP opportunity comes at a time when the small group fully-insured market is so costly and seeking solutions,” he said. Thompson will lead a session that will cover all aspects of the new movement toward AHPs at SIIA’s National Conference and Expo next month in Austin.

“The DOL rules are definitely an improvement over what has existed to date,” Thompson said. “They expanded the options for AHPs that will operate as multiple employer welfare arrangements in all states where MEWAs are recognized.” 20

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For many the AHP opportunity is yet a glass half full because it does not offer complete exemption from state-by-state regulation as individual employers enjoy under ERISA. “Many hoped the DOL would erase the boundaries of state lines to offer uniform plans to members throughout the country,” Thompson said.

always needed to follow,” Hoitt said.

The DOL’s final rule did not include the “class exemption” that would have given ERISA preemption and that SIIA advocated in CEO Mike Ferguson’s letter to the DOL which asked for legal uniformity conforming to ERISA. Ferguson pointed out that federal preemption would pose no threat to consumer interests because of the regulatory protections already provided by federal laws ERISA and the Affordable Care Act (ACA).

Hoitt suggested that some new AHPs would need to fully-insure their risk for a period of time before migrating to self-insurance with stop-loss coverage.

Thompson said that 23 states now welcome MEWAs, notably not including his home state of California. “Multi-state AHPs will still operate in a patchwork manner among the states but the difference now is that smaller employers and solo practitioners will enjoy the opportunity of coverage. Hopefully, we’ll see progress on complete federal preemption in the future.”

He posed the example of a new association plan being formed and choosing to be selfinsured with stop-loss coverage. “One of our questions would be about the group’s claims experience which, of course, does not exist,” Hoitt said. “Another question would be about rate history, which also does not exist. We have pretty big challenges facing this market that we will have to sort out over time.”

One example of a successful multi-state association health plan is the Automotive Wholesalers Association of New England (AWANE) which has operated for 30 years according to executive director Philip Healy who reports that his plan is a self-insured or fully-insured MEWA depending on the requirements of its members’ states of Maine, New Hampshire, Connecticut and Massachusetts.

“An exemption from state regulation would enable us to look at expanding to other states,” Healy said. “This is a goal that SIIA has been pursuing for many years. For the industry as a whole, expanding the AHP concept is a very encouraging development for small businesses that don’t have the staff or expertise to handle the regulatory compliance and administration a health plan requires,” Healy said.

Providers of stop-loss insurance for self-insured health plans are following the accelerated development of AHPs closely according to Jim Hoitt, senior vice president-captives division of Berkley Accident and Health, a leading provider of stop-loss insurance to self-insured group captives. “It’s very early in the game for us as we follow growth of the AHP category,” he said. “The DOL rules include some limitations on underwriting methods and even information-gathering that we have


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“By banding together, these small businesses will enjoy the purchasing power of larger businesses.” Healy noted that the current drivers of health care cost increases are mainly drug inflation and high-cost claims. “Joining an AHP will give businesses plan flexibility they wouldn’t otherwise attain, along with the administrative support they need for efficiency. “Association health plans are just as much about service as they are about low cost,” Healy said. “If a business can buy insurance at five to ten percent lower cost and get the service it needs, it’s a home run.” SIIA will continue to advocate for AHP exemption from state-by-state regulation with the DOL and Congress according to Ryan Work, vice president-government relations. “We will have ongoing discussions with the DOL about a class-exemption for AHPs, a stated goal of this administration,” Work said. “A sure federal preemption may only be possible if Congress changes the law to provide it. SIIA has been advocating for that and will continue to do so.” Home district advocacy to members of Congress will become an important aspect of the campaign at some point. SIIA members can learn how to participate by emailing Ryan Work at rwork@siia.org.

August 2018 | The Self-Insurer




Q& A T

he Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other federal health benefit mandates (e.g., the Mental Health Parity Act, the Newborns and Mothers Health Protection Act, and the Women’s Health and Cancer Rights Act) dramatically impact the administration of self-insured health plans. This monthly column provides practical answers to administration questions and current guidance on ACA, HIPAA and other federal benefit mandates. Attorneys John R. Hickman, Ashley Gillihan, Carolyn Smith, and Dan Taylor provide the answers in this column. Mr. Hickman is partner in charge of the Health Benefits Practice with Alston & Bird, LLP, an Atlanta, New York, Los Angeles, Charlotte, Dallas and Washington, D.C. law firm. Ashley Gillihan, Steven Mindy, Carolyn Smith and Dan Taylor are members of the Health Benefits Practice. Answers are provided as general guidance on the subjects covered in the question and are not provided as legal advice to the questioner’s situation. Any legal issues should be reviewed by your legal counsel to apply the law to the particular facts of your situation. Readers are encouraged to send questions by E-MAIL to Mr. Hickman at john.hickman@alston.com. 24

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DOL issues final regulations for association health plans: Real opportunity for small employers or much ado about nothing?

In October 2017, President Trump issued an Executive Order directing the Secretary of Labor to consider proposing regulations or revise its guidance to expand access to health coverage by allowing more employers to form bona fide association health plans (AHPs). AHPs sponsored by bona fide associations offer an opportunity for otherwise unrelated small employers (i.e., employers that do not have common ownership) to group together to be considered a single large group health plan, and thus, depending on membership size, avoid the additional ACA rules otherwise applicable to small group fully-insured plans.

Practice Pointer: If the association is not bona fide, then each employer that participates in the plan is a plan sponsor of a separate plan.

In January of 2018, the U.S. Department of Labor (DOL) provided a glance into its plan for AHPs by issuing proposed regulations. The proposed regulations generated significant excitement for some because they would make it much easier to form a bona fide association, which would make it easier for small employers to band together and be treated as one large employer.

On the other hand, many met the proposed regulations with skepticism because AHPs, even those sponsored by bona fide associations, are still multiple employer welfare arrangements (MEWAs), which may be subject to state insurance regulation— regulation that could make it very difficult or impossible to operate an AHP, including self-funded AHPs, within the state despite the federal rules.

In June of 2018, the DOL issued its Final Rule on AHPs with only a few (albeit significant) changes. This article discusses the key elements of the new rules and addresses whether these new bona fide AHPs provide a real opportunity for small employers or they are much ado about nothing.


AHPs have been in existence well before now. If the association is “bona fide” under the applicable rules, the association is considered the “employer” under ERISA, with the result that the AHP is considered a single health plan.

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Practice Pointer: Even though the bona fide association is considered the employer under ERISA, the AHP sponsored by the bona fide association is still a MEWA. ERISA has carved from its preemption provisions certain state insurance laws that regulate MEWAs, including selffunded MEWAs, and the associations that sponsor them.

If applicable rules are not satisfied, then each participating employer is treated as the sponsor of a separate group health plan. Fully-insured small employer group health plans are subject to additional ACA requirements that do not apply to large group or self-funded plans, such as the requirement to offer essential health benefits (EHBs) and modified community rating. Through an AHP, a small employer may be able to avoid these additional requirements, potentially resulting in lower cost coverage.

be considered the “employer” for health plan purposes.

First, the employer members of the association must have sufficient “commonality of interest”. Second, the employers must exercise “control” over the association. Establishing a bona fide association under Pre-Rule Guidance is challenging. The Final Rule relaxes these requirements in many respects, particularly the “commonality of interest” rule, making it easier to form AHPs.

Before the Final Rule, guidance as to when an association was considered “bona fide” under ERISA was contained in DOL “subregulatory” guidance, such as opinion letters and bulletins, as well as case law. This PreRule Guidance generally sets forth two tests that must be satisfied for an association to

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Key provisions under the DOL Final Rule

The primary purpose of the association may be to offer health coverage, but the association must also have at least one substantial business purpose unrelated to providing benefits. This aspect of the Final Rule is somewhat more restrictive than the proposed rule, which would have allowed associations whose only purpose was to provide benefits.

Many associations, however, will not find it difficult to satisfy the Final Rule because of the various ways the existence of a substantial business purpose may be demonstrated. The Final Rule does not define the term “substantial business purpose,� but does provide a safe harbor under which a substantial business purpose is considered to exist if the association would be a viable entity even in the absence of sponsoring an employee benefit plan.

If an organization has operated with an active membership before offering benefits, the DOL considers that compelling evidence of a substantial business purpose.

Nondiscrimination rules generally prohibit different rating or eligibility rules for each employer member. The Final Rule aims to prevent discrimination based on health conditions, consistent with HIPAA’s nondiscrimination rules, by preventing AHPs from discriminating among and between employers or employees with regard to health status, including for eligibility or rating.

An AHP may not treat member employers as distinct groups of similarly situated individuals for applying the nondiscrimination rules, although certain other bona fide business distinctions other than health risk are permitted. Examples of bona fide business distinctions that may serve as a basis for charging different premiums for different employer groups (provided the distinction is not based on a health factor or directed at individual participants) include different occupations within a retail industry association (e.g., cashiers, stockers, sales associates) and industry subsectors within a geographically based association (e.g., construction, education, financial services).

In addition, within any employer, different premiums may be based on nondiscriminatory factors such as part-time and full-time status.

The business purpose does not have to be a for-profit purpose. Examples of what may be considered a business purpose include providing conferences or other educational services to association members, acting as a standard setting organization to establish business standards or best practices, engaging in public relations activities on issues of interest to members unrelated to health benefits, and advancing the wellbeing of the industry in which association members operate through substantial activity in addition to providing health coverage.

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Practice Pointer: The DOL notes in the preamble to the Final Rule that AHPs sponsored by associations that are bona fide in accordance with the PreRule guidance do not have to satisfy the Final Rule’s particular nondiscrimination requirements. Nevertheless, such Pre-Rule AHPs must still satisfy HIPAA’s nondiscrimination requirements and “whether [a Pre Rule AHP] can treat employer members as distinct groups of similarly situated individuals depends on whether the creation or modification of the classification is directed at individual participants.” Did the DOL intend to give Pre-Rule AHPs carte blanche under HIPAA to treat each employer member participating in a Pre-Rule AHP as a separate and distinct groups of similarly situated individuals? Some are certainly reading the DOL’s comments in that manner but it is not clear whether such treatment would always be permitted under HIPAA’s nondiscrimination rules. Additional guidance from the DOL would be welcomed.

“Working owners” such as sole proprietors and partners can participate if certain requirements are met (even if the business has no employees other than the owner and spouse). The Final Rule relaxes the requirements that must be satisfied for working owner participation compared to the proposed rule.

A working owner must work on average at least 20 hours per week or 80 hours per month in the business enterprise or have income from the trade or business at least equal to the cost of coverage under the AHP.

The Final Rule drops a provision in the proposed rule that would have prohibited a working owner from participating in an AHP if the working owner had access to other employer subsidized group health plan coverage, such as coverage through a spouse’s employer.

The Final Rule, like the proposed rule, indicates that a fiduciary of the plan must make a determination when the individual first becomes eligible that the individual is a working owner as defined by the Final Rule and that fiduciary must monitor that status periodically.

And coverage may not be made available to any such individual (and his or her dependents) during a plan year following the plan year that the fiduciary determines, through reasonable monitoring procedures, that the individual ceased to meet the working owner requirements (except as may be required by COBRA). 28

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Practice Pointer: The Final Rule does not prescribe a particular monitoring process or what substantiation is required—saying only that a one size fits all process would not be appropriate. The preamble to the Final Rule does note that a sworn affidavit without more might be appropriate where the fiduciary has no reason to doubt the veracity of the affidavit.

Relaxed commonality of interest test allows for geographically based AHPs. The Final Rule retains a modified version of the pre-rule AHP commonality of interest test. Under the Pre-Rule Guidance, employers in the same line of business and same geographic location have been found to have requisite commonality of interest; however, employers that share only a common general interest, size, or geographic location have been held not to demonstrate sufficient commonality.

Thus, for example, pre-rule, the DOL found that a local chamber of commerce was not the “employer” (and therefore was not the proper sponsor of an AHP), where the primary economic nexus between the member employers was a commitment to private business development in a common geographic area.

Under the Final Rule, the employers participating in an AHP will have commonality of interest if they are in the same trade, industry, line of business or profession. Additionally, the employers will have a commonality of interest under the Final Rule if their “principal place of business” is in the LLC same geographic region within a single state or metropolitan area.

Practice Pointer: Can a geographically based AHP cover employees working at locations of the employer outside the geographic area? The Final Rule does not expressly prohibit that as long as the principle place of business in in the geographic area; however, the insurance laws of the other state may apply with respect to the AHP’s coverage of its residents.


For example, all employers in North Dakota would have commonality of interest, as would employers in the metropolitan Washington, D.C. area regardless of whether they are in D.C., Maryland, or Virginia. Those employers would not be required to share any additional business connection other than their location.

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Control test is similar to Pre-Rule Guidance. Historically, the DOL has not found that participating employers exercise control unless they have the authority to direct, replace, and supervise the plan’s insurer/administrator, and have the ability to amend the plan.

Further, the DOL has typically required that each participating employer must be involved in designing and administering the plan offered to their employees. Typically, it has been difficult to determine if the participating employers satisfy the control test.

Even the courts have had difficulty making this determination. In the Final Rule, the DOL confirms that the control test is intended to be consistent with the Pre-Rule Guidance. Thus, the Final Rule does not significantly relax the pre-rule standard.

The employer members must exercise control over the association and health plan in both form and substance, but this does not require that the employer members manage the dayto-day activities of the association or the plan. Pre-Rule Guidance generally requires regular nomination and election of directors, officers, or representatives that control the AHP, as well as by-laws or similar formalities. An AHP will need to ensure the active involvement of participating employers. Effective dates are staggered. The effective date of the Final Rule is staggered based on the type of arrangement in order to give associations and plans time to adjust to the new rules. For fully insured AHPs, the Final Rule is effective on September 1, 2018. For self-funded plans in existence on June 21, 2018 (the date the Final Rule was published) that meet the requirements of the Pre-Rule Guidance and that choose to become an AHP as defined in the Final Rule, the Final Rule is effective on January 1, 2019. In other situations where the association is being formed under the Final Rule, it is effective on April 1, 2019.

So are these AHPs the savior for small employers?

The new rules certainly provide hope for small employers who wish to band together and receive the discrete benefits available only to large employers; however, that hope may be tempered to some extent by states opposing AHPs. State laws still apply to AHPs. AHPs are multiple employer welfare arrangements (MEWAs) under both Pre-Rule Guidance and the Final Rule. Thus, an AHP is a MEWA even if it is considered a single plan at the association level rather than separate plans sponsored by each participating employer.

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One of the most significant consequences of this status is that ERISA has specific preemption provisions that allow states to regulate both fully insured and self-insured MEWAs. Under ERISA, if the AHP is fully insured, state laws that require specified levels of reserves or contributions may apply to the AHP.

Consequently, states can impose significant—perhaps even prohibitive—reserve and contribution requirements that might make it difficult to maintain a fully insured AHP in a state. If the AHP is self-funded, all state laws regulating insurance may apply to the extent such laws are not inconsistent with ERISA.

Consequently, a self-funded AHP may be treated by a state the same as an insurance carrier issuing an insurance policy within that state, including but not limited to the requirement to provide “mandated” benefits. Currently, some state laws go so far as to prohibit self-funded MEWAs entirely.

Practice Pointer: ERISA provides the DOL with the statutory authority to issue regulations exempting self-funded MEWAs from certain state laws. However, the DOL has not previously issued any exemptions and expressly chose not to do so in the Final Rule.

Current state insurance laws might also present challenges to the formation of AHPs. For example, most states require that the association already be in existence for a certain number of years (typically five years) and organized for purposes other than providing insurance. Some states have minimum participation requirements.

For example, North Carolina requires an association to have a minimum of 500 persons. Some states limit the types of entities that can form AHPs. Thus, those considering forming AHPs will need to consider state law carefully. Although state legislatures might change their laws to match federal requirements, these changes may occur slowly.

Practice Pointer: In addition to being able to regulate the AHP, States may regulate insurance companies and insurance policies issued to AHPs.


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Other federal laws may pose challenges. Federal law, through the Public Health Service Act (PHSA), requires that fully-insured coverage provided to an employer through a bona fide association must be renewed by the insurer unless the employer’s membership in the association terminates. The definition of “bona fide association” in the PHSA is narrower than the definition of association under the proposed rule.

Thus, even if an AHP is considered a single large group health plan under the DOL guidance, the guaranteed renewal requirement would still apply unless the association meets the PHSA’s definition of bona fide association. That definition requires, among other things, that the association have been in active existence for at least five years and was formed and maintained in good faith for purposes other than obtaining insurance.

MEWAs are also subject to the ACA insurance sector fee tax – regardless of whether they are self-funded or fully insured. This tax applies in 2018, is suspended for 2019, and will again apply after 2019 absent further Congressional action.

Questions also arise as to how certain federal laws based on employer size apply in the AHP context. For example, there is an exception to the parity requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) for small employers with no more than 50 employees during the preceding calendar year.

In the Final Rule, the DOL states that this exception will be based on the total number of employees of all association members, rather than on the size of each employer member. As another example, the COBRA health care continuation rules do not apply if all employers maintaining a plan normally employed fewer than 20 employees on a typical business day during the preceding calendar year. DOL plans to consult with the IRS on the COBRA issue and further guidance is expected in the future.


Will small employers now be able to form together as a single “large� employer through a bona fide association and receive the benefits previously reserved for large employers? That remains to be seen. The Final Rule certainly provides a path but it remains to be seen whether state insurance laws will set up speed bumps or roadblocks to such arrangements.

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Much Needed Correction in the Second Circuit … Is Relief (Equitable, That Is) Around the Corner?


hird party subrogation and reimbursement rights and the State of New York have always had a bit of a contentious relationship. At every turn it seems New York is tinkering with its state laws in a way that weakens the rights of insurance companies and (they think) benefit plans of all kinds. Many arguments are available both for and against the viability of a benefit plan’s rights in New York. As you can expect, Private Self-Funded ERISA Plans enjoy the benefit of preemption and surely do not have to be concerned with these changes in New York State Law … Or do they? Ask any attorney practicing personal injury law in the State of New York and most will argue (rather aggressively, in fact) that New York does not allow subrogation and reimbursement under any circumstances, and that they have the federal case law to prove it. Sereboff v. Mid Atlantic Medical Services, Inc. and its progeny be damned, despite providing that a benefit plan with clear and explicit plan terms allowing for recovery without reduction is entitled to full recovery so long as it is proactive and can trace the actual settlement fund to traceable assets. 547 U.S. 356 (2006). See also US Airways, Inc. v. McCutchen, 133 S.Ct. 1537 (2013). To them a quick read of Wurtz v. Rawlings is the law of the land. 761 F.3d 232 (2014).


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Recall Wurtz in 2014 when the Second Circuit Court of Appeals held that United Health, a fully insured benefit plan arrangement, was unable to satisfy the Davila test and obtain complete preemption from state law, and accordingly, the New York anti-subrogation law would apply to eliminate the rights of United Health and eradicate its right of recovery. Aetna Health Inc. v. Davila, 542 U.S. 200, 208 (2004). That outcome, alone, is not all that surprising given the health plans fully insured status. Wurtz, 761 F.3d. at n. 6. What did come as a bit of a surprise was the way in which the Second Circuit reached that decision. Essentially, the court reasoned in a long, somewhat convoluted opinion that a law suit by a plan beneficiary against its employee benefit plan to enforce an anti-subrogation law does not “relate to” employee benefits and therefore cannot be preempted on a defensive pleading. In pertinent part, the court stated: This expansive interpretation of complete preemption ignores the fact that plaintiffs’ claims are based on a state law that regulates insurance and are not based on the terms of their plans. As a result, state law does not impermissibly expand the exclusive remedies provided by ERISA § 502(a). Under ERISA § 514(a)-(b), state laws that “relate to” ERISA plans are expressly preempted, but not if they “regulate[] insurance.” 29 U.S.C. § 1144(a)-(b). Based on this “insurance saving clause,” the Supreme Court has held that state statutes regulating insurance that nonetheless affect ERISA benefits are not expressly preempted, with no hint that claims under these statutes might still be completely preempted and thus unable to be adjudicated under those state laws when they do not expand the remedies available for beneficiaries for claims based on the terms of their plans. See Rush Prudential HMO Inc. v. Moran, 536 U.S. 355, 377-79, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002); UNUM Life Ins. Co. of Am. v. Ward, 526 U.S. 358, 366-67, 119 S.Ct. 1380, 143 L.Ed.2d 462 (1999).


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This effectively created a race to the courthouse steps. If the participant first sues the plan for enforcement of an antisubrogation law, the plan would not be able to claim preemption and would be unable to litigate in federal court, potentially unable to enforce its right of recovery.1 Every plaintiff ’s lawyer in New York (along with its sister states Connecticut and Vermont, all notoriously anti subrogation) was provided the leverage they needed to look at all benefit plans, even private self-funded plans whose rights have repeatedly been protected by The Supreme Court of the United States and force them into settlements. After all, do the plans really want to end up in state court and argue with a court consisting of New York judges with a bias against subrogation that just went to great lengths to interpret incorrectly ERISA’s preemption framework in order to reach its outcome?

Interestingly, the court itself acknowledged in footnote 6 of the decision that the outcome for a private self-funded plan would likely be different. The footnote stated: The issue in FMC was the effect of the so-called “deemer clause” of ERISA § 514(b) (2)(B), which exempts self-funded plans from the savings clause.The Supreme Court held that the deemer clause did not cause preemption of the entire statute in all cases, but only as applied to self-funded plans. 498 U.S. at 61, 111 S.Ct. 403. Under FMC, the applicability of N.Y. Gen. Oblig. Law § 5-335 to self-funded plans would only mean that the law is preempted as applied to those plans (which is not the case here because the plans at issue are insured), not that the law is not “specifically directed” at insurance. Wurtz, 761 F.3d. at n. 6. You see, even there the court conceded that this outcome was based on the fact that this was an insured Plan, but of particular concern is how the Court determined that anti subrogation law did not relate to the benefit Plan. So really, what is the problem here? It appears the court clearly misinterpreted ERISA’s preemption framework, while likely still reaching a correct outcome given that particular plans’ fully insured status, and even conceded that the outcome would likely be different for a Private Self-funded Plan? Well, the problem is simple. We lawyers find any leverage point we have and use it to our full advantage. The fact of the matter is that that law is only as good as what can and reasonably in prudently be enforced, and lawsuits are expensive. That, along with considering the risk of the Second Circuit Court again misinterpreting the “relation to” portion of ERISA, can be a risky proposition and not always a prudent use of Plan assets to win the race to the Court, so to speak.

Enter Cognetta v. Bonavita, a case this author hopes is the beginning of a clarification of the decision in Wurtz that will finally give plan representatives the tool they need to once and for all quiet this race to the court nonsense. E.D.N.Y. No. 1:17-cv-03065 (2018). In Cognetta, the Plan paid approximately $110,000.00 to cover the medical expenses of plan participants injured in an automobile accident. In an abundance of caution, the Plan got way ahead of the game and won the race to the court. In fact, the Plan did not even wait for the case to settle. Instead, while the participant’s injury claims were still pending with the third party, the Plan shrewdly filed for a Declaratory Judgement asking the court to determine that it did, in fact, have an equitable lien and a constructive trust over the possible settlement funds and sought a Court Order that upon settlement, those funds were to be held in Trust.


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Much to the delight of self-funded benefit plans everywhere, the court ruled in favor of the Plan. Among the most interesting parts of the decision was how this court laid out the most important part of the entire dispute in Wurtz, and that is, how the Court handled this “relation to” notion. In Cognetta, the Court provided in pertinent part: …The purpose of ERISA is to provide a uniform regulatory regime over employee benefit plans.” Aetna Health Inc. v. Davila, 542 U.S. 200, 208 (2004). To that end, ERISA Section 514(a) expressly preempts “any and all” state laws that “relate to any employee benefit plan.” 29 U.S.C. § 1144(a). A state law “relate[s] to” an employee benefit plan if that law “has a connection with or reference to such a plan.” Franklin H. Williams Ins.Tr. v.Travelers Ins. Co., 50 F.3d 144, 148 (2d Cir. 1995) (quoting Metro. Life Ins. Co. v. Massachusetts, 471 U.S. 724, 739 (1985)).The scope of ERISA’s express preemption clause is “as broad as its language.” FMC Corp. v. Holliday, 498 U.S. 52, 59 (1990) (quoting Shaw v. Delta Air Lines, 463 U.S. 85, 98 (1983))… Even where a state law “relate[s] to” an employee benefit plan, however, ERISA does not expressly preempt that law if it “regulates insurance.” 29 U.S.C. § 1144(b). A law “regulates insurance” if it is “specifically directed towards entities engaged in insurance” and “substantially affect[s] the risk pooling arrangement between the insurer and the insured.” Wurtz v. Rawlings Co., 761 F.3d 232, 240 (2d Cir. 1994) (quoting Kentucky Ass’n of Health Plans, Inc. v. Miller, 538 U.S. 329, 342 (2003)). In such a situation, the state law is “saved” from express preemption. Id. Nevertheless, an employee benefit plan governed by ERISA cannot be “deemed . . . an insurance company or other insurer . . . for purposes of any law of any State purporting to regulate insurance.” 29 U.S.C. § 1144(b)(2)(B). That is, a state law cannot escape ERISA preemption by erroneously classifying an employee benefit plan as “insurance.” See id. Whether a state law that regulates insurance applies to a plan or is preempted by ERISA depends on whether the plan purchases insurance. See FMC Corp., 498 U.S. at 64; see also Arnone v. Aetna Life Ins. Co., 860 F.3d 97, 107 (2d Cir. 2017). Where a plan buys insurance, it “remains an insurer for purposes of state laws `purporting to regulate insurance.’ ” FMC Corp., 498 U.S. at 61. By contrast, where a plan is self-funded and does not purchase insurance from an insurance company, ERISA “exempt[s]” the plan “from state laws that `regulat[e] insurance.’ ” Id. (second alteration in original); see also Wurtz, 761 F.3d at 241 n.6. … Cognetta, E.D.N.Y. No. 1:17-cv-03065 And in that last paragraph lies the crux of the issue. It is because the private self-funded plan does not purchase insurance, and under ERISA’s Deemer clause, cannot be considered “insurance” that application of the rule in Wurtz is incorrect as it relates to self-funded benefit plans. Once one determines that a plan is not insurance pursuant to the Deemer clause, it is then that we determine whether the law a participant is seeking to enforce “relates to” an employee benefit Plan. An anti-subrogation clause is by definition the attempt of a plan participant to seek benefits to which it is not entitled, i.e. the ability to keep benefits paid which are subject to a subrogation or reimbursement obligation. While this is indeed an exciting development, some notes of caution.


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First, this decision was reached at the Federal Trial Court level. There are three other Federal districts in New York and none of them have binding authority over the other; meaning that if this exact same issue were to be heard in the Southern District of New York, the outcome could be different. If and only if this decision is appealed, heard, and upheld, by the Second Circuit Court of Appeals will it then be the law of the land in all Federal Districts under the purview of the Second Circuit, including Connecticut and Vermont. Until then, this decision simply gives plans the same leverage New York attorneys had against them, the risk of loss and cost of pursuit rendering such pursuit an imprudent use of funds, be that due to fiduciary concerns with respect to the plan, or practical concerns with the respect to the participant. Second, and perhaps most importantly, the ability of self-funded benefit plans to win on any issue in Federal Court in the Land still rests on one very basic concept … plan language. If the Plan language is insufficient in any way, a plan is at serious risk of losing its rights. In Cognetta, the Plan was well drafted, and assuming the Second Circuit makes good on its Footnote in the Wurtz decision, It would likely uphold the decision in the Cognetta case upon appeal. We will have to wait and see how this plays out. Either way, it is an exciting development in the Second Circuit and finally provides what looks to be a light at the end of the tunnel on the Wurtz problem in the Second Circuit. Make no mistake, New York lawyers will find other ways to make our road to recovery more difficult. Having the right tools and partners in place to identify recovery opportunities and act on them continues to be the best way to protect plan funds. Then all we can do is roll with the punches, and every so often, we’ll get some relief!


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Christopher Aguiar is an attorney with The Phia Group who has focused most of his career on subrogation and reimbursement recovery, representing TPAs and self-funded benefit plans since 2005. Chris has oversees tens of thousands of cases all over the country and spearheads negotiations between plan participants, plaintiffs’ counsel, and plan administrators on matters of State and Federal Law as well as ERISA Preemption. He has recovered millions of dollars on behalf of benefit plans in virtually every state and federal jurisdiction. He also holds the distinction of a Certified Subrogation Recovery Professional. Although Chris spent several years dabbling in other areas of benefit plan cost containment, including plan drafting as well as plan consulting matters ranging from plan language analysis, claims appeal assistance, balance billing defense, overpayment recovery, stop loss, PPO, and administrative service agreements. Chris is a regular contributor to The Self Insurer Magazine and is invited to present annually at the National Association of Subrogation Professionals National Conference.

References 1 This can present insurmountable challenges in some states, such as Illinois, where state courts have repeatedly refused to apply clear plan terms that conflict with state laws. Bishop v. Burgard, 764 N.E. 2d 24 (Ill. 2002). As an intermediate court of appeals in the state noted “…McCutchen may foreshadow a different result than our supreme court has pronounced in the past.” Schrempf, Kelly, Napp & Darr, Ltd. v. Carpenters’ Health and Welfare Trust Fund, 35 N.E.3d 988 (2015).

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The 38th National Educational Conference and Expo is September 23-25th at the JW Marriott in Austin, Texas


he SIIA National Educational Conference and Expo is the world’s largest event focused exclusively on the self-insurance/captive insurance marketplace and typically attracts more than 1,700 attendees from around the United States and from a growing number of countries around the world. The 38th National Educational Conference and Expo is September 23-25th at the JW Marriott in Austin, Texas.


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The robust educational program for this conference incorporates two great general session presentations and nearly 40 breakout sessions. The breakout sessions are further organized by subject matter tracks related to self-insured group health plans, captive insurance and selfinsured workers’ compensation programs.

New for this year, SIIA has developed a new “Fusion” track that focuses on industry topic with likely crossover interest among multiple constituencies within the overall self-insurance marketplace.You will not see this at any other industry conference.

Fusion track highlights include: Curbing the Opioid Addiction Crisis One Employee at a Time – A Guide for Self-Insurers Self-insured employers (both for group health and workers’ compensation) are uniquely positioned to help steer their employees away from joining the rapidly growing population in the United States who sadly have become addicted to Opioids. In this session Cristy Gupton, President of Custom Benefits Solutions will provide practical guidance on how employees can be counseled prior to an anticipated pain management approach, as well as how to mitigate potential adverse consequences should Opioids be required to aid in recovery from either an occupational or non-occupational condition. Don’t miss this unique opportunity to learn how you can be a hero in the lives of your employees and their families – all while helping to reduce health care costs.

Duty of Care and Dealing with the “What If” of International Travel We never know what’s around the next corner, particularly when traveling or working abroad. Unforeseen accidents, local laws and medical events can easily become more serious when traveling. Dick Atkins, the leading legal expert who was once referred to as “The Houdini of Fast Escapes from International Prisons” by National Geographic magazine, will discuss the rapid expansion of Duty of Care requirements, from medical and security coverage to the newest area of providing emergency legal assistance for expats and their family members. He will present several incredible case studies and will explain how recoveries can be made on the employee’s medical expenses, and for instances where there are serious injuries, how the employee can recover for pain and suffering and disability

Stop-Loss Captives Programs and P&C Group Captives – A Powerful Risk Management Combination An increasing number of smaller and mid-sized employers now participate as part of stop-loss captive programs to control health care cost. Smaller and mid-sized employers are also joining P&C group captives in response to rising workers’ comp, auto and general liability insurance costs. But employers who take advantage of both of these separate captive solutions in combination can further maximize total cost control opportunities. Keith Coleman, Executive Vice President of Beard Construction Group, Inc., Amanda Klimaski, Captive Director at Artex Risk Solutions, Inc., and Kevin Lamp, Treasurer & Chief Financial Officer for The Fall River Group, Inc. will feature case studies of real employers who have taken this “two-fer” risk management approach and cover related technical issues/ questions.

August 2018 | The Self-Insurer


as well as how the employer and its stop loss reinsurer can recover their outlay for medical expenses and associated medical travel costs.

or mutual referral purposes. During this session, you will hear stories from some of these service providers who have successfully diversified their business development efforts by taking this approach. Audience interaction will be encouraged. Panelists include Adam Forstot, Vice President of Business Development at Artex Risk Solutions, Richard Raup, President & CEO of Business Administrators & Consultants, Inc., John Capasso, President & CEO of Captive Planning Associates, LLC and David Wilson, President of Windsor Strategy Partners.

Self-Insurance-Captive Insurance Convergence – Business Development Stories from the From the Front Lines

Politics & Advocacy: The Self-Insurance Political Action Committee (SIPAC)

Not too long ago, self-insurance and captive insurance were viewed as distinct silos, at least from a service provider perspective. But more recently as an increasing number of smaller and mid-sized employers embrace both self-insurance and captive insurance solutions, many of the most successful service providers have learned to play “fullcourt,” establishing non-traditional strategic partnerships for operational capabilities and/

The Self-Insurance Political Action Committee (SIPAC) is the political arm of SIIA, contributing to candidates for federal office who understand and advance issues of important to our industry. This session will provide a unique perspective into the upcoming 2018 mid-term elections, how SIPAC is helping you stay involved, and how SIIA’s political and policy advocacy is making a difference. Robert Tierney, Board Member, SIIA & Former Chair, SIPAC and President of StarLine and Tom Belding, Chairman of the Self-Insurance Political Action Committee will share their experience on the importance of candidate contributions and SIIA member involvement. Ryan Work, Vice President, Government Relations of SIIA will also share a political update just weeks before key congressional elections and provide useful insights into policy campaigns on self-insured and alternative risk issues. Please contact

Look no further. Everyone claims to keep sight of the customer. But do they really? We do. At Companion Life, you can count on teamwork with individual attention. That’s a real advantage. We anticipate trends, identify opportunities, but, most importantly – we listen to you. We brainstorm with our partners. Together, we create products and solutions or carve out new distribution channels to get an early foothold in the market. Looking to the future is a large part ofour vision. We focus on relationships and listening. Together, we’ll go places. Call us. We’ll take the time to listen.

stop loss limited benefit health plans short-term medical medicare supplement Rated A+ by A.M. Best Company. Rating as of Dec. 19, 2017. For the latest rating, visit ambest.com.


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800-753-0404 Companion Life’s Specialty Markets

Wrenne Bartlett at wbartlett@siia.org with questions or to check if you are authorized.

Keshner, Senior Vice President & Chief Actuary for Spring Consulting Group and Steve Kinion, Director of Captive Insurance for the Delaware Insurance Department.

Association Health Plans, MEWAs and Stop-Loss Captive Programs – So Many Options, So Much to Know

After the conference program concludes, join us for the SIIA National Conference Party on September 25th (7:00 PM - 10:00 PM) as we head to one of the most unique entertainment areas in Austin.... historic Rainey Street! Located just a short distance from the Marriott, Rainey Street features 1930’s-era bungalows that have been renovated into casual bars with front porches, backyards and picnic tables. We’ll experience local foods, local music and a local vibe. Leave your attitude at home and “Get Local”! The SIIA National Conference party never disappoints, and you will not want to miss out on this event so make your travel plans accordingly!

With new federal regulations attempting to facilitate the formation of self-insured association health plans (AHPs), the resurgence of multiple employer welfare arrangements (MEWAs), and the rapid market growth of stop-loss captive programs, smaller and mid-sized employers have more choices than ever on pooled self-insurance solutions for their health care risks. But with more choices comes more questions and potential confusion. Larry Thompson, Founder of Inventas will moderate this panel discussion that will dissect each of these options, including the pros and cons, and address audience questions. Panelists include William F. Megna, Esq., Attorney, Megna Law Firm, Jim Hoitt, Senior Vice President – Captives Division of Berkley Accident & Health and Philip Healy, Executive Director of AWANE.

More information on the 38th National Educational Conference and Expo, including registration, can be found at www.siia.org.

Self-Insurance, Captive Insurance & the Emerging Risk Environment for Employers From on-demand employment & insurance, to marijuana legalization, to the rise in sexual harassment claims, the business and regulatory environment is rapidly changing – and along with it, the potential for related financial liability for employers. A panel of industry experts will discuss what they view as the most significant emerging risks for employers and the potential role of selfinsurance/captive insurance solutions to mitigate these risks. Panelist include Kimble Coaker, CEO of the Alabama Trucking Association Workers’ Comp Fund, Steven August 2018 | The Self-Insurer



o two groups are exactly alike and no one Reference-Based Pricing program design is right for them all. That’s why HHC Group starts by learning each group’s objectives and constraints. Then we help design and implement the right Reference-Based Pricing program for them.

Some want pre-cert and concierge services. Others want just claims repricing or repricing, provider appeal support and patient advocacy. Some want customized models and some provider contracting. We have the experience and expertise to help the group design and deliver the RBP program that’s just right for you.

163 CONTACT US 301.963.0762 sales@HHCGroup.com EXT.

www.HHCGroup.com Claims Negotiation & Repricing | Claims Editing | Medical Bill Review (Audit) | Reference-Based Pricing

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from SIIA



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 Wrenne Bartlett at wbartlett@siia. org. All submissions are subject to editing for brevity. Information about upgraded memberships can be accessed online at www.siia.org. For immediate assistance, please contact Jennifer Ivy at jivy@siia.org. If you would like to learn more about the benefits of SIIA’s premium memberships, please contact Jennifer Ivy and jivy@siia.org. August 2018 | The Self-Insurer


Diamond Members Sun Life and Collective Health’s New Integrated Stop-Loss Offering Gives Employers More Financial Control of Their Healthcare Investment Delivery is an exciting first step in long-term, strategic par tnership focused on transforming employer healthcare through more efficient, technology-driven products Sun Life and Collective Health today announced an integrated stop-loss offering that gives self-funded employers financial protection from high-dollar claims, while helping identify better treatment scenarios to get their people the right care at the right time. With their health plan and stop-loss coverage together on the Collective Health Workforce Health Management System, companies’ HR and finance executives now have more ability to predict, manage, and control costs around one of their largest, most impor tant enterprise investments: healthcare.

In addition to seamless claims reimbursement, the new offering gives mutual clients convenient repor ting, improved clinical and risk management, and the oppor tunity to benefit from pooled experience.

“For financial executives overseeing their companies’ self-funded health plans, high-cost claims can have a huge impact on their resources and bottom line. Now, companies can have better visibility into these claims, better controls to manage them, and can potentially be reimbursed before the claims hit their balance sheet, giving them more control of their healthcare expenses,” said Collective Health’s chief health officer and co-founder Dr. Rajaie Batniji. “We’re excited to deliver this fundamental solution early in our strategic partnership with Sun Life, and look forward to a long line of offerings that will allow companies to harness the power of the Employer-Driven Healthcare Economy.”

In a survey published last year by Sun Life, nearly half of employers maintained that while cost savings is their biggest motivation to self-fund, overall financial risk is the biggest challenge they face. This combined stop-loss product helps control that risk. The reimbursement process begins as soon as the claim hits the system, expediting reimbursement and offering greater oppor tunity to proactively identify options for cost savings.


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The combination of Sun Life’s extensive high-cost claims management exper tise—it’s the largest independent stop-loss provider in the country, and has saved employers millions through cost containment strategies—and Collective Health’s flexible Workforce Health Management System will also help employers identify potential claims issues earlier in the process. Clinical claim reviewers can proactively take steps to address unnecessarily high costs, such as those stemming from duplicate billing, and may be able to identify more effective treatment alternatives, offering the patient added comfor t and convenience in addition to savings for the employer. 50

“We are very excited to be able to offer stop-loss to selffunded employers on Collective Health’s platform,” said Brad Nieland, vice president of Stop-Loss & Health at Sun Life. “The improved reporting, in conjunction with data and clinical expertdriven claims analysis, will offer employers the tools and knowledge they need to monitor and manage their self-funded plan while addressing healthcare costs and providing a great experience for plan members.” About Sun Life and Collective Health’s Stop-Loss Offering Sun Life’s stop-loss coverage on Collective Health’s flexible Workforce Management System offers employers and their financial managers the combined benefits of Sun Life’s extensive expertise in managing high-cost claims and Collective Health’s open infrastructure, access to data, and trusted member engagement platform.

The Self-Insurer | www.sipconline.net

Benefits of the product include: Analytics that enable smar ter plan design: Easy-to-understand repor ts within the Collective Health Platform’s Employer Suite provide a holistic view of claims data, enabling employers to make smar t changes to health plan designs when it matters—not six months later. The ability to better control high-cost claims earlier in their life cycle: Mutual clients will have access to the Sun Life Clinical 360 program, in which nurse consultants analyze clinical and claim data, and work closely with Collective Health’s team to communicate with brokers and administrators on oppor tunities for savings, such as correcting billing errors or proposing treatment alternatives that reduce costs and provide patients with better care.

Work with like-minded employers: Eligible mutual clients can share favorable results via a pooled experience. Improved cash flow through automated reimbursement of high-cost claims: Eligible claims will be automatically reimbursed by Sun Life weekly, providing a seamless claims management and reimbursement process. The offering is available for quoting immediately, going live for joint clients on January 1, 2019. More information can be found here. About Sun Life Sun Life Financial is a leading international financial ser vices organization providing insurance, wealth and asset management solutions to individual and corporate clients. Sun Life Financial has operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda. As of March 31, 2018, Sun Life Financial had total assets under management of C$979 billion. For more information please visit www.sunlife.com. Sun Life Financial Inc. trades on the Toronto (TSX), New York (NYSE) and Philippine (PSE) stock exchanges under the ticker symbol SLF.

Artex provides a full range of alternative risk management solutions, customized for our clients’ individual challenges and opportunities. Powered by independent thought and an innovative approach, we empower our clients and partners to make educated risk management decisions with confidence.

Operating in over 30 domiciles and in more than 15 offices internationally, we have the proven capacity to supply any alternative risk need. For more information, please contact us at:

 Stop-Loss Captives

 Single-Parent Captives

 Enterprise Risk Captives

 Rent-a-Captive and Program Solutions

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 Group and Association Captives

 Bermuda Market Access




August 2018 | The Self-Insurer


Member FDIC






Connect to a smarter HSA We make HSAs so easy that choosing the right partner is exceedingly simple. As your partner, we provide you with the healthcare solutions, products and customer service you need to reach your goals.


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In the United States, Sun Life Financial is one of the largest group benefits providers, ser ving more than 60,000 employers in small, medium and large workplaces across the countr y. Sun Life’s broad portfolio of products and ser vices in the U.S. includes disability, absence management, life, dental, vision, voluntar y and stop-loss insurance. For more information, please visit www. sunlife.com/us.

As Senior Vice President of Underwriting and Marketing for the Southeast Region, you will be responsible for all regional underwriting, marketing and administrative functions of Tokio Marine HCC – Stop Loss Group. You will also be responsible for production, underwriting margin, regional expenses and net income for the Southeast region.

About Collective Health

Interested individuals should email a current resume to stoplosshr@tmhcc.com.

Collective Health is powering the Employer-Driven Healthcare Economy with the first Workforce Health Management System––giving employers a platform to simultaneously manage their healthcare investment and take better care of their people. With more than 120,000 members and 30 enterprise clients, Collective Health is reinventing the healthcare experience for self-funded employers and their employees across the U.S. Founded in October 2013 and headquartered in San Francisco, Collective Health is backed by NEA, Founders Fund, GV, Sun Life, and other leading investors. For more information, visit https://www.collectivehealth.com.

Qualified candidates will possess a Bachelor’s degree in Business Administration, a related field, or the equivalent education and/or experience with a minimum of twelve years relevant experience and eight years of leadership experience.

About Tokio Marine HCC – Stop Loss Group For more than 40 years, HCC Life Insurance Company, operating as Tokio Marine HCC – Stop Loss Group, has been leading the way in medical stop loss insurance for employers and plans who self-fund their benefit plans. Rated A++ (Superior) by A.M. Best Company, Tokio Marine HCC – Stop Loss Group is backed by the financial stability of its parent company, Tokio Marine HCC.

Tokio Marine HCC – Stop Loss Group Seeks Senior Vice President, Underwriting and Marketing – Southeast Region – Kennesaw, Georgia Tokio Marine HCC – Stop Loss Group, a leading provider of medical stop loss insurance, has the following open positions: Senior Vice President, Underwriting and Marketing – Southeast Region – Kennesaw, Georgia

August 2018 | The Self-Insurer


Tokio Marine HCC – Stop Loss Group delivers competitive coverage through exceptional customer ser vice. Our team of underwriters, claims specialists, actuaries and medical professionals provides personal ser vice and professional expertise to a network of producers and third party administrators (TPAs) across the United States. Visit www.tmhcc.com/life .

Silver Members Gilsbar Named Top Workplace by Times-

Marie Mineo, a Gilsbar Marketing Coordinator, shared, “I love the experience working at Gilsbar provides. Every day I feel like I am challenged to push myself fur ther in my career and I am learning new things about myself in the process. I believe these challenges create fulfilled employees, while also cultivating Gilsbar’s leaders of the future.” 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 www.Gilsbar.com .

Picayune Four Years Running Gilsbar has been awarded a 2018 Top Workplaces honor by The TimesPicayune and was recognized as one of the top large employers in the New Orleans area. Gilsbar has been selected for this honor every year of this award’s existence. This list is based solely on employee feedback gathered through a third-par ty survey conducted by Energage. The anonymous survey measures several aspects of workplace culture, including alignment, execution, and connection, just to name a few. “Top Workplaces is more than just a recognition,” said Doug Layman, President of Gilsbar Health & Life. “Research shows organizations that earn the award attract better talent, experience lower turnover, and are better equipped to deliver bottom-line results. We believe it shows Gilsbar prioritizes and maintains a healthy workplace culture which suppor ts employee engagement. We’re proud of our employees who make Gilsbar better each day and a place where people want to grow.”

August 2018 | The Self-Insurer


AXIS Capital Appoints Barbara A. Yastine to Its Board of Directors AXIS Capital Holdings Limited (“AXIS Capital” or “the Company”) announced that Barbara A.Yastine has been appointed to the Company’s Board of Directors, effective July 1, 2018. A respected leader in the financial services and risk management sectors, Ms. Yastine was previously the CEO at Ally Bank and also served in the CFO role at Credit Suisse First Boston and in Citigroup’s Global Corporate and Investment Bank. AXIS Capital also announced that Ms.Yastine will join the Board’s Audit Committee, effective September 1, 2018.

“Barbara is an exceptional addition to our Board. She is a leader who brings deep knowledge and perspective of financial services and risk management, and is wellattuned to the trends that are reshaping the marketplace,” said Michael A. Butt, Chairman of AXIS Capital’s Board of Directors. “AXIS will benefit significantly from Barbara’s counsel, including her understanding of how to drive profitable growth through innovation.” Ms.Yastine has held a number of senior-level management positions throughout her career. She is the past Chair, CEO and President of Ally Bank, where she guided the company’s growth in the digital and ecommerce space. Prior to that, she was Chief Administrative Officer of the bank’s parent company, Ally Financial. Before Ally Bank, Ms.Yastine was Principal of Southgate Alternative Investments, a start-up diversified alternative asset manager. Prior to Southgate, she had been CFO of Credit Suisse First Boston. Ms.Yastine also spent 15 years at Citigroup and its predecessor companies, where she held several management positions, including CFO of Citigroup’s Global Corporate and Investment Bank, Chief Auditor and Chief Administrative Officer for its Global Consumer division. She is also a past Co-CEO of Lebenthal Holdings LLC.


A N D R E D E F I N I N G H O W C O M PA N I E S PAY F O R A N D A C C E S S H E A LT H C A R E ELAP Services is a leading healthcare solution for selffunded employers across the U.S., offering unparalleled cost savings and advocacy services. ELAP’s services, which encompass plan design, claims auditing, member advocacy and legal defense, emphasize collaboration and strengthen partnerships. ELAP builds meaningful connections with employers, members, and hospitals and health systems, to ensure a fair price for quality healthcare. ELAPSERVICES.COM 610-321-1030


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Ms.Yastine currently serves on the Board of Directors of First Data Corporation, Primerica Inc. and Zions Bancorporation.

The Board appointed Ms.Yastine following an extensive search. Ms.Yastine’s appointment increases the size of the AXIS Capital Board to 11 members, nine of whom are independent directors.

“AXIS is a remarkable company that in a short period of time has grown from a start-up to a relevant player in the global specialty (re)insurance industry, and the organization is well-positioned to further grow its leadership in the sector,” said Ms. Yastine. “With big data, new technologies and innovation reshaping the (re)insurance industry, there is a unique opportunity for AXIS to leverage this change to its advantage. I look forward to working with the Board of Directors and AXIS leadership to help the Company tap into its significant potential.”

About AXIS Capital AXIS Capital is a Bermuda-based global provider of specialty lines insurance and treaty reinsurance with total shareholders’ equity at March 31, 2018, of $5.3 billion and locations in Bermuda, the United States, Europe, Singapore, Middle East, Canada, and Latin America. Its operating subsidiaries have been assigned a rating of “A+” (“Strong”) by Standard & Poor’s and “A+” (“Superior”) by A.M. Best. For more information about AXIS Capital, visit our website at www. axiscapital.com.

August 2018 | The Self-Insurer


Gold Members Berkshire Hathaway Specialty Insurance Appoints Mark Lingafelter to Lead Business in Australasia, Chris Colahan Head of UK & Europe Berkshire Hathaway Specialty Insurance (BHSI) today announced the appointment of Mark Lingafelter as President, BHSI, Australasia. He assumes responsibility for the BHSI Australasia region from Chris Colahan, who is moving into the role of President of the specialty insurance operation in the UK & Europe.

“With more than 30 years of experience in the global insurance market, Mark is well qualified to lead our ongoing profitable growth in Australia and New Zealand. Chris has been a superb leader of BHSI in Australasia, and we look forward to adding his energy and expertise to our expanding European team and operations,” said Peter Eastwood, President & CEO, BHSI.

Do you aspire to be a published author? Do you have any stories or opinions on the self-insurance and alternati ve risk transfer industry that

Mark, who will be based in BHSI’s Sydney office, was most recently Chief Underwriting Officer, Asia Pacific for QBE Insurance. Before that he spent more than 11 years as Managing Director at Chubb Insurance Company of Australia. Chris Colahan joined BHSI in February 2015, previously serving as the Chief Executive Officer of Asia and Hong Kong, for the RSA Insurance Group. Chris will be based in the London office. Berkshire Hathaway Specialty Insurance Company (incorporated in Nebraska, USA) ABN 84 600 643 034, AFS Licence No. 466713 (www.bhspecialty.com) provides commercial property, casualty, healthcare, executive and professional lines, and marine insurance. The actual and final terms of coverage for all product lines may vary. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Houston, Indianapolis, Irvine, Los Angeles, New York, San Francisco, San Ramon, Seattle, Stevens Point, Auckland, Brisbane, Dubai, Dublin, Düsseldorf, Hong Kong, Kuala Lumpur, London, Macau, Melbourne, Munich, Perth, Singapore, Sydney and Toronto. In Europe, Berkshire Hathaway Specialty Insurance operates as part of Berkshire Hathaway International Insurance Limited (“BHIIL”), an incorporated England and Wales limited liability company, Registration Number 3230337 and with a Registered Office on the 4th Floor, 8 Fenchurch Place, London EC3M 4AJ, United Kingdom. BHIIL is an affiliate of Berkshire Hathaway Specialty Insurance Company (“BHSIC”). BHSIC and BHIIL are part of Berkshire Hathaway’s National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor’s. For more information, contact info@bhspecialty.com.

you would like to share with your peers? We would like to in vite you to share your insight and submit an article to The Self-Insurer ! distributed in a digital and print format to reach over 10,000 readers around the world. The Self-Insurer has been delivering information to the self-insurance /alternative risk transfer community since 1984 to self-funded employ ers, TPAs, MGUs, reinsurers, stoploss carriers, PBM s and other service providers.

Articles or guideline to Editor Gretchen Grote at ggrote@sipconline.net also has advertising opportunities available. Please contact Shane

Byars at sbyars@sipconline.net for advertising information.


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20 Plus years of industry knowledge, expertise, and unsurpassed service Strength of Liberty Mutual which holds an A rating by both Best and S&P Plan Mirroring availability Disclosure statements no longer required on renewal business Liberty Mutual entered the Employer Stop Loss Market through its acquisition of TRU Services, LLC in April 2017.

Since then we have merged our brands and are issuing

Specific Advance Funding ability with enhanced features for qualified producers

the Liberty Insurance Underwriters Inc. (LIU) Policy. You will receive the same service you have grown to

152 Conant Street

know of TRU, but with the strength of Liberty Mutual.

2nd Floor Beverly, MA 01915

For more information please contact: Rocko Robinson, Senior VP of Underwriting and Sales

Email: Robert.Robinson01@libertyIU.com

Phone: 978-564-0200 Fax: 978-564-0201 Website: www.truservices.com


Chairman of the Board* Robert A. Clemente CEO Specialty Cace Management LLC Lahaska, PA

Nigel Wallbank Chairman Heidi Leenay President

President/CEO Mike Ferguson SIIA, Simpsonville, SC

Freda Bacon Director

Chairman Elect*

Les Boughner Director

Adam Russo Chief Executive Officer The Phia Group, LLC Braintree, MA

Alex Giordano Director

Treasurer and Corporate Secretary* David Wilson President Windsor Strategy Partners, LLC Princeton, NJ

Directors Gerald Gates President Stop Loss Insurance Services AmWins Worcester, MA Mary Catherine Person President HealthSCOPE Benefits, Inc. Little Rock, AR Kevin Seelman Senior Vice President Lockton Dunning Benefit Company Dallas, TX

Jeffrey K. Simpson Attorney Gordon, Fournaris & Mammarella, PA Wilmington, DE


The Self-Insurer | www.sipconline.net

Robert Tierney President StarLine East Falmouth, MA

INTERNATIONAL COMMITTEE Robert J. Repke President Passport For Health Novato, CA

Committee Chairs CAPTIVE INSURANCE COMMITTEE Michael P. Madden Division Senior Vice President Artex Risk Solutions, Inc. San Francisco, CA

WORKERS’ COMP COMMITTEE Mike Zucco Business Development AL Trucking Association Fund Montgomery, AL

GOVERNMENT RELATIONS COMMITTEE Lawrence Thompson CEO BSI Fresno, CA HEALTH CARE COMMITTEE Kari L. Niblack, JD, SPHR CEO ACS Benefit Services Winston-Salem, NC

*Also serves as Director

SIIA New Members Regular Corporate Members

Ted Pitynski Vice President, Self Insured Solutions ArmadaHealth Hunt Valley, MI

Christian Stormer CPA Bauknight Pietras & Stormer Columbia, SC

Kimberly Darling CEO Competitive Health, Inc. Irvine, CA

Ken Meyer President Complete Benefit Adminstrators, Inc. Libertyville, IL

Mariam Cather Vice President Comprehensive Healthcare Systems Inc. Edison, NJ

Sean Sigmon Business Development Executive Coriell Life Sciences Mercer Island, WA

Lina Chan, FSA, MAAA Managing Partner CP Risk Solutions, LLC New York, NY

Marti Powles Chief Operating Officer New Benefits Dallas, TX

Tony Trapuzzano Vice President of National Sales Glooko, Inc. Mountain View, CA

Zain Hasan Founder & CEO NICG Roswell, GA

Brad Dumbauld Vice President Gregory & Appel Insurance Indianapolis, IN

Greg Roberts Director of Operations Patient Advocates LLC Gray, ME

David Mora CEO Health & Wellness Bazaar, Inc. San Diego, CA

Jesse Crary Attorney Primmer Piper Eggleston & Cramer PC Burlington, VT

Chris Janko VP Strategic Alliances LifeWorks Atlanta, GA

Patti McCoy Senior Director PrismRx Flower Mound, TX

Horacio Milla CPO Medxoom, Inc. Atlanta, GA

Kimberly Rathbone Partner Rathbone Group, LLC Cleveland, OH

Sean Ennis Mountjoy Chilton Medley LLP Louisville, KY

Kevin Kobielski President, RemedyOne Consulting RemedyOne Collinsville, CT

August 2018 | The Self-Insurer


SIIA New Members (cont.) Maria Ana Junquera Executive Director International Business Development Sanus Health Corporation Doral, FL

Sean Farrell Vice President, Sales & Strategy Tenet Diagnostics Kenilworth, NJ

Elena Collot Director of Marketing Travisoft Houston, TX

Jay Jensen CEO Vault Health Captive Bloomington, IL

Employer Corporate Members

Silver Corporate Members

Amy Chambers CFO Agri-Business Benefit Group, Inc. Hutchinson, KS

Tim Huke Chief Growth Officer Deerwalk Lexington, MA

Christy Williams CEO Elevanta/NFA Kennesaw, GA Kevin Vogt CFO Hilmar Cheese Company, Inc. Hilmar, CA

Natalie Roberts SVP Monarch Beverage Indianapolis, IN


The Self-Insurer | www.sipconline.net

Paying Usual & Customary IS PAYING TOO MUCH

Zelis Healthcare drives over $1 BILLION IN ANNUAL SAVINGS on out-of-network charges Cost variances on out-of-network claims make budgeting for healthcare nearly impossible for the self-insured. Zelis Healthcare delivers savings with a proven, comprehensive approach that includes market-driven and acceptable reimbursement, expert support and member advocacy processes. Reduce your liability and experience sustainable cost management. Partner with Zelis to get your share of $1 billion in annual savings.

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Contact Zelis today at 888.311.3505 or visit zelis.com to find out how our pre-payment solutions are helping control the rising cost of healthcare.



in annual healthcare waste & abuse too much?

YES. At Zelis Healthcare, we’ve combined our technology, expertise, and services to pull waste from the system, improve workflow and deliver industry leading levels of service and performance. Every Network. Every Claim. Every Payment. Every Day. In fact, over 85% of the time, we identify additional savings other companies are unable to find.1

Contact Zelis today at 888.311.3505 or visit zelis.com to find out how our pre-payment solutions are helping control the rising cost of healthcare.

Better Service. Better Performance. zelis.com Copyright 2018 Zelis Healthcare. All rights reserved.

Data on File. Zelis Healthcare. 2018.


Profile for SIPC

Self Insurer August 2018  

Self Insurer August 2018