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A S I P C P U B L I C AT I O N

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PTSD: A SIGN OF TUMULTUOUS TIMES Prone to over-diagnosis, post-traumatic stress disorder requires a careful, evidence-based approach that provides support and empowers those who are suffering. Nearly a decade ago, June was designated as PTSD Awareness Month largely to spotlight the plight of many combat veterans. But this phenomenon has gradually seeped into multiple workplaces.


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Table of contents

JUNE 2019 VOL 128

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

FEATURES

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PTSD: A Sign of Tumultuous Times PRONE TO OVER-DIAGNOSIS, POST-TRAUMATIC STRESS DISORDER REQUIRES A CAREFUL, EVIDENCE-BASED APPROACH THAT PROVIDES SUPPORT AND EMPOWERS THOSE WHO ARE SUFFERING. NEARLY A DECADE AGO, JUNE WAS DESIGNATED AS PTSD AWARENESS MONTH LARGELY TO SPOTLIGHT THE PLIGHT OF MANY COMBAT VETERANS. BUT THIS PHENOMENON HAS GRADUALLY SEEPED INTO MULTIPLE WORKPLACES. By Bruce Shutan

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inside the beltway SIIA Targets House Democrats for Self-Insurance Educational Outreach – Expands Government Relations Team By Joanne Wojcik

ARTICLES 20 Seasons of Change: How to Successfully Implement Evolving Healthcare Trends 28 Big Sky Country, Small Town Feeling In a busy US captive market, Montana’s personable and reliable business environment has helped it grow into a major force. The industry backs this “small town feeling” to help that growth continue

36 Broker/Advisor Perspectives Insights for and About Brokers/Advisors Active in the Self-insurance Marketplace Insights for and About Brokers/ Advisors Active in the Self-insurance Marketplace 38

SIIA ENDEAVORS

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News from siia members

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

Self-Insurer’s Publishing Corp.

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

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FEATURE

PTSD: A SIGN OF

TUMULTUOUS TIMES

Prone to over-diagnosis, post-traumatic stress disorder requires a careful, evidence-based approach that provides support and empowers those who are suffering. Nearly a decade ago, June was designated as PTSD Awareness Month largely to spotlight the plight of many combat veterans. But this phenomenon has gradually seeped into multiple workplaces.

L L

urking in the weeds of both self-insured group medical and workers’ comp plans is a tricky diagnosis that requires a proactive stance, early intervention and compassionate approach. An estimated 24.4 million Americans, or 8% of the population, at any given time suffer from post-traumatic stress disorder, which is usually associated with battlefield experiences, while women are nearly twice as likely as men to develop PTSD. Moreover, as many as 70% of U.S. adults have experienced some type of traumatic event at least once in their lives, according to the nonprofit group PTSD United.

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It’s easy to see why. There are numerous triggers for this condition, starting of course with war but also extending to first responders or ordinary citizens who witness terrorist attacks, school or workplace shootings and natural disasters that have become a sign of tumultuous times. But there’s also no shortage of personal trauma stemming from serious accidents, assault, abuse, sudden and major emotional losses or death. The condition has been widely linked to several high-profile sexual assault cases brought to light by the #MeToo movement. Indeed, most domestic violence recipients are women, making


Tumultuous Times them likely to develop PTSD, and with more females assuming military or first-responder roles, they’re also increasingly placed in harm’s way. So says Robert Mines, Ph.D., chairman and chief psychology officer of MINES and

“one of those diagnoses that can have significant consequences.” They

Associates, who describes PTSD as Bob Mines

include chronic patients seeking treatment on the outpatient side with potential interruptions of inpatient stays that require long-term management, depending on the degree of trauma and whether it was a preexisting condition that was exacerbated by a work situation. On the work comp side, he points to more PTSD and work stress cases surfacing and occasionally being lumped together across the patchwork of differing state laws. From a self-insured point of view, Mines says “it’s really important to have the services and case management structure in place to help patients with those diagnoses navigate the mental healthcare system.”

Darcy Gruttadaro

Understanding PTSD and how to manage this condition has become increasing necessary given that more employers are hiring people with military experience “because they want to support returning veterans,” observes Darcy Gruttadaro, director of the Center for Workplace Mental Health under the auspices of the American Psychiatric Association Foundation. But the disorder certainly isn’t confined to combat, she adds, and it’s worth raising PTSD’s visibility across the organization so that managers and supervisors recognize the early warning signs and reinforce the importance of employee assistance programs (EAPs). The overriding objective is for employees who are suffering to reach out and get the support they need before it becomes a disability claim. PTSD was recognized in 1980 as a psychobiological mental disorder associated with changes in brain function and structure, and added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Since 2010, National PTSD Awareness Day has been held on June 27, which was established by Congress, while the National Center for PTSD designated June as PTSD Awareness Month. 

In the face of brow-raising statistics on PTSD, it’s important to realize that the condition is prone to over-diagnosis, cautions Fernando Branco, M.D., medical director for Midwest Employers Casualty Company (a Berkley Company). He says psychologists or EAP counselors can induce diagnoses with leading questions, noting the importance of training clinicians to avoid falling into that trap and making insurance adjusters aware of the potential for misdiagnoses for workers’ comp cases. What’s happening with PTSD is reminiscent of a proliferation in dissociative disorder diagnoses in clinics in the early 1990s, notes Mines, who says clinicians became “sloppy with their diagnoses.” Nowadays, he says it’s rare to come across diagnoses for multiple personality disorders with a true dissociative process. PTSD is a complex psychiatric disorder that is far too often mistakenly considered synonymous with trauma, according to Douglas Craig, a forensic and police psychologist with the Society for Police and Criminal Psychology.

“Just because someone experiences a trauma does not mean they have PTSD, and unfortunately the frequency of such association seems to be increasing,” he says.

JUNE 2019

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Tumultuous Times In fact, there are multiple symptoms that need to be present over a period of time to meet the criteria for that diagnosis.

Evidence-based

The potential for subjectivity in diagnoses is inevitable, surmises Jennifer Christian, M.D., co-founder, president and chief medical officer of Webility Corporation. She says academically-oriented clinicians take pains to ensure cases meet all of the established criteria before making a diagnosis, while other physicians are much more casual about putting a label on a set of symptoms. As a result, it is common for the various physicians caring for a patient to assign different diagnoses to the same set of complaints and findings. It’s also common for diagnoses to change between the time a health problem surfaces and treatments have been tried and other events have unfolded.

The best approach self-insured employers can pursue is one that doesn’t carelessly pad patient files with multiple diagnoses, Branco explains,

In addition, she says “it is unusual in American medical culture today” for one doctor to overtly question another’s diagnosis, particularly when the patient believes a diagnosis is correct, or when the diagnosis has become politicized. The danger of misdiagnosis, of course, is that patients miss out on appropriate and effective treatment. Given the propensity for over-diagnosis of PTSD, she suggests an independent medical examination or second opinion by a real expert in all PTSD cases.

approaches

“and the psychologists then are more comfortable with that because you’re still addressing patient issues, and the adjusters don’t feel like they’re adding diagnoses in there.” But it’s worth noting that as many as 80% to 90% of people experiencing PTSD have another mental health condition, Gruttadaro reports. Most often it involves depression, anxiety, alcohol or substance use. Research shows that therapy and medication are effective interventions for PTSD, she adds. There are several evidence-based practices that Mines says can be employed to treat PTSD, which may involve sleep disturbance, intrusive thoughts, internal anxiety and panic attacks. They include cognitive behavioral interventions, as well as eye movement desensitization and reprocessing, which is a newer nontraditional type of psychotherapy. In severe cases, patients may be prescribed powerful psychotropic drugs that may include a number of side effects. While it’s easy to see how rape and more primitive assaults can result in a PTSD reaction, Mines mentions that

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Tumultuous Times more subtle incidents raise much of “the same symptomology” without life-threatening circumstances. What’s important is to combat the stigma associated with seeking treatment for these traumas, he adds.

“common-sense innovations” to support legitimate injuries, minimize impairment and speed return to work. All too often, he has seen “a snowball effect” from misdiagnoses that exacerbate feelings of impairment, “and all of a sudden, there’re further away from the path of recovery.”

Craig recommends

As with all mental health conditions, Gruttadaro believes it’s critical that employers promote easy access to quality care in a timely manner and poll employees about their experiences to hold the health plan accountable. Another strategy she suggests involves teaming up with a third-party administrator to support effective interventions. One example is a collaborative care model built around primary care visits, care management and a psychiatric consultation.

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Douglas Craig

PTSD suffers may require a deeper layer of support and guidance on jobrelated responsibilities, as well as extra time to perform tasks or a more flexible schedule. Medication may make cause drowsiness in the morning or enhance performance at certain hours of the day, Gruttadaro notes.


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Tumultuous Times

In some cases, she says noise-cancelling headphones can help those who are easily distracted by their condition concentrate and focus, while adequate natural light in the workplace can improve their mood.

Returning to work Given the civilian sector’s unfamiliarity with PTSD, it may partly explain the debilitating long-term effects of the condition in workers’ comp according to Christian. Employers need to realize that many active duty service members and veterans with PTSD diagnoses are still going to work every day, which she says is clear evidence “this diagnosis does not equal work incapacity.” Understanding this fact and having compassion for individuals who do not know how to recover from a traumatic experience can help steer them to the right clinical pathway, she believes. When a police officer is involved in a shooting, Craig says some irritability and difficulty sleeping, as well as replaying the event over in one’s mind, is understandable and only natural. Negative community reactions can especially ratchet up the stress. It’s important to talk it out with the traumatized individual and suggest ways to minimize the damage so it’s not long term.

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“Being away from work is in nobody’s best interest,” he says. “It’s not good for the employer and work productivity, and it’s absolutely not good for the employee as well. Return to work is actually a treatment approach as opposed to something that we should start avoiding.”


Tumultuous Times Craig has seen too many correctional officers file petty work comp claims (i.e., an inmate spit in their direction), consult with an attorney, receive a PTSD diagnosis and wallow away for months at home. But there are success stories as well. One involves a bus operator had some pseudo panic symptoms in reaction to an accident, which thankfully did not involve any injuries. Between cognitive processing therapy and evidence-based interventions, as well as ride-alongs and modified shifts, she returned to work and regained confidence. The symptoms of PTSD are similar to those called “shell shock” in World War I and now referred to as “combat stress reactions,” Christian explains. In the 1970s, Israeli Defense Forces discovered that they could greatly decrease long-term disability by allowing troops who had psychologically fallen apart under battle conditions to recover while staying with their units instead of sending them away from the front to psychiatric hospitals. The Israeli medics at the front reassured the affected individuals that all human beings will fall apart when simultaneously underfed, overtired and overstressed – and that they would be able to bounce back.

More recently, the U.S. military invested more than $100 million in an initiative known as Comprehensive Soldier Fitness whose aim is to reduce PTSD or the damage it can wreak in people’s lives, Christian reports. The program is based on positive psychology principles. It encourages people who have been traumatized to focus on the opportunity for “post-traumatic growth” to see their recovery as an opportunity to develop inner strength, to find meaning, and achieve personal growth.

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Tumultuous Times

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Christian recently became involved in the case of a prison guard who was struck on the head by an inmate who intended to kill him. She says responses to his understandable distress were unfortunate, especially because he had a pre-existing diagnosis of PTSD due to military service. Two years later, she reports that “he still felt abandoned and betrayed by his coworkers and by the sheriff’s department for not coming to his aid sooner.” By this time, the man was in extreme distress, feeling suicidal, socially isolated, determined never to return to prison work, and believed he qualified for a disability pension. The outcome could have been much different if his employer, insurer or doctor had expressed concern and made sure his reasonable immediate needs were met. It would have required taking incremental steps back to the workplace. For example, she says “the first step could be to simply walk up to the door or enter the building and sit in the lobby for a few minutes the first day, and a little bit more the next day, and so on.”

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


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INSIDE THE BELTWAY

Cristina Antelo

INSIDE the Beltway WRITTEN BY JOANNE WOJCIK

SIIA Targets House Democrats for Self-Insurance Educational Outreach – Expands Government Relations Team

I I

n response to the Democratic takeover of the U.S. House of Representatives, the Self-Insurance Institute of America, Inc. (SIIA) expanded its government relations team earlier this year to increase advocacy and educational outreach to key Democrats. Cristina Antelo joined SIIA in February to enable the organization to more effectively balance its outreach to members of both political parties, particularly in the new Democratic-controlled House. Cristina, an attorney and former Wall Street investment banker, began her lobbying career in 2004, representing Fortune 500 companies in Washington. Her policy areas of expertise include financial services, health, tax, trade, border security, transportation and infrastructure, and crisis management.

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INSIDE THE BELTWAY She also serves on the board of the Congressional Hispanic Caucus Institute and is a founding member and former President of the Hispanic Lobbyists Association. Since joining, Cristina and the SIIA team have met with more than 50 members of Congress to build awareness of the important role that self-insurance plays in providing healthcare coverage to their constituents, and to express SIIA’s positions on certain public policy issues such as surprise billing. Cristina shared her impressions of these initial meetings with The Self-Insurer in the following “Inside the Beltway” interview.

The Self-Insurer: Since you started meeting with Democratic lawmakers, what has been their overall reaction to your outreach and about self-insurance in general?

Cristina: I think that specifically with Freshman, but even with members who have been around for a while, there’s a lack of understanding and appreciation of the role that self-insurance plays in the healthcare market. If we have a 30-minute meeting, 15 minutes of it are spent explaining what self-insurance is and how it contributes to innovation. After explaining all of that, you see the lightbulbs go on.

The Self-Insurer: What Democratic-led committee members have you met with so far?

Cristina:

We have been going beyond focusing on committees of jurisdiction and meeting with members of other key committees and caucuses to identify potential advocates and champions. For example, the New Democrat Coalition, which had 60 members in the last Congress and added 41 more in the midterm elections, now has 101 members who are mostly business-friendly and open to SIIA’s messaging. Freshman Congresswoman Angie Craig from Minnesota has experience with administering a self-insurance health plan. Before running for Congress, she was senior vice president of global human resources at St. Jude Medical, a Fortune 500 medical technology company. By engaging actively with her and her staff, we can develop a rapport so that when we need her support, we can ask for it. Sen. Catherine Cortez Masto from Nevada, who became the first Latina elected to the U.S. Senate when she took over the late Sen. Harry Reid’s seat, also is new. When I introduced myself to her, one of the first things she said to me was that she understood the concept of self-insurance because she had been enrolled in a selfinsured health plan. It’s also important to give members a constituent reason to care about self-insurance. For instance, when I met with the staff of a congressman from Florida, his attitude changed when he learned that 70% of the employers in the district were self-insured.

The Self-Insurer: Can you provide an example of lawmakers’ misconceptions about self-insurance?

Cristina: Since Virginia Representative Bobby Scott became chairman of the House Education and Labor Committee, we had some trepidation that he might not be as supportive of self-insurance even though he voted for the Self-Insurance Protection Act (SIPA). It became clear during our conversation that he had a lot of issues with Association Health Plans. He cited as a hypothetical a plan involving an association of gym trainers. He was concerned that because the group would likely be comprised of mostly young, healthy individuals, that if one of them got really sick and bankrupted the plan, the rest of the members would drop out. He suggested that rather than be in an association health plan, those members should obtain their healthcare coverage via one of the exchanges so they would be part of a larger, more diverse pool. I explained to him that’s not a concern when it comes to self-insurance. I told him that if Fortune 500 companies can self-insure, medium and small business should have the same opportunity. I also explained that these employers mostly have diverse pools of employees—not just young, healthy ones, and we certainly don’t kick sick people off their plans.

The Self-Insurer: How do you view self-insurance as a part of SIIA’s overall policy push on affordable health care?

Cristina: A lot of folks don’t appreciate the role that self-insurance has in bringing innovation to the healthcare market. For example, it behooves self-insured employers to encourage employees to become

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healthier. So they may offer wellness or smoking cessation programs and other incentives to encourage their employees to adopt healthier lifestyles. Or if they know that they will lose productivity in February because of a large number of employees going out sick with the flu, they might arrange to get everybody free flu shots in October.

The Self-Insurer: Beyond education on self-insurance, what other hot topics of the day have you been addressing in your conversations with lawmakers? What have been their perspectives on these and any other healthcare issues?

Cristina: The one issue that is getting the most attention now is surprise billing when providers charge patients for care that is not covered by their health plans. When we tell members that we care about transparency, it helps, because it shows that we agree that patients shouldn’t be on the hook for these bills. The question is, who should be? The insurance provider or the medical provider? We do believe that medical providers should make a profit, but they shouldn’t be allowed to charge whatever they want. Currently, there’s a debate over whether to use arbitration to resolve surprise billing issues. We are part of the conversation, and I think that we have moved the needle our way. SIIA’s position is that if you use arbitration, there

has to be a benchmark, whether it’s a percentage of Medicare or something else. Drug pricing is another issue at the forefront of members’ minds. We have had some pretty complex conversations on this topic, whether it’s about AWP (average wholesale price) or exclusivity on patents. A lot depends on the level of staffer understanding. But most are educated about this subject because it’s been topical for so many years.

The Self-Insurer: Several Democratic Presidential candidates have expressed their support of “Medicare for All”. Is this something that should be of concern to SIIA members?

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INSIDE THE BELTWAY

Cristina: This may be part of the

Cristina: It has helped us to be able to talk about the use of stop-loss to mitigate

public discourse, but there are not a lot of Democrats who support it. They favor more pragmatic policy approaches. For example, Former Vice President Joe Biden’s proposal is “Medicare for More.” For the most part, Democrats do not support abandoning the current system and replacing it with single-payer. When you have more than 100 members who are business-focused and pragmatic, they see opportunities to fix the system rather than replace it.

risk in plain English. It’s a financial concept that not everyone understands. I do think that helps to give lawmakers some peace of mind that self-insured employers have a financial backstop against catastrophic risk if claims go beyond a certain level. Stoploss helps them maintain financial solvency. This is one of the critical parts of our education—schooling members about the different parts of self-insurance.

The Self-Insurer: How are you able to apply some of your other prior experiences—such as working as an investment banker—in your new role at SIIA?

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The Self-Insurer: How might your involvement with the Congressional Hispanic Caucus Institute help you to increase SIIA’s visibility on Capitol Hill?

Cristina: The Hispanic Caucus is part of the “Tri-Caucus”, whose numbers have grown significantly and now represent one-half of the Democratic Caucus. Members of the Congressional Black, Asian and Hispanic caucuses have achieved seniority and now chair some very important committees. Representative Bobby Scott, who chairs the House Education and Labor Committee, is one example. New York Congresswoman Nydia Velázquez is the Chairwoman of the House Small Business Committee. California Representative Maxine Waters, former chair of the Congressional Black Caucus and Chairwoman of Financial Services, serves as a member of the House Steering and Policy Committee, making her an integral part of the House Democratic Leadership. I’ve been plugging away at the Tri-Caucus for the past decade. Now as we get to the 116th Congress where people of color and women have come into power, I am hopeful these lawmakers will open their doors to me so they can learn more about SIIA.


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Seasons of Change: How to Successfully Implement Evolving Healthcare Trends WRITTEN BY JENNIFER M. MCCORMICK, ESQ.

H H

ave you ever wondered whether you paid more for your flight than the person next to you on the airplane? What about whether you could be doing more (or less) to save money and time? I’m confident we all frequently ponder what we can do differently to save.

Whether big or small savings, we’re constantly looking for ways save money in all areas of our life. Dinner budgets, car insurance, clothes, general spending - you name it and surely, we have contemplated whether we can reduce that expense. But we also try to balance cost against convenience, expecting to save money and time. For example, we can click a couple of buttons on our phone and groceries appear at our doorstep two hours later, saving us both money and time.

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Can we say the same for our self-funded plan documents? Regulatory changes and medical technologies are continually advancing. Why aren’t we applying these new technologies, endeavoring to save money and time, to our self-funded plans? It’s probably because we don’t know how to get started.

Hopefully this discussion will help provide a framework to allow employers and plans to implement new medical technologies and other time and cost savers! We will break down some steps to help simplify implementation of new regulations and technologies.

Step 1: Ask Questions!

When approached about a new idea ask this question - what problem are you trying to solve? Not only is it key to

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understand what problem the new idea, new regulation, or new technology would be solving, but it is imperative to first determine whether it is a problem that needs to be solved! When it comes to savings, time is money too. As a result, the first part of an analysis should be ensuring that the full scope of the problem requiring resolution is realized. What is ‘costing’ the most … time, money, or both?

After understanding the extent of the problem, review whether the idea would mitigate or eliminate the problem. For example, assume Fictitious Company A has the proven and medically (and dentally) backed solution to effectively reduce the cost of elective cosmetic dental surgeries by 50% for a low monthly cost to the plan. An employer might think that would be fantastic, but after reviewing a copy of the plan document and summary plan description realized that elective cosmetic dental surgeries are excluded. In that example, even though real savings could exist, the solution does not solve a problem for the employer (i.e. with an exclusion the employer pays 0% for elective cosmetic dental surgeries).

Assume instead that the employer was hoping to remove the exclusion for elective cosmetic dental surgeries. Employer wants to offer this benefit to participants of the self-funded plan it sponsors but wants to control costs. The services offered by Fictitious Company A might be a perfect fit! Here, the idea solves a problem for the employer.


The next set of questions should aim to proactively troubleshoot barriers to implementation of the idea. How can hurdles be eliminated and what alternatives exist to address the concerns? Is there a way to take the hurdle and create an opportunity?

For example, many states are implementing paid family leave laws. For employers, the problem that needs to be solved here is investigating what must be done to comply, how must it be done, and how can it be financed. In addition to understanding what state regulations would apply, employers may wish to review their current plan materials. Does the employer currently have a policy in place that addresses the regulations? If not, can you make updates to existing benefits? Would this be a good opportunity to investigate whether establishing a self-funded benefit might solve the problem, while offering employer convenience and cost savings?

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Assuming the answer is yes, the next step would be to investigate any impediments.

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It’s important to investigate impediments to an employer’s or plan’s ability to successfully implement a valuable idea. This requires understanding what agreements should be in place, certain legal hurdles that could prevent taking further steps, and whether the claims systems would need changes to address the new technology or solution.

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For example, assume a self-funded plan has many members seeking various chronic pain treatments. A progressive employer, looking to offer an alternative to high cost treatments, investigates medical cannabis. Coverage of this benefit would save the plan money. In this case, the employer is located in a state that has legalized medical cannabis. The employer decides to investigate modification of the plan design. Upon investigation, the employer uncovers that the addition of this benefit would be problematic. While legal at the state level, it is still considered a schedule I drug under federal law. As a result, it may not be prescribed for medical use (See Section II ‘General Requirements’ of the Practitioner’s Manual from documentation issued by the United States Department of Justice, Drug Enforcement Agency, Office of Diversion Control for additional information). With

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this discovery, the employer decides that while coverage may be beneficial, medical cannabis is not a prudent addition to the plan terms.

Alternatively, let’s assume that instead of medical cannabis the benefit that the employer wanted to cover was Chronic Pain Treatment B, a brand-new cutting-edge medical technology. Upon investigation, the employer identifies that there are no legal hurdles; however, it determines that this new medical technology is considered investigational and experimental. Not only does the plan have a current exclusion for items considered investigational and experimental, but an applicable stop loss policy would not provide reimbursement for related claims.

Now, assume the same facts as above, except the medical technology in this instance is not considered investigational or experimental. The employer would seek to determine whether any executed agreements would impact implementation. Would a new agreement need to be executed, would that agreement conflict with any existing agreements (i.e. stop loss policy, network agreement, PBM agreement, etc.)? Assuming no conflicts, the employer could implement the new solution or technology.


among stop loss coverage, the plan document, and the employee handbook. When implementing a new benefit, it is imperative to analyze the impact on other entities.

Step 4: Engagement

Step 3: Implementation

A solution free of impediments has been identified to solve a problem. Does implementation of the solution require a plan update? If so, does the solution create a new benefit or reduce a current benefit? Will the solution be implemented mid-year via an amendment or at plan renewal? Will other documents need to be updated as well, like the Summary of Benefits and Coverage (SBC)? Are there concerns about the Affordable Care Act (ACA) or the Employee Retirement Income Security Act (ERISA) timelines or rules?

For example, assume an employer wants to implement New Benefit C. This new (FDA-approved) technology will save patients and the plan both time and money. The new technology, however, is so new that claims systems have not been updated to accommodate this type of service. New Benefit C is offered in collaboration with a common medical treatment, but it is unclear how coding for New Benefit C would be handled. In this example, the administrator would need to be aware of how this would be identified to ensure correct processing. Simple adoption (or modification or removal) of plan language may not be enough; a review of how (or whether) a claim may be processed is also necessary.

Instead, assume an employer wants to offer more expansive leave of absence provisions for its employees. The employer modifies the employee handbook and has a staff meeting to address the new provisions. The employer, however, fails to address this policy change in the relevant plan materials, or with the stop loss carrier. As a result, implementation of the benefit may inadvertently create a coverage gap

Engagement is going to help make the idea or solution successful. At this point, a problem was identified, a solution was envisioned, and implementation was completed. How can the employer or plan ensure the idea or solution is being utilized, since utilization is the key to success (i.e. savings)?

For example, assume an employer opted to add a new plan option to the current plan design at renewal. This new plan option includes direct primary care but will require participants to affirmatively elect that option. This plan option should not only be enticing for participants, but it has the opportunity to save the plan money. Since the employer’s participants are unaware of direct primary care the employer elects to hold an educational meeting. This session educates participants about direct primary care and what new and exciting benefits are be available under this new plan option.

In addition to educational meetings to inform participants of new benefits, employers can encourage engagement by financially incentivizing programs. For example, employers can reduce copays to encourage utilization of the new idea or solution.

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Employers can also seek ways to encourage engagement outside of the plan design. For example, why not incentivize employees to ask questions about health benefit options available to them? An employer could create a program offering a reward if an employee voluntarily opted to chat with human resources about a planned treatment. A combination of education, incentives (or penalties), and employee rewards can help employers ensure engagement in programs that are designed to protect participants and save the plan money.

Don’t let new advances pass by! Keep the plan in check and on trend with the latest and greatest healthcare innovations without sacrificing compliance. Follow this simple framework to ensure new ideas are successfully implemented so the plan, employer and members stay happy - and realize savings!

Jennifer M. McCormick joined The Phia Group, LLC as corporate counsel in 2008. As the Senior Vice President of Phia Group Consulting, Attorney McCormick concentrates on a variety of healthcare and regulatory issues facing employee benefit plans and their administrators. As Senior Vice President of Phia Group Consulting she focuses on health benefit plan regulatory compliance services, including but not limited to self funded health plan consulting, health plan exclusions, health plan limitations, health plan revisions, defining key items such as usual and customary fees, and the entire health plan summary plan description and summary of benefits and coverage. She is a constant contributor to The Phia Group’s webinars and other educational media.

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Attorney McCormick earned her J.D. from the Syracuse University College of Law, with certificates in Estate Planning and Family Law, and her B.A. in both Psychology and Criminal Justice from Indiana University, graduating with distinction as a National Dean’s List Scholar. While attending Syracuse, Attorney McCormick served as an Intercollegiate Director of the Moot Court Honor Society and as a Student Attorney in the Low Income Taxpayer Clinic where she counseled clients on state and federal tax matters and the US Tax Court appeals process.


WRITEN BY NED HOLMES This article originally ran in the Captive Insurance Times, Issue 171

Big Sky Country, Small Town Feeling In a busy US captive market, Montana’s personable and reliable business environment has helped it grow into a major force. The industry backs this “small town feeling” to help that growth continue

W W

ith an area of 147,040 square miles, Montana is the fourth largest US state, but due to its population of around one million, it has the second lowest population density among US states. It is perhaps unsurprising then that what makes ‘Big Sky Country’s’ captive market unique is the “small town feeling” at the core of its industry. “In Montana you get a quick response,” explains John Huth, president of the Montana Captive Insurance Association (MCIA). “If you call me, I’ll call you back—if you call the regulatory team, they’ll get back to you right away—I think that small town feeling helps this industry a lot.” The responsiveness and relatability of the state’s captive regulators, the Office of the Montana State Auditor Commissioner of Securities and Insurance (CSI) captive program, has helped the state grow into one of the US’ biggest captive

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domiciles. Montana has licensed more than 500 captive insurance companies since it introduced its captive law in 2001, and at year-end 2018, there were 279 active captives licensed in the state.

Market As with many captive domiciles, market conditions in the past two years have had a negative impact on Montana. The number of new captive formations fell year-on-year in both 2017 and 2018, accompanied by more captive dissolutions than formations. However, the feeling in the domicile remains optimistic. There were 26 new captives licensed in Montana last year, and Patrick Hunter, CSI captive insurance program financial examiner/analyst, says the regulator is “definitely happy with the quality of cases we are seeing”. He adds: “Our numbers were slightly down but we love the cases we are seeing.” Giving an industry perspective, Jessica Heil, senior program manager/office manager,

“The market is holding steady right now. I don’t see huge growth, as far as our business is concerned, we are just holding steady. We have had a few new captive licenses but nothing like what we have seen in prior years.” Innovative Captive Strategies, notes:

SBUs and Cells One continued positive for Montana in recent years has been the growth in the number of series LLC and protected cell captives (PCCs). The series LLC structure, introduced in Montana in 2013, allows each series member or series business unit (SBU) to maintain separate assets while carrying out its own distinct captive operations. For the last three years, formations of SBUs and PCCs have outpaced standalone captives by a ratio of at least two-to-one. Tal Redpath, CSI captive insurance program captive insurance examiner, suggests this rise in popularity, which has led to the number of PCCs and SBUs almost equal to standalone captives, is due to “the synergies and efficiencies they offer that standalone captives don’t”. He says: “The captive managers that use Montana as a domicile a lot really like the SBU-captive structure. It means their clients can get a better deal from service providers, like accountants, auditors and actuaries, and so I think the cost savings is a nice feature of the SBUs.” Heil notes that a large part of her company’s growth has been focused in the SBU space. “That is something that is unique for Montana and where we have seen our growth,” she says. “Not necessarily focused in one industry but quite a bit of growth in the SBU space. They’re relatively

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THE SELF-INSURER


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simple to set up. Once you have one series licensed it is easy to add more SBUs. The statutes in Montana allow for lower capital requirements for SBUs which makes it also easier for the smaller captives to jump in and get started.”

coming up with creative solutions. They’re very captive friendly and very business friendly.”

Regulator

“I think people like us because we listen to them, we don’t look for a way to say no, we try to find a way to say yes. If there is a way to restructure something, we are going to find it.”

Hunter says the department has taken a common sense approach to regulation by trying to be fair and flexible while keeping the bigger picture in mind. He explains: “We are certainly not afraid to turn away business. I think the managers that we have worked with for a number of years appreciate that fact, we are in this for the long run, we are not just in it to write business this year.” Redpath adds:

The SBU legislation is an example of how the flexibility and adaptability of the state regulator has been a key advantage for Montana. Heil highlights the regulator as “what makes Montana a great domicile”. “The department is top notch,” she explains, “they’re very responsive and the captive statute provides the regulators that certain amount of flexibility.”

This practical approach has also meant the domicile’s captive law has been regularly updated to keep it up-to-date and so that it reflects the needs of the industry. “Our legislature is incredibly open to passing legislation,” notes Huth, “we have never had any piece of legislation fail.” “We watch the industry to see changes that are made, and we are always trying to satisfy the needs of the industry here in the state.”

“You can call anytime and bounce ideas off them and they’re often involved in

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It is also a reflection of the close relationship between regulators and industry, which Huth, who ran the state captive insurance division between 2001 and 2007, says is one of the domicile’s “strong selling points”. Dana Sheridan, Active Captive Management chief compliance officer and Acrisure deputy general counsel, describes the relationship as “strong” and “healthy”.

An example of this is the changes made to the legislation to allow government sponsored captives to be formed in the domicile. Following interest in the structure from a number of parties, the law was changed to allow their formation three or four years ago. The first government sponsored captive was formed this year and it was a landmark moment for Montana. Hunter comments: “One of our new formations this year is a large municipalitysponsored captive, which is pretty cool. It is the first one we’ve done and might’ve been one of the first ones across the US.” The legislature in Montana meets every two years, and with the current legislative session coming to a close, there have been minor changes made to the captive law. Flexibility was added to the letter of credit statute so that the federal reserve membership requirement was removed for banks, and some small updates have been made. Redpath views the lack of any significant regulatory changes this year as a reflection of how well-positioned the captive industry is. He explains: “Since our law passed in 2001, those of us here at the department, in conjunction with our Montana captive association, have continuously kept our law on par with the market and what other domiciles are doing so that we remain competitive. I think we haven’t had to do a lot of major changes recently because we have done such a good job of keeping up in the past.”

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“It really does take a village to have a well-run and compliant captive,” adds Sheridan, “and Montana regulators apply consistent and clear rules to all captives they govern, uniting all their captives under a safe regulatory structure.” “We are all grateful to have regulators such as those in Montana. It makes all of our jobs easier when there is consistency, efficiency, clarity and fairness in regulation.”

Obstacles The quality of the current regulators is currently a strength, but could, if progression planning is poorly handled, quickly become a weakness. Heil explains: “There has to be a focus on the future. We have such a great team in Montana as far as the regulators are concerned, but Tal Redpath, Steve Matthews, and Steve Mack are all looking toward retirement, so I think the immediate focus will be to groom that next generation of captive regulators to be as good as their predecessors.”


Outside of the issue of future regulating talent, Redpath says the obstacles facing the domicile are no different to those facing many at the moment. He adds: “Micro captives have been under a lot of scrutiny, so formations are down, and retirements/dissolutions are up.”

Outlook Amongst what has been a turbulent few years for the global captive market, confidence appears high in Montana that the domicile can continue to establish itself in what is becoming an extremely congested US captive market. Heil suggests that the market will continue to reflect the current trends. She says: “Risk-retention groups (RRGs) may continue to fall off. We manage a few RRGs but we’re seeing a trend where the smaller RRGs are. They are finding it challenging to maintain a static membership and considering merging with larger insurance groups orceasing insurance operations and going into run-off.” “I do think we’ll continue to see growth in the series captive space. We have also had growth in employee benefits, and we’re working on licensing a new SBU in the EB area.”

“I think the future is looking good. There is an industry-wide downturn in the market in general but the prospects for Montana are good. I’m hoping we will see a little uptick in the number of captives but that depends on the market.” Huth believes that the domicile is “well-positioned”.

“When we came into the market in 2001, there were only about 16 or 17 domiciles, now there are close to 40. But, if you are looking to get something done, give us a shot and I think you’ll be impressed with the overall environment and industry in Montana.” He returns to the concept of the domicile’s “small town feeling” and the positive business environment that creates. “It’s about the openness of people to do business and the positive regulatory atmosphere and environment.”

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Broker/Advisor Perspectives

Insights for and About Brokers/Advisors Active in the Self-insurance Marketplace

Open Letter to Brokers/Advisors Active in the Self-Insurance Marketplace

Welcome to our world!

For nearly 40 years, the Self-Insurance Institute of America, Inc. (SIIA) has been actively protecting and promoting the self-insurance marketplace with the support and involvement of employers, third party administrators, stop-loss insurance carriers and key industry service providers. While the membership has historically included some forward-thinking brokers/advisers, our past experience has been that the majority of brokers/advisers have not fully appreciated the advantages of self-insurance and how this could be a growth opportunity for their businesses. But it’s clear now that times are changing, with self-insurance becoming the approach of choice for those advising employers on how to best control health care costs. SIIA is excited about all the positive momentum and invites this new generation of self-insurance advocates to become members of our organization. Membership will give you access to useful information and educational content, as well as to a large number of potential business partners who can help deliver self-insurance solutions for your clients with an emphasis on innovation and transparency. And while these membership benefits are important, the value of SIIA involvement is even broader than that, as it will position you to be an active industry participant. Our organization is where the important industry players connect to solve problems, influence policy-makers and identify strategies to grow the self-insurance marketplace. In other words, this is your opportunity to be a part of a bigger team working to advance the collective business interests of companies like yours and the clients you serve. Join today at www.siia.org We look forward to welcoming you as a new member. Sincerely, Michael W. Ferguson P.S. Please plan to join us in San Francisco September 30 – October 2, 2019 for SIIA’s President & CEO Self-Insurance Institute of America, Inc.

Adam V. Russo, Esq.

Chairman of the Board Self-Insurance Institute of America, Inc.

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National Conference & Expo – the world’s largest self-insurance event. Details can be accessed at www.siia.org or by calling 800/851-7789.


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ENDEAVORS

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he 2019 SIIA National Conference & Expo will be September 30th - October 2nd at the San Francisco Marriott Marquis. This is the world’s largest self-insurance event, which most recently attracted nearly 2,000 registered attendees from throughout the United States and from several countries around the world.

Attendance is comprised of all segments within the self-insurance marketplace, including self-insured employers, third party administrators, captive managers/ advisors, stop-loss insurance carriers/MGUs, brokers and key service providers.

The event blends a substantive education program, with more than 40 general and breakout sessions, a huge exhibit hall, and multiple organized networking opportunities. Taken collectively, this is a must attend event for anyone involved with self-insured group health plans, middle-market captive insurance companies, and self-insure workers’ compensation programs, including group self-insured workers’ compensation funds.

38 THE SELF-INSURER


ENDEAVORS Why This Is a Must-Attend for You:

• If you are a self-insured employer…you will experience top quality education with many sessions geared specifically for self-insured employers. You can also shop for specialized self-insurance/captive insurance services in the huge exhibit hall.

• If you are a third-party administrator…great education, opportunities to meet with your current and potential stop-loss markets, shop for vendor partners, explore new potential business opportunities with brokers as well as captive manager/advisor attendees.

• If you are a captive manager/advisor…great education combined with the opportunity to network with key players in the broader self-insurance marketplace, including brokers, TPAs and stop-loss carriers. You are very likely to meet new, useful contacts at SIIA…not just the same familiar faces who many often see at many captive-specific conferences.

• If you are a stop-loss carrier/MGU/Reinsurer…Well, virtually every significant player in the stop-loss marketplace will be at this conference for multiple reasons…why would you not be there?

• If you are a broker/advisor…All of the business partners you need to help your employer clients establish and effectively operate self-insured health plans and/or captive insurance companies will be at this conference. The educational program also incorporates multiple educational sessions designed just for you. Finally, wouldn’t it be refreshing to come to a conference where it is not just a bunch of brokers talking to themselves?

• If you are an industry service provider…you will have direct access to the largest collection of potential clients under one roof at anytime, anywhere this year.

• If you are a younger person in this industry…We are offering educational sessions and exclusive networking opportunities for attendees under the age of 40 as part of the SIIA Future Leaders program.

• If you are looking for a new job in this industry…Many of the companies in our industry are growing and we expect many attendees will be using this conference to scout for potential new hires…don’t miss this opportunity to find your next great career opportunity.

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ENDEAVORS

Continuing Education credits will be available at SIIA’s 2019 National Conference. The credits will include CEU for Adjusters and Agents (Producers), CLE for attorneys, and CPE for accountants. Please check www.siia.org often to see updates on approved states. You can enroll for CE Units when you register for the conference. There will be no cost for registered conference attendees.

The host hotel for SIIA’s National Conference is the San Francisco Marriott Marquis. Hotel reservations at the San Francisco Marriott Marquis must be made through SIIA. Accommodations will be made on a first come, first serve basis, based on availability.

Hotel reservations will only be confirmed for paid conference registrants. You will receive hotel confirmations directly from the hotel. Please be advised that the hotel is expected to be sold out quickly so advanced registration is strongly advised should you want to stay at the host hotel. If you are looking for personal suites and/or private meeting room, please visit the SIIA website for more information.

Attendees will have their choice of nearly 40 educational sessions to choose from, with many topics and speakers never included as part of previous SIIA conferences… or any other industry event. There are too many examples to list here, so please be sure to check out the program to see what is on tap.

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The event will include a huge exhibit hall with more than 130 companies showing off the latest products and services developed for self-insured employers and captive insurance companies, so this will be a true one-shop-stop for anyone in the market for new services providers/ business partners. For exhibiting information, contact Justin Miller at jmiller@siia.org.

Make sure you stay for the end of conference party. For those who have attended previous SIIA national conference parties, you know these are not to be missed and San Francisco will not be an exception, so we suggest you make your travel arrangements accordingly.

Early bird rates are available through June 14th so sign up today! Detailed event information can be accessed on-line at www.siia.org, or by calling 800/851-7789. We look forward to seeing you in San Francisco!


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NEWS

NEWS FROM SIIA MEMBERS 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 membernews@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 at jivy@siia.org.

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NEWS Diamond Members HM Insurance Group Names Caleb Knier as New Chief Financial Officer PITTSBURGH – Caleb Knier has been named chief financial officer (CFO) of HM Insurance Group (HM). In this role, he supports HM’s strategic growth and financial performance goals and is responsible for financial operations and financial oversight of HM’s business.

“Caleb’s knowledge and experience are a great asset to our leadership team as we work to achieve our current and future financial commitments,” Tom Doran, president, HM Insurance Group, said. “Not only does he have the traditional background in accounting and financial planning that you’d expect to find in a CFO, he’s also experienced in process improvement and risk assessment.”

Knier has been with HM Insurance Group since 2018 when he took on the role of vice president, Market Segment Finance. Prior to that, he spent four years at Highmark Health as the vice president of financial accounting and reporting. Before his time with Highmark, he was a manager in the audit practice for PricewaterhouseCoopers, where he spent a number of years servicing the health insurance and financial services industries. Knier has a Bachelor of Science degree in Accounting from Penn State University and is a Certified Public Accountant. About HM Insurance Group HM Insurance Group (HM) works to protect businesses from the potential financial risk associated with catastrophic health care costs. The company provides reinsurance solutions that address risk situations confronting employers, providers and payers. A recognized leader in employer stop loss, HM also offers managed care reinsurance nationally. HM Life Insurance Company and HM Life Insurance Company of New York are rated “A” (Excellent) by A.M. Best Company, one of the country’s oldest and most respected rating agencies. Through its insurance companies,

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NEWS HM Insurance Group holds insurance licenses in 50 states and the District of Columbia and maintains sales offices across the country. Contact Jennifer Mahan, Marketing & Communications Consultant, at (412) 544-1359, jennifer.mahan@ hminsurancegroup.com and visit hmig.com.

Tokio Marine HCC Announces Innovative Solution for Managing Air Ambulance Expenses HOUSTON -- Tokio Marine HCC announced an innovative solution for managing escalating air ambulance charges for its stop loss customers. Tokio Marine HCC – Stop Loss Group (TMHCC – Stop Loss Group) is

providing access to cost containment capabilities through a partnership with On Call International (On Call), a wholly owned subsidiary of Tokio Marine HCC. TMHCC – Stop Loss Group strives to provide a one-stop resource for its producers and their clients. Therefore, in addition to offering stop loss products, TMHCC – Stop Loss Group is extending to its producers access to the cost containment capabilities of On Call. And while its producers can access On Call’s services for all of their clients, only their TMHCC – Stop Loss Group’s policyholders can receive On Call’s services at discounted rates. With more than 20 years of experience in coordinating air ambulance evacuations, On Call utilizes a proprietary network of preferred providers, which allows them to pass in network cost savings on to their clients, members and partners without

the fear of large unknown costs or patient balance billing, outside of normal cost sharing requirements. “Increasing catastrophic medical claims are causing our customers to seek solutions for controlling the rising costs associated with employee benefit coverage. At TMHCC – Stop Loss Group, helping our customers understand and control these costs is our top priority. By partnering with our sister organization, On Call International, we are delivering one such solution focused on managing the cost of air ambulance evacuations via access to On Call’s proprietary network of preferred air ambulance providers,” said Daniel A. Strusz, TMHCC – Stop Loss Group’s President and Chief Executive Officer.

Only WellRithms has the medical, legal, and data expertise to accurately review medical bills. Start saving REAL dollars, and experience the WellRithms difference today. Find out more at www.wellrithms.com

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NEWS About Tokio Marine HCC Tokio Marine HCC is the marketing name used to describe the affiliated companies under the common ownership of HCC Insurance Holdings, Inc., a Delaware incorporated insurance holding company. Headquartered in Houston, Texas, Tokio Marine HCC is a leading specialty insurance group with offices in the United States, the United Kingdom and Continental Europe. Tokio Marine HCC’s major domestic insurance companies have financial strength ratings of “AA- (Very Strong)” from S&P Global Ratings, “A++ (Superior)” from A.M. Best, and “AA- (Very Strong)” from Fitch Ratings; its major international insurance companies have financial strength ratings of “AA- (Very Strong)” from S&P Global Ratings. Tokio Marine HCC is a member of the Tokio Marine Group, a premier global company founded in 1879 with a market capitalization of $34 billion as of December 31, 2018. Visit www. tokiomarinehcc.com. About Tokio Marine HCC – Stop Loss Group Tokio Marine HCC – Stop Loss Group is the marketing name used to describe the medical stop loss- related insurance operations of Tokio Marine HCC through its wholly owned subsidiary HCC Life Insurance Company (HCC Life). HCC Life is a leading provider of medical stop-loss insurance through brokers, consultants and third party administrators. The Company has financial strength ratings of “AA- (Very Strong)” from S&P Global Ratings, “A++ (Superior)” from A.M. Best, and “AA- (Very Strong)” from Fitch Ratings. HCC Life is backed by the financial strength of its parent company, HCC Insurance Holdings, Inc. Visit www. tokiomarinehcc.com/life.

About On Call International On Call International is a leading provider of fully-customized travel risk management services protecting millions of travelers, their families, and their organizations. The Company understands that when traveling, every problem is unique – a medical crisis, a political threat, even a common incident such as a missed flight - but every solution starts with customized care that ensures travelers are safe and protected. Visit www.oncallinternational.com.

Voya Financial Seeks Senior Stop Loss Underwriter As part of the application process, a candidate account is required to log in and view application(s). Please be sure to check email regularly for information regarding our employment process. Profile Summary Voya Financial is looking to hire a Senior Stop Loss Underwriter who will independently underwrite more difficult group insurance applications within guidelines set for the issuance of policies on a standard or substandard basis. Voya is looking for someone who is experienced working with un-bundled products and doing aggregate calculations.

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NEWS Profile Description

lower level group underwriters.

Develop and maintain relationships with field personnel and clients by answering general questions and obtaining information on which to base decisions. Document and communicate decisions to necessary areas in the division. Reviews cases exceeding underwriter’s review level.

• Evaluate risk for the Stop Loss

• Contribute to total division profitability by analyzing/assessing client profit-

• Provide training and guidance to

product. Analyze data such as financial condition of the client company, characteristics of employee groups, participation percentage, type of industry, or past claim experience to determine benefits and rates. Ensure proper pricing and appropriate funding methods. Coordinate underwriting activities on proposals, new cases, renewals, and amendments. Ensure that the company can administer the client’s proposed benefit plan design and funding method.

ability through experience and expense analysis and attention to product line performance.

• Participate in product development and enhancements. Represent underwriting/service team perspective based on personal knowledge and experience.

• Other duties as assigned. Skills/Knowledge/Abilities

• Bachelor’s degree or equivalent • 4-6 years of Stop Loss underwriting experience • Strong problem-solving and analytical skills • PC skills including word processing and spreadsheet applications • Excellent written and oral communication skills

Fully-Insured to Self-Funded Analysis

Compare different risk structures when a group is currently selfisured so that an employer can measure the expected impact of different deductibles. Help your clients make educated decisions as to whether their group should be self-funded or stay fully-insured.

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To learn more contact Ted Wilson at twilson@wspactuaries.com.

www.wspactuaries.com


We watch the trends.

We share our knowledge.

We deliver solutions you can trust.

There’s no simple way to overcome the rising claims trend in today’s market. But we know that incorporating smart practices into our business model is helping us to gain more control of the situation. We’re making informed decisions based on data analytics and industry knowledge; using the insight of in-house experts to create thoughtful solutions; and choosing our cost-containment partners wisely as we work to protect our clients’ financial wellbeing. Learn more about our efforts to help manage the unpredictable at hmig.com.

STOP LOSS

MTG-3173 (1/19)

MANAGED CARE REINSURANCE

Products are underwritten by HM Life Insurance Company, Pittsburgh, PA, or HM Life Insurance Company of New York, New York, NY.


NEWS Silver Members Virtual Benefits Administrator Announces VBAGateway Portal Offering As Standalone Product Germantown, WI -- Virtual Benefits Administrator, a leading-edge software design company revolutionizing the insurance industry, introduces the official launch of their payer portals, VBAGateway, as a direct to market solution.

Critical Skills At Voya, we have identified the following critical skills which are key to success in our culture:

• Customer Focused: Passionate drive to delight our customers and offer unique solutions that deliver on their expectations.

• Critical Thinking: Thoughtful process of analyzing data and problem solving data to reach a well-reasoned solution.

• Team Mentality: Partnering effectively to drive our culture and execute on our common goals.

• Business Acumen: Appreciation and understanding of the financial services industry in order to make sound business decisions.

• Learning Agility: Openness to new ways of thinking and acquiring new skills to retain a competitive advantage. About Voya Financial Voya Financial is a group of premier retirement, investment and insurance companies with 225,000 points of distribution and approximately $467 billion in total AUM and AUA as of December 31, 2018. We’re dedicated to making a secure financial future possible for all Americans. And, we have the experience, resources and commitment to help you grow your business. Visit voya.com.

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Previously, VBA provided access to their portals as part of their Benefit Administration solution. Now, payers will be able to access the portals as a standalone solution. What sets VBA portals apart in the market is the ability to display any type of benefit information including medical, dental, vision, flex (HRA/ HSA), life, disability short & long term, medical short & long-term plans, travel insurance, voluntary and non-standard benefits. Based on Google visual design principles, the portals offer a more dynamic and intuitive approach to user engagement. The VBAGateway portfolio consists of four uniquely designed portals built around the needs of each core audience. User experience is top of mind with continuous enhancements, real-time administrative communication, and true portal gamification configured to reward positive behaviors and drive loyalty. VBAGateway grows in tandem with clients’ business as a scalable portal solution.


NEWS “We’re thrilled to introduce VBAGateway to the market as a stand-alone product offering,” says Mike Clayton, CEO of VBA. “VBAGateway offers our clients seamless access to information, robust self-service capabilities, and portals that are fully implemented and functional in an average of 90 days.” About VBA Virtual Benefits Administrator (VBA) is a proactive, leading edge software design company providing custom solutions to the insurance industry for nearly 20 years. Uniquely delivered on a secure, cloud-based architecture, VBA provides one-common architecture for all Employee Benefit Administration. Our software development process focuses on continuous improvement to address the requirements of the ever-changing healthcare industry. This empowers our clients to focus on business strategy and growth while streamlining their operations. Contact Jessica Luacaw, Vice President Enterprise Solutions, at 262-374-6021, jluacaw@vbasoftware.com and visit vbasoftware.com.

D. W. Van Dyke App Appoints Joe Sabol as Senior Vice President, Marketing Shelton, CT – D. W. Van Dyke & Co., Inc., a Reinsurance Intermediary specializing in the Medical Stop Loss industry, announces the appointment of Joe Sabol as Senior Vice President, Marketing.

“We are very excited to have someone of Joe’s caliber join our company”, said Walt Roland, President of DWVD. “Joe will assist us in solving many of the challenges that today’s Stop Loss Market present. His experience and extensive knowledge of the U.S. health insurance and reinsurance industry will complement our company perfectly and we expect him to be a big part of our continuing success.” Mr. Sabol has over 30 years of experience in the insurance and reinsurance industries, most recently serving as Senior Vice President, Head of US Medical Client Markets at Swiss Re America. His professional experience also includes high level positions at Munich Re and Anthem Health & Life Insurance Company. Joe is an alumnus from Penn State University, where he earned his Bachelor of Science degree in Mathematics.

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NEWS About D. W. Van Dyke and Co., Inc. Founded in 1978, DWVD provides intermediary and advisory support for reinsurance placements, distribution, product development consulting and direct brokering services on behalf of institutional clients. DWVD works throughout the Life, Accident & Health space, most prominently in the stop loss business. DWVD’s customers and markets include Insurance Companies, Reinsurers, TPAs, MEWAs, Cooperatives, MGAs, distribution companies and others. Contact Liz Pilgrim at epilgrim@dwvd.com and visit www.dwvd.com.

ACS Benefit Services Welcome Welcomes Jon Slowik as New Regional Director of Sales Winston-Salem, NC – ACS Benefit Services announced that Jon Slowik has joined the company as Regional Director of Sales. He will report to ACS’ Vice President of Sales, Joe Meyer, and be responsible for self-funded sales in Charlotte, NC and the surrounding the region. Additionally, he will be responsible for cultivating new broker relationships and maintaining existing partnerships in support of new sales. Slowik comes to ACS with more than 25 years of experience in employee benefits. Most recently, he served as a Regional Sales Manager for Versant Health. Prior to that, he held various roles in a number of organizations including sales positions with both Coventry Health and Aetna. While at Aetna, he was recognized as top 5 in the country for level funded sales. Slowik is also active in several health care associations, including the Free Market Medical Association and The Charlotte Association of Health Underwriters. “I’m excited to join ACS and impressed with how they are working to define the future of how health care benefits are delivered and paid for,” Slowik said in a statement.

Every benefit plan needs a hero CoreSource saves members from excessive healthcare expenses by helping them make smart, informed decisions when accessing healthcare. And when members make better decisions, employers see an improvement in their bottom line. That’s the kind of hero every benefit plan needs.

Our capes are ready.

Learn more about CoreSource’s self-funded capabilities at www.coresource.com. Expect more. Benefit more. SERVICE

VALUE

©2019 CoreSource

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FLEXIBILITY

EXPERTISE

ENGAGEMENT

R450-1839_R4-19


NEWS ACS CEO Kari Niblack echoed that excitement. “Jon has deep roots and a stellar track record in employee benefits and brings an invaluable breadth of knowledge to the table. He has a clear understanding of the challenges our clients face and knows precisely how to best address them. We are thrilled to welcome Jon to the ACS team.” About ACS Benefit Services Founded in 1982, ACS Benefit Services was formed on the realization that there needed to be better benefit solutions and health plans available in the marketplace. Since then, ACS has grown to be a leading third-party administrator by focusing on the future of the industry, creating long-term solutions and predicting the benefit administration needs of our employer groups. Contact Kari Niblack, JD, SPHR, Chief Executive Officer at KNiblack@ ACSbenefitservices.com, 336.759.2013 and visit ACSbenefitservices.com.

Deerwalk Partners with Claros Analytics to Simplify Health Plan Design Boston, MA -- Deerwalk, Inc., an innovative population health management, data management, and healthcare analytics software company has partnered with Claros Analytics, an industry leader in developing software applications for the pricing and analysis of health care plans, to bring customers a new tool for modeling benefit plan design. The “Plan Design” module is available with the latest release of Plan Analytics, Deerwalk’s interoperable healthcare reporting and analytics application.

This new tool will inform stakeholder decisions by allowing them to run “what if’ scenarios to evaluate changes to plan design, calculating the most likely cost and cost-sharing outcomes based on actuarial models built and maintained by Claros Analytics. Proposed plan changes can be compared with a hypothetical “current state,” or existing plan design for a population. When analyzing populations for which data is already available in Deerwalk Plan Analytics, demographics can be loaded directly from the data lake. This provides a shortcut for modeling plan design changes on existing groups by quickly populating the demographic values based on the selected population. In addition to a group’s demographic information, various elements can be input into a proposed scenario, including plan parameters such as deductibles, coinsurance, out-of-pocket maximums, and medical and pharmacy copays. The results of the analysis return a high-level financial impact summary (anticipated net impact), visual charts showing a side-by-side comparison of the current plan versus the proposed scenario, and a table that breaks down the underlying financial components. Claros Analytics’ Chief Executive Officer Todd Owen said, “The opportunity to collaborate with Deerwalk on this project is truly exciting. This plan design capability will bring significant value for Deerwalk users.” Deerwalk’s Chief Operating Officer Jeff Rick stated, “By combining the power of Deerwalk’s computing capabilities with consistent and actuarially sound methodology from Claros, we are excited

to bring clients a tool that puts their healthcare data to work, simplifying planning and budgeting decisions.” About Deerwalk, Inc. Deerwalk is an innovative population health management, data management, and healthcare analytics software company based in Lexington, Massachusetts. Founded in 2010, Deerwalk is privately held with over 300 employees worldwide, including a technology campus in Kathmandu, Nepal. We partner with industry leaders responsible for making decisions for the health of a population to optimize costs and improve the quality of care. Deerwalk offers a complete population health management suite built on a foundation of data integrity that delivers reliable data insights and actionable intelligence. Contact Tim Huke, Chief Growth Officer, at (949) 233-4908, thuke@deerwalk.com and visit www. deerwalk.com. About Claros Analytics, LLC Claros Analytics, based in Princeton, New Jersey, develops cutting edge software for employee benefits professionals who want powerful and easy to use tools that deepen their understanding and consulting capabilities for their client’s health benefits plans. Our Health Benefits Consulting Suite and Actuarial Advisor rating manual are used by consultants, brokers, TPAs, plan sponsors, actuaries, reinsurers and stop-loss carriers. To learn more, visit www.clarosanalytics. com. Contact Todd Owen, Chief Executive Officer, at (609) 275-6550, towen@clarosanalytics.com and visit www.clarosanalytics.com.

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SIIA 2019 BOARD of directors & committee chair ROSTER

Chairman of the Board*

Directors

Committee Chairs

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

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

President/CEO

Mary Catherine Person President HealthSCOPE Benefits, Inc. Little Rock, AR

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

Chairman Elect*

Kevin Seelman Senior Vice President Lockton Dunning Benefit CompanyDallas, TX

Mike Ferguson SIIA Simpsonville, SC

David Wilson President Windsor Strategy Partners, LLC Princeton, NJ

Treasurer and Corporate Secretary* Gerald Gates President Stop Loss Insurance Services AmWins Worcester, MA *Also serves as Director

SIEF Board of Directors Nigel Wallbank Chairman Heidi Leenay President Freda Bacon Director Les Boughner Director Alex Giordano Director

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Jeffrey K. Simpson Partner Womble Bond Dickinson (US) LLP Wilmington, DE Robert Tierney President StarLine East Falmouth, MA Peter Robinson Managing Principal Integro Re San Francisco, CA

GOVERNMENT RELATIONS COMMITTEE Steven B. Suter President & CEO Healthcare Management Admtrs., Inc. Bellevue, WA Chair, International Committee Liz D. Mariner Ford Senior Vice President Re-Solutions, a Risk Strategies Company Minneapolis, MN Chair, SIIA Future Leaders Committee Craig Clemente Chief Operating Officer Specialty Care Management Lahaska, PA Chair, TPA Best Practices Task Force Ron Dewsnup President Allegiance Benefit Plan ManagementMissoula, MT Chair, Workers’ Comp Committee Mike Zucco Business Development ATA Comp Fund Montgomery, AL


SIIA new members june 2019 Regular Corporate Members Jean Paul Dupin VP Of Sales Advanced Benefits Coeur d Alene, ID Teresa Colian Vice President, Sales Carisk Partners Miami, FL

Silver Members Chris Yeatman Adams, Jenkins & Cheatham Midlothian, VA Theresa Dixon CEO Exemplar Health Benefits Administrator, LLC High Point, NC

Nicholas Opalich CEO EHO Belton, TX Steven Purkapile Regional Director of Financial Consulting Hub International Insurance Services Olathe, KS Kurt Meinberg Senior Client Executive Oswald Companies Cleveland, OH Kevin Trokey Founding Partner Q4intelligence LLC Kirkwood, MO

employer Corporate Members April Poyer Payroll and Benefits ManagerCommunity Mental Health Authority of Clinton Eaton and Ingham Counties Lansing, MI

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 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

Mark Angard CEO Stonebrook Risk Solutions Encino, CA

to Editor Gretchen Grote at ggrote@sipconline.net

Joseph Blanche President USI/FutureComp Woburn, MA

also has advertising opportunities available. Please contact Shane

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Byars at sbyars@sipconline.net for advertising information.


Pay it Right THE FIRST TIME

Through our integrated PREPAYMENT REVOLUTION Zelis is the market leader in integrating network solutions, payment integrity and electronic payments to deliver insights that drive even greater savings before a claim is paid. Working in a prepayment environment, we price the claim correctly before you pay, avoiding unnecessary costs, time and reducing member and provider abrasion. In fact, 85% of the time we find claim savings that other vendors don’t. We do this by focusing on every step of the pre-payment claim cycle and delivering value-driven solutions from payment to reconciliation.

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 Copyright 2017 Zelis Healthcare. All rights reserved.


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Market evolution creates change. Change brings opportunity. Opportunity creates conversation. We’re here to listen. www.UnitedClaimSolutions.com 866-762-4455

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Self Insurer June 2019  

Self Insurer June 2019