Page 1

MARCH 2020


What Kind of

Leadership Builds a

Culture of Health?


strength in


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.

A Safety National® Company

800.800.4007 midlandsmgt.com publicentity@midman.com



MARCH 2020 VOL 137

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



A CULTURE OF HEALTH? By Dr. Richard Safeer













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

MARCH 2020



What Kind of Leadership Builds a Culture of Health? This article is the second in a series from Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being for Johns Hopkins Medicine


n January’s issue, I explained how employers often overlook something key to building a thriving, healthy workplace: the workplace culture itself. Employers have a direct role to play in building a culture that supports healthy behaviors across the organization.

At Johns Hopkins Medicine, we’ve built an entire strategy around analyzing the factors that influence people’s health, and then making sure we are creating the conditions employees need for wellbeing. Our “Healthy at Hopkins” initiative has helped shed light on the different spheres of influence that contribute to a culture of health.

One of those spheres of influence is leadership support, which has both obvious and more subtle implications for employee wellbeing. Leaders set policies and sign off on wellness initiatives, but they also model behavior and are the stewards of any strong workplace culture.

Written By Dr. Richard Safeer



A Culture of Health Effective leaders make course corrections when the culture is off, gather feedback from employees, and most importantly, invest in a positive vision for the organization. One of the best ways to help leadership support a culture of health is to define strategies for different types of leadership roles. Different roles bring different opportunities to introduce, grow, and sustain a focus on health, so it’s worth considering what part each type of leader has to play.

The other way executives can build a culture of health is by establishing goals around employee health as they would with any other business target. An organization sets priorities by developing a set of goals, financial targets, operational benchmarks, and other business objectives.


It’s important to consider who leaders are in organizations. Executives, directors, and managers have titles and responsibilities that make them formal leaders in the workplace, and they have opportunities to promote wellbeing from the top down.

But every workplace also has informal leaders—employees who are mentors and role models, have a strong and influential voice within their teams and departments, and who play an active role in shaping the workplace culture because of those traits.

Different levels of leadership also have different touch points with employees, opening up a wide range of opportunities to grow a culture of health. Making a culture of health the shared responsibility of all levels and types of leaders ultimately results in a more resilient workplace.

Establishing formal goals around a healthy workplace not only provides motivation for departments to participate but also gives leadership a reason to check back in on progress and devote resources to the effort.

2. Mid-level managers

The power of leadership in building a healthy culture is far from limited to the top. In fact, mid-level managers may have the greatest opportunity to make a difference “on the ground” of an organization.


1. Senior executives

Executive-level support for wellness programs is critical. Senior executives establish an organization’s priorities and help set the tone for all employees. Not only do executives have the power to “green light” wellness initiatives, but they are also some of the most visible members of an organization. Their physical presence, written and verbal communication, and participation in healthy activities sends a strong message about the organization’s values.

MARCH 2020


• Consulting • Case Management • Big and Small Data Analysis & Predictive Modeling • Claims Audits • Risk Management

customerservice@arataiinternational.com www.arataiinternational.com

Call Us Toll Free: (888) 448-2470

Aratai International provides services to build and develop cost-effective and high quality healthcare strategies. We invest time in understanding your business goals, and we develop programs to help you reach them. We are committed to developing strong business relationships by exceeding your expectations. MEDICAL LEGAL







A Culture of Health By mid-level managers, I’m referring to supervisors who often have a group of direct reports and work closely with a large number of employees every day. At Hopkins, supervisors have successfully used a range of strategies to help promote a culture of health.

One of the clearest and simplest actions is to put ‘Healthy at Hopkins’ on the team agenda. This way, every week they are reminded to promote upcoming events and health resources. Sometimes, a manager taking time to put these resources in front of an employee is a strong way to signal the importance of wellbeing.

It’s also important that managers create and maintain space for health at work. That includes allowing time for healthy habits, including formal wellness programming and self-guided moments for mental health breaks and physical activity. Many of our most successful managers don’t just allow this kind of time, but actively encourage it and provide positive feedback to employees when they engage in healthy behaviors at work.

Managers should take an active interest in their team members’ physical and mental health. At Hopkins, we train new managers on how to be a buffer against stress, not to be a source of stress. A manager that is a source of stress is critical, blaming, unclear, and unsupportive.

Managers that buffer against stress can still set ambitious goals for their team and provide important structure and guidance – but they do so by modeling transparency, openness, and understanding. Managers need to not only work to reduce employees’ stress, but also focus on their own mental health and wellbeing to avoid a toxic culture.

Managers also have the opportunity to influence employees’ approach to work-life integration. They can guide employees to adopt the same healthy habits at the office as they do at home and can also advocate for healthy habits beyond the workplace – such as “unplugged” time away from digital devices and taking restful PTO as needed.

3. Peer leaders

Last, there are many other leaders within an organization whose influence is unrelated to their official title. Often these are employees who have a strong or magnetic personality, or who have earned particularly deep trust from their coworkers.

These informal leaders have great influence over their peers, whether that is taking an agreed upon work break or talking about a fitness class they attended. Peer leaders are a critical part of an organization’s social climate, which is where a culture of health can really take root.

It’s also possible to inspire employees to become peer leaders through champion programs. At Hopkins, we’ve designed a program where a select group of employees—regardless of title or position at the organization—apply to be wellbeing champions, and then undergo training on how to explain health resources and promote opportunities to participate in a healthy culture.

Overall, champion programs highlight another important truth about building a culture of health: this undertaking not only requires leaders, but also creates leaders. Good leaders help promote a healthy culture – and a healthy culture also gives rise to peers, managers, and executives who have a positive influence over the organization.

MARCH 2020


A Culture of Health So, while there is absolutely a strong topdown component to building a culture of health, this process can also create room for new leaders to emerge and for peers to impact each other for the better every step of the way.

In the next piece in the series, I’ll explore how shared values – which again, often start with the leaders I’ve discussed in this piece – are another key sphere of influence when it comes to growing a healthy workplace culture.

Dr. Safeer is the Chief Medical Director of Employee Health and Well-being for Johns Hopkins Medicine. In this role, he leads the Healthy at Hopkins employee health and well-being strategy. He also currently sees patients in the Johns Hopkins Hospital Pediatric Cardiology department. In addition, he teaches in the Department of Health, Behavior and Society in the Johns Hopkins Bloomberg School of Public Health.

Richard completed his Bachelor of Science in Nutritional Biochemistry at Cornell University before graduating from medical school at the State University of New York at Buffalo. He completed his residency in Family Medicine at Franklin Square Hospital Center, in Baltimore, Maryland. After which, he completed a Faculty Development Fellowship at the Virginia Commonwealth University. He is also certified in Clinical Lipidology by the National Lipid Association. Prior to arriving at Hopkins, Dr. Safeer practiced family medicine in Northern Virginia.

He was then on faculty at the George Washington University, where he served as the Residency Director of the Family Medicine training program prior to his departure. He was the Medical Director of an Occupational Health Center in Baltimore and Wellness Director for the Mid-Atlantic region of the parent company, just before starting at CareFirst BlueCross BlueShield in Baltimore, Maryland as the Medical Director of Preventive Medicine.

Celebrating 20 Years of Success 2020 marks a big milestone for our associates and our clients. After two decades, we have amassed an unparalleled team of professionals and partnerships that reflect the core tenets of who we were when we started 20 years ago, and who we will always be —Approachable, Knowlegeable and Dependable. www.linkedin.com/company/star-line-group (508) 809-3179





Rolling the Dice on

Emerging Risks



Written By Bruce Shutan


ince the most serious insurance risks will continue to evolve in an ever-changing world, top priorities may shift right alongside the moving targets of catastrophe. But one prudent strategy remains the same: the use of captive insurance to avoid financial ruin. Industry observers say this alternative risk transfer vehicle will keep powering organizations through a maze of uncertainty that includes cyberattacks, political instability, extreme weather, supply chain disruption, the mounting use of drones and legalized marijuana. Captives can help minimize any losses from cyberattacks by offering a layer of protection beyond where the commercial insurance marketplace is willing to tread and speed a return to business as usual, says Harry Tipper, III, chief operating officer – insurance, for CaptiveOne Advisors LLC. They serve as a risk-management mechanism that may include state-of-the-art cybersecurity insurance inclusive of a financing mechanism for cyber intrusions. “Think of a cyber incident your company may experience,” explains Tipper, who moderated a workshop on using captives to cover emerging risks at SIIA’s 2019 national conference in San Francisco. “A captive insurer may not solve the problem of a cyberattack, but it can help provide funds by which you can start to bring in the experts who can do some additional security work, as well as providing the funds



Rolling the Dice needs to hire a public-relations firm that can rebuild your brand or reputation.” Captives help fill gaps resulting from numerous exclusions in cyber insurance policies, notes Sandra Fenters, President, Capterra Risk Solutions, LLC and a member of SIIA’s Captive Insurance Committee.

“That’s why we’ll write a difference-in-conditions policy,” Harry Tipper she says. “A lot of times they keep their traditional policy and buy expanded coverages.” One such example is an act of war, which is typically found in property insurance policies and other types of coverage. Fenters recalls how Merck & Co. lost $1.3 billion in a June 2017 cyberattack traced to Russia’s military intelligence agency, which crippled more than 30,000 laptop and desktop computers. Most of the pharmaceutical giant’s 30 insurers and reinsurers denied coverage and the case was later litigated. Captive solutions come in various shapes and size – from individual and group captives to heterogeneous and homogeneous entities. One example that Tipper cites is a trade association that forms a captive insurer to make some of these insurance coverages and services available at a discount as a benefit of membership. His company’s clients include smaller businesses that don’t necessarily have the resources for costly cyber security as a shield for personally protected information or confidential health information. In many cases, he says they have to balance the breadth of coverage with budget constraints, particularly in the area of ancillary risk management/risk mitigation services. Tipper recalls a conversation he had about three years ago with one vendor that his company was considering to provide cyber security services to its clients. It guaranteed that its firewalls and real-time threat analysis would eliminate any cyber incursions, but the cost of this platinum service was an eye-popping $250,000 a month. He describes the amount as “unfathomable” to smaller businesses which currently must rely on the services of third-party vendors, the commercial equivalent of LifeLock, Norton or McAfee, to provide them with cyber security. Sandra Fenters

Cyber insurance is one of the most expansive policies in the market with at least 10 insuring agreements largely because there are so many disparate areas to address, Fenters surmises. There’s a myriad of subcategories under the cyber-risk umbrella, including computer security and privacy breaches, cyber theft, espionage, extortion and cyber terrorism.

CHAIN REACTION TO CYBERATTACKS The frightening part is that these episodes bleed into larger business concerns that include loss of revenue, reputational damage, business continuity and supply chain disruption. “It’s a massive exposure that touches the most exposure points I’ve ever seen,” she opines. Countering cyberattacks and data breaches, which have increased exponentially, is a chief concern across all organizations between a deepening global interconnectedness, as well as explosion of mobile devices and social media. Despite these mounting risks, her client base has been fortunate thus far. The closest any of them have come to a cyberattack was when a distributor of fuel products lost nearly $50,000 in damages stealing from someone stealing credit card information from a gas station pump. However, newer worries are fast emerging over a related area, which is the uncertain impact of political risks in an increasingly unstable geopolitical environment. She cites several examples that include government confiscation of

MARCH 2020


Rolling the Dice property, civil commotion, an inability to convert foreign currency, terrorism and trade embargoes.

“There’s a ton of political risks that we see a lot of our captives writing administrative-action type policies to cover,” Fenters reports. Supply chain disruptions in an increasingly global economy are another emerging area of mounting concern among smaller American businesses. While politics makes some coverage problematic currently, Tipper’s current firm has worked with its clients to provide a means within a captive insurance vehicle to develop a funding mechanism in the event of trade disputes have to be litigated outside the U.S. in the supplier’s home country’s courts where it can be much more expensive.

“We’ve seen and heard horror stories of the impact on supply chains from governmental intervention,” he notes, “and have at least found a partial solution.” In this case, he says many of his clients are following a simple, prudent riskmanagement strategy by choosing a heterogenous group of suppliers or vendors

that’s not limited geographically. “It’s acting in the same way that you don’t put all your investment portfolio into one sector of the economy.” The biggest challenge to the supply chain now is underwriting political risk, he adds.

BRACING FOR HEAVY WEATHER Captives also help fill coverage gaps for other emerging risks, including the growing category of weather-related concerns. Tipper once ran a Bermudabased company that focused on captives. While there, the firms that create the hurricane models for the insurance industry added a severity component to the computer model that previously just calculated the frequency probability of a hurricane or other catastrophic weather event occurring in a geographic area. In response, several insurers writing property insurance asked several coastal communities in the Northeast to absorb an increase to their deductibles on their property policies between $25 million and $60 million in the space of just one renewal period because of concerns about climate change and severe weather, he recalls. “Fortunately with a little bit of work, a captive was used to fund that gap so that they could build up a pool of resources over a period of time that in the event a severe storm came by and inflicted reasonably predicted damage, they would have the funding available to rebuild the community,” according to Tipper.



Being Powerful. Being Human. Being PharmPix.

Partnership is within your grasp.

Discover why PharmPix has been revolutionizing PBM since 2009. Schedule a personalized demo at www.pharmpix.com or call 404-566-2000.


Rolling the Dice soaring gas prices in frigid winters or much higher electricity costs in scorching hot summers.

“If they were buying a put or a call at, let’s say, $50 per kilowatt hour strike price,” Woytowicz explains, “we used the captive to fill that in below that strike which buys that strike down.” The pricing becomes more affordable as carriers move away Mike Woytowicz Whereas the cyber area was a unique and highly specialized emerging risk 20 years ago, increasingly severe weather driven in large part by climate change is an emerging space for captive insurance, observes Mike Woytowicz, director of business development for Artex Risk Solutions’ International division. He’s based in Bermuda where hurricanes and Bermuda Triangle folklore are cultural markers. Woytowicz recently helped incorporate a captive that essentially mirrors the weather derivative contracts available in the market for an energy distribution company to deal with Mother Nature’s wrath. The captive is being used to “de-risk” electric operations and assist weather risk management strategies by allowing the client enough flexibility to increase or decrease the insurance market attachment point (i.e., strike price) for various options available. The arrangement, which ultimately provides less downside or upside volatility in the company’s operations, serves as a hedge on either side of what’s being bought in the traditional derivative marketplace to guard against



from the attachment point or strike price in the traditional marketplace because the lower the strike price, the quicker the derivative triggers. A derivative contract also can be structured as an insurance policy that does not trade on the derivative market. Many organizations do not necessarily think of using insurance or a captive to also supplement or complement the same derivative strategy, according to Woytowicz.

BREAKEVEN POINT While companies that increasingly use captives to rein in employee benefit costs on the medical stop-loss side can expect dividend payouts in good years, that experience doesn’t translate for weather-related risks. “The weather insurance market, in its current state, is pricing seems basically breakeven,” Woytowicz reports. “No one’s really making or losing money, or not like you see with a traditional insurance policy.” There are other considerable differences such as a short tail vs. longer-tail nature. For example, he says while medical stop-loss isn’t exactly long tail, employers don’t necessarily know whether or not they’ve hit their aggregate until several months after claims have been sorted out and final bills are sent. On the weather side, however, Woytowicz notes that the cost of oil or gas

There are energy transmission organizations that coordinates the movement of wholesale electricity and they monitor and collect the pricing data for every hour of every day,” he says, “and if the price of energy hits the strike on any given day, you know instantly when the contract triggers, so it’s a bit different of an animal.” can be tracked on a daily basis. “

What are clients saying about our EmCap® program? “You have become a key partner in our company’s attempt to fix what’s broken in our healthcare system.” - CFO, Commercial Construction Company

“Our clients have grown accustomed to Berkley’s high level of customer service.” - Broker

“The most significant advancement regarding true cost containment we’ve seen in years.” - President, Group Captive Member Company

“EmCap has allowed us to take far more control of our health insurance costs than can be done in the fully insured market.” - President, Group Captive Member Company

“With EmCap, our company has been able to control pricing volatility that we would have faced with traditional Stop Loss.” - HR Executive, Group Captive Member Company

People are talking about Medical Stop Loss Group Captive solutions from Berkley Accident and Health. Our innovative EmCap® program can help employers with self-funded employee health plans to enjoy greater transparency, control, and stability. Let’s discuss how we can help your clients reach their goals. This example is illustrative only and not indicative of actual past or future results. Stop Loss is underwritten by Berkley Life and Health Insurance Company, a member company of W. R. Berkley Corporation and rated A+ (Superior) by A.M. Best, and involves the formation of a group captive insurance program that involves other employers and requires other legal entities. Berkley and its affiliates do not provide tax, legal, or regulatory advice concerning EmCap. You should seek appropriate tax, legal, regulatory, or other counsel regarding the EmCap program, including, but not limited to, counsel in the areas of ERISA, multiple employer welfare arrangements (MEWAs), taxation, and captives. EmCap is not available to all employers or in all states.

Stop Loss | Group Captives | Managed Care | Specialty Accident ©2017 Berkley Accident and Health, Hamilton Square, NJ 08690. All rights reserved. BAH AD2017-09 7/17


Rolling the Dice DRONES AND MARIJUANA Other emerging risks include the use of drones and legalization of marijuana across the U.S. dubbed “the green goldrush.” Fenters has many construction clients, whose industry is known for using drones to track the progress of a large or complex building project, as well as on the agricultural side, which relies on drones to survey crops and make more effective use of the land. Major retailers also are looking to follow Amazon’s lead by testing drones for home deliveries. But the question is, how businesses can reap the benefits of an unmanned aircraft and protect themselves from the risk of property damage or loss of growth in that area? “Drones do crash,” Fenters says. “If the drone is carrying cargo, what safety features do they have to prevent damage? The FAA is starting to finally come up with requirements for how to operate them and to meet the licensing requirements.” She notes that the Insurance Services Office is currently working on a drone-related product for property coverage. As for marijuana, she reports that insurance carriers are scrambling to determine the ramifications of driving under the influence and other issues in states that legalize medical marijuana and/or recreational use. Fenters says another area of concern is the impact on workers’ compensation in the event that employees being high in the workplace trigger accidents.

that have separated the risk management and insurance teams and more financefocused derivative teams, which are purely focused on hedging. As global companies evolve, Woytowicz believes it is possible that risk managers will be increasing their collaboration with the derivative teams on strategies to minimize potential losses to a company’s balance sheet by either utilizing a captive and derivative combination.

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

Protecting plans and patients across the U.S




On average, KF

KF has generated a

KF has handled

resolves claims

savings of 98.5% off

claims in all 50 states

within 297 days of

disputed charges for


self-funded plans

1111 Superior Avenue East Suite 2500 Cleveland, OH 44114

P 216-539-9370 www.aequumhealth.com

No Guarantee of Results – Outcomes depend upon many factors and no attorney

Meanwhile, the way emerging insurance risks are managed in the years ahead will offer an opportunity to break silos



can guarantee a particular outcome or similar positive result in any particular case.

Shift your plan into high gear There is more to successful RBP than savings.

• Claim Auditing • ERISA Appeal Management

With ClaimDOC, you're in the driver's seat to create a rich and sustainable healthcare plan. Our approach of elevating the member experience, while diligently managing risk sets us apart.

• Member Advocacy • Litigation Defense

Learn more at Claim-doc.com or call (888) 330-7295






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, and Carolyn Smith 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 and Carolyn Smith are senior 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.



ICYMI 2019 ENDS WITH SIGNIFICANT HEALTH BENEFIT DEVELOPMENTS By far the biggest news in the health benefits world at the end of 2019 is the repeal of the so-called “Cadillac plan” tax that was enacted as part of the Affordable Care Act (ACA). The Cadillac tax repeal and other health related provisions were included in the end-of-year spending package for fiscal year 2020, enacted on December 20, 2019 (the “FY 2020 Spending Bill”). This article provides a high-level overview of these and other significant 2019 year-end developments.

END-OF-YEAR LEGISLATION The FY 2020 Spending Bill had some important changes impacting health benefits:

• Repeal of the so-called Cadillac plan tax o This was a 40 percent excise tax on the cost of certain employer

sponsored health coverage in excess of a specified dollar threshold. Health benefits that would have been affected included major medical coverage, health FSA and HRA coverage and pre-tax funded HSAs. The tax was originally scheduled to go into effect in 2018 but was previously delayed until 2022. Even with the delayed effective date some employers had begun to modify their major medical plans to avoid triggering the tax, such as by increasing deductibles and co-pays. The push for repeal grew as many policy makers increasingly viewed the tax as impacting middle class Americans. Repeal is welcomed by employers and employees alike.

• Repeal of the health insurance tax (HIT) Beginning in 2021 The HIT is imposed on health insurers and certain self-funded MEWAs based on their relative market share of premiums for major medical plans and certain other health plans. Although the tax is imposed on the health insurance company, it is generally passed through to consumers as part of the premium. The tax went into effect in 2010, and under prior legislation was suspended in 2017, went back into effect in 2018, and was again suspended in 2019. The tax will apply for 2020 and is finally repealed starting in 2021.

In less welcome news, the FY 2020 Spending Bill also extended the PatientCentered Outcomes Research Institute (PCORI) fee for 10 years.

• This fee is imposed on both self-funded and fully insured health plans as well as HRAs. The fee for a year is equal to the average number of lives covered under the plan multiplied by a dollar amount. The dollar amount was originally set at $1.00 and is indexed for inflation. After the last inflation update, the dollar amount was $2.45. The fee is due once each year, on July 31. This fee was originally effective for plan years ending on or after October 1, 2012, and before October 1, 2019. The FY 2020 Spending Bill moved the end date for the fee, so that it now applies to plan years ending before October 1, 2029. The dollar amount is not yet known but would be slightly higher than $2.45 due to inflation adjustments. The IRS PCORI Fee website has further information, but as of this writing has not yet been updated to reflect the extension of the fee.

In addition to health provisions, the 2020 Spending Bill also includes the SECURE Act, which makes a variety of changes to retirement plan rules.

MARCH 2020


APPELLATE COURT RULING IN LITIGATION CHALLENGING THE CONSTITUTIONALITY OF THE ACA In its December 2018 ruling, a federal district court concluded that, since Congress reduced the ACA individual mandate penalty to $0 in 2017, the mandate is unconstitutional and, therefore, the entire ACA is invalid. The decision was appealed and, in a ruling issued in December 2019, the federal court of appeals agreed that the individual mandate is now unconstitutional but did not agree with the cursory opinion that the entire ACA must necessarily fall. The appellate court sent the case back to the district court for a thorough analysis of which, if any, parts of the ACA are now unconstitutional. In the meantime, the law continues to remain in effect. Ultimately, this issue is expected to reach the Supreme Court, but a final decision will take some time. Note: The effective elimination of the ACA individual mandate has prompted some states to pass individual mandate laws that also require reporting by



coverage providers, including employers who sponsor group health plans. To date, the following states have passed such laws: New Jersey, Washington D.C., Vermont, Rhode Island, and California. New Jersey and D.C.’s laws are effective in 2019, which means reporting will be due in 2020. The others become effective in 2020 with reporting to commence in 2021 (for 2020). Insurers and plan sponsors that cover residents in these states should ensure compliance with these requirements.

IRS DELAYS SOME ACA REPORTING The IRS has issued some IRS Form 1095 reporting relief for certain ACA reporting requirements. While Form 1095 generally applies to health insurers, it may also apply to employers with self-funded plans. Notice 2019-63:

• Delays the due date for furnishing 2019 Form 1095 to covered individual recipients until March 2, 2020.

• Provides that no penalties will be assessed for failing to furnish a Form 1095-B or a Form 1095-C to recipients if prominent notice is placed on website that a copy may be requested and a copy of the notice is provided within 30 days of the request. NOTE: These provisions do NOT extend to forms required to be filed with the IRS.

• Extends good faith relief to all ACA 2019 forms. LOOKING AHEAD A lot happened in 2019, including dramatic tax changes in the end-of-year legislation. 2020 looks to be a busy year as well. The agencies may raise the limit on permissible health FSA carryovers and possible guidance on whether certain expenses, such as direct primary care arrangements and health sharing ministries, qualify as a medical expense. We might see some Congressional developments as well, such as surprise billing legislation which was under discussion for possible inclusion in the spending bill but was not quite ready.

Flexible health plan solutions for self-funded employers.



The industry leader in reference-based pricing helps employers take back control of their healthcare costs. • Unrivaled member advocacy • Built-in price protection • Immediate and long-term savings • Over a decade of experience

Learn more. elapservices.com l info@elapservices.com Visit us at BOOTH 14 at the Executive Forum



Written By Wendy Keneipp



ho benefits most from the work you do?

Think about that question and let it really sink in. Because not everyone will get high benefit from the work your company does best. And you aren’t the best at everything. So, finding a match between what you do best and those who need the things you do is key to building your business in an intentional and scalable way. It may sound obvious to say you need an ideal client profile, but too many healthcare businesses are operating on the “whoever fogs a mirror” approach. Yet when asking an audience if anyone has clients they’d like to fire, the answer is always an uncomfortable laugh followed by hands held high in agreement. Which tells me that it’s not so obvious that we need to get more specific about which clients are a best fit.




For more than 35 years, self-funded employers have trusted Sun Life to deliver flexible stop-loss solutions and seamless claim reimbursement. And now, with our new Clinical 360 program, our clinical experts will review your claims data to identify cost savings and care optimization. With high-cost medical and pharmacy claims growing every year, you need your best partner with you every step of the way. Ask your Sun Life Stop-Loss specialist about our latest innovations.












For current financial ratings of underwriting companies by independent rating agencies, visit our corporate website at www.sunlife.com. For more information about Sun Life products, visit www.sunlife.com/us. Stop-Loss policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states except New York, under Policy Form Series 07-SL REV 7-12. In New York, Stop-Loss policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations. © 2019 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. BRAD-6503k SLPC 29427 02/19 (exp. 02/21)





Your perspective:

It feels good to get clarity on who is a good fit and who isn’t. It makes your prospecting efforts so much easier. If, through your marketing, you are talking to this audience about things that concern them the most, and speaking in a way the resonates with them, they will be prepared to engage in a conversation with you about who you are and what you do. And they will readily come into the conversation expecting to find a right fit. It sets the sales process up for success.

Who do you want to work with? What types of clients? What type of businesses? “I don’t know – anyone,” is often the sentiment of many salespeople and business owners. But when asked the right questions, the answers start to become clear. Maybe you like working with smaller companies because of access to the owners or their desire to really know their employees and feel personally connected to their team. Perhaps you like larger companies who have HR managers and CFOs where you can have detailed analytical conversations about plan designs and technical HR and compliance support. Their perspective: Who really gets the benefit from the work we do? Regardless of whether they fit the tactical/demographic profile, if a company’s goals and values/needs profile don’t match yours, they’re not going to fully benefit from what you offer. For example, if they’re looking for a price-shopping vendor and you want to be a business adviser, you’re both going to be consistently frustrated.

REFINE OVER TIME When starting out, any client often does make a “good” client because you have to get started somewhere and just bring in revenue. But as you work diligently with multiple clients over the years, you should be filtering through various ideas of what’s working and what’s not working in those relationships. Your client profile should become more refined as your business ages. For example, when we started our consulting practice, we worked with benefits producers and practice leaders. Over time, we realized that wasn’t enough, and started developing a profile of the type of leader we wanted, choosing three primary criteria: strong leaders; have the desire to change; willing to work hard. This still leads our criteria, but we’ve refined it further to recognize that at our core, we’re very empathetic people-focused people and we, and our clients, thrive when we share that people-focused connection. Quick-starts who are easily distracted by the next bright ‘n shiny, are looking for a silver bullet concept, or are more focused on revenue as their primary goal vs. believing their employees and clients should be the center of their universe are not a good match. With this criteria, size isn’t a factor; it’s the desire and willingness to be a contributing part of something larger that positively impacts many others around them.



For example, if you like the larger companies with the analytical HR managers and CFOs, you could benefit from your marketing being laser focused on the financial analysis and the productivity aspects of a benefits program. On the other hand, if you’re working with the smaller companies who are nurturing and very connected to their teams, then you may benefit from your marketing being focused on the personal connection and caretaking aspect of a benefits program. Regardless of the approach you take to your content, when you share it out in the universe for prospects to experience it (social media, email, phone, inperson), you’re giving them the chance to experience your marketing, your thinking, your approach. And now, these prospective clients begin to understand what to expect from you, and they’ll know if they like what they see. If you get to an in-person meeting, you should both be able to learn fairly quickly if you do have that right fit or not.

Allowing your prospects to filter themselves is one of the best things you can do for your sales team. Because what’s better than a “yes?” A quick “no.” And even better is letting prospects filter themselves and decide it’s a “no” before you spend time on calls and meetings.

AN EXERCISE TO DEFINE YOUR IDEAL CLIENT How do you get this clarity? Look at your list of clients and pick your three five favorites that you’d replicate if you could. Then choose three - five that are consistently frustrating to work with.

EXAMPLE OF IDEAL CLIENT PROFILE Wondering what it might look like when you’re done with the exercise? Here is a sample from a benefits agency who has a very clear idea of what they want in a client.

Now start taking notes and what you like and don’t like. Get feedback from leadership, sales, and account managers. Do a whiteboard/sticky note exercise noting characteristics for each group. Include everything from the tactical and technical and to the feelings and intangibles.

WHAT TRENDS DO YOU SEE ON EACH SIDE? Group those trends into characteristic groups, and you should develop a pretty clear profile of what you want from a client and what you need to avoid. Write these notes up into a description of what the ideal client looks like and what they don’t. It’s important to decide where your line is on the negative characteristics – which ones are deal breakers? Your team will thank you for doing this exercise, gathering their input, and then following through on it. As much as this is a business development exercise, it’s also an employee engagement exercise. Because working with clients who are not a good fit creates an unhappy workplace for the people who work with them. The leaders may not feel the pain of a difficult relationship day-to-day, but the account managers sure do.

51-250 employees; privately held; owners are at the decision-making table; open to technology. They put their employees first and write the check to prove it. They have an emphasis on healthcare consumerism and are willing to learn about the factors driving their premiums and out-ofpocket expenses, and then use that information to make decisions. They look to us to help guide them through this less-thanperfect system. The decisionmakers are decisive, detail oriented, and loyal. They see the value we bring with our analysis, advice, recommendations,

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

• Unbiased Expertise and Review • Initial Placement, Implementation and Renewal of Coverage • Claims Audit, Submission, Tracking, and Resolution Services

©2020 BenefitMall. All rights reserved.



MARCH 2020


and solutions and they look to us for guidance as an advisor in benefits, compliance, and HR. We use our solutions and expertise to help them become better businesses. Bottom line – our clients are looking for a partner to help them grow their organizations, and we become that partner.

A SURPRISING UPSIDE TO UNDERSTANDING YOUR TARGET CLIENT When you understand exactly the type of business you want to work with, you can carry greater confidence into conversations with prospects because you know you’re looking for a right fit. You’re not desperately hoping they need a new healthcare solution, and you, hopefully, have something, anything, they may need. When you are clear and confident in your profile, you can put it to work for you from the first sales conversation. One agency owner explains it this way, “I tell every company we meet with that we are only going to engage 6 – 10 new clients a year that meet our client profile. Working with people who fit our ideal profile is critical for both parties. This catches some off guard, but we communicate in a way that doesn’t come off being arrogant.” Think about that idea. What would that level of confidence do for your sales process?



Wendy Keneipp Wendy Keneipp, partner at Q4intelligence, is a business strategy and marketing/sales coach, working with independent agencies to transform them from legacy sales organizations into modern, client-focused advisory firms. In an industry starved for effective marketing, Wendy delivers a clear advantage by helping agencies create their own results-oriented messages that connect with their buyers and develop marketing and sales systems to take advantage of the new ways buyers seek out answers.

Medical Stop Loss from Berkshire Hathaway Specialty Insurance comes with a professional claims team committed to doing the right thing for our customers – and doing it fast. Our customers know they will be reimbursed rapidly and accurately – with the certainty you would expect from our formidable balance sheet and trusted brand. That’s a policy you can rely on.

Reimbursement done right. www.bhspecialty.com/msl The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.

Written By Brady Bizarro



uch ink has been spilled about prescription drug importation as a strategy for combating America’s exorbitant drug prices. Despite this practice being technically illegal, many self-funded plans have engaged in it for years without facing any repercussions.

With Congress and the Trump administration still unable to agree on a drug pricing reform bill, these programs will almost certainly become more widespread. As they proliferate, they are likely to attract more scrutiny from the Food and Drug Administration (“FDA”), which, although it has rarely enforced the law in this area, has recently taken action against vendors engaged in drug importation.

One large insurer, the state of Utah, has become the first to deliberately adopt a type of drug importation program which is much less likely to attract the attention of the FDA and might serve as a roadmap for other self-funded plans in search of relief.




There are two traditional types of drug importation: mail order and pharmacy tourism. By and large, most selffunded plans engage in mail order drug importation: that is, they partner (directly or indirectly) with a vendor that assists plan participants in obtaining a drug from outside of the country by U.S. mail. All forms of drug importation are illegal under federal law.

The Food, Drug, and Cosmetic Act (“FDCA”), codified as 21 U.S.C. §§ 301 et seq., broadly prohibits the importation of prescription drugs. The statute specifically prohibits the importation or introduction of any “new drug” into interstate commerce which has not been approved by the FDA, any prescription drug not labeled as required by federal law, or any prescription drug dispensed without a valid prescription written by a licensed American practitioner. See 21 U.S.C. § 355; 21 U.S.C. § 352, 353; 21 U.S.C. § 353(b).

functionally equivalent. Therefore, even drugs that are manufactured abroad with the same chemical composition as their U.S. counterparts are considered illegal to import because of these strict labeling requirements.


Although the practice is technically illegal, it appears that enforcement is selective, particularly when small amounts of prescription drugs imported for personal use are involved, either via U.S. mail or in baggage. According to the FDA’s own website, it does not typically object to the personal importation of unapproved drugs when all of the following conditions are met: the drug is for use for a serious condition for which effective treatment is not available in the United States; there is no commercialization or promotion of the drug to U.S. residents; the drug does not represent an unreasonable risk; the individual importing the drug verifies in writing that it is for his or her own use and provides contact information for the treating physician or shows that the product is for the continuation of treatment begun in a foreign country; and, generally, no more than a three-month supply of the drug is imported. See http://www.fda.gov/AboutFDA/Transparency/ Basics/ucm194904.htm.

While individual consumers may reasonably rely on the FDA’s selective enforcement in this context, a company maintaining a business model or a self-funded plan utilizing a drug importation program might not.

Federal law considers a drug to be misbranded if, at any time prior to dispensing, the label of the drug fails to include the symbol “Rx only.” See 21 U.S.C. § 353(b)(4) (A). Drugs that are dispensed by international pharmacies do not bear this label.

For example, Canadian pharmacies label their drugs with the tag “Pr,” as opposed to “Rx only,” and federal law does not consider these labels to be

MARCH 2020


When the FDA has acted, it has been against companies engaged in or assisting with the importation of drugs through the U.S. mail. For example, on February 26, 2019, the FDA issued a “Warning Letter” to CanaRx, a vendor which administers a popular drug importation program to self-funded employers and their covered participants. See https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm632061. htm.

Though this mail order program, the vendor essentially acts as an agent connecting patients to foreign pharmacies in “Tier 1” countries - those which meet certain standards in drug regulation - which ship the foreign version of a prescription drug directly to the patient. The patient’s health plan is then invoiced for the cost.

The FDA’s warning letter asserts that this mail order program violates numerous provisions of federal law. While CanaRx responded to the warning letter defending the legality of its program, the position taken by the FDA with respect to mail order drug importation is consistent with similar enforcement actions the FDA has taken in the past.


In contrast with using mail order drug importation programs, the state of Utah has become the first large health insurer to utilize a pharmacy tourism drug importation

program. Implemented in 2019, the program has already saved the state nearly $250,000, according to the plan’s managing director.

Due to the program’s avoidance of the U.S. mail system, carefully crafted policies and procedures, and narrow criteria for eligibility, it appears far less likely to attract the attention of the FDA than typical mail order programs.

Utah’s Public Employee Health Plan is self-funded and self-administered, covering roughly 160,000 individuals. The state had been considering various options to deal with skyrocketing drug costs. It decided against using a mail order program and instead opted for a pharmacy tourism model. In 2019, it implemented a voluntary Pharmacy Tourism Program which is offered to patients taking one or more of thirteen specialty drugs, dealing mostly with rheumatoid arthritis, multiple sclerosis, and other serious, chronic conditions. The program currently covers approximately 400 people.

As part of the program, the plan pays its plan participants to fly to either San Diego, California or Vancouver, Canada. If they are headed to Mexico, the plan pays to drive them to a specified hospital in Tijuana to pick up a 90-day supply of medicine. A representative from a specialty pharmacy escorts the plan participant across the border and stays with the individual at all



times. If necessary, the plan also covers lodging costs.

Plan participants still pay their usual copayments and are incentivized to participate in the program through a $500 cash incentive. The plan works with a designated hospital to coordinate travel and arrange for the purchase of the drugs. Throughout this process, the plan tracks the medications from the manufacturer to the pharmacy to the patient, increasing the likelihood that the integrity of the chain of custody is maintained.

integrity of the chain of custody is one important factor in determining whether the agency will scrutinize any particular drug importation program. The agency seems more concerned about programs that involve introducing foreign drugs into the U.S. mail system than it is about individuals acquiring foreign drugs at the point of sale and carrying them across the border.

With mail order programs, such as the one introduced by the state of Maine a few years back, there could be many entities mailing foreign drugs to individuals in the U.S. It would be very difficult for the FDA to track those entities and to ensure the integrity of the chain of command.

By contrast, with Utah’s program, an individual is completing the transaction in person at a designated facility and is accompanied by a representative from a specialty pharmacy. There is no middleman involved in transporting the foreign drug from the pharmacy to the individual, which significantly lessens the commercialization of the process.

In reviewing the FDA’s previous enforcement actions, it is clear that the

From operating rooms to board rooms,

QBE is there.

No matter where you do business, you can trust QBE to deliver flexible solutions for self-funded and alternative risk structures. As an integrated specialist insurer, QBE applies deep technical expertise to deliver future-ready products, customized underwriting solutions and superior service — all backed by a strong balance sheet and well-diversified portfolio. Turn to QBE for the certainty you need to manage your business across the globe and discover what’s possible, wherever you are.

Learn more about QBE at qbe.com/us QBE and the links logo are registered service marks of QBE Insurance Group Limited. © 2020 QBE Holdings, Inc.


MARCH 2020


Also, scale matters in this context and for pharmacy tourism programs, utilization is lower than it would be for mail order programs (so far only ten plan participants have traveled to Mexico under Utah’s program).

As explained, all drug importation programs are technically illegal in the United States. There are no guaranteed approaches to avoiding FDA enforcement of federal law. Still, the FDA applies enforcement discretion and very seldom seizes incoming drugs or prosecutes individuals when the importation is conducted under the right circumstances.

Politicians in Utah estimate that its pharmacy tourism program could save the state’s self-funded plan north of $1 million if more eligible individuals sign up. So long as bipartisan legislative reform remains just out of reach, self-funded plans will continue to pursue alternative approaches as cost-saving measures. If nothing else, these approaches are a constant reminder of a broken system in desperate need of repair.

Brady Bizarro is an attorney with The Phia Group, LLC



Written By Karrie Hyatt





ntil recently, the primary market for captive domiciles has been the United States, followed closely by Europe. However, that is changing as the abundance of U.S. domiciles is taking a larger share of captive business domestically. International captive domiciles are looking to emerging economic markets for new captive business, just as more countries and territories are looking to be captive domiciles.

At the end of 2018 (the last year for which complete data is available), fewer international domiciles appeared in the top ten rankings by number of captives. At the end of 2015, the top domiciles in the world were: Bermuda, Cayman Islands, Vermont, Utah, Delaware, Guernsey, Anguilla, Nevis, Barbados, and Luxembourg. The U.S. had only three state domiciles in the top ten list. By 2018, North Carolina and Hawaii had both made it to the top ten and more U.S. state domiciles will likely be added to the list in the next few years, as domestic captives continue to grow.



While Bermuda and the Cayman Islands remain the top two domiciles in the world, they are facing major competition, not only from U.S. domiciles, but also emerging domiciles from around the world eager to get into the captive sector.


The growth of captives since the 1980s has been primarily among business in North America and Europe, with a scattering of captives from businesses in the rest of the world. Even with the explosive growth of captives in the last ten years, there are still very few captives in Asia, Latin America, comparatively. There has not been much exposure to either risk management or captives in those regions. Captive professionals and captive associations have been working to change that.

powerhouse economies in Asia and Japan-based companies have already found the benefits of forming captives—many of them domiciled in Hawaii. China, with its much more recent economic growth, is just realizing how captives can benefit businesses. Its insurance market is relatively new, so alternative risk transfer vehicles will likely grow hand-in-hand with their insurance sector.

There are several other economies in the region showing large growth, including Indonesia, Malaysia, and Vietnam. These countries will be the focus of captive growth in the coming years.

Another region that is emerging as a captive market is Latin America—countries in the Western Hemisphere that speak primarily Spanish and Portuguese, including Mexico and Puerto Rico. Captives have been slow to take a foothold in this region, despite large, and growing, economies in Argentina, Brazil, and Peru.

The lack of captive growth in Latin America is partially due, again, to lack of information about the advantages of the captive structure. However, many countries in the region have an additional legislative hurdle to jump when forming a captive.

In many countries in this region, captives that are not approved to conduct business— meaning that they are domiciled outside the jurisdiction in which they are going to operate—will have to use both a local insurance carrier and a local reinsurer in order

Another reason that captives may not be on the radar of businesses in these regions is that the extended soft market has kept capacity open in the traditional market, allowing businesses to grow without feeling the pinch of large premium increases. This is changing as the global insurance market is firming with an impending hard market to follow.

With or without the hard market, as the economies of countries in these regions grow, interest in captives is picking up. The most significant emerging region is Asia. Japan and China are the two

MARCH 2020


to do business—rather than just one fronting carrier. This is known as double fronting and can cost captives two to six percent of premiums. Some countries, such as Argentina, are working to rectify this issue to create more captive business opportunities.


According to an A.M. Best market segment report published last May titled “Asia-Pacific Captive Domiciles Poised for Growth,” in 2018 there was estimated to be 6,337 captives worldwide. Fifty-one percent of those captives were domiciled in the U.S. and 34.9% were domiciled in offshore domiciles located in the North

Atlantic and Caribbean (Bermuda, Cayman Islands, etc.). “The remainder consists of captive insurers domiciled in Europe (11.2%), Asia-Pacific (2.8%), and Canada (0.3%). Although Asia-Pacific is home to massive economies such as China and Japan, the region’s captive insurance market remains small.”

Singapore is currently the largest domicile in Asia, but Labuan is growing rapidly. Singapore established captive law in 1983, making it the grandparent of captive domiciles in Asia, and had 72 captives in 2019. Labuan, an island off the coast of Malaysia that has established a special economic zone, established captive law in 2010 and has grown steadily since, with 48 captives at the end of 2018.

Last year, it took home the award for Best Captive Domicile in Asia given by Asia Captive Review. Its captive legislation allows for a wide range of captives, including cell captives, which makes it attractive to many types of companies.


Predictive Analytics That Optimize The Future Our Health Benefits Consulting Suite is comprised of three applications for employee benefits professionals who want powerful, credible, and easy to use tools that deepen and expand their consulting capabilities for their client’s health benefits plans.




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.

The Federated States of Micronesia based its regulatory standards on Bermuda and Hawaii and has attracted a number of Japanese captives—25 as of May 2018. The number of captives in Hong Kong and China are both in the single digits, but with companies in China maturing and beginning to take a closer look at risk management, the number is expected to grow quickly.

While Asia is considered an emerging market for both captives and captive domiciles, Latin America is only seen as an emerging market for captives. There are only two captive domiciles in the region—Panama and Puerto Rico—and neither of them have distinguished themselves at this point. Cayman Islands, Bermuda, and other North Atlantic domiciles have their sights set on Latin America. British Columbia, Canada’s only captive domicile, is also looking to expand into that region.

The desire to be a captive domicile is spreading to the far reaches of the world. In the Middle East, Bahrain and Dubai are the only currently active domiciles. However, Abu Dhabi is working to set itself up as the next captive domicile in the region. Both Abu Dhabi and Dubai are in the United Arab Emirate and operate as independent financial centers. A first in central Asia, Kazakhstan has entered the captive sector after instituting captive law. Located between Georgia and Mongolia, the former Soviet Republic acquired its first captive in early 2020. Kazakhstan Energy Reinsurance Company, redomiciled to its home country from Bermuda, where it was formed in 2004.

MARCH 2020





IIA’s Annual Self-Insured Workers’ Compensation Executive Forum will be May 12-14th at Renaissance Cincinnati Downtown Hotel in Cincinnati, Ohio.

The Self-Insured Workers’ Compensation Executive Forum is the country’s premier association sponsored conference dedicated exclusively to self-insured Workers’ Compensation. In addition to a strong educational program focusing on such topics as excess insurance and risk management strategies, this event will offer tremendous networking opportunities that are specifically designed to help you strengthen your business relationships within the self-insured/alternative risk transfer industry.



ENDEAVORS Educational Highlights include:

Self-Insurance in the Roaring 20’s with John Means Cooper, VP Excess Workers’ Compensation at AmWINS Brokerage of the Carolinas and Greg Toll, Director of Business Development for Broadspire There’s a lot going on in workers’ compensation as we head into the new decade. Insurance is a little all over the place. Regulatory changes are frequent and often controversial. TPAs are rapidly consolidating while vendors are fighting for a space at the table. Come get the lowdown on what’s going on, why it’s important and how to make the most of this dynamic environment.

Mitigating Top Cyber Security Risks Facing Insurers with Virginia Johnson, Executive Vice President, National Accounts of Franco Signor LLC moderating speakers Felix Negron, CEO of threatSHIELD security, Kevin Strope, Associate Director of Protiviti Inc. and additional speakers to be announced The insurance industry faces immense challenges of emerging risks from accelerated regulatory developments and ever-growing cyber threats. Our session will touch on steps to address the risks insurers face today and what insurers may encounter in the not-so-distant future. Hear from an organization that experienced the impact of a breach, and the steps they took to address vulnerabilities.

Practical Lessons From Companies Deploying AI Solutions: Lessons in Leadership with Stan Smith, Founder and CEO of gradient A.I. What leads to the best results and conversely what actions tend not to have the desired outcomes? This session will describe what can AI do and what is beyond its capabilities. Learn when a change management may be needed and how to take action to do so. Hear about what time frames are realistic versus what are fiction. You will come away from this session ready to start your journey and what comes next.

How Technology is Improving Safety with Sally Pace, CEO of Connect Healthcare Collaboration moderating speakers Tamra Gammon, Director of Safety and Continuous Improvement of Tillamook Dairy Products and Nic Patee, Founder and CEO of Work Right NW Technology is a beautiful thing, when used correctly. But, what should employers be looking for in using technology? And, what metrics should they expect to impact the overall prevention of workplace comp-related issues? We’ll hear from the employer’s perspective how to incorporate innovative technology into the day-to-day risk management of a company.

MARCH 2020



Keynote Address with Kristin Scroggin, Owner & Lead Trainer of genWHY Communications It's common in the US to have four generations represented in the same office meeting. Learn theories and ideas to improve interactions between employees at every level of your organization to ensure a happier, healthier, more engaged workforce and reduce turnover.

The New Digital Age and Workers' Comp with Michael Morris, Administrator/CEO of HomeBuilders SIF moderating and Cameron MacArthur, CEO of A.I. Insurance, Inc.



In this digital age, there is an explosion of how technology is being leveraged to change how things are done. Typically, the insurance world is cautious, and slow to change. But it feels like there is an increasing realization that new technology will change how workers comp is administered. This session will explore the idea of introducing new and innovative concepts into an age-old structure.

PTSD – The Next Big Crisis in Workers’ Comp Claims with John Means Cooper, VP Excess Workers’ Compensation of AmWINS Brokerage of the Carolinas moderating panelists Dr. Fernando Branco, Chief Medical Officer of Midwest Employers Casualty, Geoff Jones, Senior Claims Attorney of Midwest Employers Casualty and Erin Saniga, Case Manager of Allegiant Managed Care LLC Increasingly PTSD is being extended beyond first responders to cover any employee affected by a traumatic event. Given that PTSD is a subjective diagnosis and that there is no standardized method of treatment, how do you prepare for this new type of claim? Join us as our experts weigh in on the medical and legal challenges PTSD presents as well as how to effectively get employees with PTSD back to work.

ENDEAVORS The “Virtual” Reality of Medical Treatment with Steve Kokulak, Vice President, Workers' Comp. of MagnaCare moderating speakers Dan Carlin, MD, Founder & CEO of JobSiteCare and Jeff Hathaway, PT, DPT, CEO/Founder of BreakThrough Physical Therapy

Therapy to address pain behavior change and reduce downstream healthcare utilization. Understand how pain neuroscience impacts on treatment and duration of care as well as opioid use.

Learn how one general contractor reduced their workers’ compensation losses, and better managed their employees back to work, through the implementation of a virtual on site clinic. Imagine combining the roles of telemedicine, nurse triage, medical director, and concierge care all into one solution. We will also explore how virtual reality is being integrated into Physical

The necessity of regulatory relationships, being involved legislative process, as well as being active at the NAIC level. Presenters will also discuss the latest on the federal scene regarding workers compensation. Presenters will discuss a need for a seat at the table at every level.

You Need a Seat at the Table with Charles C. Caldwell, President & CEO of Midlands Management Corp. moderating and Fred Karlinsky, Shareholder of Greenberg Traurig, LLP

Best Practices for Self-Insureds with Joseph Blanche, President, FutureComp Division of USI/FutureComp, Joe Clifford, Area Vice President of Programs of RPS Regency and Stu Thompson, CEO of The Builders Group

One in eight employees will have difficulties starting a family. ARC’s Customized and Cost Effective Fertility Benefits help employees reach their family building goals.

Learn about ARC’s Employer Program alee@arcfertility.com or (888) 878-0025 www.arcfertility.com/employers



ENDEAVORS Workplace Violence: Developing a TraumaInformed Model with Carol DiPietro, Vice President, Sales of Paradigm Outcomes moderating and speakers to be announced

Discuss with TPA's who provide services to the self-insured industry, and the Administrators who utilize these "best practices" in successfully administering their Groups. Content will be helpful for both SIG's and individual self- insureds as a benchmark for their own daily responsibilities. The session is meant to be interactive with the audience in a sharing of what will make their self - insured programs and their TPA organization more successful and efficient. The Formulary Effect with Shawn Mackey, Vice President of AmWINS Brokerage of New York, Inc. moderating Jeanne Battaglia, MS, CRC, President of Managed Care Network, Inc., Robyn Satterfield, PharmD, COO of Alius Health, LLC Prescription medications make up 14% of all medical costs on workers’ compensation claims and a much higher percentage of medical costs on legacy claims. While the prescription drug prices continue to increase, the workers’ compensation industry faces additional challenges such as the Opioid Epidemic and Physician Dispensing. Many states are now implementing formularies to address these trends. In this session, we will discuss the different types of formularies, how and where they have been implemented, and the outcomes states have experienced as a result of the formularies.

Violence in the workplace presents an unbelievable challenge for employees, employers and workers’ compensation providers. Victims are left feeling violated and traumatized. Usually, the workplace will be locked down for months due to investigations. Claim reporting, medical care, benefit delivery are disrupted and your protocols will seem overly burdensome in the midst of chaos. How can you cut to the chase to provide valuable victim support? Are you prepared for immediate response? Learn how to create a first response team, coordinate with other responders and service providers to maximize benefits, and provide trauma informed support and recovery. An informed and helpful response makes a positive impact on recovery.

MARCH 2020


ENDEAVORS Bringing It All Together with Sally Pace, CEO of Connect Healthcare Collaboration, LLC What’s the point of investing time and energy at a conference if you leave without a solid game plan and ideas to implement? As the conference draws to a close, you won’t want to miss our final session – giving attendees a chance to compare notes to discuss what the top takeaways from sessions, as well as share action items that can be replicated. Not only will you have an opportunity to develop your own roadmap, you’ll also have one final chance to network and build relationships across the industry.

If you’re looking for a way to gain exposure with conference registrants and position your company as an industry leader, then add a sponsorship to your marketing plan. Sponsorships are cost-effective and targeted tools that can help your company accomplish its marketing and sales goals. SIIA’s Self-Insured Workers’ Compensation Executive Forum delivers senior-level executives. For more information visit www.siia.org.

Offers a strategic approach to prescription drug benefit programs that delivers cost savings, superior risk management and clinical designs that are sustainable over the long term. Serves employer groups, labor groups, small health plans, coalitions and third party administrators.

Mary Ann Carlisle, CEO mcarlisle@elmcgroup.com 484.433.1412

Provides comprehensive solutions to policyholders and their consultants in the Labor and Union sectors. Underwrites and manages Specific and Aggregate stop loss products for Taft-Hartley and Labor and Public Sector plans on behalf of our insurance carrier partners. CM Risk is a division of IOA Re, a leading national MGU. Arlene Cayetano, Executive Vice President & General Manager acayetano@gocmrisk.com 317.771.1399

ELMC Risk Solutions has assembled some of the most innovative minds in stop-loss reinsurance and prescription drug consulting businesses.




Claims Processing, Simplified.

See for yourself.




2020 MARCH MEMBER NEWS SIIA Diamond, Gold & Silver Member News SIIA Diamond, Gold, and Silver member companies are leaders in the self-insurance/captive insurance marketplace. Provided below are news highlights from these upgraded members. News items should be submitted to 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. 46



“Mark has utilized his strategic and execution-oriented approach to help HM INSURANCE GROUP PROMOTES DAVE MANNING TO bring our business to new heights. He DIRECTOR, UNDERWRITING is a champion for Renalogic’s vision and core values, and is a natural fit as Dave Manning has been promoted to director, Underwriting. In this role, he will take President,” said Lisa Moody, CEO of over responsibility for New England, New York and the West Coast. He also will be Renalogic. “We have created the most responsible (from an underwriting perspective) for producer agreements with Willis comprehensive approach to kidney care Towers Watson and Brown & Brown. in the industry. I am very proud of the Dave joined HM in August 2019 as a consultant underwriter and worked primarily on record growth we have achieved and the underwriting business from Willis Towers Watson throughout the renewal season. He difference we are making in our client’s lives.” joined HM from Symetra, where he held senior positions in underwriting leadership and also has experience at The Hartford. As Renalogic’s President, Mark will lead the company’s process teams, including Dave brings a wealth of industry knowledge and experience to his new role, and I expect he will be a significant resource for our current underwriting and sales teams sales and marketing, quality and strategy, project management, IT and data, cost and our clients. He is a graduate of Boston University and lives in the Hartford, containment, and the Kidney Dialysis Connecticut, area. Avoidance Program (KDAP). He will About HM Insurance Group be directly responsible for supporting future business partnerships, furthering HM Insurance Group (HM) works to protect businesses from the potential Renalogic’s organizational health financial risk associated with catastrophic health care costs. The company provides initiatives in order the help drive the reinsurance solutions that address risk situations confronting employers, providers company’s financial health. and payers. A recognized leader in employer stop loss, HM also offers managed care reinsurance nationally. Through its insurance companies, HM Insurance “I am excited to lead Renalogic’s Group holds insurance licenses in 50 states and the District of Columbia and passionate team and partners who are maintains sales offices across the country. Visit hmig.com. tireless advocates for our clients,” said

RENALOGIC PROMOTES MARK MASSON TO PRESIDENT PHOENIX, AZ -- Renalogic, the leader in comprehensive kidney care and dialysis cost containment, announced Mark Masson has been promoted to President following a year of unprecedented growth for the company. Renalogic has operated for nearly two decades around a central mission: to drive positive change for kidney disease and cost management. The company continues to be the leader in innovative services for dialysis cost containment and has proven results in delaying or preventing the progression to dialysis for its members. In 2019, Renalogic’s revenue grew over 60%, its profitability increased by 16%, and the company more than doubled its headcount. Mark Masson joined Renalogic in 2018 with 25 years of diversified experience across the healthcare sector in operations, sales and marketing, product development, and M&A.

Mark Masson. “Renalogic is transforming how the industry thinks about kidney care and dialysis, and I am thrilled to be at the forefront of this mission.” About Renalogic Renalogic has been the industry leader in dialysis cost containment for nearly 20 years and continues to innovate through the impact of The Renalogic Chronic Kidney Disease and Diabetes Management Program. We are not abandoning dialysis cost containment. We are revolutionizing it by simplifying the costs and clinical complexities of chronic kidney disease to make a positive impact on reducing the dialysis incidence rate in every population we

MARCH 2020


NEWS touch. Every chronic condition leading to kidney disease is manageable and even preventable when identified early. Visit www.renalogic.com.

“When Josh founded this company 17 years ago, he did so with a vision to solve the complex administrative challenges affecting healthcare costs – and that vision still drives us today,” said Gelb. “It is an honor to be selected as CEO to continue moving forward through the power of innovation and next-generation data integration.”


Since joining Valenz, Gelb has been instrumental in integrating key acquisitions that created the foundation for the company’s single-source solutions and data analytics platform, also known as the Valenz health administrative ecosystem. Throughout his 30+ year career, he has held leadership positions at several prestigious firms, including York (now Sedgwick), Coventry, CIGNA and others.

EXECUTIVES Key Leadership Moves Support Rapid Expansion of Industry’s First Health Administrative Ecosystem PHOENIX, Ariz. — The Board of Directors at VālenzTM today announced the appointment of Rob Gelb as Chief Executive Officer. Gelb, who joined the firm in 2018 as Chief Revenue Officer, succeeds Josh Carder as CEO, while Carder assumes a new position as Chairman of the Board.

“Rob is a highly esteemed leader with a proven record of strategic and tactical success in creating and expanding healthy companies, and I am thrilled that he is now taking the reins as CEO of Valenz,” said Carder, adding that he is equally excited to become Chairman of the Board, where he can continue to influence the Valenz vision and promise of smarter, better, faster healthcare. In addition to Gelb’s appointment, the board also announced that Amy Gasbarro has been appointed to Chief Operations Officer. With an extensive leadership background spanning two decades at companies focused on population health and cost management solutions for self-funded employers, Gasbarro joined Valenz in 2018 as President of Vālenz Care, the firm’s care management solution.

Don’t Be Left Behind!

Let Ringmaster Technologies Drive You Into the Future of Healthcare Stop-Loss Automation. We provide fully automated integrated applications for your entire administrative Stop-Loss processes and workflows. rmtsales@ringmastertech.com • 913.521.2204 • ringmastertech.com



Delaware Advantage • Delaware takes captive insurance company licensing to a new level that Speeds to Market the licensing process. • Delaware is the first in the nation to electronically offer a conditional certificate of authority as part of the general application. • Delaware’s conditional certificate of authority means receiving a license to conduct insurance business the same day of submitting the application to do business.

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

Trinidad Navarro

Insurance Commissioner

BUREAU OF CAPTIVE & FINANCIAL INSURANCE PRODUCTS Delaware Department of Insurance 1007 Orange Street, Suite 1010 Wilmington, DE 19801 302-577-5280 | captive.delaware.gov Trinidad Navarro, Insurance Commissioner

NEWS “Through the analytic and predictive power of the ecosystem, we are continuously expanding our ability to influence better health outcomes and reduce total cost of care,” said Gasbarro. “This is a very exciting time for Valenz, and I look forward to my new role in shaping a more prosperous future for our company, and more importantly, for our clients.” About Valenz Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single- source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. For more information, visit www.valenzhealth.com. Valenz is backed by Great Point Partners. About Great Point Partners Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

GOLD MEMBERS JEFF BROWN JOINS ADVANCED MEDICAL PRICING SOLUTIONS (AMPS) AS NEW REGIONAL VICE PRESIDENT OF SALES Peachtree Corners, GA -- Advanced Medical Pricing Solutions (AMPS) has expanded its channel sales team with the hire of Jeff Brown as Regional Vice President of Sales. His focus will be on new business development in the Western region. Previously with UMR and EBMS, Jeff joins AMPS with proven success in delivering comprehensive strategies and tactics to meet business development objectives. His knowledge of self-funded Health Plans and reference-based pricing programs make him an exceptional addition to the AMPS sales team. In 2019, AMPS reported record growth, under the guidance of a new and experienced leadership team. The industry is experiencing an explosive increase in the number of self-insured Health Plans and claim pricing is a primary focus in controlling overall costs. Jeff Brown will reinforce the importance of AMPS’ products and services as a way for prospects to manage their healthcare spend. To contact Jeff, email jeffreybrown@ advancedpricing.com.



ADVANCED MEDICAL PRICING SOLUTIONS (AMPS) HIRES NEW MARKETING SPECIALIST, AMANDA HERTIG Peachtree Corners, GA -- Advanced Medical Pricing Solutions (AMPS) is pleased to announce its recent hire, Amanda Hertig, who has joined the enterprise as a Corporate Marketing Specialist, working out of the new Phoenix, AZ office. Within this role, Hertig will be a strategic player in supporting AMPS through its continued growth and evolution as a market leading healthcare pricing and technology company. “I was attracted by the company’s mission to provide outstanding service to their clients, while materially reducing healthcare costs. By providing the selffunded market with the necessary tools for data-driven outcomes, they can keep their member’s satisfied with quality healthcare benefits. This will truly create a sustainable difference within the healthcare space.” Hertig comes to AMPS with a BS in Marketing and Public Relations, and over fifteen years’ experience as a Marketing professional, with five years in the healthcare industry. Previously with United Claim Solutions, now Valenz Health, she has worked extensively in brand management, digital media, event planning, graphic design and has worked diligently to educate both clients and members through targeted outreach. To contact Amanda Hertig, email ahertig@advancedpricing. com.

Work with a company that makes connections.

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

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



Coverage is underwritten by HM Life Insurance Company, Pittsburgh, PA; Highmark Casualty Insurance Company, Pittsburgh, PA; or HM Life Insurance Company of New York, New York, NY. MTG-3258 (2/20)

Alicia Rodriguez with her Paradigm Network Manager Brook Feerick, RN, CCM, CLCP

Catastrophic injuries are more than physical. They’re emotional as well. Our innovative Whole Person approach treats both mind and body. By considering every way a worker is affected by a catastrophic injury, we’re making people and their families whole again.

Learn more at: www.paradigmcorp.com

NEWS AMPS APPOINTS HEALTHCARE LEGAL VETERAN AS GENERAL COUNSEL ATLANTA, GA – Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the selfinsurance industry, today announced the appointment of Attorney Laura A. Conte, a healthcare legal industry veteran with a quarter-century of experience, as General Counsel. In her new role, Attorney Conte’s responsibilities include oversight of all legal issues within AMPS’ internal and external departments, contract management and design, negotiations and settlement structures for cost containment and corporate governance and business policy. Previously, Attorney Conte served as General Counsel and Chief Claims Officer for Massachusetts-based healthcare technology company Advanced Medical Strategies where she managed the company’s legal affairs on a broad range of matters, including internal audits and assessments. Prior to that, she served as General Counsel for INTEICO Inc. and as Vice President and Chief Compliance Officer for TRU Services Inc. Attorney Conte is a graduate of Massachusetts School of Law and Suffolk University.

“I am delighted to join such a talented team of professionals that is committed to reducing healthcare costs while

maintaining high-quality care,” Conte said. “Over my 25plus years in this industry, I have watched AMPS grow and succeed in an ever-changing market. The team’s corporate values in leadership and dedication to true cost containment align with my values as an attorney.” “Self-funded employers and other consumers of healthcare and health insurance have for too long been forced onto an unsustainable path of absurdly rising costs that divert resources from investments that could instead drive economic and job growth,” said Kirk Fallbacher, CEO, AMPS. “We are excited to add Laura’s expertise and experience to our legal team as we continue advocating for our members to secure healthcare pricing that’s fair and affordable for all.” AMPS’ addition of Attorney Conte follows the continued expansion of its executive team, which recently added several healthcare and health insurance industry veterans to its leadership team. The addition of these new experts, who together bring decades of experience in bending the cost curve to control the skyrocketing cost of healthcare, will help AMPS greatly enhance its ability to serve self-funded employer groups, brokers and third-party administrators.

AMPS EXPANDS LEADERSHIP TEAM WITH INDUSTRY EXPERTS IN HEALTHCARE COST CONTAINMENT ATLANTA, GA – Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, today announced the addition of six healthcare and health insurance industry veterans to its executive leadership team. The addition of these new experts, who together bring decades of experience in bending the cost curve to control the skyrocketing cost of healthcare, will help AMPS greatly enhance its ability to serve the self-funded industry. In the C-suite, Thaddeus Kwiatkowski has assumed the duties of Chief Financial Officer. Mr. Kwiatkowski brings a proven track record in finance, administration and accounting across several diverse industries, including healthcare, software, major airlines and communication services. He will be charged with maintaining the financial health of the organization as well as planning for the explosive growth AMPS expects in 2020 as more employers seek to tame their investments in health insurance. Mr. Kwiatkowski joins AMPS from Cotiviti, where he was Vice President, Global Financial Planning and Analysis. His healthcare finance experience includes serving as Vice President, Financial Planning and Analysis at nThrive and Director of Finance,

MARCH 2020


NEWS Spend and Clinical Management at MedAssets. He holds a Bachelor of Business Administration degree in management information systems and finance from the University of Georgia. The C-suite was further expanded with the addition of Lawrence Thompson as Chief Strategy and Revenue Officer. Mr. Thompson will be focused on using his more than 40 years of healthcare delivery experience to enhance AMPS corporate strategy, revenue and growth as well as augmenting the organization’s capabilities in client services. Mr. Thompson comes to AMPS after serving as co-founder and CEO at Inventavis as well as President/CEO at BSI Consulting. Prior to joining BSI, he was Regional President at POMCO and President of Health Insurance Company of America. He holds a Master of Business Administration in finance from the University of South Florida and a Bachelor of Arts, economics and management from Florida Presbyterian/ Eckerd College. AMPS also added two new senior vice presidents, each of whom will have direct oversight over specific functional areas. Their goals will be to ensure AMPS delivers world-class performance in those areas. Jonathan Jeffress was appointed to the position of Senior Vice President of Operations, where he will oversee daily operations as well as the delivery of AMPS solutions to the organization’s growing client list. Mr. Jeffress has more than 20 years of experience serving healthcare and health insurance organizations, and brings in-depth expertise in organizational management, process improvement, implementation/

integration, IT and service delivery. Before joining AMPS, he served as Vice President of Operations, Client Delivery and Implementation Services at Cotiviti. His experience also includes management positions at industry leaders Xerox and Lockheed Martin. Mr. Jeffress is an alumnus of the University of Alabama. Evelyn Kemp was promoted to the newly created position of Senior Vice President, Client Services after joining AMPS in 2017 as Vice President, Account Management. Ms. Kemp will lead the account management, advocacy and care navigation teams as they work to help self-insured plans take back control of their healthcare spend and educate their members to get them engaged in lowering their healthcare costs. Prior to joining AMPS, Ms. Kemp was a Senior Account Manager at Zelis Healthcare and served as an Account Manager at Viant. She holds a Bachelor of Business Administration from Kennesaw State University. This stellar executive team was put together by Kirk Fallbacher, who became President and CEO of AMPS after joining the organization in 2016 as its Chief Operating Officer/Chief Technology Officer. Mr. Fallbacher brings more than 20 years of experience serving healthcare and health insurance organizations with indepth experience in IT strategy, service delivery, enterprise integration, application development and analytic solutions. He has also served in leadership roles at several technology and consulting firms, most recently as Healthcare Practice Director at Netrix, LLC. While there, he also served as a board member on Ingram Micro’s Healthcare Advisory Council. Prior to those positions he was CEO and President of ITR Mobility when it was acquired by Zebra Technologies, and a principal at Trill Systems. His entrepreneurial and analytics experience includes positions as Chief Technology Officer/Chief Operating Officer at Swingtide, Vice President at Alternian, President/ Chief Technology Officer at Who2Trust and President at Geneva Software, which was acquired by Platinum Technology where he became Vice President, Network Management. Mr. Fallbacher holds a Bachelor of Science, computer science and mathematics degree from Western Illinois University. “Over the last few years, the cost of health insurance and healthcare has risen dramatically for employers and their employees,” said Mr. Fallbacher. “It is clear the path the U.S. is on is unsustainable. AMPS’ entire reason for being is to reverse that trend and help make healthcare fair and affordable for everyone. We have developed unique solutions and have now assembled a team of outstanding professionals to help us bring those solutions to all who need them. When I look at the talent, we now have on our leadership team I can’t help but get excited for the future, and I believe our clients will as well. We are excited for our team to bring years of experience to help even more organizations and individuals contain their costs at every level throughout the healthcare industry.”

MARCH 2020


NEWS About AMPS Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers, TPAs, and reinsurers. AMPS mission is to help clients attain their goals of reducing healthcare costs while keeping members satisfied with quality healthcare benefits. AMPS leverages 15 years of experience in auditing and pricing medical claims to deliver “fair for all” pricing both pre-care and post-care. AMPS offers innovative dashboards and analytics to provide clients with insights based on Plan performance. Learn more at www.advancedpricing.com

SILVER MEMBERS JACKSON LEWIS TAPS HOWARD SHAPIRO AS CO-LEADER OF ERISA LITIGATION PRACTICE NEW ORLEANS, LA - Jackson Lewis P.C., one of the country’s preeminent workplace law firms, is pleased to announce Howard Shapiro has joined the firm’s New Orleans office as a Principal. Mr. Shapiro has almost 40 years of experience in the employee benefits litigation space and is nationally recognized as one of the top ERISA litigators in the country. He joins the firm from Proskauer, where he was Co-Leader of the firm’s national ERISA Litigation practice and the Office Managing Partner in New Orleans. Mr. Shapiro will serve as Co-Leader of Jackson Lewis’ ERISA Complex Litigation Group alongside René E. Thorne.

“Howard is a first-rate, nationallyacclaimed ERISA litigator and we are excited that he has joined Jackson Lewis,” said Firm Co-Chairs William J. Anthony and Kevin G. Lauri in a joint statement. “His arrival at the firm elevates the firm’s national ERISA litigation capabilities and was the key factor in our decision to augment our existing ERISA litigation team by creating the ERISA Complex Litigation Group. René and Howard worked together closely in other firms for more than a decade, honing their complex ERISA litigation skills. The firm is dedicating significant resources to the newly formed ERISA Complex Litigation Group.” The ERISA Complex Litigation Group has immediate and ready access to the firm’s entire Employee Benefits Practice Group and the Class Actions and Complex Litigation Practice Group to address comprehensive client needs in the ERISA litigation space. Mr. Shapiro’s practice focuses on the defense of large, sophisticated ERISA class actions. He defends “bet-thecompany” litigation where damages are potentially material. His cases involve the defense of Defined Benefit plans, 401(k) Plans, and 403(b) Plans. Mr. Shapiro also defends litigation involving health and welfare plan issues. His practice is nationwide, and throughout his career, Mr. Shapiro has appeared as counsel across the entire country. Typically, his cases involve damage allegations in excess of hundreds of millions of dollars. Mr. Shapiro has defended cases involving: breach of fiduciary duty; breach of the duty of loyalty; Prohibited Transactions; 401(k) Plan asset




high expectations


expert capabilities


peace of mind

We’ve got your back. Four words that you want to hear when seeking to self-fund employee medical benefits, particularly when facing the potential costs and risks associated with a self-funded benefit plan. At Swiss Re Corporate Solutions, our integrative National Employer Captive program brings our brokers, payers and their clients extra peace of mind through protection against catastrophic claims. Designed for groups with 50-400 enrolled employees, this captive program allows a small or medium size employer to participate as a member of a risk bearing entity with like-minded employers, providing both peer support and long-term financial stability. Most importantly, captive members get to jointly control their own risk and spend only the money they use. We’re smarter together. corporatesolutions.swissre.com/eslcaptives Insurance products underwritten by Westport Insurance Corporations and North American Specialty Insurance Company. Š Swiss Re 2019. All rights reserved.

NEWS performance, fees, and expense issues; 403(b) Plan asset performance, fees, and expense issues; defined benefit plan asset issues, accrual issues, and cut-back issues; Cash Balance Plan issues; ESOP litigation; fiduciary misrepresentation claims; sophisticated preemption issues; Executive Compensation litigation, both pension and welfare claims; Directed Trustee claims; retiree rights litigation; severance plan class actions; Section 510 cases; and complex benefit claim cases. He has appeared in federal courts from coast to coast while maintaining an active national ERISA litigation practice. “When I retired from Proskauer, I considered a wide range of options and quickly decided that Jackson Lewis



was the right firm to continue my national ERISA litigation practice,” said Shapiro. “I have worked with René, Office Managing Principal Charles Seemann and several other attorneys in the New Orleans office, at various law firms since the 1990’s. The opportunity to ‘put the band back together’ was outcome determinative as the firm now has among the finest collection of ERISA litigation talent in the country. I am delighted to reunite with my former colleagues as we launch Jackson Lewis’ ERISA Complex Litigation Group.” Mr. Shapiro has been named as one of the Top 40 Benefits Lawyers in the country in the category of litigators representing management by The National Law Journal. Additionally, he has been featured as a Band 1 ranked attorney by Chambers and Partners, in the “ERISA Litigation in USA – Nationwide” category. Mr. Shapiro was one of the founding fellows and initial members of the Board of Governors of the American College of Employee Benefits Counsel and is a Fellow of the College of Labor and Employment Lawyers. Mr. Shapiro is also the former Chair of the American Bar Association Section of Labor and Employment Law, and past Chair of the American Bar Association's Joint Committee on Employee Benefits. He is ranked as a Top 10 attorney state-wide by Louisiana Super Lawyers. Additionally, Howard served as a member of the Board of Governors of the American Bar Association.

At AmWINS Group Benefits our team of specialists wakes up every morning committed to bringing your team innovative solutions to the opportunities and challenges you and your self-funded clients face. That’s the competitive advantage you get with AmWINS Group Benefits.


NEWS Mr. Shapiro received his J.D. from Loyola University New Orleans College of Law, his M.A. from McGill University and his B.A. from Tulane University. Mr. Shapiro is Jackson Lewis’ ninth lateral hire in the employee benefits practice within the past year. His arrival, combined with our existing ERISA litigation talent, resulted in the formation of the firm’s ERISA Complex Litigation Group. Last month, ERISA litigation pro Stacey C.S. Cerrone joined the firm as a Principal, along with seasoned ERISA litigation Associate, Lindsey H. Chopin, both also formerly of Proskauer. Jackson Lewis’ New Orleans office can be reached at (504) 208-1755. About Jackson Lewis Focused on labor and employment law since 1958, Jackson Lewis P.C.’s 950+ attorneys located in major cities nationwide consistently identify and respond to new ways workplace law intersects business. We help employers develop proactive strategies, strong policies and business-oriented solutions to cultivate high-functioning workforces that are engaged, stable and diverse, and share our clients' goals to emphasize inclusivity and respect for the contribution of every employee. Additional information about the firm can be found at jacksonlewis.com.

We’ve got a novel solution to improving health care benefits: Build plans that actually benefit the employers and employees who use them. At Homestead, we believe that’s the right way to go. Which means building plans with no network restrictions. No referrals. No hoops to jump through. Just plans built around the needs of our self-funded employer clients and their employees. Plus, on average, a Homestead Smart Health Plan saves as much as 30% on the total cost of healthcare without cost shifting to employees. All of which we think makes benefits…well, beneficial. Our proprietary, platform-agnostic Claim Watcher system is a powerful reference-based pricing tool for auditing and repricing that can either stand alone or work as part of a comprehensive benefits plan. And our Stop Loss services protect companies against catastrophic claims. Whether you are a TPA or a broker, a Homestead Smart Health Plan gives you a strong alternative to present to your clients that puts them at the center of the benefits equation. And that’s a real solution to improving health care benefits. Homestead Smart Health Plans. Better Health For All…together.

HomesteadPlans.com | 844 -307-3788



SIIA 2020 BOARD of directors & committee chair ROSTER




David Wilson President Windsor Strategy Partners, LLC Princeton, NJ

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


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

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


Peter Robinson Managing Principal EPIC Reinsurance San Francisco, CA

Mike Ferguson SIIA Simpsonville, SC

Robert Tierney President StarLine East Falmouth, MA

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

SIEF BOARD OF DIRECTORS Nigel Wallbank Chairman Heidi Leenay President

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

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

Freda Bacon Director Les Boughner Director Alex Giordano Director

MARCH 2020



Shmuel Melamed CEO ABC Insurance Trust Washington, DC

Nicole Lopes Marketing Programs Manager Enquiron Boston, MA Lois Irwin President EZaccessMD Rochester, NY


Richard Gray President/CEO Know the Costs®️ Athens, GA Pramod Ramakrishna Vice President MDI NetworX Baltimore, MD

Rebecca Pollard Business Solutions Salem, VA

Adrienne LaBorwit Director of Business Development True Rx Washington, IN

Gregory Smith Coral LLC Oklahoma City, OK Mayur Yermaneni Chief Strategy Officer eQHealth Solutions Baton Rouge, LA


Thomas DeNoma President Nevaeh Insurance Solutions Columbus, OH

Erik Newman Business Operations Director Schweitzer Engineering Laboratories, Inc. Pullman, WA

Erica DeGroff Pain Specialists of Charleston Charleston, SC


Jennifer Ryon Chief Revenue Officer Prime Health Services Franklin, TN

Matt Smith CFO First Mid Captive, Inc. Mattoon, IL

Our Solutions Won’t Drive You Mad At AccuRisk Solutions, we’ve put together a team of stop loss players that can win it all. Let’s talk about what you need to offer championship benefits. Let’s Meet. We’ll be at SIIA Executive Forum—will you? Schedule a meeting now.

info@accurisksolutions.com | accurisksolutions.com | (312) 857-9100




in healthcare waste & errors too much?

YES. At Zelis, we listen to what payers and providers want and bring technology, people, expertise, and entrepreneurial energy together to create smart solutions and a better way for the industry. Integrated solutions to price, pay, and explain healthcare on a claim by claim basis, all offered by one trusted company.

Maximized Claim Savings. Optimized Payments. Transparent Explanations. 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 2019 Zelis. All rights reserved.

When a fever disrupts a daily routine or the results of a diagnostic test disrupt your everything, we’re here to help. From episodic illnesses to the most complex and costly medical conditions, Teladoc Health is transforming how people access healthcare. In 2002, we set out to find a better way to connect doctors and patients. Today, Teladoc Health is the global virtual care leader, helping millions of people resolve their healthcare needs with confidence. With an award-winning user experience and scalable technology platform, Teladoc Health provides access to high-quality care for millions of people around the globe.

TeladocHealth.com | 1-844-798-3810 389048332 | 09032019

Š 2019 Teladoc Health, Inc. All rights reserved.

Profile for SIPC

Self Insurer March 2020