Self Insurer January 2019

JANUA RY 2 0 1 9

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

Self-Insurance & Captive

Convergence

As self-insurance and captive solutions continue to trickle down market, a multi-layered approach emerges with opportunities for service providers to forge unconventional bonds

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Table of contents

JANUARY 2019 VOL 123

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

FEATURES 4 Self-Insurance & Captive Convergence

As self-insurance and captive solutions

continue to trickle down market, a multi layered approach emerges with opportunities

for service providers to forge unconventional bonds

By Bruce Shutan

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Captive issues to watch in 2019

By Karrie Hyatt

ARTICLES 18 ACA, HIPAA and Federal Health Benefit Mandates

The Affordable Care Act (ACA), the Health Insurance Portability and

Accountability Act of 1996 (HIPAA) and other federal health

benefit mandates

39 SIIA ENDEAVORS

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News from siia members

26 Lifestyle Medicine: What Employers Need to Know 34 A Texas Federal Judge Declares

the Affordable Care Act Unconstitutional: What Next?

The Self-Insurer (ISSN 10913815) is published monthly by Self-Insurers’ Publishing Corp. (SIPC).

Postmaster: Send address changes to The Self-Insurer Editorial and Advertising Office, P.O. Box 1237, Simpsonville, SC 29681,(888) 394-5688

Self-Insurer’s Publishing Corp.

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

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FEATURE

Self-Insurance & Captive

Convergence

As self-insurance and captive solutions continue to trickle down market, a multilayered approach emerges with opportunities for service providers to forge unconventional bonds WRITTEN BY BRUCE SHUTAN

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s more small and midsize employers embrace both self-insurance and group captive solutions, they’re no longer viewed as distinct silos. Service providers are agreeing to non-traditional strategic partnerships for operational capabilities, mutual referrals or both. In doing so, the aim is to think beyond their normal revenue streams.

But it’s also born of necessity, with more employers choosing to layer these approaches in hopes of achieving better results.

“What we are seeing is the natural evolution of looking for new ways to provide better products and services for our customers in an otherwise restricted marketplace,” explains Rick Raup, president and CEO of Business Administrators & Consultants, Inc.

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Self-Insurance & Captive Convergence His TPA was asked to become involved with a self-funded client’s newly formed medical stop-loss captive. During that process his company learned that many captives and captive managers were primarily involved in property and liability coverages with little to no experience with ERISA benefit plans or medical stop loss. “Not wanting to become a captive manager ourselves, we began offering our underwriting, claim auditing and related services to captive managers as an outsourced solution,” he reports.

Rise of medical stop-loss captives Most captive business has involved the P&C line with limited application to group health benefits, observes Adam Forstot, VP of business development for Artex Risk Solutions. But that’s starting to change in a significant way.

Medical stop-loss market soared to $18 billion in premiums in 2018 from $7 billion in 2010, while captive premiums in this space reached more than $700 million from $80 million. Also worth noting is that the percentage of self-funded employers hit 60% from 48% during that same time frame. By comparison, the excess work comp market is just north of $1 billion of premium and casualty group captive market for work comp general liability auto is estimated to be in the $3 billion to $4 billion range.

“Clearly, the numbers speak for themselves,” says Duke Niedringhaus, SVP for JW Terrill Inc., a Marsh & McLennan Company. “It’s the future of the benefits world to add to the list of options to minimize growth in medical expense.”

An attendee of SIIA’s 2018 annual national conference who works in the enterprise risk 831(b) captive space approached him following a panel discussion he moderated about the convergence of self-insured and captive solutions. “She basically was convinced that she needs to make a career move over to the medical stop-loss captive side,” he recalls, trading the grey clouds of her chosen specialty for brighter growth opportunities.

While not seeing a huge upsurge of growth in the enterprise risk captives as employers try to tame group health benefit costs, especially given recent rulings by the Internal Revenue Service, Niedringhaus believes they will still continue to provide significant value. “It’s a way for employers to chart their own course,” he says.

Another point worth making is that the retention rate for casualty group captives exceeds 98%, which he attributes to better options in that market.

are plenty of spoils to share across all captive markets. John Capasso, president and CEO of Captive Planning Associates, LLC, traced 80% of his firm’s 2018 revenue to the P&C arena, which accounted for 100% of the pie in 2013, while it has edged up to 20% on the health care side from 0% during that same time frame.

Breaking down silos While integrating these solutions sounds intuitive, breaking the long-held silo mentality still takes time. Martin Eveleigh, chairman of Atlas Captive Management and member of SIIA’s Captive Insurance Committee, prefers to partner with P&C vendors “because they seem to be more experienced with captives and are actually fairly well placed to help us have conversations with their benefit counterparts.”

Self-insurance professionals, on the other hand, are more reluctant to delve into a captive solution, which he believes they may view as a threat to their livelihood.

But that also could be because advisers from the P&C and health benefit arenas barely come into contact. “It’s quite difficult sometimes to know who we should be talking to on the self-insured side of the aisle,” he explains.

The captive market’s shifting focus, as dramatic as it may appear, is still an evolutionary change and there

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Self-Insurance & Captive Convergence However, there’s a movement afoot across the C-Suite and industry groups to eliminate those barriers for the good of the company as a whole. Wilson cites the Society of Actuaries for its enterprise risk management initiative several years ago that even includes a certified enterprise risk analyst designation. This could expand a risk manager’s role job, which he believes should enable organizations to overcome inertia on the welfare and benefits side.

“Anybody involved in a group captive on the employer’s stop-loss side is already in the game,” he says. “There’s less friction to get something innovative done because the buck stops much more quickly in those organizations.”

Dave Wilson Captive managers are poised to take the lead on any intriguing industry developments, according to Dave Wilson, president of Windsor Strategy Partners.

“It’s not often the actuary that’s recommending a captive manager; it’s usually the other way around,” he says, noting how it generally starts with an attorney. Indeed, captive managers who have long steered work comp arrangements are now enjoying considerable interest on the medical stop-loss side.

It makes sense for P&C service providers to initiate conversations about the convergence of captive and self-insured solutions “because they have absolutely the most to gain by absorbing some of the welfare risk,” Wilson opines. In contrast, he says health and welfare plan administrators don’t have the same motivation to do anything different from a tax-favored standpoint once they’re selffunded. They’re also used to operating in a silo that seals off employee benefits from risk management.

“I’m starting to see companies that historically were claims adjusters for purely property and casualty now delving into other areas,” observes James Obregon, VP for Crum & Forster’s Accident & Health Division, which recently launched the only AM Best A-rated A&H segregated portfolio company.

One such example is an appointment he James Obregon scheduled with a third-party administrator, to examine their handling of accident and health claims. Obregon describes his parent company as one of a few that can deliver accident, health, property and casualty “within a relatively flat structure.”

Indeed, the firm is aligned with managing general underwriting experts who are selecting TPAs on the accident and health side, while a guaranteed-cost offering with bundled services is the focus for small and midsize P&C customers.

Obregon noticed serious thought given to group captives riding the shirt tails of workers’ compensation program success on the group medical side around 2010, which many observers believe was in response to the Affordable Care Act. Bringing together multiple lines of business as part of an unbundled solution makes perfect sense because it yields greater efficiencies and buying power, he says.

Captive owners from smaller like-minded companies are able to enjoy the scale of larger organizations by leveraging the contribution of multiple carriers across various silos, he explains. Increasingly, captive managers are partnering with their counterparts in claims, admin, pharmacy, benefits, risk, stop-loss and other areas, and in the process, integrating cultures of health and safety that reduce claims and accidents and speed returns to work.

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Self-Insurance & Captive Convergence believes “the persistency of that business tends to be much higher. If it’s more of a transactional relationship, then employers are much more likely to shop to different brokers and carriers every year.”

It’s certainly an intuitive action, Obregon says, noting parallels between the mission of work comp claim adjusters and the administration of group medical claims. But there’s an even more compelling reason for doing so.

“Some of these vendors are moving into this convergence because they’re being pulled into it by their customers,” he notes. “Oddly, it’s starting with small and medium-sized businesses, and at some point, maybe the silos will be taken down all the way up to big corporations.”

Popular solutions in the mid-market include casualty group captives, enterprise risk 831(b) micro-captives and medical stop-loss group captives.

Many TPAs and consultants manage claims on both the work comp and employee benefits side and “are now coming directly to captive groups or even forming their own solutions,” Forstot notes. He has noticed much more interaction between TPAs, administrators, captive consultants, brokers and employers.

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Considering captive caveats

“They’re much more actively involved with plan design, managing pharmacy, cost containment and large-claim advocacy,” he says.

Whatever the case may be, there are caveats along the way to cementing ties with various service providers, especially in the captive space. Michael Meloch, president of TPAC Underwriters, says few employers will create a single, standalone captive just for stop-loss coverage on their medical plan. However, he has noticed more like-minded employers banding together putting their stop loss and employee benefits in a group captive and taking risk inside of that vehicle.

For brokers and captive managers who enjoy a solid working relationship, he

His main gripe with group captives is the lack of price transparency on captive

Adam Forstot

Self-Insurance & Captive Convergence manager fees. When tallying the cost of spec and ag coverage alongside securing a letter of credit, putting up collateral and becoming involved with a TPA, broker and captive manager, he believes it’s higher than taking on more risk underneath a single-employer plan with a stop-loss carrier.

While the net cost of a group captive member absorbing a $200,000 claim across 20 employers will be less than a single-employer captive solution, Meloch cautions that not every employer in the group captive will have a stellar track record or risk profile. “The bigger the captive gets, the more average it becomes,” he cautions.

There’s certainly some intrigue associated with being part of a group captive in the Cayman Islands, a world hub when it comes to captive insurance as well as great place to visit or live, according to Meloch. “But if you’re an 80-life employer in central Wisconsin, do you really think the best way to manage your portfolio of medical business is to participate in a captive in the Caymans?” he wonders.

“I think for people that want to self-insure, it should become the new normal,” Wilson says, citing Perillo and Brownstone as driving forces for integrating work comp and benefit programs. “They have a pretty strong motivation to evolve and maintain that bleeding edge or they cease to be as relevant as they are.”

Employers are recognizing that ultimately they’re responsible for the health and wellbeing of their workforce 24/7 if employees are on the clock and covered under work comp or at home on the weekends, according to Forstot. “Whether you save $1 on the benefits side or workers’ compensation side, it’s still $1 saved,” he says.

SIIA’s Fusion Initiative Recognizing these converging market forces, SIIA launched its “Fusion” initiative last year that is designed to facilitate the exchange of information and/or business referral among its members involvement with self-insured health plans, captive insurance companies and self-insured workers’ compensation funds. The association expects to announce a variety of new Fusion related membership services in the coming months.

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

One slippery slope is that while brokers, captive managers and others may be able to sell employers on the idea of joining a captive, Meloch says many prospective customers are used to fully insured plans and need to be better educated about their options.

Amid the growing convergence of benefits and risk management solutions that are layered with captives, is it reasonable to expect a multi-faceted version of self-insurance to become more commonplace?

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FEATURE

2019 T

Captive Issues to Watch in

WRITTEN BY KARRIE HYATT

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his year there a number of issues to watch that could change the business of captives—both in the short term and long run. The following are the top four things captive professionals are looking out for in 2019.

Self-Procurement Taxes Since the Nonadmitted and Reinsurance Reform Act (NRRA), part of Dodd-Frank, was passed in 2010 by Congress, the captive industry has been wondering if it was going to be applied to them. There was a lot of discussion about it for several years but hasn’t been discussed much in recent years.

That is until 2018.

In June of last year, the Tax Court of New Jersey rejected Johnson & Johnson’s request for a tax refund for overpayment of self-procurement taxes for insurance through their Vermont-domiciled captive—Middlesex Assurance. Self-procurement taxes are levied by states when a company purchases insurance from an insurer not licensed or registered in the state. Johnson & Johnson’s claim was that they had overpaid their self-procurement taxes since 2011, when New Jersey updated their tax

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Captive Issue to Watch in 2019 law to be in alignment with the NRRA. Johnson & Johnson’s argument for a tax refund was based on the assumption that the NRRA was meant to apply only to surplus lines and reinsurance, not selfprocurement insurance.

This was the first court case that adjudicated on the subject of the NRRA and captives and could open captives and their parent companies to more taxation. According to Anne Marie Towle, captive practice leader, JLT Insurance Management, “I think there’s going to be an enhanced focus on procurement taxes. When the NRRA regulation came out a few years back there was a lot of discussion about whether or not it applied to captives. There was a bit of a scuttlebutt at the time about it but that died down for a bit. It seems now, after the recent cases, there is an interest coming from state governments to go after companies for self-procurement revenue. I don’t think it’s the end of the story. I think from a government stand point it could be a revenue grab.”

a company forming or owning a captive insurer,” said Sandy Bigglestone, director of captive insurance with the Vermont Department of Financial Regulation.

“It doesn’t seem fair,” she continued, “But the imposition of self-procurement taxes is between the company and the home state taxing authority. The impact on the captive market may affect a company’s choice for a domicile and challenges the ongoing feasibility of a company already operating a captive in a chosen domicile outside the company’s home state.”

If states are emboldened by the New Jersey Tax Court decision, it may spark a burst of redomiciling by captives. Bigglestone said, “Vermont has had a number of redomestications since the non-admitted and reinsurance reform act came into effect, however some captives that chose to stay in Vermont executed other types of solutions to limit the self-procurement exposure. One such solution was to establish a captive insurance company in the home state for the risks in that state, then reinsure that risk to the Vermont captive.”

Many states already have selfprocurement, or direct procurement, taxes on the books. However, the decision in the Johnson & Johnson case indicates that a company’s home state can tax all of the policies written even if the risk is not based in a company’s home state.

The imposition of additional taxes on a company’s private insurance transactions can steeply increase the cost of doing business. “Self-procurement tax exposure impacts the value analysis for

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Captive Issue to Watch in 2019

“I’m curious to see if the traditional domiciles that are known for great regulation and have been around for a long period of time will work to be more accommodating to retain the captives in their domicile. I wonder if there will be any sort of adjustment to their regulation—whether it’s a tax reduction or something else—because they recognize that captives in their home states are being taxed more?”

Towle added,

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Cyber Security

The worry about cyber security crimes continues to grow as we become more and more dependent on our computing devices. The Internet Security Threat Report (ISTR), published annually by Symantec, reported earlier this year that in 2017 the number of successful cyber-crimes was down. However, the crimes that were successful exposed more private information than ever before and were exponentially more costly. 2017 also saw a 600% rise in attacks on IoT (the internet of things)— meaning more phones, watches, blue tooth accessories were subjected to a cyberattack.

From an insurance perspective, it’s hard to keep up with the constant changes. “The speed with which cyber security changes is so dramatic, as opposed to something like workers comp, it makes it a real challenge,” said Towle. “I’m hopeful we’ll get to a point where security systems will be able to handle new threats, but it’s hard in today’s digital age to try to sort through the risk. As fast as technology changes cyber security is still going to be on top of the mind for many risk managers.”

We appreciate the positive response our medical stop loss coverage has received coast to coast. We look forward to bringing our trusted brand name, stellar balance sheet, and decades of underwriting experience to the medical stop loss marketplace for years to come.

Thanks.

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Captive Issue to Watch in 2019 Captives are taking the lead in establishing cyber security coverage.

According to Bigglestone, “Many companies have already placed cyber liability coverages into their captive, well before the commercial insurance could establish pricing and policies, primarily because these companies know how to protect their own systems, and at the same time, set aside reserves for the uncertainties related to vendors, contractors and others the companies are doing business with that handle data (third-party liability).”

Both the traditional and the captive insurance marketplace will continue to find cyber security an issue because of its constantly changing nature. “[This issue] will be around for a very long time, as new digital platforms and developments are made, hackers will test and find new ways to disrupt, so insurance customers will be assessing the risks continuously and the insurance markets will have to keep pace,” said Bigglestone.

insurance industry as a whole, given the insular nature of captives and that many of today’s leaders have grown with the industry since its beginnings in the 1970s and 1980s.

According to Towle, “We’re starting to see a lot of retirements of people that started in captive management 20 or 30 years ago when captives were starting to grow. The question is, who’s taking over?

Who’s going to step up? Why aren’t we hearing from the next generation of thought leaders? Part of it is going to take time, but we need to look at how to groom new talent to give them the additional experience they’ll need to become valued leaders.”

The captive sector is seeking out new ways to attract professionals 35 and younger. However, there is a gap between what young professionals want in a career and what they perceive insurance to be—a stodgy, old-fashioned industry. That is changing with new initiatives from SIIA, Captive Insurance Companies Association (CICA), and other sources.

Last spring, SIIA launched the SIIA Future Leaders (SFL) initiative. This program is designed to encourage young talent to become involved in the self-insurance industry and to become members of SIIA. In late 2017, CICA began a mentorship program that pairs experienced captive leaders with new and mid-career professionals.”

Koehler LLC

Attracting New Talent

Recruiting new talent for the insurance industry has become a looming issue.

Young people are not entering the profession as fast as people are retiring.

Figures released in 2016 by the Bureau of Labor Statistics estimated that 400,000 insurance professionals would be retiring by 2020. The captive sector is likely to be hit even harder than the

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Speed to Market

We now offer a Conditional Certificate of Authority on the same day the application is received for licensing a Captive Insurance Company.

• Recently passed, HB 334 authorizes the Insurance Commissioner to issue conditional certificates of authority (“COA”) to captive insurance company applicants.

• These conditional COA’s authorize the captive insurance company applicant to conduct business while the Commissioner completes the review of the application materials.

• Conditional Certificates of authority will be issued only upon receipt of evidence of the minimum capital and surplus required by Chapter 69 of Title 18 of Delaware Code and a certification from the captive owner that the application materials comply with the requirements of Chapter 69.

• A captive insurance company is granted a Conditional Certificate of Authority for a fee of $3600.

• Delaware applies Know Your Customer; only certain managers may submit applications for a conditional license.

“Delaware is the first in the nation to electronically offer a Conditional Certificate of Authority as part of the general application. This is a huge step in the right direction for streamlining the process for businesses looking to form a captive in Delaware.”

Trinidad Navarro, Insurance Commissioner

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

In Delaware, the captive regulators are dedicated exclusively to our captive insurance clients’ needs, and work under the direction of our Captive Bureau leadership, directed by Steve Kinion.

BUREAU OF CAPTIVE & FINANCIAL INSURANCE PRODUCTS 1007 North Orange Street, Suite 1010 Wilmington, DE 19801 302-577-5280 - captive.delaware.gov

Trinidad Navarro, Insurance Commissioner

Captive Issue to Watch in 2019 Last year, Gamma Iota Sigma—a business fraternity for students of risk management, insurance, and actuarial science—held a groundbreaking online job fair to pair students with potential jobs. Additionally, at Butler University, students in the Davey Risk Management and Insurance Program had the opportunity to launch an actual captive insurance company domiciled in Bermuda—MJ Student-Run Insurance Company Ltd.

“Attracting future talent to the industry has been a real hot topic lately and different organizations in the industry are focusing their efforts on mentoring programs, education, outreach initiatives, and succession planning. We have to start somewhere, and all the efforts are commendable. It will remain to be seen if we can begin to track the outcomes, but I do think that new talent will choose to work in the industry if given opportunities to participate in activities that prove valuable to the industry or the organization the individuals are working for.”

Bigglestone said,

Upcoming Court Decisions

The captive industry has not been faring well under the scrutiny of the IRS in recent years. In the Avrahami decision in 2017 and last year’s decision in Reserve Mech. Corp. v. Commissioner, the U.S. Tax Court has dealt some set-backs to captives operating under the 831(b) tax code. In 2019, no less than three similar cases are up for decisions from the Court. The pending cases are Caylor Land & Development v. Commissioner; Wilson et. al. v. Commissioner; and Syzygy Insurance v. Commissioner. The Wilson case is very similar to Avrahami and is being heard by the same Judge in that case. The Caylor case takes on risk distribution. In Syzygy, the only U.S. domiciled captive out of these recent cases, the Court will be judging whether or not its layered pooling arrangement is valid.

With the decisions still to come, many captive professionals that are following closely do not have a positive outlook on the outcomes. Even so, this should only be a temporary set-back for small captives that allows captive owners and managers insight into operating captives in a lawful and effective manner.

Karrie Hyatt is a freelance writer who has been involved in the captive industry for more than ten years. More information about her work can be found at: www. karriehyatt.com.

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Q A

ACA, HIPAA AND FEDERAL HEALTH BENEFIT MANDATES:

Practical

Q & A &

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he Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other federal health benefit mandates (e.g., the Mental Health Parity Act, the Newborns and Mothers Health Protection Act, and the Women’s Health and Cancer Rights Act) dramatically impact the administration of self-insured health plans. This monthly column provides practical answers to administration questions and current guidance on ACA, HIPAA and other federal benefit mandates.

Attorneys John R. Hickman, Ashley Gillihan, Carolyn Smith, and Dan Taylor provide the answers in this column. Mr. Hickman is partner in charge of the Health Benefits Practice with Alston & Bird, LLP, an Atlanta, New York, Los Angeles, Charlotte, Dallas and Washington, D.C. law firm. Ashley Gillihan, Steven Mindy, Carolyn Smith and Dan Taylor are members of the Health Benefits Practice. Answers are provided as general guidance on the subjects covered in the question and are not provided as legal advice to the questioner’s situation. Any legal issues should be reviewed by your legal counsel to apply the law to the particular facts of your situation.

Readers are encouraged to send questions by E-MAIL to Mr. Hickman at john. hickman@alston.com.

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While, once again, wholesale repeal/replace gave way to more modest ACA changes, there were a number of significant legislative and regulatory changes that occurred in 2018 which set the stage for 2019 to be an extremely pivotal year for health benefits. This advisory highlights many of the up-coming deadlines and key changes.

active duty members of the Armed Forces. The employer’s deduction for moving expenses is not affected by the suspension.

LEGISLATIVE UPDATE: RECAP OF 2018 EMPLOYEE BENEFIT PROVISIONS

The Tax Cuts and Jobs Act (TCJA) contains the most sweeping changes to federal tax laws in decades. Enacted at the tail end of 2017, most of the provisions are first effective starting in 2018. In order to help pay for reduced rates and other tax relief, the law also cuts back on and repeals some prior popular tax credits and deductions, including several in the benefits space. Key changes made by the TCJA with respect to employee benefits include the following:

• A new tax credit is available for employers who provide qualifying employees with paid family and medical leave. The new credit is currently available only for 2018 and 2019. The IRS recently provided guidance on the credit in Notice 2018-71.

• Qualified transportation benefits are no longer deductible by the employer. Starting in 2018, employers may no longer take a deduction for qualified transportation benefits, i.e., transit passes, parking, and transportation to and from work in a commuter highway vehicle, unless the transportation is necessary to ensure the safety of the employee. According to the IRS (see Notice 2018-99), this deduction denial applies regardless of whether the employer pays the expenses directly, reimburses the employee through a qualified reimbursement arrangement, or the expenses are paid through a pre-tax compensation reduction arrangement. Qualified transportation expenses remain excludable from the employee’s income and wages. Non-profit employers must pay UBIT with respect to qualified transportation benefits.

• The exclusion for qualified bicycle commuting reimbursement is suspended. Such reimbursements are taxable to the employee starting in 2018 and through 2025.

• Tax benefits for qualified moving expenses are suspended. Prior to the TCJA, qualified moving expenses paid or reimbursed by an employer were excludable from employees’ income and wages. In addition, individuals were entitled to an above-the-line deduction for any unreimbursed qualified moving expenses. Both of these tax benefits are suspended starting in 2018 through 2025. The suspension does not apply with respect to

In addition to these changes, TCJA includes a variety of other provisions that reduce tax benefits for certain common “fringe benefit” arrangements, including changes to the tax rules for meals and entertainment and significant changes to the deductibility of certain executive compensation. Employers should work with counsel to ensure compliance with these requirements.

The Bipartisan Budget Act relaxes rules for hardship distributions from 401(k) plans. The main purpose of the Bipartisan Budget Act (BBA), enacted in February 2018, was to provide funding for the federal government. A few employee benefit plan changes went along for the ride, including relaxation of rules relating to hardship distributions from 401(k) plans and similar arrangements.

Under the BBA, qualified non-elective contributions (QNECs), qualified matching contributions (QMACs) and earnings on QNECs, QMACs, and 401(k) elective contributions may be distributed on account of hardship. A participant is not required to take out a loan before taking a hardship distribution. Both of these changes apply to plan years beginning after Dec. 31, 2018.

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The BBA also directed the IRS to revise regulations relating to hardship distributions to eliminate the requirement under the IRS safe harbor that a participant cannot make 401(k) contributions for 6 months following a hardship distribution. In November, the IRS published proposed regulations making that change, as well as a variety of other changes to the hardship distribution rules.

REGULATORY UPDATE

DOL Fiduciary Rule Invalidated: The DOL’s far-reaching investment fiduciary rule would have imposed significant new disclosure and approval burdens on entities that receive investmentrelated compensation from covered plans, including HSAs. The Fifth Circuit declared the DOL rule invalid, and the DOL quickly issued a non-enforcement bulletin. See DOL EBSA Field Assistance Bulletin 2018-2 (May, 2018).

Entities that might be considered brokers under SEC rules may be impacted by a similar regulatory regime proposed by the SEC.

The President’s Executive Order on Health: Two final rules and one proposed rule were issued in 2018 in response to the President’s October 2017 Executive Order on Promoting Health Care Choice and Competition.

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• Association Health Plans (AHPs): A final rule published Jan. 5, 2018 makes it easier for otherwise unrelated employers to group together to form a single large group health plan, thus avoiding certain ACA rules applicable to small group insured plans. AHPs can also be of interest to large employers, e.g., franchisors offering a health plan to franchisees. However, barriers still exist in many states.

• Short-Term Limited Duration Insurance (STLDI): A final rule published Aug. 3, 2018, allows STLDI to have a total coverage period (including any insurer approved renewals) of up to 36 months. Combined with the repeal of the so-called “individual mandate” under the ACA, and (perhaps) the ability to fund such coverage through an HRA starting in 2020, STLDI coverage may increase in popularity. Some states, however, impose stricter limits on STLDI (e.g., limit such coverage to 12 months or less.

• Health Reimbursement Arrangements (HRAs): A proposed rule published Oct. 29, 2018, would expand the ability of employers of all sizes to use HRAs by creating two new types of HRAs. Under the proposal, if certain requirements are satisfied, an employer may establish an HRA that helps to pay for the employee’s premiums for individual market coverage (other than excepted benefit or short-term coverage) and other unreimbursed medical expenses. These premium reimbursement HRAs are considered MEC for purposes of the ACA employer penalties. Among other requirements, an employer must not offer a traditional group health plan and a premium reimbursement HRA to the same class of employees.

The second type of new HRA, the excepted benefit HRA, must satisfy four requirements (similar to requirements that apply to excepted benefit FSAs): (1) the maximum annual contribution is $1,800 (indexed, and without regard to any carryovers); (2) the employee must also be offered traditional health insurance from the same employer (but the employee does not have to enroll in that coverage); (3) the employee cannot also be offered a premium reimbursement HRA; and (4) the terms and conditions must be the same for all “similarly situated” classes of employees. The proposed rules are expected to be finalized in the early part of 2019.

MAKING A LIST AND CHECKING IT TWICE: UPCOMING DEADLINES AND EFFECTIVE DATES

Health Coverage Reporting Deadlines for 2018 Minimum Essential Health Coverage (MEC)

The Affordable Care Act (ACA) requires employers, insurers, and certain other providers of minimum essential coverage (MEC) to provide health coverage information to individuals and the IRS. Applicable large employers (generally, those with 50 or more full-time employee equivalents as defined under the employer penalty provisions in Code section 4980H), are required to provide individuals with information on health insurance offers and coverage using Form 1095-C (EmployerProvided Health Insurance Offer and Coverage).

Forms 1095-C must also be sent to the IRS with Form 1094-C. Other providers of MEC, including self-funded non-ALEs) are required to provide information to individuals using IRS Form 1095-B (Health Coverage). Forms 1095-B must also be sent to the IRS along with Form 1094-B. These Forms are provided on a retrospective basis, i.e., health offers and coverage for 2018 are reported in 2019.

The IRS recently announced the deadlines for providing the 2018 Forms, including an extended due date for furnishing the Forms to individuals. There is no extension of

the time for filing with the IRS. The IRS also has provided some penalty relief for good faith compliance. The filing deadlines are below.

February 28, 2019: Deadline for filing Forms 1094-B, 1095-B, 1094-C and 1095-C with the IRS for Forms that are not filed electronically.

March 4, 2019: Deadline for providing Forms 1095-B and 1095-C to individuals (this is an extension of the original due date of Jan. 31, 2019).

April 1, 2019: Deadline for filing Forms 1094-B, 1095-B, 1094-C and 1095C with the IRS for electronic filing. In general, persons who file 250 or more information returns a year are required to use electronic filing.

For more information see IRS Notice 2018-94.

PCORI Fee: The Patient-Centered Outcomes Research Institute (PCORI) fee is imposed under the ACA for plan years ending on or after Oct. 1, 2012 and before Oct. 1, 2019. (These dates follow the fiscal year of the federal government, which ends on Sept. 30 of each calendar year.) The fee is paid once each year, and is due on the July 31 following the end of the plan year.

Thus, for example, for a calendar year plan year, the fee for 2018 is due on July 31, 2019. The fee is imposed on specified health insurance and is payable

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EEOC wellness plan rules: In 2017 the EEOC issued comprehensive rules governing wellness program compliance under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). These rules added a number of new compliance obligations, and established somewhat of a safe harbor (30%) for the value of wellness program incentives. In AARP v EEOC, the incentive safe harbor portion of these rules has been set aside. For 2019, employers with wellness programs that include incentives should review the impact of this decision on their programs.

by the employer or other plan sponsor of a self-funded plan (including HRAs) and by the insurer with respect to fully-insured coverage. The fee is based on the average number of lives covered under the plan.

Special rules apply for health reimbursement arrangements (HRAs) required to report. For plan years ending on or after Oct. 1, 2018 and before Oct. 1, 2019 (e.g., in the case of the 2018 plan year for calendar year plans), the fee is $2.45 per participant. More information can be found on the IRS PCORI Fee website.

Repeal of the ACA Individual Mandate: Starting January 1, 2019, individuals who do not have qualifying health coverage will no longer face a tax penalty. The IRS is studying whether the related reporting requirements for self-funded employers, insurers, and others providing MEC should be changed for 2019 and future years.

As we go to press, a federal district court in Texas has concluded that repeal of the individual mandate has caused the entire ACA to be unconstitutional. This decision will undoubtedly be appealed – with (likely) several rounds of further analysis to come throughout 2019. Texas v. U.S., No.18-167 (N.D. Tex. Dec.14, 2018)].

“Cadillac Plan” Tax Delay: The so-called “Cadillac Plan” tax is a 40% excise tax on the cost of employer sponsored health coverage that exceeds specified dollar thresholds. The tax was originally scheduled to go into effect in 2018, but has been delayed several times, most recently by legislation enacted in January 2018. The tax is scheduled to go into effect in 2022, unless it is further delayed by Congress.

On the retirement side: The Department of Labor took the first formal step in fulfilling the directives of the President’s August 2018 Executive Order on retirement plans and issued proposed rules on multiple employer plans (MEPs). Similar to the goals of the AHP rules, the proposed MEP rules would clarify the circumstances under which an employer group or association or a professional employer organization (PEO) may sponsor a workplace retirement plan. The rules are expected to be finalized in early 2019.

The President also directed the DOL and IRS to make retirement plan notices more understandable and useful for plan participants, while also reducing the costs on employers. Finally, the IRS was directed to review the life expectancy and distribution tables currently used for determining required distributions from taxqualified plans. The objective is to bring the tables up to date so that retirement funds can be drawn out more slowly, rather than forcing larger distributions earlier on.

So, stay tuned, there will be more to come on retirement plans.

JANUARY 2019

23

FOR QUICK REFERENCE: 2019 COST-OF-LIVING ADJUSTMENTS FOR POPULAR BENEFITS

BENEFIT

2018

2019

HSA contribution max (including employee and employer contributions)

$3,450 ($6,900 family)

$3,500 ($7,000 family)

HSA additional catch-up contributions

$1,000 (this is not indexed)

Same

HDHP annual deductible minimum

$1,350 ($2,700 family)

Same

Limit on HDHP OOP expenses

$6,650 ($13,300 family)

$6,750 ($13,500 family)

Health FSA salary reduction max

$2,650

$2,700

QSEHRA max reimbursement

$5,050 ($10, 250 family)

$5,150 ($10,450 family)

Transit and parking benefits

$260

$265

401(k) employee elective deferral max

$18,500 (Catch-up contributions $6,000)

$19,000 (Catch-up limit unchanged)

Highly compensated employee

$120,000 (applies for 2019 plan year under look-back rule)

$125,000 (applies for 2020 plan year under look-back rule)

Is there more to come?

As this goes to press, the year isn’t quite done. Federal agencies are still at work and Congress has started a lame duck session, so it’s possible that we will see more changes in 2018. Also, as we go to press, the federal district court in Texas has found the ACA unconstitutional. 2019 will undoubtedly prove once again to be an exciting year. Key late breaking December developments will be covered in the New Year!

24

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Lifestyle Medicine: What Employers Need to Know

WRITTEN BY Richard Safeer, MD

T T

he latest numbers from the Centers for Disease Control (CDC) are staggering: nearly half of all adults in the U.S. have at least one chronic disease such as diabetes, heart disease or obesity and 25 percent have two or more. And while most employers are aware of the prevalence of chronic health conditions among employee populations and the high cost of treating them, what may not be clear is a way to move forward towards a healthier future.

The problem is not that we don’t have medical interventions for chronic conditions— dozens of treatment guidelines for medical professionals have been well researched and are available to help patients make healthier lifestyle choices. But the alarming statistics from the CDC reveal that the current system is not solving the problem.

Nothing short of a paradigm shift is needed to turn the tide in what some are calling a chronic disease “epidemic.”

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Fortunately, there is momentum to engage patients in their own health without the use of medications or surgery, using an approach called Lifestyle Medicine (LM). It’s a model of care that every employer, insurer, and health system should be interested in—one that is both evidenced-based and proven to prevent, delay and even reverse many chronic diseases.

What is Lifestyle Medicine?

“evidencebased practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life.” This practice includes not only getting people to understand the importance of As defined by the American College of Lifestyle Medicine, LM is the

their lifestyle choices but also supporting them in making behavior changes.

LM addresses such key issues as getting enough exercise, following healthy eating principles, practicing stress reduction, not smoking, and limiting alcohol use.

Programs are implemented with the care and support of an integrated team of health care professionals.

Is Lifestyle Medicine Effective?

The short answer is yes. As early as the 1970s the medical community identified a strong correlation between heart disease and the effects of poor diet, lack of exercise and overall stress levels. The well-known Lyon Diet Heart Study (or Mediterranean diet)1, served as additional confirmation that diet alone was a tremendous factor in reducing heart disease.

In response to a growing body of evidence, doctors began to develop lifestyle programs specifically designed to reverse heart disease such as the Pritikin Program. Nathan Pritikin’s program, along with two other similar programs, are now covered by the Centers for Medicare and Medicaid Services (CMS) in what’s now known as Intensive Cardiac Rehabilitation (ICR).

While this may sound simple enough, health care delivery is still very much tied to treating illness with medications and surgery over making healthy lifestyle choices or changes. In addition, there are a number of system-wide obstacles to overcome. In fact, our current health care system could be defined more accurately as a “sick-care” system. Given the situation, a major shift is needed not only in personal behavior but also in medical practice and reimbursement models that support a more holistic approach.

JANUARY 2019

27

Amazingly, these successful programs are based only on lifestyle changes, without medications. Medical research continues to expand dramatically in the area of lifestyle choices, confirming the critical impact of personal behavior on a wide variety of medical conditions.

An important milestone was achieved recently when the CMS and a number of regional and large health insurance companies (including Aenta, United, Anthem Blue Cross/Blue Shield) agreed to reimburse for programs that fall under the category of LM. Both ICR and the national Diabetes Prevention Program (DPP) are included.

Complete Health Improvement Program (CHIP). As with the ICR and DPP, CHIP participants make changes in key lifestyle areas: eating a predominantly plant-based whole-foods diet, participating in daily exercise, learning stress reduction techniques, and engaging in social support systems.

When offered in the workplace, CHIP was found to lower health care costs due to participants’ decreased need for medications2. There also was an 11 to 25 percent reduction in outpatient medical visits over the course of a year.

The outcomes from such programs continue to confirm that lifestyle changes can be implemented successfully and can positively impact participant health as well as lower health care costs. And the good news is that self-insured employers are among those organizations most likely to benefit from using a LM approach to health care— because costs go down when a defined population stays healthy.

Working Together, Creating a Better Model for Health Importantly, both of these programs provide not only education but also skill building around key lifestyle changes such as nutrition, exercise, relaxation, and social support. Programs are delivered in group settings, several hours per week for a period of months.

Participant outcomes have been impressive with both programs. For the DPP, participants were 34 percent less likely to progress from prediabetes to diabetes over a 10-year period. For ICR, outcomes included significant improvements in key metrics such as body mass index, cholesterol levels, blood pressure and most importantly, a decreased risk of a recurrent cardiac event. Interestingly, participants in ICR also experienced less depression.

While LM offers the opportunity to turn the tide of the huge burden of chronic conditions, it’s important to note that a number of key changes across the spectrum of care are needed to make this happen. System-wide issues that need to be addressed include3:

• Practitioners need to align themselves in teams—similar to optimizing delivery of other health care services such as surgery—to provide a variety of lifestyle services (e.g., mindfulness training, nutrition counseling) for enhancing health;

• Systems will have to be built to ensure that best practices in lifestyle medicine are being followed and not delivered haphazardly or by unqualified practitioners;

• Providers will need to bundle lifestyle services to address different disease states, such as diabetes and heart disease, and payers will need to reimburse for these programs. That being said, some programs, such as CHIP, are applicable to many diagnoses, making it difficult to categorize for reimbursement purposes;

• Providers must consider delivering lifestyle services as part of the treatment plan for many conditions, as well as the pre-operative and discharge plans instead of isolating lifestyle medicine as a separate unit.

Further success can be found in yet another evidenced-based program focused on lifestyle change, called the

• Health care teams will have to take some financial risk. It’s likely to be an easier match within an integrated delivery network where the payer has a large influence on the health care services delivered to the member;

JANUARY 2019

29

• Facilities need to be convenient for patients (e.g., support group locations and exercise facilities) and related programs need to be local to keep people coming back.

What Can Employers Do?

System-wide changes may take years to implement, but there’s a lot that employers can do in the meantime to make a shift toward lifestyle-change improvements for their workforce.

At Johns Hopkins Medicine, for example, we’ve launched a number of initiatives for our own employees to help positively impact their health. Some examples include:

• Building employee health into the business plan and holding our executives accountable for meaningful improvements;

• Lowering health insurance premiums for employees who don’t smoke; • Offering onsite employee health clinics that serve as a resource to address individual health and wellness needs;

• Offering comprehensive programs such as DPP and CHIP; • Making healthy foods and beverages more readily accessible; • Sponsoring walking events during work hours; • Making lactation rooms more readily available for new mothers.

Self-insured employers are in a unique position to support the health of their employees and their dependents. Primarily, employers are at liberty to design their workplaces, policies, benefits and programs so that their employees find it easy to access and make healthy—and affordable—choices throughout the workday.

Once this support is in place, employers who offer onsite LM programs are bound to be impressed with the health improvements those participants gain and as well as the resulting decreased utilization of drugs, surgeries and other health care resources.

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Offering these programs in the workplace also has the added advantage of creating a supportive social environment that will continue long after the program is over. And if the self-insured employer is a large enough factor in the community in which it resides, it can influence the delivery system by insisting that providers be compensated for these services (if the employer decides not to offer the program within its own confines).

And in another milestone for LM, in 2018 Blue Shield of California announced a unique collaboration with the American College of Lifestyle Medicine (ACLM). ACLM will provide LM continuing medical education and other training tools to the nonprofit health plan’s in-network providers, recognizing that LM can treat and reverse chronic disease at its root cause.

References 1 Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction, Final Report of the Lyon Diet Heart Study Michel de Lorgeril, MD; Patricia Salen, BSc; Jean-Louis Martin, PhD; Isabelle Monjaud, BSc; Jacques Delaye, MD; Nicole Mamelle, PhD; 1999; accessed online 5/23/18 at: http://circ.ahajournals.org/content/99/6/779.citation

2 CHIP Lifestyle Program at Vanderbilt University Demonstrates an Early ROI for a Diabetic Cohort in a Workplace Setting: A Case Study, Dexter Shurney, MD,MBA, MPH, et. al., Journal of Managed Care Medicine, Vol. 15, No. 4

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

3 As published in NEJM Catalyst, July 2017 online edition, Richard Safeer, MD; accessed

risk transfer industry that

5/2/18 online at: https://catalyst.nejm.org/valuable-healthier-lifestyle-choices.

you would like to share with your peers?

Richard Safeer, MD

We would like to in vite you to share your insight and submit an article to The Self-Insurer !

Medical Director, Employee Health, Wellness & Innovation Johns Hopkins HealthCare LLC Assistant Professor of General Internal Medicine and Pediatrics Johns Hopkins University School of Medicine Assistant Professor of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health

Richard Safeer, M.D., is the medical director of Employee Health, Wellness and Innovation at Johns Hopkins HealthCare and an assistant professor of medicine and public health at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Dr. Safeer was a family practitioner and formerly the medical director of preventive medicine at CareFirst BlueCross BlueShield, in Baltimore. At Johns Hopkins HealthCare, Dr. Safeer is responsible for developing programs to promote and sustain a culture of health. He currently serves on the Board of Directors for the American College of Lifestyle Medicine.

distributed in a digital and print format to reach over 10,000 readers around the world. The Self-Insurer has been delivering information to the self-insurance /alternative risk transfer community since 1984 to self-funded employ ers, TPAs, MGUs, reinsurers, stoploss carriers, PBM s and other service providers.

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

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A Texas Federal Judge Declares the Affordable Care Act Unconstitutional: What Next?

written by Brady Bizarro, Esq.

O O

n February 26, 2018, eighteen state attorneys general and two Republican governors filed suit in a Texas district court against the federal government over the constitutionality of the Affordable Care Act (“ACA”). While Texas v. United States is not the first serious legal challenge brought against the Obama administration’s signature healthcare law (see, e.g., King v. Burwell, 135 S. Ct. 2480 (2015); see also National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)), it is the first in which the executive branch broke with tradition and declared that it would not defend the ACA in court.

The case has certainly represented the most serious threat to the ACA since the GOP’s legislative efforts to repeal the healthcare law failed last summer. As it turns out, this threat should have been taken more seriously by industry analysts.

On December 14, 2018, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas found that the ACA was unconstitutional.

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of the existing provisions of the ACA with which employers, fully insured plans, and self-funded plans must comply are still in effect.

His decision has rattled the markets, Democratic political leaders, advocacy groups, and the broader healthcare industry. One prominent Democratic senator remarked, “This is a five alarm fire – Republicans just blew up our healthcare system.”

Senate Minority Leader Chuck Schumer (D-NY) called it an “awful ruling . . . [which, if not reversed] will be a disaster for tens of millions of American families, especially for people with pre-existing conditions.” After taking a closer look at this ruling, however, many legal experts have concluded that it is not nearly as earth shattering as the headlines have made it appear.

First, Judge O’Connor’s ruling did not block enforcement of the ACA despite the fact that the plaintiffs had asked the court to issue a nationwide injunction on the federal government from implementing, regulating, or enforcing the ACA. Since the judge declined, all

This decision has no effect whatsoever on plan design, on cost containment, on employee incentives, or on regulatory compliance. A quick check of Healthcare. gov post-ruling revealed that federal officials have even added this reassuring message: “Court’s decision does not affect 2019 enrollment coverage.”

Second, a spokeswoman for the California attorney general has already confirmed that the sixteen states (and D.C.) that stepped in to defend the ACA will appeal this district court ruling to the United States Court of Appeals for the Fifth Circuit in New Orleans, Louisiana. That means there is a chance that this decision could be overturned before the case reaches the Supreme Court.

That possibility brings me to my third point; that legal scholars across the ideological spectrum have found the legal arguments made by the plaintiffs in this case to be remarkably unpersuasive. To understand why, let us break down the court’s opinion (which sided with those arguments).

Judge O’Connor’s opinion has two major elements. First, he contends that since Congress reduced the ACA’s individual mandate penalty to $0, the mandate to purchase insurance must be invalidated.

Then, he argues that since the individual mandate is essential to and inseverable from the remainder of the ACA, the entire 2,000 page healthcare law must be struck down. This issue of “severability,” or whether one provision of a law can be severed without invalidating the entire law, is key. Prior to addressing severability, however, Judge O’Connor explains his constitutional analysis for finding that the individual mandate is no longer fairly readable as an exercise of Congress’s tax power.

JANUARY 2019

35

Regarding his first contention, that the individual mandate could not be saved from the ACA, Judge O’Connor has made a rather compelling case.

When the ACA was passed in 2010, the bill contained a requirement that all Americans purchase health insurance or pay a penalty.

In 2012, the Supreme Court ruled that this requirement, known as the individual mandate, was a legitimate exercise of Congress’s constitutional authority to tax. See NFIB v. Sebelius (2012). In late 2017, in the Tax Cuts and Jobs Act (“TCJA”), Congress zeroed out the penalty associated with the tax, meaning the individual mandate can no longer reasonably be considered a tax.

As such, the constitutional foundation identified by the majority of the Supreme

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THE SELF-INSURER

Court, on which the individual mandate was based, was invalidated (recall that the majority in NFIB v. Sebelius also declined to sustain the individual mandate’s constitutionality under the Commerce Clause).

With respect to Judge O’Connor’s second contention, that the entire ACA must fall, many legal experts strongly disagree. Nothing in the original 2010 bill spoke to the severability of the individual mandate.

Typically, when lawmakers neglect to include a severability clause in a bill, courts look to discern the intent of Congress when considering whether finding a particular provision of a law unconstitutional would require the elimination of the entire law.

In NFIB v. Sebelius, the majority never addressed severability with respect to the individual mandate since the Court upheld the requirement. Four dissenting justices concluded that the individual mandate was unconstitutional, and that Congress intended the entire ACA to be invalidated without the individual mandate.

Judge O’Connor assumes that the intent of the 2010 Congress controls the severability analysis in the case before his court; an intent only discerned by a minority of the Supreme Court. Indeed, he spends most of his 55-page opinion attempting to discern the intent of the 2010 Congress on his own.

In doing so, however, he ignores the intent of a later Congress that did speak to the issue of severability in the form a

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later legislative act. The 2017 Congress, in passing the TCJA, eliminated the individual mandate and preserved the rest of the ACA. This act presents strong evidence that Congress intended the ACA to function without the individual mandate. Judge O’Connor’s explanation for this fact is that the 2017 Congress was unable to repeal the individual mandate because of budget rules and it therefore had no intent with respect to the individual mandate’s severability.

By assuming Congress had no intent because it was shackled by complicated legislative rules, Judge O’Connor has drawn the ire of most of the legal community. If he had been so sure of his position, why would he neglect to issue a nationwide injunction on the ACA, as he could have done?

True, throwing a wrench into the middle of the healthcare system, where $600 billion in federal funding and health insurance coverage for millions of Americans is on the line, would have been a drastic action; however, if Judge O’Connor truly believed Congress intended this, he could have blocked enforcement of the ACA across the country.

I could go on at length about the consequences if this ruling were to stand; the impact on employersponsored plans, the effect on those with pre-existing conditions, the potential loss of health insurance coverage for millions of individuals, and the end of the Medicaid expansion. Yet, based on the response from the legal community of which I am a part, my position is that this

decision rests on very shaky ground.

This decision also goes much further than even the Trump administration had wanted (it wanted to preserve protections in the law for people with pre-existing medical conditions). I fully expect this case to be reversed by the United States Court of Appeals for the Fifth Circuit and to eventually be declined by the Supreme Court.

In short, we should all hold our collective horses and conduct business as usual for the time being.

Brady Bizarro, Esq. is an attorney with The Phia Group, LLC.

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Portfolio Risk Management

ENDEAVORS

SIIA ENDEAVORS

T T

he Self-Insurance Institute of America, Inc. (SIIA) launched the SIIA Future Leaders (SFL) initiative in fall of 2018, designed to encourage talented younger professionals to become involved with the association and the self-insurance industry.

To help guide the implementation of the SLF, the association has formed a SIIA Future Leaders Committee, which is comprised of younger managers/executives from leading member companies. Craig Clemente, Chief Operating Officer, Specialty Care Management and SFL Committee Chair states “with amazing support from our SIIA members, we are building upon a great sense of momentum. The SIIA Future Leaders has palpable energy, knowledge, drive and passion, and it is that dynamic that provides us the foundation looking forward to, what promises to be, an exciting 2019.”

The SFL recently held a stand-alone forum December 12-13th in Tampa, FL. This inaugural event was put together due to the overwhelming positive response from SFL attendees at the association’s National Conference & Expo in Austin, TX in September.

JANUARY 2019

39

ENDEAVORS in Austin earlier this year! I have been in the self-funded space for 12 years and I’ve never seen such momentum and enthusiasm from the young talent in our industry. The presentation from Robert Stevenson was very engaging and relevant and I’ve heard positive feedback across the board.

Craig Clemente The educational program in Tampa featured one of the country’s top keynote speakers (and a SIIA member favorite) Robert Stevenson, Author, Business Consultant and Keynote Speaker, who spoke to the SFL group about how Millennials can most effectively engage with their Baby-Boomer and/or Gen-X bosses for career advancement purposes.

Clemente continued “this event provided the industry’s young talent a unique opportunity to come together and interact with a diverse group of passionate industry professionals with a common goal: the sustained future of the self-funded industry. The twoday event provided great networking opportunities, and the participants benefited from an engaging presentation

by Robert Stevenson, on a topic that truly resonated with the entire audience.”

Attendees found the forum to be very valuable. Matthew S Hayward, Territory Manager - Western Region for OptumHealth Financial Services states “the Tampa SIIA Future Leaders Forum was a fantastic event. It is great to see the momentum coming out of our launch

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THE SELF-INSURER

I really appreciate the opportunity to network and learn from all the young leaders who are changing the face of our industry. Thank you to Mike Ferguson & Craig Clemente in particular for all the work put in so far! Definitely an investment worthwhile & the future is bright!”

Kayla Hedin, Account Executive for Lockton Companies, LLC said “the SIIA Future Leaders Initiative proves to be invaluable for rising stars in the selfinsurance industry. It was encouraging to engage in and experience the building momentum that stem from our common goals - to build relationships, learn & develop our careers, and ultimately find our place in the future of the industry as a whole. Our time in Tampa, although short, was an exciting glimpse into the future for this initiative and all who are involved.”

The next SFL event will be a miniprogram held in conjunction with SIIA’s

Matthew Hayward

Self-Insured Health Plan Executive Forum, March 18-20th at the Westin Charlotte in Charlotte, NC. This threehour time block has been reserved for educational content and networking specifically geared for SFL members (under age 40). Specific details will be announced soon. There is no cost for this mini-program and you do not need to be signed for the Executive Forum, but advance separate registration is required.

Separate SFL registration will include access to the Legislative/Regulatory Update session and forum welcome reception.

Kayla Hedin

If you have Future Leaders in your company that you would like to direct to this initiative, or if you are a future leader yourself, we invite you to join the SIIA Future Leaders LinkedIn Group at www. linkedin.com/groups/12098226. More information on SIIA’s Future Leaders initiative and the SFL mini-program at the Self-Insured Health Plan Executive Forum, including registration, can be found at www.siia.org.

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Corporatesolutions.swissre.com/esl Insurance products underwritten by Westport Insurance Corporations and American Specialty Insurance Company. © Swiss Re 2018. All rights reserved.

NEWS

NEWS FROM SIIA MEMBERS 2019 JANUARY 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.

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NEWS Diamond Members Michael Ginsberg has joined the Accident & Health Group (A&H) of Swiss Re Corporate Solutions, North America as Vice President, Business Development Manager for the West Region.

Mr. Ginsberg has extensive experience in the Employee Benefits industry including Sales and Sales Management. The West region covers California, Oregon, Washington, Nevada, Utah, Arizona and New Mexico where Mr. Ginsberg will be responsible for maintaining our existing payer and broker relationships, as well as developing new business opportunities.

About Swiss Re Corporate Solutions A&H The Accident & Health Group of Swiss Re Corporate Solutions has been providing in-depth product knowledge and solutions to customers since 1975. Our long history and continuity in this market gives both our policyholders and their trusted advisors confidence in knowing they are backed by experts who adapt to market trends and provide market-leading capacity.

Our Employer Stop Loss portfolio includes: medical stop loss, group stop loss captives, and an organ transplant solution program. We are a direct writer for self-insured employer groups in all 50 states and coverage is underwritten by Westport Insurance Corporation, rated “A+ (Superior)” by A.M. Best Company.

W. R. Berkley Corporation Names Brad N. Nieland President of Berkley Accident and Health, Christopher C. Brown Appointed Chairman GREENWICH, CT - W. R. Berkley Corporation (NYSE: WRB) announced the appointment of Brad N. Nieland as president and CEO of Berkley Accident and Health, a Berkley Company. Mr. Nieland succeeds Christopher C. Brown, who has been named chairman of Berkley Accident and Health.

Mr. Nieland joins Berkley Accident and Health with more than 15 years of experience in the healthcare and accident and health insurance sectors. Prior to joining the company, he held various positions focusing on underwriting and product management, actuarial, risk management and client relations.

Mr. Nieland most recently served as vice president of stop loss at another leading U.S. provider of accident and health insurance. He holds a Bachelor of Science degree in actuarial science and statistics from the University of Northern Iowa, is a Fellow of the Society of Actuaries (FSA) with a specialization in healthcare and is a member of the American Academy of Actuaries.

Mr. Brown joined Berkley as president of Berkley Accident and Health in 2009 and will remain an invaluable advisory resource to Mr. Nieland in his role as chairman.

Commenting on the appointments, W. Robert Berkley, Jr., president and chief executive officer of W. R. Berkley

“We have been extremely fortunate to have Chris lead our team at Berkley Accident and Health for nearly a decade, building it from a relatively new start-up into an important part of our business. He and his team have done an outstanding job in establishing the company as a leading provider of accident and health insurance products and services, and we are excited that he will continue to participate in its ongoing success. Brad brings a wealth of experience in all aspects of the business, as well as an excellent analytic approach that will create opportunities for additional growth and profitability for years to come. We are delighted to welcome him to our team.”

Corporation, said,

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NEWS About Berkley Accident and Health Berkley Accident and Health underwrites accident and health insurance and reinsurance products in four primary areas: medical stop loss, managed care, special risk and group captive. It has a diversified product and service portfolio serving a range of clients from small employers, health care organizations, and membership groups to Fortune 500 companies.

For further information about Berkley Accident and Health along with the products and services it offers, please visit www.berkleyah.com.

Founded in 1967, W. R. Berkley Corporation is an insurance holding company that is among the largest commercial lines writers in the United States and operates worldwide in two

segments of the property casualty insurance business: Insurance and Reinsurance.

For further information about W. R. Berkley Corporation, please visit www. wrberkley.com.

The Phia Group Announces the Formation of Legal Compliance & Regulatory Affairs Team Braintree, MA -- The Phia Group LLC, one of the health benefit industry’s leading cost-containment service providers, announced that it has completed the formal creation of its internal Legal Compliance and Regulatory Affairs (“LCARA”) team.

The members of this Phia Group Consulting (“PGC”) subdivision will handle the most complex Independent Consultation and Evaluation (“ICE”) queries while performing in-depth research meant to benefit both The Phia Group, and its partners.

Led by its Director of Legal Compliance & Regulatory Affairs, Brady Bizarro, Esq., as well as Compliance & Oversight Counsel, Andrew Silverio, Esq. and Compliance & Regulatory Affairs Consultant, Philip Qualo, J.D., the LCARA team will diligently track statutory and regulatory changes, to ensure both the continued compliance of The Phia Group as well as its clientele.

Mind over risk.

That’s how we properly assess risk – enabling our clients to focus on their businesses. We provide innovative stop loss solutions to protect self-funded employers from potentially catastrophic losses and flexible captive solutions that range from fronting and reinsurance arrangements to our turnkey stop loss program. We offer specialized solutions for specialty markets, including Taft Hartley and multiemployer organizations. We also offer organ transplant coverage to self-funded plans. Our clients have been benefiting from our expertise for over 40 years. To be prepared for what tomorrow brings, contact us for all your medical stop loss and organ transplant insurance needs.

Tokio Marine HCC - Stop Loss Group A member of the Tokio Marine HCC group of companies tmhcc.com TMHCC1094 - 09/18

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YOUR BEST PARTNER EARNS YOUR TRUST EVERY DAY Employers of all sizes experience high-cost medical claims. As an independent stop-loss provider with strong financial ratings, we’re here for you. Listening to you. Helping you design a stop-loss plan that meets your needs with specialized options. Delivering hassle-free claims reimbursements. Want a partner that earns your trust every day? Go with Sun Life. Ask your Sun Life Stop-Loss specialist how we can put our expertise to work for you.

STOP-LOSS | DISABILITY | DENTAL/VISION | VOLUNTARY | LIFE 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. Group insurance 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, group insurance 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. Š 2017 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.

BRAD-6503f SLPC 28097 02/17 (exp. 02/19)

NEWS By focusing both on the company’s own internal needs as well as the needs of its clients, the LCARA team represents a new stage in “crowd sourcing” information and experience.

“There are certainly a few individuals here or there who include this type of work in their list of responsibilities,” The Phia Group’s CEO Adam Russo remarked, “But we are confident that no team has ever been so focused on remaining ahead of legal challenges and ensuring that both The Phia Group and its allies learn – and benefit – from each other’s growth, wins, and losses.”

To learn more about The Phia Group, its regulatory compliance services, or any of its offerings, please contact The Phia Group’s Sales Executive, Garrick Hunt, at 781535-5644 or Info@PhiaGroup.com.

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

BULLDOG TENACITY. GREYHOUND SPEED. www.HHCGroup.com Claims Negotiation & Repricing | Claims Editing | Medical Bill Review (Audit) | Reference-Based Pricing DRG Validation | Utilization Reviews and Independent Reviews | Independent Medical Examinations

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HM Insurance Group Announces Domenic Palmieri as New Chief Operating Officer PITTSBURGH -- Domenic Palmieri has been named chief operating officer (COO) of HM Insurance Group (HM). In this role, he will be responsible for the executive oversight of operations for three core divisions within HM, including claims, underwriting and strategy.

“We conducted an extensive, nationwide search for this position,” Tom Doran, president, HM Insurance Group, said.

“And while we had significant interest from experienced, qualified professionals, I knew that Dom was the right person for the role based on his widespread knowledge and experience with our company.”

S

ome medical-claims reduction companies wait until the last minute to resolve your claims – sometimes waiting too long and leaving you and your clients with a bigger bill than necessary.

Not us. We apply our never-give-up tenacity to achieve maximum savings on your medical claims, and we promise to turn around claims in 5 business days – and usually faster – so you never lose your ability to dispute provider charges.

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OR EMAIL

sales@HHCGroup.com

INDEPENDENT REVIEW ORGANIZATION: INTERNAL & EXTERNAL EXPIRES 04/01/2020

NEWS Palmieri joined HM in 1997 in the finance and actuarial areas and over the years expanded his roles to controller and then to chief financial officer and treasurer before assuming his most current position as senior vice president, operations and strategic partnerships, in 2011.

“Dom has been a trusted colleague of mine since I joined HM,” Doran said. “I have witnessed him doing tremendous work with our Blue and reinsurer partners, and I’m excited to see him have the opportunity to provide further leadership within our company.”

With more than 20 years of experience in the insurance and risk management industry, Palmieri has expertise in captives, claims operations, cost containment, reinsurance and finance.

He earned both his Bachelor of Science

degree in business administration and his Master of Business Administration from Duquesne University. Additionally, Palmieri is a certified public accountant and a member of the American Institute of Certified Public Accountants, the Pennsylvania Institute of Certified Public Accountants and HM’s Corporate Giving team.

About HM Insurance Group HM Insurance Group (HM) works to protect businesses from the potential financial risk associated with catastrophic health care costs. The company provides reinsurance solutions that address risk situations confronting employers, providers and payers. A recognized leader in employer stop loss, HM also offers managed care reinsurance nationally under the name of RBS Re. HM Life Insurance Company and HM Life Insurance Company of New York are rated “A” (Excellent) by A.M. Best Company, one of the country’s oldest and most respected rating agencies. Through its insurance companies, HM Insurance Group holds insurance licenses in 50 states and the District of Columbia

and maintains sales offices across the country. Contact Jennifer Mahan at jennifer.mahan@hminsurancegroup.com and visit www.hmig.com.

Gold Members Partner Re Appoints Kelly Munger as New Head of US Health Bermuda -- PartnerRe Ltd. announced the appointment of Kelly Munger as Head of US Health effective December 17, 2018.

Ms. Munger has extensive experience in the health reinsurance industry, having specialized in the US Group Life, Accident and Health business for much of her 30 – year reinsurance career. Working as the Head of the US Health business unit, she will be based in PartnerRe’s Maple Grove Minnesota office, reporting to Charles Goldie, CEO, Property & Casualty.

Most recently, Ms. Munger was SVP, Group Reinsurance at SCOR. She joined SCOR in 2014 where she was responsible for growth and development of the US Group Life, Accident and Health business lines, overseeing business development, underwriting, operations and medical management.

Ms. Munger holds a BS in Mathematics from the University of Minnesota – Morris and is a Fellow of the Society of Actuaries.

About PartnerRe PartnerRe Ltd. is a leading global reinsurer that helps insurance companies reduce their earnings

JANUARY 2019

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NEWS volatility, strengthen their capital and grow their businesses through reinsurance solutions. Risks are underwritten on a worldwide basis through the Company’s three segments: P&C, Specialty, and Life and Health. For the year ended December 31, 2017, total revenues were $5.7 billion. PartnerRe enjoys strong financial strength ratings as follows: A.M. Best A / Moody’s A1 / Standard & Poor’s A+. Contact Ali Duerr, Marketing Manager, at 1 415 354 1584 and visit www.partnerre.com/health.

Berkshire Hathaway Specialty Insurance Medical Stop Loss Welcomes Richard Lord Richard Lord has joined the Berkshire Hathaway Specialty Insurance Medical Stop Loss team as Senior Stop Loss Underwriter.

Rich is joining the BHSI Stop Loss team from Voya Financial, where he spent the past eighteen years as a stop loss underwriter with increasing levels of underwriting authority and leadership responsibility.

Rich started as an associate underwriter and concluded his time with Voya as a Principal Group Underwriter for the South region. Rich’s stop loss market and underwriting expertise make him a great fit with his new BHSI team. Contact Rich at 312.702.2823 or richard.lord@bhspecialty.com.

About BHSI Berkshire Hathaway Specialty Insurance (BHSI) provides medical stop loss, commercial property, casualty, healthcare professional liability, executive and professional lines, surety, travel, programs, and homeowners insurance. The actual and final terms of coverage for all product lines may vary. It underwrites

on the paper of Berkshire Hathaway’s National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor’s.

Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Houston, Indianapolis, Irvine, Los Angeles, New York, San Francisco, San Ramon, Seattle, Stevens Point, Auckland, Brisbane, Dubai, Dublin, Düsseldorf, Hong Kong, Kuala Lumpur, London, Macau, Melbourne, Munich, Perth, Singapore, Sydney and Toronto. Visit bhspecialty.com.

Silver Members Smart Data Solutions Continues to Accelerate Growth with Openings of New Office St. Paul, Minnesota – Smart Data Solutions, a MN based collateralprocessing service, has expanded its operations with the recent opening of a new document intake facility. This new facility is also located in Eagan, MN near their corporate facility.

“We’re processing more documents than ever before and continuing our efficiency gains with it as well. For example, we are leveraging machine learning technologies to completely automate traditional mailroom sorting,” said Patrick Bores, CIO at Smart Data Solutions. “We have also invested in additional high-speed, state of the art scanning systems.”

In conjunction with the opening of the new facility, Smart Data Solutions has expanded its document processing staff

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NEWS and introduced additional management structure within that part of the business.

Development staff has also increased to accommodate the implementation of new technologies.

“As we continue to add services and clients, the new facility and personnel will help accommodate our expansion,” said Pat Bollom, Smart Data’s Co-CEO. “We’re excited about the opportunities this facility presents the organization while also providing our staff with a more comfortable place to work.”

About Smart Data Solutions Smart Data Solutions has been leveraging automation technology to enable cost savings, efficiency and improved quality to meet the needs of healthcare claims managers, for more than eighteen years. Today, more than 300 TPAs, PPOs, HMOs, hospitals and insurance companies depend on SDS technology to save money and streamline their business. From paper processing to claims management and EDI, Smart Data Solutions offers the solutions critically needed by today’s health care industry. Call 651.894.6400 and visit www.sdata.us.

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

Opus Investment Management, Inc. Wins Pensions & Investments

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.

Best Places to Work in Money Management Award WORCESTER, MA – Opus Investment Management, Inc. announced it won the money managers with 20 to 49 employees category in the 2018 Best Places to Work in Money Management awards by Pensions & Investments.

HomesteadPlans.com | 844 -307-3788

JANUARY 2019

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NEWS

LEARN | PLAN | SAVE | PROTECT RECOVERY DOLLARS MULTIPLIED

PLAN DOCUMENTS PERFECTED

FIDUCIARY DUTY SHIFTED

LEGAL EXPERTISE SECURED

www.phiagroup.com | 781-535-5600 | info@phiagroup.com Presented by Pensions & Investments, a global news source of money management, the sixth-annual survey and recognition program is dedicated to identifying and recognizing firms among the best employers in the money management industry.

“We are very pleased to be recognized for our outstanding culture and workplace practices,” said Ann K. Tripp, president of Opus. “Our company strives to create a progressive, inclusive environment for our team of dedicated employees to grow their careers and make an impact every day. This award is further validation that we have built a company where the best people want to work.”

Opus offers a competitive benefits package coupled with a focus on work/ life balance. The company truly cares and

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THE SELF-INSURER

gives back to its community as well. Opus’ involvement has been instrumental in the redevelopment and revitalization of downtown Worcester. Its team is also very active, volunteering as board members of local charities.

“Again this year, it is clear that what makes firms great employers isn’t necessarily about money management in particular. Many firms were cited for their culture and benefits,” said P&I Editor Amy B. Resnick. “Our surveys found that the employers on the list were much more likely to offer things like flex time, telecommuting, child and elder care, family leave, job sharing and adoption assistance.”

Resnick continued, “Employees at these top-ranked firms most often cited their colleagues, the firm’s culture and the benefits as the things that make it a great place to work.”

Pensions & Investments partnered with Best Companies Group, an independent research firm specializing in identifying great places to work, to conduct a two-part survey process of employers and their employees.

The first part consisted of evaluating each nominated company’s workplace policies, practices, philosophy, systems and demographics. This part of the process was worth approximately 25% of the total evaluation. The second part consisted of an employee survey to measure the employee experience. This part of the process was worth approximately 75% of the total evaluation. The combined scores determined the top companies.

NEWS

About Opus Investment Management, Inc.

Gilsbar Receives Gold Level Workplace Health

Opus Investment Management is an SEC registered investment advisor that focuses on managing fixed income portfolios for institutional clients such as insurance companies, pension plans, and public entities. Opus is dedicated to “signature performance” – investments tailored to the specific needs of the institutions we serve delivered with client–centric customer service. Based in Worcester, MA, Opus is a member of The Hanover Insurance Group with over $10 billion in assets under management. Visit us at opusinvestment.com

COVINGTON, LA -- The results of the American Heart Association 2018 Workplace Health Achievement Index were announced and Gilsbar achieved Gold level recognition for taking significant steps to build a culture of health in the workplace.

About Pensions & Investments Pensions & Investments, owned by Crain Communications Inc., is the 45-year-old global news source of money management. P&I is written for executives at defined benefit and defined contribution retirement plans, endowments, foundations and sovereign wealth funds, as well as those at investment management and other investment-related firms. Pensions & Investments provides timely and incisive coverage of events affecting the money management and retirement businesses. Visit us at www.pionline. com

Achievement from American Heart Association

The Index, created by the American Heart Association in partnership with their CEO Roundtable, uses science-based best practices to evaluate the overall quality and comprehensiveness of workplace health programs. More than 1,000 companies completed the Index assessment this year with only the highest performers receiving Gold recognition.

Gilsbar’s employees’ health was compared to the Association’s Workplace Health Achievement Index to measure the effectiveness of our workplace health programs as well as the overall heart health of our employees. The American Heart Association’s Workplace Health Achievement Index assessment is grounded in datadriven science and a quality improvement framework.

Catherine Haun, Gilsbar’s Internal Wellness Coordinator, stated “When someone joins the Gilsbar team, our corporate wellness program is one of the first things they learn about and are encouraged to join. Our wellness team and employee wellness committee work all year long to provide tools, challenges, rewards and opportunities for each person to get involved right where they are.”

Gilsbar is proud of our employees and the work they do to provide exceptional service to our clients, as well as the work they do to stay healthy and grow personally.

About Gilsbar, LLC Established in 1959, Gilsbar, LLC® is one of the largest privately-held insurance services organizations in the country. Recognized as a catalyst for creating healthy businesses, Gilsbar, LLC® offers self-funded and fully-insured benefit plan management services, along with Wellness, Advocacy, and overall Population Health Management. Gilsbar, LLC’s integrated delivery model improves the health and well-being of its members, resulting in significant health plan savings for its clients.

Gilsbar, LLC® has been honored by Inc. magazine for its sustained growth, Modern Healthcare and Business Insurance magazines as a Best Place to Work, and WELCOA and the American Heart Association for its proven wellness methodology. Visit www.Gilsbar.com.

JANUARY 2019

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Celebrating 10 years of Employee Benefit Group Captives We’ve been innovating for a very long time. Ten years ago, Berkley Accident and Health was an industry pioneer with EmCap®, our employee benefit group captive program. Today, we are a market leader with an impressive track record of building and managing successful captives.

For group captives, it’s a clear choice. Choose the team with a decade of experience and success.

These statements are illustrative only and not indicative of actual past or future results. Stop Loss is underwritten by Berkley Life and Health Insurance Company, a member company of W. R. Berkley Corporation and rated A+ (Superior) by A.M. Best, and involves the formation of a group captive insurance program that involves other employers and requires other legal entities. Berkley and its affiliates do not provide tax, legal, or regulatory advice concerning EmCap. You should seek appropriate tax, legal, regulatory, or other counsel regarding the EmCap program, including, but not limited to, counsel in the areas of ERISA, multiple employer welfare arrangements (MEWAs), taxation, and captives. EmCap is not available to all employers or in all states.

Stop Loss

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Group Captives

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Managed Care

© 2018 Berkley Accident and Health, Hamilton Square, NJ 08690. All rights reserved. BAH 2018-14

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Specialty Accident www.BerkleyAH.com

SIIA 2019 BOARD of directors & committee chair ROSTER

Chairman of the Board*

Directors

Committee Chairs

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

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

President/CEO

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

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

Chairman Elect*

Kevin Seelman Senior Vice President Lockton Dunning Benefit CompanyDallas, TX

Mike Ferguson SIIA Simpsonville, SC

David Wilson President Windsor Strategy Partners, LLC Princeton, NJ

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

SIEF Board of Directors Nigel Wallbank Chairman Heidi Leenay President Freda Bacon Director

Jeffrey K. Simpson Attorney Gordon, Fournaris & Mammarella, PA Wilmington, DE Robert Tierney President StarLine East Falmouth, MA Peter Robinson Managing Principal Integro Re San Francisco, CA

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

Les Boughner Director Alex Giordano Director

JANUARY 2019

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SIIA new members january 2019 Regular Corporate Members

Silver Corporate Members

Employer Corporate Members

Zack Bryant National Sales Executive DataPath, Inc. Little Rock, AR

William Schmitt Accolade Seattle, WA

Jody Watts Insurance Coordinator Bronson Healthcare Group Kalamazoo, MI

Michael Lyon President/CEO SIG Solutions Inc. Newport Beach, CA William Zimmerman Vice President, Business Development The Kingstree Group, Inc. Wayne, PA

At Meritain Health, we are your

Advocates for Healthier Living!

We strive to help our members lead healthy, productive lives. That's why we oer tools and services to promote long-lasting health and well-being.

For more information, visit www.meritain.com.

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Will Green Fund Administrator/President Louisiana Automobile Dealers Association Self-Insurers’ Trust Fund Baton Rouge, LA

Pay it Right THE FIRST TIME

Through our integrated PREPAYMENT REVOLUTION Zelis is the market leader in integrating network solutions, payment integrity and electronic payments to deliver insights that drive even greater savings before a claim is paid. Working in a prepayment environment, we price the claim correctly before you pay, avoiding unnecessary costs, time and reducing member and provider abrasion.

In fact, 85% of the time we find claim savings that other vendors don’t. We do this by focusing on every step of the pre-payment claim cycle and delivering value-driven solutions from payment to reconciliation.

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

Better Service. Better Performance.

zelis.com

Copyright 2018 Zelis Healthcare. All rights reserved Copyright 2017 Zelis Healthcare. All rights reserved.