Direct-To-Provider Health Plans Lowers Health Care Costs

December 11th, 2019

Remember back in the day when health care providers were paid directly, quickly and in cash? Gone were the vast armies of third party intermediaries driving up costs we see today.

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Private University Seeks TPA / RBP / PPO Proposals

December 10th, 2019

Texas based university is seeking competitive proposals for TPA services to administer a dual option Reference Based Pricing plan / PPO plan.

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Stop Hiding Behind A Logo

December 10th, 2019

In a previous post we discussed Hiding Behind A Logo and why self-funded plans should stop doing so. Plan members need to know who the real “insurance company” is, because it’s not who they think it is.

There are real advantages to understanding the difference, both to the plan sponsor and plan members.

For example, changing plans is never fun, with a lot of disruption and employee re-education. It’s HR’s worst nightmare. Besides, changing logos on an I.D. card doesn’t save money. However when you brand a plan for exactly what it is, changing a backroom claim administrator is as painless as changing stop loss carriers. It’s seamless and not at all disruptive to plan members.

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UIW Seeks Benefits Manager

December 9th, 2019

The Benefits Manager is responsible for directing and planning the day-to-day operations of the University of the Incarnate Word’s self-funded medical and dental plans, other ancillary insurance benefits, and the 403(b) retirement plans.

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We Know How To Fix Health Care

December 8th, 2019

             But No One Is Listening

Pissed Off Plan Sponsors Wanted – Apply Within

December 7th, 2019

We need to bring sanity back to health care financing. We need to stop the intimidation………

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Hiding Behind A Logo

December 6th, 2019

Why do self-funded plans hide behind a logo? Employers who self-finance their employee benefit program almost always do.

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The Farce Everyone Pays For

December 5th, 2019

Imagine going to a restaurant and having a nice dinner. You get the bill. Everything looks good except there is a facility fee added at the bottom. A facility fee? What’s that you ask. “Its what we charge for you to use our facility” says the waiter………………”Our new owner says it’s necessary.”

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Teachers Defy Injunction, Strike Over Health Care

December 5th, 2019

Teachers are crying foul about health insurance costs that eat into their salaries………………….

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Texas Doctor Heads To Trial Over Healthcare Scheme

December 4th, 2019

Dr. Jorge Zamora-Quezada

“Zamora-Quezada is accused of using his million-dollar private jet or his Maserati to go between his offices in the Rio Grande Valley and San Antonio, and of using proceeds from the alleged fraud to buy private jets, luxury vehicles, high-end clothing and real estate in the United States and Mexico.” (KSAT)

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How To Make A Killing In American Health Care

December 4th, 2019

A step by step guide to earning your first billion in American health care…………….

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Reference Based Pricing – Why Pay A Premium of 20% or More?

December 3rd, 2019

Medicare ties reimbursement to cost, health insurance doesn’t. That’s the difference………

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TPA Administration Agreements

December 3rd, 2019

By Molly Mulebriar

The picture above (on Linkedin this morning) reminded me of an infamous Texas based TPA known for preying upon mostly rural, clueless employers by hiding turbocharged TPA fees on the claim side of the ledger instead of the fixed cost side of the ledger. These clueless employers don’t read their contracts………………or don’t know any better, or both.

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PBM’s Under Fire

December 3rd, 2019

Pharmaceutical Manufacturer Concocts New Patented Drug 

PBMs have been under increased scrutiny as a potential contributor to runaway healthcare costs.

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Scientists Discover A Cure For Pancreatic Cancer ?

December 3rd, 2019

Israeli scientists find way to treat deadly pancreatic cancer in 14 days. The tumor in one mouse that was injected with human cancer cells completely disappeared.

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What?

December 1st, 2019

160,000 American citizens offered a $500 cash payout, plane tickets to San Diego and free transportation to Tijuana to receive free health care services. Meanwhile California announces free health care for Mexican citizens who enter the state illegally…………

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Texas School District Offers Students On-Demand Access To Health Care

November 29th, 2019

Texas school district implements two-way video office visit program during school hours for 32,000 Texas school children…………………..

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Teachers Learn ER Visits Are Bad For Their Financial Health

November 27th, 2019
“Half of the members from a large school district in North Texas had used the app, resolving three-fourths of cases in one patient population in a recent month, saving $667,000 in avoided ER visits.”

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Court Blocks San Antonio Paid Sick Leave Law

November 25th, 2019

SOURCE: Fisher Phillips

“Mere days before San Antonio’s Sick and Safe Leave ordinance was set to go into effect, the law was once again put on hold…. Bexar County Judge Peter Sakai temporarily delayed the start of the paid leave ordinance, which was set to take effect on December 1.”

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HHC Group Releases Survey Results

November 24th, 2019

FOR IMMEDIATE RELEASE

November 20, 2019 Contact: Bob Serber
rserber@hhcgroup.com
(301) 963-0762 ext. 163

H.H.C. GROUP RELEASES 2019 CLIENT SURVEY RESULTS

H.H.C. Group has released the results of its annual client survey. The survey is designed to assess the company’s performance and help identify its clients’ greatest needs and concerns going into 2020.

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Death of The Status Quo Health Insurance Salesman

November 22nd, 2019

When you came in here you claimed you can SAVE US MONEY. But you really can’t can you? 

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Hospitals Can Win By Losing

November 20th, 2019

Hospitals Can Bypass New Price Transparency Rules For A Price

Why are hospitals making all the fuss about the new price transparency rules announced by HHS?  Instead they would be wise to remain silent and fund $300 per day ($109,500 per year) into their “Government Punishment Fund” as an additional cost of doing business.

This is a perfect example of Winning By Losing…………..

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Direct Primary Care Symposium 12 Feb. 2020

November 20th, 2019

The purpose of this event is to inform and educate federal legislators and regulators on the merits and benefits of Direct Primary Care and the impact that Direct Primary Care can have on rising health care costs.

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The Affordable Care Act

November 19th, 2019

Size Doesn’t Matter

November 17th, 2019

Size doesn’t matter when it comes to health care……….

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Cost Shifting Is Silly

November 17th, 2019

Status quo strategies used to reduce health care spend by employers includes cost shifting to plan members. Higher deductibles and higher out-of-pocket costs reduces insurance premium costs but not health care costs.

Back in the day a health insurance deductible equaled one week’s worth of pay. A $100 deductible was standard back in 1975.

Now it’s not uncommon to see annual deductibles of $4000 and more, much more.

It’s evident cost shifting has not tamed the healthcare beast.

And it’s clearly evident size doesn’t matter. A +400,000 life self-funded health plan in Texas has been practicing cost shifting for years. 64% of plan members are on a $2,750 front end deductible with no first dollar coverage (except for preventive care) before benefits are paid.

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Arthur J Gallagher 10k Report

November 16th, 2019

The Arthur J Gallagher 10k 145 page report for the fiscal year ending December 31, 2018 provides interesting insight into insurance brokerage services.

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A Health Care Strategy That Makes Sense

November 14th, 2019

         Status Quo Broker Reacts

THE STRATEGY

Allow providers to name their price and mold the member and plan responsibility around that.

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Cash Pay Health Plans Save 50% or More

November 12th, 2019

“Paying cash to see the doctor out of network cost less than half of seeing the same doctor in-network with insurance.”

Plan sponsors should adopt cash pay strategies as many of our clients have done with good success. Whereas a typical PPO plan will pay (with your money) as much as 225% – 400% of Medicare, our cash pay program pays ( with your money) Medicare rates or below on average.

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Veterans Day 2019

November 10th, 2019

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

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Apaly Health Launches Direct Contracting Solution

November 10th, 2019

“Will my doctor accept our insurance” ….………… “Yes, unless he’s an idiot.” 

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Learn A Foreign Language – Become Bilingual

November 9th, 2019

Learn a foreign language in the comfort of your home! You will be glad you did! Never again scratch your head and wonder what the heck that health insurance salesman was trying to convey during those dreadful renewal meetings. Stop relying on body language! Become empowered NOW!

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Catastrophic Claims on the Rise

November 5th, 2019

There is no doubt catastrophic claims are on the rise. Turbo-charged hospital bills reach the ever present stop loss outlier provision (common to most managed care contracts) faster than a melting Raspa in deep South Texas on a hot day in August.

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20 Year Old Starts Hospital Charity – Now The Rest of The Story

November 1st, 2019

Hello Americans. I’m Paul Harvey. You know what the news is —– in a minute you’re going to hear the rest of the story……………………..

At 20 years old Eric started a hospital charity to benefit children in need of health care. It was a noble endeavor. In less than 10 years, he raised more than $20 million for terminally ill children at Saint Jude Children’s Research Hospital in New York. His charity maintained just over a 9 percent cumulative expense ratio, one of the lowest expense ratios of any charity in the nation, and funded the construction of one of the most cutting edge intensive care units and surgery centers dedicated to children.

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Raising Drug Prices Is A Moral Requirement

November 1st, 2019

Raising drug prices is “a moral requirement,” says Nostrum Labs CEO.

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Predatory Billing, Scare Tactics, Boggus Prices

November 1st, 2019

Many hospitals are more interested in extracting money from vulnerable patients than providing quality care at a fair price………………but greedy healthcare participants like hospitals don’t have quite as much leverage as they’d like us to think………………..

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BCBS Swims In Cash

November 1st, 2019

Your BCBS renewal could be the beneficiary of a reserve buy-down in 2020 which means lower than normal rate increases. New business rates should be below market too. That’s because “A $1.7 billion tax refund under the Trump administration’s tax cuts drove a 226 percent rise in net income to $4.1 billion, from $1.3 billion the year earlier.” 

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The God Father of Reference Based Pricing is…………………………

October 31st, 2019

By Molly Mulebriar

There appears to be some confusion these days as to rightful owner of the title God Father of Reference Based Pricing.  

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Texas Sues Aliera Healthcare

October 29th, 2019

Texas Department of Insurance estimates that Aliera has about 17,000 customers in Texas and 100,000 nationwide.

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The Case of The $153,887 Kidney Stone

October 29th, 2019

“The patient spent 1 hour in the OR.  I kid you not, the facility billed $153,887……….”

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Non-Profit Hospital Defends Finances

October 28th, 2019

“Over the past few weeks, several articles and “studies” have been filled with inaccuracies and, at best, incomplete analyses of Parkview Health’s financial position, with calls to invest more in the community. I never expected having to defend what Parkview does for the community, but I will, and I’ll also provide some context regarding our financials.”

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Price Transparency Be Damned – I’m Insured Through OPM Insurance Company

October 27th, 2019

“Americans usually put relationships ahead of money” because the money is not really theirs. “Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby” because, after all, they use Other People’s Money. No one ever cares about health care costs when using Other People’s Money (insurance). Transparency be damned………………………

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Changing TPA’s – I’d Rather Grin & Bare It!

October 26th, 2019

By Molly Mulebriar

How many times has an employer said to you “Yes, we ARE having issues with our TPA, but changing to another one is too disruptive and challenging. Plus, we are out of time since our renewal is just around the corner. We are just going to stay put for now and live with it.” Read the rest of this entry »

HCA Sued Over Cover Charge

October 23rd, 2019

A $3,935 cover charge? No problem! I’ve got Nightclub Insurance! Let’s party………..

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Insulin Patent Sold For $1 Almost 100 Years Ago – What Happened?

October 23rd, 2019

By Carl C. Schuessler, Jr., DHP, DIA, GBDS

Organized crime – this is killing diabetics…………………

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Experiment Induces Confused Supposition

October 22nd, 2019

Do retail pharmacies make more or less money through PBM contracts?  If they make less money is it to a point they lose money?  Or do they profit? Before asking your pharmacist, try this experiment first.

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Benefit Administrative Systems, LLC

October 20th, 2019


Founded in 1983, BAS is a results-driven third party administrator with a track record of delivering cost savings and customer satisfaction. We utilize our services, tools, and partners to create a robust partially self-funded plan as unique as each client.

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UnitedHealth Loses Two Big Accounts – Big Wins for Humana & Aetna

October 17th, 2019

UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits.

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Teacher Retirement System Considering Big Changes

October 14th, 2019

Formerly sleepy TRS trustees are considering “big changes” to TRS ActiveCare because member districts are threatening to leave to establish their own health plans. Competition, for the first time, is clearly at play here (Texas School District Challenges TRS ActiveCare Plan Mandates).

The TRS solution? Eliminate community rating so some districts can pay more and utilize narrow networks so all districts have less choice……………………..

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What’s at Stake in the Current Court Challenge to the ACA?

October 14th, 2019

Lord Roberts -Protector & Defender of ObamaCare

“In court in July, only two of the three judges … asked questions. ‘Oral argument in front of the circuit went about as badly for the defenders of the [ACA] as it could have gone,’ says Nicholas Bagley, a professor of law at the University of Michigan.

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Specialty Drugs, Fiduciary Duties & The Hot Potato Method

October 13th, 2019

Specialty drugs can cost hundreds of thousands of dollars per member per year, or more. One new specialty drug approved this year costs +$2,000,000 for an annual treatment………

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Schuessler To Speak at The Texas Public Policy Foundation

October 12th, 2019

Carl Schuessler is set to speak at the upcoming Texas Public Policy Foundation event in January, 2020 in Austin, Texas. The panel discussion is on “The Way Out of America’s Broken Health Insurance System.” Knowing Carl as we do, his message may be “Grow Cojones For (a) Change.

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The Mother of All Health Care Battles Looms

October 11th, 2019

We have reached a tipping point in the battle against high cost health care. Employers have run out of money to pay for it. Employees can’t afford to use their health insurance anymore. Meanwhile hospitals continue to game the system with egregious charge-master pricing and their disco-discount game with their carrier partners. They have effectively dug their grave and are about to be pushed into it……………..

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Colorado Proposing To Adopt Reference Based Pricing Strategies

October 9th, 2019

Proposal will take Colorado down several relatively untraveled roads, potentially creating a health insurance market like no other in the country that could become a national model — or a cautionary tale……………..

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Introductions Are Worth Big Bucks In The Insurance Industry

October 6th, 2019

Earning commissions forever by simply making an introduction beats working for a living………….

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The Betalin Cure

October 6th, 2019

A team of Jerusalem-based researchers and entrepreneurs claim they have a cure for diabetes that could hit the market as early as within the next few years…………..The patient should never have to inject insulin into his body again………………

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AMPS Reports Record Growth In 2019

October 6th, 2019

AMPS saw significant growth in its large customer portfolio this year, including customers with upwards of 150,000 members. The growth from small to midsize to large customers reflects broad embrace by employers and health systems……………..

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Risk Tolerance & Reference Based Pricing Strategies

October 3rd, 2019

The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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Renting Medicare’s Provider Network

October 3rd, 2019

 An idea with bi-partisan support?

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

October 3rd, 2019

Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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Dead Peasant Insurance

October 2nd, 2019

According to one source, Hartford Life Insurance estimated that one-quarter of all Fortune 500 companies have COLI policies, which cover the lives of about 5 million employees.

Can proceeds go to reduce GASB 45 ?

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Individual Coverage HRA – The Good, Bad & Ugly

October 2nd, 2019

SOURCE: Trucker Huss

“The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year…….

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Indiana Hospitals Under Scrutiny

September 30th, 2019

Indiana Jones (Michael Hicks) Sounds Alarm

“What I discovered will deeply anger every Hoosier and should embarrass most hospital administrators and board members. I also expect it to cause significant changes to state policy with respect to these hospitals. This is likely to change the way we tax them, regulate their competitors and enforce anti-trust laws. It will surely lead to civil litigation involving billions of dollars of excess profits.”

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PWC White Paper

September 30th, 2019
“There is a sense among employers that it is time to think creatively and broadly about changing the system. In 2020, medical cost trend will continue its march upward, but not without employers working to slow and perhaps even stop that march.”

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Hospitals & Insurers Fight Against Transparency

September 30th, 2019

Hospitals say price transparency won’t lower prices. So what will? 

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AMPS – RiskManagers Purchasing Coalition #1 Choice

September 29th, 2019

Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, announced a comprehensive cost containment solutions suite that will help self-funded employers significantly control healthcare costs in 2020……………..

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Government Approves New Group Health Plan

September 27th, 2019

A new government approved group health plan through which employees may purchase individual health insurance on the open market may have a significant impact in the employee benefits arena.

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American Greed Ushers In Single Payer Health Care

September 26th, 2019

Centers for Medicare & Medicaid Services Administrator Seema Verma warned insurers to shape up or face the consequences of “Medicare for All.” 

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Sleepy TRS Responds To El Paso’s Bold Move To Offer Commercial Health Plan

September 25th, 2019

“El Paso ISD found a novel way to migrate most of its staff out of the state’s program and onto a new local plan…………In response to El Paso’s decision and with the expectation that other districts may pursue a similar course of action, TRS is now looking into the possibility of regional options for school district employees.” Read the rest of this entry »

COBRA To The Rescue

September 25th, 2019

General Motors cuts health plan for 50,000 striking employees

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Revolutionary New Cancer Drug Approved

September 23rd, 2019

A “revolutionary” new class of cancer drug that can treat a wide range of tumours has been approved for use in Europe for the first time.

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We’re Live With CBS National News!

September 23rd, 2019

By Jeanne Pinder

We’re live with CBS national news! We’ve been promising big news for a while now, and here it is…….

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6 Degrees Health Discovers CASH IS KING

September 22nd, 2019

Cash payment claim strategies often saves more than what the plan would have otherwise paid proving providers will accept less reimbursement for cash………………..

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Freedom Health 100 – A New & Innovative Group Medical Plan

September 20th, 2019

Freedom Health 100 is proud to announce a new group health insurance product  – The Freedom Health 100 plan.

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Reinsurance To The Rescue!

September 20th, 2019

You never know who is behind the insurance curtain. You may think you have insurance with ABC Insurance Company,  but they may only be the “fronting” company retaining only a small portion of the risk. You might be insured with 20 or 30 carriers through a reinsurance treaty, each sharing in the risk on a prorata basis. 

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