Archive for November, 2014

Cadillac Tax – The Rest of The Story

Saturday, November 29th, 2014


Ever wonder the purpose of the Cadillac tax? In a portion of this 4 minute video Gruber explains that the tax , affecting only 8% of health plans in today’s market, will eventually affect 100% of all health plans, thus bringing an end to employer sponsored health insurance.

Will Wellness Programs Be Declared Illegal?

Saturday, November 29th, 2014



“They (employers) don’t understand why a plan in compliance with the ACA (Affordable Care Act) is the target of a lawsuit”


Medical Executive Post Publishes White Paper

Tuesday, November 25th, 2014

The PPACA [Game Changer for Health Care Financing]

The fuel which fires the self-funded engine of employee health and welfare plans

[By William Rusteberg]


PP-ACA Taxes for 2015


The Affordable Care Act (ACA) has had a fundamental impact on health care financing in this country. It has effectively provided added incentives for plan sponsors to consider modified self-funding arrangements for their employee health and welfare plans in lieu of fully-insured plans. The advantages of doing so are clear.


More States To Offer Work Comp “Opt-Out”?

Tuesday, November 25th, 2014


A national coalition has formed to take the benefits achieved in Texas and anticipated in Oklahoma and spread them to other states.

As we are all too familiar, the handling of workers’ compensation is dictated by statutes in all states. Only Texas and Oklahoma offer the freedom to “opt out” of the statute, and their approaches are quite different.


J Patrick Rooney (1927 – 2008)

Monday, November 24th, 2014

rooneyWhile Rooney acknowledges that hospitals may need to charge more than Medicare will pay, he contends that authoritative research shows that Medicare plus 25 percent is the reasonable amount for hospitals to charge…


AMPS CEO Mike Dendy Awarded 2014 Professional Achievement Award by Georgia State University Institute of Health Administration

Saturday, November 22nd, 2014


ATLANTA, Nov 13, 2014 (BUSINESS WIRE) — Advanced Medical Pricing Solutions (“AMPS”), a healthcare cost management company serving the self-funded (ERISA) payer community, today announced that its CEO and president Mike Dendy received the 2014 Professional Achievement Award from the Georgia State University Institute of Health Administration (IHA).


Happy Thanksgiving From The Obama Administration

Saturday, November 22nd, 2014


“In keeping with their grand tradition of issuing major regulations late on a Friday afternoon and right before a national holiday with comments due smack in the middle of both Advent and Hanukkah…………”

The rule also proposes requiring that all marketplaces, QHP issuers and web-based health insurance brokers provide telephonic interpreter services in at least 150 languages in addition to the existing requirement of providing language services…”

Editor’s Note: is going to thrive under ObamaCare


Health Care A $30 Billion Industry in San Antonio

Friday, November 21st, 2014


The Alamo, San Antonio, Texas

“More than one in six San Antonio workers are employed by the industry.”


Corpus Christi ISD Seeks Insurance Consultant

Thursday, November 20th, 2014

bluelight130x130Corpus Christi Independent School District is seeking a qualified insurance consultant through a public Request for Proposal process :

Wortham Insurance & Risk Management San Antonio, TX  was awarded  the CCISD insurance consulting contract several years ago at $85,000 per year.

Men’s Health Month – Award Winning Video

Thursday, November 20th, 2014
Giving Testicular Exams in Public for Charity –
A preventive benefit covered under ObamaCare? No deductible, no co-pay, no out-of-pocket…….

Wednesday, November 19th, 2014

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The Phia Group – Reference Based Pricing Webinar

Wednesday, November 19th, 2014

“Assessing the steps we need to take to continue down the path of Reference Based Pricing………..”


A Brief History of Managed Care

Wednesday, November 19th, 2014

okfarmer  The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital.


Clear Health Costs / Knight Foundation Project A Success

Wednesday, November 19th, 2014

clearhealthcost Exciting news: Our Knight Foundation prototype project has been a smashing success.We’re thrilled to report our successful project with KQED Public Radio in San Francisco and KPCC in Los Angeles……….


More Skirmishes From The Provider Network War

Wednesday, November 19th, 2014


State regulators are working on model law revisions that could have a big effect on which doctors, hospitals and other providers are in your health insurance customers’ provider networks.


Tuesday, November 18th, 2014

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What Could Be The Republican Alternative To ObamaCare?

Sunday, November 16th, 2014


By Bill Rusteberg

With the mid-term elections of 2014 there will be new impetus towards improving ObamaCare by the new Republican majority in Congress.

ObamaCare is simply not working well.

What are the alternatives? These may be  the Republican’s answer to fixing ObamaCare:

1. Maintain some  provisions such as prohibition of pre-existing condition clauses, guaranteed renewability, portability.

2. Removal of coercive aspects of ObamaCare, i.e. the employer and individual mandate

3. Creation of a national re-insurance pool (Medicare?)  for catastrophic claims to protect carriers and self-funded groups

4. Allow insurers to structure benefits at will thus removing the “one shoe fits all” approach under ObamaCare

5. Provide tax credits to the “poor.”

FOR THE DEMOCRATS :   Items 1, 3 and 5 should appeal to Democrats. Number One maintains certain ObamaCare mandates, Number two allows for an expansion of Medicare and Number 3 continues the expansion of the American welfare state.

FOR THE REPUBLICANS :   Items 2 and 4 appeals to the Republican’s innate repulsion of big government. Items 1, 3 and 5 appeal to their desire to be re-elected.






University Places Drug Vending Machine on Campus

Saturday, November 15th, 2014

instymedsPhoenix, Ariz. (CBS LAS VEGAS) – An InstyMeds vending machine has been installed on Arizona State University’s campus, allowing any student or university employee to pick up prescription drugs from the dispenser.


Stupid Americans & The Passage of ObamaCare

Friday, November 14th, 2014

stupid 1

(Start at 21:00 and listen to the next 25 seconds of Gruber’s strategy for passage of ObamaCare)


United HealthCare San Antonio Blitzkreig Continues

Thursday, November 13th, 2014


United HealthCare (UHC)  has replaced Humana Insurance Company at two large San Antonio school districts recently. Two weeks ago Harlandale ISD voted to change from Humana to UHC. Now the San Antonio Independent School District succumbs to aggressive UHC sales warriors.


Be Prepared For A DOL Audit Because It’s Coming

Thursday, November 13th, 2014

dol audit

Texas’ Commercial Health Insurance Market Growing Less Competitive

Thursday, November 13th, 2014


Texas’ commercial health insurance market is growing less competitive, a new study shows.

Blue Cross Blue Shield of Texas is the dominant player in 25 of 26 Texas metropolitan areas, said a report issued Thursday by the doctors’ group the American Medical Association.


Why Do Drugs Cost So Much?

Thursday, November 13th, 2014


“So this person, my patient, with a raging headache, left her pharmacy empty handed because she was unable to afford a medication which had been marked up over $500 above cost, a medication which has been available as a generic for over half a decade.”


Will Government Make Us Buy Broccoli Next?

Wednesday, November 12th, 2014


WASHINGTON (CBSDC/AP) — Americans will see their bank accounts shrink if they don’t sign up for Obamacare in its second enrollment season.

Uninsured Americans who decide not to enroll will face a penalty of $325 per person, more than tripling the $95 penalty those who did not enroll had to pay the first time around.

Children under the age of 18 will be fined $162.50. The maximum amount an uninsured family will be penalized is $975 under the flat-rate method.


Texas Company Offers Community Rated Health Plan?

Tuesday, November 11th, 2014


By Molly Mulebriar

A Texas company is marketing a group medical plan that has some employers excited. Employers can enroll their employees in a Base Plan for $482.71 per month or a Buy Up Plan for $598.18 per month. See here: Benefits & Rates

A visit to their website ( ) provides details of the offering.

The medical plan is represented to be insured by Aetna. However, an Aetna representative we know is puzzled.

An employer  and their insurance agent should always be cautious when selecting an insurance provider. A quick check with the Texas Department of Insurance would be a good start. Additional resources include the North Carolina Department of Insurance. (NC Comm. Order).

An interesting read can be found here: ASOexperience . We have no idea who wrote this, nor can we say for certain this article has any connection here. We leave it up to the reader to decide.



Veterans Day 2014

Sunday, November 9th, 2014



Texas Exchange Plan Comparison Calculator

Saturday, November 8th, 2014


Otra Vez! Supreme Court Takes Up ObamaCare Case

Saturday, November 8th, 2014

supremeSupreme Court

John Roberts – An opportunity for redemption ?

“Supporters of the health care law were flabbergasted and accused the court of veering into politics…….The legal challenge to the subsidies is “the most serious existential threat” facing the Affordable Care Act…….”


Friday, November 7th, 2014
A movement is beginning. Employers are partnering directly with providers. Health reform and a more value-driven approach to benefit strategy have prompted some self-insured employers to work directly with providers through arrangements that include onsite health screenings, bundled payment activities, building narrow networks, centers of excellence and more.
Is this where the future of employer-sponsored healthcare is headed?
At our December conference our expert speakers will provide education and direction on how purchasers can begin to work with providers. 
Topics to be covered:
  • The vast range of opportunities available for employer/provider partnership and how to evolve a relationship.
  • How employers should approach a partnership strategy – What are the critical areas of coordination and negotiation with health plans and providers?
  • Providers – primed for partnership – discuss why they should be part of your strategy.
  • A successful employer/provider partnership betweenAtlantic Health System and Wyndham Worldwide. 
Sessions include:
Working with Providers: What are the Options for Employers to Improve Care and Lower Costs?
Erin M. O’Connor, Esq.
Partner, Cammack Health
Primed for Partnership: A Discussion with Providers
James Barr, MD
Chief Medical Director,
Optimus Healthcare Partners
Medical Director,
Atlantic Health System’s ACO
David Shulkin
Atlantic Health System
Annette Catino

President & CEO, QualCare Alliance Networks, Inc.

Christopher Corbo
Corporate Director of Benefits and Wellness, Chrisitana Care Health System
An Employer Case Study in Partnership: Atlantic Health Systems/Wyndham Worldwide
Kristin Kubas
Vice President, Benefits
Wyndham Worldwide
Kathleen A. Fischer, MSN, APN-BC
Atlantic Corporate Health-Morristown Medical Center
Nurse Practitioner Be Well Health Services, Wyndham Worldwide
Main sponsor:
Platinum sponsor:
Gold sponsor:

DEC 10

Breakfast & Networking

8:00 – 8:30 amProgram
8:30 am – 12:00 pm

add to Outlook


Atlantic Health Systems

435 South Street
Morristown, NJ


Register here:
Open to ALL
NEBGH Employer Members: FREE
All Other NEBGH Members:$125
Nonmember Employers:$75
All Other Nonmembers:$195

Government Closing Loopholes

Thursday, November 6th, 2014


If you read this blog, you will notice on this page alone there are three entries relating to government’s focus towards various loopholes and blivets within the ACA.

Government momentum to secure the handcuffs is accelerating.

Insurance brokers and consultants are worried. For some, the thrust since passage of ACA was to prove value to clients by finding ways to skirt onerous mandates and punishing government sanctions.

Others have simply become government organs spitting out continuous updates of the do’s and don’ts. They are called “compliance officers.”

And then there are the others, and a growing number of them, who have retired or quit the business, or are seeking their fortune through other means such as voluntary employee benefits.

The shackles of government mandates continue to tighten. Escape seems uncertain, except for those who seek freedom by leaving the plantation.




Is Exchange Dumping Illegal?

Thursday, November 6th, 2014


By Molly Mulebriar

In a Memorandum issued 6 November 2014 the Department of Labor’s Benefit Security Administration issued their opinion that I believe effectively prevents an employer from Exchange Dumping.


Aetna Buys Bswift: Why Benefits Brokers Must Pay Attention

Thursday, November 6th, 2014


”In a not-so-obvious way the health care world is changing in a way that most brokers are not recognizing. Consumer-centric; mobile; doctors as wellness facilitators; employers out of the risk business? Maybe. So get ready.


Government Slams Door On Loophole

Tuesday, November 4th, 2014


SPBA Email Alert – November 4, 2014

 Agencies Release a Notice on Group Health Plans that Fail to Cover In-Patient Hospitalization Services

In IRS Notice 2014-69, the agencies state that plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services (or for both) do not provide the minimum value intended by the minimum value requirement and will shortly propose regulations to this effect.

According to IRS Notice 2014-69, employers should consider the consequences of the inability to rely solely on the MV Calculator (or any actuarial certification or valuation) to demonstrate that a Non-Hospital/Non-Physician Services Plan provides minimum value for any portion of any taxable year ending on or after January 1, 2015, that follows finalization of such regulations.

The link to the guidance is below.  SPBA is reviewing this guidance and will reach out to agency officials for clarification as needed.

Aetna’s Medsure Program – A Best Seller For 2015?

Tuesday, November 4th, 2014

AetnaAetna’s Medsure Plan offers employers a Bronze Plan of benefits requiring only 10% employee participation. This plan satisfies both the employer and individual mandate. Costs are age bracketed. Available for groups of 300+ employee lives.

Aetna will sell a lot of this, especially virgin groups. With 2015 just around the corner, Aetna reps. will be very busy during the next 45 days.

PPACA Enrollment Expected To Surge

Monday, November 3rd, 2014


Houston based Community Health Choice expects 15,000 – 40,000 new individual health insurance enrollments during the upcoming PPACA Open Enrollment period.  This is up from 500 last year.


Fully Insured Rates Skyrocketing – How To Mitigate Increases

Monday, November 3rd, 2014
By Molly Mulebriar
Fully insured rates are going through the roof this quarter. I have looked at three renewals in the past two weeks and they are brutal. The ACA punishment taxes that were not supposed to hit the middle class but is doing just that. An estimated 8% of renewal increases are directly attributable to these fees (John”If I Had A Son” Roberts calls these fees “taxes”).


Saturday, November 1st, 2014

The shared vision of and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

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