October 2025 – Risk Managers

Palace Coup – ABC Fence Company Does The Unthinkable

Employees revolt against status quo health care financing in the spirit of “No taxation without representation……….”

Aegis 2025 Medical Stop Loss Premium Survey

Key Survey Findings – 2025

Stop loss premiums vary widely due to deductible size. However, when normalized by contract (e.g. Paid, 12/12), an average cost is determined across the range of deductibles.

Zebound For $179 1st Month, $299 Thereafter

The MEDVi Semaglutide program starts at $179 for your first month with no contract. This cost covers your physician review, full personalized plan, 1:1 guidance, metabolic report, and the cost of the prescription medication shipped right to your door.

The Math Just Doesn’t Add Up

GLP-1 drugs are bankrupting self-funded health plans. We know because we’ve seen it. And it’s ugly, real ugly.

You Don’t Need A Living, Breathing Broker Anymore When Shopping Insurance

Remember back in the old days when you used a local travel agent and now you don’t. Remember sitting down with a living, breathing insurance agent to buy a policy? You may not remember now but you will sooner or later…………..

Curative Blitzkreig Captures City of Pharr

Curative Insurance Company, lead by Generalissimo Juanito Bock, conquers yet another city in the Lower Rio Grande Valley.

Tom Slack

By Bill Rusteberg

Tom was an unusual character, a master salesman and world class communicator. His out-of-the-box antics were impossible to duplicate without severe consequences to anyone else who tried. He was smart, a rising star destined, as was the common belief, to be President of the company one day.

Level-Funded Health Plans Explained

Level-Funding is a hybrid employee health plan between a self-funded plan and a fully-insured plan.

NEW! Online Dental Benefits

Frustrated Reformist Says Money Always Wins – Politics Always Realign

By Chris Deacon

You can spend years trying to do the right thing. Make sacrifices. Tell the truth. Stay the course. Trust the wheels of justice. And still find yourself wondering if any of it mattered.

ACA – A Freeloader’s Paradise

A hardworking professional paying $3,800 pre-tax per month gets the same (or worse) coverage as someone with no income, who qualifies for free, taxpayer-funded insurance………….Encouraging freeloading isn’t social justice — it’s corrosion. It hollows out ambition, punishes effort, and breeds dependency disguised as equity.

Cash Pay Health Plan Overdraft Protection

A self-funded cash pay health plan can and should be funded through a Health Reimbursement Arrangement (HRA). But how does a plan sponsor protect against overdrafts?

Dr. Oz Reveals Plan To Replace Obamacare

Dr. Mehmet Oz joins ‘Mornings with Maria’ to discuss the impact of the government shutdown on Medicare and Medicaid, warning that fraud, waste and political gridlock threaten vital healthcare programs for millions of Americans.

The Employer Health Insurance Reality Check (October 2025) — and Why ICHRA Is Winning

Brad O’Neill is the Founder and Principal Consultant of The ICHRA Shop, a national advisory firm transforming how employers design and deliver health and lifestyle benefits through individual coverage and defined-contribution strategies.

If PBMs Promise 100% Return of Rebates, Why Have Them?

By Bill Rusteberg

We’ve all heard it. “We pass 100% of all rebates on to you” says your favorite PBM.

Gag Clause Attestation Deadline Fast Approaching

October 23, 2025 – By: HUB’s EB Compliance Team

As 2025 comes to an end, plan sponsors of ERISA, church and governmental plans should submit their Gag Clause Prohibition Attestation (“Gag Clause Attestation”) to the Centers for Medicare and Medicaid Services (CMS) no later than December 31, 2025.

RosettaFest 2026: Amplifying Our Voice

Communities leading healthcare transformation from the ground up.

RosettaFest has become the platform where communities take charge of their healthcare destiny. Over 1,000 changemakers gather here to share authentic stories of transformation and amplify the voices of people building healthcare that serves their neighbors first.

These are community advocates, clinical pioneers, benefits champions, and local leaders who discovered their collective voice creates more change than any corporate boardroom ever could.

What Took You So Long To Figure This Out?

99.99% of plan sponsors are slow. Real slow. So slow it makes a melting glacier look faster than a speeding bullet. According to the article below employers are beginning to adopt direct contracting agreements with community health care providers to save money and to improve access to quality care. Plan sponsors we worked with have been doing that for past two decades with good success.

How To Achieve Razor Thin Hospital Margins Without Even Trying

Three Problematic Hospital Myths

“The reality is you can have razor-thin hospital margins if you are good at just spending all the money that is given to you.”

A New Era of True Self-Insurance for Employers with 100+ Employees

This model turns the employer into the master architect of a benefits supply chain — leveraging individual market carriers as infrastructure, not vendors.

Stephan A. Smith Says Kyrie Irving Was Right

ESPN host Stephen A Smith just admitted that NBA star Kyrie Irving was right about not trusting the vaccine.

Awesome Exit Strategy For Burned Out Health Insurance Brokers

Attention burned out health insurance brokers – here’s your exit strategy……..All you need is $15,000 to $25,000 and a P&C license (easy peasy) to start…………..

A New Texas Health Insurance Company You’ve Never Heard Of

New doctor owned and managed Austin based insurance company offers both individual and group medical insurance.

Health Care Coverage That Makes More Sense Than The Law Allows

“Traditional health plans are bloated with layers of middlemen, delays, hidden fees, and unnecessary complexity. That’s why we built MedSave — a transparent, cash-based health plan that finally puts control back in your hands” – Bill Rusteberg

Houston Doctor (UNJUSTLY) Punished for Ivermectin Treatment

It’s good for horses but not good for Texas humans? How weird!

Fat American Airlines Crew Members Are Pissed

Flight attendantS at American Airlines (AA) are pissed. The mean and evil airline announced that it will no longer cover GLP-1 medications for weight management for crew members.

Only 37% of Employees Want To Talk To A Real Person About Benefits

63% don’t want to talk with a salesman………………90% say online benefits are very or extremely important……..Almost 9 in 10 Generation Z and millennial employees said online benefits administration is very or extremely important, according to a survey.

How Eli Lilly Became The New King Of The Anti-Obesity Drug Market

By Tina Reed

Eli Lilly is poised to leapfrog Novo Nordisk and become the dominant player in an anti-obesity drug market that could reach $150 billion by the end of the decade.

Tackle Healthcare Costs With TempoPay

Unexpected bills and out-of-pocket expenses can be overwhelming and keep people from getting care when it’s needed most. Let’s change that.

County Switches From Group Health Plan to ICHRA

The switch will allow for the 265 people currently employed by the county to be able to have access to over 30 different individualized plans that can be tailored to an individual’s living circumstance.

Hospitals Hate Revenue Constraining Cost Containment

“Partners in Affordability Become Plaintiffs In Court”

By Chris Deacon

It should surprise no one that the California Hospital Association has sued the state over the Office of Health Care Affordability’s new cost growth caps.

WinCorp Marketing – Insurance Wholesaler

After working as an agent in the field and on the marketing side of the insurance world for many years, Doug J. West, founder and President, saw a need for something different.

“Our District Is In Trouble!”

By Molly Mulebriar

With help from their insurance consultant the Brownsville Independent School District, the largest employer south of San Antonio, has successfully managed to achieve a $7,000,000 health plan deficit without even trying.

Enshittification

Enshittification: This process, which Doctorow deemed 2023’s word of the year, follows a predictable pattern: corporate entities acquire successful services, then systematically degrade them to extract maximum profit.” Dave Chase

If Hospitals Lose Money on Medicare Why Do They Take It?

“Unless hospitals are committing fraud in their reporting to Medicare, their rates cover their costs and profit. To then complain that getting paid more than double that is a “hardship” is laughable” -Dave Chase

MARPAI RECOGNIZED AS 2025 TOP THIRD PARTY ADMINISTRATOR

SOURCE: PR Newswire – Tue, October 14, 2025 at 3:03 PM CDT 5 min read

Recognition Highlights Company’s Stellar Reputation and Technology-Driven Approach to Smarter Healthcare and Real Savings

Blue Cross Comes Swinging Back With A Sweeping Counter Attack

“If we overpaid or skimmed, it’s your fault for not catching us.”

How Obamacare Set In Motion Today’s Premium Crisis

BySally Pipes – Contributor

Democrats are panicking about a looming 75% average increase in the out-of-pocket cost of insurance premiums next year for the roughly 6% of the population that shops for coverage on Obamacare’s exchanges. Their panic led them to shut down the government at the end of September.

Marketer Makes Pitch For 2026 Government Marketplace Open Enrollment

The government ACA Marketplace Open Enrollment period is fast approaching and we already see marketing activity begin like this one.

The purveyor of this advertisement must know something we don’t know.

This marketer is assuming the ACA subsidies (welfare payments) will continue and many applicants will receive free health insurance.

We think so too. Taking away free health insurance from millions of people is political suicide.

Mike Keogh

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

By Bill Rusteberg

Mike Keogh was an extraordinary man. A former Blue Cross salesman in the 1950’s, he later built an independent brokerage in San Antonio with great success. I met Mike in the early 80’s and did quite a bit of business with him.

Marsh Unit Sues Rival Agency After ‘Retired’ Broker Joins

Proof that personal relationships are worth more than company branding…….

The Future of Employer Sponsored Benefits

By Bill Rusteberg

We are entering a different time now. It’s not the same as it was just a few short years ago. Employer Sponsored Benefits will give way to Employer Sponsored Stolen Money.

Amazon To Start Offering Prescription Drugs Through Vending Machines

Amazon Pharmacy Kiosks will carry hundreds of commonly prescribed medications such as antibiotics and blood pressure treatments on a seasonal basis

Stop Chasing Discounts

By Julie Wasserman

Stop shopping discounts. Using a claims’ repricing to find an extra few discount points is not strategic, nor is it consultative. A monkey could throw some numbers on a spreadsheet and call it a day.

Carrier discounts are worthless because the discount itself is based on a completely ridiculous number. Hospitals are charging up to 800% over actual costs. (See below for the Top 25 states*) These figures are based on self-reported data, but it’s so obnoxious it almost seems like I made it up.

The Future Of Healthcare: From Employer Plans To Individual Choice

“In five years, more than 100 million Americans could be buying coverage individually — with employer dollars simply funding the allowance.”

Health Insurance For The Modern Employer

As the workforce continues to evolve, so must our approach to employee benefits. ICHRAs represent the next generation of employer-sponsored healthcare: flexible, predictable, and built for modern organizations.

For HR leaders, that means less time firefighting renewals and more time building a benefits program that actually works for everyone.

IRS Announces 2026 Health and Welfare Limits

SOURCE: Groom Law Group

On October 9, 2025, the IRS issued Rev. Proc. 2025-32, which announces the 2026 indexed limits for certain health and welfare benefits. This is in addition to the limits the IRS announced in Rev. Proc. 2025-19 on May 1, 2025.

Another Cash Pay Vendor At Your Service

SOURCE: NovetraSys

Cash pay centric health plans are not new. They have been around for years. But the concept is catching on with more and more third-party vendors entering that space. Here’s the latest one…………………………

Biggest Change In Healthcare In 20 Years

By Stacy Mays

This may be the most important change in healthcare in 20 years.

Texas School District Wins Hide And Go Seek Contest

A school district in deep South Texas was paying their benefits consultant an additional $614,000 per year but didn’t know it.

One Page Direct Provider Agreements Are All You Need

By Bill Rusteberg

Warren is exactly right. All a plan sponsor needs when directly contracting with a medical provider is a one-page agreement. That’s what our clients have been doing for over two decades.

Trump Reaches Deal With AstraZeneca to Lower U.S. Drug Prices

Amazing what the threat of tariffs will do to move things along………….

Smart Strategies for a Stronger Benefits Budget

Rising insurance renewals push employers to find new ways to save. This session covers how HRAs, HSAs, and FSAs can cut costs, boost participation, and strengthen benefit strategies.

We Lost A Patient To A $0 Copay Today

One Pharmacy Charges $17.92 for a $7 Drug, The Other Charges $8,000 and the government health plan pays it.

Attn. Insurance Agents – Body Brokerage Career Opportunity Available – Apply Today!

Job Description: Assist people in need of medical care by bribing folks with good private health insurance to come to California for addiction treatment, whether folks really want treatment or not.

Your 2026 Pocket Calendar Is Ready

Your Commission, Your Clients, Your Time To Win 25% Commission

Deliver More for Your Clients with Claritev’s Vistara^TM – Exclusively for Growth-Focused Brokers Who Are Ready to Win!

The 2025 Premier Broker Program is a limited time initiative launched by Claritev to reward who bring in new clients purchasing our Vistara using PHCS network for Value-Driven Health Plan™ services. This is your chance to unlock new revenue, boost your book of business, and lead the way with smarter health plan design strategies for your clients.

No Surprises, But Plenty of Abuses: How Insurers Are Pulling the Strings on the No Surprises Act

The No Surprises Act, passed with good intent, is now being twisted against patients and doctors by big health insurance companies.

Vendor Shenanigans: Another Three Card Monte Scheme Exposed

This scheme preys on the ignorance of trusting county and city officials in places you can’t get to from here where last names are seldom used.

Amazing One Minute Open Enrollment Benefit Presentation

Here’s a power packed Open Enrollment presentation every plan member will remember – Guaranteed to throw shade at the Ebbinghaus study.

This is a no deductible health plan. Managed Care is when you ask us for help in getting the care you need. Non-Managed Care is when you don’t.

Damien Buys 147,058 Mapai Shares

Purchase price October 6 – $1.36. Price today (October 8) – $1.63. Profit – $39,705.

Vendor Collusion Is Illegal in Texas

SOURCE: Price Fixing and Collusion Regulations in Texas

Texas defines and identifies illegal price-fixing and collusion practices through Section 15.01 of the Texas Business and Commerce Code. which states that it is unlawful for any person to enter into a contract or agreement that fixes or maintains prices, allocates customers or territories, or limits production or supply for the purpose of preventing competition.

Texas Medical Association Rebuffs CDC Guidance

Attorney General Ken Paxton called the TMA’s guidance “outrageous” and suggested it “has chosen to try and ignore the overwhelming evidence and science-backed recommendations” from the CDC.

How Many Aggies Does It Take to Change A Lightbulb?

“How many Aggies does it take to change a light bulb?” Answer: “Ten. One to hold the light bulb and nine to turn the ladder!” Such is the way American health care operates.

Let’s Play Three Card Monte

“Pinch me, this can’t be true! If so, this is one for the history books, a must read for Texas public purchasing officers.” – Anonymous

Reference Based Pricing – Debunking The Myths & Empowering With Facts

Reference-Based Pricing (RBP) is often misunderstood – and that misunderstanding can lead to missed opportunities. It’s time to clear the air and tackle the most common myths head on, so more organizations can make informed, confident decisions about their healthcare strategy.

Insurers Are Wholesalers For Hospitals, Brokers Are Retail Distributors For Insurers

By Donavan Pyle

Hospitals founded health insurers throughout the 1930s so that they could stabilize their revenues during the Great Depression.

Ozempic Price In Canada is $199, PBM Price In USA is +$1,000*

*Cash price (no PBM) in USA is $499

By Hasim Zaibak

In Canada, the brand-name Ozmpic is available for US$199 without the presence of PBMs. Conversely, in the US, the identical medication manufactured by the same company is priced at over $1,000, driven by the profit motives of US PBMs.

Ozempic Now Approved For Use In India

Ozempic, approved for use in India staring September 25, 2025, may be priced from $191-$293.

“In a major development for diabetes and weight loss management, India’s drug regulator, Central Drugs Standard Control Organisation (CDSCO), has approved Ozempic (semaglutide) for use in adults with type 2 diabetes.”

Government Shutdown: It Isn’t Over Healthcare – It’s Over Healthcare Coverage

By Chris Deacon

Democrats are trying to protect the healthcare of the American people…and we are not going to support a spending bill that continues to gut the healthcare of every American…period, full stop….there is a Republican caused healthcare crisis…”

If Health Care Costs Less Without Insurance Then Why Have It?

By Bill Rusteberg

If health care costs less without insurance, then why have it? There can only be one reason……. It’s all about financing, nothing more and nothing less. It has nothing to do with health care.

When The PBM Explains Why Your $12 Generic Costs $498 After Rebates

By Joshua R.

Every independent pharmacist knows this story. PBMs spin words like “rebates” and “discounts” to make you think they’re saving money — when in reality, they’re the ones sailing off with the cash.

Benjamin Kyle

In 2004, an employee at a Burger King in Richmond Hill, Georgia, discovered a man unconscious, beaten, and sunburned behind the restaurant’s dumpster. He had no ID, no belongings, and — most chilling of all — no idea who he was.

Costco To sell Ozempic and Wegovy For $499

There’s More Than One Way To Skin A Cat

Beats average PBM price of +$1,000. Plan sponsors can drop PBM coverage, establish a HRA with fund access through a virtual debit card turning plan members into cash paying customers without insurance. They can shop at Costco, CVS or Walmart and get the same high price of $499…………or their employer can continue to pay a higher, high price through their PBM………….

South Koreans Grew Roughly 7 Inches In A Century On Average

A hundred years ago, the average Korean woman was only 4’7”. Today, she stands nearly eight inches taller than her great-grandmother did, the largest jump of any country on earth.