Month: November 2025

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.

HR Director Reacts After Served With Lawsuit

“A perfect storm of Supreme Court decisions, aggressive litigation and emerging technologies is exposing HR executives to unprecedented legal liability, even for decisions made by their outsourced partners.”

Source: Business Wire, 11/25/2025

Leveraging Capital Rx’s spread-free, full pass-through pharmacy benefit model, Capital Equilibrium is bringing Rx cost savings and renewal stability to the self-funded municipality and commercial markets

By John Riggs

When most people think of life insurance, they think of protection — not retirement income.

But for high-net-worth individuals, cash-value life insurance can play a dual role: providing long-term protection and serving as a tax-efficient income source in retirement.

By Stacy Edgar

CHRA is reshaping the individual health insurance plans. How? Carriers are putting out ICHRA-specific plans. Here’s an example: Take this new Wellpoint offering in Texas. What makes this an ICHRA-specific plan?

Largest employer south of San Antonio considers health insurance options for 2026

The district’s insurance consultant presented “Insurance Plan Options” including TRS ActiveCare to the Brownsville Independent School District insurance committee November 13, 2025.

November 13, 2025 SOURCE: Pfizer

• Acquisition brings highly differentiated clinical-stage obesity candidates with potential to reshape the treatment landscape
• Complements and transforms Pfizer’s Internal Medicine portfolio
• Positions Pfizer to lead in one of the most dynamic and high-growth therapeutic areas

NEW YORK–(BUSINESS WIRE)– Pfizer Inc. (NYSE: PFE) today announced the successful completion of its acquisition of Metsera, Inc. (NASDAQ: MTSR), a clinical-stage biopharmaceutical company accelerating the next generation of medicines for obesity and cardiometabolic diseases.

Novo Nordisk and Eli Lilly are both preparing to launch once-a-day weight loss pills by next year …….That would allow patients to avoid the jab of auto-injector pens with tiny needles……Novo Nordisk’s Wegovy pill is likely to arrive for patients first.

Underwriting Results of a Mid-Size Self-Funded Health Plan

Amazing things can happen when you pay attention. The graph above illustrates the results one can expect when a self-funded plan sponsor replaces an insurance consultant who wasn’t paying attention with one who does.

Jack Rusteberg, age 4, announced yesterday, he wants to be an actuary when he grows up.

“That’s great!” said his grandfather. We could use another actuary around here! Risk Managers will be gifting Jack a special calculator for Christmas.”

$5 office visit includes all lab work.

Photo Referred By S. McDaniel

Lung cancer patients says “What the hell, I’ll take a pack of non-filtered Camels please! And charge it to the room………..”

Status Quo Health Insurance Broker Leading His Clients

“What’s that ahead!” says one lemming to another, “No one told us about that.“ For the first time they see something other than the ass in front of them.

ANSWER: “Only the designated plan administrator—as named in the governing plan documents—can be subject to penalties.”

BACKGROUND: Nicole Mayor requested plan documents from both MetLife and Union Pacific’s HR department. She alleges that neither provided her with the governing policy. Mayor sued under ERISA, asserting (1) failure to provide plan documents under 29 U.S.C. § 1132(c) and (2) wrongful denial of benefits.

Will The Plan Gain Bipartisan Support?

Handing out billions of taxpayer dollars would create an incentive for individuals and employers to drop their current coverage and enroll in ObamaCare.

SOURCE: Normandy Insurance Company

Normandy Insurance is a commercial carrier & brokerage that provides
‍instant quotes, expert underwriting, and hands-on agent support.

Top Three Finalists Line Up For Interviews

The Problem: Death tax is 40 per cent. The only way I can pass the estate and art collection on is to leave it to the wife tax free. I cannot insure an older wife so the younger the better.

Providing group health insurance these days is fraught with danger. Unless a plan sponsor is perfect and walks on water, cross your fingers risk assumption is off the charts.

Brokers using our platform are earning more, spending far less time on admin, and giving their clients a much smoother experience.

Trump Readies Healthcare Plan

Treasury Secretary Scott Bessent said Sunday that Americans can expect an announcement from the Trump administration this week on its plan to reduce healthcare costs.

While details are scarce, President Trump has indicated on several occasions that he wants to send healthcare funds “directly to you, the people” rather than insurance companies.

Trump has also said a plan should be in place by Jan. 30, with healthcare costs expected to surge in 2026 to their highest levels in 15 years. Payment of healthcare subsidies for insurance was a central point of conflict in the 40-day government shutdown.

What will the fix be this time? Will this be yet another “Fix it until it’s more broken?“

David Alderman on Linkedin:

The PBM parasites just got eviscerated. The manufacturers pulled the trigger themselves.

$260 million to bail out a failing government health plan is a bargain. Texas bailed out the failing TRS ActiveCare government health plan several times in the past few years by over one billion dollars and it’s still not working…………

By Bill Rusteberg

There are those in our industry who say ICHRAs are not the solution to rising health care costs. They are not wrong. But they miss an important point.

Eli Lilly hits $1 trillion market value, a first for a health-care company

Data Marketing challenged a Department of Labor (“DOL”) advisory opinion that finds the arrangement is not an ERISA plan and states are free to regulate it. In 2019, Data Marketing sued the DOL in the Northern District of Texas and emerged victorious.

Self-funded plan sponsors win big when Medicare pays secondary benefits first.

Join Our Thriving Franchise Community Today

We are excited to offer a unique franchise opportunity for insurance industry experts looking to elevate their careers.

“We were skeptical of change,” admitted Superintendent Brent Evans. “Nobody does no deductible and no out-of-pocket. Every other year, it felt like we were cutting benefits or asking employees to pay more. That’s not how you retain people.”

File the following article under “What Took You So Long.” A county in South Texas eliminated their deductible and co-insurance features more than a decade ago when they realized deductibles are silly and counterproductive.

“Our clients are laughing all the way to the bank while fearful groups, afraid of change, watch the healthcare cartel devastate their health plans and devour their profitability and employee compensation.”

You can save 100% if you stop covering them, but if you don’t go HERE and see your estimated savings by opening up multiple channels to access the lowest net-cost fulfillment.

Round Rock, a city in Central Texas with 840 employees, established their own onsite clinic and reported their results at a recent conference. Here’s a few statistics which you may find useful if you are considering establishing your own clinic.

By Bill Rusteberg

It was a rare and memorable experience. Two travelers, strangers, whose paths crossed in an instant, sharing something special together.

Why serious employers can’t outsource judgment to PPO contracts and hospital billing offices anymore

Announcing the Joe Sixpack Lab Basic Test For Men

By Stacy Mays

Right Between the Eyes. We need to talk about the real cost of “coverage.”

I’ve spent 30 years building and fixing health-benefit programs… and this still hits me in the gut:

🔹 50% of Americans spend < $1,300 a year on healthcare services
🔹 90% spend < $17,000
🔹 But the average individual premium? ~$9,000
🔹 And average out-of-pocket costs? ~$3,200

By Laura

It’s that time of year again when Open Enrollment begins. Mandatory Open Enrollment meetings to educate employees on a health care plan no one understands are scheduled during company time.

By Bill Rusteberg

What’s the price we pay for free-credit drug money?

Oria enables price discovery for hospital services with an AI-powered interface that allows anyone to ask questions and quickly discover insights from hospital price transparency files.

J Patrick Rooney is considered by many to be the Father of Margin Based Pricing better known these days as Reference Based Pricing. Many believe his conclusion of what the “sweet spot” reference point should be still holds true today.

Horizon Agrees to Settle False Claims Act Case for $100 Million

Through rigorous analysis and deep industry insight, AVYM principals Mark Flores and Vince Flores assisted state officials in identifying systemic misconduct by Horizon BCBS NJ. This collaboration helped secure a historic settlement and protect public plan assets from misuse.

Is Your Health Insurance Better Today Than It Was 15 Years Ago? ……Really? Why Not?……… This 8 minute video offers one view that’s hard to discount……………

“Since when do billion-dollar vendors get to file an appeal in a public court of law – of a public contract – funded with public dollars, affecting public employees – behind closed doors?”

By Ann Lewandowski

BOOM… California, the biggest market in the U.S., just passed PBM reform. And sizzle, this is hot.

Revolutionizing health insurance with transparent pricing and actionable insights.

The administration, together with pharmaceutical manufacturers Eli Lilly and Novo Nordisk, announced an agreement to lower prices and expand access to glucagon-like peptide-1 receptor agonists (GLP-1s) for weight loss for those in the Medicare Part D and Medicaid programs as well as direct-to-consumer (DTC) purchasing.

Monies forcibly taken from working Americans and gifted to health insurance companies insuring roughly 24 million people who purchased plans under the Affordable Care Act ACA cost an estimated $1.8T in 2023, roughly 7% of the US gross domestic product.

According to Forrester Research, Health Insurance Customer Service is Ranked 15th Out of 19 Industries.

Imagine you need surgery and you want the best surgeon on the planet. You check in to your local 5 bed community hospital on the south side of the tracks where you seldom venture. After you show proof of financial responsibility and sign your life away you are wheeled into the 240 square foot operating room. You look around. “Where’s the surgeon?” you ask. “Ah, he’s in Rio enjoying a leisure day by his pool. But don’t worry, he’ll be performing the procedure remotely” purrs the reassuring PA.

In 1945, the 692nd crossed the Rhine River and advanced across Germany, arriving in Munich by April. Cpl. Myers earned a Bronze Star. See General Orders #172 – Wilber Meyers pg. 5, 27 September 1945.

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

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

By Bill Rusteberg

Billed charges are manufactured numbers having nothing to do with cost or value. It’s simply a starting point designed to create the illusion of value to the benefit of hordes of middlemen feeding off one fifth of the American economy.

Impatient ACA plan member supports Trump’s idea

Story by David Nather

President Trump said Saturday that the money that’s being spent on Affordable Care Act subsidies now should be sent directly to consumers — a position that’s likely to complicate the government shutdown deadlock even more.

By Bill Rusteberg

According to the Bureau of Labor Statistics, in 2023 93% of private-industry workers participating in medical care plans had a plan network. That means 7% don’t.

“To every broker and consultant who ignored our words, I wonder if you have a conflict of interest? I wonder how many ways you are paid on products, commissions, and overrides by the bad actor in question?”

Slated for 2026, President Trump’s direct-to-consumer TrumpRx website will offer obesity drugs to Americans for as low as $150 for a month’s supply.

TotalCare plans come with four $0 visits each to different doctors every year to make it easier to get care without worrying about costs.

“Believe it or not there are still Reference Based Pricing firms out there charging fees based on a percentage of billed charges. You would think after all these years plan sponsors would wise up.” Molly Mulebriar

While you were trick or treating, CMS released its CY 2026 Physician Fee Schedule Final rule. Here’s the link.

The 60 best risk management blogs and websites in 2025 from thousands of blogs on the web and ranked by relevancy, authority, social media followers & freshness.

My Prediction: Consolidation whispers (and not-so-whispers) are about to turn into headlines. Within 12–36 months, expect merger announcements across both Blues and non-Blues.

If agreements are finalized, President Trump is expected to announce them Thursday morning at the White House, alongside pharmaceutical executives, the people said.

“We’re pretty excited about it” said Mr. Esquivel, the district’s health insurance broker.

by: Adam Schwager – Oct 31, 2025

AUSTIN (Nexstar) — For the nearly 4 million Texans who currently use the Affordable Care Act (ACA) marketplace to get their insurance, Saturday is the time to start looking at renewals. Open enrollment starts then, and in order to have health insurance starting on Jan. 1, current enrollees must select their 2026 plan by Dec. 15. The final deadline is Jan. 15 to get insurance starting on Feb. 1.