Dallas, TX (PressExposure) February 20, 2009 — U.S. Risk Underwriters, a subsidiary of U.S. Risk Insurance Group, Inc. (www.usrisk.com), the fifth largest managing general agency in the nation, announced the launch of a new professional liability product for the medical tourism industry called MedTour Pro for Employers.

MedTour Pro for Employers is designed for companies who provide freedom of choice to their employees, including an option to obtain medical services outside of the United States. Coverage is for damages caused by any actual or alleged negligent act, error or omission by the insured while providing options for medical tourism services.

“We are the first to market with a product specifically designed for employers,” said Art Seifert, President of U.S. Risk Underwriters. “MedTour Pro for Employers enhances our suite of products designed specifically to cover the risks inherent in the dynamic new industry, predicted to generate $100 billion in revenue by 2012.”

Currently the only provider of Professional Liability for medical tourism facilitators and for employers, U.S. Risk is on the cutting edge in providing important coverage for this rapidly growing industry. Its travel and complications coverage for medical tourists is tough to beat.

MedTour Pro for Employers is written with an A.M. Best “A” rated carrier on a claims-made basis. Limits are offered up at $1 million with a minimum premium of $5,000. Excess over the $1 million limit is available.
Agents and brokers should contact Lorna Greenwood at 1-800-232-5830 or lornag@usrisk.com.

About U.S. Risk Underwriters, Inc.

About U.S. Risk Insurance Group

U. S. Risk Insurance Group, Inc. (http://www.usrisk.com) is a specialty lines underwriting manager and wholesale broker headquartered in Dallas. Operating 11 domestic and international branches, it offers a broad range of products and services through its affiliate companies, which include U.S. Risk Underwriters, U.S. Risk Brokers, Lighthouse Underwriters, LLC, Boston Insurance Brokerage, Inc., Professional Claims Managers, Omnisure Consulting Group, NCG Professional Risks Ltd. (London), and NovaPro Risk Solutions, LP.

SPBA Email Alert – December 28, 2009

Health Reform Insights & Talking Points 

By SPBA President Fred Hunt

I feel like the weatherman being asked to give a specific forecast of the weather a few years from today.  My forecast is below, but let me save your sanity by first explaining what will be playing out when/if a bill passes.   As I pointed out in my last e-mail, there are about 100 factors and processes which can change what you think you see ….even when/if the law is passed, and we all sit with printed copies in front of us and experts analyzing the actual words.

An example arose today.  A year ago, the Defense Authorization Act included what seemed like iron-clad wording that would ease and extend government medical care for wounded soldiers.  It was crystal clear.  However, a year later, the Defense Department has “interpreted” the law to deny many veterans the health services they thought the law promised, especially for Post-Traumatic Stress Disorder (PTSD).  The new interpretation decided to limit care only for things that can be proved to have happened during “armed conflict” in combat zones. This move is a blatant way to avoid paying for an expensive group of veterans and leave them uninsured or a burden on employer plans. (This is also yet another lesson for those who think government health care is embracing & caring.)

I mention this new development for two reasons:  First, as a heads-up that if this new interpretation stands, your plans may find that costs attributable to PTSD which everyone thought were covered by the clearly-stated law and Congressional intent may well apply to people who left the service after the Oct. 14, 2008 date of the Chu memo which arbitrarily changed the impact of the law. (No need for action yet, since there is an uproar of veterans groups demanding Congress return to its promise.)

My other reason for mentioning this news is that it shows how something you read in any final health reform law can have a very different real-world impact.  There is already some conniving going on behind closed doors in Congress to pull off some of these.  So, don’t drive yourself nuts to get the final language, and then assume that what you see is what you get.

The actual language of any bill will have hidden zingers.  Then, the Congressional staff draft what is called “the blue book”, which are essentially notes to give reg-writers background and “Congressional intent”.  The blue book often pictures things differently or with added pieces that you don’t see in the legislative language.  Then come the interpretations which the applicable upper-level Agency officials decide to make (like the Defense Department example).  Then come the nitty-gritty interpretations as the actual reg-writers create the regs with which we must comply.   Zingers can sometimes take a decade to emerge.   (If you are growling about the people who influence these interpretations, let me point out that  everyone who has attended an SPBA Spring Meeting has shaped law & policy effectively and constructively, and SPBA acts as a reality-check truth squad whenever possible in the rest of the process.  Please mark your calendar for the SPBA Spring Meeting April 14-16, 2010 in Washington DC to again steer policies towards common sense.)

So, it is fine to check the Library of Congress official legislative website at http://loc.thomas.gov   as often as you want.  You can also read and hear all the interpretations, but the absolute specifics of how things would work would evolve over several years.  In the case of this law, I think that the legislative tussle will also go on for several years, with each side trying to slip in later what it did not get in this first round, and parts even being negated or repealed.

MY FORECAST:

So, with all those caveats & explanations, let me share my thumbnail sketch of how I think our self-funded employee benefit market will be impacted.  (At some later date, I’ll tell you how the attendees of the 2009 SPBA Spring Meeting, and some phenomenal work by several SPBA members steered history and make this a fairly upbeat report.)

Employee benefit plans in general and self-funding were never a target (except, of course, for the hard-core single-payer advocates).  So, I think that we will be relatively unscathed (meaning less than could have been, and than many feared).   I think most problems will be TPAs & self-funded hit as unintended bystander victims of the punitive measures being thrown at insurance companies.  There is nothing designed to subvert your client plans or lure people away.

I THINK THERE WILL BE SOME GOOD THINGS for your client plans.  For example, I think:

>>More young & healthy individuals who, today, who opt out of employer plans because they feel they don’t need health coverage will be in the plan because of the direct or indirect  pressure to be insured.  Some plans suffer badly today from young healthy eligible individuals who decline coverage.  Employers will take a more energetic role in being sure their workers are in the plan, because one probable provision would wallop employers with a fine for $750 per-employee fine if even one ends up getting a government subsidy instead of an employer plan.

>>It will be harder for employers to “go bare” and not have a health plan, so that stabilizes and expands your market.

>>The medical cost “discount” headache looks like it will have a path to ending.  If there is an insurance exchange, public option or whatever in which the government (federal Office of Personnel Management – OPM -  is in the bill) negotiates with doctors & hospitals for a price formula, then I think TPAs and others will adopt that as the de facto Usual & Customary.  This is different than basing on the Medicare price, because back-room deals in 1965 recognized Medicare & Medicaid as a special situation helping the old & needy.   The new public exchanges would negotiate a presumably-fair price for regular people, so it would be hard for doctors & hospitals to say that a negotiated price for regular people is not fair for your plan participants.  The government won’t automatically extend their price to you, but, at last, a credible price list, the same as insurers’, would be available.

>>If the “Cadillac” plan tax remains, cost-efficiency in design & operation of plans will be a gigantic plus.  This has always been a forte of TPAs.

>>There will be changes in the health insurance companies.  Some markets (such as individual policies) might well become money-losers and be dropped.  Insurers may well decide that they want a less-direct role, be it more Stop-Loss or new arrangements with TPAs or whatever.  Meanwhile some non-profit Blues and others will get advantages over for-profit insurers.

>>Some SPBA members have told me that they are already spreading the word among current and prospective clients that no matter what happens and how long it takes to unfold, their TPA (as part of a nationwide network of SPBA members sharing insights & experience) will be on the cutting edge of both the visible and invisible developments.  With insurers and others facing turmoil within their arena, he says that clients and prospective clients are reacting very positively.

SPBA’s ROLE & GOAL will be to work with you day by day to maximize your options as all this evolves.  Unfortunately, in a few days, some SPBA TPA firms will be past-due on their dues & membership renewal forms, and cut off from the services they need.  It is a shame.  TPAs who pride themselves on processing claims in a few days have failed to process SPBA’s simple form in the past 45 days.  Some say “it never arrived”, but it was sent first class mail and not returned.  So, if you think it never arrived, do a thorough investigation of your mail room for what else has been lost.  For some of the excellent individuals who will be dropped in a week, we will miss you, and we strongly encourage you to arrange to get compliance and industry trend services from somewhere.  Sadly, most firms that go it alone lose clients and fade away or end up in deep legal & financial trouble that reflects badly on the whole industry,

For the members who have paid & renewed on time.  Thank you, and stay-tuned.  This will be an exciting time with both frustrations and the biggest opportunities in decades.

Happy New Year.

Fred

Coming soon – a new health plan designed for the young and healthy, generally for those age 35 and younger. Pay only $62.50 per month, or $750 per year to the United States Government – should you subsequently become ill, or need major surgery, you will automatically have the right to apply and be accepted for real health insurance that will cover all pre-existing conditions immediately. After recovering  from your illness and/or surgery, you may drop your real health insurance policy and continue to pay only $62.50 per month until you need real health insurance again!  Pay for real health insurance only when you need it! What a novel idea! Why didnt we think of this before?

Editor’s Note: The communists in Washington know exactly what they are doing with health care reform. They are just about as dumb as a fox – health care reform as now envisioned is doomed to failure and they know it – nothing in the bill addresses health care costs, nothing at all. In fact, components of the health care bill are intended to drive costs up to new highs, and fast. We expect group health insurance costs to increase dramatically in 2010. With the resultant “failure” of private insurers to reign in health care costs, the communists will use that failure as an excuse to create a single payer system. The communists have set the stage for failure – a clever strategy it seems.

We would not be surprised at all if some major health insurance companies exit the business in favor of more lucrative and less government controlled insurance markets.

See Dick Morris article here – http://www.dickmorris.com/blog/2009/12/22/day-one-how-obamacare-will-alienate-americans/#more-694.

Dr. Rene Perea, FACS, Fellow American College of Surgeons – General and gastrointestinal surgeon advertises services and prices here – http://gastrocirugia.com.mx/obesity/. His office is 15 minutes from our office in Brownsville, Texas.

Editor’s Note: The prices shown on the website are probably negotiable. For example, we know of a patient from Houston who flew down to Brownsville to seek a gastric by-pass in Matamoros. He negotiated a turn-key price of $3,500. We helped get a price for a San Antonio client recently for $4,500 all inclusive. Potential candidates for these surgical procedures may be wise to offer similar cash offers to US based physicians first. It may be difficult for a surgeon / surgical center to turn down a cash offer of $5,000 here in the United States.

The most interesting paragraph in this article – http://www.2theadvocate.com/news/78937392.html - is the following:

“The health system would be happy to consider little or no increase if the resulting savings went to patients and their employers rather than Blue Cross, Finan said. Blue Cross had indicated it will increase premiums by 9 percent to 10 percent in 2010.”

Is this a clue that some carriers do not pass on 100% of the discounts to the consumer, but instead retain a portion of the discount as an additional revenue source? We think this is a very strong clue, coming from a hospital administrator.

Harry Reid and his fellow communists passed the Senate version of the health care reform Bill today despite  polls which show that a majority of Americans are strongly opposed to this new entitlement program.

  New Symbol of American Greatness?

December 23, 2009

The Securities and Exchange Commission filed securities fraud charges against an Austin, Texas investment advisor and two of his businesses alleging he conducted a “multi-million dollar scam” that used former professional football players to promote its offerings.  

The SEC alleged in a filing Tuesday that Kurt B. Barton and Triton Financial LLC, raised more than $8.4 million from approximately 90 investors by selling “investor units” in an affiliate, Triton Insurance, and telling investors that their money would be used to purchase an insurance company.  

The SEC alleged that Barton, who is chief executive officer of Triton, instead used the funds to pay day-to-day expenses at Triton Financial and its affiliate. Triton co-sponsors the Heisman Trophy Trust, an organization that annually honors the best player in college football.

According to the complaint, which was filed in federal court in Austin, Triton used former football players as well as stockbrokers and other salesmen to promote securities and recruit potential investors.  The investment advisory firm, which according to its Web site invests in real estate and manages the securities portfolios of athletes and other clients, has raised more than $50 million for at least 40 ventures since 2004, according to the complaint.

Toby Galloway, a regional trial counsel in the SEC’s Fort Worth regional office, said that the former players aren’t facing any charges right now, but the SEC continues to “look at everyone involved.”

“There is no doubt that having these gridiron greats out there selling these investments certainly played a role in Barton stiff arming money from investors,” he said.

Former Heisman Trophy winners Ty Detmer and Chris Weinke work for Triton along with Jeff Blake, a former NFL quarterback Blake who directs Triton’s “athlete services” department, which is a marketing arm for Triton that recruits players as clients.

“By associating with former football stars, they were able to build a facade of legitimacy and gain investor trust,” said Rose Romero, the director of the SEC’s Fort Worth regional office.

Barton and Triton, which has been registered with the Texas State Securities Board as an investment advisory firm since June 2006, have consented to court orders freezing their assets.  

According to an emailed statement from Barton’s attorney, Joe Turner, Barton “has voluntarily consented to the appointment of a receiver. He intends to work closely with the receiver in an effort to ensure that the investors, many of whom are friends and relatives, do not lose their money.”

In March, Sports Illustrated published an article that described how Triton used former football players to promote its business. Following the article, the Texas State Securities Board conducted an examination of the company. According to the SEC’s complaint, Barton and Triton provided the Texas State Securities Board “with altered and fabricated documents during the examination that followed the article’s publication.

The SEC charged Barton and Triton with securities fraud and seeks permanent injunctions, disgorgement of illegal gains and financial penalties.  The regulator also wants an asset freeze and a receiver over defendants’ assets and operations.

Commander in Chief B. Hussein Obama continues to exhort his base with weekly emails. Below is an exerpt of his most recent email to the masses:

“As with any legislation, compromise is part of the process. But I’m pleased that recently added provisions have made this landmark bill even stronger. Between the time when the bill passes and the time when the insurance exchanges get up and running, insurance companies that try to jack up their rates do so at their own peril. Those who hike their prices may be barred from selling plans on the exchanges.”

“And while insurance companies will be prevented from denying coverage on the basis of pre-existing conditions once the exchanges are open, in the meantime there will be a high-risk pool where people with pre-existing conditions can purchase affordable coverage.”

“A recent amendment has made these protections even stronger. Insurance companies will now be prohibited from denying coverage to children immediately after this bill passes. There’s also explicit language in this bill that will protect a patient’s choice of doctor. And small businesses will get additional assistance as well.”

“These protections are in addition to the ones we’ve been talking about for some time. No longer will insurance companies be able to drop your coverage if you become sick and no longer will you have to pay unlimited amounts out of your own pocket for treatments that you need.”

Editor’s Note: Hussein knows that with the passing of the Health Care Reform Bill, insurance rates will necessarily rise. And rise sharply. A Wellpoint study confirms this, with group health rates going up as high as 100% to cover new mandates such as pre-existing conditions prohibition, tier rating basis, community rating, etc. He is preparing his base for the next battle – eviserate health insurance companies so that all will exit the market and a national single payer plan will be required. With only four major health insurance companies left in the national marketplace, it is not unreasonable to believe that they will change their business model from health care to property & casualty cover.

If health insurance companies are so bad, making obscene profits at the expense of the sick, why are there only 4 major players left in the market? And, is a 3-5% profit margin obscene? There are several thousand insurance companies in the United States, and 99% of them dont mess with health insurance. There must be a reason why.

The 2,000 page plus monstronsity of a Bill has probably not be read by too many people, especially those idiots in Congress who voted for it. Under “Wellness and Prevention Programs” section, gun control is addressed. The Secretary of Health “may not” (as opposed to “is prohibited”) from collecting data on who owns a gun, etc. So, what other “data” is big government to be empowered to collect about us, common citizens?  This is Orwellian – HealthCare Bill – Firearms

If you think this is “fishy”, it is your responsibility to report this to the White House at flag@whitehouse.gov . Also, if you overhear any of your neighbors speak critically of the Democrat Party, please call Harry Reid or Nancy Pelosi immediately. You will be rewarded.  

Yesterday, President Obama signed into law H.R. 3324, the Defense Appropriations Act that included a provision to extend federal COBRA premium subsidies.  Currently, it applied to those that involuntarily lost their coverage and were eligible for COBRA to 12/31/09.  The extension makes that timeframe 02/28/10.  It also extend the time period for which a subsidy can be given from 9 months to 15 months. In addition, the legislation would give beneficiaries whose subsidy expired and who didn’t pay the full premium the opportunity to receive retroactive coverage. For example, a beneficiary whose nine months of subsidized coverage ran out November 30 and who didn’t pay the unsubsidized premium for December could pay his or her 35 percent share in January and receive COBRA coverage for December.  The legislation makes clear that employers can offset future COBRA premiums or issue refund checks for beneficiaries who overpaid their COBRA premium. That could happen if a beneficiary whose subsidy ran out in November paid the full premium rather than the 35 percent share in December.

 There are additional notification requirements for those who formerly, currently, or prospectively elect COBRA continuation.  The Department of Labor has not published a model notice yet. 

COBRA subsidy expansion from HR 3324