“RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.“
The following is the RiskManagers.us 2025 Standard Fee Schedule and Consulting Agreement for new business:
Fee Schedule
☐ Tier 1 Services – $3,500
Designed for those plan sponsors who want an independent review of contracts to identify potential liabilities with remedies. This is an important first step in proper risk management evaluation.
“We review tens of thousands of plan documents per year; the bottom line is that roughly a third of these plan documents aren’t in legal compliance and over 80% need some serious cost containment language in order to keep the self-funded plan one claim away from blowing up. Why is that? Is it laziness, ignorance, or are all these rules just complicated when it comes to health benefits? – Adam Russo, Attorney
☐ Tier 2 Services – $15,000
Financial review with forecasting including actuary analysis. This critical element forms the foundation upon which comprehensive risk management services are based within the industry. Without actuarial analysis a plan sponsor cannot be certain, recommended risk management strategies will produce anticipated results.
“Actuarial attention is directed to the following areas: (1) The benefit structure should be sound, (2) The contributions levels should be reasonable and adequate, (3) Adequate reserves should be calculated and maintained, (4) The level of self-funding should be reasonable when tested against risk theory.
“The role of the actuary is not promotional nor adversarial. Rather, the actuary is a presenter of facts. The facts are that self-funding financial outcomes will vary from year to year due to (1) Judgement errors, (2) secular trends, and (3) Random statistical fluctuation.” – Carlton Harker, Society of Actuaries
☐ Tier 3 Services – $40,000
On-going risk management support intended to assist the plan sponsor towards full compliance of mutually shared fiduciary duties.
“All benefits leaders and their consultants should be overhauling how they manage care and cost or risk the consequences. It is particularly notable that the Department of Labor is now arguing that fiduciary dereliction in health benefits is rampant “– Brian Klepper
☐ Performance Based At-Risk-Fee Structure
Performance Based Fees are contingent upon achieving pre-defined goals and can be a tiered flat fee schedule per goal attained or a percentage of plan savings. Performance Based Fees are in addition to a monthly Base Fee.
“Performance-based payment structures reward consultants for their results, rather than their input or time spent working on a project. Consultants who use this type of payment structure are incentivized to achieve measurable results that benefit the client.” – Consulting Mavericks
Additional Service Options
☐ Focus Group Study – $10,000
Designed for a benefit decision process reliant upon input from plan members. This is typically a method employed by school districts whose decision-making process includes plan member input.
“A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest.”– Tegan George
☐ Cafeteria Plan & Voluntary Products – $18,000
Services include a review of Cafeteria Plan Documents, current voluntary benefits with recommendations, and management oversight of a Request for Proposals (RFP) process with recommendations. The RFP will necessarily incorporate Texas Department of Insurance recommendations in Commissioners Bulletin B-0004-08:
“The functions of the administrator are separate from the acts of an agent. These lines begin to fade during this process to the unsuspecting consumer. Administrators must separate the functions of the “enroller” from those of the “marketer.”:
“The language of the Insurance Code provisions set out in this bulletin prohibit an insurance company, insurance agent or agency with respect to the sale of health insurance from providing inducements to the sale that are not provided for in the insurance contract. Because many administrative services are not provided for in the insurance contract, they could constitute valuable consideration and an unlawful inducement or rebate in violation of the Insurance Code, regardless of whether they are provided directly or indirectly by regulated entities.” – Texas Department of Insurance
Insurance Consulting Agreement
THIS AGREEMENT is made of as of (DATE), by and between RiskManagers.us (“Consultant”) and (PLAN SPONSOR) (“Client”).
WHEREAS, Consultant has certain skills and abilities that may be useful to Client from time to time in the insurance industry.
WHEREAS Consultant is an independent contractor willing to provide services to Client for the period contemplated in this Agreement.
WHEREAS, Consultant has advised Client of its willingness, ability and desire to provide advisory services to Client on a regular but non-exclusive basis.
WHEREAS Client is desirous of engaging Consultant to provide advisory services to Client on the terms set forth herein.
NOW, THEREFORE, in consideration of the foregoing recitals and the terms, conditions and covenants contained herein, it is hereby agreed as follows:
APPOINTMENT
Client hereby engages Consultant as an independent contractor for the sole purpose of performing the Services as described in Exhibit A of this Agreement and Consultant accepts such appointment and agrees to perform the Services.
Consultant is and shall remain an independent contractor with respect to its performance and obligations hereunder and shall have no power to act on behalf of or bind Client.
TERM OF AGREEMENT
Subject to the terms of this section, this Agreement shall have a term of one (1) year starting as of the date first written above with the option to renew for four additional one-year periods. Client or Consultant may terminate this Agreement at its sole discretion, with or without cause, by sending a written notice of termination to the other party. Such notice shall specify the termination date, which shall be no sooner than thirty (30) days in advance of such termination.
STATUTORY COMPLIANCE.
In accordance with the provisions of the Texas Insurance Code, Title 13, Subtitle B, Subchapter A, Section 4052.101, Consultant hereby:
Provides to Client this written agreement in duplicate.
Acknowledges that this agreement shall be signed by Client and a copy provided to Client before any services under this Agreement are performed; and
Discloses to Client the fact that Consultant will not receive compensation of any kind either directly or indirectly, from any vendor/s contracted with the (NAME OF PLAN SPONSOR) self-funded employee health & welfare plan, or any other source, other than fees paid directly to Consultant by (NAME OF PLAN SPONSOR) as memorialized within this Agreement.
CONSULTANT’S DUTIES
Consultant’s duties under this Agreement are to provide, at the request of Client, non-exclusive, independent advisory and consulting services for the purposes of assistance in the procurement and placement and ongoing risk management services of Client’s self-funded employee health & welfare plan/s.
Consultant shall serve with objectivity and complete loyalty solely upon the interests of Client and shall render to Client such information, counsel, and service as within the knowledge, understanding, and opinion, in good faith of the Consultant, best serves the Client’s needs and interests.
Services are limited to an advisory capacity only and represent the opinion(s) and suggestion(s) of Consultant. Notwithstanding the Services being provided by Consultant, Services shall not be construed as decisions on the part, or in behalf, of Client.
Client hereby specifically states and agrees that all decisions related to Client’s business, operations, personal affairs and any and all other matters discussed between Client and Consultant, are deemed to have been made and shall be made by Client in its sole and absolute discretion.
Client hereby specifically states and understands that Consultant is not an attorney, a certified public accountant, or an actuary, and that no representations or warranties to that effect have been made by Consultant. Client hereby assumes the sole responsibility for the legality of any and all decisions made, whether or not at the suggestion of Consultant.
Notwithstanding the above, failure to agree with and/or implement the suggestion(s) of Consultant shall not be deemed cause for non-payment of Services.
COMPENSATION
☐ Tier 1 Services –Contract Review – $3,500
☐ Tier 2 Services – Financial review with forecasting including actuary analysis. – $15,000
☐ Tier 3 Services – On-going risk management support – $40,000
EMPLOYMENT STATUS
Consultant will act hereunder as an independent contractor and not as an employee, agent, or representative of the Client. Consultant recognizes that as an independent contractor, Consultant and his employees, officers and agents are not eligible to participate in any of the Client’s employee benefit programs, and that the only consideration by the Client to the Consultant for services rendered hereunder shall be set forth in the preceding section of this Agreement.
INDEMNIFICATION.
Consultant agrees to defend, indemnify, save and hold Client, its directors, employees, agents and other consultants harmless from and against all costs, expenses (including reasonable attorneys’ fees and court costs, fines and penalties), suits, actions, losses, liabilities, claims, damagers and other charges incurred by the Client or the other indemnified parties arising out of the act or omission of consultant, its agents, employees, officers or directors.
The scope of the foregoing indemnity includes any and all costs and expenses properly incurred in connection with any proceedings to defend any indemnified claims, or to enforce the indemnity, or both. The indemnification provided herein shall survive the termination of this Agreement.
ATTORNEYS FEES
Should either party employ an attorney or attorneys to enforce any of the provisions hereof or to protect its interest in any manner arising under this Agreement, or to recover damages for the breach of this Agreement, the non-prevailing party in any action agrees to pay to the prevailing party all reasonable costs, damages and expenses, including attorney fees, expended or incurred in connection therewith.
AMENDMENT OR MODIFICATION
This Agreement may be amended or modified only by written agreement signed by both parties hereto.
EVIDENCE OF PROFESSIONAL LIABILITY INSURANCE
Consultant will provide the Client with evidence of Errors and Omission liability insurance coverage with minimum limits of $1,000,000 per cause. Such evidence will be provided prior to the effective date of this Agreement.
DUTY OF LOYALTY
Consultant understands and agrees that he owes a duty of loyalty to Client for which he performs services hereunder. Consultant will disclose, in writing, any direct or indirect conflicts of interest he may have to Client at the time such conflicts arise.
CONFIDENTIALITY
Consultant shall receive and have access to information that is considered proprietary and confidential to Client. Both during and after the term of this Agreement, Consultant agrees to preserve and protect the confidential nature of this information. Confidential and proprietary information shall include, but not be limited to, any information pertaining to materials, contributors, practices, processes, systems, products, projects, financial condition or business of Client, but does not include any information that has become publicly available other than by reason of Consultant’s failure to comply with this Agreement.
REPRESENTATIONS, WARRANTIES AND COVENANTS
Each of the parties hereto warrants and represents that it has the authority, corporate and otherwise, to enter into this Agreement and perform in accordance with the terms hereof.
Client acknowledges and agrees that Consultant shall be providing Services hereunder based upon information provided to Consultant by Client. Client warrants and represents said information is true and correct. The client agrees to indemnify the Consultant for any breech of the foregoing warranty or representation.
NOTICES
All notices under this Agreement shall be in writing and shall be deemed duly given when delivered, if personally delivered, or three (3) days after the date mailed if sent by registered or certified mail, return receipt requested and postage prepaid, and addressed to the parties at the following addresses:
| If to Client to: | and if to Consultant to: William Rusteberg, dba RiskManagers.us, Stratton, Texas 77995 |
unless a party receives written notice of any change.
Neither Client nor Consultant may assign or transfer this Agreement or any rights or benefits under this Agreement to any person or entity without the prior written approval of the other party.
The rights and remedies provided in this Agreement are cumulative and not exclusive and are in addition to any other rights and remedies the parties may have at law or otherwise.
Neither party’s waiver of the other’s breach of any term, covenant or condition contained in this Agreement shall be deemed to be a waiver of any subsequent breach of the same or any other term, covenant or condition in this Agreement.
The headings appearing in this Agreement are inserted only as a matter of convenience and in no way define, limit, construe or describe the scope or intent of any article or section of this Agreement.
The covenants contained in, or liabilities accrued under this Agreement which, by their terms, require their performance after the expiration or termination of this Agreement shall be enforceable notwithstanding the expiration or other termination of this Agreement.
This Agreement shall be governed by and construed in accordance with the laws of the state of Texas.
If any provision of this Agreement shall be determined to be invalid or unenforceable, the remaining provisions of this Agreement shall not be affected thereby, and every provision of this Agreement shall remain in full force and effect and enforceable to the fullest extent permitted by law.
Time is of the essence in the performance of the duties under this Agreement.
This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.
This Agreement, and the materials incorporated herein by reference, constitute the entire agreement between the parties. There are no promises or other agreements, oral or written, express or implied, between the parties other than as set forth in this Agreement. No change or modification of, or waiver under, this Agreement shall be valid unless it is in writing and signed by duly authorized representatives of Client and Consultant.
IN WITNESS WHEREOF, this Agreement has been duly executed by the parties hereto as of the date first written above.
| “Client” By:___________________________________ Printed: _______________________________ Title: _________________________________ | “Consultant” By:___________________________________ Printed: William Rusteberg Title: Risk Manager, Tx. Lic. # 149261 |
Date: ______________________________ Date: _____________________________
About RiskManagers.us
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
The shared vision of RiskManagers.us 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.
2024 RiskManagers.us All Rights Reserved
Business is about solving other people’s problems. Solving the high cost of healthcare giving employers a competitive advantage is ours.
Status quo convergent thinking solves problems through a very narrow lens. Divergent thinking empowers us to solve problems with a wide lens allowing us to see what others don’t. You can’t fix what you don’t see. You don’t know what you don’t know. We see opportunities others miss. We do what others don’t. Winning together is our goal.
Shared Values
Demonstrated reluctance to consider suggested strategies indicates a growing tendency towards static risk management which is contrary to proper oversight. We bring no value in exchange for the fees you pay us when the status quo isn’t continuously challenged with evolving strategies and a wiliness to act when it’s in the best interests of the plan and plan members no matter how hard change may be.
The value we bring includes years of risk management experience, contacts within our industry built on trust over time as well as our continuous commitment toward means and methods a dynamic and changing market may warrant in order to best serve our customers. Contributing these resources to achieve best results requires a receptive audience sharing the same philosophies and goals. The ability to embrace and adapt to change is key to the process. Otherwise frustration of purpose leads to mediocre results.
The Best Work Comes Out Of Great Relationships
“The best work comes out of great relationships. Honesty, respect and gratitude are the keys to a great relationship and therefore we have an interest in treating each other with these values at all times. As much as legal documents are important, what truly binds us is our drive to do great work with great people and to develop a relationship of mutual respect and trust.” – Carrie Wingate
Risk Management
FOR MORE INFORMATION: RiskManager@RiskManagers.us
