Risk Managers – Thought Leadership on Health Insurance

TRS ActiveCare Income Versus Expenses (Loss Ratio)

Source: TRS audited financial reports, Board reports.

NOTE: The accuracy of the following information is not guaranteed. Readers should independently seek confirmation.

Over five years, health care claims exceeded premium income by approximately $1.375 billion. However, when including rebates, five-year claims exceeded premium and rebate income by approximately $195 million.

Compare Your Hospital Bill To Medicare Rates in 30 Seconds

The CoveredUSA Bill Analyzer

Upload your hospital bill PDF and it compares each line to the current Medicare rate, flags charges above the benchmark, identifies common billing codes associated with overbilling, and shows you charity care options if the bill is too large to pay.

Cost-to-Charge Ratio: Why Your $50,000 Bill Cost the Hospital $8,000

“The red line represents Chargemaster rates (sticker prices no one ever pays). The green line represents the cost of care hospitals must report to CMS. The difference between the red line and green line is “The Spread.” That’s where the real money is made by third party intermediaries and it’s hidden on the claim side of the ledger” – Bill Rusteberg

A PBM Reckoning Starts With The Receipts

By Rachel Strauss – November 04, 2026

I spent 23 years selling PBM services for a company that started without a single rebate contract. So forgive me if I’m not moved by how complicated it’s going to be for pharmacy benefit managers to explain how they get paid. Especially the ones calling themselves “transparent”.

Kingsville ISD Touts Three-Year Fixed Health Insurance Cost

Kingsville Independent School District trustees were informed at their October 27 workshop that the district has saved over $3 million on their group health insurance plan and their costs are now fixed at $1.6 million per year for three years.

The Best Work Comes Out of Great Relationships

By Bill Rusteberg

As a self employed insurance agent I’ve worked with hundreds of clients over the past 50 years, the result of calling on thousands more in prospecting efforts to gain more business. I’ve met all types of personalities, developing a skill few have. Understanding motivation, goals and interests is secondary to understanding moral and ethical values of those you strive to do business with.

Patternicity in Health Care

“Sometimes it takes a prick to solve health care”

By Bill Rusteberg

Our brain is a belief engine fueled by outside stimuli, recorded, sorted and placed in filing cabinets in our cranial warehouse to be retrieved at will when needed.

‘Catastrophic’ Insurance Issue Causes $3M Deficit at Sharyland ISD

$3,000,000 Health Plan Deficit Stuns School District Officials

By Lea Juarez | October 18, 2026

Sharyland ISD’s health insurance fund is in a $3 million deficit following a series of high claims from the last two to three months.

He Broke The Company Record By Selling 271 Policies In One Week

Taking a job as a door-to-door salesman for Combined Insurance the slick-talking salesman was a natural. He broke a company record by selling 271 policies in one week. Unfortunately, most of those were nullified when it was found he sold the bulk of them to patients at a nearby psychiatric hospital.

Kovacic Set To Retire in 2027 At Age 90

“Looking back for a moment, I’m amazed and greatly thankful for my life experiences and the health I enjoy still today. I stumbled into the group business in 1957. After helping my Dad and a couple brothers complete the hay bailing season………”

Doctors Excited About AI Driven TPA Call Center

“I’ve been very impressed with the agents’ ability to handle the needs of our providers,,,,,,,,,,,,,”

Insurance Agent Compensation Guide 2026: Commissions, Overrides, and Bonuses

Complete guide to insurance agent compensation structures in 2026. Covers commission rates by product line, override structures, bonuses, and how to use compensation as a recruiting tool.

Most Plan Sponsors Will Never See The Email I Got Today. They Should.

By Donavan Ryckis

It was a carrier’s 2026–27 large group incentive program, sent to brokers. You won’t find it in a renewal deck or a broker presentation, but it gives you an inside look at how renewal decisions actually get made.

Mental Health Alert: Fisher Discovers Logorrhea Cure

Simple kitchen device cures a form of mental illness long baffling mental health experts. Victims across the Fruited Plains rejoice at the news……….

Association Healthcare

“Strengthening associations with non-dues revenue while providing their membership with exceptional healthcare plans and savings.”

Drug Middlemen Will Soon Have to Share Details on How They Are Paid

The new rule is part of a push to overhaul the industry. Julio Cortez/AP

Pharmacy Benefit Manager Fee Disclosure Final Rule

SOURCE: U.S. Department of Labor

The U.S. Department of Labor released a final rule under the Employee Retirement Income Security Act (ERISA) to improve transparency into fees and compensation received by pharmacy benefit managers (PBMs) and their affiliates, including affiliated providers of brokerage and consulting services.

The South Texas Risk Pool

Fee-Only Healthcare Consulting – Zero Conflicts Of Interest.

In 2005, Dan Ross founded Med-Vision with a straightforward mission: give self-funded employers an honest, independent look at their healthcare data. With more than 30 years of experience in the employee benefits industry, Dan is experienced in a wide variety of employer self-funded health plan data elements. His prior experience includes consulting for Hilb Rogal & Hobbs (HRH) and eighteen years in various management and sales roles for CIGNA Group Insurance.

Health In Tech Launches HitRix, a Broker-First Environment for Self-Funded Stop-Loss Placement

PR Newswire – October 8, 2026

Broker-first marketplace brings submission intake, market routing, quote comparison and case tracking into one coordinated process.

High Speed Underwriting in 2 Minutes

Administer your own plan with Health-In-Tech and run your own program with our proprietary underwriting platform. The platform allows you to medically underwrite and produce a bindable quote for any group within minutes with seamless, DocuSign powered implementation and plan administration.

International Captive Exchange vs. ESC‑100, Glenn Hillyer & Others……

International Captive Exchange vs. ESC-100.

The suit is brought under the Defend Trade Secrets Act (DTSA), 18 U.S.C. § 1836(a), seeking an injunction against alleged misappropriation of trade secrets.

Best Sales Coaching Happened In An Uber

By Chris Fisher – BenefitsAlly

Some of the best sales coaching I’ve ever been part of happened in the back of an Uber between two broker meetings.

New Pricing Approach for Districts Joining TRS-ActiveCare

Effective Sept. 1, 2026, TRS-ActiveCare will use a new pricing model for districts joining the program. The change helps ensure new districts contribute their share of expected health care costs and reserves while maintaining stable rates for all participating districts.

Chris Fisher’s 3 X 3 X 3 Challenge

If someone can’t be clear, concise, and compelling in 3 minutes, why give them 30. Take fewer bad meetings. Miss fewer good ones. Ask for their 3x3x3 Challenge first.

Medicare Guidance Can Help Reduce Group Insurance Costs

Healthpilot uses AI-powered Medicare guidance to match employees with the right plan, helping members save money and employers reduce group-plan costs with less HR burden.

VytlOne Signs Agreement with MedImpact

By Amy Garrigues. President, VytlOne Oct 26, 2026

I’m writing to share that VytlOne has signed an agreement for MedImpact to acquire our PBM and our affiliate Gateway Health Partners. The proposed transaction does not include VytlOne’s 340B or pharmacy fulfillment assets.

How to Join TRS-ActiveCare

Considering TRS-ActiveCare? We’re Here to Help

Sara Pushes For Healthcare Price Transparency

Your PBM Promised an 18% Brand Discount. The Real Number Is 1.6%

Brand pricing is usually a discount off Average Wholesale Price (AWP). According to Milliman’s March 2026 primer, brand AWP is typically the manufacturer’s list price (WAC) plus 20%. So AWP starts about 20% above list.

Sierra-Berkshire Associates, Inc.

Sierra-Berkshire Associates, Inc. is a Nevada-based corporation, incorporated in February, 1996. The company’s main office is located in Las Vegas, Nevada. Principal Associates are also located in the Hartford, CT area.

How Much Does It Cost?

Want to know the price? Book a discovery call………………….

Health Insurers Must Give Personalized Cost Estimates by Phone Starting with 2027 Plan Years Under Final Federal Rules

“Americans should know what their healthcare will cost before they receive it.” Robert F. Kennedy Jr

Hidden Secrets of the Uninsured

Personal responsibility, shopping for health care, think about health insurance as protection against catastrophic risk to have in case something bad happens………..Insuring a $75 office visit, a $16 lab test, a $1,500 dental benefit by adding the cost of health insurance on top is insanity…………..

Through personal experiences and a passion for his work, Shaun will challenge people to change their perspectives on the 29 million U.S. citizens who do not have health insurance……………

City of Tulsa Implements $2,400 Spousal Surcharge

Well Carol, Cheers To Saving $2,400!

SOURCE: City of Tulsa

Non-sworn employees who are enrolled in the City of Tulsa Benefit Plans will incur an annual spouse surcharge of $2,400 ($92.31 per pay period) if their spouse has access to healthcare benefits through their employer but chooses to enroll through the City of Tulsa plan.

Insane IDR Awards Turbocharge Claims Up To 30 X Medicare Rates

“Mr. Kueter said upwards of 40% of claims that start the IDR process are ineligible, and about 60% of arbitration cases are brought forward by five entities. He added that when arbiters align with the out-of-network providers, the average payout is now 11 times what Medicare would pay, and some determinations are 30 times Medicare rates.”

On-Exchange vs. Off-Exchange ACA Marketplace Plans

SOURCE: UnitedHealthcare

If you’re familiar with Affordable Care Act (ACA) Marketplace plans, you may already know how they work. ACA Marketplace plans are health care plans that people can buy on their own, rather than through an employer or another government-run program, like Medicare or Medicaid. But do you know the difference between an on-exchange plan and an off-exchange plan? Read on to learn which choice could be the right fit for the coverage you need.

Rip Off Artists Feed Off Clueless Plan Sponsors

By Bill Rusteberg

Somebody is getting ripped off somewhere. And it could be you.

Best Benefits Online™ Is Your New Best Friend

Best Benefits Online™ modernizes employee benefits with real choice, and zero admin complexity—all in one platform – A modern, sensible and common-sense solution for employer sponsored health plans and associations.

Texas County Seeks Fee-Based Insurance Consultant

Willacy County Seeks Insurance Consultant

Willacy County is not seeking a conventional insurance broker or another plan administrator. It wants an outside expert who can help protect and improve an existing cost-containment model, evaluate claims performance, strengthen direct provider arrangements, and support sound financial decisions.

PRAM Rx

PRAM is a licensed Insurance Underwriter and General Agent. PRAM is one of the nations leading Pharmacy Underwriters that brings over one hundred years of knowledge in underwriting and managing employee benefits for not only Independent Companies, but Associations, Franchises and Trusts.

Port of Corpus Christi Seeks Broker of Record

The Port of Corpus Christi Authority is soliciting proposals from qualified insurance brokers to provide insurance brokerage and risk management consulting services, including insurance placement, risk exposure analysis, claims assistance, and ongoing advisory services for the Port’s insurance and risk management programs.

Check It Out, Urgent Care Is Fun

Ever been to an urgent care? Check it out, it’s fun. There’s no ego in an urgent care.

The Legal Wave: Why Health Plans Are The Next ERISA Battleground

Plan sponsor pleads for mercy…….”I didn’t know my broker made us broker!”

Passive plan management is no longer an option plan sponsors can afford…………

Weslaco ISD Believes The More The Merrier…………..

The Weslaco Independent School District believes having three insurance agents sharing the spoils is better than having just one, so they hired four…………..

Brokers: Learn More About ZERO FIRST

We shared Curative’s new plan design, Zero First, with you last week. Friday’s your chance to get additional details, straight from our CEO, Fred Turner.

Look Up Where Your Generic Prescription Drugs Were Made

SOURCE: ProPublica

The FDA won’t tell Americans where their generic drugs are made, so ProPublica did it instead. Use information on your prescription label to locate the factory and see inspection reports.

Plan Sponsors Suffer From Learned Helplessness

“Learned helplessness occurs when a person who has experienced repeated challenges comes to believe they have no control over their situation. They then give up trying to make changes and accept their fate” – Seligman & Maier

Section 125 Cafeteria Plan Penalties: What Happens When a Plan Fails

SOURCE: Section 125 Cafeteria Plan Penalties for Employers

Quick Answer (as of 2026): The IRS does not charge one flat fine for a Section 125 cafeteria plan failure. The penalty is that the plan stops being a cafeteria plan, so every pre-tax deduction becomes taxable wages. The employer then owes back FICA and income tax withholding, plus IRS failure-to-deposit penalties of 2% to 15% and interest.

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

The Kaiser Foundation recently reported that in Texas nearly half of nonprofit hospitals say they will bill patients before screening them for financial aid. And most hospitals will not offer refunds to patients who pay and are eventually found to qualify for free care.

All Self-Funded Health Plans Must Do This March 2027

Government says if you’re self-funded you have to do this in 2027 or face punishment if you don’t.

Medicare GLP-1 Bridge

The Medicare GLP-1 Bridge is a short-term demonstration run by CMS that will provide eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs between July 1, 2026, and December 31, 2027.

Congress Wants to Eliminate IDR

“I knew it was not going to go well, but I didn’t know it was going to be this bad.”

American Tries Healthcare in China — He Couldn’t Believe the Cost

Americans are increasingly choosing healthcare in China for advanced medical treatment. See how technology is changing care.

TotalRx Is A Free Service

Never pay retail for any FDA approved prescription with TotalRx.ai !

Willacy County Seeks Insurance Consultant

The Willacy County Health Plan risk pool is a community-based plan. Participating entities join through an interlocal purchasing agreement and share underwriting losses/profits and administrative expenses.

HR Conducts Short & Pithy Open Enrollment Meeting

HR DIRECTOR: Good Morning Children! Welcome to Open Enrollment. Everyone should have a copy of the Plan Document in front of them. Let’s get started!

McAllen ISD Has A $9,000,000 – $12,000,000 Headache

SOURCE: McAllen ISD Board Meeting October 20, 2026

At their 20 October 2026 board meeting trustees of the McAllen Independent School District will be reminded they have a $9,000,000 to $12,000,000 health insurance problem.

The good news is they should feel much better knowing the Brownsville Independent School District just down the road has a $28,000,000 health insurance headache.

THE BROKER PAY FILES | EPISODE 1

“In a Blue Cross and Blue Shield of Texas proposal for the CITY OF GALVESTON‘s 2025 health plan, under “Commissions,” Gallagher was listed to receive $2.25 for EACH net paid pharmacy claim…….Now look at Austin Independent School District ……………”

ZERO FIRST HEALTH PLAN

Over the past year, brokers kept telling us the same thing: clients love Curative, but price is often the deciding factor. So, we built Zero First. A Curative plan that stays true to our mission of $0 access to care at a more competitive price point.

Get Sick To Get Paid

When a provider bills less than the benefit the plan member receives a check for the difference………………..

Knowing When To Say Goodbye

Albert knew when it was time to say goodbye……………………

Were The Cats On The Ship?

By Marc Gravely

In 1780, a London broker told a client his claim came down to one question. Were there cats on the ship?

Another Win For Curative Insurance Company

Bexar Central Appraisal District trustees awarded a one-year contract to Curative Insurance Company at their October 12 board meeting after a 37 second pithy yet compelling presentation by the district’s insurance consultant.

More Large Groups Adopt ICHRA

“Except the fastest-growing segment is employers with 1,000+ employees. Adoption there is up 178%. These aren’t businesses with no benefits history. These are companies that ran full group plans for years and decided a defined-contribution individual model is the better buy.”

OPEN LETTER TO BISD TRUSTEES

By Bill Rusteberg

You will not hear this from any insurance broker or consultant. But it needs to be said………..

Digital Therapeutics: When Apps Become Medicine

“As we transition into an era defined by patient-centric care, the integration of digital tools into traditional clinical pathways is no longer a futuristic concept but a tangible reality.”

Algorithmic Underwriting: The Future of Payer Ecosystems

“In an era where consumers expect instantaneous service, the traditional underwriting turnaround time—often spanning weeks—is no longer competitive. Algorithmic underwriting addresses this bottleneck by automating complex approval workflows, allowing for near-instantaneous decision-making.”

West Texas Hospital Administrator VS RBP Rable Rouser

Lubbock Texas is a two-hospital town supported by managed care plans including Medicare and Medicaid. Commercial insurance plans, 100% of which are managed care plans too, subsidize Medicare and Medicaid patient because hospitals say they do.

Legislation Introduced To Fix The No Surprises Act Arbitration Process

When You Can’t Get It Right The First Time….

“The arbitration process (IDR) is clearly not working. A few bad actors—largely backed by private equity—are gaming the system……………..”

Why Your Group Health Plan Feels Like a Group Project That Never Ends (And How ICHRA Fixes It)

By Michael Reagan, CBPA – October 10, 2026

Remember when health benefits were simple? You picked a carrier, hoped the renewal didn’t make you cry, and spent the rest of the year explaining why Brenda in accounting still can’t find an in-network dermatologist. Those days are mostly gone.

Another School District Health Plan Serving 100 Districts Bites The Dust……….

By Allison Bell, BenefitsPro, 10/2/2026

Idaho school districts used the trust to provide medical, dental and vision benefits.
The trust served 16,500 school district employees and dependents.
The trust was not backed by the state guaranty fund.

PPOs Double Your Pleasure, Double Your Fun….

“Double your pleasure, double your fun with double mint, double mint, double mint gum.”

RiskManagers.us Business Statement

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.

HR Executives Face Unprecedented Personal Liability

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.”