Uncategorized – Page 6 – Risk Managers

75% Will Use It, But Only 31% Offer It

“Only 20% of [small] Texas businesses provide vision coverage, as opposed to 31% that offer dental care. When dental services are provided, 75% of employees utilize them, while 72% take advantage of vision services.” SOURCE: Employee Medical Benefits Summary Texas

Benefits / Salary X 100 = Fringe Benefit Rate

The Fringe Benefit Rate Calculator is a practical tool which is designed to measure the percentage of fringe benefits relative to an employee’s salary or wages.

The Industry Leader in Benefit Analytics for Employers

Smarter benefits decisions start with better data.Benchmark, model, and measure your benefits against the market, instantly.

Fringe Benefits Online

Fringe Benefits Online™ modernizes employee benefits with real choice, and zero admin complexity—all in one platform.

Occupational Accident Coverage For Individuals & Groups

Truckers Occupational Accident Insurance covers injuries that result from eligible on-the-job accidents that owner-operators or contract drivers sustain.

On Demand 24/7 Doctor Visits For Less Than $20 Per Month

EBS – “A Flexible, Low-Cost TPA”

Employee Benefit Systems (EBS), established as a Third Party Administrator (TPA) in 1984, is located in Burlington Iowa. EBS prides itself on providing a full range of high-value insurance and administrative services to meet our customer’s needs.

Scientists Engineer “Tumor-Eating” Bacteria That Devour Cancer From Within

A new strategy uses genetically programmed bacteria to detect when enough of them have gathered inside a tumor – then switch on survival mechanisms at just the right moment. Credit: Shutterstock

By University of WaterlooApril 7, 2026

Researchers are exploring an unconventional cancer treatment that uses engineered bacteria to target the unique, oxygen-free environments inside tumors.

Insurer fights $2.8 Million BBQ Sauce Burn Verdict Over Insured’s Silence

The insured never reported a burn lawsuit – until it was too late

Get Me Out Of The Voluntary Benefits Jungle!

“A modern, sensible and common-sense solution for employer sponsored health plans and associations…………….”

By Jack Stanley, CPA

As a freelance auditor working with hundreds of corporate clients over the past +20 years, I’ve heard from a multitude of HR directors and payroll staff members complaining about voluntary benefits and the extra work involved.

Roger “The Teflon Kid” Survives Once Again

Roger Garza “The Teflon Kid” of Valley Risk Consulting has once again survived another attempt to terminate his consulting gig at the Brownsville Independent School District.

When ERISA Is Preempted

SOURCE: ERISA WATCH

Congress has determined that ERISA displaces “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan,” 29 U.S.C. § 1144(a), thus making almost every dispute over the operation and application of benefit plans an exclusively federal concern.

Michigan Employers Shift to ICHRA to Control Benefits Costs

SOURCE: Press Services

Why Michigan Mid-Market Employers Are Replacing Group Health Plans with ICHRA

Municipalities, have you been talked into a tax liability debacle by your Employee Benefits Consultant?

“What may a municipality face if their Section 125 plan was implemented without a Plan Document?”

Corpus Christi Hosts 2026 NABIP-TX Annual Conference

SOURCE: Annual Conference

For less than $300 brokers can mingle, socialize and learn from other brokers and vendors important to their ongoing education to better serve their clients. Its all about staying on top of one’s profession.

Marpai – Going Where The Real Money Is…………

“Marpai management is smart! Screw earning a lousy $18-25 pepm off claims administration. They are going after the Motherload…….the lucrative world drug dealers” – Molly Mulebriar

Ethos – Making Life Insurance Easier

SOURCE: ETHOS

Ethos is a technology company. Our technology makes it easier than ever for everyone to protect their families with life insurance. We’re taking something traditionally founded on exhausting processes and paperwork and infusing it with the insurance industry’s most advanced proprietary technology, developing instant and accessible products. We issue billions in coverage each month and invaluable amounts of peace of mind every day.

Insurance Franchise Opportunity

Keith Needed A New Roof

A few years ago, Dr. Keith Smith needed a new roof. His insurance company wouldn’t cover the hail damage, so he did something most of us rarely get to do: he asked for real prices with no insurance in the picture.

85 Insurance Agencies for Sale in Texas

Why are so many brokers selling off their Allstate agency franchises? Why are more insurance agents selling their agencies? Why are some of the biggest brokerages downsizing? Do they know something we don’t know?

Does AI have anything to do with it? You can buy auto and home owners insurance with a click of a button these days, Meet George, your new insurance broker.

GLP-1 Drugs Unleash Divorce Boom

The growing popularity of fat jabs is expected to increase Britain’s divorce rates as slimmed-down partners look for new love, health experts have said.

The NSA Was Built on Insurer Math—Now Employers Are Paying the Price

By Mark Flores – Executive Vice President and Co-Founder at AVYM Corporation

April 6, 2026

From Hidden QPAs to TPA Failures in Arbitration: self‑insured employer plans are paying for a system they cannot see, and carrying the liability for a system designed to protect insurers, not employers

Hospital Owned Health Insurance Brokers Beat Back The Infidels

“I’ll make you an offer you can’t refuse…………!”

By Bill Rusteberg

There are areas in Texas where hospitals have circled the wagons against Reference Based Pricing infidels. “We ain’t gonna see you unless you have an emergency!” snarls the local hospital intake clerk. “Go somewhere else to die!”

There are many benefits advisors. Only a few practice as true fiduciaries.

By Dave Chase

What sets them apart is infrastructure.

Here’s a clear example. A Health Rosetta, a Public Benefit Corporation Advisor walks into a new employer meeting with a compliance diagnostic that uncovers regulatory gaps in about 15 minutes. In that first conversation, they typically surface three missed items such gag clause attestations, compensation disclosures, & incomplete Form 5500 filings. Before any strategy talk begins, they’ve already shown what fiduciary guide looks like in action.

Yuzu Health Raises $35 Million Series A to Modernize Health Insurance Plan Infrastructure

PRESS RELEASE GlobeNewswire

Apr. 6, 2026, 11:00 AM

NEW YORK, April 06, 2026 (GLOBE NEWSWIRE) — Yuzu Health, a next-generation third-party administrator (TPA) that serves as the infrastructure behind health insurance plans, today announced a $35 million Series A round, bringing total capital raised to $40 million. The round was led by General Catalyst and Chemistry, with participation from Anthropic’s Anthology Fund, Bain Future Back Ventures, Timeless Ventures, Lachy Groom, and Neo. Alex Tran, Managing Director at General Catalyst, will also join Yuzu Health’s board of directors.

Today We Fired A Client

The following article was written several years ago. I was reminded of it this morning as I contemplate a reenactment.

By Bill Rusteberg

One of the hardest things a consultant can do is fire a client. Today we did just that. It wasn’t an easy decision. This is a client we’ve served for many years, earning deep friendships within the organization that will endure.

It’s Raining Babies In Waco!

“Hey, you know, it’s raining babies up here. So, if you want to come in, we would love to have you…………..”

I Have a Dream… of a Post-Network World

The carrier gangsters have spent decades making sure you can’t leave. Here’s how that ends.

Texas Company Provides Healthcare Settlement Solutions

Austin Resolutions has been negotiating savings on medical bills since 1994. Our service lines include Group Health, Workers’ Compensation, Medicare Exhaust, Auto Liability, Marine, Transplant, Catastrophic Care, and International Travel plan options.

Best Term Life Insurance Companies of April 2026

Term life insurance provides great coverage and affordability, see which of our top-rated picks best fits your needs.

Every Payer. Every Provider. Every Negotiated Rate.

SOURCE: Payerset

Drill from market-level views into the exact dollar amount negotiated between any payer and provider — for any billing code, any plan.

Where Healthcare Is Headed

“The traditional hospital model is breaking. Even HCA — the fee-for-service king — is targeting 20:1 outpatient access points per hospital. Ascension sold 35+ hospitals, bought AmSurg for $4B, and is targeting 20% EBITDA margins. Emerging strategy = fewer hospitals, more density, ambulatory-first.”

Mending Launches Mending Access, Bringing Integrated Direct Primary Care to TPAs and Self-Funded Employers

MyHealthGuide Source: Mending via PRNewswire (full article), 3/31/2026

Excerpts

NEW YORK — Mending announced the launch of Mending Access, a new platform that enables third-party administrators (TPAs) and self-funded employers to offer Direct Primary Care (DPC) as a fully integrated health plan benefit. Since launching in January 2026, Mending Access has already expanded DPC access to more than 100,000 covered lives across employer-sponsored health plans.

Death By Queue

The Unheralded Pandemic: Death-by-Queue

Though more Americans are insured, wait times for medical care are so long that people die waiting for technically possible medical care unavailable in time to save them.

Why Is Selling in Healthcare So Hard??

Here’s why

Car Insurance Isn’t Exactly Getting Cheaper Right Now

But here’s the thing… a lot of people are overpaying and don’t even realize it.

Marpai, Inc. Secures Major Strategic Marketing Collaboration to Continue Acceleration of MarpaiRx Growth Nationwide

TAMPA, Fla., April 1, 2026 /PRNewswire/ — Marpai, Inc. (“Marpai” or the “Company”) (OTCQX: MRAI), a leader in innovative healthcare technology, Third-Party Administration (TPA), and Pharmacy Benefit Management (PBM) services, today announced the execution of what the Company believes is its largest to date definitive marketing agreement with a leading healthcare solutions provider. This strategic collaboration is designed to scale the reach of MarpaiRx, Marpai’s pharmacy benefit management (PBM) services, across a vast network of self-insured employer groups and third-party administrators.

Health Insurance Premium Payment (HIPP) Program

HIPP is the Texas Medicaid program that helps families pay for employer-sponsored health insurance premiums. It is for families with at least 1 person who gets Medicaid.

When We Couldn’t Find A TPA We Liked We Started One

Solving Health Care One Client At A Time

Our healthcare consulting business is built on fearless patient advocacy, efficiency, and attention to detail. So when we couldn’t find a Third-Party Administrator (TPA) that consistently met our high standards of care, we took action.

Corpus Christi Drains Aquifer Faster Than A Melting Raspa On An August Afternoon

April 2, 2026 – SOURCE: U.S. Drought Monitor

Orange Grove, Texas: The Evangeline/Goliad Sands Aquifer, the community’s primary source of water, dropped 17 feet a few days after Corpus Christi started drawing water from the aquifer last month. The increased usage has also elevated the concentration of particulates in the water.

Amazon Redefines Benefits: Move to ICHRA

Amazon Announces Launch of “Amazon Health Benefits,” Bringing a Unified Healthcare Marketplace to Employees and Employers by 2027

The Grand Healthcare Price Illusion

By Craig Gottwals – Mar 31, 2026

Most people assume that when a massive insurance company negotiates with a doctor, there is a single, disciplined price for a routine visit. We like to think that these billion-dollar entities use their size to ensure every patient gets a fair, standardized deal. The data recently shared by Josh Nakka and his team at PriceMedic proves that this is simply an illusion.

Jesse “Jay” Beck’s Texas Road Show

Our upcoming roadshow is an opportunity to connect in person, strengthen relationships, and share where we’re headed with our 2.0 initiative.

Attention P&C Brokers

We are an insurance intermediary

Avoid the delays and headaches associated with typical brokering arrangements and gain direct platform access through our program. We provide a unique opportunity for agents of any size to access primary markets that would otherwise be out of reach. Our function is to assist independent agents in the growth of their business without a partnership or merger of their enterprise. Our unique operation helps our affiliated agents stand out above the crowd.

ACE – A Unique Alternative In The Texas Marketplace

As a physician owned and operated entity, ACE provides a unique alternative in the Texas marketplace. We are focused on actively engaging with and managing the health of our members through our unique care coordination approach, optimizing care delivery.

Will Roger Survive Palace Coup Attempt?

Brownsville ISD To Consider Status of District’s Insurance Consultant

The Brownsville Independent School District is scheduled to consider the status the district’s insurance consultant during their April 7, 2026 board meeting.

Largest Public Sector Brokerage In Indiana

Apex has held the endorsement of the Association of Indiana Counties since 2006 and serves more public sector clients than any other Indiana advisory firm to this day.

How Aggressive Should Government Price Regulation Be?

According to this article efforts to lower commercial health care prices through government price fixing will:

Lead to lower quality health care
Reduce local employment
Cause hospital closures

No one, particularly politicians, wants lower quality health care, reduced local employment and hospital closures. So what’s the solution to solving an unsustainable system that’s bankrupting the American middle class?

State Laws to Lower Costs through Reference-Based Pricing

SOURCE: State Successes Passing Laws to Lower Costs through Reference-Based Pricing (FINAL, March 2026)

As of March 2026, 13 states have implemented reference-based pricing……..and underscores the increasing interest by states to lower health care costs

More Employers Are Directly Partnering With Healthcare Providers

SOURCE: Brighton HPS

In an effort to contain healthcare costs, many employers are creating health plans based on health systems, or hospital systems, near where their employees live and work.

23.1 Million Enroll on Free, Or Near Free Health Insurance Using Other People’s Money

Federal Open Enrollment Flyer

Nearly half of enrollees (46%) had household incomes between 100-150% of the federal poverty level with the vast majority receiving financial assistance. This highlights the program’s role in expanding access to affordable coverage for those who need it most.

Galena Park ISD Seeks Property & Windstorm Coverage

Date: April 14, 2026 before 2pm CST

The Galena Park Independent School District seeks responses to Request for Proposals #T01725 Property & Windstorm Coverage.

Express Scripts Just Got Sued for Racketeering. Here’s What That Means

Plaintiffs say a shadowy offshore entity helped Cigna and its PBM quietly siphon money meant for employers, unions and patients.

By Wendell Potter

A powerhouse law firm has filed a class action lawsuit that should make everyone who pays for prescription drugs through an employer or union health plan sit up and take notice. The target: Express Scripts, the nation’s largest pharmacy benefit manager — and its parent company, Cigna, where I used to work.

Houston Hospital Field Manual For RBP Plans

Sun Tzu

Choosing The Right Battlefield

The Houston medical industrial complex is a fortress built on BUCA market dominance. Reference Based Pricing infidels foraging for hospital encounters must understand the market and the extent to which hospitals will grant entry within their walls if at all.

TPA Opportunity

RiskManagers.us is searching for a Third Party Administrator with experience in Reference Based Pricing, Cash-pay / Direct contracting and care navigation support services for employer sponsored health plans in Texas

Southern Premier Administrators

Southern Premier Administrators is a third-party administrator (TPA) based in Austin, Texas, specializing in employee benefits administration and health plan management. The company partners with employers, brokers, and healthcare providers to deliver customized plan solutions and claims management services across the southern United States.

Ready To Quit Yet?

You built the business. Now let’s work on your legacy.

The Price Dropped But Yours Didn’t

“We do not expect the reduction in list price to impact net price.”

So……….What Else Is New?

Express Scripts Targeted By Racketeering Class Action

The PBM is accused of enriching itself through a fraudulent kickback scheme while its customers missed out on billions of dollars in drug rebates.

Excepted Benefit HRAs: An Introduction

March 27, 2026 – By: HUB’s EB Compliance Team – SOURCE: HUB International

An Excepted Benefit HRA (EBHRA) is an employer-funded health reimbursement arrangement that allows employers to reimburse employees, on a tax-free basis, for certain out-of-pocket medical expenses and premiums for excepted benefit coverage. Established under the 2019 tri-agency final rules, EBHRAs have been available for plan years beginning on or after January 1, 2020.

The Curative Mobile App Is Here

Give your employees an easier way to manage their care

Beyond the Network: Mastering the Cash-Pay Healthcare Model

There’s a reason more brokers are moving beyond PPO networks.

USPS Postmark Changes Could Affect Employee Benefit Plans

March 24, 2026 – SOURCE: Mercer

Employee benefit plan sponsors and administrators should be aware of changes to the United States Post Office (USPS) postmark process that could affect when government filings and participant disclosures are considered to have been sent on time.

Group HealthUnderwriting Solutions

With Gradient AI, insurers enhance their underwriting capabilities by gaining a more complete, in-depth picture of risk.

School Finance Annual Conference – South Padre Island, Texas

Property Casualty 360

Reference Based Pricing

By Robert M.

March 24, 2026

Reference-based pricing has a reputation for being disruptive. Providers push back. Employees get nervous. HR professionals hear the term and brace for a fight.