America's Benefit Specialist April 2023
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CAPITOL CONFERENCE HIGHLIGHTS PRICE TRANSPARENCY ISSUES MEDICARE MATTERS
Online Learning Institute
Affordable courses are available in NABIP’s Online Learning Institute library, which provides 24-hour access to the course curriculum. Online courses are self-paced, succinctly explain complex concepts for profes sionals of varying knowledge levels and backgrounds, and allow learners up to one year to complete. The online courses consist of recordings, supporting documents, quizzes, and a final exam. Upon completing any of the certification courses, students receive a logo brand representing professional academic achievement recognized by clients and peers. Most of the courses offer continuing education credits to maintain state licenses and SHRM certification credits. COURSES CAN BE TAKEN ONE AT A TIME AND MOST WORK TOWARDS EARNING THE REGISTERED EMPLOYEE BENEFITS CONSULTANT® (REBC) DESIGNATION. LASTLY, NABIP MEMBERS RECEIVE A SAVINGS OF 30% OFF OF NABIP COURSE TUITION AND A PLETHORA OF RESOURCES THAT PAIR WITH CONTINUED PROFESSIONAL SUCCESS. IF YOU ARE NOT A MEMBER, JOIN NABIP TODAY. Visit NABIP.ORG/PROFESSIONAL-DEVELOPMENT/COURSES for more information. NABIP Benefit Specialist Institute courses are ideal for employee benefit advisors, consultants, HR, and legal professionals looking to grow their knowledge of public and private healthcare structures. Continued professional development advances careers and provides an edge over the competition.
April 2023
34 Reference-Based Pricing in Self-Funded Health Plans: A Key to Cost Savings By Omar Arif and Mike Sigal
YOUR INDUSTRY 3
Recent Mergers and Acquisitions
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Industry Events
YOUR ASSOCIATION 37 Capitol Conference Highlights
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Price-Transparency Issues By David Ostrowsky
43 Welcome to NABIP
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Biosimilars Are Integral for Modern Healthcare By Nathan Cassin How the End of the Public Health Emergency WIll Affect Health Insurance By Scott Stevens
46 Chapter News
South Central Indiana
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46 Gordon Award Nominations
47 CPC Quiz
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49 Congratulations, Registered Employee Benefits Consultants!
11 Product News
15 People on the Move
50 NABIP’s Board of Trustees
19 Noteworthy
24 Medicare Matters
51 Your NABIP Staff
YOUR SALES 32 Voluntary Disruption
52 Association Events
Benefits Agency? No. Marketing Agency? Yes. By Eric Silverman
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VOLUME 70, NO. 3
EDITOR Martin Carr (202) 595 0724
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advertisements or published articles. Send editorial submissions to: America’s Benefit Specialist Editor, 999 E Street NW, Suite 400, Washington DC 20004. America’s Benefit Specialist (ISSN 2475-5826, publication no. 238660), 2023, volume 70, number 3 Published 10 times per year (January/February, March, April, May, June, July, August/ September, October, November and December) by the National Association of Benefits and Insurance Professionals, 999 E Street NW, Suite 400, Washington DC 20004. $25 annual subscription price is included in NABIP member dues. Periodical postage paid at Washington DC and additional mailing offices. POSTMASTER: Please send address changes to America’s Benefit Specialist, 999 E Street NW, Suite 400, Washington DC 20004.
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RECENT MERGERS AND ACQUISITIONS
Headquartered in Lafayette, Louisiana with six additional locations in the state, Dwight Andrus Insurance is one of the largest independent insurance agencies in the country with 130 employees. For more than 75 years, Dwight Andrus Insurance has provided commercial insurance, surety and bonding, captive and alternative risk insurance, personal insurance and employee benefits. Dwight Andrus Insurance leadership, including Dwight Andrus IV, Dwight Andrus III, David Andrus and Charlie Babineaux, and the Dwight Andrus Insurance team will join Hub Gulf South. Dwight Andrus Insurance was represented by Reagan Consulting for the transaction. CRUM & FORSTER A&H DIVISION ACQUIRES PARTNERS MGU Crum & Forster Accident & Health recently announced the acquisition of medical stop-loss insurance agency Partners Managing General Underwriters LLC, as the latest move in expanding its position in the self-insured marketplace. C&F has been underwriting stop-loss insurance for over 20 years and will continue to offer a broad suite of products and services on a direct and program basis through various distribution channels, including managing general under writers, managing general agencies, brokers and third-party administrators. “The acquisition of PMGU marks an exciting start to 2023,” said Gary McGeddy, president of C&F Accident & Health. “Our companies share the same vision and culture, and a commit ment to partner service. Brian and his team will report into Gary Nidds, executive vice president of the Medical Business Unit, and the collective mission of our two organizations presents a wealth of opportunity to evolve and scale in a growing ecosystem.” SENIOR SOLUTIONS & SERVICES JOINS INTEGRITY Integrity Marketing Group LLC has acquired Senior Solutions & Services, an independent marketing organization based in Chesterfield, Virginia. As part of the acquisition, Traci and Earle Spencer III, managing partners at Senior Solutions & Services, will become managing partners in Integrity. Finan cial terms of the acquisition were not disclosed.
AGENCYBLOC ACQUIRES RADIUS TO PROVIDE ENHANCED CAPABILITIES FOR BROKERS AgencyBloc, an agency management system solution pro vider for independent life and health insurance agencies, recently announced the strategic acquisition of Radius, a provider of sales-enablement solutions supporting life and health insurance brokers. The Radius solution offers a host of sales-enablement features to life and health insurance brokers, including lead distribution, texting, VoIP calling and call routing, supporting brokers’ commercial activities and helping them grow their book of business. With a customer base of over 8,000 agents, Radius is dedicated to providing enhanced sales-enablement solutions for life and health insurance agents. “We have seen how well the AgencyBloc team serves its clients, and we are excited to join forces in our shared mission to help insurance agencies grow and manage their business,” said Clu Connors, CEO of Radius. This acquisition combines the complementary strengths of Radius and AgencyBloc. The vision is to bring together the sales-enablement functionality from Radius with the agency-management capabilities from AgencyBloc into a single platform with a seamless set of workflows to man age both sales and back-office agency management in a single solution. The combined company will better serve the unique needs of high-volume organizations, including IMOs and FMOs. Existing Radius clients will be able to remain on their existing platform free of disruption. “Radius has developed an innovative solution to help bro kers grow their business,” said Adam Lewis, CEO of Agency Bloc. “This acquisition reflects our commitment to assist our broker clients with growing their business.” HUB INTERNATIONAL EXPANDS EMPLOYEE BENEFITS CAPABILITIES WITH ACQUISITION Hub International Limited, a global insurance brokerage and financial services firm, has acquired the assets of Dwight W. Andrus Insurance Inc., Dwight Andrus & Richard Insurance Inc. and DAI Shreve LLC (Dwight Andrus Insurance).
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Senior Solutions & Services specializes in providing prod ucts for the senior market, including Medicare Advantage and Medicare Supplement plans. The company has dedi cated itself to developing exemplary training systems that enable agents to build their own successful businesses. EMPYREAN ACQUIRES EMPLOYEE COMMUNICATIONS AND ENGAGEMENT PLATFORM Empyrean recently announced the acquisition of employee communication and engagement platform Enspire. Through the acquisition, Empyrean adds an expanded people-cen tric dimension to its benefits-administration technology and compassionate support services. Called +YOU, the new solution integrates Enspire’s employee communication and engagement technology with Empyrean’s benefits-adminis tration platform to become a fully customizable and em ployer-branded people experience—a single front door to an employer’s suite of tools for employee productivity, wellness, communications and benefits. As part of Empyrean, Enspire will continue offering a stand-alone communication and engagement platform for employers. KRAUSE ACQUIRES LTCI BROKERAGE FIRM Krause Brokerage Services LLC (De Pere, Wisconsin) has acquired USA-LTC, a California-based brokerage firm that specializes in long-term care insurance, including employ er-sponsored worksite LTCI for businesses offering LTCI as a benefit to their staff. Don Levin, J.D., MPA, CLF, CSA, LTCP, CLTC, the former president and CEO of USA-LTC, will serve as strategic rela
tions director at Krause. He will assist with recruiting and training of insurance agents while managing and expanding the worksite LTCI facet of the business. Additionally, Levin will play an instrumental role in introducing new LTCI services to Krause’s attorney network. He will work directly with attor neys to successfully incorporate LTCI within their practices. “With other states following in the footsteps of the Wash ington Cares Act, more people than ever will be seeking private long-term care insurance coverage,” said Lori Gu bash, national LTCI director at Krause. “All legal and financial professionals must be ready to service this need. Don is here to help provide that connection point. With his expertise, the people we work with will be better equipped with the tools needed to expand their businesses and help more clients plan for long-term care.” Levin brings vital insight and experience to Krause. He served as chairman of the board of the National Long-Term Care Network, regularly contributes to Broker World Mag azine, and has authored several books, including The Right Combination: Unlocking Your Future Through Marketing and Wisdom of the Diamond: The Five Bases of Effective Team Leadership . Levin is an experienced speaker on LTCI and will be featured as a regular presenter and educator on Krause’s platforms. For more than 30 years, Krause has provided asset-pres ervation solutions related to long-term care for legal and financial professionals nationwide. The acquisition of USA LTC comes shortly after Krause’s acquisition of LTC Solutions in 2021, along with Krause’s introduction of Medicare prod ucts and the establishment of new Medicaid planning and wealth-management partnerships in 2022.
INDUSTRY EVENTS
MAY 8-10 BENEFITSPRO BROKER EXPO Atlanta, GA www.event.benefitspro.com/ bprobrokerexpo JUNE 5-7 Q4LIVE San Diego, CA www.q4live.q4intel.com
JUNE 11-14 SHRM23 ANNUAL CONFERENCE & EXPO
JUNE 16-18 WOMEN OF INSURANCE ANNIVERSARY CONFERENCE Nashville, TN www.womenofinsurance.org OCTOBER 22-24 LIMRA ANNUAL CONFERENCE National Harbor, MD www.limra.com
Las Vegas, NV www.shrm.org JUNE 13-15 AHIP 2023 Portland, OR www.ahip.org
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PRICE-TRANSPARENCY ISSUES
By David Ostrowsky The Phia Group dostrowsky@phiagroup.com
When initiating last month’s SIIA Price Transparency Forum, Chris Condeluci (SIIA’s Washington counsel) and Ryan Work (senior vice president, government relations for SIIA) didn’t mince words when describing the dire state of American healthcare costs. The moderators predicted that if healthcare costs remain on this decades-long rising trajectory, one that has been exacerbated by Americans returning to their physi MANY OWNERS OF PROVIDER NETWORKS REFUSE TO SHARE PRICING AND CLAIMS DATA WITH PLAN SPONSORS AND, ULTIMATELY, THE PLAN MEMBERS.
cians en masse following the 2020 shutdowns, it could lead to the end of employer-based healthcare as we know it. The ensuing statistical presentation provided compel ling support for their argument. Out-of-pocket healthcare spending hasn’t grown at such a prodigious rate since 1985. The average premium for an employer-based family health care plan reached $22,221 in 2021—a staggering sum that amounts to approximately one-third of the median Ameri can household income and marks a threefold increase from 2001. Inflation is surely a factor, but not the primary culprit. Although there’s no silver bullet, the No Surprises Act (NSA), passed as part of the Consolidated Appropriations Act of 2021 (CAA) to safeguard patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, has moved the needle a tad in the right direction as evidenced by the prevention of 9 million surprise bills in the NSA’s first nine months of existence. But there have still been quite a few roadblocks, including a far greater number of out-of-net work payment disputes submitted compared to original
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projections and the fact that a vast number of submissions were ultimately deemed ineligible. The latter can largely be attributed to the fact that many claims falling under a state’s jurisdiction—or ones that apply to Medicare—are incorrectly going through the federal arbitration process. Another major focal point of Condeluci and Work’s pre sentation was hospital price transparency, or rather the lack thereof. Among the many sobering statistics presented, it was indicated that 85% of hospitals remain non-compliant with the federal requirements to publicly post prices for services and drugs. Perhaps even more troubling, among the 188 hospitals comprising HCA Healthcare, the country’s largest for-profit hospital system, zero were compliant. Mean while, among the Big Three hospital chains—HCA Health care, Ascension and CommonSpirit Health—merely two out of 361 hospitals were following the price-transparency rules. As if this situation wasn’t challenging enough for consum ers of healthcare, many owners of provider networks refuse to share pricing and claims data with plan sponsors and, ulti mately, the plan members—even though Congress recently prohibited “gag clauses” in contracts between a plan sponsor and the owner of a provider network with the express pur pose of ensuring that electronic claims data and negotiated in-network service pricing is available to self-funded plans and their members. Apparently, the network owners are find ing workarounds in the form of other contractual language that upholds the restriction of data. In short, there’s still quite a bit of work needed to ensure the American workforce has more insight into provider charges. It is also readily apparent that some providers are sim ply not adhering to the negotiating process as set forth in the NSA. A cornerstone of the NSA is the 30-day business period during which there would be good-faith negotiations between plans and healthcare providers. In many cases, however, providers have no incentive to engage in good-faith negotiations (they are often so confident they will reach a fa vorable outcome in front of the IDREs) instead holding fast to their billed charges—hence, the exceptionally large volume of disputes headed to the arbitration process, one that is still in its nascent stages and struggling to account for such an unexpectedly voluminous caseload. Meanwhile, it is often the case that the information presented in the arbitration pro cess lacks sufficient credibility and transparency and is not always relevant to the circumstances of the dispute.
The perspective and behavior of healthcare consumers regarding healthcare consumption also bears mentioning. In 2023, the overwhelming majority of Americans are accus tomed to accessing desired information within a matter of seconds. When shopping for healthcare, many often have lit tle incentive to spend considerable time perusing data files, ones that may not be particularly accessible or grounded in proper context, because there is no apparent upfront finan cial savings. After all, their respective health plans are respon sible for the initial costs. But, as has been well-documented, if a self-funded health plan can be spared unnecessarily high costs, its participants win in the long run. Hence, the reason that many employers craft incentive-laden benefit plans. Surely, greater price transparency in the healthcare field is a multifaceted issue with no definitive resolution in sight. But hopefully in the coming years, healthcare consumers will become more enlightened about the cost and quality vari ables associated with medical services while information will be transmitted to them in a more user-friendly fashion. All of which would be instrumental in preventing healthcare costs from spiraling out of control. IT IS ALSO READILY APPARENT THAT SOME PROVIDERS ARE SIMPLY NOT ADHERING TO THE NEGOTIATING PROCESS AS SET FORTH IN THE NSA.
David Ostrowsky serves as a content special ist for The Phia Group, a position in which he generates a wide range of written content for both internal and external functions. A graduate of Brandeis University, David was previously a content specialist for the recruiting company formerly known as WinterWyman. He is also a regular contribu
tor to the Atlanta Jewish Times and has authored multiple books, including his most recent, Pro Sports in 1993 , published by McFarland & Company in 2020.
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BIOSIMILARS ARE INTEGRAL FOR MODERN HEALTHCARE
By Nathan Cassin Pharmacy Director Holmes Murphy
Today’s healthcare needs are deeply intertwined with issues like consistently increasing prices and inflation. As employers and insurance professionals alike know all too well, this has led to many who are struggling to obtain their prescriptions at a reasonable cost and, in turn, may not be able to maintain the necessary resources for optimal health. As employee benefits brokers, we also know that so much of our value comes from offering trusted solutions during cir cumstances like these, especially solutions that are modern and innovative, and provide needed expense relief. One of these newer solutions is biosimilars.
For clarity, biosimilars are medicines that are very close in structure and function to a biologic medicine. Essentially, it is almost an identical copy of the original drug, but it is man ufactured by a different company. In slightly more elaborate terms, these medicines are possible because biologic medi cations that lose patent protection do not go “generic” in the traditional sense because the drug chemistry of biologics in volves living tissue and complex molecules that are not easily or directly replicable from one manufacturer to another. Competing products to these original medications are called biosimilars because they are therapeutically equiv alent to the originator product and have a similar yet not exact replica of the biological makeup. When it makes sense to offer biosimilars in a health plan, they can help reduce the costs of all biosimilars for the originator product in the mar ket: Biosimilars typically launch at list prices that have been on average 15% to 40% lower than the originator product.
ENSURE THAT DRIVING THE LOWEST NET COST SHOULD BENEFIT THE PLAN SPONSOR AS WELL AS THE PATIENT.
Continued on page 9
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HOW THE END OF THE PUBLIC HEALTH EMERGENCY WILL AFFECT HEALTH INSURANCE
By Scott M. Stevens, RHU Dodge Partners Insurance Omaha, Nebraska sstevens@dodgepartners.com
The federal government has announced the current COVID-19 related Public Health Emergency and National Emergency periods will expire on May 11. These periods were officially opened and recognized by the government effec tive January 27, 2020, and were intended to make it easier for the nation to deal with the pandemic. Included among the many affected areas of our econo my was the loosening of a number of health insurance and employee benefits-related coverages, timelines and dead lines. Employers need to prepare for the resumption of the
guidance that was in place and changed during the national state of emergency. PUBLIC HEALTH EMERGENCY During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing (i.e., copay, deductible, coinsurance), prior autho rization or other medical management requirements. This requirement was later expanded to include over-the-counter home COVID-19 test kits. Although the PHE period was slated to expire April 11, with the government’s renewal of this period to now terminate on May 11 (prior to the end of the original 90-day period), employer plans will no longer be required to cover such tests and services without cost-sharing. NATIONAL EMERGENCY Several employee benefit plan-related deadlines were sus pended for up to one year as long as the national emergency was in place. Now that the national emergency declaration
SUSPENDED TIMEFRAMES WILL BEGIN TO RUN AGAIN AT PRE-PANDEMIC RATES EFFECTIVE JULY 11.
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PUBLIC HEALTH EMERGENCY
Continued from page 7 will be terminated as of May 11, the 60-day period following the end of the national emergency will begin on May 12. Once this 60-day period ends (July 10), these suspended timeframes will begin to run again at pre-pandemic rates effective July 11 and include: • the 14-day deadline for plan administrators to provide COBRA-election notices to qualified beneficiaries • the 30-day period (or 60-day period, in some cases) to exercise HIPAA special enrollment rights in a group health plan following: birth, adoption or placement for adoption of a child; marriage, loss of other health coverage; or eligi bility for a state premium assistance subsidy • the 60-day deadline by which a participant or qualified beneficiary must provide notice of divorce or legal sepa ration, a dependent child that ceases to be an eligible de pendent under the terms of the plan) or a Social Security disability determination used to extend COBRA coverage • the 60-day deadline in which to elect COBRA coverage • the 45-day grace period for the payment of initial COBRA premium, and 30-day period for subsequent premium pay ments. Note: Presently, individuals electing COBRA outside of the initial 60-day election period (as referenced above) generally have one year and 105 days after the election no tice is provided to make the initial premium payment, and individuals electing COBRA within the generally applicable This can begin to sound like a great prospect for employers on all fronts, but if they are looking to capitalize on biosim ilars, they should also consider the important factors that drive market share when selecting a PBM and a biosim ilar strategy. Also ensure that driving the lowest net cost should benefit the plan sponsor as well as the patient. Vital factors that go into the pricing strategy include list prices, discounts, financial assistance and rebates. It’s imperative to recognize that not just choosing to offer biosimilars, but the right biosimilar, is integral to maintaining the balance in benefits between plan sponsors and employees. The success of biosimilars will also be heavily dependent on pre scribers feeling confident in the safety and efficacy of this format of medication. Understanding that it can be overwhelming to lean into modern healthcare for employers, brokers remain accessible
60-day election period have one year and 45 days after the date of their election to make the initial payment. • the deadline under the plan by which providers and participants may file a benefit claim (generally one year, under the terms of the plan) • the deadlines for appealing an adverse benefit determi nation (generally 30 days), requesting an internal review (generally six months) or an external review of a claim denial (generally four months). Importantly, the guidance that allowed HSA-qualified high-deductible plans to offer telehealth coverage on a first-dollar basis without affecting HSA eligibility is NOT impacted by the end of the public health/national emergen cy. However, this relaxation is in effect through 2024, per the Consolidated Appropriations Act.
Scott Stevens is an employee benefits and consumer-directed healthcare specialist, helping employer organizations of all types reduce their health insurance and related employee benefits costs. His career has included stints as vice president of sales/ marketing for a national insurance company, co-founder and executive vice president of a
TPA and founder of The HSA Toolkit (employer/employee education and sales system). Scott earned a B.S. in marketing/ economics from the State University of New York at Oswego.
BIOSIMILARS
and ready to provide information regarding solutions such as biosimilars. It can certainly be a smart option for organiza tions where it fits their needs and is based on the well-being of their employees.
Nathan Cassin is pharmacy director at Holmes Murphy. In addition to his decade of experience in the pharmaceutical industry, Cassin is respected as a financial thought leader and negotiator. He has expertise in financial analysis, strategic consulting and contract language, and provides financial savings and pharmacy contracts for Holmes Murphy clients.
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HOT PRODUCTS
Special advertising feature Special Advertising Feature
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The benefits landscape has changed. Employees have more bargaining power than ever and employers are reevaluating how they attract and retain top talent. Don’t let your portfolio fall behind! Reach more clients and maximize your worksite business with LifeSecure’s accident, critical illness and hospital indemnity insurance. People are demanding relevant benefits that help fill growing gaps in their health coverage and finan cial safety net. In turn, employers need products that work alongside traditional health plans to create benefits that are flexible, easy to understand and use, and support a diverse workforce. With LifeSecure you can provide a solution for both: help clients
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LifeSecure’s worksite product suite • Accident : guaranteed issue; benefits based on actual medical expenses, often with higher payouts than scheduled benefit plans • Critical Illness: guaranteed issue opportunity; 9 covered conditions including skin cancer, and an unlimited lifetime benefit maximum • Hospital Indemnity: guaranteed issue opportunity; 30+ days of benefits per year with high daily benefit options and observation coverage in most states
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PRODUCT NEWS
three lump-sum payments during the first year of a covered cancer diagnosis. Ongoing Education and Empowerment: Opportunity to learn about genetics and its relationship to cancer and receive and store genetic test results in a secure, HIPAA- compliant online Interactive User Portal. Cancer Advocate Plus is a supplement to health insurance and is not a substitute for major medical or other minimal essential coverage. Insurance underwritten by ACE Property & Casualty Insurance Company, a Chubb company. Addition al information can be found at www.chubb.com. MASSMUTUAL EXPANDS SUITE OF EMPLOYEE BENEFITS Massachusetts Mutual Life Insurance Company recently an nounced another expansion of its suite of employee benefits with additional offerings and enhancements that are adapt able to diverse situations and needs of employees, inclusive of all generations, genders and lifestyles. Recent additions to MassMutual’s suite of employee benefits designed to sup port overall well-being include: Quadrupling caregiver leave to eight weeks of paid time off per rolling 12-month period to assist with responsibility in the care of a loved one, no matter how the employee defines a loved one. A new well-being wallet that reimburses employees up to $1,250 a year for eligible expenses that elevate their holis tic well-being. From gym memberships to ski lift tickets to meditation apps to massages to tax prep, the wallet covers a wide range of eligible expenses to support employees’ phys ical, emotional and financial well-being. This complements other offerings, such as the company’s student debt/college savings program. Expanded mental health solutions including fast access to high-quality providers across the care and service spectrum for employees and members of their households—100% free and 100% confidential. Access to a dedicated and diverse team of care coordinators that offer one-on-one, specialized health advocacy and navi gation support tailored specifically to African American and LGBTQ+ employees enrolled in a MassMutual medical plan. For more information, visit www.massmutual.com.
CHUBB LAUNCHES PERSONALIZED, GENETICS BASED CANCER PROGRAM Chubb Workplace Benefits, which partners with benefits brokers and consultants to offer voluntary benefits to the employees of middle-market and large companies in the U.S., has announced the launch of Cancer Advocate Plus, a cancer-specific, genetics-based insurance program. Cancer Advocate Plus provides tools and resources for an individual to proactively understand their risk of cancer, more effectively manage a cancer diagnosis, and offers insurance protection to help with the potential financial impact of a cancer diagnosis. Cancer continues to impact Americans at substantial rates. One in two men and one in three women will be diagnosed with cancer during their lifetime. Early detection has proven critical, as the five-year survival rate for early-stage cancers is 91.1%, compared to 30.6% for late-stage cancers. The ability for average Americans to obtain cancer-related genetic testing has been challenging largely due to reimbursement, awareness, and cost issues. Chubb’s Cancer Advocate Plus makes it accessible for today’s workers. Through an exclusive agreement with genomics-based, health-navigation company healthŌme, the Chubb Cancer Advocate Plus program offers policyholders tools and sup port across the cancer continuum, including: Screening: Genetics-based testing to identify inherited genes that increase cancer risk, as cancer is a genetic dis ease. In case of elevated risk, healthŌme genetic counselors can develop a personalized action plan for reducing risk. Policyholders also have access to pharmacogenomic testing to better understand how an individual will respond to com monly prescribed medications. Cancer Management: In case of cancer diagnosis, policy holders are provided access to personalized support, tools, and resources for complex illness navigation: • Molecular Diagnostic Tumor Testing – Genetic evaluation of an individual’s specific cancer to guide and optimize treatment. • Expert Medical Review by Molecular Pathologists and an Oncology Nurse Advocate to provide the individual’s phy sician with a Precision Treatment Report and, if applicable, assistance with clinical-trial enrollment. Cancer Recovery: Continued support during remission, in cluding access to advanced blood-based cancer-recurrence monitoring, which enables earlier detection than traditional medical testing. Insurance Protection: Comes with a guaranteed-issue in surance benefit that complements employees’ existing med ical coverage by paying benefits directly to the insured in
TRANSAMERICA REVEALS NEW RIDERS Transamerica has announced the availability of new benefit riders with its employer-offered hospital indemnity insurance
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PRODUCT NEWS
help build everyday resilience and support emotional and mental health. Sun Life members and their families can use Self Care+ at their own pace, and the program provides tai lored content and activities to help them reach their wellness goals. The addition of Self Care+ is part of Sun Life’s contin ued expansion of its health-related products and services that complement the member’s health insurance and drive improved health outcomes. Employers have the option to add Self Care+ with Sun Life basic or voluntary Life insurance. Self Care+ is available anytime, anywhere, and provides access to digital tools, in cluding mood and habit tracking, meditations and wellness content rooted in cognitive behavioral therapy (CBT) meth ods. Participants can learn ways to manage stress, change negative thoughts, maintain better boundaries, build healthy habits, and become more resilient and in control. Self Care+ will be available alongside Sun Life’s other life insurance services, which include emergency travel assistance, identity theft protection and financial planning. For more information, visit www.sunlife.com. CONTINENTAL GENERAL ANNOUNCES LAUNCH AS TPA Continental General Insurance Company, which serves approximately 100,000 policyholders across the life and accident and health insurance categories, has announced the strategic expansion of its platform with its launch as a third-party administrator. As a dedicated TPA, Continental General is better posi tioned to offer efficient, administrative solutions and ongoing management of policies. The company will offer operational and administrative support services ranging from claims auditing and claims processing to full policy administration. Continental General’s expansion builds on its more than 60 years of experience in long-term care, life insurance, annuity and supplemental health insurance. Learn more at www.cgic.com. HUMANA TO EXIT EMPLOYER GROUP COMMERCIAL MEDICAL PRODUCTS BUSINESS Humana Inc. recently announced that it will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs. No other Humana health plan offerings are materially affected. The company remains
to help workers financially when they experience a hospital stay. The new riders expand the hospital indemnity options available to employers as they design the proper benefits for their employees. “Hospital stays are not the same for everyone. Different circumstances call for different measures of care,” said Phil Eckman, president of workplace solutions at Transamerica. “Hospital indemnity insurance from Transamerica offers a base benefit of a covered, daily in-hospital stay with the ability to add riders for other common treatments, improving employees’ ability to financially overcome hospitalizations.” The base policy offers an inpatient benefit paid for each day the insured spends in the hospital. Employers may add riders to the base policy to build and customize a more comprehensive benefit combination to help keep employees financially secure. Transamerica offers a selection of contem porary riders with broader options for inpatient and outpa tient care. Hospital indemnity insurance is especially valuable because it is delivered without pre-existing condition barriers and can provide access to benefits not covered through a major medical plan. Some of the riders available to employers through Transamerica’s hospital indemnity insurance include: Newborn Child In-Hospital Indemnity Benefit Rider offers an additional benefit that helps with costs for the birth and expenses associated with a newborn’s care. The rider can be configured to pay a daily benefit, a lump-sum benefit, or both for the birth in a hospital. Inpatient Mental and Nervous Disorder Indemnity Benefit Rider pays the daily benefit to the insured in an inpatient facility for a mental or nervous disorder. Inpatient Drug and Alcohol Addiction Indemnity Benefit Rider pays a daily benefit for inpatient services treating alco hol or drug addiction. Rehabilitation Unit Confinement Benefit Rider provides additional benefits to help the insured get back on their feet in a rehabilitation unit. The benefit helps with recovery and return to work. Demand is growing for hospital indemnity insurance offered through the workplace. According to a recent report from LIMRA, supplemental hospital indemnity insurance ranked highest in combined year-over-year growth for total employers and employee policies among other workplace supplemental insurances. For more information, visit www. transamerica.com.
SUN LIFE TO OFFER DIGITAL SELF-CARE Sun Life U.S. is broadening access to health services by enhancing its group life insurance portfolio with AbleTo Self Care+, an on-demand, digital wellness program designed to
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PRODUCT NEWS
committed to the long-term growth of its core Insurance lines of business, including Medicare Advantage, Group Medicare, Medicare Supplement, Medicare Prescription Drug Plans, Medicaid, military and specialty (dental, vision, life, etc.), as well as its CenterWell healthcare services business. Following a strategic review, the company determined that the Employer Group Commercial Medical Products business was no longer positioned to sustainably meet the needs of commercial members over the long term or support the company’s long-term strategic plans. The exit from this line of business will be phased over the next 18 to 24 months. The company is committed to ensuring a smooth transition of services for members and commercial customers. GUARDIAN INTRODUCES HOLISTIC PROTECTION IN A SINGLE SOLUTION The Guardian Life Insurance Company of America has intro duced SafeGuard360, a solution that offers essential financial protection for consumers in one product. SafeGuard360 is a patent-pending product that includes life insurance, long term care and income-protection benefits, helping individu als build the foundation for lifelong well-being. “Providing a well-rounded policy that inspires well-being and helps protect people at every life stage was founda tional to building SafeGuard360,” said Michael Ferik, head of individual markets at Guardian. “Research tells us people don’t follow through on financial plans because they say the process is too cumbersome. This one-of-a-kind product ad dresses that challenge for consumers by creating one unified solution that speaks to many financial concerns.” SafeGuard360 offers three protections in a single solution: Whole life insurance—Provides lifetime protection with three guarantees including a guaranteed level premium, guaranteed death benefit and guaranteed cash value. Long-term care protection—Accelerated death benefit for LTC services. Disability income insurance—Offers three benefits during a period of disability including income replacement if you are unable to work at all, income replacement if you are only able to work on a limited basis, and waiving premiums for the coverage while disability continues. Additional benefits include ease of purchase through a single digital application and underwriting process, and relationship management through Guardian’s financial representatives. Clients will also have a single point of claim initiation across all coverages of SafeGuard360 and will be assisted by Guardian’s team of claims representatives.
AFLAC ENHANCES INDIVIDUAL HOSPITAL INSURANCE TO INCLUDE MENTAL HEALTH COVERAGE Aflac recently enhanced its hospital insurance product to include income protection for mental health treatment while reducing hospital confinement hour requirements to qualify for benefits. The enhanced product, named “Aflac Choice,” is designed to help customers with expenses associated with doctor visits, hospitalizations and mental health treatment that health insurance doesn’t cover. Mental illness and/or substance use disorders are a compo nent of one in every eight emergency department visits by an adult in the United States, and mood disorders are the most common cause of hospitalization for all Americans under age 45, according to the National Alliance on Mental Illness. Additionally, 24.7% of all adults with a mental health condition cited insufficient finances as a barrier to seeking treatment. “Today many Americans face stress, anxiety, depression and other concerns that can lead to mental health challeng es and hospitalization,” said Keith Farley, senior vice presi dent, Aflac Individual Voluntary Benefits. “Amid rising health care costs, seeking appropriate and timely care can be costly, which only contributes to the burden for many who are facing a health crisis. Aflac Choice Hospital Insurance puts healing and recovery at the forefront so that policyholders can focus on getting better rather than worry about how to help close the gap between what their health care insurance does and doesn’t cover.” In addition to helping policyholders, Aflac Choice Hospital Insurance can help protect the overall physical, financial and mental health of an employer’s workforce. With a variety of options, employees can tailor coverage to their specific needs and budgets, which helps ensure their employees have the protection they need whenever a health event arises. Highlights of the strengthened individual hospital product include: • Expanded benefits for covered hospital confinements caused by common mental health conditions includ ing, but not limited to, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, eating disorders, post-traumatic stress, substance and alcohol use disorders. • Expanded coverage with no rate increase to policyholders. • Decreased minimum number of hours required to qualify for hospital confinement from 23 hours to 18 hours. • Optional riders to help further amplify income protection coverage. For more information, visit www.Aflac.com/business.
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PRODUCT NEWS
member awareness of their health risks and engaging them in individualized health improvement programs for sustain able behavior change. Risk-Reduction Package—For organizations looking for a more comprehensive health and well-being solution that focuses on reducing health risks and improving health out comes through health coaching, personal goal-setting and tailored interventions. This combination of digital self-service and live experts provides personalized support for every member, regardless of where they are on their health and well-being journey. Virgin Pulse’s programs enable organizations to provide their employees with personalized, gamified, AI-driven health and well-being tools and resources, delivering higher utiliza tion and improving the overall employee experience. Virgin Pulse leverages a proprietary combination of behavior sci ence, data on over 275 million people, and fun and motivat ing incentives for employees to create healthy, lasting habits. For more information, contact keenanwell@keenan.com. GUARANTEE TRUST LIFE INSURANCE COMPANY & AMERILIFE UNVEIL TURBO TERM LIFE Guarantee Trust Life Insurance Company and AmeriLife Group LLC have launched Turbo Term Instant Issue Life In surance, a level term life product engineered to deliver clients fully customized benefits and policy lengths to match their unique needs. With GTL’s underwriting platform powered by hr | ReFlex, Hannover Re’s automated underwriting system, long applica tion processing is a thing of the past. With a fully digital appli cation process—and no medical exams—agents can deliver their clients an affordable policy instantly with customizable coverage, flexible benefits, a variety of level term lengths, and coverage between $100,000 and $1,000,000. For agents, Turbo Term lets them stay in the driver’s seat by owning the business they write, offering advance commissions at all levels and supporting full hierarchy, a wholly unique value proposition versus any other product on the market. “Turbo Term was built for agent distribution. No long apps. No uncomfortable medical exams. Just a fully digital applica tion process and great, affordable and customizable coverage to deliver the financial stability client needs—fast,” said David Paul, AmeriLife’s national sales director of Simplified Issue Life. Turbo Term Instant Issue Life Insurance is currently avail able in all states except California and New York. For more information, visit www.turboterm.com.
METLIFE WORLDWIDE BENEFITS LAUNCHES PROGRAM TO HELP GLOBALLY MOBILE EMPLOYEES UNDERSTAND THEIR BENEFITS MetLife Inc. has announced an enhancement to the on boarding process for MetLife Worldwide Benefits members that offers globally mobile employees a personalized benefits communication experience throughout the first year of their assignment. According to MetLife’s Annual 2022 Expat Em ployee Benefit Trends Study, 65% of globally mobile employ ees are looking for more relevant benefits information. The new program was designed to give them the information they need when embarking on a new assignment. The member-welcome journey includes a series of custom ized informational email communications that target each employee’s unique needs and are delivered when a member hits certain milestones in their assignment. With candid, straightforward messaging grounded in insights, the expe rience equips globally mobile employees to make informed decisions and understand all their benefits and resources. From understanding important policy documents to using an ID card to submitting claims, it can be difficult for employ ees to understand their benefits, especially during a global assignment. This new benefits communication program uses a high-touch, tailored approach throughout every stage of an assignment. Brokers and clients can find valuable information and re sources on MetLife Worldwide Benefits products and services available by visiting MetLifeWorldwide.com. KEENAN EXPANDS ITS PORTFOLIO OF EMPLOYEE HEALTH-MANAGEMENT SOLUTIONS Keenan, a brokerage and consulting firm, recently announced the addition of Virgin Pulse’s employee health and well-being platform to its portfolio of employee health-management solutions. Through this strategic partnership, clients of Keenan and its affiliated companies will be able to select from turnkey wellness program packages powered by Virgin Pulse to provide their members with streamlined access to the re sources and tools needed to build lasting, healthy behaviors. Keenan’s wellness program packages, powered by Virgin Pulse, provide clients with two core package options, with ad ditional customizations available based on the organization’s goals and needs: Awareness & Prevention Package – Designed to help orga nizations kickstart their well-being initiatives by promoting
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PEOPLE ON THE MOVE Rusty Rice, 2018-2019 NAHU president, has been promoted to director of commercial sales at Avesis LLC, a national vision and dental company. In his new role, Rusty will lead the commercial sales team and bring product expansion to the company as it undergoes a facelift under its new owner, the Cressey & Company. With Avesis for over 19 years, Rusty has served the compa ny in many roles including regional sales manager after his return in late 2019 following his NAHU presidency. “The best part about my job,” said Rusty, “is the dedication each mem ber of the Avesis family has serving our members through product innovation and integrity.”
mental benefits by focusing on increased access to care or, as he likes to say, advocation backed by education garnished with a twist of wellness.
Tom Daniels has joined gente as vice president of sales. Tom will cultivate new rela tionships in the tax-favored benefits market as well as the administrative outsourcing market that includes HR services, compli ance, payroll and COBRA administration. Tom has held sales-management positions at multiple insurance companies and has
worked in the wholesale and retail markets. Tom has worked for major health carriers including Prudential, US Life and Chubb. He also was an integral part of two other successful start-up health plans in New Jersey, which resulted in over $400 million in revenue. Most recently, Tom served as the SVP of sales and business development at Members Health Plan New Jersey. During his 35-year career, Tom has served as CIGNA’s representative on New Jersey Small Employer Health Ben efits Program Board, participated in Governor McGreevey’s Health Care Task Force, served as the New Jersey AHU’s president and received the NJAHU Lou Mattei Lifetime Achievement Award. Alliant Insurance Services has made a number of personnel moves: Kelly Lima has joined Alliant Insurance Services as vice pres ident within its Employee Benefits Group. Based in Boston, Lima will focus on designing, implementing and managing employee benefits solutions for a diverse and growing client base throughout the Northeast. Prior to joining Alliant, Lima was executive vice president in the New England offices of a global employee benefits and consulting firm. She studied at Framingham State University. George Close has joined Alliant Insurance Services as vice president within its Employee Benefits Group. Based in Ar lington, Virginia, Close joins Alliant with a broad background spanning employee benefits, payroll and HR solutions. Prior to joining Alliant, Close was vice president of a national insurance brokerage and consulting firm. He earned his bachelor’s degree in political science and government from Roanoke College. Stephanie Miller has joined Alliant as vice president with in its Employee Benefits Group. Based in Portland, Maine, Miller will focus on designing, implementing and managing tailored employee benefits solutions for a diverse portfolio of
Former NAHU Board of Trustees member Ashley Kapostins has founded Kapsher Consulting LLC, an association-management company created to take professional trade associa tions to the next level. Ashley
has partnered with Dave Sherrill , who has served as execu tive director of NABIP Florida since 2006. Ashley and Dave have worked together on multiple boards and committees within NABIP, NAHU and NAIFA for 15 years. Kapsher Consult ing was born from their joint passion for assisting the volunteer leaders of association chapters with building structure, preserving history and growing their membership. Ashley and Dave can be contacted at execs@kapsherconsult ing.com.
Derek Galloway , vice president of the NABIP New Mexico Board, has been named AVP/ producer at HUB International. His focus will be on educating HUB’s partners primarily on the correlation between employee engage ment and an employer’s empathy, and
advocating for increasing access to care and creating customized solutions that support attracting, engaging, and retaining talent within the middle market. Derek previously served as a market development execu tive for Beam Benefits. Derek launched ancillary rep part nerships, supporting the West Texas, New Mexico, Nevada and Florida markets. He introduced Beam to brokers across four states, working with over 450 brokerage firms across the country to educate agents on dental wellness and supple
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