America's Benefit Specialist August/September 2023

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August/September 2023

33 Highlights of NABIP’s Annual Covention

YOUR INDUSTRY

2

Letter to the Editor

36 People on the Move

3

RxDC Reporting: Best Practices for Stress-Free Reporting in 2024 By Ben Smith Understanding Health Plan Rights and Compliance Strategies in Response to the No Surprises Act By Christine Cooper

MEDICARE MATTERS

38 Building and Transferring A Block of Medicare-Related Policies YOUR SALES

3

5

43 Voluntary Disruption 5.5 Strategies to Enhance

10 Mergers and Acquisitions

Communication and Increase Employee Engagement By Eric Silverman

13 Product News

18, 47 Where in the World

YOUR ASSOCIATION

5

20 As I See It Epic Errors

45 CPC Quiz

By Grace-Marie Turne r

48 Welcome to NABIP

21 Industry Events

49 Congratulations, Registered Employee Benefits Consultants!

22 NABIP Policy Series

Reducing the Cost of Healthcare: Provider Consolidation

50 NABIP’s Board of Trustees

26 Noteworthy 27 Tom Harte and Dave Mordo Receive NABIP’s Highest Honor

43

51 Your NABIP Staff

52 Association Events

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LETTER TO THE EDITOR Dear Martin, The government is trying to shorten short-term health plans back into the three-month-max cycles. This is the wrong thing to do! I even completely disagree with the someone’s idea of STPs being six-month cycles. I have put many clients on STPs, including myself and my family, because of the high ACA premiums for those of us who can’t get a subsidy. As a small-business owner: • We are too small to be on a group plan. • We make too much money to get a subsidy. • Without a subsidy, the Marketplace premiums are way too high. • The out-of-pocket max is way too high. In 2024, individual OOP max will be $9,450, leaving an $18,900 exposure to the families! Currently, for our family of three, the lowest premium on the marketplace is $1,500 per month, and that’s for a $9,100 deductible. In addition to that, there’s a family max OOP exposure of $18,200. The only thing that would be covered up front is preventive care. Any treatments required would all come out of our own pocket until we met the max OOP. We would have to pay $18,000 in premiums in order to get “free” preventive-care benefits. Our current premium on the short-term plan is $950 for a $2,500 deductible, and we still get preventive benefits. As long as we stay healthy, we can continue to renew short-term health plans. Having STH plans end and begin every three months is terrible for our clients. This poses a high risk to those who develop a health condition in the middle of the year outside of open-enrollment period because losing STH coverage is not an allowable SEP. This would leave the insured without health insurance coverage when they need it most. Even if the plan can roll into another three-month policy period, the OOP for deductibles and coinsurance starts over during each term. Which plan would Biden’s administration choose if they had a choice? Why would they care? They get group insur ance for FREE (that we also pay for). Leave short-term health insurance alone! It’s the only affordable way many of us have to healthcare coverage. Let’s get this information to anyone who can help us.

VOLUME 70, NO. 7

EDITOR Martin Carr (202) 595 0724

ADVERTISING SALES The YGS Group (717) 430 2238

GRAPHIC DESIGN The iMage Worx (703) 731 6515 theimageworx@aol.com PRINTER Walsworth (573) 442 8714 www.walsworth.com REPRINTS The YGS Group (717) 505 9701, x2205 Send editorial submissions to editor@nabip.org Back issues are $4 each. Call (202) 595 0724 MAILING ADDRESS 999 E Street NW, Suite 400 Washington DC 20004

The opinions expressed in this magazine are not necessarily endorsed by

NABIP nor does the magazine assume responsibility for statements made in

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 7 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.

Angie Pavelka Holdrege, Nebraska

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RxDC REPORTING: BEST PRACTICES FOR STRESS-FREE REPORTING IN 2024

By Ben Smith, JD Managing Director, ACAPrime

Indianapolis, Indiana ben@acaprime.com

1. Understand the requirements . Generally, all employers that offer a group health plan, regardless of size, are sub ject to RxDC reporting and ultimately responsible for its completion. The intricacies of regulatory compliance can be complex, and plan sponsors may not be well-versed in the specific reporting requirements for RxDC. Your clients can familiarize themselves with the specific requirements and guidelines provided by CMS and the HIOS system for reporting. This includes understanding the necessary data elements, formats, submission deadlines and any support ing documentation that may be required. CMS provides great resources on its RxDC website: www.cms.gov/CCIIO/ Programs-and-Initiatives/Other-Insurance-Protections/ Prescription-Drug-Data-Collection. 2. Establish clear responsibility/ownership of tasks in advance. So many times, we talked with employers that thought they needed to complete all the reporting them selves, or they thought someone else had completed all the reporting for them, when, in reality and regardless of

Over the past couple of months, many employers that are plan sponsors of group health plans were caught by surprise that they had a responsibility to create and submit RxDC reports to CMS via the Health Insurance Oversight System. Completing the RxDC (Prescription Drug Data Collection) reporting to CMS via HIOS can be a complex process. There are several lessons learned that can help ensure a smoother experience for reference year 2023 reporting. Here are five key takeaways: RxDC REPORTING IS NOT GOING AWAY! KEEP ABREAST OF ANY UPDATES, CHANGES, OR CLARIFICATIONS FROM CMS OR THE HIOS SYSTEM REGARDING REPORTING REQUIREMENTS.

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circumstances, the employer just needed to create and submit the P2 and D1 reports. It is important for employers to ask specific questions to their carrier, TPA, broker, etc., about who is creating and submitting what reports. They should have direct communication by April of 2024 with their providers/advisors to ensure everyone understands their roles and responsibilities in the reporting process. Additionally, if they have any questions or issues with HIOS or the reports, communicate with CMS early in the report ing period. For many, getting set up in the HIOS system was the biggest struggle this past reporting period. 3. Plan ahead for deadlines . The reporting deadline for RxDC is June 1, so it’s essential for your clients to plan ahead and allocate sufficient time and resources for data collection, report creation and submission. They should put a reminder on their calendar for January-February to look for communication from their carrier, TPA or broker, who likely will send out a “survey” asking for information they need to complete the reporting on the client’s behalf. If a client is submitting for themself, they need to ensure their access and setup in HIOS is done in early April. 4. Stay informed of updates and changes . RxDC reporting is not going away! Keep abreast of any updates, changes, or clarifications from CMS or the HIOS system regarding reporting requirements. CMS will learn a lot following the 2020, 2021 and 2022 reporting cycles, and we expect the RxDC reporting requirements to evolve. Subscribe to relevant newsletters, attend webinars and actively engage with industry forums and professional associations to stay informed about the evolving landscape of RxDC reporting. REGTAP and the CMS RxDC websites are great resources. Don’t ignore or gloss over information provided by carriers and other providers. 5. Seek expert guidance if needed . If you find the reporting process particularly challenging or have limited experi ence in this area, consider seeking guidance from experts in compliance reporting, such as consultants or special ized compliance-reporting providers. There are service providers that can create and submit the RxDC reports you need for a small fee. That fee might be an acceptable exchange for peace of mind that the reporting is handled correctly. Their expertise can help streamline the process and ensure compliance with CMS requirements. Additionally, it’s worth mentioning that the RxDC report ing requirement is separate from other compliance-re porting requirements, such as the Medicaid Drug Rebate Program or the reporting obligations under ERISA, HIPAA or the Affordable Care Act. Each program or requirement may have its own distinct reporting obligations and guidelines. By incorporating these lessons learned into your RxDC reporting to CMS and the HIOS system, your clients can prevent the last-minute stress to get their RxDC reporting completed and submitted while reducing time and effort.

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UNDERSTANDING HEALTH PLAN RIGHTS AND COMPLIANCE STRATEGIES IN RESPONSE TO THE NO SURPRISES ACT

By Christine Cooper CEO, aequum LLC Cleveland, Ohio ccooper@aequumhealth.com

to new disclosure requirements and, once regulations are issued, plans will be required to provide detailed information about expected out-of-pocket costs for scheduled services in the form of an Advanced Explanation of Benefits. Beyond compliance, the NSA is an opportunity for employ ers to leverage NSA rights and provisions, such as the Trans parency in Coverage final rule. Multiple strategies enable plan administrators to take advantage of price transparency, capitalize on cost-containment initiatives, and reveal the true cost of provider health services before participants receive care. This insight has potential to transform utilization of health services, putting the economic purchasing power and decision making in their hands. A strategic response can also act to lower risk, reduce costs and achieve savings. This involves (re)positioning and encouraging participants to take a healthcare consumerism approach to cost savings—one that engages and empowers employees in their healthcare decisions and puts them in the driver’s seat.

Employer-sponsored health plan administrators need to understand their rights under the No Surprises Act and how to leverage price-transparency mandates designed to reveal the true cost of provider health services before receiving care and submitting a claim. Benefits consultants and spe cialists are uniquely positioned to advance the knowledge base and provide a clear presentation of the opportunities and challenges. Introduced as part of the Consolidated Appropriations Act, the NSA applies to participants in group and individual health plans by protecting them from balance-billing for certain emergency services and care received from out-of network providers at in-network facilities. Compliance with the NSA remains a top priority for employee health plans as plan sponsors and administra tors need to respond to new federal healthcare regulations, administer/comply with the Independent Dispute Resolution (IDR) process and stay abreast of litigation challenges to the IDR process. For example, health plans are now subject

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Expect More FROM YOUR GENERAL AGENCY

To address complex issues surrounding the NSA, plan sponsors may call upon their health insurance brokers and administrators to provide strategic guidance. WHAT BENEFITS SPECIALISTS NEED TO KNOW ABOUT THE NSA What is or is not an emergency bill under the NSA? The definition of emergency ser vices was expanded by the NSA to include pre-stabilization services provided after the patient leaves the emergency department and is admitted to a hospital. For services in an emergency department of a hospital or an independent freestanding emergency department, a plan cannot limit services for emergency medical conditions solely on the basis of diagnosis codes—for example, ignor ing symptoms presented by the patient. Benefit specialists will want to ensure that coverage does not impose any adminis trative requirement or limitation on cover age for emergency services received from nonparticipating providers and emergency facilities that is more restrictive than those applied to network providers or emergency facilities. Benefit specialists will also want to review the status of urgent-care-center contracts. The NSA expands the protections to include emergency services provided at an independent freestanding emergency department or urgent care center permit ted/licensed by state to provide emergency services. When does post-stabilization care be come emergency services under the NSA? Post-stabilization services are considered emergency services under the NSA unless the following are met: • The attending emergency physician or treating provider determines that the patient can travel using nonmedical or nonemergency transportation to an available participating provider or facility located within a reasonable distance based on the patient’s medical condition and that the transfer will not cause the patient any other unreasonable burdens. Unreasonable travel burdens include barriers such as the ability to pay for a taxi, access to a car, safely taking public transit, or the availability of public transit.

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UNDERSTANDING HEALTHCARE PLAN RIGHTS

• The patient must be in a condition to receive notice from the provider of the transfer and provide consent as deter mined by the attending physician or treating provider. Can in-network primary care physicians order tests from an out-of-network lab? The NSA protections apply to lab tests rendered in connection with emergency services at an in-network facility. This creates an additional hurdle for lab oratories that generally are not privy to the specific context in which a test was ordered. Should a lab test be performed as part of an emergency service, regardless of whether the treating facility or provider is in-network, the laboratory is prohibited from balance-billing the patient more than the in-network amount. What is or is not a healthcare facility for purposes of the NSA? The NSA broadly define facilities as inpatient hospitals, critical access hospitals, hospital outpatient departments and ambulatory surgery centers. Some state statutes also include skilled nursing facilities, infusion centers and dialysis centers, among other sites, or include services like diagnostic imaging or laboratory services. At least two state laws also extend surprise-billing protections to services delivered in physician offices or other outpatient settings. NSA also adds protections where state laws were not comprehensive, such as for facilities omitted from certain state laws (like critical access hospitals in Nevada) and excluded medical services (such as nonsurgical, nonemergency services provided in Virginia facilities). THE DISPUTE-RESOLUTION PROCESS In the first six months, the Independent Dispute Resolu tion (IDR) process got off to a rocky start as the number of disputed claims submitted was nearly five times the antici pated annual estimate—and only one in 30 of those claims was resolved. Further, litigation challenged certain aspects of the IDR process. On February 10, 2023, HHS announced a temporary halt to reimbursement decisions under the NSA, pending review of a court ruling that ruled the IDR regula tions unfairly favored payers. HHS later clarified that determi nations may be made for all claims with a date of service of October 25, 2022, and earlier. DISTINGUISHING BETWEEN “SURPRISE” AND “UNEXPECTED” BILLS Participants broadly define “surprise” when it comes to medical bills—beyond the “balance-bill” for charges by an out-of-network provider. Data compiled by the Health Care Cost Institute confirms that in 2017, about 16% of emergen cies and included a “balance-bill.” Otherwise, only a small percentage of balance-bills would be covered under the NSA. Yet, 16% of insured adults ages 18-64 say they have received a “surprise” bill related to care received from an out-of-network provider. And one-third of insured adults ages 18-64 say there

has been a time in the past two years when they received an “unexpected” medical bill. Clearly, “surprise” ≠ “unexpected.” But benefit specialists can offer solutions that reduce both. A STRATEGIC AND COMPLIANT RESPONSE As with health reform, most plan sponsors amended their plans to comply with the NSA. A “compliance-only” approach adds to administrative burdens and increases the cost of coverage by treating certain out-of-network expenses as if incurred in-network. While most failed to strategically ad dress the NSA, benefit specialists now have an opportunity to identify the impact of NSA compliance and prompt con sideration of the most effective plan design that fulfills the requirements of the NSA and Transparency in Coverage final rules to create a competitive advantage. Fully optimizing plan value requires a holistic approach to plan design, as well as initiating changes to ensure the most effective strategies are implemented to meet NSA require ments and support the health and wealth of participants. REFERENCE-BASED PRICING One of the best strategic responses to NSA compliance is the adoption of reference-based pricing, a benefits cost-manage ment option that avoids unreasonable or excessive provider charges. RBP “done right” minimizes NSA compliance via a strategic response that will reduce healthcare costs for both the plan sponsor and participants, today and tomorrow. RBP primarily uses Medicare pricing multiples as a benchmark to establish reasonable payments for services to providers, although plans may use other pricing benchmarks. Broadly, this creates a ceiling for payments and establishes a standard of integrity and transparency for service payments. Because the NSA has no bearing on initial payments to the provider, existing cost-containment strategies such as RBP are still valid under the new provisions. In addition, most RBP plans don’t use traditional network providers, therefore will see little effect. In fact, the NSA will likely increase interest in RBP models because they often eliminate excessive charges shouldered by employers and employees. However, plan administrators should be prepared to address restrictions of the legislation by adopting RBP plans that prioritize the patient. In response to the NSA’s new protections, many providers will attempt to ameliorate the reduction in billed charges. And, because more expenses will be paid in-network, patients are most likely to feel the cost of a compliance-only response once it shows up as a future increase in employee contributions. Cost increases can be offset by emphasizing a RBP model that negotiates billed charges on a per-item basis. Provid ing patients with a strong repricing mechanism will further empower the transparency and protection afforded to them

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UNDERSTANDING HEALTHCARE PLAN RIGHTS

by the NSA. Adoption of a “pure” RBP plan, one that does not contract with providers (or only contracts with primary care physicians) should remain mostly unaffected by NSA since there is no median in-network rate on which to calculate a qualified payment amount (QPA)—a NSA-required reim bursement rate that in network plans is usually substantially higher than the RBP maximum covered charge. A “pure” RBP structure may avoid unreasonable or excessive provider charges, potentially lowering both the cost of coverage and employee point of purchase cost sharing. PRICE TRANSPARENCY Transparency in Coverage requires health plans to disclose negotiated rates for in- and out-of-network rate history and drug-pricing information. The goals are the same in terms of prompting healthcare consumerism: ensuring participants have access to the information necessary to incorporate financial criteria into their decisions regarding medical ser vices. This puts price information in the hands of consumers and other plan stakeholders, and ensures participants are empowered with the critical information they need to make informed healthcare decisions. The mandated provision of an online tool needed to access pricing information through their health plans requires real-time cost estimates for covered services and items, including pharmacy. Paper versions must be available upon request. Initially, for plan years beginning on or after January 1, 2023, the online tool must provide cost estimates for 500 shoppable services. In the future, for plan years beginning on or after January 1, 2024, the online tool must provide cost share estimates for all covered services. ADVANCED EOB One part of the NSA transparency rule that would empower participants to be healthcare consumers is the Advanced EOB requirement. Because guidance has yet to be issued, the Advanced EOB is not required at this time. Done right, the Advanced EOB would likely be the most effective prompt of consumerism, as it would provide participants options for reducing their out-of-pocket expense, in turn lowering the cost to the plan. Nothing stops plan administrators from introducing the Advanced EOB on a voluntary basis before regulations are issued. Once regulations are issued, the NSA mandates that pro viders must give patients advanced notice of their network status and a good-faith estimate of costs for scheduled services. The Advanced EOB requirement is designed to give advance notice to participants of how a claim for future,

scheduled medical services might be processed—and, most important, what the plan expects to pay and how much the participant will pay out of pocket for a particular test or procedure. The NSA requires health plans and insurers to provide an Advanced EOB when requested in advance of treatment. The requirement applies whether these non-emergencies scheduled medical services are to be delivered in or out-of network. The Advanced EOB must be issued within certain timeframes after the provider submits to the plan or insurer a good-faith estimate of charges for each service. Because the Advanced EOB is the only document that would give a participant sufficient information to make an informed decision on pending treatment, a forward-look ing, strategic response to NSA compliance would prompt plan sponsors and their claims administrators to add the Advanced EOB now, before regulatory guidance is issued, to gain an additional competitive advantage. Visit aequum’s dedicated NSA Website https://knowthe nosurprisesact.com for current federal rules and regulations, resources that support health plan compliance, and valuable updates on current litigation, news and developments. 1 www.congress.gov/bill/117th-congress/house-bill/2617 2 www.cms.gov/newsroom/fact-sheets/no-surprises-understand your-rights-against-surprise-medical-bills 3 www.cms.gov/newsroom/fact-sheets/transparency-coverage-fi nal-rule-fact-sheet-cms-9915-f 4 www.bpslaw.com/how-medical-testing-laboratories-must-com ply-with-the-federal-ban-on-surprise-billing/#:~:text=The%20 %E2%80%9CNo%20Surprises%20Act%E2%80%9D%20(,her%20 health%20plan’s%20network%2C%20resulting 5 www.commonwealthfund.org/publications/fund-reports/2022/ oct/no-surprises-act-federal-state-partnership-protect-consum ers#:~:text=Abstract,enforce%20these%20new%20consumer%20 protections. 6 https://healthcostinstitute.org/out-of-network-billing/how-com mon-is-out-of-network-billing

Christine Cooper is the CEO of aequum LLC and the co-managing member of Koehler Fitzgerald LLC, a law firm with a national practice. Founded in 2020, aequum serves third-party administrators, medical cost-management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide, defending medical

balance-bills and delivering savings to employer-sponsored health plans. Christine is an avid runner and Ironman and is active in a variety of community affairs.

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benefitspecialistmagazine.com | ABS 9 All insurance policies and group benefit plans contain exclusions and limitations. We recommend you consult the policy for coverage and benefit details. GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York), an independent licensee of the Blue Cross and Blue Shield Association. GeoBlue is the administrator of coverage provided under insurance policies issued by 4 Ever Life International Limited, Bermuda, an independent licensee of the Blue Cross Blue Shield Association. INDV2249-BRK-9/22

MERGERS AND ACQUISITIONS

Stockton, Vice president. With more than four decades in the industry, Stockton Agency has exhibited steady growth as its agents help seniors get the most out of their Medicare cover age. The agency provides Medicare Advantage and Medicare supplement plans to seniors across Arkansas and Missouri. River City Senior Benefits, an IMO headquartered in Chat tanooga, Tennessee, and led by Philip Edwards, has joined Integrity. After years spent working as an agent and gaining insurance experience and expertise, Edwards launched River City Senior Benefits in 2000. The agency helps seniors across the Southeast navigate the complexities of Medicare to find the right Medicare Advantage and supplemental plans for their needs. The company also provides life insurance and annuity products to its network of agents. Integrity has partnered with Senior Health & Life Benefits, an IMO located in Savannah, Georgia, and led by Lawrence Bradley Sr., founder and CEO. Since its founding in 1993, the agency has focused on providing seniors with Medicare and final expense insurance products, as well as solutions tailored to fit their specific needs. Senior Health & Life Benefits serves thousands of Americans annually, with licensed agents working in Georgia, Alabama, North Carolina, South Carolina, Virginia, Florida and California. Allen and Associates, an IMO based in Memphis, Ten nessee, and led by founder and CEO Arric Allen, has joined Integrity. Founded in 2010, Allen and Associates is a Medi care-focused insurance agency. Allen and Associates is a top-performing agency in the Memphis Tri-State area, serv ing seniors in more than 15 states. Integrity has partnered with The Porter Group, led by Gene Porter, CEO, and Julia Porter, COO. The Porter Group is a life and health insurance agency based out of Morehead, Kentucky. Known for hosting extensive educational events and passionately serving multiple community organizations, The Porter Group established the Medicare Resource Center with a mission to serve as an advocate for seniors. By helping

BRIGHT HEALTH GROUP TO SELL CALIFORNIA MEDICARE ADVANTAGE BUSINESS TO MOLINA HEALTHCARE Bright Health Group Inc., a technology-enabled, value-driven healthcare company, has entered into a definitive agreement with Molina Healthcare Inc. to sell its California Medicare Ad vantage business, Brand New Day and Central Health Plan, for a total purchase consideration of $600 million. The com pany intends to use the proceeds to satisfy its obligations to its bank lenders with the remaining proceeds used toward liabilities in its discontinued ACA insurance business. “We are excited to enter into this agreement with Moli na as it will allow Brand New Day and Central Health Plan to continue delivering localized, personal care to California consumers and will position Bright Health’s Consumer Care Delivery business for long-term success,” said Mike Mikan, president and CEO of Bright Health. “The sale allows us to focus on driving differentiation and sustainable growth through our Consumer Care Delivery business.” As part of the agreement, Bright Health Group’s Consumer Care Delivery business will enter into a provider agreement with Molina to serve Medicaid and ACA Marketplace popula tions in Florida and Texas in 2024. The transaction is subject to regulatory approval and other closing conditions. The closing of the transaction is expected to occur by early 2024 and is not subject to a financing con dition. Moelis & Company LLC is serving as Bright Health’s fi nancial advisor and Simpson Thacher & Bartlett LLP is acting as Bright Health’s legal advisor. INTEGRITY WELCOMES NEW PARTNERS Integrity Marketing Group LLC has made several new acquisitions: Integrity has acquired the Stockton Agency, an inde pendent marketing organization based out of Bentonville, Arkansas, and led by Russ Stockton, president, and Rachel

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seniors navigate the complexities of Medicare, the team at The Porter Group is dedicated to ensuring everyone receives the Medicare and retirement benefits they need. Finally, Alliance Insurance Services had joined Integrity. Alliance is based in El Paso, Texas, and led by Raul Parga, president and COO, and Ofelia Parga, vice president and CFO. Established in 2009, AIS specializes in providing field support and resources to help agents succeed, including in-person training, marketing, in-house broker support and turnkey office spaces at no cost. With hundreds of broker agents across the United States and physical offices locat ed throughout Texas, New Mexico and Nevada, AIS helps thousands of families annually with life, health and Medicare insurance products. CURATIVE ACQUIRES AMERICAN COUNTRY INSURANCE COMPANY Curative Insurance Company, provider of a “no-copay, no-deductible health plan,” has announced the recent acquisition of American Country Insurance Company by its parent, Curative Health Holdings Inc., as part of the plan to expand its insurance offering to more markets across the country. Curative will rename the entity to Curative Insurance Company of Illinois, fully integrating the acquisition. Curative will now have licenses to sell large-group health insurance in select additional states. Curative Insurance Company currently offers a fully insured PPO offering in select regions of Texas and a level-funded insurance offering across the state. The acquisition will allow Curative to expand into other states more quickly and effi ciently (pending additional regulatory approvals).

NASSAU FINANCIAL GROUP COMPLETES ACQUISITION OF DELAWARE LIFE INSURANCE COMPANY OF NEW YORK Nassau Financial Group L.P. recently announced that its sub sidiary, Nassau Life Insurance Company, has completed the acquisition of Delaware Life Insurance Company of New York from Delaware Life Insurance Company, a Group 1001 com pany. NNY and DLNY are New York-domiciled life insurance companies, and Nassau plans to merge DLNY into NNY. “It has been our pleasure to work with the team at Group 1001 and Delaware Life, enabling the sale of their non-stra tegic business line,” said Phil Gass, Chief Executive Officer of Nassau. “As Nassau’s fourth insurance acquisition, the closing of this transaction marks yet another milestone as we con tinue to expand our New York presence. We look forward to welcoming the DLNY policyholders to Nassau.” “We have worked closely with Nassau Financial Group to ensure a smooth transition for our policyholders,’’ said Dan Towriss, CEO and president of Group 1001, the parent compa ny of Delaware Life. “Our highest priority has been to ensure that this change is as seamless as possible.” DLNY is a provider of fixed annuities, variable annuities and life insurance products with approximately 16,000 policies in force and $1.6 billion in assets as of March 31, 2023. The company does not have employees, and its business was managed as part of Delaware Life. Sidley Austin LLP served as legal advisor to Nassau, and Willkie Farr & Gallagher LLP served as legal advisor to Delaware Life.

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HOT PRODUCTS

Special Advertising Feature Special advertising feature

PRODUCT ALERT: LIFESECURE’S NEW HOSPITAL INDEMNITY INSURANCE IS NOW AVAILABLE Enhance health coverage for your individual and small group clients with this next-gen customizable Hospital Indemnity product

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Since 2010, LifeSecure Insurance Company has helped countless health clients like yours pay out-of-pocket medical costs with cash benefits from Hospital Indemnity Insurance. And now LifeSecure has released its best Hospital Indemnity product yet to the individual and worksite markets! Here’s a quick look at how this next-gen product can deliver incredible value to you and your clients. You’ll appreciate: guaranteed issue opportunities; streamlined online applications; simple underwriting; issue ages through 85 (in most states); no commission reductions at higher ages; and first-rate customer service.

LifeSecure’s product suite can be a great fit for you and your clients. • Accident: benefits based on actual medical expenses, often with higher payouts than scheduled benefit plans • Critical Illness: 9 covered conditions including skin cancer, and an unlimited lifetime benefit maximum • Long Term Care: flexible worksite product with four simple coverage options

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PRODUCT NEWS

employee well-being. A Guardian survey found that employ ees who have supplemental health benefits are 33% more likely to report high overall well-being compared to those who don’t, and having supplemental health insurance is cor related with higher self-reported financial health. Employers also recognize the many ways these benefits contribute to well-being: For example, six in 10 employers agree that sup plemental health benefits help them meet employees’ need for financial security. Guardian’s new Critical-Illness insurance offering aims to provide care for the whole family by offering additional cov erage for childhood illnesses and disorders such as autism, congenital heart defect and multisystem inflammatory syn drome caused by COVID-19. Guardian has also streamlined the management of critical-illness insurance benefits in several ways, enabling employees to access and use benefits as quickly and conveniently as possible. Key changes include simpler language for benefits explanation, benefits for less severe illnesses and earlier payouts at earlier stages of some neurological conditions such as Alzheimer’s, multiple scle rosis and Parkinson’s disease. Guardian also automatically checks for eligibility across all supplemental health coverag es when a short-term disability, paid family medical leave or a state-mandated disability claim comes in to help ensure employees receive all benefits to which they are entitled and can focus on recovery, not finances. Guardian’s new Critical-Illness offering has been approved in a number of states. Visit www.guardianlife.com/group/criti cal-illness-insurance/well-being to learn more. ADMINAHEALTH INTRODUCES INTUITIVE BILLING SUITE AdminaHealth, a provider of employee benefits billing solu tions for the healthcare, insurance and voluntary benefits marketplace, has announced the release of the intuitive AdminaHealth Billing Suite user interface. Building upon the success of its automated reconciliation, consolidation and payment features, AdminaHealth is taking a major leap forward with a new user-driven interface that further revolu tionizes the administration of employee benefits premium billing. The new user interface (UI) empowers brokers, carriers and employers with greater control and independence, and transforms how they manage employee benefits premium billing. The updated AdminaHealth Billing Suite UI features: Innovative design: A fresh look and feel that is both aes thetically attractive and exceptionally user-friendly, ensuring a seamless experience for all users. Comprehensive billing-reconciliation process: Users have real-time visibility into the health of their billing processes.

FRESHBENIES LAUNCHES VIRTUAL PRIMARY CARE WITH $0 VISITS freshbenies, an employee benefit that cuts healthcare costs and confusion for employers and their employees, has launched a Virtual Primary Care service that empowers employees to: 1) establish ongoing, personalized doctor visits by video with a U.S. primary care physician of their choosing 2) maintain routine well visits and manage chronic con ditions including diabetes, blood pressure, cholesterol, GI issues, arthritis, respiratory illness and more, and 3) schedule unlimited visits for $0. This new service completes 3 levels of enhanced telehealth services with $0 visit fees: General, Primary Care and Behavioral Telehealth. To learn more, visit www.freshbenies.com. The Guardian Life Insurance Company of America recently announced an enhanced Critical-Illness insurance prod uct, giving employers more flexibility to help ensure overall well-being for employees and their loved ones through all stages of life. Employers are looking for unique ways to show employees how much they’re valued and are increasingly turning to benefits that can help boost employee financial confidence and overall well-being. To address this need, Guardian is introducing coverages in high demand among employees, including optional family-planning benefits that support employees during infertility treatments and through preg nancy and potential delivery complications. Guardian also doubled the number of covered diseases and conditions and offers coverage for preventative measures taken due to hav ing a BRCA1 or BRCA2 genetic mutation, which can increase the risk of certain cancers, including breast cancer. “We know the impact that major illnesses and medical conditions can have on the well-being of employees and their families, and this expanded offering helps ensure employees feel financially confident in good times and bad so they can focus on recovery and lifelong well-being, “ said Jonathan Mayhew, head of group benefits at Guardian. “As new and expanded benefits continue to be in demand, this offering will help organizations protect the well-being of their employees and their families and help ensure they can easily access benefits in times of need.” Research shows that benefits like Guardian’s expanded critical illness offering play an important role in fostering GUARDIAN UNVEILS CRITICAL-ILLNESS INSURANCE EMPLOYEE BENEFIT

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PRODUCT NEWS

Moda Health entered the Idaho market in 2022, offering its evidence-based plans, programs and customer service to individuals and family purchasers, employers with up to 50 employees, and Medicare Supplement plans to those 65 and older. “We were excited last year to begin offering Idaho more choice,” says Jason Gootee, VP of sales & strategic market de velopment at Moda. “We exceeded our membership goals by more than 100%, and now we’re expanding our coverage to make it even easier for Idaho’s employers to find the health plan that will better care for their employees and families.” Moda Health continues to partner with the Saint Alphon sus Health Alliance network, the Patient Quality Alliance network, a comprehensive network of hospitals and physi cians throughout Southeast Idaho, and Minidoka Memorial Hospital, along with other local providers. “We’re delighted with the ongoing strategic growth of this partnership,” says Lannie Checketts, chief financial officer at Saint Alphonsus. “These new plans will bring added oppor tunities to deliver on our shared mission of creating health ier communities. Even more Idahoans will have access to our network of more than 3,000 providers, including many long-established practices in Treasure Valley.” To help deliver on this promise, Moda Health focuses on: • Helping members get the care they need: Moda Health combines its Idaho networks in Treasure Valley, South Cen tral Idaho and Southeast Idaho with a national network to support today’s workforce. It then layers on modern and convenient care options to connect members with doctors and mental health support via secure apps. • Tools to help improve health and wellness: Moda Health offers tools, discounts, coaching and care programs that put members in the driver seat of their health. • Service to make things easy: There are no phone trees for Moda Health, just access to experts that care and are ready to guide and help. • “Patient Quality Alliance supports this expansion,” says Brock Merrill, Executive Director of PQA. “This additional option for Idaho’s large employer groups will ensure more members of our communities have access to high quality preventative healthcare in a partnership focused on ad dressing rising healthcare costs.” Moda Health’s Individual and Employer Group plans for 2023 are now available in Ada, Adams, Bannock, Bingham, Boise, Canyon, Caribou, Elmore, Gem, Minidoka, Oneida, Owyhee, Payette, Power and Washington counties. Medicare Supplement plans are available statewide. More information can be found at modahealth.com/Idaho. Producers can also reach Jim Light at 503-243-5213.

The suite syncs with users’ monthly workflows, allowing for efficient reconciliation of billing cycles and facilitating streamlined operations. On-time reconciliation and bill pay: Tracking the progress of all clients and their individual billing cycles is remarkably easy. Users can effortlessly maintain an organized billing workflow and be assured of timely payment. Visit www.AdminaHealth.com for more details.

TRITON BENEFITS & HR SOLUTIONS UNVEILS GAME-CHANGING APPROACH TO PRESCRIPTION RX SOURCING Triton Benefits & HR Solutions, a specialist in group health benefits, payroll and HR services, is leveraging international sourcing to slash the costs of prescription Rx for its clients. The innovative strategy has been shown to cut the cost of prescription medications by half, making healthcare signifi cantly more affordable for businesses and their employees. For example, Triton’s global sourcing approach can reduce the cost of a $25,000, 90-milligram prescription of Stelara to just $12,500, delivering substantial savings without compro mising on quality or efficacy. Additionally, Triton is now working closely with employees and pharmaceutical manufacturers to tap into Patient Assis tance Programs (PAPs). These initiatives aim to provide high cost medications at little to no cost for businesses enrolled in Triton’s group health insurance plans. Medications covered under this new approach include Stelara, Humira and a range of antiviral drugs. The strategic utilization of these programs can lead to substantial savings, contributing significantly to the affordability of healthcare for Triton’s clients. For more information, visit www.TritonHR.com or call 877-OK-TRITON.

MODA HEALTH BRINGS LARGE-GROUP PLANS TO IDAHO

Idaho’s large employers have a new health option to consid er when they’re looking for competitive, affordable medical insurance plans to help them attract and retain top talent. “As an employer ourselves, we understand the benefits package you offer employees is a reflection of your company, culture and values,” said Jim Light, head of Idaho sales and development for Moda Health. “We all know attracting and retaining employees is more competitive than ever.”

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