America's Benefit Specialist December 2023

Animated publication


NABIP offers health insurance professionals a multitude of educational opportunities, including advanced designations, certifications, continuing education and online learning.

December 2023


MEDICARE MATTERS 26 NABIP Statement on Medicare Marketing Practices YOUR SALES 31 Voluntary Disruption

Dissecting the CAA Gag Clause Prohibition By David Ostrowsky


Industry Events


The Latest on Account Based Plans From NABIP


1 0.5 Ways to Enhance Open Enrollment Communication By Eric Silverman


Comparing HIPAA and NIST By Bethany Adams

YOUR ASSOCIATION 33 NABIP Policy Series Consolidation of Dialysis Providers



10 Gag Clause Prohibition

Compliance Requirement By Scott Stevens

35 CPC Quiz


37 Congratulations, Registered Employee Benefits Consultants!

11 Product News

15 People on the Move

38 Welcome to NABIP

16 Mergers and Acquisitions

18 Is Your Firm Diligence Ready By Brett Rosen

39 NABIP’s Board of Trustees

40 Your NABIP Staff

20 A Conversation with Jessica Brooks-Woods

IBC Association Events

18 | ABS 1

VOLUME 70, NO. 10

EDITOR Martin Carr (202) 595 0724

ADVERTISING SALES The YGS Group (717) 430 2238

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

At BenefitMall, we understand the need for speed, accuracy, and efficiency. That’s why we’re thrilled to introduce our new Search and Add Plans experience in Client Ready Quote System ® (CRQS) . In addition to overall system enhancements that prioritize faster results, reliability, and ease of use, the new Search and Add Plans experience includes: • A sleek and modern user interface • An advanced and intuitive navigation menu • An interactive shopping cart and e-commerce experience More 2 CRQS Search & Add Plans: An exponentially quicker way to quote

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 10 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.

See how much easier and quicker quoting just got!

Scan to watch video.

©2023 BenefitMall. All Rights Reserved.

2 ABS |


By David Ostrowsky The Phia Group

While the primary purpose of the Consolidated Appropri ations Act of 2021 may have been to provide fiscal relief to tens of millions of Americans in the depths of the pandemic, the CAA has also proven to be a landmark piece of health care legislation by virtue of initiating sweeping reforms for employer-sponsored group health plans, arguably the most influential ones since the Affordable Care Act was enacted in March 2010. One such reform ensures there is heightened price trans parency for healthcare consumers, a development that is encapsulated in the legislation’s “gag clause” prohibition. This provision of the CAA bars health plans or health insur ance issuers from entering into contracts with a healthcare provider, network or third-party administrator providing access to a network of providers that restrict a plan from releasing data and information for public consumption. For example, if there is a contract between a TPA and a plan in which the plan sponsor’s access to provider-specific cost and quality of care information is solely at the discretion of the TPA, such a contractual provision would be deemed a prohibited gag clause. Meanwhile, the CAA-issued guidance also clearly stipulates that even any provision indirectly

limiting access to data/information or the ability to disclose information is forbidden. Further, per this CAA provision, plans are required to submit an annual attestation that they have not engaged in any such prohibited contractual arrangements. The first attestation is due December 31, 2023, which covers the peri od starting December 27, 2020 (or the effective date of the applicable group health plan or health insurance coverage, if later) through the date of attestation. Subsequent attesta tions must be submitted by December 31 of each year and cover the period since the last one was delivered. (It should be noted that while this attestation, which can be done by the TPA on behalf of the self-insured plan so long as there is a written agreement between the plan and the service provider in place, is applicable to grandfathered plans, it does not pertain to HRAs, stand-alone retiree health plans and issuers of only excepted benefits plans or short term limited-duration insurance.) The underlying concept of this provision is that removing gag clauses on price and quality metrics, effectively ensur ing that electronic claims data and provider-specific cost or quality of care information as well as claim-related financial obligations included in the provider contract is accessible | ABS 3


to plan members, will spark enhanced transparency and is in the same vein as other wide-ranging price-transparency provisions of the CAA, including patient protections against surprise billing, prescription drug cost reporting and mental health parity comparative analysis disclosures. But, as is so often the case with complicated legislative initiatives, the aforementioned conceptual premise can potentially differ from reality. While on the surface it may appear that the gag clause prohibition is a surefire way to facilitate healthcare price transparency, there is still an un told number of owners of provider networks devising crafty workarounds, potentially leaving healthcare consumers deprived of critical claim-related financial data and provider background information. Consider the following hypothetical scenarios: • A self-funded plan cites the CAA in requesting access to its claims data. The TPA sends a file of claims data containing merely 22 of the 170+ fields needed to process and evalu ate claims. Subsequently, the plan obtains a file of virtually meaningless claims data and is left unable to discern what it is being charged for each claim. • A self-funded plan in a rural one-network region, also referencing the CAA, requests access to its claims data for review. Unfortunately, the network responds by saying it will not remove the gag clause and noting that the plan can terminate the contract if it is an issue. What is even more unfortunate is that not only does the plan receive no pricing data but, at the same time, it cannot terminate the contract for further use because it does not have access to any competing networks given its remote, sparsely popu lated location. • A union fund with well over $450 million in yearly health care spending asks to review its claims data. The TPA ref

erences its contract, which only allows for an audit of 200 claims per year, arguing this meets the CAA requirement for access to claims. Resultingly, the fund can only review .0004% of its members’ total claims, while being unable to identify whether it is paying claims appropriately and thus getting a square deal. Such situations are highly unfortunate given that the overwhelming majority of plan sponsors and TPAs across the nation are doing their due diligence to ensure compliance with the CAA gag clause prohibition when signing contracts and agreements with networks and other service providers. But, ultimately, with the CAA gag clause provision still being so new, there are some networks and TPAs that have been able to expose loopholes. In sum, the evolution of the gag clause prohibition is a promising development for Americans covered by employ er-sponsored health plans who have a vested interested in understanding the financials behind their patterns of con sumption. That said, considerable roadblocks still exist for full price transparency to become a staple of the American healthcare system.

David Ostrowsky serves as a content specialist 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, pub lished by McFarland & Company in 2020.



APRIL 29-MAY 1 BENEFITSPRO BROKER EXPO Aurora, CO bprobrokerexpo JUNE 11-13 AHIP 2024

JUNE 23-26 SHRM24 Chicago, IL

Las Vegas, NV

4 ABS |



unused amounts, the maximum carryover amount has been raised to $640 for 2024. The IRS has updated the maximum amount employers may contribute for excepted-benefit HRAs due to inflation. For 2024, the maximum annual amount that may be contrib uted to excepted-benefits HRAs will increase to $2,100, which is a $150 hike from 2023. Individual Coverage Health Reimbursement Arrange ments offer an alternative to traditional group health plan coverage and are tailored to fit a variety of business types and sizes. ICHRAs allow employers of any scale to reimburse employees for qualified medical expenses, including health insurance premiums, on a tax-free basis. The prevalence of ICHRAs has been on the rise since their inception. A study found that U.S. employer adoption of ICHRAs increased by 64% from 2022 to 2023, indicating a significant move toward these arrangements by businesses looking for more autonomy in their health benefits offerings. 2 Moreover, adoption rates among applicable large employ ers, companies with at least 50 full-time employees, have more than doubled between 2022 and 2023. This growth has been described as a 25-fold increase since 2020. The

For Health Savings Accounts, Flexible Spending Accounts and Health Reimbursement Arrangements, there are several recent developments and regulatory changes. In 2023, the maximum contribution to an HSA was $3,850 for self-only coverage and $7,750 for family coverage, re sponding to inflation adjustments. The minimum deductible for a single person with a high-deductible health plan is $1,500. HSAs continue to grow in popularity, with projections indicating assets surpassing $100 billion in 2023. For 2024, the contribution limits are set to rise again, to $4,150 for self-only coverage and $8,300 for family coverage. In addition, a qualifying HDHP must have an annual deductible in 2024 of at least $1,600 for self-only coverage or $3,200 for family coverage (up from $1,500 and $3,000 in 2023, respectively) and annual out-of-pocket expenses (deductibles, co-payments and other amounts, but not premiums) cannot exceed $8,050 for self-only coverage (up from $7,500 in 2023) or $16,100 for family coverage (up from $15,000 in 2023). 1 For FSAs, the contribution limits for 2023 were $3,050 for healthcare FSAs. However, the Dependent Care FSA max imum annual contribution remained steady at $5,000 per household, or $2,500 if married and filing separately. The FSA contribution limit is slated to increase to $3,200 for 2024. Furthermore, for cafeteria plans that permit the carryover of

Continued on page 19 | ABS 5


By Bethany Adams Sales Executive Total HIPAA Raleigh, North Carolina

Incident Response Plans: Both frameworks necessitate having plans for addressing security breaches, crucial for maintaining client trust and compliance. Training and Awareness: Training staff in security policies and procedures is emphasized, as knowledgeable employees are key in safeguarding client information. KEY DIFFERENCES Scope and Applicability: HIPAA specifically targets the healthcare sector, including health insurance agents, focus ing on ePHI protection. Broader in scope, NIST is applicable across various sectors. While not healthcare-specific, its guidelines can enhance overall data-security practices. Mandate: As a federal law, HIPAA non-compliance can re sult in legal penalties, making adherence essential for health insurance agents. While NIST’s guidelines are advisory, ad herence to certain standards may be required under specific contracts or regulations.

For health insurance agents, understanding the distinction between Health Insurance Portability and Accountability Act and National Institute of Standards and Technology frame works is crucial. Both prioritize data security and privacy, but their applications in the health insurance sector differ significantly. KEY SIMILARITIES Emphasis on Security and Privacy: Both HIPAA and NIST focus on safeguarding data. HIPAA specifically targets the protection of electronic protected health information (ePHI), which is critical for health insurance agents dealing with client data. Risk Assessment: Health insurance agents must conduct thorough risk assessments under both frameworks to identi fy and mitigate threats to sensitive information, a vital step in protecting client data. Access Control: Ensuring that only authorized individuals have access to sensitive information is a shared requirement, particularly important for agents handling ePHI.

Continued on page 19

6 ABS |


show U.S. adults keep up with their oral hygiene to avoid unforeseen costs and prevent dental issues such as cavities and gum disease. The report also finds that adults understand the impor tance of preventive oral health care for maintaining good oral health and avoiding unexpected care. Further, adults and children continue to follow recommended oral health guide lines at home to improve their overall health and wellness. Key findings: • More than six in 10 (64%) adults replace their toothbrush at least every three months, as recommended by the Amer ican Dental Association. This represents a 10% increase compared to 2022. • More than seven in 10 adults (79%) and children (73%) brush their teeth at least twice a day. However, children do a bet ter job flossing once a day (55%) compared to adults (31%). • While prevention is the main reason for dental visits among adults (78%) and children (85%), personal appearance (16%) has become a motivator for adults. • In fact, adults are citing more personal appearance reasons for flossing than in 2022, such as freshening their breath (26%) and keeping teeth as white as possible (20%). The 2023 State of America’s Oral Health and Wellness Re port is based upon Delta Dental Plans Association-commis sioned research conducted between January 6 and January 23 by Material Holdings a global insights and strategy con sultancy, using an email invitation and online surveys of two audiences recruited through an opt-in panel: 1,000 nationally representative Americans ages 18+ and 1,253 parents of chil dren ages 12 and under. BENCHMARK SURVEY: ANNUAL FAMILY PREMIUMS FOR EMPLOYER COVERAGE RISE SEVEN PERCENT TO NEARLY $24,000 IN 2023 Amid rising inflation, annual family premiums for employ er-sponsored health insurance climbed seven percent on average this year to reach $23,968, a sharp departure from virtually no growth in premiums last year, the 2023 bench mark KFF Employer Health Benefits Survey finds. On average, workers this year contribute $6,575 annually toward the cost of family premium, up nearly $500 from 2022, with employers paying the rest. Future increases may be on the horizon, as nearly a quarter (23%) of employers say they will increase workers’ contributions in the next two years. Workers at firms with fewer than 200 workers on average contribute nearly $2,500 more toward family premiums than those at larger firms ($8,334 vs. $5,889). In fact, a quarter of covered workers at small firms pay at least $12,000 annually in premiums for family coverage. This year’s seven-percent increase in average premiums is similar to the year-over-year rise in workers’ wages (5.2%) and


A new study from Lincoln Financial Group shows that 86% of those surveyed say insurance benefits other than medical insurance are a “must-have or very important” for an employ er to offer. In today’s economic environment, employees are increasingly interested in workplace benefits that can pro vide financial protection and support as they face competing financial challenges, including saving enough for emergen cies, paying down debt and increasing medical expenses. Amid rising costs and concerns around inflation, 82% of those surveyed say it is important for them to have protec tion against expenses or lost income in case of an unexpect ed event. The addition of voluntary benefits like accident, critical-illness and hospital indemnity insurance can help provide protection against unforeseen health issues or accidents—and research shows these types of supplemental health products are of great interest among workers. Yet, along with the lack of availability, one of the biggest barriers to widespread adoption is understanding the value these benefits can provide. In fact, 54% of workers surveyed believe that supplemental benefits are designed only for people who already have specific health issues. Here are some strategies employers can adopt to help en hance the benefits experience during open enrollment: Provide expert advice: For many workers, an ideal benefits education program includes having experts readily available to answer employee questions. This advice can be delivered to employees in a variety of ways, from lunch-and-learns to webinars to one-on-one meetings. Connect employees directly to the benefits provider: Em ployees prefer to hear directly from their benefits providers nearly nine in 10 respondents reported that they would be very or somewhat interested in receiving communication directly from an insurance carrier. Employers can help facilitate this by ensuring the contact details for their benefits carrier are prominently placed on benefits materials and intranet sites. Highlight affordability: Many workers aren’t aware of how affordable supplemental health benefits can be. In fact, the perception that supplemental benefits are unaffordable is the top reason workers choose not to enroll. Conversely, among those who are enrolled in supplemental benefits, the most common reason for enrollment was affordability (41%). Employers can dispel these misperceptions by highlighting the cost and value of supplemental health benefits in open enrollment communications. REPORT FINDS ADULTS PRACTICE GOOD ORAL HEALTH CARE TO AVOID SERIOUS DENTAL ISSUES AND MAJOR EXPENSES Delta Dental recently shared additional findings from its 2023 State of America’s Oral Health and Wellness Report that | ABS 7


inflation (5.8%). Over the past five years, premiums rose 22%, in line with wages (27%) and inflation (21%). Among workers who face an annual deductible for single coverage, the average this year stands at $1,735, similar to last year. The average deductible amount has increased 10% over the last five years and 53% over the last 10 years. Workers at small firms (under 200 workers) on average face much larger deductibles than workers at larger firms ($2,434 vs. $1,478). The modest rise in deductibles may reflect employers’ perceptions about the burden of cost-sharing on workers. More than half (58%) of employers say that their workers have at least a moderate level of concern about the affordability of their plan’s cost-sharing requirements. “Rising employer healthcare premiums have resumed their nasty ways, a reminder that while the nation has made great progress expanding coverage, people continue to struggle with medical bills, and overall the nation has no strategy on health costs,” KFF President and CEO Drew Altman said. Almost 153 million Americans rely on employer-sponsored coverage, and the 25th annual survey of more than 2,100 small and large employers provides a detailed picture of the trends affecting it. Among large employers (with at least 200 workers) that offer health benefits to at least some workers, the vast ma jority (88%) say their plan has enough primary care doctors to provide timely access for enrollees. Substantially fewer say the same about their mental health (59%) and substance use condition (58%) networks. Nearly one in five (18%) of large offering firms say that they took steps in the past year to increase the number of mental health providers in their largest plan’s network. This includes 44% of the largest employers (with at least 5,000 workers). On the other hand, one in five (21%) of large offering em ployers say their plan has limits on the number of covered mental health services, potentially restricting access for enrollees with long-term needs. Other findings include: Nearly all employers with at least 200 workers offer health benefits to at least some workers, though smaller firms are increasingly less likely to offer health benefits as they get smaller. For example, 83% of firms with 10 to 199 employees offer health benefits to at least some of their workers, while just 42% of firms with three to nine workers do so. Among firms offering health benefits, most also offer separate dental coverage (91%)—double the share that did so in 2010 (46%). Most also offer vision (82%) insurance, also up sharply since 2010 (17%). Fewer offer long-term care insurance (26%). Among employers with at least 200 workers, 23% cover gender-affirming survey in their largest health plan. More

than a third (37%) say they do not cover such surgeries, while a large share (40%) are not sure about such coverage. Among the largest firms (at least 5,000 workers), nearly two thirds (62%) cover gender-affirming surgery, many of which expanded the benefit in the past two years. About one in five (19%) offering employers with at least 200 workers say their plan includes a “center of excellence” program for specific services, either limiting enrollees to a narrower group or providers or offering lower cost-sharing for doing so. Among these firms, 22% have introduced a new center of excellence program within the last two years. Among firms with a center of excellence program, 45% had a program for joint replacement, 42% for back or spine surgery, 31% for bariatric surgery, 30% for mental health and 28% for substance use disorders. KFF conducted the annual employer survey between Jan uary and July. It included 2,133 randomly selected, non-fed eral public and private firms with three or more employees that responded to the full survey. An additional 2,759 firms responded to a single question about offering coverage. MAJORITY OF HEALTHCARE BUSINESSES EXPECT U.S. ECONOMY TO IMPROVE Across the board, healthcare leaders are focused on one of their most important assets: employees. Talent acquisition and retention is among the top three areas of business focus, a top investment priority, and among their top concerns. To address employee recruitment and retention matters, 22% plan to invest in recruitment and retention ahead of market ing (21%) and cybersecurity (15%). These insights are part of a nationwide survey of small and middle-market companies across the U.S. conducted by Umpqua Bank as part of its annual 2023 Business Ba rometer report. Over half of healthcare professionals expect the country’s economic conditions to improve over the next 12 months. Additionally, 67% expect an increase in revenue and 62% expect an increase in profitability. The survey also found that healthcare, manufacturing and agricultural businesses are the most optimistic as it relates to the country’s future eco nomic conditions. “Healthcare businesses are focused on enhancing their fundamentals as they prepare for 2024. This translates into increased attention to managing staffing issues, promoting their services and investing in cybersecurity,” said Umpqua Head of Middle Market Banking Richard Cabrera. “Although an essential industry, healthcare leaders are not taking this status for granted and are intent on improving efficiencies, strengthening financial management as well as employee recruitment and retention.”

8 ABS |


Survey participants within the healthcare industry be lieve the two most important issues their businesses need to address to succeed are: (39%) attracting, hiring qualified personnel, and retention and (32%) growing their busi ness through marketing. Healthcare leaders also expect to increase efficiencies through the automation of tasks (28%), leveraging artificial intelligence to analyze data and support decision making (23%), and adding new goods or services with higher profit margins (19%). The report shows 65% of respondents expect prices for their products and services to increase over the next 12 months, and 70% of healthcare leaders have raised the prices on their products and services in the last 12 months. Other notable insights from the research: • Seventy-eight percent are planning to invest in financial tools to protect their payments systems.

• Sixty-five percent of survey participants expect to make significant changes to their lines of products and services. • Similar to the majority of survey participants, 65% plan to find ways to digitize new areas of the business to improve efficiency. • Given that healthcare leaders expect economic conditions to improve in the next 12 months, they appear more com fortable taking on debt, with 53% noting they will likely take on debt to invest in expanding their business. • Fifty-one percent are considering an increase in their real estate footprint. On behalf of Umpqua Bank, DHM Research conducted an online survey of 1,250 owners, executives and financial deci sion-makers of American small and middle-market compa nies from July 27 to August 8.

Health Care Benefits Can Be…

Expensive. Confusing. Overwhelming.

Valuable Understandable Supportive

Let us show you what’s possible. | ABS 9


By Scott M. Stevens, RHU, CDHC Dodge Partners Insurance Omaha, Nebraska

The Consolidated Appropriations Act requires an annual “gag clause prohibition compliance attestation” (GCPCA) be submitted by December 31 and annually hereafter. Important ly, carriers/administrators/payers have largely removed any references to gag clauses and prohibitions of sharing pricing and quality data, which was prohibited by the CAA. It is now the responsibility of carriers, administrators and employers to confirm compliance with the gag clause prohibition by way of an annual online attestation. It might come as a surprise that such gag clauses have here tofore existed but, in many instances, they did. Specifically, cer tain agreements between health insurance plans/issuers and healthcare providers/networks would prevent the disclosure of both cost and quality of care data to stakeholders. Healthcare providers/networks are still allowed to place “reasonable restric tions” on the public disclosure of such information. The compliance burden associated with the GCPCA consists of two separate aspects: 1. Confirming your plan is in compliance with the provision (Note: The required Confirmation of Compliance states: ABC Payer hereby confirms that the administrative services it provides to its customers are consistent with the require ments set forth in the Consolidated Appropriations Act, 2021 (PL 116-260), Division BB, Section 201: INCREASING

TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE AND QUALITY INFORMATION). 2. Submission of the attestation via the federal government link/webform (see below). Employers are encouraged to check with their health plan issuers, administrators, brokers, consultants, etc. to verify if number one and/or two above is/are being handled by their plan issuer/administrator. For more guidance and information on the annual GCPCA compliance requirement, see about/oversight/other-insurance-protections/gag-clause-prohi bition-compliance-attestation. To actually make a filing, here is the link:

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.

10 ABS |


AGENCYBLOC CONCLUDES EARLY-ADOPTER PROGRAM OF SMALL-GROUP QUOTING SOLUTION AgencyBloc, a management platform in the health, life, se nior-market and group-benefits space, announced the suc cessful conclusion of its early-adopter program for its small group benefits quote-to-close solution, Quote+. Quote+ allows brokers to easily access and compare group benefit products with almost 130 regional and national group health carriers and 40,000 plans available across the U.S. Launched in March, Quote+ enables brokers to quote and compare multiple types of group health insurance offerings, including community rated, medically underwritten and sev eral ancillary options in one central place with tools to reduce the normally manual, time-consuming processes involved in quoting, product comparison, proposal generation and enrollment. In addition, Quote+ provides regional and national group health insurance carriers the ability to showcase their prod ucts, map data to their custom forms and import underwrit ing and enrollment data more efficiently. For more information, visit OPTUM RX TAKES ADDITIONAL STEPS TO LOWER THE COST OF INSULIN Optum Rx, UnitedHealth Group’s pharmacy services company, recently announced additional actions to make insulin more affordable, moving several rapid-, short- and long-acting insu lins to tier one, which offers the lowest cash price consumers pay. This is the latest effort by Optum Rx to ensure consumers have access to affordable medications and are protected from the high prices set by drug manufacturers. In all, Optum Rx will shift eight products, including all short- and rapid-acting insulins, to tier one, or “preferred” status, on standard formularies. Three manufacturers will have products added to tier one, including Eli Lilly, Novo Nordisk and Sanofi. In 2022, the company supported UnitedHealthcare in its work to eliminate copays for consumers in group fully insured plans for insulin and other critical drugs used to treat emergencies such as severe allergic reactions, hypoglyce mia, opioid overdoses and acute asthma attacks. In total, 170 unique medications are part of the Optum Rx Critical Drug Affordability program that includes a recommended cost share of $35 or less for consumers.

Q4INTELLIGENCE LAUNCHES PROFESSIONAL GROWTH PLATFORM Q4intelligence has announced the launch of Q4i Online. This platform is an online subscription service offering an array of proven ideas, resources and lessons that welcome all levels of professional salespeople and business owners. “Our vision has always centered around empowering professionals in the insurance industry with sales training, business planning and growth techniques. While we’ve had great success doing just that, we’ve also been limited with our reach and impact because of our hands-on approach and knew it was time to expand our point of access,” explains Wendy Keneipp, partner at Q4intelligence. “With Q4i Online, we’re not just adapting; we’re leading a new era of accessi ble, continuous professional growth.” Q4i Online is tailored for employee benefits and insurance agency owners and salespeople seeking a support system that ensures consistent business expansion. “Blowing sales goals out of the water requires more than just ambition; it demands a systematic approach and the right set of tools,” says Kevin Trokey, founding partner at Q4intelligence. “This is our invitation to every committed in dividual in the industry at every stage of your career: Engage with a platform engineered for your success.” There are four subscription tiers designed for targeted growth: SELL—Geared towards individual producers, this entry-lev el engagement offers online sales training videos, focusing on cultivating a buyer-centric sales process, replacing the redundant renewal meet-ups with strategic problem identi fication and solution alignment. EXPAND—This level provides producers with additional training videos, tools and tips beyond the SELL offering, focusing on maintaining a healthy prospect pipeline and small-agency owners, this tier integrates the benefits of SELL and EXPAND with opportunities to connect with a support ive community of peers and coaches, further enhancing growth potential through an extensive support network. INTEGRATE—Tailored for agencies poised for collective growth, this comprehensive package grants access to an all-encompassing suite of agency growth resources, cater ing to multiple facets like marketing, service and leadership, apart from sales, for up to 10 team members. For additional information and pricing options, visit www. fostering habits that underpin sustainable growth. ENGAGE—Intended for individual producers or | ABS 11


Today more than 70% of people who use Optum Rx already pay less than $35 per month on insulin. Effective January 1, 2024, 98% of all Optum Rx consumers will have access to insulin for $35 or less per month. “I’ve seen firsthand how high prices for insulin and other necessary medications can cause patients to limit or skip doses,” said Dr. Patrick Conway, chief executive officer of Optum Rx. “Medicine that people can’t afford is useless, and by taking this important next step to change our formulary, we will lower costs and improve access for more people who need this life-saving medication. Our goal is to make all es sential medicines affordable.” For more information, visit CENTRO BENEFITS RESEARCH ANNOUNCES LAUNCH OF BROKER-CARRIER RFP AND QUOTING API INTEGRATION WITH METLIFE Centro Benefits Research, an employee-benefits consulting and technology firm, has announced the launch of a bro ker-carrier RFP and Quoting API integration with MetLife for all ancillary employee benefits products. This API connection will enable Centro and MetLife to exchange RFP and quote proposal data directly between the Centro platform and the MetLife Group operating platform and, as a result, signifi cantly improve the speed, accuracy, operational efficiency and cost of this manually intense process. “In an era where digital transformation has become an in dicator of progress, Centro is creating a unique value by deliv ering a powerful technology platform that eliminates most of the manual steps across the value chain for the carriers and brokers we serve,” said Treg Balding, chief revenue officer at Centro Benefits Research. “Working with MetLife to launch the RFP and Quoting API integration is a big step towards modernization of these processes.” Centro’s RFP and Quoting API Integration with MetLife transforms the labor-intensive RFP and Quoting process for employers with fewer than 100 employees and enables seamless, real-time data exchange. This results in faster turnaround times, greater accuracy and downstream error reduction, leading to an enhanced overall user experience for brokers and employers. For information, visit

“The Leaf Health Captive will allow our clients to greatly reduce their healthcare costs and mitigate their risk. We’ve combined our specialty administration, medical-rebates, clinical-review and alternative-funding programs with Berkley Accident and Health’s risk-management strategies to offer our clients a flexible solution that works for them,” Robert Shelley, founding partner and CEO of Leaf Health, explained. The Leaf Health Captive manages specialty claims costs through an extensive clinical-review process performed by an in-house pharmacy and mitigates volatility by providing no new lasers and rate cap options. It also increases healthcare savings through returned surpluses and lower insurance premiums for members. “We’ve taken a new approach to a typical captive solution with the Leaf Health Captive,” Shawn Lanter, vice presi dent-captive business development of Berkley Accident and Health, said. “With Leaf Health’s industry expertise, we have the opportunity to greatly reduce our client’s prescription drug spending without sacrificing a member’s quality of care through a robust clinical review of high-cost drugs.” For more information, visit PRODIGY ADOPTS GRADIENT AI’S SAIL FOR ENHANCED MEDICAL STOP-LOSS INSURANCE RISK MANAGEMENT Gradient AI, a software provider of artificial intelligence solutions in the insurance industry, announced that Prodigy Health Insurance Services, a managing general underwriter specializing in medical stop-loss insurance, has chosen Gradient AI’s SAIL solution to optimize its self-funded insurance plans. Prodigy is using Gradient AI’s SAIL group health under writing solution to quote new business and transition clients from fully insured to more cost-effective self-insured plans. The company’s Integrated Health Solutions offers employers fixed monthly costs for administration, claims payments and stop-loss insurance. Prodigy uses SAIL’s analytics to help em ployers be more proactive in improving healthcare outcomes while reducing healthcare costs. Gradient AI’s medical data and advanced analytics enable Prodigy to offer innovative self-funded plans and to partner with employers to offer affordable high-quality healthcare to their employees. SAIL has the ability to leverage prescription, medical and lab data at scale to inform predictions. Using SAIL’s analytics, Prodigy’s solutions focus on deliv ering proactive employee healthcare management and cost reduction. This approach benefits employees and employers, and aligns with Prodigy’s mission of ensuring quality care and outcomes. To learn more, visit

LEAF HEALTH AND BERKLEY ACCIDENT AND HEALTH TO PROVIDE CLIENTS WITH A COMPREHENSIVE GROUP CAPTIVE SOLUTION Leaf Health, a pharmacy benefits consultant, has partnered with Berkley Accident and Health to establish the Leaf Health Captive, a turnkey, group captive solution.

12 ABS |


WASHINGTON NATIONAL RELEASES CRITICAL ILLNESS PRODUCT Washington National Insurance Company, a national pro vider of supplemental health and life insurance products for middle-income Americans, recently announced the intro duction of its new Critical Illness Insurance product. Available for individual and worksite sales, Critical Illness Insurance offers financial protection in the form of lump-sum cash benefits and helps ensure financial security for policyholders and their families when they are faced with an unexpected critical illness such as cancer, heart attack or stroke. Washington National’s Critical Illness Insurance also offers policyholders the flexibility to use their cash benefits without restrictions, including out-of-pocket expenses, deductibles, coinsurance, living expenses and everyday bills. Beyond the physical and emotional toll it brings, critical illness carries significant financial burdens for impacted patients. According to the ACS Cancer Action Network, 51% of cancer patients and survivors carry medical debt from their cancer-related treatment. “Many middle-income Americans are continually being challenged by increasing cost-of-living expenses, and when they are faced with an acute health situation, the last thing they should be concerned about is finances,” said Kari Desai, vice president, product development, CNO Financial Group. “Policyholders and their families need supplemental health benefits, like Critical Illness Insurance, to give their family extra financial protection.” The new solution covers major illnesses and complements existing Washington National supplemental health insurance plans. It also offers customized pricing by providing three base level choices with enhanced optional riders, such as: • an optional Return of Premium/Cash Value Benefit rider that enables customers to get 100% of their premiums paid, minus any claims incurred, at the end of the rider period • Critical Conditions Benefit rider • Cancer Benefit rider • Heart and Stroke Benefit rider • Hospital Intensive Care Unit Benefit rider • Wellness Screening rider Washington National’s Critical Illness Insurance is available in 25 states: Alabama, Arkansas, Arizona, Colorado, Florida, Georgia, Iowa, Kentucky, Michigan, Missouri, Mississippi, Mon tana, North Carolina, North Dakota, Nebraska, New Hamp shire, Nevada, Oklahoma, South Carolina, South Dakota, Tex as, Wisconsin, West Virginia and Wyoming. It will be available in additional states in the future. To learn more, visit

LINCOLN FINANCIAL GROUP INTRODUCES HEALTH SAVINGS SOLUTIONS FOR PLAN SPONSORS Lincoln Financial Group recently launched an expanded suite of health savings solutions designed to empower retirement plan sponsors with a holistic approach to employee financial wellness. The comprehensive offering now includes a fully in tegrated Health Savings Account that serves as a tax-efficient tool to manage qualified medical expenses, achieve savings and pursue retirement readiness. Research shows that 45% of Americans surveyed say cov ering out-of-pocket medical expenses of $500 or more would be a financial hardship. The HSA allows employees to set aside pre-tax money for eligible healthcare expenses, and it can be used to save for retirement. When given the opportu nity, 60% of employees chose to enroll in an HSA-qualifying health option. “In the U.S., financial wellness is tied to overall health. Lincoln’s health savings solutions provide a comprehensive, integrated approach to both. By offering HSAs as part of their benefits package, plan sponsors can empower their employees to take control of their financial future, effectively managing healthcare expenses today while building a robust retirement savings nest egg,” said Ralph Ferraro, senior vice president, Retirement Plan Services, Lincoln Financial Group. HSAs are an integral part of Lincoln’s health savings solutions, offering numerous advantages for employers and employees: • streamlined administration and investment flexibility • enhanced employee recruitment and retention • triple tax savings -flexibility to use funds • holistic financial wellness support Lincoln’s new HSA offering is powered by vendors WEX and Benefit Plan Administrative Services. AMBETTER FROM MERIDIAN EXPANDS HEALTH INSURANCE OFFERING IN MICHIGAN Ambetter from Meridian, a product offered by a wholly owned subsidiary of Centene Corporation that provides insurance to under-insured and uninsured populations through the federal Health Insurance Marketplace, will offer a variety of affordable health insurance plans to residents in 33 counties in Michigan for 2024. “Everyone deserves access to high-quality healthcare that is affordable, convenient and provides a broad network of providers close to their home, school or work so they can | ABS 13


Banner|Aetna plans are available to individuals and their families in Gila County for the first time in 2024. The insurer continues to support Arizonans throughout Cochise, Coconi no, Maricopa, Pinal, Pima and Yuma counties. The company has launched new programs that will help consumers more easily access care at a lower cost. In addition to coverage for 10 essential benefits like prescrip tion drugs, maternity and newborn care, and mental health services, plans include: • Open access to in-network providers. Referrals are not required, and members can see any in-network doctor without selecting a primary care provider. • A yearly allowance of $100 for CVS-brand health and well ness items. Members also get 20% off CVS Health prod ucts. • $0 visits at MinuteClinic and HealthHUB locations. Mem bers can receive flexible, one-on-one support for acute and chronic care needs. • $0 on-demand, text-based primary care through 98point6. Members have 24/7 access to board-certified doctors for diagnosis and treatment. Enrollment can be completed directly through BannerAet, on or with the help of an authorized health insurance broker. FAIR HEALTH LAUNCHES VIDEO TUTORIAL FOR OLDER ADULTS Independent nonprofit FAIR Health recently launched a video tutorial on a dedicated section for older adults, avail able on its free, national, award-winning consumer website, Created as part of a three-year initia tive funded by The John A. Hartford Foundation to facilitate shared decision-making discussions and healthcare engage ment among older adults and family caregivers, the video tutorial orients users to the tools, educational content and resources available in the Older Adults section. The FAIR Health Consumer Older Adults section—which launched in September 2022 as part of a prior JAHF-funded planning grant—offers actionable tools, educational content and resources to help older patients and their family caregiv ers understand and manage their healthcare costs and make informed healthcare decisions. The video tutorial shows consumers how to use FAIR Health’s shared decision-making

live better, healthier lives, which is why we’re excited to add St. Clair County to serve more people across Michigan,” said Patty Graham, Meridian plan president. Ambetter from Meridian provides coverage of all essential health benefits, including preventive and wellness services, maternity and newborn care, pediatric services, mental health services, hospitalizations and prescription drug cover age. Some plans also include dental and vision coverage. Virtual 24/7 Care offers members an Ambetter-designated licensed provider via telehealth without having to leave their home to get quick remedies for non-emergency illnesses such as flu, skin conditions, ear infections, fever and respira tory infections. Through the Ambetter from Meridian website, people can browse and compare coverage options, determine their eligi bility for financial subsidies, and directly enroll in coverage— all in one place. The platform is accessible through mobile devices, so people can enroll using smartphones. If a person is unable to complete enrollment all at once, the system will save progress and provide reminders to finish enrollment. Members have access to the My Health Pays program, where they can earn points for practicing healthy eating habits, staying active and leading a healthy lifestyle. Through the program, members can complete health-related activ ities and challenges, and can earn up to $500 in rewards in 2024. These rewards can be used for health-related expenses such as copays and deductibles. My Health Pays also allows members to set and reach health goals at their own pace by providing seasonal suggestions for activities and guidance to help stay on track. Here is the full list of Michigan counties in which Ambetter from Meridian will be offered in 2024: Allegan, Barry, Berrien, Calhoun, Cass, Genesee, Hillsdale, Ingham, Jackson, Kalam azoo, Kent, Lake, Lapeer, Macomb, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Ottawa, Roscommon, Sanilac, St. Clair, St. Joseph, Van Buren, Washtenaw and Wayne. Visit for details.

BANNER|AETNA NOW OFFERING ENHANCED ACA INSURANCE PLANS TO MORE ARIZONANS Banner|Aetna, a joint venture health plan owned by Banner Health and Aetna, a CVS Health company, is offering Afford able Care Act health insurance plans with additional benefits across more Arizona counties in 2024. Banner|Aetna will offer Silver plans at zero premium in Maricopa, Pima and Yuma counties for fully subsidized members.

Continued on Page 34

14 ABS |

PEOPLE ON THE MOVE Warner Pacific, a health insurance general agency supporting healthcare brokers in California, Colorado, Oklahoma, Texas and Florida, is pleased to announce that Janet Trautwein is joining the company as its compliance and government affairs executive. Trautwein’s appointment to Warner Pacific will open new opportuni ties for the general agency’s employees, brokers, carrier partners and more. Trautwein has a distinguished career in the insurance industry, spanning 35 years. Having served at the helm of the National Association of Benefits and Insurance Profes sionals (formerly NAHU) since 2005, Trautwein brings with her an extensive network of broker professional associa tions and is highly respected for her in-depth understand ing of legislative and regulatory matters from an insider’s point of view. In her role as CEO for NABIP, Trautwein acted as prima ry representation for the association, worked with mem bers of Congress, senior government officials, governors and state legislators to direct government and political affairs of the organization, and provided oversight of its political action committee. Trautwein is a sought-after speaker, frequently speaking to groups from 50 to 2,000 members on health policy and health-reform issues and is an approved instructor for continuing education for health insurance and human resources professionals in all 50 U.S. states. As Warner Pacific’s compliance and government affairs executive, Trautwein will serve as a critical resource for the agency’s broker partners in compliance-related matters, providing hands-on guidance and insight to support bro kers in navigating policies that impact the industry. “One of the key benefits of Janet joining the Warner Pacific team is that our brokers will have access to her ex tensive inside knowledge of health insurance compliance, empowering them to better serve their clients,” said John Nelson, co-CEO of Warner Pacific. “Janet has been on the inside and will bring an unprecedented understanding of future trends and a unique perspective of the industry.” “I’m honored to join Warner Pacific. I have long ad mired their commitment to outstanding service and their reputation for being an excellent partner to their bro kers,” Janet Trautwein said. “I share their commitment to high-quality, innovative products and services, and I am

excited to collaborate closely in their mission to make a difference in our industry.”

Medica’s Board of Directors named Lisa Erickson pres ident and chief executive officer effective November 1. Medica operates in 12 states under Medica, Dean Health Plan and Prevea360 Health Plan brands. Prior to being named president and CEO, Erickson served as an executive in several national organizations in industries including healthcare, retail and consumer products. Erickson holds a Bachelor of Business Administration with a major in Finance and Marketing from the Univer sity of Wisconsin-Madison and an MBA from the Carlson School of Business at the University of Minnesota. She is a member of the Board of Directors of the Animal Humane Society and previously served on the Board of Trustees for the Academy of Holy Angels, where she served as Finance Committee chair.

Insurance Office of America is pleased to welcome Adam Balas to its employee benefits team as IOA continues to expand its Florida Division marketplace. Before joining IOA, Balas spent more than a decade working with two large national brokerage firms where he was responsible for overseeing and managing

his clients’ employee benefits programs. His industry spe cializations include construction, healthcare, hospitality, manufacturing, nonprofit/not-for-profit and technology. Balas creates bespoke programs utilizing data analytics, self-funding, care-coordination models and high-perfor mance networks with the goal of reducing healthcare spend and improving quality of care and outcomes. Balas earned his Bachelor of Science degree in finance and financial management services from Fitchburg State University. He is a frequent featured speaker at professional events, addressing the topics of compliance, employee education and self-funding.

Continued on Page 30 | ABS 15

Made with FlippingBook - Online catalogs