America's Benefit Specialist July 2023

Renaissance understands what it takes to build a trusted relationship in ancillary benefits. to the heart of the matter. Ancillary benefits Expertise goes straight

See more at RenaissanceStandsOut.com

SPECIAL ADVERTISING FEATURE

We understand how Important You Are to the process and us. Relationships drive this business. That’s why Renaissance continuously strives to develop successful, long-lasting relationships. It’s critical to providing an experience that Stands Out every day—for brokers, employers and employees.

Focused on ease of use. Our organization and our culture are built around the idea of making ancillary benefits easier for everyone. The easier things are, the better the relationship is. For example, our new cloud-based end-to-end system makes billing easier for your clients by enabling consolidated multiline billing statements. There’s power in trusted relationships. A recent study indicated that one of the things brokers value most in choosing a carrier is their sales rep relationship.* We do all we can to be true partners. That’s why every sales rep is backed by dedicated account team members averaging 18 years of experience. It’s easy to see why so many brokers rely on Renaissance for their ancillary benefits needs.

Multiline expertise simplifies a perfect fit. With such a wealth of experience in Dental, Vision, Life and Disability insurance, our team streamlines the process of developing the ideal customized program for every client, regardless of case size.

To see what our experience can do for your relationships, visit RenaissanceStandsOut.com

*Renaissance, 2023 Broker Insights Survey, Internal Data Underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN, and in New York by Renaissance Life & Health Insurance Company of New York, Binghamton, NY. Both companies may be reached at PO Box 1596, Indianapolis, IN 46206. Products may not be available in all states and jurisdictions. For broker use only. Not intended for distribution.

NEW NABIP PRESIDENT ERIC KOHLSDORF

Carriers are not created equal.

The better choice for Medicare supplement and outstanding service. Helping your clients choose their Medicare supplement carrier is one of the most important things you do. That means picking the right carrier the first time. Since plans are standardized, how can carriers differentiate themselves to customers? While price matters, so does peace of mind. • Confidence. We’ve been in the market for more than 55 years and, as a carrier with a national presence, we hold more than 1.4 million policies in force. Clients can rest easy with us. access to underwriters and a dedicated sales support staff. For clients, it means we deliver on our promises to pay, to provide competitive rates and to offer a household discount of up to 12%. We also offer underwriting automation, as we auto decision over 60% of our applications. • Outstanding service. For you, this means direct As the nation’s number two carrier for Medicare supplement, Mutual of Omaha offers:

• Brand awareness. Our recognized name among Medicare-eligible clients means your customers know us. You don’t have to sell us.

Plans that make a difference!

• Check out our competitive prices and savings on Plan N.

• High-Deductible Plan G available.

A+

A1

A+

Superior This rating is the Second highest of 16.*

Good This rating is the Fifth highest of 21.* MOODY’S INVESTORS SERVICE

Strong This rating is the Fifth highest of 21.*

S&P GLOBAL

AM BEST

*as of 3/1/23

For clients who are looking to make the right Medicare supplement decision, look no further than Mutual of Omaha. Contact your marketer or visit mutualofomaha.com/ sales-professionals.

615408 For producer use only. Not for use with the general public.

July 2023

YOUR INDUSTRY

YOUR SALES

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35 Five Considerations to Maximize Level Funding By Daniel MacLeod 38 Why Do Clients Leave an Agency? By Kelsey Rosauer 42 Organizational Culture Is a Sustainable Competitive Advantage By Gorden Zellers

Mergers and Acquisitions

7

Product News

12 NABIP Policy Series

Reducing the Cost of Healthcare: Site Neutrality

12

13 On the Horizon:

Legislative and Compliance Issues to Watch By Misty Baker

15 Industry Events

YOUR ASSOCIATION

16 Insulin Prices Capped by Eli Lilly By Scott Stevens 18 An Interview with NABIP President Eric Kohlsdorf

46 Association Events

38

47 CPC Quiz

50 Welcome to NABIP

25 Noteworthy

51 Congratulations, Registered Employee Benefits Consultants!

MEDICARE MATTERS

52 Your NABIP Staff

31 CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs

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If you paid for or provided reimbursement for some or all of the purchase price of brand or generic Exforge® (fixed combination of amlodipine and valsartan tablets), you could get a payment from a class action lawsuit.

A federal court authorized this Notice. It is not a solicitation from a lawyer.

A Settlement has been reached with Novartis Pharmaceuticals Corp. and Novartis AG (“Novartis”) in a class action lawsuit that will provide $30,000,000 in cash to resolve the End-Payor Plaintiffs’ claims against Novartis. The lawsuit is captioned In Re: Novartis and Par Antitrust Litigation, Case No. 1:18-cv-04361 (AKH), pending in the United States District Court for the Southern District of New York. What does the Settlement provide? Novartis has agreed to pay $30,000,000 in cash to the Settlement Fund for pay ment of the following: (i) valid Claim Forms for cash benefits submitted by Settlement Class Members; (ii) the notice and other administrative costs actually incurred by the Claims Administrator; (iii) Attorneys’ Fees and Costs, as may be ordered by the Court; and (iv) service awards of $25,000 for each of the Class Representatives, as may be ordered by the Court. Who is included in the Settlement Class? You are a member of the Class if you purchased or paid for brand and generic Ex forge (fixed combination of amlodipine and valsartan tablets) between September 21, 2012 through June 30, 2018 in the District of Columbia, Arizona, California, Florida, Hawaii, Iowa, Maine, Michigan, Minnesota, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, South Dakota, Utah, Vermont, West Virginia, or Wisconsin. How do I get a payment from the Settlement? To qualify for a settlement payment, you must complete and submit a valid Claim Form by August 18, 2023 . You may complete and submit a Claim Form online at www.exforgeantitrustsettlement.com or mail a completed Claim Form to Novartis and Par Antitrust Litigation, c/o Claims and Notice Administrator, 1650 Arch St, Ste 2210, Philadelphia, PA 19103. Claim Forms are also available by calling 1-833-741-2334 , or by emailing info@exforgeantitrustsettlement.com . What are my options? If you are a Settlement Class Member and do nothing, you will be bound by the Settlement and will give up any right to separately sue Novartis for the claims made in this lawsuit and released by the Class Action Settlement Agreement (“Settlement Agreement”). If you don’t want to be legally bound by the Settlement, you must exclude yourself from it by August 18, 2023. Unless you exclude yourself, you won’t be able to sue or continue to sue Novartis for any claim made in this lawsuit or released by the Settlement. If you stay in the Settlement (i.e., don’t exclude yourself), you may object to it or ask for permission for you or your lawyer to appear and speak at the Final Approval Hearing – at your own cost – but you don’t have to. Objections and requests to appear are due by August 18, 2023 . More information about these options is available at www.exforgeantitrustsettlement.com. Do I have a Lawyer? The law firm listed below has been appointed by the Court as Class Counsel for the EPP Class:

VOLUME 70, NO. 6

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

Robin A. van der Meulen DICELLO LEVITT LLP 485 Lexington Avenue, Suite 1001 New York, NY 10017

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 6 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.

You will not be charged for their services.

The Court’s hearing. The Court will hold a Fairness Hearing at 10:30 a.m., ET on October 3, 2023 , in Courtroom 14D, of the United States District Court for the Southern District of New York, Daniel Patrick Moynihan U.S. Courthouse, 500 Pearl Street, New York, NY 10007. At this hearing, the Court will consider whether the Settlement with Novartis is fair, reasonable, and adequate. If there are objections, the Court will consider them. After the hearing, the Court will decide whether to approve the settlement. This notice is only a summary. For more information, including the long form notice and Settlement Agreement, visit www.exforgeantitrustsettlement.com, email Info@exforgeantitrustsettlement.com, or call 1-833-741-2334

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MERGERS AND ACQUISITIONS

Integrity has partnered with Christian Brindle Insurance Services, an independent marketing organization based in Sandy, Utah, and led by Christian Brindle, president. CBIS serves seniors across the nation, specializing in Medicare Advantage and Medicare Supplement plans. The agency has cultivated a strong online presence to provide mentorship to agents and to educate seniors through podcasts, e-books and social media, including the creation of the Seven Figure Medicare Agent Facebook Group, a community of nearly 6,000 agents. Additionally, Integrity has partnered with Patriot Family Financial, an independent marketing organization based in Fredericksburg, Virginia, and led by Sean Schickel, president. Prior to founding Patriot Family Financial in 2018, Schickel served in the United States Marine Corps for 24 years. His service included leading hundreds of Marines in combat and serving as the Marine Corps lead planner for the 2013 Pres idential Inauguration of President Barack Obama. Schickel brings his military management and leadership principles to the robust agent training program developed at Patriot Family Financial. The agency is renowned for growing agents into top producers by inspiring client trust and focusing on finding solutions to client needs. Patriot Family Financial is a rapidly growing distributor of solutions for the senior market. Since 2018, the Fredericks burg, Virginia-based agency has helped thousands of Ameri cans prepare for the future and get health and drug cover age that fits their needs. With agents located across the U.S. and a local virtual enrollment center, Patriot Family Financial reaches people nationwide. Patriot Family Financial is a certified Service-Disabled Veteran company and is known for its robust agent training and use of modern technology and enrollment platforms. Finally, Integrity has acquired The Insurance Superstore, an independent marketing organization based in Colora do Springs, Colorado, and led by Brad Keating, president.

GALLAGHER ACQUIRES BERNARD BENEFITS In late May, Arthur J. Gallagher & Co. announced the acquisi tion of Nashville, Tennessee-based Bernard Benefits and Ber nard Healthcare Financial Planning, subsidiaries of Bernard Health. Terms of the transaction were not disclosed. Bernard Benefits is a health and employee benefits brokerage firm with a focus on small-group businesses in Tennessee, Indiana and Texas. Bernard Healthcare Financial Planning advises individuals and families on health insur ance coverage. Brian Tolbert, Matt Kleymeyer and their team will remain in their current location under the direction of Robby White, head of Gallagher’s South Central region em ployee benefits consulting and brokerage operations. “Bernard complements our existing employee benefits of ferings and represents an excellent cultural fit,” said J. Patrick Gallagher Jr., chairman, president and CEO. “I am very pleased to welcome Brian, Matt and their associates to Gallagher.” THE BLAIR AGENCY JOINS LTC GLOBAL LTC Global Inc. has acquired The Blair Agency Inc., a Capitas Financial Inc. member headquartered in St. Louis. Michael Blair will continue to manage The Blair Agency, which oper ates across the central United States. The Blair Agency, founded in 1972, joins other LTC Glob al group and Capitas Financial member agencies: Pacific Southwest Financial and Insurance Services Inc., The Smith Companies, NorthCoast Brokerage Agency Inc. and Pitts burgh Brokerage Services Inc. The Blair Agency operates a life and health insurance agency serving brokers and clients throughout Missouri, Arkansas, Kansas, Oklahoma and Southern Illinois. INTEGRITY CONTINUES TO GROW Integrity Marketing Group LLC has announced several recent acquisitions:

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Financial terms of the acquisition were not disclosed. Keating founded The Insurance Superstore in 2008 to help seniors understand their health insurance options through Medi care and the Affordable Care Act. The agency now serves thousands of Americans across multiple states through its growing team of agents. In addition to health insurance, The Insurance Superstore also provides life insurance and annu ities. Since its establishment, The Insurance Superstore has helped thousands of families throughout Colorado, Nebras ka, Arizona, Missouri and Florida. HUB INTERNATIONAL ACQUIRES HORAN’S EMPLOYEE BENEFITS DIVISION Hub International Limited has acquired the employee bene fits assets of HORAN Associates, Inc. and HORAN Smart Busi ness, LLC (collectively HORAN Health). Terms of the transac tion were not disclosed. With HORAN Health, Hub creates a new regional hub to be called Hub Heartland. HORAN is one of the largest privately held insurance and financial services organizations in the Cincinnati Tri State area. HORAN Health’s nearly 120 employees in Ohio and Northern Kentucky will join Hub. HORAN Health pro vides employee benefits solutions to more than 650 small and midsize companies, covering thousands of lives. HORAN Health serves both corporate and individual clients in 48 states. The HORAN Wealth division will continue to independen tly serve individual and corporate clients in the areas of retirement, investment advising, life insurance, financial planning and social security under the leadership of current President and Chief Executive Officer, Terence L. Horan, CLU, ChFC, CAP.

Hub Heartland will be led by Valerie Bogdan-Powers, president of HORAN Health. She will work with Neil Hughes, president of Hub’s U.S. Central Region. Bogdan-Powers has led HORAN Health’s overall strategy with a focus on growth for the organization. Prior to HORAN, Bogdan-Powers was in sales and brand management for over 20 years at Procter & Gamble. Bogdan-Powers is a graduate of Harvard University and holds her life and health insurance license. MarshBerry served as financial advisor to HORAN for the transaction. HIGHSTREET INSURANCE PARTNERS COMPLETES 150TH AGENCY ACQUISITION Highstreet Insurance Partners (Traverse City, Michigan) has partnered with Pennsylvania-based Yorke Agency (Yorke) and Maine-based Curley & Associates (Curley) marking their ninth and tenth acquisitions in 2023. Highstreet is one of the fastest growing insurance agencies in North America and has now reached a milestone of 150 acquisitions since form ing the company in mid-2018. “We are delighted to welcome the Yorke and Curley teams, as well as their clients to Highstreet. As we continue our rapid growth, we do it with agency partners who share our values, have entrenched relationships with their clients and are committed to their community.” said Scott Wick, founder & CEO of Highstreet. Highstreet Insurance Partners is a full-service independent insurance agency. The company provides a broad array of business insurance, employee benefits, personal insurance, retirement services and specialty risk solutions that are deliv ered through community-focused agencies.

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HOT PRODUCTS

Special Advertising Feature Special advertising feature

SIGNIFICANT RECURRING REVENUE FOR YOUR REFERRALS Your Clients need Work Comp, why not help them save money on their Work Comp premium and expand their access to services while earning recurring revenue?

WorkCompMGA 7395 E Orchard Rd Greenwood Village, CO 80111 1.888.659.2642 WorkCompMGA.com WorkCompMGA Associates Insurance Group, Inc. Powered by

Associates Insurance Group, the Premier Work Comp Brokerage in the Country. Because we specialize in Work Comp, we find savings that other Brokers miss and add services that other Brokerages don’t. We have access to over 100 Work Comp Carriers, exclusive Carrier programs, safety resources, and an In-House Medical Division, staffed by Registered Nurses, that triage initial workplace injuries and properly advocate the claims with the Carrier. Referring your Clients is easy. You make the introduction; We will professionally contact them, quote their policy with up to 100 Carriers, structure their policy properly, and service the policy--giving your Client access to our expanded services including our In-House Medical Division and Safety Resources. And you earn significant recurring revenue.

Your Clients will receive Industry-Leading Savings and Services: • In-Depth Workers’ Compensation Policy Design Review • E-MOD Analysis • Deductible Analysis • Discount Analysis • Yearly Quotes from up to 100 Carriers at renewal • Safety Programs and resources designed for them • Access to the In-House Medical Division for claim advocacy

You work hard for your Clients to ensure they have the proper health coverage. Because Workers’ Compensation deals with employee injuries, improper education and management can impact your Client’s healthcare utilization. Unfortunately, more than 90% of the Work Comp Policies we see are not structured and serviced correctly by the P&C Industry. WorkCompMGA is powered by

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PRODUCT NEWS

states coming online throughout the remainder of 2023. For more information, visit www.sunlife.com.

WASHINGTON NATIONAL ANNOUNCES NEW ACCIDENT INSURANCE PRODUCT Washington National Insurance Company, a national pro vider of supplemental health and life insurance products for middle-income Americans, has announced its new Accident Insurance product. Available for individual and worksite sales, Accident Insurance offers financial protection in the form of lump-sum cash benefits paid directly to the policyholders when a covered accidental injury occurs. Accident Insurance benefits can help policyholders pay for accident-related costs that aren’t covered by a traditional health or disability insurance plan. It includes four levels of coverage, six optional benefit riders, and built-in accidental dismemberment and death benefits. The optional Return of Premium/Cash Value benefit rider is a distinctly competitive feature in the marketplace that allows customers to get back 100% of their premiums paid, minus any claims incurred, at the end of the rider period. Accident Insurance is available in 30 states: AK, AL, AR, AZ, FL, GA, HI, IA, IL, KS, KY, LA, ME, MI, MO, MS, MT, ND, NE, NH, NV, OK, PA, SC, SD, TX, WA, WI, WV and WY, with additional states being added later this year. To learn more, visit www. WashingtonNational.com. SUN LIFE OFFERS NEW DENTAL PLAN OPTIONS As part of its Lifetime of Smiles oral health platform, Sun Life U.S. has launched two PPO dental plan options for employer clients, to help their employees stretch their benefit dollars and get more coverage for the dental care they need. The Preventive Rewards option incentivizes people to get regular cleanings by adding money to the annual maximum amount covered by their policy when they maintain preven tive care. The RollMax option allows dental members to roll over a portion of unused annual maximum dollars for future use. Both options provide additional funds to cover more dental care, from preventive or routine care to major services such as root canals, dentures, or oral surgery. Employers can use Sun Life’s comparison tool to see which plan option is the best fit for their employees. Preventive Rewards and RollMax are currently available in 32 states for policies effective January 1, 2024, with additional

PETERSEN INTERNATIONAL DEBUTS NEEDLESTICK INSURANCE

Petersen International Underwriters has announced a new product for employee benefits market called Needlestick Insurance. This group benefit plan offers a significant cash lump sum to help compensate healthcare workers, emer gency services workers and first responders who have been injured by a needlestick occurrence and have contracted a bloodborne pathogen. The purpose of the insurance is to help cover costs associated with testing, treatment and other expenses that may arise as a result of needlestick injury, such as lost wages and travel expenses. The plan provides benefits up to $100,000 and covers Hep atitis B, Hepatitis C and HIV. Also, the product offers census enrollment as an employer-paid group plan. The policy term is one year, and it is available in most states. Petersen International Underwriters specializes in unique medical, life and disability insurance platforms for high-net worth individuals, small businesses and large corporations. Visit www.piu.org to find out more. SOLA LAUNCHES SELF-FUNDED HEALTH PLANS TO HELP EMPLOYERS SAVE ON BENEFITS Sola Health has launched a portfolio of self-funded health plans that deliver premium medical and pharmacy coverage at a lower cost. With these plan designs, Sola is helping employers of all sizes break free from the skyrocketing pre mium and renewal costs commonly experienced with fully insured carriers. As part of the Goodroot community of companies, Sola is on a mission to address rising healthcare costs for employ ers and their people. Aside from zero-dollar renewals, Sola plans include targeted solutions for high-cost medical and pharmacy claims—a true differentiator for employers in the self-funded market. From level-funded plans with major national carrier net works to more aggressive value-based pricing plans, Sola caters to varying degrees of self-funding experience. Their team guides groups new to self-funding through the transi tion, mitigating unseen risks and protecting businesses from potential high-cost claims and employee disruption.

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PRODUCT NEWS

difficult, if not impossible, to read and use: The data sets are extremely large. To find a single rate for a physician at a facili ty requires querying billions of lines of data in real-time. The data are also too limited to have value alone with out appending additional information and adding context, including provider demographics. Finally, the data are noisy. Every contracted rate for a provider is required to be included regardless of whether or not they offer that service. For ex ample, Zelis found chiropractors with cesarean delivery rates and an allergist with rates for knee joint replacement. Zelis’ Healthcare Insights 360 addresses these challeng es by making the data digestible down to the specific CPT codes, facility and provider, empowering both collective containment on rising costs as well as enhancing individual payers’ market position. Zelis’ Healthcare Insights 360 em powers payers to: • understand how an organization’s cost position compares to the national, regional and local market to hone financial planning and expansion opportunities. • make strategic decisions for geographic-based plan growth, like entering or exiting markets, based on cost and provider performance. • identify opportunities and risks related to how an organi zation’s contracted rates compare to competitors • leverage pricing data to showcase plan value to prospec tive employer clients by quantifying value. Visit zelis.com to learn more. NEW YORK LIFE LAUNCHES SUITE OF TERM LIFE PRODUCTS New York Life has launched a suite of attractively priced term life products that provide greater value for clients’ protec tion dollars and support preparedness for life’s financial challenges and opportunities. Designed for individuals and small-business owners, New York Life’s updated Term Life suite includes: Level Term—Available for 10-, 15- and 20-year periods. Level Term enables customers to put financial protection in place for themselves and their families for a specified period, ensuring peace of mind and opportunity to address other long-term financial goals. Yearly Renewable Term—Delivers year-to-year protection for those with short term needs or who plan to convert to long-term coverage within a few years.

With the company’s user-friendly mobile app, employees can easily manage their prescriptions, access digital ID cards, track deductibles and more. The Sola app also integrates benefit navigation, 24/7 free virtual care and hospital finan cial assistance applications to ensure employees have dozens of ways to save on healthcare. While Sola serves groups of all sizes, their primary focus is on those with 25-200 employees. This segment is frequently underserved and often unaware that self-funding is a viable alternative to traditional healthcare funding methods. Go to www.solahealth.com to learn more. WARNER PACIFIC FORMS CARRIER PARTNERSHIP WITH COMMUNITYCARE Warner Pacific Insurance Services recently announced a partnership with CommunityCare, a health plan serving in dividuals and businesses in Oklahoma. Brokers working with Warner Pacific now have a new fully insured product to offer their group clients. The partnership took effect June 1. CommunityCare offers Warner Pacific brokers and their cli ents a wealth of experience, services and access to excellent care. Their dedication to customer satisfaction aligns perfect ly with Warner Pacific’s core values, making this partnership an ideal match. “We are thrilled to announce our partnership with Com munityCare,” said John Kurath, Chief National Sales Officer for Warner Pacific. “Their commitment to providing afford able, high-quality healthcare and the vast services they offer members is impressive. Together, we will support the well-being of individuals and businesses in Oklahoma.” The partnership reflects the shared vision of Warner Pacific and CommunityCare to make high-quality healthcare acces sible to all Oklahomans.

ZELIS UNLOCKS POWER OF PRICE TRANSPARENCY DATA

Zelis, a healthcare technology company modernizing the healthcare financial experience, has launched Healthcare Insights 360. This new healthcare intelligence solution pairs data from Zelis’ network analytics solutions with intelligent technology that collects, normalizes and translates the billions of cost-data elements that have recently become available through the federal Transparency in Coverage Rule. The rule requires companies offering health insurance cov erage to disclose in-network provider-negotiated rates via machine-readable files (MRFs). As is, these payer MRFs are

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PRODUCT NEWS

Options to Purchase Additional Living Benefits—Including access to a portion of the death benefit should a policyholder become terminally ill, and the ability to have their premiums waived if the policyholder becomes disabled. Recent research has demonstrated a significant gap be tween the amount of life insurance consumers have versus the amount they believe they need. The gap stands at an all time high of 18 points, more than double the gap 13 years ago. “Often the amount of life insurance coverage in place is de termined by how much individuals can afford to pay in pre miums, versus the amount of income they need to replace and doesn’t reflect a changing financial picture,” said Aman da Kuhl, SVP and head of Life Products. “The competitive pricing on this new suite of term life products ensures clients can secure more value from their coverage and access policy features that support bigger goals, like keeping a business afloat, saving for retirement or a child’s college education.” For more information, visit www.newyorklife.com. SPROUTT ADDS GENERATIVE AI CAPABILITIES TO ITS AGENT PLATFORM Sproutt, a company that modernizes life insurance for agencies, agents and their customers, has announced the development of a groundbreaking AI engine, currently avail able only to limited groups, to boost its SmartLife platform. The platform’s capabilities will be supercharged by genera tive AI technology, empowering agents and agencies with more predictive product fulfillment and client-engagement capabilities based on Large Language Models (LLM) technol ogy. The introduction of AI will revolutionize the way agents interact with clients and marks a significant milestone for Sproutt, further demonstrating its commitment to providing technology solutions within the life insurance ecosystem. Sproutt’s SmartLife platform is leveraging the power of generative AI to create unique and personalized client com munications based on multiple data sources and previous interactions with clients. By evaluating this data, the platform will generate relevant and timely content that agents can utilize to enhance customer engagement and sales. Events such as a client’s policy anniversary, renewal date, birthday and even local sports team news can be factored in to trigger precise communications. SmartLife’s user-friendly interface enables agents to easily navigate and access the information they need to be successful. The platform will also be boosted by AI-driven product recommendations, employing multiple data sources to deliver tailored product solutions for each client. Predictive modeling capabilities will enable agents to anticipate future client needs, further elevating their potential. Leveraging AI for product fulfillment will overhaul the insurance sales

process, increase STP rates, and effectively transform agents into experts. Learn more at www.sproutt.com.

FRINGE BENEFIT GROUP ANNOUNCES THE CONTRACTORS PLAN ICHRA Fringe Benefit Group recently announced The Contractors Plan ICHRA, a flexible, cost-effective and compliant solution for Service Contract Act (SCA) and Davis-Bacon Act employ ers that face challenges in providing health benefits to their employees. By offering Individual Coverage Health Reim bursement Arrangements as part of the fringe benefit pack age, prevailing-wage contractors can fulfill their obligations while providing valuable health benefits to their employees. Employees can now choose their own individual health in surance plans based on their needs and not a one-size-fits-all group health plan. The Contractors Plan, Fringe Benefit Group’s flagship brand, is a comprehensive third-party administrator, offering retirement plans and major medical, dental, vision and life insurance designed specifically for government contractors. The addition of the ICHRA option to The Contractors Plan further expands the company’s offering. The Contractors Plan ICHRA solves several problems. Tradi tional group health insurance plans can be expensive, partic ularly for prevailing-wage contractors that are often required to provide bona fide fringe benefits as part of their employ ees’ compensation package. By offering ICHRA as part of the fringe benefit package, employers can fulfill their obligation, stay compliant, stay in budget, greatly reduce time spent administering group benefits, and provide valuable health benefits to their employees. The Contractors Plan ICHRA simplifies benefits adminis tration by allowing employers to focus on managing reim bursements rather than navigating complex group health insurance plans. Additionally, brokers can assist with the setup and ongoing management of ICHRA accounts, further easing the administrative burden for employers. For more information, visit www.fbg.com, www.thecontrac torsplan.com or www.theamericanworker.com.

SECURIAN FINANCIAL AND RECLAIM HEALTH USE ANALYTICS TO HELP CUSTOMERS GET THE MOST OUT OF THEIR SUPPLEMENTAL HEALTH BENEFITS Securian Financial is teaming up with Reclaim Health to increase benefit utilization for Securian Financial’s supple-

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Level up your health and life insurance agency with the #1 Agency Recommended Management Platform

mental health insurance customers through claims integration and analytics. Reclaim Health is a claims-driven health care financial advocacy platform help ing plan members optimize their health care benefits. Through Securian Financial’s business relationships with self-insured employer clients, its supplemental health insurance customers can opt in to proactively manage their supplemental health benefits claims through Re claim’s medical claims integration. Reclaim’s AI-powered claims analytics then matches with Securian Financial’s supplemental health insurance records to determine benefit eligibility and proactively sends notifications to employees who are eligible to submit claims for those benefits. “While more employers are offering supplemental health benefits to their employees to help stem the tide of rising medical bills, the benefits are still new and unknown to many employees. As a result, whether it’s forgetting that they signed up for the benefits or simple inertia, some employees fail to seek claims for benefit payments in which they are entitled,” said Ross Stedman, Securian Financial second vice president of business services. “Claims integration tackles this, with employees receiving a text message or email whenever they may be eligible for a claim. It’s important to our customers that the claims experience is fast, easy and personalized, and this medical claim integration solution really checks all those boxes.” Claim integration powered by Reclaim is available at no additional cost to all Securian Financial supplemental health insurance customers. AEQUUM LAUNCHES NO SURPRISES ACT WEBSITE TO ADVANCE UNDERSTANDING AND COMPLIANCE aequum LLC, acting on behalf of over 400 self-insured health plans and their participants, has launched its dedicated website (https://knowthenosurprises act.com) and information portal. Employers, plan sponsors, third-party admin istrators, brokers, payers and patients can access the portal for current informa tion relating to the No Surprises Act (NSA). This hub enables visitors to quickly review current federal rules and regulations, access resources that support health plan compliance and acquire valuable updates on current litigation, news and developments. Christine Cooper, CEO of aequum, explains: “Our team is at the nexus of discussions and activities surrounding NSA and is implementing this resource center to help guide the industry with an understanding of the rules, regula tions and rights under the NSA. We are proactively responding to the needs of our partners, clients and their members, helping to protect them against unreasonable medical charges and balance-billing.” Surprise billings and the lack of price transparency have been significant challenges for all stakeholders. The NSA is designed to protect patients from surprise medical bills for certain emergency services as well as services received from out-of-network providers at in-network facilities. “NSA compliance remains a top priority for plan administrators and the most effective way to address the NSA is through a combination of strategic and compliance-oriented approaches,” Cooper said. “This may include adopting a ‘pure’ reference-based pricing plan design to limit plan benefits and partici pant out-of-pocket costs to the true cost of provider services.” Visit aequumhealth.com to discover more.

agencybloc.com/NABIP2023

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Sell plans that sell themselves

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Get appointed with Cigna Healthcare today. Visit cigna.com/sell-ifp-dental

06/23 © 2023 Cigna Healthcare. Some content provided under license.

POLICY SERIES

REDUCING THE COST OF HEALTHCARE: SITE NEUTRALITY THE PROBLEM Prices for healthcare can be distorted by many things, but one very import ant factor is Medicare paying higher reimbursements for hospital settings than in physician office settings for the same service. Because many commercial plans base payment rates on an enhanced percentage of what Medicare pays for healthcare services, the distorted Medicare payments also affect private health plans. According to the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy, this disparity in reimbursements for the same service creates increased incentives for healthcare-provider consolidation, which has resulted in higher health care costs. As an example, in its June 2022 report to Congress, MedPac reported that in 2022 Medicare paid 141% more in a hospital outpatient department than did for the same care in a freestanding office for the first hour of chemotherapy infusion. • Medicare pays higher reimbursements for hospital settings than in physician office settings for the same service, which affects private health plans. • Expanding site-neutral payment policies in Medicare could gen erate $6.6 billion in annual savings for Medicare and taxpayers and lower cost-sharing for Medicare beneficiaries by $1.7 billion. • New research estimates that expanding site-neutral payment reform could result in nearly $60 billion in savings annually in the commercial market. Payment rates based on treatment settings have incentivized hospitals to shift sites of care from physician offices to hospital outpatient depart ments, and we have seen a significantly increased rate of hospitals acquir ing physician practices. In the report, MedPAC noted that the increased reimbursements are not linked to improved quality of care for beneficia ries, but they are directly linked to increased costs for patients. MedPAC’s June 2022 report estimated expanding site-neutral payment policies in Medicare could generate $6.6 billion in annual savings for Medicare and taxpayers and lower cost-sharing for Medicare beneficiaries by $1.7 billion. New research estimates that expanding site-neutral pay ment reform could result in nearly $60 billion in savings annually in the commercial market. THE SOLUTION At a high level, site-neutral payment is the concept of aligning payment rates for certain services across the three main sites where patients receive outpatient care: hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs) and freestanding physician offices. While Congress and CMS have made progress toward balancing pay ments between healthcare settings, NABIP believes more needs to be done to lower costs for patients and generate savings for the Medicare program and private health plans. We support both Congressional and regulatory action to align Medicare fee-for-service payment rates across ambulatory settings and encourage adoption of these policies in the commercial market.

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ON THE HORIZON: LEGISLATIVE AND COMPLIANCE ISSUES TO WATCH

We may be at the halfway point of the year, but there are still big things on the horizon that brokers should be keeping an eye on. Your clients are depending on you to help them stay on top of key deadlines and to understand their responsibil ities with respect to changing legislation and legal rulings. Here are three issues your clients need to be aware of: GAG CLAUSE ATTESTATION Both employer groups and insurance carriers must attest that they have not engaged in contracts with providers that have gag clauses. The Consolidated Appropriations Act (CAA) defines a “gag clause” as: • restrictions on the disclosure of provider-specific cost of quality-of-care information or data to parties such as the plan sponsor, participants, beneficiaries or referring providers • restrictions on electronic access to de-identified claims and encounter information or data for each participant, By Misty Baker Director of Compliance and Government Affairs BenefitMall Leander, Texas misty.baker@benefitmall.com

beneficiary or enrollee upon request and consistent with HIPAA, GINA and ADA privacy regulations • financial information, such as the allowed amount, or any other claim-related financial obligations included in the provider contract • provider information, including name and clinical designation • service codes or any other data element included in the claim transactions • restrictions on sharing information or data or directing that such information or data be shared with a business associate The “no gag clause” rule applies to contracts between a plan and a healthcare provider, a network or association of providers, a third-party administrator or another service pro vider offering access to a network of providers. The gag clause

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provisions of the CAA (specifically Code section 9824, ERISA section 724 and PHSA § 2799A 9(a)(1)) generally prohibit plans and carriers from entering into agreements with providers, TPAs or other service providers that include such provisions. One example of a gag clause would be a contract between a group health plan and a TPA that states the plan will pay providers at designated “point of service rates,” but the TPA contractually prohibits the plan from disclosing the rates to participants. If a contract between a group health plan and TPA states that the plan sponsor’s access to provider-specific cost and quality-of-care information is only available at the TPA’s discretion, that would also constitute a gag clause. What it means for you: Make sure your employer groups understand their responsibilities related to attestation. The first Gag Clause Prohibition Compliance Attestation is due no later than December 31, 2023, but don’t wait! This require ment applies to employer groups of all sizes. Make sure your clients understand that there are no exceptions. The first attestation covers the period beginning Decem ber 27, 2020, (or the effective date of the applicable group health plan or health insurance coverage, if later) through the date of attestation. Employers should visit the official Gag Clause Prohibition Compliance Attestation website, https://hios.cms.gov/HIOS-GCPCA-UI, for instructions on how to submit. Subsequent attestations (covering the period since the last preceding attestation) are due by December 31 of each year thereafter. Moving forward, self-funded plans that are engaging new partners or carriers should carefully review contracts to en sure there are no gag clauses. MEDICAID UNWINDING In March 2020, as part of COVID-19 relief legislation, Congress provided increased Medicaid funding to states. States had to meet several conditions to receive the federal funds—collec tively called a Maintenance of Effort (MOE) requirement—as well as a “continuous coverage” requirement that prohibited states from terminating most Medicaid enrollees’ coverage until after the public health emergency ended. During the PHE, Medicaid agencies could not disenroll anyone from Medicaid unless the individual asked to be disenrolled, moved out of state or died. Continuous coverage allowed millions of people to stay covered without any inter ruption during the pandemic. Since the PHE ended in May 2023, states have begun “un winding”—the process by which states resume annual Med icaid-eligibility reviews. Medicaid agencies will first attempt to complete an automated renewal based on information available to them. If that is not possible, agencies then send renewal notices and requests for information to enrollees. When enrollees respond, agencies process the cases, renew coverage for those who remain eligible, and notify those who are no longer eligible that their coverage will end.

If enrollees don’t respond—because they don’t get the request for information due to having changed their address or phone number or they don’t understand what they are supposed to do, for example—their coverage will end. There are an estimated 90 million people enrolled in Med icaid today; all of them will need to be reviewed for eligibility during unwinding. Estimates are that 15 million to 18 million people will lose Medicaid coverage during this process. Up to 4 million individuals may be eligible for employer-based insurance plans, but others need to move to federal or state based exchanges, where they may be eligible for subsidies. The unwinding process could take 12 to 14 months in each state, with each state determining its own timeline. Because of this, a special enrollment period (through July 2024) allows affected individuals to enroll in an employer-based plan or the individual market. What it means for you: Visit Georgetown Universi ty’s 50-State Unwinding Tracker (https://ccf.georgetown. edu/2023/04/01/state-unwinding-tracker/) for a data dash board and links to individual state resources and timelines. Reach out to clients who may no longer qualify for Medicaid coverage to discuss their options for private health insurance or Medicare-related products. Each state is managing unwinding differently, so some current Medicaid enrollees may not realize they will be losing access to the program. As part of open-enrollment commu nications, employers may want to include information about Medicaid unwinding to prompt employees currently enrolled in Medicaid that they should elect company-sponsored ben efits during open enrollment rather than waiting until the state completes its review. RULING ON PREVENTATIVE CARE In March, a federal judge struck down a key provision of the ACA, ruling that certain aspects of the preventive care man date violate the Constitution. The legal challenge was brought by eight individuals and two businesses, all from Texas. They argued that the mandate for plans to cover drugs related to HIV prevention requires business owners and consumers to pay for services that are counter to their religious beliefs. YOUR CLIENTS ARE DEPENDING ON YOU TO HELP THEM STAY ON TOP OF KEY DEADLINES AND TO UNDERSTAND THEIR RESPONSIBILITIES WITH RESPECT TO CHANGING LEGISLATION AND LEGAL RULINGS.

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A nationwide injunction has been issued, halting certain preventative-care coverage. What this means for your clients will depend on whether they are fully insured or self-funded. The injunction will not have any immediate impact on em ployers with fully insured plans as those plans are approved by the state and the terms are likely locked in until renewal. Addi tionally, those fully insured policies may be subject to certain state preventive care mandate requirements. For employers with self-funded group health plans, the injunction allows employers the option to amend their plans to make changes, such as implementing cost sharing for the preventive-care services impacted by the decision, includ ing screenings for cancer, mental health, HIV and diabetes, colonoscopies, pap smears and tobacco-cessation services. These employers have the option to implement cost sharing for some or all of these screenings, but are not required to do so, nor is there a time frame in which they must decide. The Justice Department is appealing the judge’s decision, so it is possible that this decision will be reversed. If appeals continue to the Supreme Court, as many ACA challenges do, a final decision may not come until some time in 2024. What it means for you: Reach out to both fully insured and self-funded clients to make sure they are aware of the ruling and understand whether or not it applies to them. Employers with self-funded plans should not feel rushed to amend plans; changes come with their own complications around informing employees and managing their reactions. Employees who have become accustomed to accessing

screenings and preventative care without cost sharing may react negatively to the takeaway of expected benefits. Addi tionally, preventative screenings enable patients to iden tify and address issues early, potentially avoiding invasive, expensive treatments later. For employers that self-fund, the implications of delayed diagnoses and care can be costly. While these are not the only legislative and regulatory issues to watch in the latter half of the year, they are a good starting point for client conversations. Your clients will ap preciate your guidance in navigating compliance issues and understanding their responsibilities.

Misty Baker is a compliance and agent advocate, specializing in ACA, ERISA, FMLA, COBRA and legislative advocacy for over 20 years. She was a registered lobbyist in Texas for four years and is a strategic leader focused on compliance, agent knowledge, legislative advocacy and ultimate client understanding of how to be successful in the changing world

of compliance. Her passions include agent education, insurance advocacy inside and outside of the Capital, and compliance. Misty was awarded one of the most influential women in employee benefit advising by Employee Benefit Advisor in 2015. She’s been a member of NABIP since 1999 and she chairs its Legislative Council.

INDUSTRY EVENTS

JULY 17-19 VOLUNTARY ADVANTAGE VIRTUAL CONFERENCE Online Event https://voluntary-advantage.com/conference-2023

OCTOBER 22-24 LIMRA ANNUAL CONFERENCE National Harbor, MD www.limra.com MARCH 25-27 WOMEN’S LEADERSHIP SUMMIT 2024 Las Vegas, NV www.ellevatefoundation.org

OCTOBER 8-10 SIIA NATIONAL CONFERENCE Phoenix, AZ www.siiaconferences.org

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