America's Benefit Specialist November 2023

THE VALUE OF BIOSIMILARS PROTECTING YOUR CLIENT RELATIONSHIPS LEVEL-FUNDING RESOURCES

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November 2023

YOUR INDUSTRY 3

YOUR SALES 31 Customizable Benefit Solutions Can Deliver

How Agents and Brokers Can Protect Themselves and Their Marketplace Clients From CMS

Impressive Cost Savings By Andy Bonner

34 Help Your Clients Maximize the Value of Biosimilars By Melissa Andel

6

Noteworthy

3

10 Mergers and Acquisitions

YOUR ASSOCIATION 37 Welcome to NABIP

12 Protecting Your Client Relationships when You Sell Your Agency By Dan Mangus

39 CPC Quiz

13 Where in the World

41 Congratulations, Registered Employee Benefits Consultants!

14 Product News

12

18 Use Key Resources to Your Advantage with Level Funding By Chris Riter

42 NABIP’s Board of Trustees

43 Your NABIP Staff

44 Association Events

20 People on the Move

21 Industry Events

MEDICARE MATTERS 22 Medicare Ads Are

Dominated by Plans Featuring Celebrities, Active and Fit Seniors, and Promises of Savings

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VOLUME 70, NO. 9

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

Nationwide Employee Benefits ® Discover supplemental health insurance offerings that your clients’ employees want. We offer the easy-to-quote, affordable employee benefits that your clients are looking for. Our products and approach help support your business, and we deliver helpful service from dedicated sales and service specialists. • Nationwide Provide SM supplemental health insurance pays upon diagnosis rather than making employees wait until they’ve been billed for treatment. • MedPair supplemental health insurance helps reduce out-of-pocket expenses by filling in the gaps in employees’ primary health insurance.

The opinions expressed in this magazine are not necessarily endorsed by

NABIP nor does the magazine assume responsibility for statements made in

Scan this code to visit Nationwide.com/ VoluntaryBenefits

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 9 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.

The products are underwritten by Nationwide Life Insurance Company, Columbus, Ohio (CA COA #7032). Product availability, benefits and provisions may vary by state and may be subject to state mandates. Limitations and exclusions apply. Nationwide, the Nationwide N and Eagle, Nationwide Employee Benefits and Nationwide Provide are service marks of Nationwide Mutual Insurance Company. © 2023 Nationwide NSM-0283AO.1 (06/23)

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HOW AGENTS AND BROKERS CAN PROTECT THEMSELVES AND THEIR MARKETPLACE CLIENTS

From CMS

In recent years with expanded tax credits and more compet itive markets, the Health Insurance Marketplace® has seen a substantial increase in the number of consumers enrolling in Marketplace coverage and the number of agents and bro kers registering to sell Marketplace plans. Marketplace-registered agents and brokers have played an important role in the growth of the Marketplace, and the vast majority of agents and brokers are focused on serving their clients to help them get access to the health insur ance coverage and essential care they need. However, even a small number of potential bad actors can cause signifi cant harm to the Marketplace program. When agents and brokers act without proper authorization from consumers, this puts people at risk of losing coverage, financial assis tance, preferred doctors and critical prescriptions, as well as paying tax penalties. With these concerns in mind, the Centers for Medicare & Medicaid Services has adopted new regulations that require agents and brokers who assist with or facilitate enrollment in Marketplace 1 coverage to document that they have consent

from consumers or their authorized representatives before assisting them with Marketplace enrollment or applying for advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs). The new regulations also require that agents and brokers document that consum ers or their authorized representatives have reviewed and confirmed the accuracy of all eligibility information on the Marketplace eligibility application before it is submitted. While obtaining consumer consent has always been a requirement in the Marketplace, this Open Enrollment Pe riod, which runs from November 1 through January 15, will be the first OEP that these new documentation regulations are in effect. Agents and brokers may document consumer consent and Marketplace eligibility application review in any manner that best works for them, as long as their documentation meets all regulatory requirements. Some formats that may be acceptable include electronically signed forms, an image of a physical form with a wet signature from the consumer, emails or text messages from the consumer to the approved

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HOW AGENTS AND BROKERS CAN PROTECT THEMSELVES AND THEIR CLIENTS

AGENTS AND BROKERS MAY DOCUMENT CONSUMER CONSENT AND MARKETPLACE ELIGIBILITY APPLICATION REVIEW IN ANY MANNER THAT BEST WORKS FOR THEM, AS LONG AS THEIR DOCUMENTATION MEETS ALL REGULATORY REQUIREMENTS.

agent or broker, and recorded phone conversations between the consumer and approved agent or broker. However, to ensure consumers understand the consent process and can ask questions, CMS does not recommend website-based forms alone or other methods that do not involve directly engaging with the consumer. CMS created a model consumer consent form 2 that Market place-registered agents and brokers can use to comply with the new consumer consent requirement. This optional model consent form is meant to act as a template that agents and brokers can use as provided or adapt for their use and busi ness practices. States may have additional requirements that are not addressed in this optional model consent form, and agents and brokers interested in using or adapting this form should confirm with their relevant state agencies that this form would also meet state requirements. CMS does not have a model form to document the eligibility application review requirements. Ultimately, these regulations give CMS greater authority to terminate any agent’s or broker’s registration with the Market place who cannot provide documentation that a consumer or consumer’s authorized representative gave the agent or broker permission to act on their behalf in connection with enrollment in Marketplace coverage or submission of an appli cation for APTC or CSRs. When making compliance determi nations related to consumer consent, CMS will confirm if the consent was given before an agent or broker assisted with or facilitated enrollment in Marketplace coverage. This includes conducting person searches on an approved direct enrollment (DE) platform. In addition to reviewing the documentation showing that the consumer or an authorized representative consented to the agent or broker assisting the consumer with enrolling in Marketplace coverage or applying for APTC or CSRs, CMS will determine if agent- or broker-initiated application or plan changes are consistent with the documented consent for that initial enrollment. CMS will make this determination when any changes are made to a consumer’s application such as changes in issuer or plan selections, dependents,

contact information, income information or other application fields. If agents and brokers have concerns that another agent or broker has engaged in potential non-compliance, including fraud or abusive conduct, they can contact the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs. gov. Additionally, agents and brokers can also send operational and policy questions to this help desk. In the 2024 Payment Notice: CMS finalized regulatory up dates requiring agents, brokers and web-brokers to: • document that the consumer or an authorized representa tive consented to the agent or broker assisting them with Marketplace enrollment or applying for APTC or CSRs prior to that assistance being provided. • document that eligibility application information has been reviewed by and confirmed to be accurate by the consumer or their authorized representative prior to application sub mission. CONSUMER CONSENT The documentation must contain, at a minimum, the follow ing information: • a description of the scope, purpose, and duration of the consent provided by the consumer or their authorized rep resentative • the date the consent was given • the name of the consumer or their authorized representative • the name of the agent, broker, web-broker or agency being granted consent • a process through which the consumer or their authorized representative may rescind the consent ELIGIBILITY APPLICATION INFORMATION REVIEW The documentation must contain, at a minimum, the follow ing information: • the date the information was reviewed

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HOW AGENTS AND BROKERS CAN PROTECT THEMSELVES AND THEIR CLIENTS

• the name of the consumer or an authorized representative • an explanation of the attestations at the end of the eligi bility application • the name of the assisting agent, broker or web-broker Documenting that eligibility application information has been reviewed and confirmed to be accurate by the consumer or their authorized representative, and that the consumer or an authorized representative consented to the agent or broker assisting them with Marketplace enrollment or applying for APTC or CSRs, requires the consumer or their authorized representative to take an action to produce a record that can be maintained by the agent, broker, or web-broker. The agent, broker, or web-broker must maintain the documentation for a minimum of 10 years and provide it to CMS upon request in response to monitoring, audit, and enforcement activities.

RESOURCES FOR AGENTS AND BROKERS • Marketplace Compliance 2024 Payment Notice Updates Webinar: https://regtap.cms.gov/reg_librarye.php?i=4716 • 2023 Agent/Broker Summit Presentation on Compliance: www.cms.gov/files/document/ab-summit-2023-compli ance.pdf • Agent and Broker Resources Website Model Consent Form: www.cms.gov/files/document/cms-model-con sent-form-marketplace-agents-and-brokers.pdf • FAQs on Consumer Consent and Application Review Requirements: www.cms.gov/files/document/2024-pn ab-faq-9823.pdf • 2024 Payment Notice: Fact sheet: www.cms.gov/news room/fact-sheets/hhs-notice-benefit-and-payment-pa rameters-2024-final-rule • HHS Notice of Benefit and Payment Pa rameters for 2024: www.federalregister.gov/ documents/2023/04/27/2023-08368/patient protection-and-affordable-care-act-hhs-notice-of-bene fit-and-payment-parameters-for-2024

1 The term Marketplace refers to the FFEs and SBE-FPs for pur poses of this document. 2 www.cms.gov/files/document/cms-model-consent-form-mar ketplace-agents-and-brokers.pdf

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• providing ongoing support to answer employee questions • taying compliant and up to date on regulatory changes • seeking new solutions Many employers rely heavily on brokers to bring them cre ative benefits ideas and, now more than ever, employers are seeking new options. More than four in five employers (86%) would be interested in their advisor bringing them more innovative, non-traditional solutions like ICHRAs. And 83% would be more willing to offer an ICHRA if they had support from a dedicated vendor partner. “For employers who are looking for alternatives to group health plans but that still allow them to contribute to their employees’ coverage expenses, ICHRAs are emerging as an incredibly appealing option,” said Reeves. “With the right partner working in concert with their advisors to manage compliance, contribution strategies, and marketplace navi gation, ICHRAs really are meeting the needs of both employ ers and their employees.” For more information about this research, visit www.gravie. com/ichra. EMPLOYERS’ PERCEPTIONS OF EMPLOYEE ENGAGEMENT MAY NOT MATCH REALITY Nearly four in 10 employers (38%) increased the importance of career wellbeing in 2023, according to Gallagher’s 2023 Career Wellbeing Report. Even though this marked a five point year-over-year increase, career wellbeing was the least emphasized wellbeing initiative, falling behind employees’ emotional (74%), financial (49%) and physical (47%) wellbeing. “When employers provide their employees with clearly defined career trajectories, their workforces are more en gaged, retention rates climb and, most importantly, business outcomes improve,” said William Ziebell, CEO of Gallagher’s Employee Benefits & HR Consulting Division. “While this is common knowledge for decision makers, just four in 10 (43%) provide their employees with support in developing and pur suing a career path. That means there’s significant room for improvement. The purpose of this study is to help employers optimize their investment in career wellbeing through em ployee engagement and communication strategies.” Gallagher’s Career Wellbeing Report is the third install ment of the larger Workforce Trends Report Series. The research was conducted from December 2022 to March 2023, and sourced data and insights from a total of 4,030 organiza tions across the U.S. Employers often rely on incomplete data to measure employee engagement . The study found that more than half of employers agreed (49%) or strongly agreed (nine per cent) their employees were highly engaged. But it’s possible employer perceptions don’t accurately reflect employees’ feelings because just half of employers (51%) have conduct

NEW STUDY: EIGHTY-NINE PERCENT OF EMPLOYERS CONSIDERING ICHRAS FOR HEALTH BENEFITS SOLUTION OVER NEXT THREE YEARS Gravie released a new study in partnership with Wakefield Research that highlights a growing interest in Individual Cov erage Healthcare Reimbursements Arrangements among employers, even though some barriers are prohibiting them from offering this type of solution today. The survey, conducted in August, polled 500 health bene fits decision-makers at companies with 1 to 1,000 employees who don’t currently offer ICHRAs, to better understand their awareness, consideration and perceptions of this tax-advan taged health benefits option for their employees. Before taking the survey, approximately half (49%) of the respondents had not heard of ICHRAs, but most showed interest in learning more. Interestingly, respondents from midsize and large companies expressed the most interest in learning about ICHRA options (92% among those with 50-299 employees and 94% among those with 300-1,000 employees). “We know companies of all sizes can benefit from adopt ing an ICHRA to support their employees’ unique health and wellness needs,” said Gravie ICHRA General Manager Andrew Reeves. “The model is finally catching fire as an increasing number of businesses are turning to ICHRAs and looking for help navigating the individual market, managing contribu tion strategies and meeting compliance requirements.” According to the HRA Council, adoption of ICHRAs has more than tripled since they were introduced in 2020. De spite highlighting the need for more overall awareness and education, Gravie’s survey also indicated that the adoption rate for ICHRAs isn’t likely to slow down anytime soon. With medical trends increasing, the ability of employers to set a defined contribution toward their employees’ health benefits is a major part of the appeal. As many as 89% of benefits decision-makers who don’t currently offer them are considering ICHRAs for their em ployees over the next three years. Others are looking further out, with 87% of respondents agreeing that ICHRA could be a long-term fit for their company. While more benefits leaders are giving ICHRA a strong look as a potential new or expanded health benefits solu tion, many are stretched for time and resources. On average, they are spending nine hours per week managing health benefits for their company, and for nearly three in four (71%), managing health insurance is one of the most difficult parts of their job. Benefits managers have demanding jobs and over 80% of respondents consider each of these factors a barrier to embracing ICHRAs:

• helping employees navigate the marketplace • managing employee-contribution strategies

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organization’s priorities and direction and, ultimately, im prove the employee experience. “Employers that commit to employee engagement and communication strategies, measure their effectiveness and adjust accordingly earn an advantage over the competition,” Ziebell said. “That’s because employees tend to give as much as they get. And we developed the Gallagher Career Wellbe ing Report to help employers uncover the best practices to unlock their employees and the organization’s potential.” AMERICANS ARE HIGHLY SATISFIED WITH THEIR DENTAL INSURANCE Dental health is an important part of overall health and well-being. In a recently released survey of people with den tal insurance, 90% of respondents reported being satisfied with their dental plan. Global Strategy Group (GSG) conduct ed the online survey on behalf of AHIP, focusing on dental in surance enrollees who have visited their dentist, oral surgeon, orthodontist or other dental specialist in the past year. Key survey findings: • Enrollees continue to be satisfied (90%) with their dental insurance plans, driven by easy access to providers and the value they provide. • Enrollees continue to prioritize preventive care (90%) and are satisfied with their ability to quickly access local, in-network dentists and specialists. • Enrollees remain overwhelmingly satisfied with the af fordability (87%) of their plans and believe their plans help them maintain and preserve their oral health. • Parents are increasingly satisfied (82%) with their dental plans’ benefits for their children. The survey was fielded July 24-July 27. GSG took care to ensure that the geographic and demographic divisions were properly represented by the survey’s respondents. STOP-LOSS PREMIUMS INCREASE 7% TO 16% High-dollar claimants remain a driver of total healthcare increases currently experienced by U.S. employer-sponsored, self-funded health plans. Accordingly, annualized increases in individual stop-loss premiums, measured from 2021 to 2023, show increases of 6.9% to 15.9% or higher as the individual stop-loss deductible increases, as reported by the 2023 Aegis Risk Medical Stop-Loss Premium Survey, cosponsored by the International Society of Certified Employee Benefit Specialists. This dynamic, known as leveraged trend, occurs as the underlying increase in expense of a catastrophic medical claimant is fully borne by an unchanged stop-loss deductible from one year to the next. Stop-loss insurance provides protection to self-funded health plans against large and unpredictable expenses that can arise when one plan participant, or claimant, has cata

ed an in-depth employee engagement survey over the past two years. This shift away from more detailed research began during the pandemic because employee needs, wants and concerns evolved at such a rapid rate. To capture these changes, pulse surveys—abbreviated questionnaires requiring minimal time investment for participants or data analysis—became one of employers’ go-to tactics. The insights gathered were so useful that many employers continue to rely on pulse surveys to formulate their engagement strategies. However, when measuring a complex variable such as employee engagement, pulse surveys can provide an incom plete picture. Transitioning back to annual surveys will help decision makers uncover the organization’s strengths and ar eas for improvement, and this investment will provide signifi cant cost savings compared to the cost of filling vacancies. Communicating benefits is as important as offering bene fits. Familiar HR priorities are repeating their well-established role as focal areas for effective talent management, including retention (66%), attraction (49%), training and development (35%), strengthening work culture (33%), and increasing engagement and productivity (27%). Like any other integral goal in any other year, strategic internal communication is a key tool for achieving these outcomes. Only about half of employers (53%) rate their employees’ understanding of compensation and benefits as excellent or good. As such, employers are increasingly realizing how communication can positively influence the engagement with compensation and benefits, allowing employees to wor ry less and be more productive—particularly in an uncertain economy. And in response to the current economy, nearly three in four employers (74%) increased their emphasis on communicating about compensation and benefits in 2023. Crafting employee communications through a mar keting lens will improve outcomes . What employees see and hear from leadership often influences their attitudes and behaviors, making employers’ communication about business strategies, people priorities and work approaches mission critical. For these reasons, nearly every employer surveyed (93%) indicated their organization takes a deliber ate approach with its internal communication function. But of those, only than one in four (23%) claimed to have imple mented a comprehensive internal communications strategy. There is also skepticism about whether communications can drive change. Just over one-third of employers (37%) believe their communications create tangible results or a desired change in behavior. Organizations will improve out comes by developing messaging through a marketing lens. Accomplishing this involves creating and leveraging commu nications that elicit an emotional response, while reinforcing shared values. Strategically planning and regularly delivering these messages will ensure the workforce understands the

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strophic medical bills (known as specific or individual stop loss coverage) or when a higher frequency of overall claims is substantial in the aggregate (known as aggregate coverage). Individual stop-loss coverage deductibles are often tied to the underlying employee size and risk tolerance of the plan sponsor, ranging from as low as $50,000 to as high as $1 million or more per covered participant per policy year. As a result, the average premium cost per covered employee is highly variable and dependent on the size of the deductible. According to the survey, the average monthly premium per covered employee at a $100,000 deductible is $193.16; at a $500,000 deductible, it is $43.76. At a $1,000,000 deduct ible, the premium lowers to $14.08 per covered employee per month. For this survey, all contracts are equated to a mature “paid” contract. A paid contract will cover all claims that are paid during the 12-month policy period regardless of when claims are incurred. Aggregate stop-loss coverage, which is additional insur ance against overutilization of the health plan, is most prev alent alongside individual stop-loss deductibles of $250,000 or less and enrollments around or below 1,000. It becomes less common at higher deductibles and/or enrollments since those plans tend to be more stable. The most prevalent level, cited by 93% of respondents with aggregate coverage, is 125% of expected health claims. Average monthly premiums vary by size of the individual stop-loss deductible; the median premium overall is $8.55. The frequency of truly catastrophic claimants (in excess of $500,000) continues. The Medical Stop-Loss Premium Survey also collected data on the occurrence of catastroph ic claimants. Twenty-five percent of respondents reported a claimant in excess of $1 million over the last two years, with seven percent of those in excess of $2 million. These catastrophic claimants result from more aggressive hospital billing as well as specialty pharmacy and orphan drug thera pies, according to survey respondents. Forty-two percent of respondents reported that none of their catastrophic claims exceeded $500,000. When asked about lasering (which occurs when an un derwriter excludes certain individuals from coverage), 20% reported the presence of at least one known lasered claim ant, down slightly from 23% in 2022. The 2023 Aegis Risk Medical Stop Loss Premium Sur vey measured data from 799 plan sponsors covering over 845,000 employees with $727 million in annual stop-loss premium. A copy of the full survey is available on the ISCEBS website or by request at info@aegisrisk.com. SURVEY SHOWS THAT STRENGTHENING INDUSTRY TELEHEALTH HABITS WILL IMPROVE PATIENT ACCESS, CARE AND SATISFACTION Sage Growth Partners, a healthcare research, strategy and marketing firm, has released a new telehealth innovation re

port centered around what virtual care currently is, and what it can eventually come to be in the future. “Telehealth: The Innovation That’s Not Yet a Habit” offers insights from physicians and industry leaders within hospi tals, health systems and private medical practices. The report is based on results from an August survey of 155 respondents nationwide and was created in conjunction with Project Healthcare and The Disruption Lab – in support of this year’s TELEHEALTH ACADEMY III. Survey respondents stated that the current market is view ing telehealth services in many diverse ways from primary, specialty, and behavioral healthcare to condition manage ment and coordination of care in preventative, urgent and acute settings. Additionally, as telehealth continues to disrupt the healthcare marketplace, medical practices and hospitals have indicated that companies such as Amazon and CVS Health are viewed as at least a moderate business threat. Top findings and takeaways of the report include: • Patient follow-up visits make up 37% of medical practice telehealth services and 27% of hospital services. • The biggest year-over-year gains of medical practice tele health use came in the areas of behavioral health (13% to 20%) and chronic care management (eight percent to 19%). • Telehealth YOY usage declined the most for initial hospital visits (21% to 11%). • For 2025, medical practices expect telehealth use to increase the most for behavioral health and primary care. Hospitals believe that behavioral health services will grow from 20% to 31%. “Our report findings show that there is a significant missing opportunity in telehealth usage,” said Dan D’Orazio, CEO, Sage Growth Partners. “Since patients drive so many telehealth decisions, medical providers don’t yet think of it as a broader business tool. But it could be. When implemented correctly, telehealth can increase efficiency, decrease burn out, and improve costs, revenue and market share.” One additional survey finding highlighted in the report is that respondents indicate they use telehealth for follow-up care far more than for intake or any other services. Converse ly, this use has declined since 2020. Data also shows that consumerism is driving telehealth, just as it influences other aspects of the industry. “Our latest research found that patient preferences drive decisions approximately 54% of the time for medical practic es and 45% of the time for hospitals. Based on this, telehealth should not just be thought of as solely a video visit. It is very important that all stakeholders begin to connect the future success of telehealth to the future success and satisfaction of the healthcare workforce to be able to deliver the best care possible,” said D’Orazio. To download a copy of the complete report, visit sage growth.com.

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for specific services. Additionally, the study highlights contin ued financial challenges for uninsured patients or those who want to comparison shop for healthcare. While the Hospital Price Transparency Rule allows the Cen ters for Medicare & Medicaid Services to fine hospitals up to $2 million for failing to post prices, there is no formal mecha nism for CMS to audit or penalize hospitals with erroneous or misleading price data. “Transparency is critical to changing the trajectory of healthcare costs in this country,” said Mark Cuban, one of the co-authors of the study. “Our paper shows that while some progress has been made in hospital transparency, we still have a ways to go.” VAST MAJORITY OF ADULTS BELIEVE DENTAL COVERAGE IS AN IMPORTANT PART OF OVERALL WELLNESS Delta Dental finds an overwhelming majority of U.S. adults value dental insurance in supporting overall wellness, ac cording to the recently released 2023 State of America’s Oral Health and Wellness Report, a nationwide analysis of con sumer opinions and behaviors relating to oral health. The report indicates that having dental insurance provides health, emotional and financial benefits ranging from good overall health to peace of mind to helping save money. Delta Dental commissioned the research, which included more than 2,000 U.S. adults and parents of children 12 and under. Key findings from the report: • The report finds 86% of adults agree that having dental coverage allows for good overall health. • A vast majority of adults (82%) believe that dental insur ance is an essential part of overall wellness. • Nearly nine in 10 adults (87%) agree that dental insurance gives them peace of mind. • Further, most adults (81%) say having dental insurance instills confidence in their smile. • More than eight in 10 adults (85%) recognize dental insur ance helps save money in the long run.

HOSPITAL PRICES VARY FOR THOSE WHO CALL TO ASK, REPORT SHOWS Hospitals in the United States may quote vastly different prices for their services – depending on how you find that information, according to a new study published in the Jour nal of the American Medical Association: Internal Medicine. In the cross-sectional study of 60 U.S. hospitals, there was a significant difference in prices found online and those given over the phone to “secret shoppers.” “The prices given on the phone were substantially different from those posted online,” said Vivian Ho, the James A. Baker III Institute chair in health economics at Rice University’s Bak er Institute for Public Policy. “And the cash prices given over the phone were not always the less expensive price. More over, prices for the same services vary wildly across different hospitals even in the same city. Anywhere from a 30% to 100% difference in price.” Cash prices are required to be posted online under the Hospital Price Transparency Rule, but prior studies have found that many hospitals do not comply. Even for those that do, these prices can be difficult to find and obtain. The authors calculated the difference between prices given by a hospital online versus over the phone for vaginal childbirth and brain magnetic resonance imaging (MRI). They identified different hospitals as top-ranked or safety-net hospitals. (Safety-net hospitals typically provide care to indi viduals regardless of their ability to pay.) For vaginal childbirth, 63% of top-ranked hospitals were able to provide both online and phone prices compared with 30% of safety-net hospitals and 21% for non-top-ranked, non safety-net hospitals. For brain MRI, 85% of the top-ranked hospitals and 100% of the non-top-ranked, non-safety-net hospitals were able to provide both online and telephone prices, but only 50% of safety-net hospitals were able to do so. “There were multiple hospitals with online prices that were greater than $20,000 (for vaginal childbirth), but telephone prices of less than $10,000,” the report reads. “For brain MRI, two hospitals provided telephone prices of more than $5,000 when their online prices were approximately $2,000.” The findings of the study demonstrate hospitals’ contin ued problems in knowing and communicating their prices

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MERGERS AND ACQUISITIONS

wherever they are—in person, over the phone and online. Prosper with Purpose Financials’ commitment to em powering agents and advocating for clients has cement ed its reputation. • LP Insurance Marketing Group, an IMO based in Hartford, Connecticut, and led by Hector Torres and Carlos Ruiz. Since founding LP Insurance in 2008, Torres and Ruiz have led the agency to become a trusted community resource for insurance information in the diverse communities they serve—often providing guidance and insight to both agents and clients in their native languages. LP Insurance now includes hundreds of agents across the United States and Puerto Rico. The agency specializes in serving seniors by providing Medicare products and annuities. • Legacy Protectors Life Group, an IMO based in Sarasota, Florida, and led by Jordan Lowery. A former collegiate athlete, Lowery brings a deep level of dedication and hard work to his business. Founded with a strong desire to serve, the company has experienced significant growth by building empathetic, respectful relationships with those it serves and treating each client like family. Legacy Protectors offers life insurance, mortgage protec tion and final-expense products through thousands of agents nationwide. • Invictus Marketing Solutions, an IMO based in Jefferson City, Missouri, and led by Travis LePage and Scott Amos. Amos and LePage founded Invictus in 2015 to deliver health and life products that would holistically serve the wellbeing and financial needs of each client. The agency specializes in Medicare coverage as well as life insurance, with the goal of helping senior clients thrive and feel con fident in their futures. By devoting time and personalized attention to helping each agent succeed, Invictus has con tinued to grow rapidly, expanding throughout the country. RISK STRATEGIES ACQUIRES orchestrateHR AND EBEN BENEFITS Risk Strategies, a national specialty insurance brokerage and risk-management firm, has acquired human resources and employee benefits specialist orchestrateHR Inc. and its

GALLAGHER ANNOUNCES ACQUISITIONS Arthur J. Gallagher & Co. recently announced the acquisi tion of Louisville, Kentucky-based WLA Insurance LLC, dba Altman Insurance Services. Terms of the transaction were not disclosed. Altman Insurance Services provides employee benefits brokerage and consulting services to large- and small-group businesses in Kentucky, Indiana, Ohio and Tennessee. Billy Altman, Mike Summerfield and their team will remain in their current location under the direction of Robby White, head of Gallagher’s South Central region employee benefits consulting and brokerage operations. Gallagher has also signed a definitive agreement to ac quire Natick, Massachusetts-based Eastern Insurance Group LLC, a subsidiary of Eastern Bank. The transaction is subject to regulatory approval and is expected to close this quarter. Eastern Insurance offers personal lines products as well as employee benefits consulting to clients throughout the Northeast U.S. Tim Lodge and his team will remain in their current location under the direction of Patrick Kennedy, head of Gallagher’s Northeast region retail property/ca sualty brokerage operations, and John Neumaier, head of Gallagher’s East region employee benefits consulting and brokerage operations. Eastern Insurance pro forma revenues and EBITDAC (including minimal expected synergies) for the trailing 12 months ended June 30, 2023, were approximately $104 million and $37 million, respectively. Under the agreement, Gallagher will acquire the assets of Eastern Insurance for consideration of $510 million net of agreed seller-funded expenses. INTEGRITY EXPANDS ITS REACH Integrity Marketing Group LLC recently partnered with sev eral firms: • Prosper with Purpose Financial, an independent mar keting organization located in Doral, Florida, and led by Marco Conde. Prosper with Purpose Financial helps tens of thousands of families each year protect their life, health and wealth. The company has built a tech-infused culture where it prioritizes simplicity and meeting clients

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Founded in 2013, Sunshine Life & Health Advisors is a woman- and minority-owned firm consisting of two sister companies, Living Secure Insurance Advisors Inc. and Sun shine Life & Health Advisors LLC. The combined operations function as a field marketing organization focusing on the sale of individual health insurance plans provided under the ACA. The firm has provided insurance coverage to more than a quarter of a million members nationwide and is among the largest FMOs in the nation. Sunshine Life & Health Advisors and its team will join the Alliant family of companies and will continue operating under its current name and brand. Terms of the agreement were not disclosed. HUB INTERNATIONAL EXPANDS EMPLOYEE BENEFITS SERVICES Hub International Limited has acquired the assets of Dief fenbach Benefits Group LLC d/b/a F.A.R.E. Healthcare. Terms of the transaction were not disclosed. Located in St. Louis, Missouri, F.A.R.E. Healthcare provides comprehensive group benefit packages, life insurance and employee healthcare. Principal and Co-Founders Mollie Dieffenbach and John Byrne, along with the F.A.R.E. Healthcare team, will join Hub Mid-America and become the first official Hub office in St. Louis. F.A.R.E. Healthcare will be referred to as F.A.R.E. Healthcare, a Hub International company. Hub has also acquired the assets of Great Basin Insurance, Eugene LLC, a subsidiary of Great Basin Insurance Inc. in Klamath Falls, Oregon. Terms of the transaction were not disclosed. Great Basin Insurance Eugene is a provider of multi-line insurance, including employee benefits, to clients in the Northwest. Michael May, partner, and the Great Basin Insurance Eugene team will join Hub Northwest team in Eugene led by Erik Finrow, executive vice president of Hub Northwest. Great Basin Insurance Eugene will be referred to as GBI Eugene, a Hub International company.

affiliate, Ebenconcepts Company (dba eBen Benefits). Also included in the transaction were the company’s specialty operating subsidiaries, Employers Direct Health and Employ ers Direct Administrative Solutions. Terms of the deal were not disclosed. Based in Dallas, Texas, with offices in nine states and a family-owned history tracing back over 50 years, orches trateHR is a provider of holistic employee benefits solutions. In conjunction with its associated operating groups, it offers a broad range of services, including human resources and technology consulting, third-party administration, and pay roll and associated administrative outsourcing services. Established in 1999 as an orchestrateHR affiliate, Ebencon cepts Company is an HR consulting and custom employee benefits brokerage firm with offices throughout the United States. One of the largest independent benefits agencies in the Southeast, eBen works with employers of all sizes and supports a robust Medicare and ACA marketplace. eBen is also a managing general agent able to provide preferred access to a comprehensive suite of employer-funded and vol untary insurance products for clients of all sizes. “We’re excited to join with Risk Strategies and bring new strength to its National Employee Benefits Practice,” said Muzzy Bass, president, orchestrateHR and eBen Benefits. ALLIANT PARTNERS WITH SUNSHINE LIFE & HEALTH ADVISORS Alliant Insurance Services has partnered with Sunshine Life & Health Advisors, a Florida-based health insurance firm focused on helping members of the Hispanic community understand and enroll in Affordable Care Act health plans. Sunshine Life & Health Advisors serves clients in Florida and Texas as well as various Hispanic communities throughout the United States. The move expands Alliant’s direct-to-consumer capabilities and strengthens its Employee Benefits Group.

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PROTECTING YOUR CLIENT RELATIONSHIPS WHEN YOU SELL YOUR AGENCY

By Dan Mangus Vice President of Growth and Development Senior Marketing Specialists Columbia, Missouri dan.mangus@smsteam.net

For years, you have worked hard to find new clients. Once you found them, you cared for them through careful product selection to protect them, and ongoing communication and support to ensure your products did everything they were supposed to do to protect your clients financially and provide them peace of mind. Now the time has come for you to open the next chapter of your life and to give your attention to enjoying retirement or caring for other obligations. You don’t want to leave your clients without someone to care for them, but who can care for them as much as you do? How can you find someone who can pick up where you left off and give you the financial freedom you deserve from your hard work? If you are at this point, there are several things to remem ber as you start your search for the person to whom you hand off these client relationships. There are many options for agents to sell their block of commissions to, but the tricky

part is finding someone who can give you the money you need and care for your clients and staff.

THE MORE EFFORT YOU PUT INTO MAINTAINING RELATIONSHIPS, THE MORE VALUE YOUR AGENCY HAS TO A BUYER AND THE MORE PEACE OF MIND YOU WILL ENJOY BECAUSE YOU WILL KNOW YOUR CLIENTS AND STAFF ARE COMFORTABLE WITH THE NEW OWNER.

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Generally, your clients decide to do business with you because of your type of personality, your values and ethics. A potential buyer of your agency should share those qualities. If you do not look for a character match, the ongoing relation ship between your clients and the new owner will probably break down. Is the potential buyer willing to maintain the way you currently do business? If you see your clients in their homes, is the new agent willing to do the same? What if you have an office that the clients are used to coming to? Is the buyer willing to keep your office and staff it adequately so that the clients have someone to stop by a visit with if they need help? Do you have employees? Is the buyer ready to provide them with the same compensation, work environment and opportunities for their future that you were providing? There are many items to consider as you transition, but relation ship continuity is critical to both you and the buyer of your agency. To effectively work with your clients, your potential buyer will need to get to know your clients as you do. The only way they can do that is to have the information and introductions that only you can provide. Have you set the stage correctly? You can do that by en suring all of the names, addresses, phone numbers, e-mail addresses, etc., are accurate in your database of files. It would

help if you also had plenty of notes on each client so the new agent can understand the individuals and their unique needs. Build a game plan with the new agent to make introduc tions to your clients and any centers of influence you have in your community. The more effort you put into maintaining relationships, the more value your agency has to a buyer and the more peace of mind you will enjoy because you will know your clients and staff are comfortable with the new owner. You have worked hard to build a past to be proud of. A good buyer will be committed to providing a future for all of the relationships you have created.

Dan Mangus joined Senior Marketing Specialists in 2012 as the national sales director, serving over 10,000 agents nation wide. He teaches Medicare courses at universities and keynotes national insurance conferences. He also conducts Medicare certification courses for both the National Guardianship Association and the American

Association of Daily Money Managers. Dan has published numerous books and articles for advisors in the Medicare market.

Where in the World

St. Louis member Lynn Lewis in Shenzhen, China

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PRODUCT NEWS

Product enhancements include: CRITICAL ILLNESS INSURANCE

Metastatic Cancer Benefit: provides a benefit for the metas tasis of cancer diagnosed prior to the plan effective date. Type 2 Diabetes Benefit: provides a benefit for a Type 2 diabetes diagnosis. Infertility Benefit: provides a diagnoses-triggered benefit to support families dealing with infertility, with multiple plan options available. Mental Health Benefits: adds screening and support ben efits for several mental health conditions, including depres sion, generalized anxiety, substance abuse disorder, ADHD and autism. HOSPITAL INDEMNITY INSURANCE Newborn Coverage: automatically covers all newborn chil dren (not just firstborn child) for first 31 days. Outpatient Mental Health Benefits: provides benefits for ongoing mental health and substance abuse disorder support. ACCIDENT INSURANCE Personal Safety Training Coverage: provides a benefit for the completion of CPR/First Aid certification, self-defense classes and more. Pet-Boarding Coverage: provides a benefit to pay for the care of a pet while an insured person is hospitalized due to an accident. Organized Sports Benefit: provides coverage for a child or adult injured while playing organized sports. Additionally, all three products offer dependent parent coverage and expand the age of covered dependent children from 18 to 26. Benefits brokers interested in learning more can find a Securian Financial supplemental health insurance sales professional to talk to in their region at www.securian.com/ contact-us/group-sales.html. LAUNCH OF MEDICAL STOP-LOSS CAPTIVE PLATFORM AIMS TO DELIVER FREEDOM OF CHOICE FOR SMALL TO MIDSIZE EMPLOYERS ClearPoint Health, a medical stop-loss captive and employer services platform, recently launched, focused on catering to benefit advisors and small to midsize employers. ClearPoint’s platform offers a powerful vehicle to empower more employ ers and benefit advisors to transition their employer health benefits to one of the most transparent, affordable and clini cally integrated insurance programs in the market. ClearPoint Health was founded by a diverse group of clinicians, underwriters, technologists and risk-management experts, led by Co-Founder & CEO Jeb Dunkelberger. “Phe-

ASSURITY LAUNCHES GUARANTEED-ISSUE INDIVIDUAL ACCIDENT INSURANCE Assurity Life Insurance Company launched new Individu al Accident Insurance, providing affordable protection for unexpected medical expenses from accidents and injuries. It offers plans at different price points and levels of protection to meet a wide variety of needs. Customers receive a direct benefit they can use however they want for events like bro ken bones, ambulance rides, x-rays and more. “More customers than ever find themselves with a gap between what their health insurance covers and what needs to be paid,” says Todd Reimers, senior vice president and chief distribution officer. “Accident Insurance is designed as an easy, affordable way for them to complement their health coverage and help cover sudden medical costs without rely ing on savings.” Coverage is guaranteed issue with no medical tests, exams or health questions, making application fast and easy. Plans are available for individuals and families, as well as unique coverage for children, giving customers new ways to tailor protection to their unique situations. A native online quote-to-application platform is available at launch to streamline sales for distributors. Plans can be customized with optional riders and choices for both 24-hour and off-the-job coverage. All policies include an Accidental Death Rider that pays a benefit if an insured person dies in a covered accident. SECURIAN LAUNCHES ENHANCED WORKPLACE SUPPLEMENTAL BENEFITS Securian Financial is significantly enhancing its three-prod uct suite of workplace supplemental health insurance benefits as these products continue to be popular additions to employers’ benefit packages. Securian Financial’s critical illness, hospital indemnity and accident insurance products are all being enriched with numerous employee-friendly features. The new products are available to quote in most jurisdictions beginning January 1, 2024. “Economic forces and shifting generational expecta tions are making benefits enrollment more important and personal than ever,” said Lydia Jilek, Securian Financial 2nd vice president and voluntary benefits practice leader. “Our enhanced supplemental health insurance products empow er employees to prepare for unexpected expenses aligned with their lifestyle needs, while helping employers retain and attract talent with little to no business cost.”

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