Marc Glickman, FSA, CLTC

Most workplace benefits prioritize supporting plan members over cost containment, yet the question remains: How can the costs of these plans be managed in the long run? One key cost-containment measure to consider: with Pillcheck plan sponsors avoid the costs of covering ineffective, sometimes harmful prescriptions, and lost productivity until the right treatment is found. 👀   Drug claims for women are growing higher year after year. Women experiencing depression, hot flashes, gastrointestinal problems, or medication-induced side effects may benefit from personalized medication optimization. https://lnkd.in/dXzhqn3S #womenhealth #wellness #groupbenefits

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2025 𝙊𝙥𝙚𝙣 𝙀𝙣𝙧𝙤𝙡𝙡𝙢𝙚𝙣𝙩 𝘾𝙝𝙚𝙘𝙠𝙡𝙞𝙨𝙩 - To get ready for open enrollment, employers who sponsor group health plans should be aware of compliance changes affecting the design and administration of their health plans for plan years beginning on or after Jan. 1, 2025. These changes include limits that are adjusted for inflation each year, such as the Affordable Care Act’s ACA) affordability percentage and cost-sharing limits for high deductible health plans (HDHPs). Employers should review their health plan’s design to confirm that it has been updated, as necessary, for these changes. For checklist please click here: https://lnkd.in/gubWvCA8

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As I review a 2021 letter to a state client, I lament the continued references to the ‘CSR Defunding impact’ as "silver loading", & the resulting confusion of state legislators & misframing of holistic actuarial professionalism concerns. https://lnkd.in/gvy5WmCB "Detractors of premium alignment sometimes resort to disingenuous arguments to confuse the situation. For example, some suggest that premium misalignment is merely the result of an emergency response to CSR Defunding, & therefore excusable because it was not anticipated by the ACA. That is clearly a false assertion; as illustrated, premium misalignment began years before CSR Defunding was a consideration. In fact, the impact of CSR Defunding (in 2018) was a little more than an offset to the degree of premium alignment that had already occurred. CSR Defunding has complicated the understanding of premium misalignment, but it did not cause it. Premium misalignment was present before CSR Defunding occurred, it is present now, and it will continue if CSR funding is restored. States should not be fooled by this conflation." 'Due to silver loading, it appears that current metal-level premiums are misaligned & do not reflect coverage generosity.' https://lnkd.in/gEDhNgXx Charles Miller puts this way, "The problem of underpriced silver plans that effectively violates single risk pool requirements is independent from the ‘silver-loading’ debate & existed prior to CSR defunding. However, the question of how to legally & compliantly fund CSR expenses in the absence of appropriation has muddied the issue & created an opportunity for those who support violating the single risk pool requirements to try to conflate these independent issues.” Despite the harmful impact to ACA consumers via higher premiums & lower derived subsidies, many prominent voices openly champion ‘relaxed rating compliance’ in ACA markets & speak transparently of the policy efficacy & market benefits of not aligning premiums with coverage generosity as required by the ACA’s single risk pool guidelines. They cite reasonableness, distribution of ‘healthy enrollees’, ‘experience rating’, ‘pricing differentiation’ & eliminating cross-subsidization, ‘lower risk transfers’, behavior of ‘members in silver plans’, metal level experience, ‘regulator responsibility to choose among enforcement strategies based at least in part on their consequences’, compliance causing ‘members to choose gold plans’, competing at right metal levels, fragile exchanges, & people getting ‘money’s worth’, but the ears of the regulatory community are afflicted by those who have catalyzed the mischaracterization of actuarial integrity related to single risk pool compliance as ‘Silver Loading Policies’. https://lnkd.in/gErG7NW8 Opinions are mine alone & not those of Axene Health Partners, LLC.

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This is why I emphasize that a THIRD-PARTY INDEPENDENT BILL REVIEW is essential for your plan—one that is free from BUCA, private equity, and investor influence. MULTIPLAN—🚩 Lawmakers on Tuesday called on health insurance regulators to detail their efforts against “troubling practices” that have raised costs for patients and employers. In a letter to a top Labor Department official, two congressmen cited a New York Times investigation of MultiPlan, a data firm that works with insurance companies to recommend payments for medical care. The firm and the insurers can collect higher fees when payments to medical providers are lower, but patients can be stuck with large bills, the investigation found. At the same time, employers can be charged high fees — in some cases paying insurers and MultiPlan more for processing a claim than the doctor gets for treating the patient. The lawmakers, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California, both Democrats in leadership positions on a House committee overseeing employer-based insurance, highlighted MultiPlan as an example of “opaque fee structures and alleged self-dealing” that drive up health care costs. In their letter, they pressed the department for details on its efforts to enforce rules meant to promote transparency and expose conflicts of interest. MultiPlan’s business model focuses on the most common way Americans get health coverage: through an employer that “self-funds,” meaning it pays medical claims with its own money and uses an insurance company to process claims. Insurers such as Aetna, Cigna and UnitedHealthcare have pitched MultiPlan’s services as a way to save money when an employee sees a provider out of network. In many cases, MultiPlan uses an algorithm-based tool to generate a recommended payment. Employers typically pay insurers and MultiPlan a percentage of what they call the “savings” — the difference between the recommendation and the original bill. While this arrangement is usually disclosed in contracts, the fees have surprised some employers. In one case, UnitedHealthcare used MultiPlan to cut a $152,594 hospital bill to $7,879 and then charged the employer a $50,650 fee for doing so. us-beacon.com #healthcare #pricetransparency #multiplan #BUCAH #inelibigblecharges #fraudwasteabuse

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If you’re an advisor writing self-funded business, you need to know about this. there’s a solution out there that: -creates a partnership between your actuarial consultant and agency (no more being too afraid of an hourly rate to call your actuary) -gives you new actuarial value for a plan change at the click of a button -automates your renewal year and initial underwriting -gives clients transparent access to plan experience reporting -will build you custom software tools yeah, I’m talking about BLUE RAVEN actuarial while this is a blatant sales pitch, I still mean it. we were the best kept secret in EB until the beginning of March and are now partnering with some of the most innovative advisors, employers, and health plans in the country. don’t miss the next big thing.

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Webinar Invite - How Benefits Brokers Can Avoid this Colossal and Expensive ICHRA Mistake September 12th and 18th 2:00 - 2:30 EDT - Register Below In this webinar I will discuss and reveal the one mistake that benefits brokers are making as it relates to ICHRA's that can be very costly. For one broker it could be over $1 million. Attend this webinar and I guarantee you will hear a unique perspective around ICHRA's. It will be well worth your time.

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When it comes to ACA dynamics, it often seems that the public discourse and political media groupthink are on a different planet, so it was refreshing to hear Republican Vice-Presidential candidate JD Vance say something last Sunday that 'separated politics from policy' and was in alignment with what I had recorded in 2020. Unsurprisingly, the general political media response over the last week has been to claim Vance is "rewriting history". https://lnkd.in/gV7q3fDD "President Trump’s regulations have ignited a makeover of the ACA with more attractive consumer offerings, increased popularity and tolerability, insurers returning to ACA markets, and three years (2019-2021) of flat premiums…President Trump’s signals have suggested not only advocacy for a broader coverage model and principled opposition to the inefficient ACA design, but a willingness to enhance funding and work within the law’s constraints to improve coverage levels." https://lnkd.in/gHNEyU4 "He chose to build upon a plan even though it came from his Democratic predecessor. And I think it illustrates Donald Trump's entire approach to governing, which is to fix problems, even if he may have disagreed with the original legislation, to fix the American people's problems, not just to blow things up because it happened to be implemented by your predecessor." https://lnkd.in/gsHw_U2j Opinions are mine and not those of Axene Health Partners, LLC.

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Every CFO should ASK these QUESTIONS about insurance ANNUALLY. Your PERSONAL ASSETS are on the line, if you're wrong. 1. How comprehensive is our coverage? → Why it matters: GAPS can lead to costly UNINSURED losses → What to listen for: Analysis of HOW your actual risk EXPOSURES are COVERED → Red flag: If your broker doesn't explain the EXCLUSIONS in your policies… 2. What's our claims history telling us? → Why it matters…underwriters think: PAST claims can predict FUTURE ones → What to listen for: TREND analysis and risk MITIGATION strategies → Red flag: If they HAVEN'T REVIEWED your claims in detail 3. Are our limits adequate for our risk profile? → Why it matters: UNDERINSURANCE can be CATASTROPHIC! → What to listen for: BENCHMARKING against industry PEERS → Red flag: If they CAN'T JUSTIFY your current limits 4. How are we addressing emerging risks? → Why it matters: NEW THREATS require PROACTIVE protection → What to listen for: REGULAR risk assessments and POLICY UPDATES → Red flag: If they're NOT DISCUSSING new coverage options 5. What's our total cost of risk? → Why it matters: PREMIUMS are just ONE PART of the equation → What to listen for: Analysis of RETAINED LOSSES, ADMINISTRATIVE COSTS → Red flag: If they focus SOLELY on premium reduction Want a THOROUGH REVIEW of your insurance program?​​​​​​​​​​​​​​​​ P.S. Hit the dislike 👎 button if the all caps were annoying today! Haha And follow me Mark Flippen for more daily insurance tips!

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For tomorrow's study group, we'll be joined by Steve Sheehan, Regional Vice President of Transamerica Employee Benefits. Steve will be giving us an overview of Transamerica's group UL solution, which includes LTC and Chronic Illness riders! 📅 Date: Thursday, August 8, 2024 ⏰ Time: 1:00 p.m. PT | 3:00 p.m. CT | 4:00 p.m. ET 🔗 Link in comments Here's what you can expect to learn: 💡Full product overview 💡Product sweet spots and ideal groups 💡Opportunities that Transamerica is well equipped for 💡Process notes and how to get started working with the product See you on the call!

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Group plan administrators: make sure to check this out. The most commonly missed one I see is the minimum deductible threshold to be HSA eligible (when you have a embedded deductible).

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Inadequate insurance is a ticking time bomb. Don't believe us? 100% of the FI insurance programs we review have 10+ material coverage gaps. Institutions spending MILLIONS on protection that won’t work. It’s insane. In today's edition of the LION Specialty Newsletter, we're exposing the dangers of settling for B-team insurance brokers… Including: → Why "good enough" coverage crumbles under pressure → The 5 devastating consequences of coverage gaps → How to know if you've got a B-team problem → What A-team expertise looks like in action We're also sharing the 4 critical questions every FI leader should be asking about their insurance program. (Spoiler: Most can't answer confidently!) Want to read our blog breaking it all down? Like this post and comment "newsletter" to get our latest edition delivered straight to your inbox. Stay covered! Natasha I. Kiemnec, ARM & Mark Flippen Enjoyed this post? ♻️ Repost it to your network and follow us for more daily insurance insights.

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