The Softening and Widening Stop Loss Market

Vintage processing of an open for business sign in small town America.

For the last several years, we’ve highlighted the dramatic market trend of employers adopting self-funding and the rationale supporting the move. As premium dollars have left the insured medical market, lots of those dollars have moved to the reinsurance markets with employers offloading the tail risk associated with their self-funded arrangements. Meeting the demand have… [Read More]

A Look at Catastrophic Claims in the World of Stop Loss


Sun Life Financial recently released a report on the top ten claims conditions which give rise to stop loss claims under a self-insured healthcare plan. Sun Life analyzed four years of their catastrophic claims data and found that these ten claims represent 53% of all stop loss claims reimbursements. 26.6% of all stop loss claims… [Read More]

Risk Corridor Shortfalls Are Wreaking More Havoc on Our Healthcare System

Reshaping Healthcare in the United States

What a mess we have created. In order to balance potential inequities resulting from barring underwriting by insurance carriers, the Affordable Care Act established three risk-sharing programs. The first is an ongoing risk adjustment program which transfers payment from insurers who have assumed better risk, to those that acquire worse risk. The second is the… [Read More]

Ebola Epidemic and Your Healthcare Plan


Anyone who has turned on a television or read a newspaper over the last few weeks has come to recognize what a significant humanitarian threat Ebola is presenting to the international community. What started as a dreadful disease in West Africa has now spread to 9 countries including the United States and Spain. In fact,… [Read More]

Soak the Rich, But How?


There have been a number of trends that have accelerated in recent years in response to unmanageable cost increases and due to regulatory influence. One of the more prominent concepts—historically adopted only by the legal and financial services industries, but increasingly making its way into every board room conversation—is salary banding employee contributions. The idea… [Read More]

Who, Me? Fiduciaries Often Don’t Understand Their Responsibilities & Exposure


How well do the members of your 401(k) committee understand their fiduciary responsibilities? How many of them understand that they could be found personally liable for breaches of their duties? With committees I have encountered, members are often recruited (sometimes reluctantly) based on their position with the company or perceived investment knowledge. But that does… [Read More]

Exchange Risk Stabilization: A Solid Backstop for Bad Underwriting Results?


Hand in hand with the elimination of pre-existing conditions are risk stabilization mechanisms built into ACA. The first we are all learning about is a reinsurance fee, which is paid by every belly button: the $63 fee. This temporary fee, assessed and reducing each year from 2014 to 2016, is meant to offset adverse high… [Read More]

Nowhere to Hide: For Groups with 50-99 Employees, 2016 Is Coming Soon


The Affordable Care Act is starting to wear on me. Like bleeding to death from a thousand small cuts, the implications of this problem-ridden legislation are slowly and painfully unfolding. I am starting to be concerned about 2016. The delay in the employer mandate for groups from 50-99 employees is a good thing. Those groups… [Read More]

Re-Enrollment: A Step Too Far?


There will be some in the retirement industry who disagree with me, but I think that the trend of re-enrolling all employees on a regular basis and defaulting their investments into target-date funds, even if the participant had previously picked another investment, is taking the employer’s role as plan fiduciary a step too far. Don’t… [Read More]