Benefits Dirty Dozen, Part 1. Health plan tactics 12 to 7.

Employers can spot six common health plan tactics by laying the broker disclosure, the contract and the invoice side by side. In Part 1 of the Benefits Dirty Dozen, the Ethos Benefits team covers PEPM fees that become PMPM, contracts that drift from the proposal, hidden ownership interests, PBM collectives, captives and controlled market checks.

Key takeaways

  • A fee quoted per employee per month (PEPM) can show up per member per month (PMPM) in the contract, which Donovan Ryckis says multiplies it by about 2.4 times on average.
  • Termination notice, contract length, performance guarantees and data rights can all change between the proposal and the signed contract, so employers should ask for the contract up front and compare every term.
  • Patrick Ansara says the 60 days before open enrollment is the worst time to negotiate, and that Ethos Benefits starts at least 150 days before renewal depending on the size of the client.
  • Chelsea Ryckis treats it as a red flag when the same few vendors win every renewal, because that is a shortlist rather than a market check.
  • Broker compensation built into a group captive and made unassignable can block an employer from changing advisors, so the hosts recommend keeping it out of the captive and on the TPA invoice.
  • Patrick Ansara says employers should never accept a no-look renewal offered in exchange for not taking the plan to market.

Chapters

  1. Cold open: claims data and contract terms
  2. What is the Benefits Dirty Dozen for health plans
  3. How each tactic is graded: dirty or dumb
  4. Tactic 12: PEPM vs PMPM fees in broker and vendor contracts
  5. Tactic 11: Vendor contract doesn't match the proposal
  6. How early to start the health plan renewal process
  7. Tactic 10: Undisclosed broker equity and ownership interests
  8. Tactic 9: Broker PBM purchasing collectives and coalitions
  9. Tactic 8: Group captives as the broker's easy button
  10. Tactic 7: The controlled market check at renewal
  11. Should you accept a no-look renewal?
  12. Closing thoughts: education for plan sponsors

Listen on Apple Podcasts · Spotify · YouTube

"So never assuming what somebody's telling you. It has to be in writing."

Chelsea Ryckis, Ethos Benefits

"And I think at the end of the day, the contracts are with the plan sponsor. It's not with the advisor."

Patrick Ansara, Ethos Benefits

"A broker is going to do what a broker does. They're going to broker a risk transfer."

Donovan Ryckis, Ethos Benefits

In this episode.

Employers rarely see the full chain from proposal to contract to invoice, and that gap is where many health plan tactics live. In Part 1 of the Benefits Dirty Dozen, Donovan Ryckis, Chelsea Ryckis and Patrick Ansara of Ethos Benefits adapt the IRS’s annual Dirty Dozen list to health and welfare plans and work through tactics 12 to 7.

For each tactic they cover how a plan sponsor can spot it, what it costs, whether it is ever fair, the fix, and a verdict: dirty or dumb. Chelsea Ryckis closes by stressing that the episode is education for plan sponsors, not broker bashing.

  • PMPM instead of PEPM. A one-letter change between the broker compensation disclosure and the contract that can multiply a fee.
  • The contract doesn’t match the proposal. Why to get the contract first and compare every term, and why the health plan renewal timeline should start well before open enrollment.
  • Undisclosed equity and ownership interests. Advisors and vendors recommending companies they hold a stake in, and how asking for a 408(b)(2) disclosure before renewal brings it out.
  • PBM purchasing collectives. Broker-run coalitions that restrict data and contract terms, and what matters when choosing a PBM directly.
  • Captives as the broker’s easy button. When a stop-loss captive makes sense, and why to compare it with traditional stop-loss insurance.
  • The controlled market check. The same carriers every year, data released late, and the no-look renewal, with lessons that carry over to how to vet benefits vendors.

On this episode.

  • Donovan RyckisBringing Fiduciary Strategy to Employer Healthcare | Benefits Advisor to Large Employers | Founder & CEO, Ethos Benefits

    Former Series 65 investment advisor who brought the fiduciary standard into employer health plans in 2016.

  • Chelsea RyckisFounder and President, Ethos Benefits

    BenefitsPRO 2024 Advisor of the Year. Leads strategy and benefits committees for Ethos clients.

  • Patrick AnsaraPartner and Director of Client Operations, Ethos Benefits

    Turns a plan's claims data into a multi-year cost strategy. In employee benefits since 2013.

Questions from this episode.

What is the difference between PEPM and PMPM fees?

PEPM means per employee per month, and PMPM means per member per month, which counts every spouse and dependent. Donovan Ryckis says the difference averages about a 2.4 times multiple. The hosts say PMPM can make sense for vendors that touch every member, such as a nurse line, but Chelsea Ryckis flags the case where the compensation disclosure says PEPM and the contract says PMPM.

How can an employer tell if a vendor contract doesn't match the proposal?

Lay the sales proposal, the contract and the first invoice side by side and check each term. Patrick Ansara says the changes are not always fees: performance guarantees, termination clauses, multi-year lock-ins and data rights can drift too, including in renewal contracts. He recommends asking for the contract up front during the RFP.

How early should an employer start the health plan renewal process?

Patrick Ansara says the 60 days before open enrollment is the worst time to negotiate, because the employer has little room and carriers know it. He says Ethos Benefits starts at least 150 days before renewal, depending on the size of the client, and sometimes 180 to 360 days when procurement takes longer.

Is a group captive better than standalone stop-loss?

Not automatically. Chelsea Ryckis says group captives can make sense for some midsize employers with volatile claims, but they are not the pinnacle of self-funding. The hosts recommend comparing the captive side by side with traditional stop-loss quotes and reviewing fees, assessments, collateral and exit terms.

Can a captive stop an employer from changing brokers?

Donovan Ryckis describes captives that build broker compensation into the captive layer and make it unassignable, which can block a broker of record change. His fix is to keep consultant compensation out of the captive contract and show it as a line item with the TPA, so it can be reassigned.

Should an employer accept a no-look renewal?

No, according to Patrick Ansara. If a carrier can offer a lower number in exchange for not going to market, it can probably offer it when the plan is marketed, and skipping the market check works against the plan sponsor's duty to evaluate its options.

How can an employer tell if a broker's market check is real?

Chelsea Ryckis suggests counting the distinct vendors across the last three market checks: if it is the same three every year, it is a shortlist. Patrick Ansara adds that every market should get the identical claims data package, and that the markets should be agreed in a pre-renewal meeting.

Full transcript.

Transcribed from the recording and lightly corrected. It may contain errors; the recording is the record.

00:00Patrick Ansara: You should be getting access to your claims data first upfront in the contract terms, but then also upholding that with the carrier or TPA in that regard. If they're holding onto that data, there's generally a reason they don't want the market to see that. If you're not able to see all of your options or you're not being informed of all of your options, you can't really make an informed decision. No renewal I've ever received said, hey, just so you know, these contract terms changed. So it's always on us to review that.

00:28Donovan Ryckis: You know, one of our mentors said that this industry pays incredibly well for mediocrity, and I couldn't agree more. Welcome to the Business of Benefits.

00:40Chelsea Ryckis: The Business of Benefits is your no BS, no sales guide to real solutions.

00:45Donovan Ryckis: No gimmicks, just the truth about how to take control, transform your benefits, and care for your most valuable asset, your people.

00:52Chelsea Ryckis: If you're tired of the same old sales pitch and you're ready to rethink your benefits, this podcast is for you. The truth is out there. Are you ready to hear it?

01:01Donovan Ryckis: All right. Welcome to the Business of Benefits Podcast. Today is a recording that I've wanted to do for quite some time. And I thought it'd be hard to put all this content together. And actually, I sat down and did it all at once. So Ethos actually started and our founding story is as a fiduciary securities firm. And every year the IRS puts out this memo called the Dirty Dozen. And essentially it is, it's legal tax structures that people are kind of abusing. So it's legitimate processes that are being just abused and used in the wrong way. And they kind of put it out as things to focus on, make sure you have in order, and also where they're going to be kind of enforcing, you know, the IRS code for the upcoming year. And I thought that'd be the perfect thing to do for benefits. So the Benefits Dirty Dozen, I thought that'd be hard to put together 12 tactics and things we're seeing in the market that are being abused. And I actually sat down and wrote like 14 or 15 all at once. So there's certainly plenty of stuff going on. Not saying this is happening everywhere, but I would bet just about any plan sponsor can find one or two of these things going on, if not a heck of a lot more within their healthcare plan or over the past couple of years. With me, I have Chelsea and Patrick.

02:31Chelsea Ryckis: Everybody knows me, so we're not doing an intro, but Patrick, why don't you tell the plan sponsors listening who you are, your role, et cetera?

02:38Patrick Ansara: Yeah, yeah, for sure. So I am the Director of Client Operations here at Ethos. So I really like to manage everything in relation to plan operations, so making sure things are running smoothly. But also that gets into what's inside of the contracts, what's happening behind the scenes, and what are the vendors actually agreeing to, and are they holding up their end of the bargain? So I think we'll talk a lot about that as we get into some of these dirty dozen topics. But yeah, I've got my skin in the game with health policy studies at the University of Michigan. So I've been doing this since I was in college, and then started cutting my teeth in the industry at a local agency that I worked at for a while, and then I worked at some carriers as well. So I've gotten to see both sides of the scenes, and yeah, looking forward to talking about this a little bit more.

03:31Donovan Ryckis: So as we go through this, we're going to be kind of covering each one in the same way. So each tactic of the dirty dozen. So we're going to be talking about what this looks like from being a plan sponsor? How can you tell if this is going on? I'll be covering the tactic. Patrick will be reviewing the damage. So what does this mean? How does this complicate things? How do the numbers shake out? In fairness, is this a fair play? Is this a mistake? Kind of maybe coming on the broker's defense a little bit. And then the fix, how can we do it? And then lastly, I kind of want to talk about dirty or dumb. So is this a dirty tactic or is it just a dumb tactic? Maybe bad business practices, people falling behind, not staying up with their account management, those kinds of scenarios. You guys ready to get into it?

04:24Chelsea Ryckis: Let's do it.

04:25Donovan Ryckis: All right, so number 12, our first one here, PMPM instead of PEPM. So PEPM is per employee per month, and PMPM is per member per month. So that includes every dependent, every spouse, instead of just tracking employees. The difference is about a 2.4 times multiple on average. So that's how many more members you have over just employees enrolled in a plan. So we've seen a lot of this being stated as one thing, and then we find out it's another thing. So it's stated as per employee per month fees. And then when we get to the contract, we start to see that actually they're being charged per member per month. So that one letter change basically adds a 2.4 times multiplier to fees or commissions when we get into it.

05:24Chelsea Ryckis: So the way that a sponsor would know this would be that you'd be looking at the compensation disclosure. So friendly reminder for all of our plan sponsors listening, 408s are really great to have on file for all service providers making over $1,000 a year, which should be pretty much everybody in your plan. But the compensation disclosure, so the tell is that it would say, likely it's gonna say PEPM in your compensation disclosure, but the contract could say PMPM. So that's how you'd know.

05:58Patrick Ansara: Yeah. So it can make a big difference when you look at the pricing overall, like Donovan mentioned, 2.4 times. So that 2.4 number is basically what we normally see as far as a dependent-to-employee ratio. So 2.4 times as many members on the plan as you have employees. And so in reality, if you're talking about having 500 employees on the plan and maybe 1,200 members. And let's say that fee is about $2. So that's a difference of about $16,800 per year in that cost. And I think the biggest difference you're going to see and where we've seen that be an issue is we have one thing that's written on the proposal, but then when you get into that contracting stage, it changes and maybe nobody notices. And that makes a huge difference at the end of the year.

06:50Chelsea Ryckis: And in fairness, right, it's not that this is all across the board a nefarious way that people or brokers or whoever's vendors are hiding, right? Like, PMPM is a legitimate pricing basis. It's just... and there are certain vendors where it makes more sense than others. So for example, maybe care navigation, like a nurse hotline, sometimes pharmacy, like if the programs are actually touching every member, perhaps that pricing model does make sense. But what we're saying doesn't make sense is to put one thing, which we see again, we've seen it multiple times this year. The disclosure says PEPM, but the contract says PMPM. That's what we're referring to specifically being the issue.

07:34Patrick Ansara: Yeah.

07:34Donovan Ryckis: And in fairness, do we think a broker or consultant should really be getting any fees PMPM over PEPM for their work?

07:47Patrick Ansara: I don't think so unless they're, unless they have a service team that's actually handling things for particular members. So if they're doing any sort of healthcare concierge, that may be a situation where that might take place. But I don't think most consultants are, are doing that. So yeah, most times I wouldn't say so.

08:08Chelsea Ryckis: I agree.

08:09Donovan Ryckis: So what's the fix, Patrick?

08:11Patrick Ansara: Yeah, so I think the biggest fix is really just making sure that Whoever's reviewing those contracts has a good process in place to do a comparison at the end of it. So you wanna, when you're going through implementation, making sure that you're taking a look. All right, this was the sole proposal. This is what the contract says. And at the end of the day, what does that first invoice say too? Because you wanna make sure all those fees are lining up at the end of the day. And that's really what you need to be watching out for. And a good advisor, should be doing that for you.

08:41Donovan Ryckis: Yeah. I think the quick tell is putting all these disclosures together. So the annual compensation disclosure you're probably getting from your broker consultant, the invoice, and then the contract. And you can just throw those all into an AI and say, hey, do my fees add up here? Is this kind of what I was told in the compensation disclosure? And get to a very quick answer on if these things match. So is this tactic dirty or dumb?

09:15Chelsea Ryckis: Can it be both?

09:16Patrick Ansara: I think it's both. Sure.

09:18Chelsea Ryckis: Because we have seen it. I do think there are instances where somebody like fat fingers it, or just maybe they... there's an account manager doing a disclosure and they don't genuinely understand the difference, which by the way would be very problematic. But nonetheless, no malintent. But I have also seen it be more nefarious.

09:38Donovan Ryckis: I'm going dirty. Yeah, if you look at your keyboard, the E and the M are nowhere near each other. That's a good point.

09:46Chelsea Ryckis: The fat of the fingers is really the question here.

09:48Donovan Ryckis: And we have yet to ever see a disclosure say PMPM and then the contract says PEPM. So we've seen this multiple times this year, 2.4 times multiplier on the broker's fees. And I've only seen the mistake go one way. And I just, from the scope of services that, you know, the accounts that we take over, I don't see it ever being appropriate for a broker consultant to get a PMPM. For vendors in the healthcare plan chain, that makes sense for your cost containment solutions. That might be viable, makes sense. I don't personally see it ever being appropriate. Patrick, dirty or dumb?

10:33Patrick Ansara: I'm, I'm with Chelsea here. I think it's a little bit of both. I do, I do agree with you, Donovan, though, because every time we've seen it's always only been in one direction. It's always been dirty. But I, the amount of disjointment that I see between sales teams and implementation teams with vendors can sometimes just be dumb. So I think it can be either. I think most of the time it's dirty.

10:55Chelsea Ryckis: Okay.

10:56Donovan Ryckis: Fair enough. All right. So number 11, which would be the contract doesn't match the proposal.

11:03Chelsea Ryckis: A lot of the times this will happen when the timing from, you've been sold on something, you're into it.

11:09Donovan Ryckis: Yay.

11:10Chelsea Ryckis: Let's get into, you know, legal review, procurement review, et cetera. And then months later, you finally have a signed contract. It's the time in between where things change and nobody actually laid that initial sales proposal against the final contract.

11:26Donovan Ryckis: Yeah. So the tactic here is basically the terms drifting either during negotiation, maybe it's a notice window for termination, maybe it's extending the contract length to like 3-year term, which should never really be done. Performance guarantees coming out. There's a whole host of different contract terms depending on the vendor that can start to change. And often it happens during price negotiations, right? Like as they're coming down on price, they're trying to add in some contract terms to make it work for them on the back end.

12:02Chelsea Ryckis: I actually just had this happen recently where we were negotiating some reporting packages from a point solution vendor and they wanted to provide it quarterly and I was like, I prefer it monthly. And when they agreed to monthly, they then took out one of their performance guarantees, like completely took it out. And then they were like, well, now that we offered... and then I caught it. They didn't say anything, of course, but I caught it in the review and was like, hey, where did the response time thing go for member-facing advocacy type work? And they were like, oh, well, now that we're providing reporting every month, we just needed to take something away. And I'm like, you didn't want to tell me? That couldn't have been... also, they're not related in any way.

12:47Patrick Ansara: Yeah.

12:48Chelsea Ryckis: That potentially if something was more related, that would be where the negotiation happens. It was completely unrelated and it was just dropped. So it doesn't even have like, this, this is where we'll get to the dirty and dumb. Like, that was just dumb. That wasn't dirty, I don't think. But interesting, right?

13:06Patrick Ansara: Could have been. But I think that kind of speaks to the damage that can be done between, you know, the time you're asking for something and the time they deliver the new contract to you. It's not always a fee that's, that's the problem. It's going to be an actual guarantee that they put in place or a termination clause, or maybe they're expanding their, their data rights and saying that it's their data and not your data.

13:28Patrick Ansara: All of these things can happen. So it's really about going through each of those terms with a fine-tooth comb to say, all right, this is what was sold and this is what we're signing up for. And I think one of the biggest things you can do when you're in that RFP process and looking at different vendors to procure to be a part of your plan is get the contract upfront. So when you're sending out for that RFP, you should be getting that contract first and foremost. So, you know, all right, this is a vendor I wanna work with, or this is one who's not gonna allow me to see anything that's happening as a part of my plan.

14:00Chelsea Ryckis: So, I'm trying to figure out the unfairness part and I'm having a hard time with it because it's like, really, I just think if you're gonna change, if you're mid-negotiation, and you're going to change your offer in any material way, there needs to be notice and attention brought to that. Like, I don't really think that there's a... Oh, but sometimes they forget that they... how about this, like changing our fee? How many times has that happened where we're negotiating back and forth, and then it goes from whatever the PEPM was, all of a sudden it drops $10? And nobody says anything. Like, it's that where I don't think there is an unfairness. I don't know, what do you guys think?

14:43Donovan Ryckis: I think the only unfairness... we've seen it a lot because our process is to get the contracts upfront. And sometimes even the, you know, account executives or sales representatives at these vendors and carriers, they're so not accustomed to that, they don't even have it, because that's after they go through, you know, the case is sold, it gets pushed to the next desk, right? So not only do they often not have contracts, they're not up to speed on the terms. And then when we're negotiating kind of unique terms separate from their stock agreement, right. They're kind of pulled into a different process, right? And they really don't understand. We saw this with 2 TPAs through the same TPA procurement for the same client, where both of them provided their stock agreements. And then the next week they're like, oh, I'm sorry, that was last year's.

15:37Patrick Ansara: Right.

15:37Donovan Ryckis: And it's like, wait, we're in, you know, at that point it was like July or August. It's like, how are you sending me last year's? We're here. Right. So I think that's the only thing is sometimes the people that we're dealing with day to day to kind of get this done, they're not even part of that because the standard process so far, and it's widely accepted, is you make an agreement and then you get the contract last that actually sets forth the terms. After you're already going through implementation, you're now kind of past a timeline.

16:12Patrick Ansara: Yeah, I think one other thing I'd add to that too is like, I think we're talking a lot about maybe like a new vendor or carrier that you're doing that you're trying to implement, but also with renewal contracts. And it's not always that, you know, your account executive at the TPA or the PBM that you're dealing with understands really what's happening behind that contract. They likely didn't review it. They're just getting what's passed down to them from their legal team. But I've seen renewal contracts change dramatically from one year to the next. And then you always have to just view what you initially signed up for and then compare that against what they're trying to sign you up for with the renewal. So that's always a quick gotcha that you'll find inside of those where you have extended termination clauses or early termination fees or trying to lock you in for multiple years.

17:02Chelsea Ryckis: Such a good point.

17:03Patrick Ansara: Yeah. So I think there's a couple ways to fix that. And I think the biggest thing is giving yourself some time. You don't want to be stuck in that 60-day window before open enrollment starts. That's the worst time to try and negotiate anything. You don't have a lot of leverage and the carriers do know that. So the biggest thing is really just start early. We like to start depending on the size of a client, at least at 150 days prior to renewal. But a lot of times we're expanding that 180 or maybe 360 days if you have a really long procurement process. So these are all things to keep in mind at, at, you know, this day. We want to make sure that these carrier renewal requests go out to make sure that we're understanding what's, what are the renewal terms? What's the renewal going to be? If you don't have the rates for me, then let me see what my renewal contract is so I can at least see what that's going to look like.

17:59Chelsea Ryckis: Yeah, right, exactly. I think, Patrick, that's a really good point that a lot of the times when rates and numbers, so if the financials aren't available, everybody just stops. And it's like, why aren't we working on the contract language? Why aren't we working on the member experience? Why aren't we working on all the other million things that need to get done? Right? There tends to just be such a focus on price. And I think that exactly brings us back to how this started, was you look at the price on the sales proposal, and then you look at the price in the contract, and most people are like, okay, cool, we're good. It's $2 PEPM or whatever it is versus the focus on the terms.

18:37Donovan Ryckis: I think the other thing is, you know, you want to make sure you're negotiating like for like. You know, this is kind of analogous to like how most... how a lot of plan sponsors unfortunately deal with premium increases, which is they start changing the benefits coverage, right?

18:52Chelsea Ryckis: Yes.

18:52Donovan Ryckis: So now we're not even negotiating like for like. So let's agree that we're not taking away anything from our coverage first and then work on the price and then figure out if we do have to adjust terms. But all that needs to be upfront and just handled way better.

19:08Chelsea Ryckis: You know what the other side of this is? Is when I've heard this from plan sponsors that we started working with, especially on compliance items where they'll say, Oh, my broker said we were meeting affordability, or, oh, somebody told me we were good with this, and there isn't the actual check in the contract, right? So it's not even necessarily just like proposals. I think there's a lot of verbal things that are said by sales reps, marketing reps, and like Patrick said, when there's... there can be sort of a disintegration between sales and implementation. And I mean, we've had it happen where reps say, yeah, yeah, it's a guaranteed renewal for 2 years or whatever it is, right? And then we get into it and it's like, yeah, everything except for this one thing and this one thing and this one thing, and we find it in the contract. So never assuming what somebody's telling you. It has to be in writing.

20:04Donovan Ryckis: So Chelsea, what's the quick tell for plan sponsors?

20:08Chelsea Ryckis: Well, basically just looking at your contracts, right? Look at the proposal, look at the contract and make sure the timing of everything is in your favor.

20:20Donovan Ryckis: So dirty or dumb? Start with Patrick.

20:23Patrick Ansara: I am gonna say dumb here. Really? Yeah, I am.

20:29Chelsea Ryckis: Dude, I'm dirty all the way.

20:31Patrick Ansara: Yeah.

20:32Chelsea Ryckis: This is dirty.

20:34Patrick Ansara: I, so the reason why I'm saying dumb is mostly on the renewal part because I do think when When you're working with that account executive and they say, hey, here's your renewal contract, they haven't looked at it. And they don't know what the changes are. Now, should they know? Yeah, probably. But they're not delivering any of those. No renewal I've ever received said, hey, just so you know, these contract terms changed. So it's always on us to review that. So I do think it's dumb from that regard, and I also think it's dumb on the, the vendor to just kind of change those contract terms without them saying anything, which in essence is, I guess, dirty. But, a little bit of both. I'm leaning more towards dumb here though.

21:18Donovan Ryckis: I'm gonna go 50/50. Obviously like changing terms is a viable way to make, you know, a price adjustment work for both parties, but it needs to be called out. And I think what, doesn't happen is any kind of notice. You know, that's typically something we're catching. And then we certainly look at the vendor differently. And the question is like, on an everyday basis, are broker consultants catching this stuff for plan sponsors? I don't know, 50/50, right? So I think there's some dumbness on both sides as well.

21:54Donovan Ryckis: All right, so number 10, undisclosed equity and ownership interests. So this is speaking directly to these legacy agencies. And if you read the compensation disclosure that they provide, which is usually 10 to 15 pages, it's usually provided after the open enrollment when everybody is thoroughly fatigued and doesn't want to read a single other disclosure, contract, or proposal. That the advisor holds equity in and takes a revenue share from carriers that they recommend, right? So this advisor, if you will, that a plan sponsor has hired to give them unbiased advice for the best interest of the plan participants and the plan sponsor is actually quite biased to companies they recommend that they hold equity interests in.

22:51Chelsea Ryckis: Plan sponsor would be able to identify this as potentially happening if every single year that you go through the renewal process, there tends to be a favorite, a winner, and maybe it's the best network or the best customer service, or they pay the most in claims, like stuff that just... they have the best reimbursement rates, like kind of stuff that's really hard to prove. If your broker has a favorite vendor in every category every year and it's relatively consistent, that would be a red flag to me.

23:22Patrick Ansara: Yeah, for sure. And I think it can cause a lot of damage in the plan as well, especially long-term. You think about it, if you're not able to see all of your options or you're not being informed of all of your options, you can't really make an informed decision. And I think, you know, we're talking about it on the advisor side, but we've also seen this on the vendor side as well, where there's integrations with the vendors where they own multiple pieces that be disclosed, or maybe it's a TPA that owns an Rx arrangement and that's not disclosed. And they're trying to shuffle, you know, pharmaceuticals through that Rx arrangement. So I think we've seen this in a few different ways, but it can cause big problems because you're not always getting down to lowest net cost or best service or all of these things that actually matter for your plan participants. And just that disclosure will let you know kind of what's happening behind the scenes.

24:14Donovan Ryckis: What we're talking about with this particular tactic is undisclosed. Equity and ownership interest, or maybe disclosed but at the wrong time of the year and not at the proposal, right? Because nobody's going to remember compensation disclosure that was provided 2 months after open enrollment last year, right? So I see this as, you know, basically serving the wrong master, right? Like you're going to the plan sponsor telling them, you're... I'm a buyer's agent, like I'm going to help you, we're going to get the best pricing. But in truth, like, they actually own equity and ownership. And so when they create those proposals, they're saying, guess who's top of the pile? Yeah, right.

24:58Patrick Ansara: Yeah, I think if it's disclosed, like, there is real reason to have these integrated components, maybe with an advisor relationship, maybe with a vendor relationship. I think all that can make sense, but it's when it's hidden, and not upfront, especially in the decision-making stage. If it comes later, that's not very much help is it? So you wanna have that information upfront. And I think as long as that's disclosed and you know, going into the decision, it's not a terrible...

25:25Chelsea Ryckis: But don't you think this is kind of like what Patrick said earlier, and this will get to the dumb or dirty, but like a lot of the times reps, like a sales rep or a marketing rep or whatever, they're not, they're disjointed from the equity. Of the carrier and the brokerage, right? So, like, what they're hearing from their teams is like, let's just... [company removed], right? Whatever is the best, or this carrier is the best. And they're hearing that, but they might not actually know that, oh, there's actually a huge line of credit from [company removed] or whoever it is, right? Like, they... I think that this is going to end up being one of those things where it's like, it's potentially nefarious up here, but by the time you get to where it's actually being executed, there's usually a lack of context.

26:13Donovan Ryckis: Yeah. Well, let's talk about the fix. So from a plan sponsor's perspective, because you're right, I don't think consultants, when they work at an agency that does $10 billion a year, they're not privy to all these details. So let's talk about it from a plan sponsor. How would you know and how could you kind of question these things? So what's the fix? I think overall, the biggest fix for one is the broker compensations coming out of these large agencies are problematic and they're not what you should be getting, right? The CAA says you should be getting a 408 disclosure just like your 401, which lists this all out. All the stuff that they don't want to disclose properly is required in a 408. So first step I think would be revisiting the compensation disclosure and all the conflicts of interest that they list but don't quantify, and then asking them to fill out a 408 prior to this renewal discussion. And they'll say like, hey, you know, I don't know what it is. Well, you could tell me what it was for last year on a 408 because I'm supposed to have it, you know, via this, the CAA, right? Like, this is something we should have had on file anyway. So go ahead and fill this out for our last plan year and use that as kind of a decision-making tool to understand those conflicts of interest and also quantify compensation before going into the renewal, because that's how it's supposed to be delivered anyway. You're supposed to have a 408. It's supposed to be before you make a decision, not after. It's not supposed to be on the broker's disclosure where they kind of skirt these rules.

27:57Chelsea Ryckis: If you want an even quicker tell, look at the last 3 renewals. That there was a market check done. And then I would just count the distinct number of vendors. And if it's the same 3 every single year, that's a shortlist. That's not really a market check.

28:14Donovan Ryckis: Yeah. Dirty or dumb?

28:19Patrick Ansara: Undisclosed. Dirty. I don't think it's dumb.

28:23Donovan Ryckis: Yep. Dirty. You know, if you're going to the plan sponsor and telling them you're working for them, you shouldn't be getting paid. By the other side of the table, period.

28:34Chelsea Ryckis: Period.

28:35Donovan Ryckis: Dirty.

28:37Patrick Ansara: Period.

28:38Donovan Ryckis: All right, number 9, PBM purchasing collectives and coalitions. So this is exclusively done by the largest agencies, really. And they say that, hey, we have this PBM collective and we've negotiated better prices and better terms. On drugs and guarantees on rebates, and you can't renegotiate any of the terms on the contract. And usually they also come with a lot more restrictions on data than you would get from that same PBM just on the open market away from the collective of that brokerage.

29:20Chelsea Ryckis: Yeah.

29:21Patrick Ansara: So I think I've seen this damage plan sponsors in a couple of different ways. So one is on the terms of that coalition contract and one's on pricing. So 2 different distinct situations, but I think I've seen this happen on the, the term side where we weren't able to get in certain audit rights or reporting service level agreements because they're part of this coalition or collective that was, that was taken over. And then on the pricing side, it can also be damaging. We went through a PBM RFP. Someone was in a collective with a large PBM and we went direct to that PBM and asked for a reprice study. Lo and behold, on a $9 million claim spend, their pricing was $1.4 million better outside of the collective. So that type of damage is pretty large at scale when you talk about having thousands of members on your plan and a ton of money out the door that really shouldn't be because you're part of this collective that should be helping you.

30:25Chelsea Ryckis: I think this is my favorite thing to talk about. Like, I just spoke to a plan sponsor recently too who was like, well, it's just like a PEO, right? Like, when I joined this collective, I'm getting the buying power of millions as opposed to my small company of maybe a couple thousand. That sounds rational, right? Like, when you hear it at face value, you're like, yeah, totally. Like, size, scalability, leverage. That makes sense. But guys, it does... like Patrick's saying, it does not work that way, actually. Donovan, we talk about this a lot, but like market leverage generally works the opposite way that plan sponsors think it does. So it doesn't actually favor them. It favors whoever the entity is. So in this case, the brokerage coalition for a PBM. What was the... you said the difference was $1.9 million?

31:16Patrick Ansara: $1.4 million. Yeah. And so actually it's, so the difference there, it was funny because the gross plan cost was the same in both columns, but outside of the collective, the rebates were increased significantly. So they're like, oh, we'll give you a lot more in rebates though. So those dollars were there in the first place, but where were they getting shuffled to is, I guess, the question.

31:40Donovan Ryckis: I think also, I mean, like anytime there's a proprietary product, which is all this is, and I saw this in securities all the time, right? So like every firm out there has proprietary funds and then they sell that. And there's often some truth that their proprietary fund is better than the copy of the one that's on the open market, the chance that it's marginally better, but it's also not as good as other options that are just freely available that they don't have extra compensation built in because that's what's happening, right? You're taking something that exists on the open market anyway. The collective is meant to generate revenue for that agency. So that's got to be additive, right? That's why they're offering it and pushing it. So it's never better than what's just openly available. So a fiduciary PBM will beat any collective any day of the week with any client, period. Right. And that's available for employers of all plan sizes. So it's just... There may be some truth occasionally that it is marginally better. But the way they restrict the data and are unwilling to share or quantify or provide that, like, if there was true value there, they'd be showing you that and kind of claiming that and taking pride in that spreadsheets and showing you how much you'll be saving, which is not the case.

33:05Chelsea Ryckis: What about though, in fairness, hahaha, the consultant that isn't an expert, right? Like the consultant, the maybe the more traditional broker that really doesn't understand this world, and they've got no idea what's going on. Like, wouldn't it be better for them to leverage some type of collective or coalition than to screw it all up on behalf of the plan sponsor if nobody has the expertise? Problem, by the way, guys, if you're listening, don't work with people that don't know what they're doing, obviously. But in that case, like, wouldn't this be okay?

33:39Donovan Ryckis: No.

33:41Chelsea Ryckis: Devil's advocate. That's my role in today's show, okay?

33:43Donovan Ryckis: Yeah, yeah, no, fair. And, you know, we're, we're red team, blue teaming this, which is, I think a good way to have a conversation about it. Yeah, in fairness, broker consultants may not know and they don't get to understand the market. But I think it is you know, an advisor's job to be curious and understand what's happening. I think particularly in the PBM space, every American knows it's problematic. So if this is your business and this is your industry, you need to know better and do better.

34:21Chelsea Ryckis: Yeah.

34:22Patrick Ansara: Yeah. And I think at the end of the day, the contracts are with the plan sponsor. It's not with the advisor. So I think a lot of this responsibility lies within the plan sponsor too, to make sure that their advisor is doing a good job. At presenting this information to them. So there's a couple of things to talk about. How do you fix this? And yes, I think a coalition or collective contract may be better than a standard agreement with a PBM, but you always have the right to negotiate. So you own that contract at the end, at the end of the day, and you want to make sure that the guarantees and the service level agreements that are being put in place are going against your plan and your members and attached to your claims. So all of that needs to be attached to your plan and not attached to everybody else's plan that's sitting out there.

35:10Chelsea Ryckis: Yep.

35:10Donovan Ryckis: Agreed. Anything else for collectives?

35:16Chelsea Ryckis: Dirty or dumb, folks.

35:17Donovan Ryckis: Dirty or dumb? I think I'm 75% dirty. 25% done.

35:30Patrick Ansara: I'm in the dirty camp because of the fact that these collectives are seldomly set up to help plan sponsors. They're set up to help the agency that is setting it up.

35:43Donovan Ryckis: Yeah.

35:44Chelsea Ryckis: I'm with Patrick. Dirty.

35:46Patrick Williams: Hi, I'm Patrick Williams, co-founder of Fiduciary in a Box. Employers today need more than just renewal strategies. They need a smarter approach to benefits, and that's why I recommend the Business of Benefits podcast. It's packed with actionable ideas, thoughtful discussions, and insights from some of the top experts in the industry. For the past 3 years, Fiduciary in a Box has supported Ethos Benefits by delivering the fiduciary operating system that empowers employers to organize, document, and manage their fiduciary responsibilities with clarity and confidence. If you're looking to build a better health plan, not just maintain one, start tuning in to the Business of Benefits podcast.

36:32Donovan Ryckis: All right, number 8, captives and consortiums as the broker's easy button.

36:37Chelsea Ryckis: Favorite. Okay, so I can't tell you. I literally saw this yesterday. Yesterday, the day before, either way, a certain captive being pushed or a certain consortium being pushed by a broker, especially when a group is new to alternate funding arrangements and nobody can tell you like how all of the self-funding works, but they're going to bring a captive on the call to explain it all. That's generally an indication that the partner that you're working with doesn't have the expertise to build you a custom. Health plan, and they're going to be relying heavily on those vendors. And in a lot of cases, I'm sure we'll get into this, but those vendors are actually protecting the brokers that don't really understand how these plans work. That's it.

37:28Donovan Ryckis: Yeah, we've definitely seen a lot of this in the past few years, and it's almost being pitched and brought to plan sponsors as like the pinnacle of health plan design.

37:39Chelsea Ryckis: Right.

37:40Donovan Ryckis: So a self-funded employer getting placed into a group captive or a consortium. And the conversation about the risk layer, it makes sense sharing that risk layer over a larger pool, right? Like, it's generally the concept of insurance in general, right? That risk is split amongst a larger group of people, where it's problematic is often these plan sponsors are coming from places where they haven't first addressed risk appropriately. So they haven't looked at what risk can we avoid, what risk can we reduce first, and then how much are we going to retain, right? So what they're doing instead is going to an additional layer of risk transfer. So they're doing their stop-loss layer, their captive layer. So they're just loading up on more insurance costs before they've properly measured their plan and put some strategies in place to reduce risk and avoid risk and then figure out if they need an additional transfer layer, right?

38:44Patrick Ansara: Yeah, and I think, you know, that kind of gets into the damage piece. So you talk about how does this really impact the plan overall, and it comes down to the additional fees, the assessments that you have, the capital that you may have to introduce and provide to the captive. What's the cost of leaving the captive? What are the termination provisions? All of these things can factor into that decision. And it's not that any of them are necessarily bad by themselves, but you do need to evaluate it against the entirety of your options, not just looking at one solution and saying, that's the one.

39:20Donovan Ryckis: I think another piece of damage that we saw twice towards the end of last year is we got hired as the new consultants for their healthcare plans. They were in captives, and I think both plan sponsors are like, "Hey, this seems to be working okay. Can you just take this over?" Like yeah, absolutely. Like it's you know that's we're not compensated differently based off you know what insurance protections you take in place. So we don't care if you guys think it's valuable, then it's fine. We'll we'll maintain that. But another piece of damage that gets pulled in and why this is pushed so heavily in our marketplace for one. A broker is going to do what a broker does. They're going to broker a risk transfer. Captive is a larger risk transfer, which means more sales, right? More compensation. But another thing that we see amongst the vast majority of these captives and consortiums... and granted, there are a lot of different ones, not saying everybody, but a lot of the ones that we have taken over... what the captives do is they'll build broker compensation into the captive layer. And in order to protect the relationship, the broker and the captive will agree to make that unassignable to anybody else. So essentially, the stop-loss protections for your company and the broker have aligned themselves against the plan sponsor to say, no, we're going to protect each other and we're going to maintain this. So the plan sponsor decides, hey, my broker's not working out, you know, we want to hire Ethos. We listen to their plan, their strategy, that's going to work better for us. We go over to the captive and they say, no, like, we're not going to sign that. So what they're trying to do is essentially make taking over that account to new representation kind of worthless, right? Because now that's compensation, that's cost that's built in, baked into the employer's plan. And they're trying to protect each other and trying to make sure that broker continues to sell. So they try to block the plan sponsor's decision to change representation, which is a huge piece of damage. We can navigate through it. We did in both cases, and we'll get to the...

41:40Chelsea Ryckis: It scares plan sponsors. I mean, imagine a plan sponsor. Yes, of course we navigated through it because we're problem solvers, but the majority of People, if they aren't working with a team that's like, we're gonna get this done no matter what it takes, would hear like, we're not allowed.

41:57Donovan Ryckis: Yeah, you can't do it.

41:58Chelsea Ryckis: We're not allowed to have a broker of record change. So therefore we're going to continue in this, what, forever? Like, I don't understand. It's, it's wild. In fairness, I think it's really important to say group captives do make sense for a lot of employers. Especially like a midsize employer with volatile claims and, you know, things, things like that. And they get access to different reinsurance markets that maybe they wouldn't on their own. It can make sense. But I think the piece that's missing is it's not the be-all end-all. It's not the pinnacle, like Donovan said earlier. And for some reason, a lot of the good captives out there have marketed it as such as that's, you know, you've, well, you've really understood self-funding and gotten to this high level once you're in a captive. That's not necessarily true. It's risk dependent. And I think if you're looking at your risk on the market on itself with the captive, like side by side, that makes more sense. So, yeah. The other thing I've seen is that captives will require that you use certain vendor stacks, which always makes me... or not, right? Which can also be a problem. Like, oh, somebody has a network, another employer has RBP, but they're priced the same. Like, that's a very different conversation. But it does make me question like what's going on behind the scenes at these preferred vendor relationships as well.

43:15Patrick Ansara: Yeah, so I think there's a few ways to fix this overall. So, which I think you mentioned, Chelsea, and it's just let's do that exercise where we're comparing the captive and we're comparing stop loss outside the captive. And what does that look like? What am I gaining or, losing by being inside of that captive? And if you are going into that agreement, or really any agreement, let's make sure that those, compensation items for your consultant that you have tied to it are assignable. So you're not locked into something. If things start going poorly, you have the ability to make those decisions to move without it impacting that decision for the rest of your benefits community.

43:57Donovan Ryckis: I think another thing on the fix... so this again is captives and consortiums as an easy button for a broker consultant, right? I think another important fix is to make sure there is no compensation in the captive arrangement. That should be held strictly with the TPA, right? So whatever the broker or consultant's compensation is, it should not be tied up in the captive contract. It should be as a TPA line item right there. So if, as a plan sponsor, you do need to make a change with a consultant, you can assign that over with the TPA, and it's not being held with the stop-loss protections that you might enjoy and have a lot of value for you, right? Because now those 2 have aligned against any decisions that you are trying to make. So that's a really easy fix. And I think with the tell, just understand the captive arrangement, make sure you understand the renewal dates, any collateral, any restrictions, pricing, and also go out to market just against traditional stop-loss policies, right? You can get a lot of the same protections, no new lasers, rate cap guarantees, Make sure you're still doing due diligence often.

45:09Chelsea Ryckis: The difference is making sure that you're working with somebody who knows how to design the right policy, because that's the whole point of this section, right? Is it's an easy button. If somebody is not a stop-loss expert, you defer that responsibility to a captive.

45:23Donovan Ryckis: Yep. So again, not captives and consortiums dirty or dumb, but Captives and consortiums as an easy button for broker consultants. Dirty or dumb?

45:37Patrick Ansara: Dumb, because it's, it's the easy button. It's, I'm lazy, I don't want to look at other things. So at... if you're being brought captives, great, but have they looked at any other options?

45:49Donovan Ryckis: Yeah, I think I'd agree with that. I think the only dirty tactic is the, the broker lockup in the contract, the compensation, because Now those fees are baked in, right? So then it takes some, some work to do. So it also to the fix, you know, like if you're already in one that's already the arrangement at renewal, negotiate that and we'll renew. But the compensation is coming out of there because we do like the captive or consortium. Get that out of there, move it over to the TPA, make it transparent. Right. All right.

46:24Donovan Ryckis: Last one, number 7 for today's episode. We're going to do 1 to 6 on the following Business and Benefits podcast episode. But for today, number 7, it's going to be the controlled market check.

46:39Chelsea Ryckis: So the tell is you went to market and you came back to the incumbent again and again and again.

46:51Donovan Ryckis: So this is... the tactic is the marketing exercise. How honest that is. We often see these when we're looking at a renewal presentation from a prior year, and we look at where they went to market, and we immediately know, like, those were not good viable options. An insurance company is just like any other company. They have an ICP, right? Like, they have the type of clients they work with, whether that's the amount of data they have, if they're coming from fully funded the certain risk parameters, the geography where you're at in the US, multistate, like you name it, like every carrier has their sweet spot. So it's often that we see marketing, right, from prior renewals and we're like, oh, this was, this was not a legitimate exercise, right?

47:46Patrick Ansara: No, not at all. And I think there's a couple of tactics that go along with that too. So one of those things, if you're noticing, like you mentioned, RFPs are just sent to the same carriers every single year. There's no real variance in that. Generally when you see that, there's an agency override, happening, or maybe a strong relationship with that carrier. You might also have that, that kind of issue happen on the carrier side where they're not releasing data or refusing to release it until they're 60 days out. You should be getting access to your claims data first upfront in the contract terms. But then also upholding that with the carrier or TPA in that regard. But if they're holding onto that data, there's generally a reason they don't want the market to see that for good or bad, and they want to retain your business, obviously. So I think that piece can be dirty as well. And, you know, I think if you look at the incumbent, if they're getting special treatment in the whole process, we should be evaluating everybody kind of on a level playing field. Without skewing towards one or the other. Let's look at these and who is going to deliver the best value for the plan participants at the end of the day. That's the overarching question that you need to ask.

49:00Chelsea Ryckis: But like, risk is risk. So like, how can plan sponsors know? Like, there's no way for them to know.

49:06Patrick Ansara: Yeah.

49:07Chelsea Ryckis: What's true?

49:08Patrick Ansara: Well, I think you can, you can get to what's true as long as you have the data to provide to other underwriters. So if you're not getting the data, you're not going to get a really good market check because a lot of that data's withheld, so you're not able to assess the risk as well. But if you can get access to all that data, then you can send it to multiple markets and see, hey, does, do all these underwriters agree what my claims are going to be and what my costs should be to protect those claims? So I think that's the check that needs to be done. And I think we found that too, especially actually just recently we were evaluating a captive relationship and found that underwriters on the individual stop-loss market, so outside of that captive, had priced their, their claims liability or their expected claims much lower than what the captive was projecting. And that allowed us to, to get some adjustments in that side of things as well, within that captive.

50:08Donovan Ryckis: Yeah, I agree. I think the marketing effort has to be wide enough to get a general consensus, because it is it can be wildly variable, right? How different carriers will kind of view this. So it has to be a thorough exercise and more more more often than not, it's like a two to three exercise. You know, I'm thinking of that enhanced benefit RFP we did. You know, company has two thousand five hundred employees or so, and they were facing a significant increase. And you know, we took it out to like eight carriers. To kind of get it to where it needed to be. And we ended up getting the incumbent from like, I think 32 down.

50:50Patrick Ansara: 34, yeah.

50:51Donovan Ryckis: 34 down to 7. But it was only after bringing in that competitive data. And, you know, some even came in, we had one that came in flat, but there's other considerations for the plan sponsor, like their data integration with their HRIS.

51:08Patrick Ansara: Well, I think...

51:08Donovan Ryckis: But we would've never gotten that far without that comprehensive of an RFP, right? Because we had all the carriers on there and we had 2 to 3 come back much more favorable. And that's what kind of allowed it to happen.

51:24Patrick Ansara: I think that kind of leads into the, the other tactic and it's a damaging one too, where you're given an initial renewal and then they ask, hey, what's the number we need to be at?

51:34Chelsea Ryckis: That's my favorite.

51:35Patrick Ansara: For you not to take this to market.

51:37Donovan Ryckis: Yeah.

51:37Patrick Ansara: Where do we need to be? The no-look bullshit.

51:39Chelsea Ryckis: Yeah.

51:40Patrick Ansara: Right. Yeah. Hey, if you don't market this, we can do this. It's like, well, if you can do that with it, if I don't market it, you can probably do it if I do. So I think that can be a damaging piece too. So just kind of watching out for that tactic, it doesn't make a whole lot of sense. It goes against your fiduciary obligation as a plan sponsor to evaluate your options. So I'd never recommend accepting a no-look renewal.

52:06Chelsea Ryckis: Agreed. I was hoping we would touch on that on this section. But I do think too, when there's consultants that maybe don't have a deep expertise, especially when we do have claims experience, and they're just going to blast out an RFP to, you know, 20, 30, 40 different markets, that's also like, is that really serving the plan sponsor? Like, isn't the job to curate? Market check, right? And like really make it something that makes sense for, for that plan sponsor. You know what, the more we have this conversation today, the more, I keep coming back to the fact that like a true consultancy role is so nuanced, right? Because like you have the fiduciary obligation of the employer where you really need to go out and explore every option with serious due diligence and the, expertise of a reasonable expert, right? But at the same time, like we know, if we go to a certain carrier, you're going to get shitty contract terms. You're going to be locked in. It's, you're going to have no data. Right. And it's like this exercise sometimes in futility is what it feels like to me.

53:16Donovan Ryckis: But I think the nuance can go to the category. So like one of the things I saw this month where I was really, I was like, come on. It was a stop loss contract that just happened to get placed, you know, with the ASO every single year. And at that side, you know, it had been like 4 or 5 years in a row that the ASO carrier was also the best stop loss. And I was just like, come on, like, there is not a chance that happened every year. It's just, it's not going to happen. If we can open that up to 30 stop loss markets and keep the same network and the same TPA for the plan sponsor and participants, like, Certainly, just about every one of those years, we could have got better contract terms on a stop-loss policy. I think when you get to like the enhanced benefit side, disability, life insurance, dental, vision, I think it's a little bit more nuanced there. It should be able to be controlled a little bit easier, except for those kind of off years where you are facing the 20%, 30% plus. And I think that's a whole nother area and that's probably going to go into compensation because we're seeing a lot of loading. Sometimes that market check is designed to encourage a change.

54:36Chelsea Ryckis: Yes.

54:37Donovan Ryckis: Where it's not necessary. So I think it works both ways where a lot of times the controlled marketing is to get a status quo renewal where the agency bonuses, perhaps where they own equity interests. In that carrier, and then sometimes it's used to secure a new you know heavy first-year commission. So it certainly can be nuanced. But if it's the same things, I think every year, I think that's kind of the tell, right? Like the same options. You're seeing two to three. You're facing significant double-digit increases, and there's just a lack of solutions and options. It's a big marketplace. There's a lot of great carriers out there. There is no best state. They all do what they say. There are spots and reasons one might work better for some employers than others. But overall, there's a lot more options out there. If you're seeing a very limited range and it's the same every year, I'd say that's the tell.

55:35Chelsea Ryckis: The other tell that I've heard from a lot of plan sponsors this year, and I think this is probably a good way to kind of sum up the entire conversation we've had today, which is if you're being made to feel, whether it's by a consultant or a vendor that what you're asking for is silly, like if you're asking for more or you're, you know, you kind of feel like you're being like patted on the head and like, oh, that's cute. That's it. Yeah, that's it. That's, that's adorable. If there's like a condescending nature or tone or, and just like overall lack of education around where the future possibilities lie with your health plan, that's generally a good tell that there's probably something going on behind the scenes.

56:15Patrick Ansara: Yeah. And I don't think we talked about the fix here, but there is a, is an easy fix to all of this. And that is not waiting until you get to that renewal meeting to know who was marketed to, but having that discussion ahead of time in a pre-renewal session before anything goes out to market. You should, as a plan sponsor, be able to say, yes, that looks good. Let's go to these markets, or we want to look at this market and this market as well. 'Cause I think that'll give you know, the, the best insight into what to expect when you do get to that renewal stage and to understand what your options are. And the other thing here is you wanna make sure that all the markets that are being sought after are getting the identical information, because if you're quoting apples to oranges, you're gonna get wildly different results. So same claims data package, same request, making sure that everything lines up. So there's no favoritism in anything there.

57:10Donovan Ryckis: Yep. I think another important thing for the fix on this is it goes to renewal timing. You know, if it's 90 days and you, and as a plan sponsor, you don't know the renewal number, you need to be asking your consultant for it immediately, because what happens often is they receive it and then they're deciding if they're going to go to market, where they're going to go to market, how big of a problem this is. How much they think they can negotiate. But at the end of the day, it's the plan sponsor's risk and dollars and responsibility to their employees. So like, that information needs to come out first. Hey, your incumbent carrier released this renewal. Here's what I think based off your data and claims where it should be. Here's what I think we should do and go to market. What are your thoughts? Like, that needs to happen sooner rather than Plan sponsor doesn't know or understand the severity of the renewal, and then it gets closer to 60 days and that marketing activity is done, meaning it's now too late really to throw additional carriers in, right, to kind of fix and remedy that. So the day that renewal comes out, plan sponsor really needs to be made aware as well with a plan from the consultant. On their perspective of the positioning of that renewal and what they think the market's going to...

58:39Patrick Ansara: All right, what do we think? Dirty or dumb here?

58:42Donovan Ryckis: The controlled market check. Dirty or dumb?

58:46Patrick Ansara: Chelsea?

58:47Donovan Ryckis: Dirty, dirty, dirty.

58:49Patrick Ansara: Yeah, I'm saying dirty also.

58:52Chelsea Ryckis: Lazy? Is that a new option? Can I add a third?

58:56Patrick Ansara: Dirty, dumb, or lazy?

58:57Chelsea Ryckis: Yeah.

58:59Donovan Ryckis: Lazy is the same.

59:01Patrick Ansara: Yeah.

59:02Donovan Ryckis: So Patrick, you're dirty?

59:04Patrick Ansara: Yeah, I think it's dirty in most cases that I've seen, at least. Yeah. I'm... I...

59:13Donovan Ryckis: When we understand it's a controlled market check, I would say dirty 100%. I... where I leave some room for dumb is just plan sponsors understanding this. Obviously, they don't have the same perspective to the industry, to the claims. So that's where I kind of hold back a little bit because it can be nuanced. And obviously, like, the suggestion here is not that every plan sponsor should always be going for the lowest premium and doing carrier flips year after year, right? It's just positioning everything to have the best value, and hopefully that's continuing with the same carrier. I'm a mix. I'm 50/50, just because from our perspective, we understand when it is being done dirty. I think, you know, there is a lot of nuance to it on the plan sponsor side of understanding it.

1:00:08Patrick Ansara: But...

1:00:08Chelsea Ryckis: Yeah, the difference is purely strategy. Is there an actual strategy in play? Like, we talk about it all the time, right? Like, we go to the stop-loss markets with our business plan for the year versus just going to every single market that's available, because that's that's not a strategy. That's a year-by-year reactive game.

1:00:27Donovan Ryckis: Okay. Well, that is number 12 through number 7 of the Dirty Dozen. Part 2 of this episode, we're going to go through 6 to 1, which I think are going to lean a lot more towards the dirty side. And also, they're going to be the tactics that are impacting the cost of health and welfare plans a lot more significantly, a lot more often that we're coming across these things, and certainly strategies for plan sponsors to just avoid those tactics. Any closing thoughts on the first half of the Dirty Dozen here, guys?

1:01:09Chelsea Ryckis: I have one, and a little bit, it's like, I don't think that... I think sometimes when we have these conversations, I keep getting messages like, oh, we're broker bashing, broker bashing, or you know talking shit about your industry. It's not that at all. We're purely coming from the side of the plan sponsor, and plan sponsors have no idea what's going on behind their health plans, right? And and it's not it is their job to know, but it's really hard to know the nuances that we're discussing here today. So it's about shining a light and about providing education information. It's not I hope it's not perceived as broker bashing because that's not our intent in any way.

1:01:56Patrick Ansara: Yeah. And just to kind of add onto that, I don't always think, you know, if your advisor is giving you this advice, they may not be in the know of all these things that are going on behind the scenes. So it's not always dirty on their part. Maybe you have a good relationship with them. That's not to say anything negative about that, but there are some, I guess, larger forces behind the scenes that do have their hands in places where they shouldn't be.

1:02:18Chelsea Ryckis: And it's important that plan sponsors know that's happening, right? And then you can listen to something like this, ask better questions. But I... and then the caveat to that is like, once brokers actually know about all of these things that are going on, or once plan sponsors know about these things going on, it's your responsibility to do better, right? So there can be an aspect of ignorance or just lack of awareness, but when you know better, you have to do better. And I think that's the difference between like, learning something and actually taking action is that, that gap right there. And I think a lot of people can stay on the safe side and just maybe claim ignorance, as opposed to, right, actually doing something about it.

1:03:00Donovan Ryckis: Yeah. You know, one of our mentors said that this industry pays incredibly well for mediocrity. And I couldn't agree more. So this is, to Chelsea's point, not necessarily broker bashing. Not everybody does this. The tactics are not always nefarious. But if they're not, then bring the data, like, be transparent, bring the data, and then that can be clear to the plan sponsor and they can understand it and not be concerned about, you know, these items that we talked about. So it's not a never for all these things, but there's certainly been a lot of abuse that we've seen taking over new accounts in these particular areas. And hopefully this talk kind of gave some insight into some of those areas and how to still use them but not have any concerns about the contract language or how pricing is being structured on the back end. So the goal of this is for plan sponsors, not for brokers.

1:03:58Patrick Ansara: Right.

1:03:58Donovan Ryckis: Right. We don't work for brokers. We don't care. Like our client and who we're serving, our plan sponsors, plan participants. That's the spirit of this, to get the best outcome for them.

1:04:09Chelsea Ryckis: So, and ultimately this education...

1:04:12Donovan Ryckis: Yeah, keep it all in mind.

1:04:13Chelsea Ryckis: Expands everybody, right? Yeah.

1:04:16Donovan Ryckis: Yeah. All right, guys, thank you for joining me. We'll be shooting episode 2, and that'll be our next episode. So thanks everybody for joining us. See you on the next one.

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