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Tag: Large Claim Solutions

13 Jan 2021

Gene Therapy Poses Volatility Concerns for the Self-Insured Community: An Actuarial View

In recent years, science and technology have been rapidly innovating, bringing the cure to many genetic diseases within reach. Along with excitement is an equal level of nervousness as the costs of gene therapy poses significant financial concerns to risk-bearers. For large self-insured employers who do not typically purchase stop loss coverage, they are exposed to these new treatments that can cost over $2M.  For example, a 20,000-employee plan sponsor may be spending roughly $200M per year in health and benefit expenses, and is expected to have between zero and four Zolgensma treatments within their population. If they have one, it can be absorbed with the margin built into the premium equivalent rates. If they have four, the expense could exceed $10M, creating volatility that these large plan sponsors just haven’t seen before.

Smaller self-insured plans cannot manage this type of volatility, which is why they purchase employer stop loss coverage. But even the stop loss carriers are not immune to volatility. Take for example a $100M stop loss carrier that expects to run at a 75% loss ratio – one additional Zolgensma claim could impact the loss ratio by 2%, eating into margins that are already suppressed. That impact will eventually make its way down to the self-insured plan upon renewal. It is common for stop loss carriers to purchase excess of loss coverage that provides catastrophic protection, but it doesn’t provide the frequency protection that many carriers, and large self-insured plan sponsors, currently assume (i.e. getting more than your fair share of gene therapy claims).

The gene therapy pipeline is rich with several new treatments in the works and several with expected price tags ranging between $2M and $4M dollars. Expect risk management activities to expand for those in the self-insured community, whether it be large plan sponsors or even employer stop loss carriers. Contact BCS today to find out how we can help with risk mitigation, and provide protection against these treatments, which are creating financial volatility, but also bringing much needed curative therapy to members suffering from genetic disease.

17 Nov 2020
BCS Important News

BCS Financial Announces Partnership with the National Hemophilia Foundation

Emphasis on quality of care, cost containment for members

BCS Financial (BCS), a market leading insurer and reinsurer today announced its partnership with the National Hemophilia Foundation (NHF), bringing to market a solution set for health plans and their members to improve the quality and cost of care.

Founded in 1948, NHF strives to provide better treatments and cures for inheritable bleeding disorders and prevent complications of these disorders through education, advocacy and research.

“The partnership with NHF, a trusted advocacy organization aligned with our focus on assisting with quality and cost of care, is a first-of-its-kind in the industry,” said Peter Costello, President and Chief Executive Officer of BCS, “NHF’s unique ability to advise on optimal care management truly benefits our customers not only with cost but the level of service we strive to provide.”

According to NHF, there are approximately 20,000 individuals with hemophilia, and hemophilia consistently ranks within the top 10 highest catastrophic case spends. Costs range several hundred thousand dollars per year, with more than $1 million in annual costs is not unheard of for patients with the most severe forms of the disease (Source: Optum).

“The partnership between the NHF and BCS and its member plans allow us to establish baseline data on payment claims for people with hemophilia and develop strategies for Blue payers to facilitate the delivery of high-quality care through the network of federally-funded hemophilia treatment centers,” said Leonard A. Valentino, MD, President & CEO of the NHF. “BCS supports our goal to ensure optimal patient outcomes at the lowest possible cost.”

The three major factors affecting hemophilia cost containment include:

  • Site of Care – hemophilia treatment center Gold Standard
  • Assay Management
  • Prescription Management

The partnership addresses all three factors providing customers with increased access to BCS and its broad portfolio of complementary products including Excess of Loss, Stop Loss, International Health, Limited Benefit, and Group Supplemental insurance.

To learn more about BCS and its offerings visit:

About BCS Financial Corporation:

For over 70 years, BCS Financial Corporation has delivered a wide-range of insurance and financial solutions primarily designed for Blue Cross and Blue Shield organizations and their customers nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by A.M. Best. BCS Financial is headquartered in Oakbrook Terrace, Illinois. Learn more at

About the National Hemophilia Foundation

NHF (the National Hemophilia Foundation) is a 501(c)(3) nonprofit organization dedicated to finding better treatments and cures for inheritable bleeding disorders and to preventing the complications of these disorders through education, advocacy and research. NHF’s programs and initiatives are made possible through the generosity of individuals, corporations and foundations, as well as through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). Additional information on hemophilia and NHF can be found at

View the full release on Newswire: 

06 Oct 2020
BCS Important News

BCS Announces Expansion of Risk Navigator Solution Set With Acquisition of Medical Risk Managers, Inc.

Acquisition joins two specialized Stop Loss Insurance and Excess of Loss Reinsurance underwriters

BCS Financial Corporation (BCS) announced today it has acquired Medical Risk Managers, Inc. (MRM), a market-leading provider of Stop Loss pricing and underwriting services.

As a market-leading insurer and reinsurer, BCS protects more than six million medical, supplemental, and travel customers. With this acquisition, MRM’s comprehensive managing general underwriting service model becomes an additional feature included in BCS’s Risk Navigator solution set, a highly predictive and actionable approach to managing carrier and employer large claim risks.

“For three decades, BCS has provided our customers with a portfolio of products and services designed to help flatten the growth of large claim risks,” said Peter Costello, president and chief executive officer of BCS Financial. “BCS’s acquisition of MRM advances our efforts to provide a comprehensive solution-set for our customers.”

In conjunction with MRM, BCS and its customers immediately gain access to market-leading Stop Loss pricing, underwriting, and case management capabilities. MRM and its customers, meanwhile, benefit by gaining increased access to BCS and its broad portfolio of complementary products, including Excess of Loss, Stop Loss, International Health, Limited Benefit, and Group Supplemental insurance.

“It’s undeniable that the volume and severity of High Cost Claimants is a growing problem for self-funded employers,” said Mehb Khoja, president of MRM. “Our new alignment enables both BCS and MRM to grow by sharing strengths, capabilities, and market access.”

Under BCS’s ownership, Khoja will continue as president of MRM, which will remain headquartered in South Windsor, Connecticut.

About BCS Financial Corporation (BCS)

For over 70 years, BCS Financial Corporation has delivered a wide-range of insurance and financial solutions primarily designed for Blue Cross and Blue Shield organizations and their customers nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by A.M. Best. BCS Financial is headquartered in Oakbrook Terrace, Illinois. Learn more at

About Medical Risk Managers, Inc. (MRM)

For over 35 years, Medical Risk Managers, Inc. has underwritten Stop Loss insurance on behalf of its insurance carrier partners. As a managing general underwriter, MRM has underwritten over $4 billion in Stop Loss premium since its inception. Among its capabilities, MRM is able to price Stop Loss coverage at any deductible level, over any network, and in any zip code nationwide. MRM is headquartered in South Windsor, Connecticut. Learn more at

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16 Sep 2020
BCS Important News

BCS Announces Partnership with 2nd.MD to Improve Member Healthcare Cost, Quality, and Outcomes

Partnership will deliver free, top-tier medical navigation and second opinion virtual consultation for members facing complex diagnoses and treatments

CHICAGO, September 16, 2020 ( – BCS Financial (BCS) announces today it has partnered with 2nd.MD to provide top-tier medical navigation, expert consultation, and personalized second opinions to 4M policyholders. Under the agreement, members covered under BCS Stop Loss and Excess of Loss policies can work with highly skilled, experienced nurses to help them navigate diagnoses, virtually connect with elite doctors who specialize in their specific condition, and receive assistance finding a local doctor or specialist in their area – at no cost to them.

As the number one reinsurer of Blue Cross Blue Shield plans, BCS offers a wide range of products and services to help insurance carriers and their members navigate healthcare costs, particularly those exceeding $500K annually. The partnership is one of several features included in BCS Financial’s Risk Navigator solutions, a highly predictive and actionable approach to managing claims risk.

“Second opinions can play a vital part in ensuring healthcare costs are not wasted on unnecessary or incorrect care,” said Peter Costello, president and chief executive officer, BCS Financial. “BCS is committed to helping our policyholders and their members manage their risks, while improving healthcare outcomes.”

Members see direct benefit from the second opinion consultation. “Members facing a complex diagnosis, surgery, or healthcare decision often find it difficult to navigate the healthcare system and manage costs,” said Chris Kurtenbach, vice president, Services & Operations, BCS Financial. “With this partnership, we can help members get the appropriate care they need by connecting them with board-certified, elite specialists from top medical institutions, and reducing their costs along the way.”

In many cases, the second opinion can change the treatment trajectory – 85% of 2nd.MD’s consultations result in improved treatment plans, 35% lead to alternative diagnoses, and nearly 30% of surgery consults result in surgery cancellation.

This is an especially important service as the market for gene therapy and cellular immunotherapy continues to ramp up. An estimated 50-75 therapies will be approved for the US market by 2030, with costs for cellular immunotherapies averaging around $400K, and gene therapy costs estimated in the $2-$4M range. For those with complex cancers, rare or orphan conditions, and aggressive recommendations, access to top specialists can make all the difference.

“Better care and outcomes for members is always our priority,” said Costello. “This partnership is just one of the ways we are delivering value to our Blue Cross and Blue Shield partners and their members by helping them continue to manage healthcare costs and quality.”

This service is currently available to members covered by BCS Stop Loss and Excess of Loss policies.

About BCS Financial Corporation (BCS)

BCS Financial Corporation has more than 70 years of experience delivering a wide-range of insurance and financial solutions for Blue Cross and Blue Shield organizations nationwide. Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is licensed in all 50 states and is rated A- (Excellent) by A.M. Best. BCS Financial is headquartered in Oakbrook Terrace, Ill. Learn more at

About 2nd.MD

2nd.MD offers medical certainty by connecting you with board-certified, leading specialists from across the country for an expert second opinion via video or phone within three to five days, from the comfort of your own home. From the minute you reach out, 2nd.MD’s Care Team of nurses will put you at the center of your medical care by coordinating all the details. This includes, understanding your health goals, gathering all of your medical records and connecting you with a doctor who specializes in your specific medical condition, so that you can focus on what matters most — getting the best care possible. No travel. No hassle. No cost. If you haven’t used 2nd.MD before, it can be life changing. In fact, 98% of people who use 2nd.MD recommend it to their friends and family.

For more information, please contact Nathan Post at 630.472.7860.

05 Aug 2020

Stop Loss 2021: Uncertainty is the Only Certainty

Employers are looking at an uncertain future as they mitigate the current pandemic crisis on top of predictive numbers of health insurance costs in 2021. Large, self-insured organizations worry that due to their employees reducing their use of coverage because of at-home orders and safety precautions, there will be a surge in sickness and procedures in the next year. That is in addition to increased COVID-19 testing that many businesses require for employees to return to work in the office. These companies worry they are going to see a rate increase of at least 3 to 4.5%*, if not more.

Unfortunately, it is hard to accurately confirm the rise in cost. According to analysts at PwC’s Health Research Institute, “there’s so much uncertainty because of the COVID-19 disruption that it’s difficult to pinpoint whether medical-cost trends will be significantly lower or higher next year”. With this in mind, the best thing our industry can do for our clients is continuing to educate ourselves on these trends and inform them on changes that could affect their health insurance needs.

BCS is dedicated to providing best in class Stop Loss products and sharing our expertise with our partners. Our annual conference Sept 1-3 (VIRTUAL) will cover a variety of topics with leading industry experts. We encourage your participation and hope you can join in on the conversation. As we look towards 2021, the only certainty we have is that things continue to change and we need to be prepared for a variety of outcomes while keeping a positive focus on our employer groups.
For more information about Stop Loss, or our Risk Navigator Conference, contact Kendal Sasso.

*SOURCE: Coronavirus outbreak is already upending health insurance premiums and copays for next year, by Bertha Coombs,
27 Aug 2019

BCS Financial Adopts Blue Health Intelligence’s Predictive Model to Help Health Plan Members with Serious and Expensive Health Conditions Earlier

To view the full press release via BHI, click here.

CHICAGO (August 27, 2019) – BCS Financial Corporation (BCS), which provides insurance and financial products to Blue Cross Blue Shield Companies, has selected Blue Health Intelligence®’s (BHI®) award-winning predictive algorithm to identify members who have or may develop health conditions that cost more than $250,000 a year. The goal is to help individual Blue Plans work with these high cost claimants (HiCCs) to improve their health outcomes and mitigate escalating expenses.

While HiCCs represent fewer than one in 1,000 of all Blue Plan members, they are expected to generate nearly $20 billion in annual costs by 2022. In developing meaningful solutions for this vulnerable population, BHI found that three of every five high cost members are new or emerging, and many suffer from heart disease, cancer, or neurological disorders. The remaining 40% have recurring high costs each year, and typically suffer from chronic conditions such as blood disorders, metabolic illnesses, and renal disease. Contributing factors for all HiCCs include specialty drugs, new genetic therapies, and advanced treatments such as cancer immunotherapy.

The BCS and BHI HiCC solution, currently being implemented by five Blue Plans, is called the High Cost Predictor Algorithm (HCPA). It uses machine learning to efficiently achieve the needle-in-a-haystack work of identifying who among tens of millions of Plan members will reach or exceed more than $250,000 in annual costs, including a few thousand whose care is expected to exceed $1 million per year. Earlier this year, BHI was recognized by MedTech Awards as having the best predictive analytics solution.

“BCS is committed to helping Blue Plans and their members achieve high-quality healthcare at a lower cost through a variety of tools and reinsurance solutions, and we are thrilled to add this leading-edge solution to our cost-containment offerings,” said Peter Costello, BCS Financial’s president and chief operating officer.

BHI specifically trained and validated the HCPA using longitudinal claims information from more than 190 million Americans in its National Data Repository, along with publicly available socioeconomic and claims derived data. BHI’s data scientists evaluated thousands of predictive variables to isolate the clinical complexities, utilization patterns, and contextual factors most closely linked to extremely high costs.

“The combination of BHI’s machine learning, artificial intelligence, and clinical validation make these predictions extremely scalable, actionable, and accurate,” said Swati Abbott, BHI’s CEO. “As a result, BHI is proud to be supporting BCS’ early identification efforts to help lower members’ high costs and improve their health experiences.”

The HCPA is now part of the BCS Risk Navigator suite of cost-containment solutions. Using its National Data Repository, BHI augments the predictive model output with additional historical insights on each member to aid nurse reviewers.