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87. Health & Welfare Plan Practices Part 1: Tactics or Tricks - Dirty or Dumb?
Season 2
Episode 87
Published 1 day, 20 hours ago
Description
Every year the IRS puts out a memo called the "Dirty Dozen": a list of legal tax structures and processes that people are abusing. They're legitimate tools used the wrong way, and the memo flags them so people can get their house in order and know where the IRS plans to focus enforcement.
Donovan Ryckis applied the same concept to benefits. Twelve tactics Ethos is seeing in the market that are legitimate on paper but get abused in practice. This isn't happening everywhere, but almost any plan sponsor could probably find one or two of these in their plan, if not a lot more.
This is Part 1, tactics 12 through 7, with Donovan Ryckis (Co-Founder & CEO), Chelsea Ryckis (Founder & President) and Patrick Ansara (Director of Client Operations). Every tactic gets the same treatment: the tell, the damage in dollars, an honest look at whether there's a fair explanation, the fix, and then the verdict. Is it dirty, or is it just dumb?
What's covered: PMPM instead of PEPM, one letter that multiplies your fees 2.4 times. Contracts that quietly stop matching the proposal. Undisclosed equity between advisors and the carriers they recommend, and the 408 disclosure you're entitled to. PBM collectives, including a reprice study that came back $1.4 million better on a $9 million claim spend. Captives used as a broker's easy button. And the controlled market check, where you go to market and somehow land on the incumbent every year.
Built for mid-market and large-market plan sponsors. Part 2 counts down tactics 6 through 1.
Time Stamps
00:00 – Cold open
00:38 – Welcome to The Business of Benefits
01:01 – Where the benefits Dirty Dozen came from
02:31 – Meet Patrick Ansara
03:31 – How we grade each tactic: dirty or dumb?
04:25 – Tactic 12: PMPM instead of PEPM
11:54 – Tactic 11: The contract doesn't match the proposal
22:56 – Tactic 10: Undisclosed equity and ownership interests
30:36 – Tactic 9: PBM purchasing collectives and coalitions
37:42 – A word from Fiduciary in a Box
38:30 – Tactic 8: Captives as the broker's easy button
48:21 – Tactic 7: The controlled market check
1:03:09 – What's coming in Part 2
1:03:51 – This isn't broker bashing
1:05:43 – An industry that pays well for mediocrity
1:06:58 – Final thoughts
Ethos Benefits: https://ethosbenefits.com
Podcast: https://businessofbenefitspodcast.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305
LinkedIn: https://www.linkedin.com/company/ethosbenefits
Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/
Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Patrick Ansara: https://www.linkedin.com/in/patrickansara/
FROM OUR SPONSOR
You're doing the work. Don't leave the proof behind.
Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary pr
Donovan Ryckis applied the same concept to benefits. Twelve tactics Ethos is seeing in the market that are legitimate on paper but get abused in practice. This isn't happening everywhere, but almost any plan sponsor could probably find one or two of these in their plan, if not a lot more.
This is Part 1, tactics 12 through 7, with Donovan Ryckis (Co-Founder & CEO), Chelsea Ryckis (Founder & President) and Patrick Ansara (Director of Client Operations). Every tactic gets the same treatment: the tell, the damage in dollars, an honest look at whether there's a fair explanation, the fix, and then the verdict. Is it dirty, or is it just dumb?
What's covered: PMPM instead of PEPM, one letter that multiplies your fees 2.4 times. Contracts that quietly stop matching the proposal. Undisclosed equity between advisors and the carriers they recommend, and the 408 disclosure you're entitled to. PBM collectives, including a reprice study that came back $1.4 million better on a $9 million claim spend. Captives used as a broker's easy button. And the controlled market check, where you go to market and somehow land on the incumbent every year.
Built for mid-market and large-market plan sponsors. Part 2 counts down tactics 6 through 1.
Time Stamps
00:00 – Cold open
00:38 – Welcome to The Business of Benefits
01:01 – Where the benefits Dirty Dozen came from
02:31 – Meet Patrick Ansara
03:31 – How we grade each tactic: dirty or dumb?
04:25 – Tactic 12: PMPM instead of PEPM
11:54 – Tactic 11: The contract doesn't match the proposal
22:56 – Tactic 10: Undisclosed equity and ownership interests
30:36 – Tactic 9: PBM purchasing collectives and coalitions
37:42 – A word from Fiduciary in a Box
38:30 – Tactic 8: Captives as the broker's easy button
48:21 – Tactic 7: The controlled market check
1:03:09 – What's coming in Part 2
1:03:51 – This isn't broker bashing
1:05:43 – An industry that pays well for mediocrity
1:06:58 – Final thoughts
Ethos Benefits: https://ethosbenefits.com
Podcast: https://businessofbenefitspodcast.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305
LinkedIn: https://www.linkedin.com/company/ethosbenefits
Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/
Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Patrick Ansara: https://www.linkedin.com/in/patrickansara/
FROM OUR SPONSOR
You're doing the work. Don't leave the proof behind.
Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary pr