SPeaKer - SIIA
SPeaKer - SIIA
SPeaKer - SIIA
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31st Annual Self-insurance Institute of America, Inc.<br />
National Educational Conference & Expo<br />
J.W. Marriott Desert Ridge Resort & Spa • Phoenix, AZ • October 9-11, 2011
ConferenceOverview<br />
The <strong>SIIA</strong> National Conference & Expo is the world’s largest event focused exclusively<br />
on the self-insurance/alternative risk transfer marketplace and typically attracts more<br />
than 1,600 attendees from around the United States and from a growing number of<br />
countries around the world.<br />
Consistent with the theme of this year’s conference –<br />
Innovation Shaping The Future of Self-Insurance – <strong>SIIA</strong> has<br />
assembled a truly impressive collection of speakers who<br />
will share their expertise on the most innovative strategies to<br />
effectively manage all types of self-insured programs.<br />
Separate educational tracks will be offered in the areas of<br />
self-insured health plans, self-insured workers’ compensation<br />
programs, alternative risk transfer (captives, RRGs, etc.) and<br />
international self-insurance strategies.<br />
This top notch educational program will be supplemented<br />
with quality networking opportunities, including an exhibit<br />
hall with more than 150 companies showcasing a wide<br />
variety of innovative products and services now available<br />
to self-insured entities.<br />
In short, the <strong>SIIA</strong> National Conference & Expo is simply<br />
a must-attend event for any company involved in the selfinsurance/ART<br />
marketplace.<br />
Our faculty includes several employer representatives<br />
who will describe how they have innovated within their<br />
own organization through case study-style presentations,<br />
making this a “must attend” event for risk managers and<br />
benefit managers interested in peer-to-peer educational/<br />
networking opportunities.<br />
In addition to the many speakers representing self-insured<br />
entities, <strong>SIIA</strong> has also lined up senior executives from<br />
many of the industry’s biggest service providers who will<br />
share their unique perspectives on how self-insured /ART<br />
programs will evolve in the future thanks to innovative<br />
business process solutions.<br />
Rounding out the program will be a collection of sessions<br />
addressing timely legislative/regulatory issues affecting selfinsured/ART<br />
programs.<br />
800.851.7789 | www.siia.org
New to Self-Insurance<br />
Alternative Risk Transfer<br />
<strong>SIIA</strong> Welcomes You<br />
While the conference will be packed with industry<br />
experts, <strong>SIIA</strong> warmly welcomes those who are interested<br />
in learning about self-insurance/ART programs. To help<br />
you get started, we have scheduled “beginner” sessions<br />
early in the conference to help you more fully participate<br />
in the overall event. We are also offering discounted<br />
registration fees for individuals representing employers that<br />
are considering self-insurance.<br />
Exposure Opportunities<br />
<strong>SIIA</strong> has a limited number of spaces for companies<br />
to exhibit their products and services to conference<br />
attendees. If you’re looking to increase company and<br />
product awareness, develop sales leads and new<br />
customers, and make immediate sales, then exhibiting<br />
at this event is a must! The Conference also offers a<br />
wide range of sponsorship packages designed to fit<br />
any budget. Becoming a sponsor is a cost-effective and<br />
targeted tool that can help your company accomplish its<br />
marketing and sales goals and position you as an industry<br />
leader to attendees. Information on exhibiting and/or<br />
sponsorship opportunities can be accessed on-line at<br />
www.siia.org, or by calling 800.851.7789.<br />
We originally joined <strong>SIIA</strong> to<br />
support its important lobbying work<br />
in support of risk retention groups,<br />
but we have found participation<br />
at its national conference to be<br />
equally important due to the high<br />
quality educational content and<br />
unique networking opportunities.<br />
It’s the only national self-insurance<br />
business conference we attend.<br />
– Phil Salvagio, President<br />
Preferred Contractors Insurance Company, RRG<br />
More medical stop-loss deals<br />
are done during <strong>SIIA</strong>’s National<br />
Conference & Expo than at any<br />
other single event in the country.<br />
If your company is involved in<br />
either the buying or selling of<br />
stop-loss insurance this is the<br />
premier opportunity to transact<br />
business face-to-face with<br />
decision-makers.<br />
– Bill Knarr, President & CEO<br />
One America/RE Moulton, Inc.<br />
It’s impressive how <strong>SIIA</strong> can pull<br />
together such a top-notch collection<br />
of speakers for its National<br />
Conference & Expo each year.<br />
We look forward to being part<br />
of this premier industry event and<br />
to learning firsthand about the<br />
innovative strategies that will no<br />
doubt shape the future of selfinsured<br />
programs.<br />
– David North, President & CEO<br />
Sedgwick Claims Management Services, Inc.
GeneralSessions<br />
Previewing America’s Next Financial Crisis<br />
A leading financial journalist who has written extensively about the causes of the financial meltdown<br />
of 2008, has now written about a potentially larger financial crisis still to come – grossly underfunded<br />
pension liabilities, particularly in the public sector. This keynote presentation will describe in detail what<br />
is looming for the United States should policy-makers fail to take aggressive action. This is a unique<br />
opportunity to learn more about a crisis before it actually happens.<br />
SPEAKER<br />
Roger Lowenstein Author, While<br />
America Aged – How Pension Debts Ruined<br />
General Motors, Stopped the NYC Subway,<br />
Bankrupted San Diego, and Loom As the Next<br />
Financial Crisis<br />
<strong>SIIA</strong> Legislative, Regulatory & Political Update Report<br />
Join us for a comprehensive panel presentation covering important legislative and regulatory<br />
developments affecting the self-insurance/alternative risk transfer industry. The session will also<br />
highlight <strong>SIIA</strong> lobbying strategies/activities and showcase how its political action committee (PAC) has<br />
been used throughout the year to enhance the association’s political influence in Washington, DC and<br />
preview plans for 2012.<br />
SPEAKERS<br />
Mike Ferguson<br />
Chief Operating Officer<br />
Self-Insurance Institute of America, Inc.<br />
Additional panelists to be announced.<br />
Jay Fahrer<br />
Director of Government Relations<br />
Self-Insurance Institute of America, Inc.<br />
800.851.7789 | www.siia.org
ConferenceOverview<br />
(Subject to change)<br />
Sunday, October 9, 2011<br />
SIEF Golf Tournament<br />
Exhibitor Registration Open<br />
Attendee Registration Open<br />
Annual Membership Meeting<br />
1st Time Attendee/<br />
New Member Reception<br />
Welcome Reception<br />
& Exhibit Viewing<br />
<strong>SIIA</strong> Approved<br />
Hospitality Suites Open<br />
Monday, October 10, 2011<br />
Exhibitor & Attendee<br />
Registration Open<br />
7:00 a.m. ‐ 1:00 p.m.<br />
7:30 a.m. – 7:00 p.m.<br />
12:00 p.m. – 7:00 p.m.<br />
3:30 p.m. ‐ 4:00 p.m.<br />
4:00 p.m. – 5:00 p.m.<br />
5:00 p.m. – 7:00 p.m.<br />
8:00 p.m. – 11:00 p.m.<br />
7:30 a.m. – 6:30 p.m.<br />
Networking Continental Breakfast 8:00 a.m. – 8:30 a.m.<br />
Welcome Remarks<br />
& Keynote Address<br />
Refreshment<br />
& Networking Break<br />
8:30 a.m. – 10:00 a.m.<br />
10:00 a.m. – 10:15 a.m.<br />
Educational Breakout Sessions 10:15 a.m. – 11:30 a.m.<br />
Luncheon in Exhibit Hall/<br />
Exhibit Viewing<br />
Educational Breakout Sessions<br />
11:30 a.m. – 1:30 p.m.<br />
1:45 p.m. – 3:00 p.m.<br />
Refreshment & Networking Break 3:00 p.m. – 3:15 p.m.<br />
Educational Breakout Sessions<br />
Networking Reception<br />
& Exhibit Viewing<br />
<strong>SIIA</strong> Approved<br />
Hospitality Suites Open<br />
3:15 p.m. – 4:30 p.m.<br />
4:30 p.m. – 6:30 p.m.<br />
8:00 p.m. – 11:00 p.m.<br />
Tuesday, October 11, 2011<br />
Exhibitor & Attendee<br />
Registration Open<br />
7:30 a.m. – 4:30 p.m.<br />
Networking Continental Breakfast 8:00 a.m. – 8:30 a.m.<br />
General Session<br />
Refreshment<br />
& Networking Break<br />
8:30 a.m. – 10:00 a.m.<br />
10:00 a.m. – 10:15 a.m.<br />
Educational Breakout Sessions 10:15 a.m. – 11:30 a.m.<br />
Luncheon in Exhibit Hall /<br />
Exhibit Viewing<br />
Educational Breakout Sessions<br />
11:30 a.m. – 1:30 p.m.<br />
1:45 p.m. – 3:00 p.m.<br />
Refreshment & Networking Break 3:00 p.m. – 3:15 p.m.<br />
Educational Breakout Sessions<br />
<strong>SIIA</strong> National Conference Party<br />
3:15 p.m. – 4:30 p.m.<br />
6:30 p.m. ‐– 9:00 p.m.
Alternative Risk<br />
TransferTRack<br />
Presented by:<br />
Captive Insurance for Beginners<br />
This session has been designed for employer representatives interested in learning the basics about captive insurance and how to determine whether<br />
captive insurance is a viable option for their organizations. The content will also be useful to individuals working for industry service providers who may<br />
need to brush up on captive insurance basics.<br />
SPEAKER<br />
Justin Mead<br />
Executive Vice President<br />
Camelback Captive Insurance Services, Inc. Camelback Captive Services, Inc.<br />
Captive Managers Talk Marketplace Innovation<br />
A panel of senior executives from leading captive management companies share their unique perspectives on how ART programs are being structured and<br />
used in innovative ways to help companies of all sizes deal with a variety of corporate risks.<br />
SPEAKERS Les Boughner Arthur Koritzinsky<br />
Executive Vice President & Managing Director Managing Director, Captive Solutions<br />
Willis North America Captive & Consulting Practice Marsh USA Inc.<br />
Gary Osborne<br />
Fred Turner<br />
President<br />
President<br />
uSA Risk Group, Inc.<br />
Active Captive Management<br />
Keeping The Taxman Away from Your Captive<br />
One of the country’s top captive insurance tax attorneys shares a collection of case studies of how captives have attracted unwanted attention from<br />
the IRS. This is a must-attend session for those responsible for captive financial management.<br />
SPEAKER<br />
Tom Jones<br />
Partner<br />
McDermitt Will & Emory LLP<br />
Creating New Markets With a Protected Cell Captive<br />
This case study-style presentation will describe how and why the for-profit subsidiary of the American Society of Association Executives (ASAE)<br />
created a protected cell captive and detail how this ART solution has enabled the organization to preserve – and then dramatically expand –<br />
its program of sponsored insurance for associations and nonprofit organizations. This is the perfect session for those interested in learning how<br />
cell captives can be used creatively.<br />
SPEAKER<br />
Dixie Arthur<br />
President<br />
ASAE Business Services, Inc.<br />
The Captive Owners Guide to Purchasing Fronting Insurance<br />
Fronting is an important component for many captive insurance companies. This session will provide practical guidance to captive/RRG owners<br />
on how they can shop most effectively for fronting insurance to ensure optimum pricing and coverage terms.<br />
SPEAKERS Blaine Bontempo dAvid Raymond<br />
President<br />
Specialty Marketing Group, a Division of Discover Re<br />
Chief Underwriting Officer<br />
Specialty Marketing Group<br />
City of New York Relies on Innovative ART Program to Help Rebuild After<br />
9/11 Attack Destruction<br />
While everyone knows about the 9/11 terrorist attack on the World Trade Center in New York, few know that the City of New York<br />
created the World Trade Center Captive Insurance Company to cover the myriad risks assumed by the city and contractors working without<br />
commercial insurance to rebuild the destroyed area. Come here the interesting story on how the captive was structured and its experience<br />
over the past 10 years.<br />
SPEAKERS David Biester James Schoenbeck<br />
General Counsel<br />
Chief Financial Officer<br />
World Trade Center Captive Insurance Co., Inc. World Trade Center Captive Insurance Co., Inc.<br />
800.851.7789 | www.siia.org
Transforming Your RRG Membership Into a Winning “Team”<br />
This session will describe a specific RRG management strategy directed at the dual challenges of marketing through insurance brokers while<br />
maintaining a sense of cohesion among thousands of relatively small members. One key area of focus will be how to develop effective loss<br />
control programs with this model. This “team-oriented” approach means sweating the small details to ensure that all members can maintain<br />
cost effective coverage and the RRG is able to maintain a top A.M. Best rating. For those looking for inspiration on how to balance building<br />
member loyalty while attracting new members, this is a must-attend session.<br />
SPEAKER<br />
Pamela Davis<br />
President & CEO<br />
Alliance of Nonprofits for Insurance<br />
Key Decisions in the Life of a Captive<br />
This session will provide a fascinating case study describing the formation and growth of a successful group captive, which now provides a variety of<br />
coverage for more than 95 members spread across 22 states. Key decisions in the life of this captive, including:<br />
• ▪How it overcame a fronting carrier that became insolvent;<br />
• ▪How it was able to close policy years when the cost of the tail was too expensive;<br />
• ▪Cash flow considerations and investment strategies;<br />
• ▪How it was able to jump start growth<br />
The panel will include both the captive manager and owner representatives.<br />
SPEAKERS Denis Wiener robert Forsyth<br />
Senior Vice President & Principal<br />
Captive Resources, LLC<br />
President<br />
FKG Oil Company<br />
Participating in an RRG – It’s Not Just for Risk Financing!<br />
An active owner/member of a successful risk retention group (RRG) discusses the reasons her organization joined the RRG and explains all the benefits<br />
her organization has gotten out of participating. Specific topics will include financial benefits of ownership, insurance availability, quality improvement<br />
initiatives, benchmarking, education sessions, peer group interaction and access to grant. As part of the presentation she will also talk specifically about<br />
the recent safety initiative in the obstetrics department of her organization that her hospital has participated in which is sponsored by the RRG. The<br />
primary session speaker will be joined by the RRGs administrator who will be able to address technical questions.<br />
SPEAKERS Pamela Burger chris Brucciani<br />
Chief Risk Officer<br />
Baystate Health<br />
Vice President, Underwriting<br />
Premiere Insurance Management Services, Inc.<br />
ART Program Provides Innovative Health Care Cost Containment<br />
Solution for Self-Insured Employers<br />
This case study-style presentation will detail how an existing alternative risk transfer program works in conjunction with multiple individual self-insured<br />
health plans that are pooled together to better control health care costs. Attendees will learn exactly how this program is structured and what the<br />
specific results to date.<br />
SPEAKER<br />
Steve Heussner<br />
President<br />
American Construction Benefits Group<br />
Using a Captive to Reduce Your Workers’ Compensation Costs<br />
This session will describe how and why many companies are utilizing captives to fund a layer of their workers’ compensation financial risk exposures.<br />
The panel will include the risk management director of a Fortune 500 company that operates such an ART program as well as experts on managing<br />
workers’ compensation costs within self-insured corporate structures.<br />
SPEAKER Nicolas Deparday Additional Speakers to be announced.<br />
Director of Insurance & Risk Management<br />
Michelin North America, Inc.<br />
Affordable Care Organizations (ACOs) – New Opportunities for Captives?<br />
The recently-passed Patient Protection and Affordable Care Act (PPACA) enables the formation of Affordable Care Organizations as alternative health<br />
care delivery structures. This session will provide a general ACO overview, a summary of ACO regulations (expected to be published prior to the<br />
conference) and explore how ACOs may be able to utilize captives and/or risk retention groups to as part of their financial risk management planning.<br />
SPEAKEr<br />
To be announced.
Presented by:<br />
HealthcareTRack<br />
Self-Insured Health Plans for Beginners<br />
This session has been designed for employer representatives interested in learning the basics about self-insured group health plans and how<br />
to determine whether self-insurance is a viable option for their organizations. The content will also be useful to individuals working for industry<br />
service providers who may need to brush up on self-insurance basics.<br />
SPEAKER<br />
Debi Hardwick<br />
President & CEO<br />
Coastal TPA, Inc.<br />
Health Care Reform – The Self-Insured Employer Perspective<br />
By the date of the conference, it will be about a year since regulations began to implement the Patient Protection & Affordable Care Act<br />
(PPACA). With a year of experience behind us and further changes to the health care system still scheduled to be phased in, we have<br />
assembled a panel of self-insured employers to share their perspective on how PPACA has affected their group health plans and what they<br />
anticipate for the future.<br />
SPEAKERs Chris Mangelsdorf Philip Healy<br />
Risk & Benefits Manager<br />
Martin Sprocket & Gear, Inc.<br />
Mark Hopkins<br />
Sr. Director, Compensation, Benefits & HRIS<br />
Mohawk Industries, Inc.<br />
Executive Director<br />
A.W.A.N.E.<br />
Additional panelists to be announced.<br />
Health Care Reform – The TPA Perspective<br />
By the date of the conference, it will be about a year since regulations began to implement the Patient Protection & Affordable Care Act<br />
(PPACA). With a year of experience behind us and further changes to the health care system still scheduled to be phased in, we have<br />
assembled a panel of leading TPA executives to share their perspective on how the PPACA has affected their businesses and what they<br />
anticipate for the future.<br />
SPEAKERs Tom Byrd todd Archer<br />
President & CEO<br />
Group Resources, Inc.<br />
President<br />
Mutual Assurance Administrators<br />
Kathy Major<br />
Jim Pennington<br />
President<br />
President<br />
Innovanté Benefit Administrators, a division of HealthTrans Healthsmart<br />
Builder Constructs Model Self-Insured Employee Health care Plan<br />
Attendees will hear the interesting story how a leading building construction company has improved its self-insured group health plan (covering<br />
1,300 employees) over the past few years to keep costs flat while still adhering to a company philosophy of a no cost plan for employees.<br />
These improvements include saving over $1m in prescription costs, an on-site medical clinic, changes in the provider network and a robust<br />
wellness program.<br />
SPEAKER<br />
Richard Condit<br />
Senior Vice President & Chief Administrative Officer<br />
The Sundt Companies, Inc.<br />
800.851.7789 | www.siia.org
Health Care Reform – The Stop-Loss Insurer Perspective<br />
By the date of the conference, it will be about a year since regulations began to implement the Patient Protection & Affordable Care Act<br />
(PPACA). With a year of experience behind us and further changes to the health care system still scheduled to be phased in, we have<br />
assembled a panel of leading stop-loss insurance executives to share their perspective on how the PPACA has affected their businesses and<br />
what they anticipate for the future.<br />
SPEAKERs Craig Kelbel Michael Fry Daniel Lebish<br />
CEO Senior Vice President Chairman & CEO<br />
HCC Life Insurance Company, Inc. Symetra Financial HM Insurance Group<br />
willard (Bill) Knarr<br />
President & CEO<br />
One America/RE Moulton, Inc.<br />
michael E. Shunney<br />
Senior Vice President & General Manager<br />
Sun Life Financial<br />
Medical Devices and other Provider Mark Ups – Challenges and Solutions<br />
for Self-Insurers to Better Negotiate Lower Pricing<br />
It has been determined that hospitals and other provider organizations often incorporate huge price mark-ups for medical devices, which inflate<br />
health care costs for self-insured employers. Learn more about this mark-up practice and negotiation approaches intended to produce more<br />
equitable reimbursement arrangements.<br />
SPEAKERs Debi Kelbert Joseph Hodges<br />
Claims Administrator<br />
President<br />
Dart Container Corporation<br />
Inetico, Inc.<br />
How Well is Too Well? – A Look at the Future of Wellness Programs and Restrictions<br />
Placed on Incentives<br />
One of the keys to cost containment is a wellness program for plan participants. Today, many employers provide incentives to employees<br />
for participation in wellness programs designed to lower health care costs, reduce absenteeism, and improve employee health. Wellness<br />
programs, however, are subject to various laws such as HIPAA, PPACA, and GINA. As a result, the provision and management of a wellness<br />
program can be a complicated legal nightmare. This session will help you navigate these stormy waters and achieve true wellness.<br />
SPEAKER<br />
Adam V. Russo, Esq.<br />
Chief Executive Officer<br />
The Phia Group, LLC<br />
The “Top 10” Compliance Issues for Self Insured Plans, Plan Sponsors, Administrators<br />
and Other Benefits Professionals<br />
We have seen a flurry of new health and welfare related laws, regulations and litigation over the last two years. It has become increasingly<br />
difficult for plan sponsors, administrators and other benefit professionals to keep up with the myriad of new “rules”. A top legal expert puts all<br />
the new rules into a blender and pulls out the top 10 compliance issues that affect self insured plans, plan sponsors, administrators and benefits<br />
professionals. The “Top 10” presentation will address regulatory compliance issues, pressing trends in litigation, state health care reform,<br />
reporting and disclosure issues and other significant issues, including the following questions:<br />
• Can I just match my mental health/substance co-pay to my specialist physician office copay?<br />
• When can our health plan ask for genetic information?<br />
• What are the key issues that every service agreement between an employer and a third party administrator should address?<br />
• How do wellness incentives impact my grandfather plan status?<br />
• Do external reviews for self-insured plans apply to more than medical necessity determinations?<br />
SPEAKER<br />
Ashley Gillihan<br />
Attorney<br />
Alston & Bird, LLP<br />
Self-Insured Health Plans for the Smaller Employer<br />
With the recent passage of the health care reform legislation, there has been more interest than ever by smaller employers (50-500 employees)<br />
considering self-insured group health plans. This session will provide on overview of effective self-insurance strategies specifically for smaller<br />
employers. The presenter will also discuss common pitfalls and complications faced by smaller employers when considering self-insurance.<br />
SPEAKER<br />
Kent Boyer<br />
Executive Vice President<br />
Wells Fargo Insurance Services
Presented by:<br />
HealthcareTRack<br />
Continued<br />
Targeting Unnecessary Medical Spend: A Treatment Decision Support Study<br />
According to some reports, up to 30% of care delivered in the U.S. may be unnecessary, and the impact on health outcomes and medical spend is<br />
dramatic. Consumers play a critical role in overcoming this challenge. However, they often lack the support and resources they need to make an informed<br />
medical decision. Treatment decision support programs empower consumers with objective medical information that helps them partner with their provider<br />
to make better decisions, saving everyone health care dollars. In this session, review a new study of national employer groups which demonstrates<br />
the savings generated from treatment decision, discover how key demographic attributes impact consumer engagement in treatment decision support<br />
programs and understand the role treatment decision support programs can play in generating health care value for employers and health plans.<br />
SPEAKER<br />
800.851.7789 | www.siia.org<br />
Thomas Knabel, MD<br />
Vice President of Healthcare Informatics Consulting<br />
Ingenix Consulting<br />
Does Your Self-Funded Health Plan Pass Nondiscrimination Muster?<br />
Identifying and Correcting Potential Tax Issues in Your Plan Design<br />
Although the provisions in Section 105(h) of the Internal Revenue Code – which prohibit offering more favorable eligibility terms and benefits<br />
under a self-funded group health plan for employees deemed “highly-compensated” without adverse tax consequences - have been in place<br />
for decades, these nondiscrimination concepts have received renewed scrutiny with the passage of health care reform and the extension<br />
of Section 105(h) concepts to fully-insured health plans. This session will break down the nondiscrimination requirements of Section 105(h)<br />
applicable to self-funded health plans, as well as review the potential penalties for noncompliance. The session will also offer practical<br />
approaches for identifying and correcting potential nondiscrimination issues. Finally, this session will offer insight into relationship between<br />
Section 105(h) requirements and the extension of these requirements to fully-insured health plans in light of health care reform.<br />
SPEAKER<br />
Catherine Stowers<br />
Senior Attorney<br />
Kreig DeVault LLP<br />
Medical Stop-Loss Market Trends – A Review and Preview<br />
A panel of leading independent stop-loss marketplace analysts discusses major trends witnessed during 2011 and previews what is on the horizon<br />
for 2012. Specific topics will include organic growth, mix of business, claims experience (cat cases, etc.), use of captives, carve outs (transplant,<br />
neonate, etc.) types of networks and network contracting. Session time will be reserved for the panel to take questions from the audience.<br />
SPEAKERs David Wilson Horace F. Garfield<br />
Partner<br />
Windsor Strategy Partners<br />
President<br />
AEGON Alliances, Inc.<br />
Self-Insured Employer Embraces Innovative CDH Strategies<br />
This case study-style presentation will describe how a mid-sized self-insured employer has incorporated and integrated innovative consumerdirected<br />
health care (CDH) strategies, which have produced tangible results as measured by a healthy and productive workplace. Specific<br />
topics will include wellness programs, on-site medical care and disease management approaches.<br />
SPEAKER<br />
Mark Hopkins<br />
Senior Director, Compensation, Benefits & HRIS<br />
Mohawk Industries, Inc.<br />
Leveraging PPO Value for the Self-Insured Employer and TPA<br />
<strong>SIIA</strong>’s Health Care Committee is working to develop recommendations on how to better leverage the value that preferred provider organizations<br />
(PPOs) provide to self-insured employers and their TPAs. This “working” session will provide a forum to present these recommendations and solicit<br />
feedback from attendees in an informal, roundtable-style setting. Based on this dialogue, the association will explore ways to use this information in<br />
a way that will be helpful to employer, TPA and PPO members.<br />
SPEAKERs Representatives of <strong>SIIA</strong>’s Health Care Committee
Self-Insured Health Plan Innovations in a Public Sector and Political Environment<br />
Making changes to self-insured group health plans are especially complicated in the public sector due to collective bargaining and political<br />
considerations. This session will prove an interesting case study report on how a large teacher’s union embraced innovative changes to their<br />
health plan, which have proven to keep costs down with improving access to treatment.<br />
SPEAKER<br />
Mickey Hall<br />
Director of Budget and Finance<br />
Wilson County Board of Education<br />
Health Care TPAs and Stop-Loss Carriers/MGU Roundtable Discussion<br />
This will be a moderate roundtable discussion session designed to facilitate a free exchange of questions and comment about the latest “hot<br />
topics” of interest to TPAs and stop-loss/MGU company executives.<br />
moderatoR<br />
Richard Ritchie<br />
President<br />
RICS<br />
Healthcaremini-TRack for Brokers<br />
Self-Funding 201/Stop Loss 101<br />
This session will cover the essentials of self-funding with an emphasis on stop loss basics including:<br />
• How to assess whether a group is a good candidate for selffunding<br />
• Stop Loss quote process and what you need to know in order to<br />
• Stop Loss product options and what’s best for your client<br />
• How to sell self-funding – what is the value proposition<br />
communicate to your client<br />
• Onboarding considerations once the group decides to self-fund – • Stop Loss policy overview – things to look out for<br />
do’s and don’ts<br />
SPEAKER<br />
Maria K. Iarossi<br />
Area Vice President, Client Development<br />
Gallagher Benefit Services, Inc.<br />
Case Studies/Lessons Learned<br />
This session is designed to give attendees real-world examples of good and bad experiences of selling, implementing and servicing self-funded<br />
groups. Speakers will represent the perspectives of the MGU, TPA and carrier.<br />
SPEAKERs Eric C. Ludwig rAchel Miller (Invited)<br />
President<br />
Interactive Medical Systems<br />
Jim Clark<br />
Director of Marketing<br />
International Specialty Underwriters, Inc.<br />
Vice President - Medical<br />
Fairmont Specialty, a Div. of Crum & Forster<br />
Juli S. Warren<br />
Senior Manager<br />
Blue Cross Blue Shield Florida<br />
Broker Panel<br />
This session will give attendees exposure to best practices as heard from the experts on the front-lines. This will be an interactive session with the<br />
presenters to assist your understanding as to why these experts do what they do.<br />
SPEAKERs Maria K. Iarossi denise A. Doyle mArk Bailey<br />
Area Vice President, Client Development President Bailey Group<br />
Gallagher Benefit Services, Inc. Stop Loss Insurance Brokers, Inc. (Invited)<br />
Adding Value<br />
Health Care Reform is driving changes in how minimum loss ratios are calculated and will drive changes in how brokers are compensated. There<br />
has never been a better time to develop new strategies for adding value to your clients while becoming an expert in how to drive cross selling of<br />
ancillary lines and other diversified product opportunities. Creative compensation approaches will be explored within the context of what is working<br />
in the market now and future opportunities.<br />
SPEAKER<br />
Elizabeth Midtlien<br />
Senior Vice President<br />
Star Line Group
InternationalTRack<br />
International Employee Benefit Management Strategies<br />
for Mid-Sized Companies<br />
An ever increasing number of mid-sized companies face unique challenges as they try to develop, implement and manage employee benefit<br />
plans to match up with increasingly global operations. A leading industry expert will describe these challenges and how such companies can<br />
best leverage their limited staff by engaging the expertise, processes, technology and information resources to effectively address the employee<br />
benefit requirements of a geographically diverse workforce.<br />
SPEAKER<br />
Patrick G. Hickey<br />
Managing Director, National Practice Leader<br />
International Employee Benefits<br />
Wells Fargo Insurance Services USA, Inc.<br />
Self-Insured Employer Says Yes to Medical Travel Option<br />
Over the last few years, many self-insured employers have been introduced to the concept of medical travel as viable strategy to reduce health<br />
care costs for certain treatments. In this session, a representative of a self-insured employer with more than 3,000 plan participants will discuss<br />
how they evaluated the medical travel option and explain why they ultimately decided to incorporate a medical travel option into their health<br />
plan. The presenter will also discuss how this option was communicated to employees and how it has been received thus far. This is one of<br />
the first true medical travel case study presentations specifically from a self-insured employer’s perspective.<br />
SPEAKER<br />
Thomas Showalter<br />
Human Resources Director<br />
Chenega Corporation<br />
The Evolution of Multinational Benefits Pooling Networks<br />
This presentation will discuss networks that have been in place for over 50 years, controlling more than $5B in insurance placements. Despite<br />
their long history, networks are experiencing profound change in structures and partnership arrangements in the past 12-18 months driven by<br />
AIG issues/changes as well as recognition by major global life carriers of opportunities in this space. A leading industry expert will comment<br />
on how these networks have evolved and provide an up-to-the-minute description of what they look like now.<br />
SPEAKER<br />
Greg Arms<br />
Global Head, Employee Benefits Practice<br />
Marsh, Inc.<br />
Solvency II – Implications for U.S-Based Companies and Insurance Entities<br />
This introductory-level session will provide an overview of how the European Union’s existing insurance solvency regulations will be updated<br />
and modernized effective January 1, 2013 through Solvency II and what this sweeping development means for U.S. based insurers/selfinsurers,<br />
as well as U.S. subsidiaries with parent companies based in the EU. Specific implication topics will include capital position, product<br />
strategy, ERM framework, risk culture and technology applications.<br />
SPEAKER<br />
Les Boughner<br />
Executive Vice President & Managing Director<br />
Willis North American Captive & Consulting Practice<br />
800.851.7789 | www.siia.org
A Primer on Global Health Care<br />
This session will provide attendees with a general overview of global health care and how U.S.-based employers can utilize this strategy to<br />
better contain health care costs while providing expanded treatment options for plan participants. Specific topics will include an assessment<br />
on international medical facilities, the specifics around purchasing low-cost employer and employee medical travel liability policies, and the<br />
integration points for medical travel benefits, regardless of specific health plans.<br />
SPEAKER<br />
David Boucher<br />
President & Chief Operating Officer<br />
Companion Global Healthcare, Inc.<br />
I have been attending the <strong>SIIA</strong><br />
National Conference & Expo for<br />
the past several years because I<br />
am able to connect with decision<br />
makers from around the world. If<br />
your company is involved in the<br />
self-insurance market on a global<br />
basis, or would like to be, you<br />
really need to be at <strong>SIIA</strong>.<br />
– Dr. Edward Watson,<br />
Executive Chairman Medtral New Zealand
Presented by:<br />
Workers’<br />
CompensationTRack<br />
The ADA Amendments Act of 2008 – Implications for Workers’<br />
Compensation Self-Insurers<br />
When the Americans with Disabilities Act (ADA) was passed in 1990 it represented a significant change in the way employers recruited,<br />
interviewed, evaluated, hired and promoted persons with disabilities. The law had an unexpected and significant impact on workers’<br />
compensation and disability management return-to-work programs. From pre-offer medical examinations to wrongful termination and failure to<br />
accommodate disabled workers, the ADA changed the way that employers conducted disability management with their injured employees.<br />
The ADA has now been amended and the updated version creates new compliance challenges for workers’ compensation self-insurers. The<br />
top industry expert on this topic will provide an overview of key ADA changes with a specific focus on return-to-work programs.<br />
SPEAKER<br />
Dr. Richard Pimentel<br />
Senior Partner<br />
Milt Wright & Associates, Inc.<br />
The ADA Amendments Act of 2008 – A Compliance Action Plan for<br />
Workers’ Compensation Self-Insurers<br />
This will serve as a follow-up session on the amended ADA. Participants will learn how to modify existing return to work programs to be<br />
consistent with the new ADA compliance requirements – and avoid large financial penalties currently being levied by the Equal Employment<br />
Opportunities Commission (EEOC).<br />
SPEAKER<br />
Dr. Richard Pimentel<br />
Senior Partner<br />
Milt Wright & Associates, Inc.<br />
Wounded Warriors – Keeping Them Safe Now That They Are Back<br />
Every day, many of our brave men and women fighting in Iraq and Afghanistan return from deployment looking to get back to their jobs or<br />
seeking first-time civilian employment. Post traumatic stress disorder and traumatic brain injuries present very real challenges for safety and<br />
production supervisors. Returning veterans have a higher than average accident and injury rate. Safety programs need to target returning<br />
veterans for tailored safety training. Dr. Pimentel, with his vast knowledge of the workers’ comp arena coupled with his experience as a war<br />
veteran, will bring you insight and strategies to honor these war veterans by successfully bringing them into your organization and helping them<br />
return to civilian life.<br />
SPEAKER<br />
Dr. Richard Pimentel<br />
Senior Partner<br />
Milt Wright & Associates, Inc.<br />
Utilizing Social Media to Investigate Workers’ Compensation Claims<br />
Self-insured employers are increasingly looking at utilizing social media as an additional avenue to investigate workers’ compensation claims.<br />
While it’s possible to collect a wealth of information through Facebook, MySpace, LinkedIn and other social media sites, there is a right way<br />
and wrong way to conduct on-line investigations in order to ensure that the discovery process is not compromised. The co-author of Social<br />
Networking and Workers’ Compensation Law at the Crossroad will share her unique expertise on this timely topic.<br />
SPEAKER<br />
Jaclyn S. Millner<br />
Attorney<br />
Fitch, Johnson, Larson & Held<br />
800.851.7789 | www.siia.org
TPA Compensation Practices – Perspectives on Transparency, Disclosure<br />
and Practicality<br />
This panel presentation will include representatives from both third party administrators and workers’ compensation self-insurers who will discuss<br />
the differing approaches to how TPAs should be compensated for their services. Time will be reserved at the end for questions and comments<br />
from the audience, so this promises to be a particularly lively and interactive session.<br />
SPEAKERs Kenneth F. Martino Judie Tsanopoulos<br />
President & CEO<br />
Broadspire<br />
Director of Workers’ Comp & Loss Control<br />
St. Joseph Health System<br />
Pam Ferrandino<br />
Executive VP & Casualty Practice Leader<br />
Willis North America<br />
cArla Wynn<br />
Director, Workers’ Compensation<br />
Aramark<br />
Emil Bravo (Invited)<br />
Executive Vice President<br />
Gallagher Basset Services, Inc.<br />
Major University System Innovates to Slash Workers’ Compensation Costs<br />
The University of California, with more than 170,000 employees, has been able to reduce workplace injuries by 47% over the last five<br />
years through the implementation of its internally developed Be Smart About Safety program. This program empowers individual campuses to<br />
propose their own specific workplace safety initiatives and then “apply” for funding to implement these initiatives. This approach has created<br />
a sense of “ownership” among the individual campuses to take control of their workers’ compensation claims, with the University establishing<br />
performance targets and rewarding the best performing campuses. The creator and current director of this innovative program describes how it<br />
operates and how it can be adapted for private sector workers’ compensation self-insurers with multiple business unit locations.<br />
SPEAKER<br />
Grace M. Crickette<br />
Chief Risk Officer<br />
university of California<br />
Group Fund Provides Workers’ Compensation Self-Insurance Solution<br />
for Small- and Mid-Sized Companies<br />
For companies not large enough to self-insure their workers’ compensation liabilities, there can be another option - participate in a group<br />
workers’ compensation fund where costs and risks are pooled with other small and mid-sized employers. This session will tell the story about<br />
one of the largest and most successful group funds in the country to help attendees understand this self-insurance solution.<br />
SPEAKERs Shelly Brotzge Pete Proffer<br />
Account Manager<br />
Midwest Employers Casualty Company<br />
Owner<br />
Midwest Risk Management Services, Inc. (MRMSI)<br />
Leonard Wiggins<br />
Board Chairman<br />
Arkansas Self-Insurance Trust (ASIT)<br />
Alan McClain<br />
CEO<br />
Arkansas Workers’ Compensation Commission<br />
The Holistic Approach to Managing Workers’ Comp Costs<br />
The best run self-insured workers’ compensation programs recognize that equal attention needs to be paid to preventing injuries before<br />
they happen, as well as effectively managing claims once injuries do occur. This session will profile how a leading retail/grocery company<br />
has successfully embraced such a “holistic” approach by focusing on and connecting both front end and back end program management<br />
strategies and related employee communication initiatives.<br />
SPEAKER<br />
Beth Rau<br />
Risk Manager<br />
Fry’s Food & Drug Stores
Presented by:<br />
Workers’<br />
CompensationTRack<br />
Continued<br />
How Obesity, Smoking and Alcohol is Spiking Your Workers’ Comp Costs<br />
Wellness programs effect have been well documented and their long term affects on Group Health Plans. Participants will walk through how<br />
a wellness program can actually impact a workers’ compensation program, uniquely addressing how there are short and long term outcomes.<br />
Learn about a pioneered post-accident program that specifically targets injured workers’ compensation morbidities that can be inhibitors to a<br />
return to work. Obesity, smoking and diabetes can delay a return to work. Whether you are responsible for workers’ compensation or your<br />
organizations health plan, you can pick up insights on how to better your program.<br />
SPEAKER<br />
Avrom Simon, M.D., MPH, CPE<br />
Medical Director<br />
MCM Solutions for Better Health<br />
Cost Containment in the Hot Zone, Part I: The TPA Blueprint Process<br />
California is the hot zone for Work Comp claims costs. Medical costs on indemnity claims are up 60% since 2005. The TPA Blueprint process<br />
is the model for creating a self-insured-TPA partnership that can take the heat and produce better outcomes<br />
SPEAKER<br />
Barry Bloom<br />
Consultant<br />
Cost Containment in the Hot Zone, Part II: Clinical and Litigation<br />
Management on the Leading Edge<br />
California is the hot zone for Work Comp claims costs. Medical liens are tying up the system. Litigation is racing ahead of national averages.<br />
Erosion and rollbacks of the 2004 reforms are underway. This session will introduce and review leading edge clinical and litigation<br />
management programs that help employers have positive cost containment<br />
in a treacherous environment.<br />
SPEAKER Barry Bloom Additional Speakers to be announced.<br />
Consultant<br />
Hot Topics for Workers’ Compensation Self-Insurers<br />
This will be a moderated roundtable discussion designed to encourage a free exchange of questions and comments about the latest “hot<br />
topics” of interest to workers’ compensation self-insurers an informal setting.<br />
moderatoRs Duke Niedringhaus Charlie Caldwell<br />
Vice President<br />
J.W. Terrill, Inc.<br />
President & CEO<br />
Midlands Management Corporation<br />
800.851.7789 | www.siia.org
I was a first time attendee last<br />
year and had a very positive<br />
experience. The educational<br />
sessions provided me a unique<br />
opportunity to learn about<br />
successful health plan management<br />
strategies from other self-insured<br />
employers and the exhibit hall was<br />
truly impressive.<br />
– Tom Yopp, Senior Vice President<br />
Hendrick Automotive Group, Inc.<br />
We rely on <strong>SIIA</strong>’s National<br />
Conference & Expo for timely<br />
educational content and to provide<br />
a forum where we can connect<br />
with other industry players and<br />
business partners under one roof.<br />
– Elliot Cooperstone, CEO<br />
Meritain Health<br />
Dart Container Corporation is<br />
self-insured for medical, dental<br />
and workers’ compensation<br />
benefits. We also have both an<br />
on-shore and off-shore captive<br />
which we utilize for benefits and<br />
other corporate risk exposures.<br />
The <strong>SIIA</strong> National Conference<br />
and Expo is the most important<br />
industry event we attend each year given that it pulls<br />
together all of the educational content and networking<br />
opportunities we need under one roof.<br />
– Dan Ide, Risk Manager<br />
Dart Container Corp.
GolfTournament<br />
Play it for yourself and see what everyone<br />
is talking about – Voted one of the Top 75<br />
Resorts in North America by Condé Nast<br />
readers, voted Best Courses You Can Play by<br />
Golfweek Magazine, voted America’s Top<br />
Golf Courses by Zagat, voted World’s Best<br />
Golf Resorts for Family Trips and Best Resort<br />
Course in the Southwest by Travel & Leisure<br />
Golf Magazine and so much more!<br />
Wildfire Golf Club is situated in the rugged<br />
Sonoran Desert of Northeast Phoenix, and<br />
features two picturesque 18-hole courses<br />
designed by two of golf’s greatest legends--<br />
Arnold Palmer and Nick Faldo.<br />
The Palmer Signature Course at Wildfire Golf<br />
Club offers scenic and expansive fairways<br />
allowing the ball to remain in play even on<br />
an errant shot. The Faldo Championship<br />
Course features generous fairways,<br />
large bent grass greens and tee boxes.<br />
Surrounding both courses are the majestic<br />
McDowell Mountains and century-old<br />
saguaro cacti, providing a spectacular setting<br />
for golfers.
As this year’s SIEF Golf Tournament Chairwoman, I would<br />
like to personally invite you to participate in this year’s event.<br />
Tournament proceeds will help The Foundation continue<br />
its important work of developing educational initiatives that<br />
benefit the self-insurance/ART industry, so make plans to join<br />
us in this spectacular location! Enjoy a great round of golf<br />
while supporting a great cause. I look forward to seeing you<br />
in Phoenix.<br />
You are cordially invited to participate in this fundraising<br />
event to benefit the Self-Insurance Educational Foundation<br />
(SIEF). Don’t miss this exclusive opportunity to better<br />
your handicap, refine your putting skills and support the<br />
foundation dedicated to ensuring the development of<br />
tomorrow’s leaders in the self-insurance/ART industry. The<br />
SIEF Golf Tournament Fundraiser, scheduled on opening<br />
day of <strong>SIIA</strong>’s National Conference & Expo, is open to all<br />
conference registrants and promises to be an excellent<br />
opportunity to network with executive-level industry<br />
colleagues and peers.<br />
Player Information<br />
Date: Sunday, October 9, 2011<br />
Registration: 7:00 am – 8:00 am<br />
Shot-Gun Start: 8:00 am<br />
Tournament Play: 8:00 am – Noon<br />
Lunch: Noon – 1:00 pm<br />
$500 per person<br />
$1,800 per foursome<br />
Includes: Greens Fees for 18 Holes, Golf Cart,<br />
Continental Breakfast, Beverages, Post-Tournament Lunch<br />
and Various Prizes<br />
Please return completed form with payment to:<br />
SIEF<br />
P.O. Box 1237<br />
Simpsonville, SC 29681<br />
Fax to 864.962.2483<br />
Contact Name ______________________________________________________________________________________<br />
Title_______________________________________________________________________________________________<br />
Company Name_____________________________________________________________________________________<br />
Address_ ___________________________________________________________________________________________<br />
City___________________________________________________________ State__________ Zip___________________<br />
Telephone___________________________________________ Fax_ ___________________________________________<br />
E-mail_______________________________________________ Website________________________________________<br />
Player Registration<br />
One Player – $500<br />
Player’s Name ____________________________________<br />
Payment Information<br />
Enclosed is my check made payable to SIEF in US funds.<br />
Please charge the following:<br />
Avg/Hcp________________________________________ Visa Mastercard American Express Discover<br />
Club Rental: No Yes If yes: Right-hand Left-hand Card No._________________________________________<br />
Foursome – $1,800 Foursome pairing will be handled by tournament director. Name on card_____________________________________<br />
Name’s of Players<br />
Avg/Hcp Exp. Date_________________________________________<br />
_______________________________________________<br />
_______________________________________________<br />
_______________________________________________<br />
_______________________________________________<br />
____________________________________________________<br />
VAL Code (MC, Visa, Discover – 3 digits on back; Amex – 4 digits on card front)<br />
Billing Address_____________________________________<br />
City______________________ State_____ Zip___________<br />
Authorized Signature_________________________________<br />
Date_____________________ Total____________________<br />
Cancellation Polic y: Written cancellations postmarked or faxed on or before September 9, 2011 will receive a refund of 50% of the registration fee. All cancellations postmarked or faxed after September 9, 2011, are<br />
nonrefundable; however, substitutions are permitted. Because this is a fundraising event, no refunds will be given should the tournament be rained out. Note: Credit card payments will be processed through <strong>SIIA</strong> with funds<br />
transferred directly to the Foundation. Please consult with your tax advisor regarding the tax deductibility of your participation in this event.
Hotelinformation<br />
5350 E. Marriott Drive<br />
Phoenix, AZ 85054<br />
(800) 835-6206<br />
www.jwdesertridge.com<br />
$269+tax per night<br />
The luxurious J.W. Marriott Desert Ridge Resort &<br />
Spa will be the host for <strong>SIIA</strong>’s 31st Annual National<br />
Educational Conference & Expo. J.W. Marriott Desert<br />
Ridge Resort & Spa provides luxury, unparalleled<br />
service, endless recreation and exquisite dining.<br />
This desert mountain luxury hotel near Phoenix<br />
has Arizona’s largest ballroom, a pampering spa,<br />
outstanding restaurants and championship golf.<br />
Upon arrival, you’re greeted with an expansive grand<br />
lobby, splashing fountains, stunning floor-to-ceiling<br />
windows, sparkling waterways and majestic palmlined<br />
pathways. Resort suites and hotel rooms include<br />
views, signature bedding and balcony or patio. Come<br />
experience Arizona resort grandeur in the mountains of<br />
Phoenix -- J.W. Marriott Desert Ridge Resort and Spa<br />
-- where the elements meet.<br />
Overflow Hotel<br />
Xona Resort Suites<br />
7677 E. Princess Blvd.<br />
Scottsdale, AZ 85255<br />
(888) 222-1059<br />
www.xonaresort.com<br />
Rooms starting at $199 + tax per night<br />
800.851.7789 | www.siia.org
Hospitality<br />
Suites<br />
Hospitality suites opportunities are<br />
available to sponsoring and exhibiting<br />
companies on Sunday 10/9 and<br />
Monday 10/10. Entertain attendees,<br />
clients and friends in a more social<br />
atmosphere. For more information on hosting<br />
a Hospitality Suite, visit www.siia.org.
Registrationinformation<br />
Prior to June 24, 2011 After June 24, 2011<br />
Employer/Self-Insured Entity<br />
<strong>SIIA</strong> Member $295 $350<br />
<strong>SIIA</strong> Member Additional $250 $295<br />
Non-Member $450 $495<br />
Industry Service Provider<br />
<strong>SIIA</strong> Member $850 $995<br />
<strong>SIIA</strong> Member Additional $695 $750<br />
Non-Member $1,295 $1,395<br />
*For groups of 6 or more please contact <strong>SIIA</strong> Headquarters for discounted group<br />
pricing information at 800.851.7789.<br />
EMPLOYER/SELF-INSURED ENTITY<br />
Self-Insured Entity is defined as an organization that is self-insured<br />
for group health care and/or workers’ compensation, or is a<br />
captive insurance company/risk retention group. This also includes<br />
employers considering self-insurance/captive insurance. Selfinsurance<br />
industry service providers including but not limited to,<br />
TPAs, MGUs, & captive management companies do not qualify<br />
for this registration rate even if their organization is self-insured.<br />
Registrations submitted by service providers selecting the employer<br />
rate will not be processed.<br />
INDUSTRY SERVICE PROVIDER<br />
Industry service provider is defined as any organization that<br />
provides a product or service to the self-insured, fully insured or<br />
alternative risk transfer marketplace. This includes, but is not limited<br />
to TPAs, MGUs, and captive management companies.<br />
MEMBER ADDITIONAL<br />
Member additional rates are available to the second and any<br />
subsequent registrations from the same member organization.<br />
MEMBERSHIP & REGISTRATION FEES<br />
<strong>SIIA</strong> memberships belong to the company, not the individual and<br />
are listed in the name of said company. Membership rights and<br />
privileges do not extend to subsidiary companies. Special affiliate<br />
memberships are available. Call <strong>SIIA</strong> Headquarters for details at<br />
800.851.7789.<br />
800.851.7789 | www.siia.org<br />
HOST HOTEL INFORMATION<br />
JW Marriott Desert Ridge Resort & Spa<br />
5350 E. Marriott Drive<br />
Phoenix, AZ 85054<br />
Phone: 800.835.6206<br />
www.jwdesertridgeresort.com<br />
Note: Only full conference registrants are eligible to reserve rooms<br />
at the host hotel.<br />
OVERFLOW HOTEL INFORMATION<br />
Xona Resort Suites<br />
7677 E. Princess Blvd.<br />
Scottsdale, AZ 85255<br />
Phone: 888.222.1059<br />
www.xonaresort.com<br />
Hotel reservations at the host hotel and the overflow hotel must be<br />
made through <strong>SIIA</strong>. Accommodations will be made on a first come,<br />
first serve basis, based on availability. Hotel reservations will only<br />
be confirmed for paid conference registrants. You will receive hotel<br />
confirmations directly from the hotel.<br />
REGISTRATION CONFIRMATION<br />
Conference registration will be sent via email from <strong>SIIA</strong><br />
Headquarters within two weeks of receipt of your form.<br />
SPECIAL SERVICE CLAUSE<br />
If you require special accommodations to fully<br />
participate, please attach a written description of<br />
your needs to your registration form.
Registrant Information<br />
To register, please type or print all information requested below. For<br />
multiple registrations, please photocopy this form. A separate form<br />
must be completed for each conference registrant.<br />
Full Name____________________________________________<br />
First Name for Badge____________________________________<br />
Title_________________________________________________<br />
Company _ ___________________________________________<br />
Address_ _____________________________________________<br />
City ______________________ State_____ Zip______________<br />
Phone _____________________ Fax_______________________<br />
E-mail________________________________________________<br />
Is this your first <strong>SIIA</strong> National Conference? ❑ Yes ❑ No<br />
Registration Payment Information<br />
Please select registration level: (fee schedule on previous page)<br />
❑ Employer/Self-Insured Entity (Do not select this option unless<br />
your company fits the definition provided on previous page)<br />
Industry Service Provider<br />
Total amount due $____________________________________<br />
Enclosed is my check made payable to <strong>SIIA</strong> in US funds in the<br />
amount of $_ _______________________________________<br />
❑ Please charge the following: ❑ VISA ❑ MC ❑ Amex ❑ Discover<br />
Credit Card Number____________________________________<br />
Name on Card ________________________________________<br />
Billing Address_ ________________________________________<br />
City ______________________ State_____ Zip______________<br />
VAL Code_____________________________________________<br />
(MC, Visa, Discover—last 3 digits on card back; AMEX—4 digits on card front)<br />
Signature____________________________ Exp Date ____ /____<br />
3 Easy Ways to Register<br />
1. Fax your registration to:<br />
864-962-2483<br />
2. Mail your registration to:<br />
<strong>SIIA</strong>, P.O. Box 1237<br />
Simpsonville, SC 29681<br />
3. Online www.siia.org<br />
❑ ❑<br />
Hotel Reservation<br />
No Yes Will you need hotel reservations?<br />
(If yes, continue below)<br />
Hotel reservations can only be made by completing this form. Only<br />
FULL conference registrants may secure hotel reservations at the host<br />
hotel. All other conference registrants will be placed at the overflow<br />
hotel, at the room type/rate available at that time. Accommodations<br />
will be made on a first come, first served basis.<br />
❑ JW Marriott Desert Ridge Resort* - $269 + 13.27% tax = $304.70<br />
*Full conference registrations only.<br />
❑ Xona Resort - King Suite - $219 + 13.27% tax = $248.06<br />
❑ Xona Resort - 2 Bedroom Suite - $350 + 13.27% tax = $396.45<br />
❑ Xona Resort - Traditional - $199 + 13.27% tax = $225.41<br />
Please check appropriate box below for type of accommodations<br />
required: ❑ King ❑ ❑ Double/Double (Hotels are non-smoking)<br />
Rooms reserved after September 13, 2011 will be made on a space<br />
and rate availability only.<br />
Arrival Date___________________________________________<br />
Departure Date_________________________________________<br />
Marriott Rewards #_____________________________________<br />
Guarantee Hotel Reservation<br />
Payment for one night’s lodging is required to secure hotel<br />
reservations. Hotel Reservations will be made based on availability.<br />
❑ Enclosed is my check payable to my chosen hotel for one night’s<br />
lodging. Please send the check to <strong>SIIA</strong> with this registration form.<br />
❑ Please charge the same account number in the payment<br />
information section.<br />
❑ Charge a different account: ❑ ❑ VISA ❑ ❑ MC ❑ ❑ Amex ❑ ❑ Discover<br />
Credit Card Number____________________________________<br />
Name on Card________________________________________<br />
Billing Address _____________________________________<br />
City ______________________ State_____ Zip______________<br />
VAL Code_____________________________________________<br />
(MC, Visa, Discover—last 3 digits on card back; AMEX—4 digits on card front)<br />
Signature____________________________ Exp Date ____ /____<br />
IMPORTANT: You will receive confirmation of your conference registration via e-mail<br />
from <strong>SIIA</strong> Headquarters within two weeks from receipt of your form. If you do not<br />
receive registration confirmation within two weeks, please contact Michiale Machado at<br />
800.851.7789.<br />
You will receive confirmation of your hotel reservations via e-mail directly from your chosen<br />
hotel. Once confirmation has been received from the hotel, please contact the hotel directly<br />
regarding reservation cancellations or changes. One night’s lodging and tax will be charged<br />
to the credit card provided upon receipt of registration. To avoid charges, cancellations for<br />
accommodations must be received by the hotel 48 hours prior to arrival date.<br />
Cancellation Policy: Written cancellations postmarked or faxed on or before September 9, 2011 will receive a refund of 50% of the registration fee. Due to hotel and staffing commitments, all<br />
cancellations postmarked or faxed after September 9, 2011, are non-refundable and cannot be transferred to other <strong>SIIA</strong> functions; however, substitutions are permitted.
P.O. Box 1237<br />
Simpsonville, SC 29681<br />
31st Annual Self-insurance Institute of America, Inc.<br />
National Educational Conference & Expo<br />
J.W. Marriott Desert Ridge Resort & Spa • Phoenix, AZ • October 9-11, 2011