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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

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