The Business of Benefits Podcast

In this episode of The Business of Benefits, Chelsea Ryckis, Donovan Ryckis and Patrick Ansara count down the back half of the Benefits Dirty Dozen: the six tactics that cost employers the most, and the one that makes all the others possible.

Every year the IRS publishes a "Dirty Dozen" memo listing legal structures people are abusing. Donovan applied the same idea to employee benefits. These are legitimate tools used the wrong way, and almost any plan sponsor could find one or two in their own plan. Each tactic gets the same treatment: the tell, the damage in dollars, an honest look at whether there is a fair explanation, the fix, and the verdict. Is it dirty, or is it just dumb?

This is Part 2, tactics 6 through 1. Part 1 covered 12 through 7: https://youtu.be/sgfQDq7PtyY

What you'll learn

• Why market leverage is never quantified, and how cross-plan offsetting decides which client absorbs someone else's increase
  
• How to check your own renewals, and the underwriting exhibit that cut one client's renewal by 10 percent
  
• What a 12 percent renewal really costs: $720,000 worse for the plan, $28,000 better for the advisor
  
• When percentage compensation is legitimate, and the disclosure language that commits a broker to never going to market
  
• Why $4 per employee per month is $144,000 a year, and whether your contract even permits that point solution
  
• Where PBM money hides: script fill fees, rebate retention, spread pricing, and PEPM quietly becoming PMPM
  
• What free enrollment technology costs employees, with heaped first year commissions past 60 percent
  
• The ERISA suits filed this year, and the 2 to 6 percent benchmark most of them missed by 30 points
  
• What claims data access actually means, and why it is the fix that solves the other eleven tactics
  

Time Stamps
00:00 - Cold open
00:51 - Welcome to The Business of Benefits
01:12 - What this episode covers
02:04 - Tactic 6: Market leverage and cross-plan offsetting
04:31 - How cross-plan offsetting actually works
06:53 - Devil's advocate: do relationships help?
08:27 - The underwriting exhibit that cut a renewal 10 percent
09:16 - Verdict: market leverage is fairy dust
11:06 - Tactic 5: Compensation that scales with your premium
12:51 - The disclosure that says we will not go to market
14:11 - $720,000 worse for the plan, $28,000 better for the advisor
16:18 - When commissions are the only model that works
17:36 - 90 percent have no idea what they are paying
18:47 - Nobody else gets paid more as your results get worse
19:01 - Verdict on tactic 5
20:22 - Tactic 4: The point solution pile-on
20:38 - The point solution the contract never allowed
22:55 - $4 per employee per month is $144,000 a year
24:47 - There's a buck in everything
28:31 - Verdict on tactic 4
29:48 - Tactic 3: PBM compensation
30:55 - PEPM to PMPM, a 2.4x multiplier for one letter
31:52 - The pharmacy that invoiced the broker
33:36 - The PBM RFP red flag
35:03 - What North Carolina's spread pricing rule revealed
36:07 - Verdict on tactic 3
37:35 - Tactic 2: Voluntary benefits and free technology
38:58 - Heaped commissions and this year's ERISA lawsuits
42:38 - Why heaped commissions drive carrier churn
43:28 - Verdict on tactic 2
44:34 - Tactic 1: Obstruction of data and contract access
46:24 - What data access actually means
48:40 - This is what real leverage looks like
51:14 - Fix number one and you solve all twelve
53:24 - Negotiate terms, not just price
54:33 - The gag clause attestation, December 31, 2026
56:14 - Closing thoughts
Ethos Benefits: https://ethosbenefits.com
Podcast: https://businessofbenefitspodcast.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305
LinkedIn: https://www.linkedin.com/company/ethosbenefits
Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/
Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Patrick Ansara: https://www.linkedin.com/in/patrickansara/
Finished with the content? Claim your CE credit here:
https://ideas.ethosbenefits.com/continuing-education
SHRM
Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.
HRCI
Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.

Host Chelsea Ryckis sits down with ERISA attorney Chris Vanderwolk to answer the question every plan sponsor is asking in a cost crisis: how do you tell a legitimate cost containment solution from a scheme dressed up to look like one?
Chris is Director of Compliance and Innovation and he spent two decades in employee benefits before he ever went to law school. He walks through the vendor pitches landing in CFO inboxes every week, explains where each one breaks, and gives employers a test they can run themselves.
We get specific on FICA double-dip and SIMRP programs, fixed indemnity and wellness plans, and charity care arrangements. Chris explains why an NDA on a compliance memo is a red flag, how ERISA 408 fee reasonableness works when you price the services yourself, and which regulators are in play when a program goes wrong.
What you'll learn
How to run vendor due diligence, and why the responsibility never transfers to your broker or TPA
Why nobody has a proprietary interpretation of the tax code
The FICA double-dip pitch, and the missing element that makes it fail
How to apply ERISA 408 fee reasonableness: price the bundle yourself, then compare it to the invoice
Which regulators you implicate beyond the IRS: ERISA, HIPAA, the ADA, and the Public Health Service Act
Where wellness programs cross into tax scheme, and why a guaranteed ROI is a reason to ask questions
The only two legal ways to fund individual coverage, and the COBRA rights employees give up
The compensation question to ask your advisor, and what their reaction tells you
Time Stamps
00:00 - Cold open
00:37 - Welcome to The Business of Benefits
02:58 - Meet Chris Vanderwolk
04:12 - From Army interrogator to ERISA attorney
06:05 - Proactive compliance vs reactive cleanup
08:20 - Why there is suddenly a vendor for everything
11:22 - The bingo marker problem
11:53 - You can delegate authority, not responsibility
13:00 - What vendor due diligence actually looks like
13:44 - The NDA on the compliance memo is a red flag
15:52 - The FICA double-dip scheme explained
17:06 - How these vendors react when you push back
20:15 - Why the websites never say what the program is
21:36 - Which regulators are actually in play
23:06 - ERISA 408: is the fee disclosed and reasonable?
24:27 - Unwinding a scheme and the Classic 105 prosecution
27:14 - Who actually pays when it falls apart
28:14 - Wellness program or tax scheme in a wellness costume
29:35 - The truth about wellness ROI
30:50 - Charity care arrangements explained
33:05 - Donative intent and the golf outing test
34:45 - When a charity becomes a conduit
35:18 - The only two legal ways to fund individual coverage
36:44 - The COBRA rights employees give up
38:19 - Pricing the conduit against real market fees
41:32 - For-profit hospital assistance programs
43:01 - Cutting through the noise: follow the incentive
44:55 - The Big 4 test
46:16 - Should vendors be co-fiduciaries?
48:00 - Why consultants don't belong on the fiduciary committee
49:37 - Good work is never afraid of the fee conversation
51:13 - Scope of work and the stewardship report
52:48 - Red flags in a consultant relationship
53:39 - If you're trying to do the right thing, you probably are
55:31 - Final thoughts and where to find Chris
Ethos Benefits: https://ethosbenefits.com
Podcast: https://businessofbenefitspodcast.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305
LinkedIn: https://www.linkedin.com/company/ethosbenefits
Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/
Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Connect with Chris Vanderwolk
LinkedIn: https://www.linkedin.com/in/christophervanderwolk/
FROM OUR SPONSOR
You're doing the work. Don't leave the proof behind.
Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary process speaks for itself. Learn more at www.fiduciaryinabox.com
Finished with the content? Claim your CE credit here:
https://ideas.ethosbenefits.com/continuing-education
SHRM
Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP or SHRM-SCP recertification activities.
HRCI
Ethos Benefits is approved to offer HRCI recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR, PHR, SPHR, and GPHR certification.
#employeebenefits #healthcarecosts #selffunded #plansponsor #benefitsstrategy #pbm #fiduciaryduty #cfo #chro #businessofbenefits

Every year the IRS puts out a memo called the "Dirty Dozen": a list of legal tax structures and processes that people are abusing. They're legitimate tools used the wrong way, and the memo flags them so people can get their house in order and know where the IRS plans to focus enforcement.

Donovan Ryckis applied the same concept to benefits. Twelve tactics Ethos is seeing in the market that are legitimate on paper but get abused in practice. This isn't happening everywhere, but almost any plan sponsor could probably find one or two of these in their plan, if not a lot more.

This is Part 1, tactics 12 through 7, with Donovan Ryckis (Co-Founder & CEO), Chelsea Ryckis (Founder & President) and Patrick Ansara (Director of Client Operations). Every tactic gets the same treatment: the tell, the damage in dollars, an honest look at whether there's a fair explanation, the fix, and then the verdict. Is it dirty, or is it just dumb?

What's covered: PMPM instead of PEPM, one letter that multiplies your fees 2.4 times. Contracts that quietly stop matching the proposal. Undisclosed equity between advisors and the carriers they recommend, and the 408 disclosure you're entitled to. PBM collectives, including a reprice study that came back $1.4 million better on a $9 million claim spend. Captives used as a broker's easy button. And the controlled market check, where you go to market and somehow land on the incumbent every year.

Built for mid-market and large-market plan sponsors. Part 2 counts down tactics 6 through 1.

Time Stamps

00:00 – Cold open

00:38 – Welcome to The Business of Benefits

01:01 – Where the benefits Dirty Dozen came from

02:31 – Meet Patrick Ansara

03:31 – How we grade each tactic: dirty or dumb?

04:25 – Tactic 12: PMPM instead of PEPM

11:54 – Tactic 11: The contract doesn't match the proposal

22:56 – Tactic 10: Undisclosed equity and ownership interests

30:36 – Tactic 9: PBM purchasing collectives and coalitions

37:42 – A word from Fiduciary in a Box

38:30 – Tactic 8: Captives as the broker's easy button

48:21 – Tactic 7: The controlled market check

1:03:09 – What's coming in Part 2

1:03:51 – This isn't broker bashing

1:05:43 – An industry that pays well for mediocrity

1:06:58 – Final thoughts

Ethos Benefits: https://ethosbenefits.com

Podcast: https://businessofbenefitspodcast.com

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305

LinkedIn: https://www.linkedin.com/company/ethosbenefits

Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/

Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/

Patrick Ansara: https://www.linkedin.com/in/patrickansara/

FROM OUR SPONSOR
You're doing the work. Don't leave the proof behind.
Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary process speaks for itself. Learn more at www.fiduciaryinabox.com

Finished with the content? Claim your CE credit here:
https://ideas.ethosbenefits.com/continuing-education

SHRM
Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.

HRCI
Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.

In this episode of The Business of Benefits, host Chelsea Ryckis talks with Brett Morris, Founder and CEO of the Samaritan Fund Program, about one of the toughest problems in employee benefits: high-cost claimants. Brett spent 15 years as a benefits broker before founding Samaritan Fund Program in 2021, which connects employees facing high-cost diagnoses with charitable funding so they can move to individual coverage at little to no out-of-pocket cost, fully compliant with ERISA and DOL rules.
We cover how self-funded employers can quantify the savings one high-cost claimant is driving on their renewal, why paying an employee to leave the plan is illegal (and why routing it through a vendor doesn't fix that), and how Samaritan Fund built a compliance framework reviewed by Nixon Peabody and examined by the DOL and six state regulators. Brett also shares a real case where a $250,000 renewal increase was fully offset while the affected member's costs dropped to zero.

What you'll learn

• What counts as a "high-cost claimant" and why a handful of claims usually drive most of a renewal increase
• The legal line employers can't cross when moving a high-cost claimant off the group plan
• How Samaritan Fund sources charitable funding, and why the money can never touch the employer or a vendor
• The four ways to manage risk (avoid, reduce, transfer, retain) and where this program fits
• How to quantify the savings opportunity from a high-cost claimant before your next renewal
• A case study eliminating $250,000 in renewal increase while the member's costs dropped to zero
• How Samaritan Fund Program is paid, and why it's built around performance, not a cut of savings

About Brett Morris and the Samaritan Fund Program 
Brett Morris is the Founder and CEO of the Samaritan Fund Program, which now works with more than 2,000 employer groups across 49 states and the Virgin Islands. He also leads the Samaritan Fund Foundation, the nonprofit side of the organization.

Brett Morris on LinkedIn: https://www.linkedin.com/in/brett-morris-5179b737/
Samaritan Fund Program website: https://samaritanfundprogram.com/
Samaritan Fund Program on LinkedIn: https://www.linkedin.com/company/samaritan-fund-program
Samaritan Fund Foundation website: https://samaritanfundfoundation.org/
Samaritan Fund Foundation on LinkedIn: https://www.linkedin.com/company/samaritan-fund-foundation
Email: [email protected]

FROM OUR SPONSOR
You're doing the work. Don't leave the proof behind.
Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary process speaks for itself. Learn more at www.fiduciaryinabox.com

HOSTED BY

Chelsea Ryckis, President, Ethos Benefits
LinkedIn: https://www.linkedin.com/in/chelsea-ryckis-8508a192/

MORE FROM ETHOS BENEFITS

Website: https://ethosbenefits.com/
Podcast site: https://businessofbenefitspodcast.com/
YouTube: https://www.youtube.com/@thebusinessofbenefitspodcast

Finished with the content? Claim your CE credit here:

https://ideas.ethosbenefits.com/continuing-education

SHRM

Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.

HRCI

Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.

This episode is built entirely from your favorite moments. In this year-in-review special, hosts Chelsea Ryckis and Donovan Ryckis of Ethos Benefits count down the most-watched clips of the year, the conversations that changed how employers think about their self-funded health plan. Across seven conversations you'll hear from an HVAC owner who found a 97% price difference on the same medical claim, an HR leader who saved her company $24 million, a PBM insider who exposes who owns who in the drug supply chain, a stop loss expert who makes self-funded vs. fully insured make sense, a reference-based pricing specialist who busts the biggest myth about balance billing, a birth advocate making the case for doulas as a benefits strategy, and Mark Cuban on where healthcare pricing is headed next. If you only watch one episode of this podcast, make it this one. What You’ll Learn * What a PBM actually is, and who owns who in the "Big 3" * Why international drug sourcing can cut prescription costs by more than 75% * How an $80,000 medical claim became $2,000 for the identical treatment from the identical doctor * The real financial impact of reference-based pricing: one company's path to $24 million in savings * How to tell when your broker isn't actually on your side, and what fiduciary disclosure should look like * Why "balance billing" fears are mostly a scare tactic, and what the real numbers show * The simplest way to explain self-funded vs. fully insured health plans to any employer * Why doulas and maternal health support belong in a modern employee benefits strategy FROM OUR SPONSOR You're doing the work. Don't leave the proof behind. Managing a health or retirement plan takes time, oversight, and judgment. Fiduciary In A Box documents your governance, vendor oversight, and committee decisions in one secure platform, so your fiduciary process speaks for itself. Learn more at www.fiduciaryinabox.com. Time Stamps 00:00 - Welcome to The Business of Benefits 01:14 - Meet Your Host: A Highlight Reel Intro 02:08 - What Is a PBM, Really? (feat. Rachel Strauss) 05:20 - Who Actually Owns the PBMs (Vertical Integration) 07:33 - International Drug Sourcing and Real Savings Numbers 12:15 - The $80K Skin Graft That Became $2K (feat. Bryan Orr) 15:49 - The Big Lie of Healthcare Pricing (feat. Stephanie Porrino) 20:07 - The Problem-Solution Cycle and Choosing Your Hard 21:12 - Rolling Out a New Plan Before Open Enrollment (feat. Danielle Young) 22:52 - Balance Bills, Mythbusted 25:42 - A Word From Fiduciary in a Box 26:30 - Self-Funded vs. Fully Insured, Explained (feat. Spencer Smith) 31:00 - POSIWID: The Purpose of a System Is What It Does 32:37 - RFP Gatekeeping and the Trip to Aruba (feat. Mark Cuban) 34:04 - Get Rid of Insurance Completely: The Future of Healthcare Banking 37:13 - The Truth About Childbirth in America (feat. Brittany George) 40:47 - Why Doulas Are Like Direct Primary Care for Birth 42:43 - We Are Robbing Women of This Experience Connect with Rachel Strauss, "PBM Princess," VP of Strategic Development at EHIM LinkedIn: https://www.linkedin.com/in/rachelmstrauss/ Website: https://rachelmstrauss.com/ Company: https://www.ehimrx.com/ Bryan Orr, Co-Founder, Kalos Services LinkedIn: https://www.linkedin.com/in/bryanorrkalos/ Company: https://www.kalosflorida.com/ Stephanie Porrino, Founder and CEO, Empower Healthcare Insights LinkedIn: https://www.linkedin.com/in/stephanie-kochporrino/ Danielle Young, VP of Business Development, ClaimDOC LinkedIn: https://www.linkedin.com/in/rbpdanielleyoung/ Company: https://claim-doc.com/ Spencer Smith, ParetoHealth LinkedIn: https://www.linkedin.com/in/spencer-smith-self-funded/ Company: https://paretohealth.com/ Mark Cuban, Co-Founder, Mark Cuban Cost Plus Drug Company Website: https://www.costplusdrugs.com/ LinkedIn: https://www.linkedin.com/company/costplusdrugs Brittany George, HeR Consulting LinkedIn: https://www.linkedin.com/in/brittanyspaziano/ Company: https://herconsulting.net/ Patrick Williams, Co-Founder, Fiduciary in a Box LinkedIn: https://www.linkedin.com/in/corporatefiduciary/ Company: https://www.fiduciaryinabox.com/ Chelsea Ryckis, President, Ethos Benefits LinkedIn: https://www.linkedin.com/in/chelsea-ryckis-8508a192/ Donovan Ryckis, CEO, Ethos Benefits LinkedIn: https://www.linkedin.com/in/donovanryckis/ MORE FROM ETHOS BENEFITS Website: https://ethosbenefits.com/ Podcast site: https://businessofbenefitspodcast.com/ YouTube: https://www.youtube.com/@thebusinessofbenefitspodcast Finished with the content? Claim your CE credit here: https://ideas.ethosbenefits.com/continuing-education SHRM Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities. HRCI Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.

In this episode, host Chelsea Ryckis sits down with Patrick Williams, Co-Founder of Fiduciary in a Box, to reset what it actually means to be a fiduciary over your company’s health plan, and why “I don’t know” is the one answer that won’t hold up in a Department of Labor audit. We cover the core tenets of fiduciary duty under ERISA, the difference between settlor and non-settlor functions, and why the same prudent-process standard employers already apply to their 401(k) now applies to their health plan under the CAA. Patrick shares real stories from his own client base, including a company that went seven years without filing a required Form 5500, and a 3,000-life employer that declined a fiduciary platform only to get hit with a DOL audit six months later. Chelsea and Patrick also break down a fiduciary liability insurance gap most health and welfare advisors don’t carry, why most RFP processes are built to protect incumbents, and the exact questions plan sponsors should be asking before they ever sign a contract.
What You’ll Learn
•     The core tenets of fiduciary duty under ERISA, and why prudence matters more than perfection •     The difference between settlor functions and fiduciary functions, and which one actually carries liability
•     Why health plans now face the same committee, documentation, and vendor-review scrutiny as retirement plans
•     A fiduciary liability insurance gap most health and welfare advisors don’t carry, and the question to ask them directly
•     Real DOL audit and Form 5500 penalty stories, and what actually holds up as a defense
•     Five RFP questions that separate a real fiduciary process from a marketing claim
•     Practical steps to build a documented, audit-ready fiduciary process starting today

Whether you’re an HR professional, CFO, CEO, or a plan sponsor tired of guessing your way through renewal, this episode is your call to build a fiduciary process you can actually defend.

Connect with Patrick Williams
LinkedIn: https://www.linkedin.com/in/corporatefiduciary/
Website: https://www.fiduciaryinabox.com
Connect with Chelsea and The Business of Benefits
Website: https://www.businessofbenefitspodcast.com
YouTube: https://www.youtube.com/@thebusinessofbenefitspodcast
The Business of Benefits Podcast
Subscribe wherever you listen to podcasts: Apple, Spotify, or your favorite podcast app.
Ethos Benefits is a fee-only, fiduciary benefits consulting firm. We don’t take commissions. We don’t represent carriers. We represent you.

Finished with the content? Claim your CE credit here:
https://ideas.ethosbenefits.com/continuing-education

SHRM
Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.

HRCI
Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.

In this episode of The Business of Benefits, host Chelsea Ryckis sits down with Dr. Romie Mushtaq, triple board-certified physician, national bestselling author, Chief Wellness Officer at Great Wolf Resorts, and founder of the brainSHIFT Institute, to have the workforce wellness conversation that the benefits industry has been missing.
Dr. Romie pulls back the curtain on why burnout has become one of the most overused and misunderstood terms in corporate America, and what's actually driving the crisis. From her personal story of near-fatal burnout in 2010 to building science-backed, data-driven wellness programs for 14,000+ employees, she brings the clinical receipts to a conversation that most "wellness influencers" simply can't.Chelsea and Dr. Romie also dig into what burnout really looks like in claims data and it's probably not what you think plus how organizations of any size can build a culture shift that drives measurable ROI without jump ropes, Pelotons, or wellness apps nobody uses.

The 45th Annual Employee Benefits Symposium (Aug. 23–26, Phoenix) is where benefits professionals go to connect, learn, and level up. Register by July 21 for early bird pricing: www.iscebs.org/symposium

What you'll learn

• Why burnout is being misdiagnosed and what employees are actually asking for
• How the Busy Brain Test gives organizations a data-driven snapshot of workforce mental health
• What burnout really looks like in claims data (hint: it's musculoskeletal injuries and metabolic syndrome, not just mental health claims)
• Why trust is the pathway to actual utilization of every benefits program you've invested in
• How Dr. Romie's three-pillar framework Protect Your Brain, Protect Your People, Protect Your Business, applies to companies of 25 or 25,000
• What happened when one plan sponsor removed every barrier to mental health access (the cost result will surprise you)
• Why wellness dies when it lives solely with the benefits director
• How empathy and accountability coexist and why caring cultures still have high expectations