We bring compliance specialist Carol Taylor back to unpack why employers keep getting blindsided by benefit plan obligations like RXDC reporting, PBM disclosures, and fiduciary duties under ERISA. We map the real-world risks, the paperwork traps that cause rejected filings, and the simple audit habits that keep penalties from stacking up. 
• RXDC reporting basics and why it exists 
• why employers still miss RXDC years later 
• where legal responsibility lands even when vendors file 
• practical steps for HIOS access and employer uploads 
• CAA 2026 expansion of PBM disclosure and rebate rules 
• what PBM transparency can reveal about pricing and compensation 
• ERISA fiduciary exposure for employers and individual decision-makers 
• how advisors draw boundaries to avoid functional fiduciary status 
• renewed ACA employer mandate enforcement around 1094 and 1095 filings 
• why a mental health parity enforcement pause does not remove MAPEA duties 
• ongoing No Surprises Act IDR problems and cost impacts 
• using a compliance audit checklist and reviewing E&O coverage limits 

We talk with Mark Gaunya about why employer health insurance often feels like a casino where the house wins and how employers can flip the odds with transparency, ownership, and smarter plan design. 

We break down how captive risk sharing works, what it takes to implement, and the real financial and employee-experience wins that come from getting off the less bad renewal hamster wheel. 
• Why the US healthcare system “works” as designed for rulemakers, not end users 
• How the less bad renewal cycle traps employers without claims data and transparency 
• Why Mark wrote Captivated Health and how case studies teach faster than jargon 
• Captive insurance versus traditional self-funding, including stop loss and risk layers 
• The four pillars of Captivated Health: members first, consumerism, wellbeing culture, self-governance 
• How employers can control the SPD, stop loss contract, and TPA agreement 
• outcomes from captive ownership: lower trend, pharmacy control, surplus, and rebate distributions 
• Practical stories: bundled maternity pricing plus shared savings, adding LASIK through plan design 
• The leadership mindset shift from system decision to self-decision 
• What implementation really looks like for HR and finance without adding headcount 

If you're an employer and you're struggling with these kinds of issues, and most of you are,  or if you're a broker and you have clients who are struggling with these issues, please get the book, "Captivated Health. Take Control. Gain Transparency. Leverage Confidence." CLICK HERE

We challenge the old wellness playbook and show how coaching, claims integration, and clinical guardrails turn behavior change into measurable cost control. GLP-1s, chronic condition priorities, and realistic timelines come together in a system that bends trajectories instead of chasing fads.

• why awareness and incentives fail without habit formation
• building coaching into chronic care to shift daily decisions
• measuring ROI with leading indicators and claims trends
• onboarding with claims to target high-impact conditions
• integrating point solutions into a coordinated system
• using GLP-1s with coaching, guardrails, and taper plans
• setting realistic timelines for years two and three
• how AI and claims integration guide next-best actions

For more information or to schedule a demo of the Benepower Advantage, go to Benepower.com

They absolutely can either call me or they can email me at arutkowski at navigatewell.com

Medicare is full of fine print, fast-changing rules, and enough junk mail to fill a suitcase. So what actually separates the agents who barely survive from the ones who become the trusted name in their community? We sit down with Paige Phillips, founder of the Paige Phillips Insurance Agency and author of Medicare Playbook for Agents, to get practical about what works when the stakes are someone’s healthcare and finances.

We talk about the unglamorous details that build a thriving Medicare book of business: relationship-building, client education, and the discipline of doing a true needs analysis. Paige shares why “getting the plan right” means checking doctors and prescriptions down to the dosage, and why the best agents think long-term through retention, renewals, and referrals instead of chasing AEP like a short-term payout. We also dig into year-round touchpoints that keep clients connected, from birthday outreach to thoughtful follow-up after major health events, and how a simple “call me first” mindset protects seniors from confusing ads and sales calls.

On the regulatory side, we cover Medicare compliance, CMS oversight, and why cutting corners is the fastest way to lose trust. Paige breaks down IRMAA (the income-related monthly adjustment amount), the two-year lookback, and how to set expectations so clients aren’t blindsided by a premium surcharge. We close by looking forward at technology and AI, and what the next generation of retirees may demand from the Medicare enrollment process.

Subscribe for more conversations on the shifts shaping benefits and insurance, then share this with an agent who cares about doing it right and leave us a review with your biggest Medicare question.

Healthcare stays expensive because the system hides prices and quality from the people paying for care, especially employers. We talk with Katie Talento about how CAA 2026 transparency and Department of Labor fiduciary rules could expose PBM practices, reshape contracting, and give plan sponsors real leverage if enforcement follows.

• Why invisible prices and invisible quality break the healthcare market 
• How incentives and lobbying protect opacity across hospitals, PBMs, insurers and drugmakers 
• Why Washington lacks ERISA and employer-plan expertise 
• What CAA 2026 changes for PBM disclosures and fiduciary responsibility 
• How “check the box” compliance can fail without enforcement 
• How employers can use machine readable files plus claims data for network analysis 
• Why cash-pay and direct contracting get blocked by network contract provisions 
• What near-term reforms could bend the cost curve, including stronger HSA and ICHRA models

You can find me at katytolento.com

Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine.

Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA’s national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill.

We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement.

If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?

Employers keep paying for the symptoms of obesity, diabetes, and metabolic syndrome while the root causes go untouched. We unpack why many wellness models fail, how insulin resistance hides for years, and what chronic disease reversal can look like when a physician-led metabolic health team measures the right signals and tapers meds safely. 
• metabolic syndrome as a dominant driver of employer healthcare costs 
• why low-fat guidance and ultra-processed food worsen hunger and outcomes 
• fasting insulin and CGMs as earlier and more actionable markers than glucose alone 
• nutritional ketosis versus diabetic ketoacidosis and why the terms get conflated 
• GLP-1 medication costs plus the idea of a structured GLP-1 off-ramp 
• reported outcomes including weight loss and guaranteed improvements in A1C and blood pressure 
• deprescribing as a safety requirement when health improves quickly 
• ROI logic for self-funded plans including claims reduction and lower pharmacy spend 
Call my cell phone, 262-255-9545. [email protected]

We explore how employers can manage healthcare like any other cost by shifting from insurer-built, passive plans to employer-built, actively managed designs. Carl Schuessler, Jr. shares candid tactics on data, precision testing, and honest change management that help advisors become true risk partners.

• defining a health plan mission that aligns to EBITDA and predictability
• focusing on data hot spots such as MSK, imaging, pharmacy, and facilities
• using billing audits and cost containment partners to reduce leakage
• when and how to apply precision tests as costs drop
• overcoming fear of self-funding with worst-case clarity and reserves
• building crawl-walk-run-fly ramps with navigation, pharmacy, and bundles
• unbundling components to align incentives and improve outcomes
• elevating advisors to CFO-level strategic partners

As a benefits advisor, you need more than a platform. You need a partner that makes you indispensable and impossible to replace. That’s BenePower. For more information or to schedule a demo of Benepower, go to BenePower.com

We dig into who truly makes claim decisions in self-funded plans and why that matters when ethics and compliance collide. Adam Russo shares how fiduciary prudence, transparent compensation, and NSA arbitration are reshaping risk, trust, and costs.

• plan sponsors as final decision makers on claims
• plan documents lagging laws and mandates
• compliance versus ethics as distinct obligations
• transparent compensation, performance fees, and caps
• fiduciary prudence in subrogation and settlements
• NSA and IDR process failures driving higher spend
• negotiation strategy, data, and calibrated offers
• governance, documentation, and audit-ready processes

For more information or to schedule a demo of Benepower, go to BenePower.com

We dig into why growth stalls when roles blur and the founder stays the bottleneck. Forrest Durer shows how clear seats, weekly scorecards, and steady leadership cadence create accountability and make scaling calm and repeatable.

• common founder-led bottlenecks and warning signs
• seats defined by 5–7 responsibilities not titles
• building a simple pyramid with an integrator or COO
• activity-based KPIs and weekly scorecards
• busy work versus productive work
• weekly one-to-ones and leadership cadence
• documenting processes for onboarding and quality
• writing and using vision and core values daily
• letting go at the 80% standard to free the founder
• when and how to use fractional leaders