Sessions

Artificial intelligence is rapidly moving from experimentation to real-world deployment across the health insurance ecosystem. For TPAs, carriers, and point solutions, AI is already transforming how organizations underwrite risk, adjudicate claims, detect fraud, manage care, and deliver better member experiences. In this panel, leading operators and AI builders will share how they are actually deploying AI inside their organizations today. The conversation will focus on practical use cases, implementation lessons, and measurable results. Panelists will discuss where AI is driving real operational leverage, where it is still overhyped, and what self-insurance industry leaders should be prioritizing over the next 12 to 24 months.

Join us for an engaging session where we will share practical tips and insights on navigating career paths and honing the skills needed to excel as future leaders in the industry. Our discussion will include strategies for exploring different job opportunities within the same company, as well as insights from a former future leader who will share their experiences and lessons learned. Whether you are just starting out in your career or looking to advance to leadership roles, this session will provide valuable guidance to help you succeed in your professional journey.

While the overall self-insurance marketplace continues to expand, the growth of the stop-loss captive program market segment has been growing an at even faster rate. To help you better understand why this rapid growth has occurred, as well as the challenges and opportunities that may be ahead, we have organized this panel discussion session featuring key executives from leading stop-loss captive program managers who will share their unique perspectives and take your questions.

Each year, SIIA conducts a survey to gather insights into the current state of the captive insurance marketplace, which is intended to help inform captive managers and owners of trends and overall perspectives on business transacted throughout the year. This panel will take a deep dive into the results of SIIA’s 2026 captive survey and analyze emerging captive trends, growth and challenges, and what to expect for the captive industry’s future.

This truly unique session breaks down the mechanics and negotiations of the largest direct-to-employer healthcare contract in U.S. history. By bypassing traditional insurance middlemen, this partnership is projected to save the 32BJ Health Fund $46 million—a 20% reduction in 32BJ's Northwell spend—in its first year alone, while slashing member hospital copays by 90% and offering $0 copays for primary and specialty care. Attendees will gain a replicable roadmap for stabilizing costs and enhancing care quality, detailing how to leverage data-driven trust and a 5% annual fee cap to align incentives between payers and providers. This session proves that organizations can solve the affordability crisis through transparent innovation, objective data and open communications rather than shifting financial burdens onto workers.

Rethinking decades of ingrained practices for addressing medical and pharmacy benefits requires employers to carefully shift their approach to these interconnected areas. Attend this session to hear from industry pros who are actively helping and advising employers to more rapidly adopt innovative models to achieve transparency, prioritize pass-through pricing and adjust rebates while implementing medical benefits that move from reactive, one-size-fits-all coverage to proactive, personalized, and holistic wellness initiatives. Panelists will provide proven strategies and tactics to control runaway drug spend by moving away from traditional, opaque PBMs toward “open-book" partners that eliminate spread pricing and provide clear, actionable data. The discussion will also touch upon the need to address specific patient needs, such as mental health support and chronic condition management. Audiences will return home with a compendium of ideas that they can implement now or in 2027.

For decades, risk management in self-insured health plans has relied upon lagging indicators, manual analysis, and backward-looking assessments. Attendees will gain a better understanding of why this is changing, primarily the result of artificial intelligence (AI), including generative AI (GenAI) and agentic AI, which are fundamentally shifting that paradigm. Panelists will utilize real-world experience to demonstrate how this seismic shift is enabling employers and risk partners to move from reactive protection to proactive strategy amid rising costs and increasing volatility. Audiences will learn from the pros the importance of accurate data and how the use of advanced data analytics and AI allows for proactive risk management and targeted interventions to mitigate high-cost claims, which impact financial performance and stop-loss premiums. The take-away lessons will provide a foundation for applying advanced machine learning to claims and clinical data, implementing the use of AI to deliver actionable insights at both the population and member level, and adopting innovative technology that makes medical knowledge accessible, usable, and extrapolative to better analyze risk for the many conditions that are growing in occurrence and cost.

The self-insurance industry has witnessed a series of employee-participant lawsuits filed against an employer sponsoring a “major medical” self-insured group health plan, alleging that the employer-sponsor breached their ERISA fiduciary duties for making decisions – and not making decisions – relating to the cost of covered benefits. More recently, we have seen lawsuits involving “voluntary benefit” plans in which employee-participants alleged fiduciary breaches for paying excessive fees and failing to monitor plan service providers. How are all of these lawsuits related? What can self-insured plan sponsors – and especially their service providers (e.g., brokers and TPAs) – learn from these lawsuits? This Panel will take a deep-dive into these questions, while also identifying what contractual provisions should – and should not – be included in agreements with “owners of the provider networks.”

As more Americans enroll in health care exchanges, it’s in the U.S. government’s best interest to have a more a competitive individual market, which individual coverage health reimbursement arrangements known as ICHRAs accomplish by opening it up to more generally younger and healthier workers. Since their January 2020 creation, the focus of ICHRAs has been on employers with historically higher risk or higher cost medical expense trends. But there are other reasons to adopt these accounts. Year-over-year growth remains high, and coverage is scaling from tens of thousands to roughly a million covered lives, but overall penetration relative to traditional group plans is still under 1%. This session will focus on the conditions under which it makes sense to implement this model, as well as how the change should be communicated and strategies for helping employees navigate their way through coverage decisions to reduce friction.

Employers across the spectrum are scrambling to better manage pharmacy drug benefits as they struggle to balance rapidly evolving member healthcare needs against increasingly unsustainable costs. Today, there are innovative strategies, opportunities, and solutions for addressing high-cost specialty drugs and the exploding popularity of GLP-1s for weight loss and obesity. A curated panel of experts reflecting decades of industry experience and expertise in pharmacy benefits will share “what comes next.” After implementing legacy programs for encouraging generics, handling rebates, instituting specialty drug carve-out programs, applying prior authorizations or other programs, stakeholders have discovered that many of these may fall short in containing surging pharmacy drug costs. Attendees will also learn how to tackle the issues associated with direct consumer purchasing options and understand the value of concrete strategies to change the trajectory of outsized costs for specialty drugs.

The pace of financial transactions (acquisitions, mergers, recapitalizations, etc.) is not slowing down for companies involved in the self-insurance marketplace. This session brings together leading transaction advisors who have done many deals representing SIIA members to highlight recent developments and trends, as well as preview the investment landscape going forward.

Don’t miss what promises to be a compelling conversation featuring a panel of state insurance commissioners who will share their perspectives on a variety of public policy issues and related developments of interest to employers that operate self-insured health plans and/or captive insurance companies.  They will also provide insight into the latest relevant policy agenda of the National Association of Insurance Commissioners (NAIC).

Artificial Intelligence is rapidly reshaping healthcare, influencing everything from underwriting and claims review to cost containment, provider navigation, and member engagement. But what does AI adoption truly mean for the self-funded marketplace? This forward-looking session will examine how AI is affecting plan performance, fiduciary responsibility, compliance risk, and cost management strategies. Panelists will discuss where AI is already delivering measurable value, where caution is warranted, and how employers and their partners can thoughtfully evaluate emerging solutions. From predictive analytics and claims automation to contract review and fraud detection, this conversation will separate practical opportunity from industry buzz. Attendees will gain a clearer understanding of current applications, emerging risks, and the strategic questions every self-funded stakeholder should be asking as AI adoption accelerates.

Discounts aren’t the whole story on high-cost claims. This session looks at what happens when you go beyond the price tag to examine the clinical picture, billing patterns, contracting structure, and the questions that often go unasked, and how those answers can change the outcome.

At a time when traditional, legacy network-based health plans are focused on solving the cost problem by narrowing access to care and saddling employees with cost sharing, a cash-pay option does just the exact opposite. One such example is NovetraSys, a next-generation digital AI-driven cash-pay ecosystem that replaces outdated virtual cards with secure, barcode-locked vouchers that enable employees to pay providers directly at the point of care. Another is Sidecar Health, a pioneer in this area that broadens the aperture for care without provider network restrictions, prior authorization, formularies and step care. Learn how these fresh and transparent approaches are expanding access to care, helping employees shop for services, improve outcomes and reduce health benefit costs.

The pace of cell & gene therapy developments continues to accelerate, putting increased pressure on self-insured payers to make coverage decisions and determine appropriate financial risk transfer arrangements. This session will feature members of SIIA Cell & Gene Task Force who will recap the big CGT developments in 2026 and preview what to expect in the months and years ahead.

If you are keeping track of regulatory and legislative changes, 2026 started out with a bang. First, we saw the release of proposed regulations requiring entities providing “pharmacy benefit management services” to a self-insured health plan to disclose specified “compensation streams” to the plan’s fiduciary. Then, we saw legislative changes requiring PBMs to disclose to a self-insured plan the cost of covered prescription drugs and various PBM payment practices, including rebates received and spread pricing. And not to be outdone, Congress also passed legislation confirming that TPAs and other entities providing services to a self-insured plan are subject to ERISA’s Compensation Disclosure requirements. This panel will examine the impact of these regulatory and legislative changes, and also discuss future rulemaking that TPAs, stop-loss carriers, and other self-insured plan service providers should expect.