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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 10:56 – Tactic 11: The contract doesn't match the proposal 17:03 – The fix: start 150 days out, not 60 21:54 – Tactic 10: Undisclosed equity and ownership interests 27:50 – A shortlist is not a market check 28:38 – Tactic 9: PBM purchasing collectives and coalitions 29:53 – $1.4 million better outside the collective 35:46 – A word from Fiduciary in a Box 36:32 – Tactic 8: Captives as the broker's easy button 46:24 – Tactic 7: The controlled market check 1:00:27 – What's coming in Part 2 1:03:00 – An industry that pays well for mediocrity 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 SPONSORYou'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 SHRMEthos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities. HRCIEthos 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 Karen van Caulil, Ph.D., President and CEO of the Florida Alliance for Healthcare Value, to unpack how employers are building real leverage in healthcare by purchasing together. If you have ever been told "we're not going to do a one-off for you," this one is for you.Karen explains what an employer-led healthcare coalition actually does, how the Florida Alliance moves 80 public and private sector members from passive payers to sophisticated purchasers, and why the Alliance now works in health policy. She and Chelsea dig into the new Pulse of the Purchaser survey, Florida's standing as the most expensive state in the nation for hospital services at roughly 345% of Medicare, and a real case where Central Florida employers pushed back on a double-digit hospital increase with data and a coalition at the table. Chelsea connects it to fiduciary duty, why compliance is leverage, and the auto-renewals and point solution sprawl that keep plan sponsors stuck. WHAT YOU'LL LEARN• How to tell a real coalition from a pay-to-play purchasing group• Why employers with complete claims access implement at least four more cost strategies• What to ask your PBM today: 100% rebate pass-through, claims-level data, full audit rights• Why price, not utilization, is the real cost driver• The 90-day auto-renewal trap and how to get ahead of it TIME STAMPS00:00 Cold Open: You Can't Purchase What You Can't See00:47 Welcome to The Business of Benefits01:10 Why Every Plan Sponsor Should Be Part of a Coalition02:36 Meet Karen van Caulil and the Florida Alliance03:13 From Payer to Purchaser05:37 Moving Into Health Policy06:37 Real Coalitions vs. $180,000 Committee Seats10:03 "We're Not Going to Do a One-Off for You"11:53 Trust But Verify12:57 Does Every State Have a Coalition?16:37 Regional Differences: Pricing, Direct Contracting, Primary Care19:47 There Is No Good Price for Bad Care20:40 Sponsor: Fiduciary in a Box22:43 Case Study: Pushing Back on a Hospital Increase24:43 Pulse of the Purchaser: What Employers Expect26:18 Florida's Hospital Prices by the Numbers30:16 Data Is a Strategic Asset31:56 Don't Wait for the Law: Act on PBM Transparency Now34:57 Point Solution Overload36:35 The Auto-Renewal Trap40:05 Final Thoughts and Where to Find Karen FROM OUR SPONSORYou'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 CONNECT WITH KARENFlorida Alliance for Healthcare Value: https://flhealthvalue.orgKaren on LinkedIn: https://www.linkedin.com/in/karenvancaulilphd/Pulse of the Purchaser 2026: https://www.nationalalliancehealth.org/resources/pulse-of-the-purchaser-2026-survey-results/ CONNECT WITH CHELSEA AND ETHOS BENEFITSSchedule a Strategic Analysis: https://ethosbenefits.com/contact/Chelsea on LinkedIn: https://www.linkedin.com/in/chelsea-ryckis-8508a192/Ethos Benefits on LinkedIn: https://www.linkedin.com/company/ethosbenefits/ LISTENApple Podcasts: https://podcasts.apple.com/us/podcast/the-business-of-benefits-podcast/id1724134305Spotify: https://open.spotify.com/show/0nlniHvhiOKPJmowsdDlTISponsored by Fiduciary in a Box, the fiduciary operating system for health plan sponsors: https://www.fiduciaryinabox.com Finished with the content? Claim your CE credit here:https://ideas.ethosbenefits.com/continuing-education SHRMEthos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities. HRCIEthos 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.

At SHRM26, moderator Chelsea Ryckis and Ethos Benefits co-founder Donovan Ryckis brought two employers on stage to show what taking control of a self-funded health plan looks like in dollars and cents. Stephanie Porrino (formerly HR Director at Hendry Marine Industries, now Founder & CEO of Empower Healthcare Insights) and Jaimie Jarvis (HR Director at Kalos Services) walk through the plan changes, broker breakups, and multi-year strategy that took their companies from reactive renewals to governed, fiduciary-driven plans, backed by real claims data. We cover the four moving parts of every health plan (PBM, network, TPA, stop loss), why fully funded and level funded plans leave employers with no real data, how reference-based pricing works, and how two very different employers landed in the same place: lower costs, better access to care, and employees who feel it.What you'll learn:Fully funded vs. level funded vs. self-funded, and why most employers never see their real claims dataHow reference-based pricing works, and why 13 states have already adopted itA 300-employee shipyard's five-year case study: 77% off billed hospital claimsHow a construction company went from a 37% renewal increase to zero premium increases in four yearsWhy removing cost-sharing on primary care, imaging, and mental health can lower total spendWhy more balance bills can actually be a good signHow to tell if your broker or advisor is really working in your best interestGet more on our guests at: Stephanie Porrino, Founder & CEO, Empower Healthcare Insights Website: https://empowerhcinsights.com LinkedIn: https://www.linkedin.com/in/stephanie-kochporrino/Jaimie Jarvis, HR Director, Kalos Services LinkedIn: https://www.linkedin.com/in/jaimie-nyhuis-jarvis/Patrick Williams, Co-Founder, Fiduciary in a Box LinkedIn: https://www.linkedin.com/in/corporatefiduciary/Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink your benefits strategy and finally take control.Connect with Chelsea and Donovan: Website: www.businessofbenefitspodcast.com YouTube: https://www.youtube.com/@thebusinessofbenefitspodcast Instagram: https://www.instagram.com/ethoseffectpodcast/ Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/ Donovan: https://www.linkedin.com/in/donovanryckis/ 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-educationSHRM: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 learnWhy burnout is being misdiagnosed and what employees are actually asking forHow the Busy Brain Test gives organizations a data-driven snapshot of workforce mental healthWhat 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 inHow Dr. Romie's three-pillar framework Protect Your Brain, Protect Your People, Protect Your Business, applies to companies of 25 or 25,000What 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 directorHow empathy and accountability coexist and why caring cultures still have high expectations

The benefits industry is broken. $37,824. That's the average cost of a family of four on an employer-sponsored health plan in 2026 and it's growing at 9% a year. So how did we get here, and what does it actually look like to fight back? In this episode, host Austin Townend sits down with Chelsea Ryckis (President) and Donovan Ryckis (CEO) of Ethos Benefits for the origin story nobody asked for but everyone needs to hear. From Donovan's background as a fiduciary securities advisor who saw the same conflicts in healthcare and couldn't look away, to Chelsea getting hit in the head with a softball and learning the hard way that you can run but you can't hide from medical debt... this is the story of how Ethos was built different on purpose. Take the next step in your career. Start your CEBS journey today at CEBS.org. https://bit.ly/48k4aeZ What You'll Learn Why Donovan left a lucrative securities career to fix a bigger problem in healthcare Chelsea's personal experience with medical debt and how it shaped the Ethos mission The real definition of fiduciary — and the three things it actually requires Why there is zero fiduciary standard in insurance (and what that means for you) The $37,824 number every employer needs to hear A claim is a dollar, not a condition — and why that distinction changes everything The four things you can do with healthcare risk: reduce, avoid, retain, or transfer Why brokers go straight to the transfer (and how that lines their pockets) How to vet whether your advisor is actually living the fiduciary standard — not just marketing it Where the industry is headed over the next five years, including PBM legislation and litigation at  Connect with Chelsea Ryckis: LinkedIn: https://www.linkedin.com/in/chelsea-ryckis-8508a192/ Connect with Donovan Ryckis: LinkedIn: https://www.linkedin.com/in/donovanryckis/ Connect with Austin Townend: LinkedIn: https://www.linkedin.com/in/austintownend/ Connect with Ethos Benefits: LinkedIn: https://www.linkedin.com/company/ethosbenefits/ Website: https://www.ethosbenefits.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 #FiduciaryDuty #BusinessOfBenefits #EthosBenefits #HRLeadership #GroupHealthInsurance #BenefitsStrategy #HealthcarePlanning #PBM #ERISA #HealthBenefits #EmployerHealthcare #BenefitsBroker #OpenEnrollment #HealthcareCostContainment #SelfFundedHealthPlan #HRPodcast #BenefitsPodcast #PlanSponsor

In this episode, host Chelsea Ryckis sits down with Brittany George( insurance industry veteran, founder of Her Consulting, and author of A Tale of Two Births) to pull back the curtain on maternal healthcare in America. Brittany brings a rare perspective: 17 years in health insurance, time at Fountain Health, and two profoundly different birth experiences that changed everything she thought she knew about the system she worked in. They cover the cascade of interventions most women don't know they're signing up for, why the incentives inside hospitals are misaligned against patients, what fentanyl has to do with labor and delivery, and — critically — what self-funded employers can do RIGHT NOW to support the women on their plans. What You'll Learn - Why 70% of women get an epidural containing fentanyl — and most aren't told - How a C-section can cost a health plan $80,000–$100,000+ vs. $4,000–$7,000 for a vaginal birth - Why doula coverage is the single highest-impact benefit employers can add today - The downstream health risks for dependents born via C-section — and what that means for your plan - How the birth center vs. hospital vs. home birth decision affects both outcomes AND claims - Why women at every stage — postpartum, perimenopausal, infertile — are being underserved by traditional benefits - What "A Tale of Two Births" taught Brittany about asking better questions in any healthcare setting Connect with Chelsea Ryckis: LinkedIn: https://www.linkedin.com/in/chelsearyckis Website: https://www.ethosbenefits.com Connect with Brittany George: LinkedIn: https://www.linkedin.com/in/brittanyspaziano/ Website: https://ataleoftwobirths.com/ Connect with Ethos Benefits: LinkedIn: https://www.linkedin.com/company/ethos-benefits YouTube: https://www.youtube.com/@ethosbenefits Instagram: https://www.instagram.com/ethosbenefits Website: https://www.ethosbenefits.com 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.

What if making mental health care completely free for your employees actually lowered your total plan costs? In this solo episode, host Chelsea Ryckis breaks down one of the most compelling case studies in Ethos Benefits' history, a manufacturing company with 350–380 employees that eliminated every financial barrier to mental health care. Zero copays. Zero deductibles. Unlimited sessions. Open network. No prior authorization. The result? 12% utilization (vs. a 4% national benchmark), 594 claims, an average of 14 sessions per member — and a total cost of just $7 per employee per month. Meanwhile, traditional plans with restrictions are benchmarking at $14–$17 PEPM for mental health. Chelsea also covers the Mental Health Parity and Addiction Equity Act (MHPAEA), updated in 2024, and walks plan sponsors through the compliance pitfalls she sees most often — from restrictive prior authorizations to narrow behavioral health networks to inconsistent NQTLs. This episode is for HR leaders, CFOs, and plan sponsors who are tired of designing benefits around fear of cost — and ready to see what happens when you design around actual employee needs. What you'll learn: Why EAPs alone are not enough (only 4% of employees actually use them) The real cost of untreated mental health: 23% more absenteeism and 3x higher healthcare costs What a zero-barrier mental health plan design actually looks like How 594 claims over 2.7 years cost just $129 per claim on average The MHPAEA compliance pitfalls plan sponsors overlook — including NQTLs and network adequacy Why the cultural component of mental health support matters as much as the plan design How to audit your current plan for mental health parity compliance. Connect with Chelsea Ryckis: LinkedIn: https://www.linkedin.com/in/chelsearyckis Website: https://www.ethosbenefits.com Connect with Ethos Benefits: LinkedIn: https://www.linkedin.com/company/ethos-benefits YouTube: https://www.youtube.com/@ethosbenefits Instagram: https://www.instagram.com/ethosbenefits Website: https://www.ethosbenefits.com 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. Learn about CEBS! In a field as complex as employee benefits and retirement, experience alone isn’t always enough. Credibility matters. That’s why professionals turn to CEBS—the Certified Employee Benefit Specialist designation. Developed in partnership with the Wharton School of the University of Pennsylvania and the International Foundation of Employee Benefit Plans, CEBS delivers comprehensive expertise across both group and retirement benefits—equipping you to lead with confidence and authority. Set yourself apart with a designation that speaks for itself. Start your CEBS journey at CEBS.org.  https://bit.ly/48k4aeZ — 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 special episode of The Business of Benefits, host Austin Townend flips the script and interviews our very own President and Co-Founder, Chelsea Ryckis. Together, they break down exactly what employers need to know about healthcare compliance, vendor accountability, and controlling costs heading into 2026. We cover the massive compliance shifts from the last 12 months—including the CAA of 2026 and FTC scrutiny on PBMs—and why these changes are the ultimate leverage for plan sponsors. Chelsea unpacks why Direct Primary Care (DPC) combined with HSAs is a game-changer, why ICHRAs are just a bandaid for healthcare inflation, and how to spot the red flags in your broker and PBM contracts. Plus, learn how to stop accepting the bare minimum from your vendors and start demanding true fiduciary alignment. What you’ll learn How recent compliance changes (like the CAA of 2026) give employers unprecedented leverage over their health plansWhy the traditional high-deductible health plan (HDHP) is failing low-wage earners, and how Direct Primary Care (DPC) actually reduces claimsThe hidden dangers of ICHRAs and why they don't solve the root cause of healthcare inflationHow to identify "red flags" with your PBMs and brokers, including spread pricing and refusing compensation disclosuresWhy vendor accountability requires more than just a "nice account manager"—and how to use KPIs and scorecards to evaluate themThe truth about big company purchasing power: why 10,000+ employee companies are often paying more than mid-market competitors Connect with Us Chelsea Ryckis on LinkedIn:  https://www.linkedin.com/in/chelsea-ryckis-8508a192 Austin Townend on LinkedIn: https://www.linkedin.com/in/austin-townend-619520103 Ethos Benefits: https://ethosbenefits.com/ The Business of Benefits Podcast: https://businessofbenefitspodcast.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 sits down with Dr. Cristin Dickerson, founder of Green Imaging, to uncover the power of direct contracting for employer-sponsored health plans. They dive deep into how getting the "middleman" out of the equation can save plan sponsors up to 60% on medical imaging while actually improving the quality of care for employees. We cover how direct contracting works in practice, why traditional insurance models artificially inflate imaging costs, and how Green Imaging is flipping the script by providing transparent, cash-pay rates. Dr. Dickerson explains the HIPAA Omnibus Law that makes this possible, how to build a zero-out-of-pocket benefit that employees actually use, and the real-world savings employers are seeing. Chelsea and Dr. Dickerson also discuss the future of direct primary care, navigating hospital pushback, and why every employer has a fiduciary duty to explore these solutions. What you’ll learn • What direct contracting is and how it eliminates the middlemen driving up healthcare costs • Why there is an inverse correlation between cost and quality in the U.S. healthcare system • How the HIPAA Omnibus Law protects employers and employees when carving out imaging benefits • The exact process for members using Green Imaging, from text-based scheduling to receiving care • How plan sponsors can structure their benefits to incentivize zero-out-of-pocket imaging • The challenges of navigating the "down the hall" mentality and how to educate employees • Why direct contracting for imaging and direct primary care are the easiest first steps for employers Connect with the Speakers: Cristin Dickerson:  LinkedIn: https://www.linkedin.com/in/cristin-dickerson-md-a1a1b013/ Green Imaging: https://greenimaging.net/ Chelsea Ryckis:  LinkedIn: https://www.linkedin.com/in/chelsea-ryckis-8508a192/ Ethos Benefits: https://ethosbenefits.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 explosive episode of The Business of Benefits, host Chelsea Ryckis and Fiduciary Benefits Consultant Talia Hansen sit down with entrepreneur and billionaire Mark Cuban to discuss the massive disruption happening in the healthcare industry. Mark shares the origin story behind Cost Plus Drugs and Cost Plus Wellness, and why employers hold the ultimate power to fix the broken healthcare system. We cover how employers can stop overpaying for healthcare, the critical importance of aligned incentives, and why direct-to-employer programs are the future. Mark breaks down the hidden games played by traditional PBMs and carriers, and how taking an "outside-in" approach is the only way to truly advocate for patients. We also explore the value of having an internal "Healthcare CEO" to manage claims, and Mark shares his visionary idea for replacing health insurance premiums with a revolutionary healthcare banking model. What you’ll learn: • The "aha moment" that led Mark Cuban to start Cost Plus Drugs and expose the massive markups in the pharmaceutical industry. • Why the traditional RFP process is designed to protect incumbents and keep employers in the dark. • How to identify and eliminate misaligned incentives in your health plan to save money and improve care. • The power of direct contracting and why employers need an internal "Healthcare CEO" to audit claims and manage vendor relationships. • Mark Cuban’s vision for the future: eliminating traditional health insurance companies in favor of a healthcare banking and loan model. 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.

Your health plan contracts are full of hidden traps and most employers never read them until it's too late. In this solo episode of The Business of Benefits, Chelsea Ryckis of Ethos Benefits pulls back the curtain on the most alarming contract clauses she's encountered in the last six to eight months. From undisclosed broker bonuses and spread pricing to termination traps and one-sided indemnification clauses, Chelsea breaks down exactly what to look for and what it actually means for your company. This episode is essential listening for any business owner, HR professional, or benefits committee member who wants to fulfill their fiduciary duty and protect their plan participants. What You'll Learn: - The six forensic lenses Ethos Benefits uses to review every vendor contract - How to identify hidden conflicts of interest and undisclosed compensation - Why your scope of services must be written down and what happens when it isn't - How to use KPIs and performance guarantees to hold vendors accountable - Why implementation guarantees matter more than service guarantees - How vendors use HIPAA as an excuse to block your access to your own data - The termination clause that forced a plan sponsor to pay a broker they'd already fired - Why the future of healthcare reform lives in contract language Connect with Chelsea Ryckis: https://www.linkedin.com/in/chelsea-ryckis-8508a192/ Ethos Benefits: https://ethosbenefits.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 special episode of The Business of Benefits, we pull back the curtain on a real-life, multi-year healthcare strategy transformation. Join our hosts as they sit down with Connie Alvarez, Director of HR at Wynden Stark, to dissect the five-year journey of their self-funded health plan. This is a masterclass for any employer feeling trapped by rising premiums and lack of control. We explore the highs, the lows, and the unexpected curveballs—from navigating mergers and acquisitions to tackling the complexities of a fluctuating workforce in the healthcare staffing industry. Discover how Wynden Stark, with the guidance of Ethos Benefits, moved from a fully insured model to a custom, unbundled, self-funded plan, achieving over $3.7 million in savings in just two years. This case study reveals the power of a fiduciary approach, the critical role of data in negotiations, and how to build a plan that delivers both financial results and a superior member experience. If you want to learn how to take back control of your healthcare spend and become a true steward of your company’s benefits, this episode is a must-listen. What You’ll Learn The 5-year roadmap from a fully insured plan to a high-performing, self-funded model.How to navigate a 42% renewal increase and turn it into a -1.3% decrease.The power of carving out your Pharmacy Benefit Manager (PBM) and the massive savings potential in Rx.Strategies for implementing an unbundled plan with an independent TPA and fiduciary PBM.How to use data and analytics to negotiate with carriers and stop-loss providers.The importance of member communication and advocacy in a self-funded environment.Innovative solutions like international pharmacy sourcing and spousal HRAs that drive down costs.How to maintain an excellent member experience even with major plan design changes.  -------------------------------- 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 session, Chelsea Ryckis and Julia Watt, Director of HR at Medical Technology Transfer (MTT), delve into a case study on "Future-Proofing Your Health Benefits." They discuss how MTT, a 125-employee company, achieved a 67% reduction in claims cost over three years through a multi-year strategic plan. This conversation offers a roadmap for employers of all sizes to move away from the traditional, reactive renewal cycle and adopt a proactive, data-driven approach to managing healthcare costs and fiduciary responsibilities. What you'll learn:How a small employer (125 employees) can implement innovative healthcare strategies often considered only for large corporations.The limitations of fully insured plans and the benefits of transitioning to level-funded and self-funded models.The importance of data transparency in understanding and controlling healthcare cost drivers.How to strategically unbundle your health plan and select vendors aligned with your company's best interests.The critical role of a fiduciary PBM in managing pharmacy costs, which are often a significant expense.Actionable steps to take control of your health plan, negotiate better terms, and reduce costs without compromising employee benefits.-------------------------------- 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.