What can I say? You definitely proved yourself! We are thrilled to partner with you in our recovery efforts for our clients. Having The Phia Group as a partner truly brings value to us as a TPA.
Rayne Niehaus
CDS

Plan Document Services

The Phia Group’s attorneys are at the forefront of the developing health benefits industry as demonstrated by our innovative plan provisions. Our attorneys are actively pursued to lecture at conferences, write articles for various industry publications, and participate in the legislative process in the regard. To promote efforts and improve the health benefits industry, our attorneys publish a leading industry blog and promote education for all involved in the drafting and implementation of benefit plans.

Initial Plan Document Assessment

Many plan documents are antiquated and do not support sound claims processing. In certain circumstances revisions may be enough to repair the issue, but frequently plan documents require an overhaul. An initial appraisal of the plan document is necessary to identify the best method for strengthening the rights of the plan.

Upon provision of a standard plan document (or template plan document), our attorneys:

  • Review the plan document and provide an initial assessment memorandum addressing potential areas of concern; and
  • Provide a recommendation for updating the plan document, as well as a price and time estimate for performing such updates.

Single or Template Plan Provision Review and Revision

The plan’s rights are only as good as the plan’s language. Inadequate terminology or a lack of essential provisions acts as a barrier, reducing or eliminating the plan’s ability to conserve assets and maximize savings opportunities. To counteract this risk, our attorneys:

  • Review your plan documents (or template plan document), make crucial recommendations, and provide provisions to maximize plan rights in a “red-line” (tracked changes) format; and
  • Customize plan provisions based on clients’ needs and ensure plan language continues to be in compliance with recent federal regulatory requirements.

By providing suggestions in a “red-line” format, plans can review the changes and updated language, and only with their approval, incorporate the language into their plan documents.

Customized Plan Document Checklist Creation

Establishing an efficient process for internally drafting plan documents is crucial. Improper or ineffective procedures can cause much delay. Our plan drafting team can review your existing plan document template and craft a custom checklist for internal use. This checklist can be provided to groups and plans and returned to the Third Party Administrator for use in drafting customized plan documents.

Innovative Plan Document Design

In addition to enhancing your existing plan documents, we offer customized plan document drafting services. Our attorneys develop plan documents customized to meet unique plan specifications. All plan documents developed by our attorneys will be strong enough to withstand the latest legal challenges. Also, our standard language can be modified to fit individual plan needs and ensure the terms accurately reflect the true intentions of the plan.

We Offer Three “Plan Drafting Services”

Custom Plan Design Subscription – The client pays a monthly fee and we will produce customized plan documents for them, upon request. Please note some restrictions apply.

Custom Plan Design Single-Use – The client pays a flat fee, and we produce a single, customized plan document. Please note some restrictions apply.

Template License – The client pays a flat fee, and we issue a license to them allowing them to internally use a customizable template, containing all of our language, as many times as they wish.

Regulatory and Legal Compliance Updates

Changes in the law force plans to comply with new regulations faster than they can change their administrative procedures. Our attorneys maintain and offer regular legal updates relating to regulatory and legal changes in the industry.

With this service, on a monthly basis, The Phia Group will inform subscribers of developments related to pending regulations meeting industry specific search criteria, as well as relevant news within the healthcare industry.  Clients may then request additional in-depth research be performed for an hourly fee, regarding any particular regulation of which they are so advised.

Global Self-Funded ERISA Language Updates (Federal Laws Only)

ERISA compliance begins with knowing the relevant rules and regulations. Changes in the law will require revisions to administration and documents for group health plans.

Upon subscription, clients may access legal compliance issues and updated generic plan document provision templates to customize and incorporate into their existing plan documents.

PPACA Generic Template Amendments

The biggest concern across the self funded industry today is implementation of PPACA regulations. Many changes need to be implemented for plans beginning on (or after) September 23, 2010. Being proactive in addressing plan compliance issues in a timely fashion is vital for plans to avoid pitfalls.

In response to a major industry need, The Phia Group is offering a generic template that is specifically designed to deal with the necessary changes under healthcare reform. We offer varying templates, one applicable for plans wishing to maintain grandfathered status and one for those who do not.

General Plan Document Consultation

One of the many benefits of establishing a self-funded ERISA plan is the freedom to customize benefit coverage. While healthcare reform does set forth certain restrictions, plans are still granted certain liberties in plan document creation. Our attorneys are available to discuss general plan document questions and issues, and can even work with plans to customize specialized language to best suit the individual needs of a plan.

 

For additional information about The Phia Group’s Plan Document Services, please contact:

Andrew Milesky
Director of Client Services
Phone: 781-535-5636
amilesky@phiagroup.com