Recent Posts

  • Act Now, Plan Ahead – The 2021 Endgame and 2022 Outlook
    November 16, 2021
    Renewal season is in full swing, and 2022 will be here before you know it. Are you confident that you have done everything you need to do to close 2021 on a high, and enter 2022 on the right foot? Join The Phia Group as they discuss what must be done now to finish 2021 strong, as well as forecast what to expect in 2022. The Phia Group’s unrivaled access to data, industry developments, and ongoing analysis has allowed us to identify what to expect and how to prepare. From the No Surprises Act and transparency, to COVID fallout and threats posed by prescription drug costs and rehab facilities, both the constant stream of regulatory changes and provider efforts to squeeze payers, hurdles and opportunities of today will dictate the outlook for 2022. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P122 – COVID-19 Vaccine Mandate Update
    November 12, 2021
    This week on Empowering Plans, Kelly Dempsey and Kevin Brady discuss the controversial OSHA vaccine mandate rules – where they started, where they stand now, and the many legal challenges that have arisen. This won’t be the last you hear of this topic and despite the legal challenges, employers should not delay in getting their action plan and policies in place. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • Empowering Plans: P121 – Transplants: The Future is Now!
    October 29, 2021
    This week on Empowering Plans, Nick Bonds and Jon Jablon discuss a highly nuanced topic that has been the bane of many health plans: organ transplants. From interspecies organ transplantation to COVID’s effect on the global organ trade, it’s an evolving topic with serious implications on healthcare. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • The Needle of Damocles: OSHA’s Anticipated Vaccine Rules
    October 27, 2021
    By: Nick Bonds, Esq. At the beginning of this month, President Biden took a step he’d previously been reluctant to take – imposing new vaccine rules on federal workers and contractors, health care workers, and large employers. Widely characterized as a “vaccine mandate,” the rules are actually not quite a mandate for private employers. Under President Biden’s “Path Out of the Pandemic,” the Department of Labor (DOL) is tasked with developing a rule requiring employers with 100 or more employees to ensure their employees are either 1) vaccinated, or 2) can produce a weekly negative COVID test result. Even so, reactions to the requested rules were swift and polarizing. The day after the announcement, Press Secretary Jen Psaki was peppered with questions about how this new vaccine rule would be enforced, how quickly rules would be published, and what the timeframe for compliance would look like. All reasonable questions, and all with no immediate answers. Many in our industry, myself included, had hoped the rules might be published quickly. Our eagerness appeared vindicated when news dropped that the Occupational ...
  • Empowering Plans: P120 – To Appeal, or not to Appeal
    October 15, 2021
    Join The Phia Group’s CLO, Ron Peck, and SVP of Consulting, Jen McCormick, as they dissect the No Surprises Act and reveal how and why there will be confusion regarding what constitutes a basis for appeal, and what should be disputed per the NSA.  This, along with updates on the cost of COVID testing, mandatory vaccine orders, and more are in store with this episode of Empowering Plans! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • Empowering Plans: P119 - Workers' Compensation & COVID-19 Claims
    September 30, 2021
    In this episode of Empowering Plans, Attorneys Rebekah McGuire-Dye and Cindy Merrell, discuss how current Workers’ Compensation regulations impact health plans, and who is responsible for employee’s Covid-19 related claims. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • Stories from the Front Lines – A Collection of Recent Relevant Case Studies & COVID-19 Vaccine Mandate
    September 21, 2021
    It has been said that failure is often the greatest teacher.  This is true both for the one that failed, as well as those who learn from others’ experiences.  Join The Phia Group as they share cautionary tales meant to enlighten, and ensure you don’t make the same mistakes or fall into the same traps.  From mishandled appeals to fiduciary breach; misapplication of plan terms to compliance violations; dubious provider billing schemes to abusive treatment facilities; by witnessing others’ unfortunate experiences (and hearing how The Phia Group responded), you will be better prepared when similar issues affect you.  Don’t worry; the names have been changed to protect the innocent!  UPDATE: On September 9th, President Biden made an important announcement regarding federal COVID-19 vaccine and testing mandates. The federal mandate would impact private employers and some 80 million employees. In this webinar, our legal team will address this unprecedented mandate and the impact it will have on private employers and their self-funded plans. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to ...
  • Covid-19 Vaccine Boosters – Are they Ethical?
    September 17, 2021
    By: Andrew Silverio, Esq. Throughout the day, the FDA will be discussing whether the general American public should start getting COVID-19 vaccine booster doses.  This will include presentations from Pfizer, who has been pushing for booster shots across the general population, but the FDA will provide its own interpretation of available data as well.  Even before any guidance from the FDA, Dr. Fauci and the NIH have been advocating for booster doses for months. However, with a third and arguably less crucial dose being contemplated for wide swaths of healthy people in the general population, many, even accepting that a booster dose may provide significant additional protection, are questioning whether it’s ethical to even be considering booster doses when so much of the developing world is still without any protection at all. The Director-General of the World Health Organization on August 4 called for a worldwide moratorium on booster doses through the end of the September, citing a goal of having 10% of the world’s population vaccinated.  This is of course little more than a recommendation, and with much of the world’s ...
  • Biden Administration Announces Sweeping New Vaccine Mandates
    September 10, 2021
    By: Kevin Brady, Esq. On September 9, 2021, President Biden announced his COVID-19 Action Plan, which seeks to impose new vaccine mandates on federal employees, health care workers at Medicare and Medicaid participating hospitals, and private sector employees. Federal Employees President Biden signed an executive order which requires all federal government employees (as well as employees of contractors who do business with the federal government) to be vaccinated. Importantly, federal employees will no longer have the option to do regular testing in lieu of the vaccine. Federal employees now have 75 days to be vaccinated or they risk losing their jobs. Healthcare Workers The COVID-19 action plan also calls for workers in healthcare facilities that receive Medicare or Medicaid reimbursement from the Centers for Medicare and Medicaid Services (CMS), to be vaccinated. CMS is expected to issue the implementing rule to that effect in the coming weeks. Private Sector Employees The Occupational Safety and Health Administration (OSHA) is to issue a rule that requires employers with 100 or more employees to mandate vaccinations. In the alternative, for those employees who remain unvaccinated, employers will be ...
  • Empowering Plans: P117 – Boost Your COVID-19 Vaccine Knowledge
    September 1, 2021
    This week on Empowering Plans, there are important COVID-19 vaccine updates to discuss. Pfizer’s vaccine was granted full FDA approval, booster shots are coming, and employers are debating whether and how to implement premium penalties for the unvaccinated. What do employers and their plans need to know? Join Attorneys Brady Bizarro and Kelly Dempsey as they break it all down for you. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • A Failure to Communicate
    August 13, 2021
    By: Ron E. Peck One of my favorite sayings is, “a penny wise and a pound foolish.”  Too often, people and organizations are too quick to act on a short-term desire and fail to contemplate the long-term impact. Consider, as an example, COVID-19 and the vaccines.   When the vaccines were first made available to the public, there was a desire to get as many people vaccinated as quickly as possible.  Unfortunately, many entities in control of general communication disseminated messaging that suggested the vaccine “prevents” people from contracting COVID-19.  While it was true that is seriously reduced the likelihood that you would actually contract the disease, it certainly wasn’t a guarantee.  Furthermore, we didn’t have adequate statistics to show us with certainty how effective the vaccine would be at preventing people from actually contracting COVID-19… not to mention mutations (known and unknown, present and not-yet-developed).  A false promise was publicly made, giving people a generally untrue belief that the vaccine would prevent them from contracting the disease, giving people a false sense of invincibility.  Now, as breakthrough cases are popping up ...
  • Empowering Plans: P115 – A Lightning Round of Healthcare Updates
    August 6, 2021
    In this episode of Empowering Plans, Attorneys Nick Bonds and Brady Bizarro, discuss a number of healthcare topics to keep you updated on the latest topics buzzing around the industry. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • Empowering Plans: P112 – Healthcare Subrogation, The Comeback! Post-Covid Edition
    June 25, 2021
    Subrogation Attorneys Cindy Merrell and Maribel Echeverry McLaughlin discuss healthcare subrogation in the post-Covid environment, and the difficulties faced during the international pandemic. What can Plans expect now that the courts are reopening, and drivers are back on the roads, and how Plans can assist in getting higher recovery numbers. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Good to Be Back
    June 10, 2021
    By: Ron E. Peck, Esq. Regardless of whether you are an employer, or service employers, or both (like The Phia Group), one question keeps popping up.  As restrictions are lifted in each State, people find themselves emerging from their basement offices.  This, then, begs the question amongst employers: “When do we have employees return to the office?  What can we do to incentivize them to return to the office?  Can we force them to return to the office?”   The other day, my five-year-old son was enjoying some mini-muffins, sitting comfortably on the kitchen floor.  As crumbs rained down from his mouth and sprinkled around him upon the floor, I asked him to please eat at the kitchen table.  He asked why.  Of course my knee-jerk reaction was to respond that I, as his father, am not required to provide a reason… however… I opted instead to explain etiquette as well as how and why his behavior at best would be more difficult to clean, and at worst would attract bugs into the home.  After some more discourse, he opted to finish ...
  • The Light at the End of the COVID Tunnel – Pandemic Fallout and Permanent Changes
    May 24, 2021
    As we turn the page on the COVID-19 pandemic and witness a gradual return to normalcy, we – as both members of the health benefits industry, and employers – must assess the fallout, and determine which changes are temporary, and which aren’t going anywhere.  From how we seek and deliver healthcare to rules controlling how we pay for it, join The Phia Group’s team on Tuesday, May 25, 2021, at 1:00 PM EST, as they discuss pandemic era regulations – such as ARPA and the American Families Plan, analyze employer “return to work” policies, as well as predict how the past year will impact the future – and cost – of health care.  Following the free webinar, the team will conduct two breakout sessions.  The first will provide a deep dive into COVID-19’s effect on health care providers, influence on patient behavior, and how both will result in higher costs for the foreseeable future.  The second will provide a deep dive into employer policies, best practices, and what every organization needs to know as they welcome their teams back ...
  • Empowering Plans: P109 – The Unanticipated Costs of COVID-19 Testing
    May 14, 2021
    In this episode of Empowering Plans, Kelly Dempsey and Kevin Brady, revisit a subject quite popular at the beginning of the pandemic; testing for COVID-19. Plan members don’t have to pay for COVID-19 tests, but group health plans do. Unfortunately, there are no limits in place on how much the plan has to pay for those tests. Listen to this week’s episode to hear about the current state of pricing for these tests, and how we see things shaping up moving forward! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • The New Normal… Same as the Old Normal?
    May 10, 2021
    By: Ron E. Peck, Esq. We are already almost halfway through 2021; can you believe it?  Throughout 2020, I recall many people (myself included) desperately looking forward to a better 2021.  We all convinced ourselves that 2021 would result in an instantaneous return to a pre-COVID way of life.  More than five months into 2021, however, and we are still enduring many restrictions (though far fewer than this time last year).  That being said, while a return to normalcy didn’t take place overnight, things are certainly improving.  This, then, causes me to wonder – which changes are tattooed to our society, and which are merely sunburns? One slogan that I refused to adopt was the phrase: “The new normal.”  Not being able to leave my home without a mask or a healthy dose of fear is not normal.  I like many refused to accept what we experienced as “normal,” new or otherwise.  With that in mind, we – as members of society, employers and employees, friends and family, and members of the health benefits community – must determine which changes ...
  • Empowering Plans: P107 – Updates Employers Need to Know About the COVID-19 Vaccines
    April 30, 2021
    As COVID-19 infection rates appear to be trending downwards in most areas in the U.S., employers across the country are hard at work on reopening plans in anticipation of the lifting of most occupancy limitations to slow the spread of the virus. The big question employers are asking themselves is whether to mandate COVID-19 vaccinations for employees returning to the workplace to ensure a safe work environment. Phil and Brady take a deep dive into this issue discussing compliance considerations implicated when considering mandating vaccination as we as explore limitations, risks, and current trends being established by employers that have already reopened. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Empowering Plans: P105 – The Mystery Surrounding COVID-19 Long Haulers: Employment & Benefit Considerations
    April 6, 2021
    Legal Compliance & Regulatory Affairs Consultant, Phil Qualo, and Vice President of Consulting, Kelly Dempsey Esq., explore the phenomena surrounding COVID-19 long haulers. Although the term “long haulers” trigger thoughts of cross country truck driving, it has actually been used as a common reference to people who have been infected with the COVID-19 virus and have not fully recovered for weeks, months, and even up to a year after first experiencing symptoms. This episode provides personal insight into the challenges that these long haulers are facing that impact both employer and benefit considerations, including access to disability benefits and health care. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Here for the Long Haul – Are Employers and Plans Ready?
    April 6, 2021
    By: Kelly Dempsey, Esq. Change that creates challenge is nothing new for the self-funded industry, which is why the amount of changes that have been required to address COVID-19 are not a shock to our industry. But now that we’re over a year into a global pandemic, the long-term consequences are only beginning to come to the surface. To date the focus has been on prevention and vaccines, but do you know what a long hauler is? No, not a truck driver, a COVID long hauler: individuals who are not recovered from COVID-19 weeks and even months after the initial onset of symptoms (which may include a positive diagnosis). This concept of long haulers includes those that have experienced subsequent diagnoses that are potentially linked to COVID-19. I have a friend who is a long hauler and her story has captivated me as I’ve watched and listened to her discuss her struggles, including the fact that she hasn’t been able to smell or taste since October 2020. It took her months of being her own advocate to find a ...
  • Fallout in the Spring – COVID Claim Disputes, Surprise Billing RBP Opportunities & Return to Work Vaccine Mandates
    March 24, 2021
    The costs and conflicts ushered in by the COVID-19 fallout are becoming more apparent. Industry members are debating numerous issues, such as when a plan should pay and whether workers’ compensation should be a primary payer. Both opportunities and challenges appear, especially for fiduciaries, from post-pandemic legislation, such as the No Surprises Act, to state and federal COVID-19 rules – impacting Reference Based Pricing and claims processing in general.  Join The Phia Group as we discuss post-COVID era regulations applicable to benefit plans, as well as industry issues emerging from this new chapter in the pandemic saga. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com. To obtain a recording of our Breakout Sessions, please use the links below: Breakout #1: Stop-loss Claims, Fiduciary Obstacles & COVID-19 Breakout #2: Surprise Billing & RBP Opportunities
  • Empowering Plans: P104 – COVID-19 Vaccine Candidates – Vaccinating Vulnerable Populations
    March 17, 2021
    In this episode of Empowering Plans, Jen McCormick and Andi Goodman discuss the future of vaccinating vulnerable populations such as pregnant women and children, and the importance of vaccinating children in achieving herd immunity. What are the next steps for expanding vaccine eligibility? What do employers need to know if they are considering requiring their staff to get vaccinated before returning to work? Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • EBSA Provides Clarification and Sows Confusion with Outbreak Period Guidance
    March 8, 2021
    By: Andrew Silverio, Esq. On Friday, February 26, the EBSA released its Disaster Relief Notice 2021-01 (available at https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/disaster-relief/ebsa-disaster-relief-notice-2021-01), addressing a conflict that many commentators had already picked up on – the fact that previous relief (see https://www.federalregister.gov/documents/2020/05/04/2020-09399/extension-of-certain-timeframes-for-employee-benefit-plans-participants-and-beneficiaries-affected#footnote-2-p26352) provided for the tolling of various timelines under health plans during the “outbreak period”, which is now over a year old and still ongoing, but the authority on which that relief relies expressly limits any such tolling to one year.  Because of this conflict, many commentators had concluded that this must mean that the “outbreak period” ends as of February 28, 2021, making it one full year in length.  However, the EBSA has clarified that this is not the case – they have interpreted the one-year limitation as applicable to each individual event tolled as opposed to the tolling relief/outbreak period itself.  Essentially, they explain that the duration of any tolling granted under the rule can be no longer than one year.  This means that an event with an original due date of March 1, 2020 will now have a due ...
  • So the Outbreak Period Ended?
    March 2, 2021
    By: Kelly Dempsey, Esq. In case you haven’t heard, the Employee Benefits Security Administration (EBSA) released Disaster Relief Notice 2021-01 on Friday, February 26th to address statutory language in section 518 of Employee Retirement Income Security Act of 19745 (ERISA) and section 7508A(b) of the Internal Review Code (the Code). In plain English, the statutes place a one year limit on the authority originally used to create the “Outbreak Period” – meaning by statute, the tolling of timeframes cannot exceed one year. Since Friday, Phia has received a large amount of questions related to this Notice and what it really means for plans. Phia has certainly read and re-read the Notice to determine what this means for self-funded plans and all the players in the self-funded industry. Unfortunately, some of the examples in the Notice fall short of the guidance we would have expected. We have reached out to the DOL seeking clarification on some other potential fact patterns that we know exist. In the meantime, we have re-reviewed plan language that we crafted to accommodate all of the COVID-19 ...
  • Empowering Plans: P103 – One Step Forward; Two Steps Back - The Lockdown and its Effect on Children with Disabilities
    March 2, 2021
    Join Timothy Pope, an Attorney in the Provider Relations Department, and Garrick Hunt, Phia’s Sales Manager, as they host a candid discussion about the harmful effects that the sweeping lockdown has had on families, and in particular on children with disabilities. Since the closing of most public schools, many children with disabilities have suffered immensely. As a parent of a child with mental disabilities, Garrick dives into his first-hand account of the lockdown’s impact on his family. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)