Recent Posts

  • Recognizing Risks, Reaping Rewards… Industry Responses to Costly Threats, and How Plans Must Prepare.
    March 22, 2022
    Since 2020, the pandemic and health care regulations have dominated the air waves.  The issues that existed prior to 2020 haven’t vanished, however, and they continue to fly under the radar.  In 2022, we anticipate these issues – such as costly medical procedures, devices, and specialty drugs – will be causing serious headaches for plan administrators.  Adding to the perfect storm, stop-loss carriers are looking to protect themselves from what they believe will be a series of expensive years in health care.  Join The Phia Group as we expose these risks, explain what to look for, and provide some best practices to deal with them. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P129 – Single Scoops Only (No Double Dipping): COVID OTC Testing
    February 18, 2022
    On this week’s episode of Empowering Plans, Kelly Dempsey and Kevin Brady discuss over-the-counter COVID testing and the complications surrounding up-front payment by participants with account-based plans (HSA, FSA, HRA). Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • The Compliance Landscape for 2022
    February 15, 2022
    One month in, the new year has brought into focus three major compliance concerns – mental health parity, COVID-19, and fiduciary duties. The Department of Labor just released its first annual report to Congress on mental health parity compliance. None of the plan sponsors in the report earned a passing grade. Join The Phia Group as they break down the report, explaining what went wrong, and what plan sponsors can do to earn a passing grade. The team will also reveal how you can best prepare a compliance strategy to keep up with new legal developments in ERISA law and with COVID-19. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P128 – The Comparative Analysis: A Year in the Life
    February 3, 2022
    February 10 marks a full year since the requirement to provide a written report document a plan’s comparative analysis of its NQTLs took effect. In today’s podcast, Jon Jablon and Nick Bonds discuss some of what they’ve learned from a year’s worth of analyzing NQTLs, some practical considerations for health plans, and their takeaways from the recently-published report on MHPAEA compliance from the DOL, HHS, and Treasury. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and Apple Podcasts Channels!)
  • All the COVID Things - COVID As a Disability & More Paid COVID Leave
    January 31, 2022
    By: Kelly Dempsey, Esq. With all the NSA, NQTL, and OTC testing rules and talk, it’s possible you may have missed that the EEOC has published a bunch of guidance and FAQs discussing COVID-19 as a disability under the ADA. You may recall from prior blogs and articles I’ve written that I have a friend that has long-COVID, making this a topic I’m very passionate about. She is a long hauler who suffers from chronic fatigue, “brain fog,” dizziness on standing, and migraines just to name a few daily symptoms (she also still can’t smell or taste normally). Like any medical condition or potential disability, diagnosing long-COVID requires an individualized assessment. This also means that employers have a duty to accommodate when long-COVID is a disability. In December, the EEOC added an additional section to the existing COVID-19 Technical Guidance to help clarify when COVID-19 may be considered a disability under the ADA and the Rehabilitation Act. I’ll be honest, the guidance provided isn’t earth shattering and shouldn’t be a surprise to employers, but it is something that employers should take ...
  • Don’t Forget About Third-Party Liability When Dealing with COVID-19 Claims
    January 28, 2022
    By: Andrew Silverio, Esq. Entering year three of this pandemic with no clear end in sight, there is still a good deal of uncertainty surrounding who should ultimately be responsible for the expense of some COVID-19 treatment.  Followers of our social media and webinars will be somewhat familiar with some of the developments in the workers’ compensation realm.  Various states have passed laws establishing COVID-19 as a potential occupational injury, some focusing on first responders and healthcare workers and others doing so more broadly. However, case law is also developing in the more general areas of negligence and wrongful death.  Recently, a district court in Texas entertained such a wrongful death claim against a nursing home, where a decedent’s estate alleged that the facility is responsible for the resident’s death by failing to institute and implement infection control programs, as well as by negligently failing to care for the resident, leading to her exposure to and eventual death from COVID-19. The court rejected the facility’s motion for summary judgment, which asserted that the Public Readiness and Emergency Preparedness Act (“PREP” Act) gave ...
  • Tune in to Win – Are You Ready for 2022?
    January 25, 2022
    A flurry of regulatory changes, alterations to plan design, implementation procedures, claims processing and stop loss assessments will impact your business in 2022.  We cannot afford start the new year unprepared.  Fortunately, The Phia Group will address the issues and trends most in need of your attention right now.  From ongoing litigation to political developments, regulatory developments to procedural best practices, start the year on the right foot with The Phia Group! Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P127 – What is Required for Plans for OTC COVID-19 Testing Coverage?
    January 20, 2022
    This week on Empowering Plans, Jen McCormick and Katie MacLeod discuss the controversial new OTC COVID-19 Testing coverage requirement that went into effect on January 15, 2022 for plans – how it interacts with other COVID-19 coverage requirements, what plans need to cover and available safe harbors, and how plans can be prepared for compliance. This won’t be the last you hear of this topic, plans 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!)
  • Battling Vaccine Hesitancy with Financial Incentives
    December 27, 2021
    By: Andrew Silverio, Esq. With a troubling portion of Americans still unwilling to protect themselves and others against COVID-19, many employers are looking at ways to both protect themselves from the expenses associated with COVID-19 infection amongst the unvaccinated and incentivize hesitant workers to get vaccinated by creating financial incentives. Followers of The Phia Group’s webinars and social media will already be somewhat familiar with common health plan-based approaches.  Most notably, plan sponsors can set up wellness programs to create differentials in health plan contributions based on vaccination status without running afoul of HIPAA requirements.  These are subject to the same wellness program rules we see for programs aimed at things like tobacco cessation – by following these guidelines a plan can create an incentive or disincentive surrounding certain behavior which would otherwise be considered a health factor under HIPAA. However, New York’s Metropolitan Transit Authority has taken more drastic steps, declaring that it will not be paying an otherwise-available $500,000 death benefit to the families of workers who die of COVID-19 if the workers were unvaccinated. We would not be surprised to ...
  • 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!)