Recent Posts

  • 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!)
  • Empowering Plans: P101 – Groundhog Day - A Year of COVID-19
    February 4, 2021
    In this episode of Empowering Plans, join Brady Bizarro and Jen McCormick as they have a conversation about the impact of COVID-19 on employers, health plans, and employees. How should employers be dealing with mental health, physical health, and productivity issues? What steps can health plans take to reduce claims exposure? How are employers planning to return to the office later this year? It may feel like Groundhog Day, but our advice is certainly not more of the same. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • The Hefty Price Tag of Covid-Related Substance Abuse Disorders
    January 27, 2021
    By: Philip Qualo, J.D. Life as we know it came to a halt in February of last year due to the quick and vicious spread of the COVID-19 virus. Although the US has made significant strides in slowing the spread, and pharmaceutical companies have manufactured vaccines, employees across the country continue to struggle with the realities of working from home. Whether due to stress associated with juggling work and family within an eight-hour workday at the kitchen table, or the inherent loneliness of performing job functions without peers or colleagues to interact with, working remotely and isolation orders have taken a toll on the American psyche. COVID-19 continues to be an uncertain, ever-evolving reality, and its impacts are particularly being felt among those with addiction and those in recovery from substance use disorders. As a result, health plans are already experiencing an influx of costly claims associated with substance abuse. In order to combat the spread of the virus, the government, the media, and even our employers have told us “stay at home”. The bars and restaurants we frequented ...
  • Empowering Plans: P100 – President Biden's First 100 Days - What to Expect
    January 22, 2021
    In this episode of the Empowering Plans podcast, Ron and Brady discuss the inauguration of President Biden and what his presidency could mean for healthcare policy. With Democrats in control of government, a lot could get done in the first 100 days - on COVID-19 relief, the ACA, and rolling back Trump-era rules. Join us as we break it all down. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • The “No Surprises Act,” COVID Relief, and Plan Design Changes Impacting Your Business in 2021
    January 20, 2021
    After a hectic political showdown, the president has signed legislation which includes comprehensive protection from surprise medical billing. This 5,000-page bill, along with a raging pandemic and a new administration, is certain to have our industry scrambling to keep up. Join The Phia Group in a new webinar format as they discuss the COVID-19 relief bill, the impact on the industry, and everything in between. From plan design changes to updates on fiduciary duties and subrogation, we have got you covered as we ring in the New Year. Following the one-hour webinar, there will be two 30-minute breakout sessions, addressing plan design changes, stop-loss issues, and legal and regulatory updates affecting claims. 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 reach out to mpainten@phiagroup.com.
  • Empowering Plans: P99 – Balance Bills, Medical Tourism, and Vaccines – Oh My!
    January 13, 2021
    In this episode of the Empowering Plans Podcast, Ron Peck is joined by Corey Crigger, an attorney in the Provider Relations Department. Ron and Corey discuss balance billing in the COVID world, medical tourism, and vaccine passports. What can we expect in the not so distant future? No one has a crystal ball, but Ron and Corey offer an insight on the implications of a tiered vaccine rollout that may not be uniform and business requiring proof of passport. Also, what parts of the pandemic does Corey see as a positive? Tune in to find out! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Empowering Plans: P98 – Balance Billing During COVID-19 and Beyond
    December 23, 2020
    In this episode of the Empowering Plans Podcast, Brady Bizarro is joined by a new face at Phia, Mitch Hilbert. Listen in as Brady and Mitch discuss how balance billing has been on an uptick during COVID, and how patients can possibly prevent this from occurring. Is Congress doing anything? What can we expect in the near future? Find out in our latest Empowering Plans Podcast. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • FFCRA Leave Entitlements Set to Expire December 31, 2020
    December 16, 2020
    By: Kevin Brady   In March of this year, the President signed the Families First Coronavirus Response Act (FFCRA) into law. The FFCRA represents the first major legislative response to the COVID-19 pandemic. In an effort to reduce the spread of COVID-19 and to protect the financial interests of those employees and families who are impacted by the COVID-19 pandemic, the FFCRA provides new and expanded leave entitlements under the Expanded Family and Medical Leave Act (EFMLA) and the Emergency Paid Sick Leave Act (EPSLA).   The EFMLA provides additional leave entitlements to employees who must take time off because they are unable to work (or telework) due to a need to care for a child in the event that the child’s school or place of child care has been closed or is unavailable due to the COVID-19 pandemic. Additionally, the Emergency Paid Sick Leave Act (EPSLA) requires employers to provide paid sick leave (up to 80 hours) to employees who are unable to work (or telework) for any of the following reasons: The employee is subject to a Federal, State, or local quarantine ...
  • A Transparent 2021 - Further Analysis of the Year to Come
    December 15, 2020
    Following on the heels of their incredibly informative assessment of what to expect in 2021, The Phia Group will dives back into their pool of predictions in another free webinar. The team targets rules that will impact 2021, including the recently released transparent pricing rules.  Additionally, they discuss some best practices developed and applied in 2020 and how those changes will assist plans in 2021. If success in 2021 is in your plans, check out this webinar and look forward to tomorrow. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P97 - COVID-19 Vaccine Candidates – What Health Plans Need to Know
    November 30, 2020
    In this episode of Empowering Plans, Brady is joined by Attorney Andrew Silverio. They discuss current COVID-19 vaccine candidates and everything health plans and employers need to know about them. When can we expect the first vaccines to arrive? Do health plans have to cover them at full price? Can (or should) employers make this vaccine mandatory? Join us to find out. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Desperately Looking Forward to 2021
    November 16, 2020
    The end (of 2020) is near, and we are anxiously looking forward to 2021.  Between the Presidential Election, the COVID-19 Pandemic, and the ACA’s “Day in Court” before SCOTUS, any one of these ongoing topics would be enough to keep us busily planning for what is to come.  Suggesting that 2021 is poised to be one of the busiest years in our industry’s history might be an understatement.  At times, it may be overwhelming to keep up with everything that is impacting us – as employers, as service providers, and as human beings.  That’s why The Phia Group is proud to invite you to enjoy another webinar, where we will be discussing these and other hot topics, forecasting what we expect to see in 2021, and giving you a head start as you – like we – plan, and look forward, to 2021. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • The Dangers of Politicizing Health
    November 16, 2020
    By: Ron E. Peck As I – like so many others – anxiously watched election day results on television, a commercial played more than once.  The advertisement displayed a mask (not a fun Halloween mask, but rather, one of the protective masks with which we have all become familiar).  The voice advises that this is a mask.  It protects the wearer and others around them.  It is not a political statement.  It is a mask. The advertisement struck me, but not for the reasons they likely intended.  It moved me for two reasons.  First, I was saddened that the message even needs to be sent.  Second, I was even more saddened by the fact that the message was wrong.  Love it or hate it, masks – like so many other things – have become a political statement. This is one example of what I fear; the politicizing of health.  Many important decisions are made by politicians on a daily basis.  Yet, there are some decisions that transcend politics.  If a school is under siege by a shooter, police respond, rescuers do all ...
  • Empowering Plans: P96 - Election Aftermath – Where Things Stand
    November 13, 2020
    In this episode of the Empowering Plans Podcast, Ron Peck, Brady Bizarro, and Nick Bonds reunite to discuss their developing thoughts on the presidential election results. They speculate as to what moves a Biden administration can make on health care with a potentially Republican-controlled senate, and what effects those moves could have in the self-funded industry. They also discuss California v. Texas and try to anticipate how the Supreme Court might rule on the fate of the ACA. Lastly, they talk through the exciting news of a potentially viable coronavirus vaccine. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Updating the Employee Handbook in Unprecedented Times
    October 21, 2020
    By Philip Qualo, J.D.   In general, employers should review and revise their employee handbooks at least annually to account for changes in local, state, and federal laws and workplace safety requirements. As employers begin to focus on reviewing their employee handbooks in preparation for a… hopefully better… 2021, many are pondering how to update their handbooks to adequately respond to the challenges presented by the COVID-19 pandemic and continuing racial tensions sparked by the murder of George Floyd. Although employers have generally been quick to adopt and enforce policies addressing COVID-19-and diversity related issues, the rapidly changing guidance and dramatic shift in cultural perspectives has also necessitated swift revisions as best practices and requirements continue to change from day to day. In finalizing our own employee handbook for the upcoming year, we can share two important tips employers may want consider in reviewing and updating their employee handbooks in these challenging times.   Tip #1: Limit the Handbook to Static COVID-19 Language Where Possible As updating an employee handbook multiple times within a fiscal year can be an administratively burdensome task, ...
  • Empowering Plans: P92 - Healthcare on Stage & COVID-19 in the White House
    October 13, 2020
    In this episode, Ron Peck and Brady Bizarro guide you through a chaotic week for healthcare news. What did we learn (if anything) from the first presidential debate? With COVID-19 infecting the President and much of the West Wing, what can we learn from the President’s experimental treatment? Would self-funded plans cover this treatment? What impact could all of this have on the Affordable Care Act lawsuit? Join us to find out! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Offer More for More!
    October 8, 2020
    By: Ron E. Peck, Esq.   COVID-19 and the current pandemic has caused even more attention to be paid to health care and health insurance.  Yet, despite health care being a topic of discussion “in general,” during this Presidential election, I am surprised by how “little” airtime the specific issue of “Medicare-for-All” is receiving, compared to (for instance) the Democratic primaries.  Yet, I wonder if that is due (in part) to a false belief that, by nominating Joe Biden (as compared to, for instance, Elizabeth Warren) the people of this nation have rejected the idea of Medicare-for-All, and can move on to the issue of saving or eliminating the ACA.   Yet, some eagle-eyed viewers will note Vice President Biden’s oft referenced “Medicare-for-All-Who-Want-It” and “Public Option” rhetoric.  Make no mistake; if such a plan proceeds, it will amount to – eventually – a Medicare-for-All scenario.    Looking at individual States that have already proposed public options for its citizens, the backbone of such programs is a payment methodology, with that methodology centering on payment of a “percent of Medicare.”  In other words, these ...
  • COVID-19 Impact on Self-Funded Health Plans
    September 29, 2020
    COVID-19 has impacted just about every aspect of our lives, and self-funded health plans have not been spared. Along with being mindful of employees' health during the pandemic, employers and HR managers must also be mindful of the state of their self-funded health plans. More than half of the non-elderly population in the United States receives health care coverage through an employer-based plan. The majority of this group are covered by either fully or partially self-funded health care plans. As such, the health care plans of many Americans could be impacted by COVID-19.  What Are Self-Funded Health Plans? Despite so many Americans having self-funded health plans, many are unfamiliar with the term. So what exactly are self-funded health plans? A self-funded health plan, also referred to as a self-insured plan, is a health an welfare plan through which the employer takes on the full financial risk associated with providing health care benefits to employees. Usually, self-insured employers establish a special trust fund to cover incurred claims. Self-funded and fully insured health plans operate similarly. Money is collected and covers medical expenses for the insured population. ...
  • Empowering Plans: P91 - The Pandemic & The Employer Mandate
    September 24, 2020
    In this episode of the Empowering Plans podcast, Brady is joined by Kelly Dempsey to discuss a particularly damaging impact of the pandemic that does not get much media attention: with many businesses forced to operate at reduced capacity, they still have to comply with the ACA's employer mandate. That can be very burdensome given falling revenues. What can be done by the regulators and by Congress? Find out in our latest podcast. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)