The Tax Man is Dead; Long Live the Health Plan!

On January 21, 2022
People (especially politicians) refer to “healthcare,” when in fact they are referencing health insurance. When they talk about the cost of healthcare, they don’t mean how much a provider charges for the care they provide. Instead, they are referring to the premiums, co-pays, and deductibles for which the patient will be responsible out-of-pocket.

The Phia Group's 1st Quarter 2022 Newsletter

On January 20, 2022
The Phia Group is off to a great start in the first quarter of 2022! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Empowering Plans: P127 – What is Required for Plans for OTC COVID-19 Testing Coverage?

On 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.

The Stacks – 1st Quarter 2022

On January 19, 2022
This is "The Stacks" from The Phia Group's 1st Quarter 2022 Newsletter.

Reasons for the Value-Based Care Gap Between Public Payers and Employer Groups

On January 10, 2022
The long-term struggle over the price of health care services between providers and payers is a tale as old as time. On one side, providers want to preserve the status quo, fee-for-service payment (FFS) system, which often leads to unnecessary treatment and wasteful health care spending. Meanwhile, payers have consistently pushed new payment models that attempt to tie spending with results. Collectively, the models pushed forward by payers are often referred to as “value-based care” (VBC) or “alternative payment models.”

Empowering Plans: P126 – Challenges and Opportunities with Value-Based Care for 2022

On January 6, 2022
Kicking off the first episode of Empowering Plans in 2022, Phia’s Chief Legal Officer and Attorney Micah Iberosi-Parnell talk value-based care, what it is, where it’s at right now, and where it’s headed. Listen for a preview of what action self-funded plans can begin taking now to reduce costs without sacrificing the quality of coverage.

Don’t Swear Off MHPAEA Compliance for the New Year

On December 29, 2021
Mental Health Parity continues to be a priority for DOL compliance – and should be on every plan’s wish list this Holiday Season to have in case the DOL or a plan participant requests for a copy of the plan’s mental health parity comparative analysis.

Battling Vaccine Hesitancy with Financial Incentives

On December 27, 2021
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.

Empowering Plans: P125 – The Night Before an Emergency Room Visit

On December 22, 2021
This week on Empowering Plans, Rebekah McGuire-Dye and Lisa Hill, bring you back to the basics of recovering subrogation dollars and identifying subrogation opportunities through an entertaining holiday story. Listen in to hear Rebekah's holiday story and how this story relates to multiple subrogation cases.

Roe v. Wade/Planned Parenthood v. Casey

On December 21, 2021
Over the past few weeks, in light of the Supreme Court case Dobbs v. Jackson Women’s Health Organization, hearing arguments over Mississippi seeking to ban abortions after fifteen weeks of pregnancy, the landmark 1973 Roe v. Wade case has come to the forefront of our attention. For the sake of understanding historical context, the following is a brief background to the case that laid the groundwork for the current Supreme Court precedent on abortion rights … and may get overturned by the summer.

The Fear Group

On December 17, 2021
The list of innovative and promising approaches to medical cost containment that have been beaten to a pulp by the pandemic is long, and I could keep offering examples, but I would like to instead focus on the positives. I’ve often heard that you can’t have bravery without fear, because bravery is – by definition – the act of facing one’s fears… To be brave, you must first be afraid, and then act despite it.

The 11th Hour - Last Minute Moves to Make for 2022 as a New Era in Cost Containment Begins

On December 13, 2021
Ready or not here it comes! As the final countdown to 2022 begins, we both look forward to a new era in cost containment, and prepare for increased regulatory attention and enforcement. From vaccine mandates to transparency; mental health parity to the No Surprises Act; this is our last chance to make the necessary moves and identify the tools we will need before the new year begins. With solutions at every stage, together we will centralize workflows and tie it all together; regardless of where you are in the process. Join The Phia Group as we learn, plan, save and protect your plans – now and in the future. Also, some fresh faces will share fresh ideas – Introducing our new VP of Provider Relations, Scott Bennett! This is one you won’t want to miss..

Empowering Plans: P124 – Healthcare Subrogation and Plan Document Requests

On December 10, 2021
In this episode of Empowering Plans, Attorneys Chris Aguiar and Cindy Merrell, discuss what a health plan should do in the event of a pesky U.S.C. 1024(b)(4) records request. Tune in for all of the details!

The Boston Globe Names The Phia Group as a Top Place to Work for 2021

On December 6, 2021
It is with great honor and humility that The Phia Group announces it has been named by The Boston Globe as one of the Top Places to Work in Massachusetts. In its 14th annual employee-based survey, The Boston Globe – having assessed anonymous employee feedback, and details about the company – determined that The Phia Group provides one of the most rewarding, meaningful employment experiences in the Commonwealth of Massachusetts.

Stop-Loss “Gaps”: Level Funding Is Far From Immune

On December 6, 2021
Level-funding is a method for self-funded plans to effectively cap their monthly expenditures. It usually entails reinsurance with an aggregate deductible only, and it relies on the notion that the carrier will reimburse the employer for plan benefits paid above the aggregate deductible, most often on a monthly basis, and usually including advanced funding. That sounds fantastic from a risk perspective; the ability to cap monthly claims expenses at a predetermined level can eliminate the high aggregate claims risk inherent in self-funding!