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3rd Quarter Newsletter – Phia News
Phia Gives Back – 2014 Charity

As is our tradition for the past several years, The Phia Group partners with a local charity where we invest our time, money and support to ensure a successful program. We not only make monetary donations, but also collect needed items and have a company-wide day off so that our employees can volunteer their time and efforts to the cause. This year we have chosen to work with Jewish Family Service of Metro-west (JFS).

JFS provides vital social, health, and community services to alleviate suffering, enhance lives, and support people in need. The program that The Phia Group is involved with is the Reducing Achievement Gaps program (RAG). RAG is a comprehensive system of interventions to address the academic and social needs of poor children of immigrant families in Framingham, Massachusetts, located 30 miles from our office in Braintree.

RAG is based at the 550 student Woodrow Wilson Elementary School, located in Framingham’s poorest and highest-crime neighborhood. RAG gives Framingham’s most economically and educationally challenged school age children and their families the help and resources they need to succeed in school and in life. Please click on the link to this video to learn more:  https://www.youtube.com/watch?v=p4eowvE4kLw  

Summer Event:  In July, The Phia Group spent a day at Woodrow Wilson Elementary School for our annual volunteer day. We spent the day helping the school with various tasks such as: planting and expanding the school vegetable garden, fixing the concrete school yard by repainting lines, a US map, and other recess games, enhancing the playground by purchasing and installing additional equipment, and interior painting of classrooms and the gym.

We would love to be able to provide the students of Woodrow Wilson Elementary School with everything they need, and would greatly appreciate any donation from you. If you would like to make a donation you may do so by visiting: http://www.jfsmw.org /JFS_giving.html?action_donateReport=1&partner=networkforgood&ein=04-2730898, or by mailing a check made payable to JFS of Metrowest to The Law Offices of Russo & Minchoff, 123 Boston St., 1st Floor, Boston, MA 02125

Phia in the Industry

In Case You Missed It …

7/30 – EBMS – Employer’s View:  Cost Containment

8/28 – Sun Life – Self Funding … The Future

9/10 – Connecticut – Pequot – “Curiosity Saved the Healthcare Budget”

9/16 – Sun Life – Self funding … The Future

9/17 – Sun Life – Self Funding … The Future

9/25 – CDB – “Affordable Care Act: What’s in the cards?”

9/26 – Kempton – Oklahoma City – The Perfect Self Funded Plan

Coming to a Conference Hall Near You!

10/6 – SIIA – Best Practices & Cautionary Tales of Referene Based Pricing for TPA & Employers

10/15 – SPBA -Controlling the Hidden High Costs of Drugs Through Your Plan Design

10/23 – HealthFirst – The Perfect Self-Funded Plan

10/28 – Delaware Captive Insurance Association – “Best In Class Self-Insured Group Health Plans – What Captive Insurance Professionals Needs to Know!

11/11 – NASP – Reform & Recovery – Not the Type of R&R You Needed!

New Faces at Phia

Angela Grande – Legal

Lisa Tamulynas  – Recovery

Talise Rivers – Case Support

Joseph Huddleston – Case Support

Moving on Up !!!

Jason Kemp advanced to a CRS IV (specializing in WC)

Amanda Grogan transitioned from CE to CI

Leiana Turner transitioned from CI to a CRS Assistant

Naviana to CS Auditor & Trainer

Kathy Gatanti to Team Leader

Shannon Burns – Info Tier to Case Tier

Derriek Mish – Info Tier to Case Tier

Lyneka Hubbert – CSR to Info Tier

Jessica Goscik – Promoted to Customer Services Department

Additions to the Phamily … Mattie Sesin welcomed a new addition to her family … Say Hello to  …

Kaitlyn Francis Sesin

The Phia Group, LLC Announces The Release of its New “Phia Document Management” (PDM) Software
October 1, 2014; Braintree, MAA first of its kind plan document drafting solution, Phia Document Management (PDM) was created to satisfy the needs of the entire health plan industry. PDM allows for instant population of an online template featuring The Phia Group’s critically acclaimed plan language, while still ensuring customization to meet each client’s unique needs.For years, The Phia Group’s clients have asked them to not only draft plan documents, but also review and revise documents prepared by others; including vendors’ online templates and in-house efforts. The intent of such secondary review has always been to ensure that these plan documents are not only compliant, but forward thinking in areas of cost containment and the defense of plan rights.“Missing from the market was software that encompasses the three C’s: Compliance, Cost Containment and Customization,” said The Phia Group’s CEO, Adam V. Russo, “Our goal was to deliver a powerful and intuitive solution for plan document creation and management.” “Options presently available to the health plan industry either promote a detail oriented customized approach, or a quick and easy mass production approach…” remarked Jennifer McCormick, Vice President of Consulting, “… but until now, nothing offered a balance of the two.”“Phia Document Management is a SaaS (Software as a Service) product,” Michael Branco, The Phia Group’s co-founder and Principal said, “as a SaaS commodity, no additional hardware is necessary to access PDM; all you need is the internet.”For more information regarding PDM and The Phia Group’s other innovative offerings, please contact the PDM Project Manager, Toussaint Anderson III, by email at tanderson@phiagroup.com or by phone at 781-535-5662.About The Phia Group:The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, The Phia Group is truly Empowering Plans.

Stop-Loss Market Expected to Grow to $14 Billion by 2018
MyHealthGuide Source: Cyril Tuohy, 8/5/2014, InsuranceNet Article

A new report published by the ratings agency A.M. Best finds that rising demand for stop-loss insurance will come from small and midsize employers as self-insured insurance plans are not subject to certain requirements of the Affordable Care Act (ACA).

Analysts Tom Zitelli and Jason Hopper, co-authors of the report, estimated that the fee assessed on health insurers is expected to generate $8 billion in 2014 and grow to $14 billion by 2018. The fee has been passed along to employers in the form of rate increases.
According to the Self-Insurance Institute of America, the self-insurance industry’s main trade group, self-funding has advantages over the traditional insurance model.


Among the advantages are that employers can customize their plans to their employee population, employers maintain control over interest-bearing health plan reserves, self-funded plans follow federal Employee Retirement Income Security Act regulation instead of state health rules and employers avoid paying state health insurance premium taxes.

U.S. Department of Health and Human Services data show that in 2012, 59.9 percent of private-sector health plan enrollees were covered through self-insured plans, an increase of 20 percentage points from 40.9 percent in 1998.
Based on the research of 33 stop-loss insurers, A.M. Best said it expects stop-loss insurance to remain “a very competitive line of business.” Prices, therefore, will be attractive for smaller businesses considering self-insurance.

Sun Life, one of the largest writers of stop-loss coverage in the U.S., said a study of its claims data found that the increases were due to new medical technologies and advanced drug therapies.

Malignant forms of cancer were the top catastrophic medical condition from 2010 to 2013 with a value of paid stop-loss claims of $347.9 million, or 17.5 percent of all paid stop-loss payments that Sun Life made to policyholders over the four-year period, Sun Life said.

Chronic and end-stage renal diseases were next with a value of paid stop-loss claims reaching $164.3 million, or 8.2 percent of all paid stop-loss claims over the past four-year period.

2nd Quarter 2014 Newsletter – Phia News
Phia Gives Back: As is our tradition for the past several years, The Phia Group partners with a local charity where we invest our time, money and support to ensure a successful program. We not only make monetary donations, but also collect needed items and have a companywide day off so that our employees can volunteer their time and efforts to the cause. This year we have chosen to work with Jewish Family Service of Metrowest (JFS).

JFS provides vital social, health, and community services to alleviate suffering, enhance lives, and support people in need. The program that The Phia Group is involved with is the Reducing Achievement Gaps program (RAG). RAG is a comprehensive system of interventions to address the academic and social needs of poor children of immigrant families in Framingham, Massachusetts, located 30 miles from our office in Braintree.

RAG is based at the 550 student Woodrow Wilson Elementary School, located in Framingham’s poorest and highest-crime neighborhood. RAG gives Framingham’s most economically and educationally challenged school age children and their families the help and resources they need to succeed in school and in life. Please click on the link to this video to learn more: https://www.youtube.com/watch?v=p4eowvE4kLw.

 The Phia Group recently held a very successful recess drive for Woodrow Wilson Elementary School, and raised over 250 items for the students’ after school programs.

The Phia Group will be spending the day at Woodrow Wilson Elementary School for our annual volunteer day in July. We are going to help the school with various tasks, such as: planting and expanding the school vegetable garden, fixing the concrete school yard by repainting lines, a US map, and other recess games, enhancing the playground by purchasing and installing additional equipment, and interior painting of classrooms and the gym.

We would love to be able to provide the students of Woodrow Wilson Elementary School with everything they need, and would greatly appreciate any donation from you. If you would like to make a donation you may do so by visiting: here, or by mailing a check made payable to JFS of Metrowest to The Law Offices of Russo & Minchoff, 123 Boston St., 1st Floor, Boston, MA 02125.

New Faces at Phia:

Kayla Catarella, Accounting Administrator

Geraldine Legros, Claims Recovery Specialist Assistant

Andrew Silverio, Attorney

Adam Fralick, Customer Service Representative

The Legal Department has hired a new attorney, Andrew Silverio, to assist with its subrogation, reimbursement, and overpayment recovery operations.

Christopher Aguiar (J.D.) and Sean Donnelly (J.D.) are busily studying for the Massachusetts Bar Exam.

Toussaint Anderson has joined the “PGC” team as a Project Manager for the forthcoming PDM system.

Giuliano Stracco has progressed to the next level of Case Support.

Leiana Turner has progressed from a Case Investigator to a Claims Recovery Specialist III.

Jay Kemp has progressed from a Case Investigator to a Claims Recovery Specialist II.

Ashley Schramm has progressed from a Claims Recovery Specialist II to a Claims Recovery Specialist III.

Elizabeth Galewski has progressed from a Claims Recovery Specialist Assistant to a Case Investigator.

Regina Cattel has moved from Case Investigation to the Overpayment Department, now serving as an Overpayment Recovery Liaison

State/Legislative Regulatory News
Self-Insurance Institute of America, Inc.

Exclusive Reporting for the Week of May 7, 2014

May 7, 2014 — This is your weekly update of state legislative/regulatory developments affecting companies involved in the self-insurance/alternative risk transfer marketplace. Should you have any questions on information provided in these reports and/or would like to alert SIIA to new state legislative/regulatory activity (health care, workers’ compensation and/or captive insurance matters) we may have missed, please contact Adam Brackemyre, Director of State Government Relations directly at 202/463-8161, or via e-mail at abrackemyre@siia.org.


Connecticut- Assessment is Out of the Latest Budget Bill
The Connecticut House has passed a budget bill without including a previously proposed assessment on self-funded plan covered lives. While the final budget has not been approved, sources close to the Governor’s office and involved in budget negotiations told SIIA that a new self-funded assessment will not appear in the final bill (HB 5596).

SIIA and allied stakeholders had been vigorously opposing the assessment, which was designed to fund a new health care delivery system in that state, on the grounds that it was preempted by federal law and was bad public policy.

Several of the association’s individual members played critical roles in this successful lobbying effort. Brooks Goodison of Diversified Group contacted his clients and brokers, encouraging them to engage and provided them sample letters and updates. Denise Doyle of Stop Loss Insurance Brokers and Bob Madden of Lawley Benefits Group each provided clients with sample letters to send to their legislators. Charlie Barger of Pequot Health Care and Chris Brown of Berkley Accident and Health submitted letters opposing the assessment. Mike Kemp of IHC Risk Solutions alerted his clients and brokers, urging them to oppose the assessment. Rob Melillo at Guardian Life Insurance Company contacted brokers, who in turn, contacted clients urging them to oppose the assessment, too. A special thank you goes to Anita Schepker, a lobbyist retained by Diversified Group, who coordinated with SIIA’s government relations team throughout the effort.

While this was an important win in Connecticut, it has broader implications as additional states are contemplating assessments on self-insured employers and/or TPAs to fund public exchanges or other purposes.

New York – Stop Loss Legislation
The New York Senate’s stop-loss legislation is moving.

On Monday, S. 6917, which will protect the ability of organizations in New York with 51-100 employees/members to purchase stop-loss insurance when the small group market definition changes after January 1, 2016, was reported unanimously from the Senate Insurance Committee to the floor without discussion. SIIA submitted a memorandum of support.

On Wednesday, SIIA’s retained counsel met with high-ranking Assembly staff to discuss companion legislation and begin the push for a successful legislative push in that chamber. The association has also initiated an integrated advocacy strategy including the mobilization of numerous SIIA members who are engaging their smaller self-insured clients in New York to communicate the urgency of this legislation to their elected representatives.

Member companies already actively engaged in the grassroots lobbying effort include Berkley A&H, Lawley Benefits Group, Sun Life, HCC Life Insurance Company, East Coast Underwriters, Standard Insurance, Meritain Health and Gerber Life Insurance.

Please contact Adam Brackemyre right away if you would like to participate as part of this grassroots strike team. Thank you again to everyone who is already helping.

Washington DC- Council Approves Very Broad Insurance Assessment to Fund Exchange
Yesterday, the DC Council approved a new one percent tax on nearly all “health-related” insurance products, which probably includes stop-loss insurance.

Mayor Vincent Gray proposed the tax on Tuesday night as a way to ensure that the DC health insurance exchange had sufficient funding. Originally, the exchange was to assess qualified health and dental plans inside and outside the exchange. But with only 23,000 privately-insured individuals, the city council had to look elsewhere for funding the exchange’s $28 million budget.

Multiple entities are contemplating a legal challenge to the new law. As this situation continues to develop, SIIA will provide additional information.

SIIA’s 34th Annual Conference
SIIA’s National Conference and Expo is scheduled for October 5-7, 2014 in Phoenix, AZ, which will feature a dedicated Legislative/Regulatory/Legal update session. Conference details, including registration forms, can be accessed on-line at www.siia.org, or by calling 800/851-7789.

Letter from The Phia Group’s editior, Andrew Milesky
The winds of change are coming, and they blow closer than ever. It seems so recent that we were all looking forward to 2014, and feeling confident that we had plenty of time to get things in order and prepare – both financially and in terms of compliance – to address President Obama’s sweeping healthcare[insurance] reform law. Yet here we are, clueless as ever and full implementation looming.

Since the passing of the law, various waves of reform have impacted our industry, sending many of our clients into panic mode as they hustle and bustle to update their plans and implement measures to ensure compliance. At this point, SBCs seem like a thing of the past; as new “bigger and badder” issues arise!

As we sit here, with the air getting a little chillier and January 1st getting a little closer, we once again await our inevitable lives without pre-existing exclusions, no more than 90 day waiting periods, no annual limits on essential health benefits, and for some of us a change in clinical trial coverage.

But let’s not rush to winter; the fall is upon us and that means conference season is too. As we do each year, we road warriors head out to the major industry events to talk and listen; to address your greatest concerns. This interaction is invaluable to us; so when you see us, please let us know how we can help. It is your concerns, your requests, and your pleas that inspire us to research and develop new services and cost containment strategies focused on growing your businesses.

The time to chat is now! There has never been a more appropriate time to tell us how we can help and for us to be your strategic partner. The potential for financial burdens on plans means we must seek new and innovative ways to save our clients money, and ensure the preservation of our industry.

The use of strong, effective plan language can be the first step to maximizing plan benefits and savings. A successful claims recovery process to ensure every recoupable dollar spent is placed back in the mix for future health claims, is another step you must take – and something we are happy to assist with.

If you have yet to work with The Phia Group, now might be a great time to start. We are here for the long run and are dedicated to the growth and stability of the employer based health benefits industry.