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Healthcare Subrogation and Reimbursement and Why it Matters

On December 8, 2022
Most self-funded employee welfare benefit plans contain a statement in their plan document which allows the Plan to recover benefits in the event a third party caused a member’s injuries. The strength of a Plan’s language is vital to the extent the Plan recovers from the proceeds of a settlement or judgment.

Empowering Plans: P149 – Another Ping-Ponging of IC/EE Rules?

On November 17, 2022
In recent history there have been several rules that have been amended and re-amended (or just overturned and new rules published). Join Kelly Dempsey and Kevin Brady as they explore the ever-changing world of employee classification rules. The 2021 rule is viewed as leaving workers vulnerable to misclassification and was inconsistent with existing federal court decisions, thus the current administration is seeking to make a change. Tune in to learn more and why this rule matters to self-funded health plans.

Down the Stretch: Wrapping up a Historical 2022

On November 15, 2022
We are entering the home stretch. With a couple months to go, we can confidently say that 2022 has been one of the most momentous years in the history of American healthcare. The Phia Group’s panel of experts will revisit what they feel were the ten most impactful healthcare developments of 2022, covering a broad swath of topics that includes price transparency (the Consolidated Appropriations Act and No Surprises Act), governance (state laws that preempt ERISA), and equitable benefit coverage (Mental Health Parity and Addiction Equity Act). Who knew one year could have such a profound impact on our industry? Join the fun and find out how impactful 2022 has been.

NSA’s Model Notice: Doing Your Own Thing

On November 14, 2022
It’s November, and most TPAs are neck-deep in No Surprises Act compliance. This is a busy time of year as it is – but with new, daunting requirements piled onto a TPA’s usual renewal-time craziness, this is a special year. Some have opined that the last time they had a year like this was when the ACA was first passed, and that’s saying something!

The Fair Labor Standards Act (FLSA): Who Benefits and Who Doesn’t

On November 4, 2022
It’s hard to fathom today, but less than a century ago, America was a country in which elementary-school-aged children were accustomed to laboring in coalmines, glass factories, and shipyards; an untold number of employees earned less than $1 per day; a typical workweek consisted of six 12-hour shifts. Such was life for tens of millions of Americans barely scraping by during the depths of the Great Depression before FDR implemented his landmark New Deal, which, among other initiatives, provided workers greater protection with the passage of the Fair Labor Standards Act (FLSA).

Empowering Plans: P148 – The Ever Changing Times of Healthcare

On November 3, 2022
“It’s an ever-changing time…” in the healthcare landscape. Corey Crigger and Nick Bonds are back on the podcast mics to discuss some of the more interesting developments they’ve seen in 2022. Tune in to be sure these developments aren't burdensome and rest assured that the dreams you believe in will still come true.

The 2022 SIIA National Conference: What Lies Ahead for the Self-Funded Industry

On November 3, 2022
The SIIA National Conference, the world’s largest self-insurance industry event, resumed early last month at the JW Marriott Desert Ridge Resort and Spa in Phoenix, Arizona. The three-day event, which ran from October 9-11, covered a litany of timely topics, including a preview of the midterm elections (and impending regulatory changes); how evolving digital tools will enhance patient care; means by which insurance companies are accounting for emergent—and exorbitantly expensive—cell and gene therapies; the process by which captive insurance is countering “uninsurable” risk challenges; the multi-faceted relationship between TPAs and brokers; PBM business practices; far-reaching compliance matters such as the relationship between the No Surprises Act (NSA) and reference-based pricing (RBP) as well as the quest to obtain sufficient information for NQTL testing; and the booming growth of the medical stop-loss market in light of increasingly more U.S. employers transitioning to self-insurance.

RxDC Reports Are Almost Due – Make Sure You Are on Track for Compliance

On October 27, 2022
Our consultants have been receiving tons of questions in the last month about the upcoming Prescription Drug and Health Care Spending reporting (RxDC) requirements. The first two reports are due on December 27, 2022, for the 2020 and 2021 calendar years.

Empowering Plans: P147 – Transparency & More: Burning CAA/NSA FAQs

On October 27, 2022
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jen McCormick and Jon Jablon bring up some of the most common questions that The Phia Group’s consulting team has been asked to field over and over again. From the so-called broker compensation rules to a TPA’s obligations related to a group’s No Surprises Act compliance, Jen and Jon highlight some of the main points to keep in mind when making important decisions regarding your business.

Book of Russo: Chapter 5

On October 21, 2022
In the latest episode of The Book of Russo, tune in to find out what The Phia Group’s CEO, Adam Russo, and guest host, Mike Ferguson, President & CEO of the Self-Insurance Institute of America (SIIA), have to say about SIIA’s 2022 National Conference, the history of SIIA, and what to expect from SIIA in years to come.

The Witching Hour for Healthcare Plans

On October 20, 2022
Quite a few treats are in store for those tuning into The Phia Group’s next webinar, one that will cover some tricky topics. From breaking down regulatory changes impacting the healthcare industry (i.e., mental health parity, discretionary authority) to developments concerning plan drafting language, Phia’s roundtable of experts will keep you in the know. Oh, and did we mention that there’s also going to be a discussion of what to expect from a health policy standpoint in next month’s midterm elections?

The Phia Group's 4th Quarter 2022 Newsletter

On October 19, 2022
The Phia Group is off to a great start in the fourth quarter of 2022! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

The Stacks – 4th Quarter 2022 Newsletter

On October 19, 2022
This is "The Stacks" from The Phia Group's 4th Quarter 2022 Newsletter

Empowering Plans: P146 - A Possible Threat to a Plan’s Discretionary Authority

On October 14, 2022
Currently before the Senate, a new bill has been announced that would ban all references to a plan administrator’s discretionary authority, as well as remove all deference courts give to their claims determinations. Regardless of whether this bill will be passed, what does this and similar rhetoric say about public and political attitudes towards self-funded health plans? Ron Peck, Chief Legal Officer, and attorney Kaitlyn MacLeod are here to talk about this and more. Enjoy!

Mental Health Matters Act: Why the MHPAEA Needs Reinforcement

On October 6, 2022
It was fourteen years ago this month that the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law. The landmark piece of legislation had a profound impact on the healthcare industry, requiring group health plans and insurance companies to provide coverage for mental health/substance use disorder treatments in parity with medical services.