The Phia Group’s legal team frequently addresses the biggest issues impacting the health benefits industry today. Join them as they dissect the conflicts threatening every entity involved in the business of health benefits, and share real life examples of clients who implemented forward thinking solutions… and those that didn’t. From fiduciary liability to claim re-pricing by stop-loss carriers… from international importation of prescription drugs to handling large out of network costs and resolving balance billing of patients… We will together discuss the biggest trends, solutions, and results.

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Extra!  Extra!  Have you heard the news?  Laws are changing, regulations are shifting, and benefit plans are scrambling to keep up. 

Thank you for joining The Phia Group’s legal team on July 13th, as they discuss the biggest issues and most common questions facing our industry, as well as ideas and solutions to not only survive but thrive in this changing environment.  This is your chance to learn from others’ questions, concerns, mistakes and successes.  Check it out!

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PPOs, EPOs, HMOs… The days of simple network categories is past.  Today, innovative providers are offering up-front transparent pricing, subscription-based direct primary care (DPC), value based pricing, ACOs, medical tourism, international prescription plans, on-site clinics, telemedicine and direct contracting with “centers of excellence.”

Thank you for joining The Phia Group’s legal team on Thursday, June 22, as they discussed what a health plan needs to do to ensure the plan document supports the chosen methodology, which contracts and arrangements an employer needs to analyze to avoid conflict, and more.

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Between a traditional PPO plan, a MEC or “skinny” plan, reference-based pricing, narrow network, cafeteria plan, or high-deductible health plan, who can choose? They all have their nuances, and which plan type is best for a given plan sponsor will depend on factors including risk tolerance, geographical location, employee base, and more.

Thank you for joining The Phia Group’s legal team on Tuesday, May 16, as they discussed the different plan options available to plan sponsors these days – including benefits, dangers, best practices, stop-loss and network considerations, and the future.

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Nearly all Plan Documents have some mention of discretionary authority. The ability to interpret the terms of the plan is necessary to receive deference from the courts, and is needed since not every conceivable scenario can be planned for within the plan document. When it comes to stop-loss, however, open-ended discretion can be a deal-breaker. Particular areas of concern include definitions of Usual and Customary, Medical Necessity, and Experimental/Investigational – and gaps between the Plan Document and the employee handbook are more and more prevalent. When an employer, seeking to exercise blanket discretionary authority, offers to extend coverage to employees on leave, despite the plan document clearly ending coverage well before then, that discretionary authority begins to seem arbitrary and capricious.

Thank you for joining The Phia Group's legal team on April 27, 2017, as they analyzed some of the pros and cons of discretion, what can be done to avoid these difficult situations, and some changes we have made to our own health plan to fix the same issues for our own organization and users of our plan document template.

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It’s common knowledge that not every network contract adds real value, nor can medical providers always be relied upon to bill responsibly. As the fiduciary duty to be prudent with plan assets becomes increasingly relevant, it's important that self-funded health plans, and those who service them, not fall behind.

Thank you for joining The Phia Group's legal team on March 23, 2017 as they analyzed the various ups and downs we associate with "provider relations," including overpayments, claim negotiations, reference-based pricing, balance billing and more - and discussed some best practices for working within each of these domains.

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Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an  employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.

Thanks for joining The Phia Group’s legal team on February 15, 2017, as they discussed top miscues employers make when it comes to their health  plans, and what we all can do to become health plan heroes; rescuing employers who have blurred the lines, and will without our help soon be stuck between a rock and a hard place.

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The past decade has ushered in both outrage and opportunity for self-funded plans, and 2016 was no different. The characteristics of self-funded plans continued to alter in concert with new laws and regulations. While these bureaucratic efforts often hindered our ability to self-fund, for those daring enough to change with the times, we saw increased growth and prosperity. We will no doubt see these issues and opportunities continue to evolve in 2017, and only those that prepare will thrive.

Thank you for joining The Phia Group’s team of attorneys on January 19, 2016 as they reviewed the most troublesome and costly issues of 2016 and opportunities that were born from strife - and examined how they will impact self-funding in 2017 while offering some solutions for the new year.

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2016 has been another huge year for self-funding, and a year of significant change for healthcare in general – and with the results of the recent presidential election, 2017 is slated to be an exciting year as well. 2016 has played host to all sorts of new federal regulations, state laws, market trends, and cost-containment options, and we expect 2017 to be even more unpredictable…but still great for self-funding.

Thank you for joining The Phia Group’s legal team on December 13, 2016, for the 2017 Phia Forecast.

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The election is behind us, and no matter who you supported, it was one of the most divisive in recent history. Regarding the contentious topic of healthcare, President-elect Donald Trump has promised to repeal the Affordable Care Act and replace it with a better, more efficient system. The future of our industry is sure to change.

Thank you for joining The Phia Group as we shared our predictions in a special-edition webinar. It’s going to be an interesting year…

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