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9 Secrets For Coordinating Leave Under the FMLA and ADA
HR professionals may often see the following scenario: An employee is granted FMLA leave to treat a serious health condition that poses long-term restrictions and limitations; 12 weeks pass; the employee fails to return to work; company terminates employee under a “no-fault” absence policy. The employer granted the full 12 weeks allowed by the FMLA, so it is free to terminate, right?

Missouri Slayer Law Preempted by ERISA
In Mitchell, et. al. v. Marcus Tyrone Robinson, Sr., et. al. the Plaintiffs are the grandparents of some minor children of Marcus Tyrone Robinson and his deceased wife. The allegation is that Mr. Robinson killed his wife. The wife had $121,000.00 in life insurance through her employer, Unilever, and insurer MetLife. Mr. Robinson made a claim for benefits under the policy which was paid. Thereafter, the grandparents filed suit alleging that Mr. Robinson was not entitled to recover under the Missouri Slayer Statute, and claimed that the benefits were wrongfully paid as a result thereof. Plaintiffs asserted several state law claims to recover the money and named Unilever and MetLife as Defendants. In the attached order the court is deciding Unilever’s motion to dismiss the state law claims based upon ERISA preemption. The court holds that the Missouri Slayer Statute is preempted.

Looking Forward to 2013 - The Phia Group Looks Back at 2012 and Forward to 2013
Looking Forward to 2013 - The Phia Group Looks Back at 2012 and Forward to 2013

If you thought 2012 was a wild ride, wait until you see 2013.  Obamacare is the law of the land, and it’s here to stay.  The entities empowered by PPACA to issue mandates are prepared to unleash a tidal wave of regulations in 2013.  Subrogation and coordination of benefits once again appear before the Supreme Court.  The very definition of self-funding, rights under ERISA, and access to stop-loss have come under attack.  Join The Phia Group’s CEO, Adam V. Russo, Sr. V.P. and General Counsel, Ron E. Peck, and V.P. of Consulting Services, Jennifer McCormick, as they discuss what we can expect to see in 2013, and how best to prepare for what’s coming.

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November 2012 Newsletter

The elections are over and regardless of who you voted for, the fact remains that PPACA is here to stay.  While many of you have been utilizing our firm to assist in your compliance needs, we have never publicly announced that our team of experts can assist your organization with Regulatory Compliance issues until now.

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The Bay State Crystal Ball - How Massachusetts May Predict the Future for America's Healthcare
The Bay State Crystal Ball - How Massachusetts May Predict the Future for America's Healthcare

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Mitt Romney has been distancing himself from the healthcare reform he signed into law whilst governing Massachusetts.  His team has responded to comparisons between “Romneycare” and “Obamacare,” stating that the two laws are vastly different, and vary based on scope of coverage, communities they apply to, and terms themselves.  That being said, we can still draw many parallels between the two.  Those of us who fail to look at the Bay State as a prototype for post-PPACA America are missing an opportunity to gaze into the future.  From early successes, to a gradual bloating of the program… from red-tape, to recent moves to address the actual cost of care… the Commonwealth of Massachusetts is certainly a crystal ball.  Join us as we dissect The Phia Group’s home state, and attempt to predict the nation’s future.


Trick Or Treat
Trick Or Treat

Plan sponsors are looking for ways to cut costs without limiting benefits. New solutions are popping up everywhere, from medical tourism, to carving out dialysis; from placing a Medicare + cap on allowable expenses, to having outside auditors reprice claims. The industry is shifting from a pure PPO focus, but with change comes uncertainty. Believe it or not, but these programs present risks along with rewards. Conflicts with providers, balance billing, accusations of discrimination, stop-loss denials, and other negative repercussions are only some of the “tricks” we will help you avoid as you seek to indulge in the newest, innovative “treats” our industry has to offer.

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Doing It For Ourselves
Doing It For Ourselves

June 28th, 2012 is a date that will not live on in infamy or otherwise. On that date The Supreme Court of the United States (“SCOTUS”) took the path of least resistance, declaring that The Patient Protection and Affordable Care Act (“PPACA”) is Constitutional, while tearing the claws from the so-called “mandate’s” enforceability. In one fell swoop, SCOTUS both locked PPACA in as the law of the land, and eliminated the government’s ability to enforce the mandate against individuals. With the smoke clearing, and exchanges advancing nationwide, the eyes of regulators now shift to employers and self-funded plans. State commissioners, who since ERISA’s passage in 1974 have sought to control self-funded benefits, now wave the Obamacare flag in efforts to advance their long held desires. As the cost of providing insurance increases, and employers – long since thought untouchable by the self-funded industry – must decide between exiling employees to the exchange, or sampling self-funding, self-funded plans that implement cost containment solutions can position themselves to reap the rewards of this paradigm shift.

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The Supreme Court Opinion on PPACA
The Supreme Court Opinion on PPACA

The US Supreme Court upheld the sweeping 2010 healthcare law, declaring that Obama and Congress acted within their powers in requiring most Americans to obtain health insurance.

The ruling reaffirms the most ambitious and controversial undertaking of President Obama’s first term: attempting to guarantee that most of the 45 million Americans without insurance will get better access to medical care.

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October 2012 Newsletter


Well, it’s that time of year where here in New England the leaves are turning colors, the summer outdoor furniture is being put away, and by the time I leave the office its already dark outside. So depressing, yet I feel so inspired by what I see happening across the industry. People are getting creative with their cost containment ideas and I see more and more innovative approaches to reducing the cost of health care. But we have to be diligent in how we do these things.

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September 2012 Newsletter


Fall is in the air here in New England but the conference schedule is heating up earlier than ever for me. I’m doing the nationwide tour and the focus from audience questions is on two areas – health care reform and self funding. The same people who ask me about reform then follow up with whether self funding is a good move to lower their costs. The interest in self funding is the highest I have seen in my life time so we here at The Phia Group will continue to preach the virtues of this option and how to make it work right.

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