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Learn - Independent Consultation & Self Funded Health Plan Evaluation (Ice)

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Moving To Self-Funded Health Plan Guide
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Confront the issues that impact our industry by addressing conflicts that threaten plan operations and viability, coordinating relationships, and providing guidance.

The Phia Group is the industry’s premier self-funding expert.  Collaboration between our organizations adds value to all entities involved, and ensures satisfaction amongst those we service. We understand that our success is directly correlated with that of our clients. We are stationed at the front line to ensure the industry is strong, growing, and ripe with opportunity. Our involvement as both advocates and leaders in the industry is unique to The Phia Group; no other firm is as active in facing its clients’ issues. 


Independent Consultation & Self-Funded Health Plan Evaluation (ICE)

Plan complexity in the self-funded world is on the rise. Our team of renowned attorneys and paralegals provide a wide spectrum of consulting services to the ever-changing health plan industry, dealing with any and all regulatory compliance issues. Compliance concerns, multifaceted factual dilemmas, business disputes, and any other situation that involves the administration of a self-funded health plan are provided with assessment of the issues involved, necessary legal research, discussion of best practices, and unrivaled guidance. Schedule a self-funded health plan evaluation with our team of experts today! 


Claim Assessment & Analysis

We obtain facts, documentation, and answers that are a requisite for the successful processing of claims. The team also reviews claim scenarios upon request, aids in determining proper claims adjudication, and assists with stop-loss submissions and appeals. 


Third Party Agreement Review, Revision, Drafting & Templates

From Administrative Service Agreements to HIPAA Business Associate Agreements; from network contracts to vendor statements of work; whenever a benefit plan or an entity servicing such a plan finds itself with a contract, proposal, or agreement, they can rely on us to provide a review, commentary, and proposed revisions on health plan compliance related provisions prior to executing the deal.


General Plan Regulatory Inquiries & Compliance

Sponsoring and administering a self-funded health plan has become a complicated process.  Between regulations, statutes, contracts, and case precedent, it is harder than ever to navigate the complexities of self-funding a health plan.  We provide consultation and support to plan sponsors and administrators every step of the way – from plan establishment, to licensing, to administration, to conflict resolution.


The ICE Playbook: Get Unlimited Help With the Following:


Federal & State Law Compliance & Regulatory Consultation:

  • ACA – Notice Requirements, Employer Mandate Rules, Essential Health Benefits & Section 1557
  • COBRA - Procedural Issues (i.e., Offers, Timing, and Notices)
  • ERISA – ERISA Preemption of State Law, Fiduciary Duties, Reporting & Disclosures
  • FMLA & Leaves of Absence – Plan Document & Handbook Coordination
  • HIPAA – Data Privacy Regulations & Nondiscrimination
  • IRS Regulations – HDHPs, HSAs, FSAs & HRAs
  • Mental Health Parity & Addiction Equity Act – Coverage Options & Exclusion Language Review
  • MSPA – Interaction of Medicare Eligibility & Employer Sponsored Coverage
  • TPA Licensing – State Law Review & Application Assistance

Claim Reviews & Plan Document Assessments:

  • Assess Claims Incurred Against Plan Document Language & Stop Loss Policy
  • Plan Document Assessments (Level I, Level II, Level III)
  • Phia Plan Document Certification
  • Gap Free Analysis™ (i.e., compare Plan Document to Employee Handbook or Stop Loss Policy)

Third Party Contract Analysis:

  • Administrative Services Agreement (ASA)
  • Business Associate Agreement (BAA)
  • Stop Loss Contracts
  • Network Contracts such as:
    • Preferred Provider Organization (PPO)
    • Exclusive Provider Organization (EPO)
    • Wrap Network Contracts
  • Pharmacy Benefit Manager Contract (PBM)
  • Vendor Service Contracts
  • Captive Insurance Contracts