Photo Of Phia Group Consulting Team Member - Jonathan Jablon

“As times change, you're looking for guidance. Our expansive knowledge base helps us provide that much needed wide-ranging guidance to customers. ”

JONATHAN JABLON
Learn With Us - Independent Consultation & Evaluation (Ice)
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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 & 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 legal and 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.

Claim Assessment & Analysis

 We obtain facts, documentation and answers requisite to 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 review, commentary, and proposed revisions prior to executing the deal.

General Plan Regulatory Inquiries & Legal Compliance

Sponsoring and administering a self-funded health plan has become a legal process.  Between regulations, statutes, contracts, and case precedent, it is harder than ever to navigate the legal 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.

Leave of Absence Review

Both states and the federal government are starting to enact richer leave of absence requirements, and employers have begun implementing policies in their employee handbooks to comply with the law. These policies can be very comprehensive and have significant implications for eligibility and continuation of coverage. Employers face a tough task in ensuring that plan documents, employee handbooks, and applicable stop-loss policies all align with regard to leave policies. A single variation in terms or conditions can result in a coverage gap, state compliance issues, or even fiduciary liability.

The Phia Group routinely evaluates plan documents, employee handbooks, and stop-loss policies to identify variances. This conflict – between employee handbooks, health benefit plan documents, and the law – is both prevalent and becoming more common every day.  To this end, The Phia Group has developed the Leave of Absence Review service.

What is The Phia Group’s Leave of Absence Review?

Similar to our “Gap Free”™ service, a Leave of Absence Review reviews an employee handbook in an effort to identify potential variances between employer policies and applicable health benefit plan documents. We review three major areas:

(1)  Eligibility provisions
(2)  Leave of absence provisions (state and federal)
(3)  Continuation of coverage provisions

*Note that our analysis is limited to eligibility for health benefits and those benefits which have a direct impact on health insurance coverage or continuation of coverage (such as a leave of absence). We do not consider whether particular employee groups are entitled to other benefits, such as life insurance, private disability insurance, social security disability insurance, overtime compensation, workers’ compensation, retirement benefits, or fringe benefits.