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Plan Drafting FAQ's
“Setting the Industry Standard for Plan Language” by combining cutting edge technology with forward thinking creativity, and a client-centric customized approach.
Plan Document Assistance and Collaboration
Regardless of how you choose to develop your plan document, The Phia Group’s team of plan drafting experts is available to assist in the process. Our team will ensure that your language is best-in-class, your questions are answered accurately, and that your plan drafting experience proceeds smoothly.
Some employers are looking to self-fund for the first time, while others are approaching self-funding with an existing policy or plan document. If you have a plan document or insurance policy, whose terms are acceptable, but need improvement to stay viable, The Phia Group’s team of expert plan drafters can maintain the integrity of the existing benefit structure and limitations in a new and improved template plan document.
All Plan Document Review, Revision, and Drafting
We combine a forward thinking ideology with years of experience to analyze benefit plan documents, identify areas of concern, make recommendations, and apply strategies to strengthen plan rights.
Gap Free Review
When plan documents, stop-loss policies, networks, employee handbooks, and service agreements fail to align, claims go unpaid and nancial ruin is a real possibility. By comparing pertinent documents to ensure uniform coverage, financial security and a smooth operation are assured.
Any self-funded plan document can become Phia Certified. The Phia Group will review plan documents to ensure they meet our stringent standards. A tangible report card is produced to identify areas of need and ensure compliance with applicable laws and regulations.
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.
Frequently Asked Questions About Document Drafting:
What kind of documents can The Phia Group draft, revise, or assess?
The Phia Group can perform drafting, revision, or assessment services on all types of plan documents, including wrap documents, amendments, summaries of bene ts and coverage (SBCs), and other self-funded plan documents. Plan document variations include medical, dental, vision, and short-term disability plan documents, as well as summary plan descriptions. Medical plan document variations include “skinny” or “MEC” plans, wrap documents, traditional PPO plans, and refer-ence-based pricing plans.
How often are The Phia Group’s templates updated to ensure regulatory compliance?
There is no set schedule, but templates are updated whenever necessary to meet new requirements, regulations, court mandates, or other industry changes.
Can The Phia Group train my team and account managers?
Yes. At your request, The Phia Group’s attorneys and expert plan drafters will provide personalized training in the form of conference calls, webinars, or even on-site training at your convenience.
Can The Phia Group customize my existing templates and internal drafting process?
Yes. Phia will work in conjunction with your existing internal plan drafting team to review and revise existing materials, as well as provide insight into plan drafting best practices to help your internal team be more efficient and provide more value to your groups.
How often should I update my plan document?
ERISA regulations specify that a plan should be updated every five years, but a best practice is to update the plan at least annually to ensure that the plan remains compliant and contains the most robust and up-to-date cost-containment language.
What kind of plan drafting services does The Phia Group offer?
We offer multiple solutions to empower plans - Through Plan Document Review, Assessment and Revision, The Phia Group is "Setting the Industry Standard for Plan Language®"
1. Phia Certification - Ensure Plan Language Meets Best-in-Class Standards
- A Tangible Report Card Identifies Areas of Concern Highlight Compliance or Regulatory Issues Address Issues and Achieve Phia Certification
2. Plan Document Assistance, Collaboration, and Transition to Self-Funding
- Existing Insurance Policies are Improved as Self-Funded Plan Documents Maintain Integrity of Existing Benefit Structures in an SPD Template
3. Plan Document Review and Revision
- Any Plan Document Can be Improved
- Address Compliance and Cost Containment at the Same Time