Recent Posts

  • Empowering Plans: P99 – Balance Bills, Medical Tourism, and Vaccines – Oh My!
    January 13, 2021
    In this episode of the Empowering Plans Podcast, Ron Peck is joined by Corey Crigger, an attorney in the Provider Relations Department. Ron and Corey discuss balance billing in the COVID world, medical tourism, and vaccine passports. What can we expect in the not so distant future? No one has a crystal ball, but Ron and Corey offer an insight on the implications of a tiered vaccine rollout that may not be uniform and business requiring proof of passport. Also, what parts of the pandemic does Corey see as a positive? Tune in to find out! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Empowering Plans: P98 – Balance Billing During COVID-19 and Beyond
    December 23, 2020
    In this episode of the Empowering Plans Podcast, Brady Bizarro is joined by a new face at Phia, Mitch Hilbert. Listen in as Brady and Mitch discuss how balance billing has been on an uptick during COVID, and how patients can possibly prevent this from occurring. Is Congress doing anything? What can we expect in the near future? Find out in our latest Empowering Plans Podcast. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • FFCRA Leave Entitlements Set to Expire December 31, 2020
    December 16, 2020
    By: Kevin Brady   In March of this year, the President signed the Families First Coronavirus Response Act (FFCRA) into law. The FFCRA represents the first major legislative response to the COVID-19 pandemic. In an effort to reduce the spread of COVID-19 and to protect the financial interests of those employees and families who are impacted by the COVID-19 pandemic, the FFCRA provides new and expanded leave entitlements under the Expanded Family and Medical Leave Act (EFMLA) and the Emergency Paid Sick Leave Act (EPSLA).   The EFMLA provides additional leave entitlements to employees who must take time off because they are unable to work (or telework) due to a need to care for a child in the event that the child’s school or place of child care has been closed or is unavailable due to the COVID-19 pandemic. Additionally, the Emergency Paid Sick Leave Act (EPSLA) requires employers to provide paid sick leave (up to 80 hours) to employees who are unable to work (or telework) for any of the following reasons: The employee is subject to a Federal, State, or local quarantine ...
  • A Transparent 2021 - Further Analysis of the Year to Come
    December 15, 2020
    Following on the heels of their incredibly informative assessment of what to expect in 2021, The Phia Group will dives back into their pool of predictions in another free webinar. The team targets rules that will impact 2021, including the recently released transparent pricing rules.  Additionally, they discuss some best practices developed and applied in 2020 and how those changes will assist plans in 2021. If success in 2021 is in your plans, check out this webinar and look forward to tomorrow. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Empowering Plans: P97 - COVID-19 Vaccine Candidates – What Health Plans Need to Know
    November 30, 2020
    In this episode of Empowering Plans, Brady is joined by Attorney Andrew Silverio. They discuss current COVID-19 vaccine candidates and everything health plans and employers need to know about them. When can we expect the first vaccines to arrive? Do health plans have to cover them at full price? Can (or should) employers make this vaccine mandatory? Join us to find out. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Desperately Looking Forward to 2021
    November 16, 2020
    The end (of 2020) is near, and we are anxiously looking forward to 2021.  Between the Presidential Election, the COVID-19 Pandemic, and the ACA’s “Day in Court” before SCOTUS, any one of these ongoing topics would be enough to keep us busily planning for what is to come.  Suggesting that 2021 is poised to be one of the busiest years in our industry’s history might be an understatement.  At times, it may be overwhelming to keep up with everything that is impacting us – as employers, as service providers, and as human beings.  That’s why The Phia Group is proud to invite you to enjoy another webinar, where we will be discussing these and other hot topics, forecasting what we expect to see in 2021, and giving you a head start as you – like we – plan, and look forward, to 2021. Click Here to View Our Full Webinar To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • The Dangers of Politicizing Health
    November 16, 2020
    By: Ron E. Peck As I – like so many others – anxiously watched election day results on television, a commercial played more than once.  The advertisement displayed a mask (not a fun Halloween mask, but rather, one of the protective masks with which we have all become familiar).  The voice advises that this is a mask.  It protects the wearer and others around them.  It is not a political statement.  It is a mask. The advertisement struck me, but not for the reasons they likely intended.  It moved me for two reasons.  First, I was saddened that the message even needs to be sent.  Second, I was even more saddened by the fact that the message was wrong.  Love it or hate it, masks – like so many other things – have become a political statement. This is one example of what I fear; the politicizing of health.  Many important decisions are made by politicians on a daily basis.  Yet, there are some decisions that transcend politics.  If a school is under siege by a shooter, police respond, rescuers do all ...
  • Empowering Plans: P96 - Election Aftermath – Where Things Stand
    November 13, 2020
    In this episode of the Empowering Plans Podcast, Ron Peck, Brady Bizarro, and Nick Bonds reunite to discuss their developing thoughts on the presidential election results. They speculate as to what moves a Biden administration can make on health care with a potentially Republican-controlled senate, and what effects those moves could have in the self-funded industry. They also discuss California v. Texas and try to anticipate how the Supreme Court might rule on the fate of the ACA. Lastly, they talk through the exciting news of a potentially viable coronavirus vaccine. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Updating the Employee Handbook in Unprecedented Times
    October 21, 2020
    By Philip Qualo, J.D.   In general, employers should review and revise their employee handbooks at least annually to account for changes in local, state, and federal laws and workplace safety requirements. As employers begin to focus on reviewing their employee handbooks in preparation for a… hopefully better… 2021, many are pondering how to update their handbooks to adequately respond to the challenges presented by the COVID-19 pandemic and continuing racial tensions sparked by the murder of George Floyd. Although employers have generally been quick to adopt and enforce policies addressing COVID-19-and diversity related issues, the rapidly changing guidance and dramatic shift in cultural perspectives has also necessitated swift revisions as best practices and requirements continue to change from day to day. In finalizing our own employee handbook for the upcoming year, we can share two important tips employers may want consider in reviewing and updating their employee handbooks in these challenging times.   Tip #1: Limit the Handbook to Static COVID-19 Language Where Possible As updating an employee handbook multiple times within a fiscal year can be an administratively burdensome task, ...
  • Empowering Plans: P92 - Healthcare on Stage & COVID-19 in the White House
    October 13, 2020
    In this episode, Ron Peck and Brady Bizarro guide you through a chaotic week for healthcare news. What did we learn (if anything) from the first presidential debate? With COVID-19 infecting the President and much of the West Wing, what can we learn from the President’s experimental treatment? Would self-funded plans cover this treatment? What impact could all of this have on the Affordable Care Act lawsuit? Join us to find out! Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • Offer More for More!
    October 8, 2020
    By: Ron E. Peck, Esq.   COVID-19 and the current pandemic has caused even more attention to be paid to health care and health insurance.  Yet, despite health care being a topic of discussion “in general,” during this Presidential election, I am surprised by how “little” airtime the specific issue of “Medicare-for-All” is receiving, compared to (for instance) the Democratic primaries.  Yet, I wonder if that is due (in part) to a false belief that, by nominating Joe Biden (as compared to, for instance, Elizabeth Warren) the people of this nation have rejected the idea of Medicare-for-All, and can move on to the issue of saving or eliminating the ACA.   Yet, some eagle-eyed viewers will note Vice President Biden’s oft referenced “Medicare-for-All-Who-Want-It” and “Public Option” rhetoric.  Make no mistake; if such a plan proceeds, it will amount to – eventually – a Medicare-for-All scenario.    Looking at individual States that have already proposed public options for its citizens, the backbone of such programs is a payment methodology, with that methodology centering on payment of a “percent of Medicare.”  In other words, these ...
  • COVID-19 Impact on Self-Funded Health Plans
    September 29, 2020
    COVID-19 has impacted just about every aspect of our lives, and self-funded health plans have not been spared. Along with being mindful of employees' health during the pandemic, employers and HR managers must also be mindful of the state of their self-funded health plans. More than half of the non-elderly population in the United States receives health care coverage through an employer-based plan. The majority of this group are covered by either fully or partially self-funded health care plans. As such, the health care plans of many Americans could be impacted by COVID-19.  What Are Self-Funded Health Plans? Despite so many Americans having self-funded health plans, many are unfamiliar with the term. So what exactly are self-funded health plans? A self-funded health plan, also referred to as a self-insured plan, is a health an welfare plan through which the employer takes on the full financial risk associated with providing health care benefits to employees. Usually, self-insured employers establish a special trust fund to cover incurred claims. Self-funded and fully insured health plans operate similarly. Money is collected and covers medical expenses for the insured population. ...
  • Empowering Plans: P91 - The Pandemic & The Employer Mandate
    September 24, 2020
    In this episode of the Empowering Plans podcast, Brady is joined by Kelly Dempsey to discuss a particularly damaging impact of the pandemic that does not get much media attention: with many businesses forced to operate at reduced capacity, they still have to comply with the ACA's employer mandate. That can be very burdensome given falling revenues. What can be done by the regulators and by Congress? Find out in our latest podcast. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • New Guidance on HIPAA – Using PHI to Contact Recovered COVID-19 Patients Regarding Plasma Donation
    September 21, 2020
    By: Andrew Silverio, Esq. Recently, the Department of Health and Human Services released updated guidance outlining some permissible uses of Protected Health Information (PHI) under HIPAA in regard to recovered COVID-19 patients (available at www.hhs.gov/sites/default/files/guidance-on-hipaa-and-contacting-former-covid-19-patients-about-plasma-donation.pdf).  This guidance, which applies to health care providers, health plans, and their business associates, is an expansion of previous guidance which applied only to health care providers. In essence, the guidance provides that these entities can use PHI to identify and contact individuals who have recovered from COVID-19 in order to inform them about how to donate their plasma, which will contain antibodies to SARS-CoV-2 which are useful in potentially treating COVID-19 patients. This activity has been classified as falling within the category of “health care operations,” and thus PHI can be used for this purpose without an individual’s authorization.  HHS outlines that these activities constitute “health care operations” in that “facilitating the supply of donated plasma would be expected to improve the covered health care provider’s or health plan’s ability to conduct case management for patients or beneficiaries that have or may become ...
  • Empowering Plans: P90 - IRS Notice 2020-29, COVID-19 and Cafeteria Plans: Self-Funded Plans Beware!
    September 15, 2020
    The COVID-19 pandemic has brought about an unprecedented wave of federal legislation in a short period of time specifically aimed at regulating employer-sponsored group health plan coverage. Similarly, the Internal Revenue Service (IRS) has followed suit and released several formal Notices aimed at extending COVID-19 relief options to cafeteria plans. In the most recent notice issued by the IRS, however, IRS Notice 2020-29, there are certain provisions that impact employer-sponsored coverage. If adopted by a cafeteria plan sponsor that also sponsors a self-funded health plan, these provisions can result in significant cost liability for the plan and create issues for stop-loss reimbursement. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • An Overview of the Recent New York Federal Court Decision and its Potential Impact Moving Forward
    September 9, 2020
    By: Kevin Brady, Esq. In April of this year, following the passage of the Families First Coronavirus Response Act (FFCRA), the State of New York sued the Department of Labor (DOL), claiming that several provisions of the FFCRA exceeded the DOL’s authority under the statute. On August 3rd, the United States District Court of the Southern District of New York issued an opinion, siding with the State of New York and invalidating several provisions of the FFCRA. Specifically, the court invalidated the following regulations: The “work-availability” requirement Under the FFCRA regulations, individuals are not eligible for Emergency Family Medical Leave or Emergency Paid Leave if their employer does not actually have work for the individual to do. The court concluded that the DOL failed to properly explain this additional requirement, and invalidated the regulation. Employer approval of intermittent leave Under the FFCRA regulations, employees are required to have approval from their employer in order to take leave under the FFCRA intermittently. The court opined that this was not permissible and vacated the regulation. Requirement to provide documentation of leave in advance Employees are ...
  • Empowering Plans: P89 - Healthcare Policy at the DNC/RNC
    September 2, 2020
    In this episode of Empowering Plans, Ron and Brady assess what we learned from the candidates on healthcare policy at the virtual Democratic and Republican national conventions. Over the course of two weeks, both parties showcased their platforms; one focused heavily on restoring the Affordable Care Act and a nationwide COVID-19 response, and the other on lowering prescription drug prices and covering all pre-existing conditions. What can our industry learn from the talking points? Join us as we cover all the angles and discuss what comes next as the presidential election draws ever closer. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • HEALS vs. HEROES
    August 24, 2020
    By: Nick Bonds, Esq.   As the worldwide coronavirus crisis continues to grind on, impacting virtually every aspect of our lives, we have necessarily become familiar with the many pieces of legislation passed by Congress in its attempts to soften the blow to our country’s economic and healthcare systems. This has engendered a whole new can of alphabet soup: CARES, FFCRA, EFMLEA, EPSLA, PPP. Enacted late spring/early summer, these legislations have become staple pieces of the daily conversation in the arena of health benefits for employees. They’ve nearly begun to blend in with the furniture.   But as we are all keenly aware – these pieces of legislation were not designed to be permanent. Many of these temporary rules are set to expire by the end of 2020, with a number of the key components like the payroll protection program, already lapsing, many of us are looking back to Capitol Hill and wondering if and when more economic aid will be coming.   Democrats in the House of Representatives put together a follow-up aid package in May. Clocking in at roughly $3 ...
  • Conflicts Abound – Providers & Facilities Fight Back
    August 17, 2020
    U.S. hospitals have lost over $200 billion from March to June as a result of canceled services due to the COVID-19 pandemic. In response, providers have changed their tactics. They are raising prices, appealing more denied claims, more aggressively fighting referenced-based pricing, and stepping up collections efforts. Now, more than ever, it is imperative for plans and their partners to be vigilant and protect their members and plan assets. Join The Phia Group’s team as they discuss these new aggressive tactics as well as the conflicts they are causing with networks and stop-loss. Click Here to View Our Full Webinar on YouTube To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Returning to Work Safely and Smartly. Who Bears the Cost?
    August 13, 2020
    By: Bryan M. Dunton Earlier this year, the coronavirus swept through the country and became such a major concern that employers shut down their physical offices and moved their operations remote. Not long after, states began mandating shutdowns and shelter-in-place orders. The overarching theme focused on how to keep everyone safe. Now, months later, states and employers have begun to relax those restrictions by reopening, albeit in phases. With that, employees have slowly been allowed to return to work in traditional office settings. Given that employers have an interest in the wellbeing of their employees, and would likely face significant business consequences in the event of an outbreak at their place of business, some employers have implemented mandatory return-to-work testing for those employees who come back to the physical office space. On the national level, we have seen this approach implemented in major sports leagues such as the NFL, NBA, and MLB. The idea is essentially to test everyone who enters the building, regardless of whether they are displaying symptoms or have had known exposure. The expansion and implementation of mandatory return-to-work ...
  • Texas Still Working On Mental Health Parity Rule Implementation
    August 3, 2020
    By: Kelly Dempsey, Esq.   Texas House Bill 10 was passed in 2017. The House Bill 10 “Study of Mental Health Parity to Better Understand Consumer Experiences with Accessing Care” was published in August of 2018. On June 16, 2020, the Texas Department of Insurance (TDI) published an informal draft rule to implement House Bill 10. Before we dive into the requirements, you’re probably wondering why I’m writing about this topic. My motivation is to draw attention to these requirements as they impact self-funded non-ERISA plans.   There are four division to the Bill which are summarized here: Division 1: Imposes mental health parity requirements that essentially mirror the federal requirements. The goal is a single unified standard for assessing parity. Division 2: Imposes requirements to submit reporting to the state on utilization review outcomes. The TDI notes that this data will not always be evidence of a violation, but this information will help TDI further assess the need to investigate potential issues and monitor benchmarking and changes over time. Division 3: Imposes requirements to analyze quantitative and non-quantitative treatment limitations for compliance ...
  • A Brief Anecdote on Testing for COVID-19
    July 29, 2020
    By: Kevin Brady, Esq.   This week, a close friend reached out and asked for my help. As an attorney, this is not all that uncommon. I am often asked to read apartment leases, organize estate plans, and opine on the merits of a potential tort claim. This request however, was a bit different. This time, my friend asked for help in getting tested for COVID-19.   As a bit of background, my friend lives and works in Chicago, Illinois. She has health insurance through her employer and she has outstanding benefits. She had “known exposure” to the virus last weekend and wanted to take a test to confirm whether she had contracted the virus as well. Now you may be asking, why would she ask you? What do you know about it? And the truth is, I didn’t know much about it, but I certainly do now. I know that there are a number of options for testing, but each of those options has a myriad of issues that go along with it.   Testing Options FDA Approved at-home Test Kit First, we ...
  • Empowering Plans: P87 - COVID-19’s Catch-22
    July 23, 2020
    In this episode of the Empowering Plans podcast, Ron and Brady discuss a Catch-22 emerging in the midst of the global pandemic - as more government intervention is needed to deal with COVID-19, calls for a public option and Medicare for All grow louder. Join them as they discuss this issue and other looming threats to the industry; from uncertainty over the ACA and out of control drug prices to the disruption of employment-based health insurance. Click here to check out the podcast!  (Make sure you subscribe to our YouTube and iTunes Channels!)
  • The Underlying Regulatory Landscape - Don’t Get Lost in the New Normal
    July 15, 2020
    As we remain hyper-focused on COVID-19, it is easy to forget other ongoing impactful industry events. Life goes on, and so too does lawmaking and litigation. Statutes, regulations, and case law have been and continue to be considered, debated, and finalized; resulting in serious, lasting effects.  It behooves us all to track them accordingly. Luckily for you, The Phia Group’s legal team has done just that – and they will happily inform and advise on what to watch, and how to adjust. Join us for this free, but invaluable event. Click Here to View Our Full Webinar on YouTube To obtain a copy of our webinar slides, please reach out to mpainten@phiagroup.com.
  • Black Lives Matter … Yes, Even in Healthcare
    July 8, 2020
    By: Philip Qualo, J.D. Just when the United States was starting to adjust to a new COVID-19 reality, where bejeweled face masks, social distancing and hand sanitizer have become as fundamental to our existence as water, current events have yet again set us down a new trajectory in these unprecedented times. The May 25th murder of George Floyd, a Black man who was unarmed and handcuffed at the time of his death at the hands of law enforcement sparked a series of national protests that has called on the world to reexamine policies and practices that disproportionately impact people of color. The protests have spawned into a national movement in the U.S. that has aimed at reforms in law enforcement practices and legislative accountability. There is a very important arena, however, where racial disparities are not being discussed at this time, and that is in healthcare.  Disparate access to affordable, yet effective, healthcare has and continues to have disproportionately negative impact on people of color. In most cases, access to healthcare can be the difference between life and death. ...