Phia Group

Empowering Plans: P177 – Entering the Danger Zone: Cross-Plan Offsetting

On December 8, 2023
Attorneys Jon Jablon and Cindy Merrell discuss the practice of cross-plan offsetting and the recent settlement between the Department of Labor and EmblemHealth Inc. Who wins and who loses when a TPA decides to use cross-plan offset?

Empowering Plans: P176 – Copay Accumulator Programs Take a Hit: What’s Next?

On November 21, 2023
Attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court decision that saw drug manufacturers and patients alike score a win against copay accumulator programs – programs that help maximize the manufacturer assistance available to patients but decline to count those amounts toward deductibles and out-of-pocket maximums. With the latest rule being struck down, where does the law stand now and what will happen next?

Empowering Plans: P175 – No Surprises Act Brings More Surprises & Other Surprises for 2024

On November 9, 2023
Join Provider Relations Senior Attorney, Brian O’Hara, and Vice President of Consulting, Kelly Dempsey, for a quick rundown of changes to be prepared for as we near 2024. While there are the regular recurring changes to ACA and IRS out-of-pocket limits, this podcast will uncover a couple lesser-known items hidden in some NSA proposed rules and a couple other items for 2024 that might have fallen off the radar, including COVID-19 tolling requirements. (COVID may be over but the impact on certain items could extend well into 2024…).

Empowering Plans: P174 – PCORI and Parity and Lawsuits, Oh My!

On October 26, 2023
It’s the spookiest time of the year, and I’m not just talking about renewal season. In this Halloween episode of the Empowering Plans podcast, Jennifer McCormick and Nick Bonds talk through some of the scary issues creeping up on health plans: rising PCORI fees, proposed regulations on mental health parity rules, and two fascinating court cases that may have significant implications for ERISA plans going forward. But don’t be scared, Phia is here to help!

Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy

On October 12, 2023
Your wish is our command! Join Ron Peck and Corey Crigger as they discuss how this emerging treatment can impact self-funded health plans. With prices as high as $3.5 million, you can’t just wish for a strategy for dealing with these therapies, you must plan for it. Ron and Corey discuss the motivations to cover, the future benefits, and the concerns they are hearing from clients. You don’t know what we can see, so join us on a magic carpet ride around this life saving, but costly treatment.

Empowering Plans: P172 – Navigating the Gag Clause Prohibition

On September 28, 2023
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson delve into the issue of the gag clause prohibition, a mysterious law that continues to confound the self-funded industry. With the first attestation requirement approaching at the end of 2023, now is the time to make sure you know what needs to be done, how to do it, and how to keep yourself safe and compliant.

Empowering Plans: P171 – Mass Torts 101

On September 15, 2023
From time to time, do you hear about mass torts in the news but feel like you could use a little more background knowledge? Look no further than the latest edition of the Empowering Plans podcast series, (“Mass Torts 101”) in which attorneys Cindy Merrell and Lisa Hill explain the difference between the two types of mass tort cases -- class action and multidistrict litigation (MDL) – while delving into a couple of the larger MDLs making news of late.

Empowering Plans: P170 – PSA on the NSA

On August 31, 2023
It’s 10’o clock, do you know where your IDR determinations are? Join Attorneys Brian O’Hara and Corey Crigger as they issue a public service announcement on the state of the No Surprises Act, and specifically the challenges with the IDR process. Friends don’t let friends miss this podcast! In addition to the PSA on NSA, Corey discusses a case study highlighting the benefits of the Safeguard Program. Just Say No to skipping this episode of Empowering Plans.

Empowering Plans: P169 – Let’s Keep Learning - Back to (Law) School

On August 17, 2023
In the latest edition of the Empowering Plans podcast series, “Let’s Keep Learning - Back to (Law) School,” Attorneys Kelly Dempsey and Corey Crigger are here to take us all back to school! Listen as they discuss renewal season preparation items and a variety of late breaking lawsuits that pertain to multiple aspects of the self-funded industry. From civil courts hearing cases about NSA administrative issues all the way to ACA compliance (or lack thereof) there is something in this podcast for everyone. Once you listen to the podcast - class dismissed!

Empowering Plans: P168 – “Drafting” Plan Exclusions

On August 4, 2023
In this episode of Empowering Plans, Andrew Silverio and Kevin Brady discuss the unanticipated costs of playing pickleball and then “draft” their favorite (and least favorite) plan limitations and exclusions. Let us know who you think had the better picks!

Empowering Plans: P167 – Who is a Fiduciary and Does it Even Matter? Lawsuits Abound!

On July 21, 2023
In this episode of Empowering Plans, The Phia Group’s Chief Legal Officer – Ron Peck – and Sr. VP of Consulting – Jennifer McCormick, analyze recent lawsuits involving self-funded plan sponsors and their third party administrators, and accusations of fiduciary breach on the part of TPAs. We delve into whether TPAs can be fiduciaries, what this means, and whether it even matters when it comes down to how administrators manage plans. Finally, are plan sponsors signing contracts enabling TPAs to do things contrary to ERISA, and who is to blame when this is the case? Anyone and everyone handling self-funded plan assets needs to tune into this one!

Empowering Plans: P166 – Delving Into Dobbs, One Year In

On July 7, 2023
In the latest episode of Empowering Plans, attorneys Nick Bonds and Kendall Jackson discuss the changes that have occurred in the past year following the Supreme Court’s decision in Dobbs. How will new abortion laws affect self-funded plans and what are the implications for their participants? Tune in to learn how plans can navigate these changes.

Empowering Plans: P164 – The Key to a Successful Self-funding Experience: Knowledge!

On June 9, 2023
With many self-funded employers entering the field from a world where their benefits are “set it and forget it,” educating plan sponsors about their obligations, relationships, opportunities, and risks is often the difference between retaining and losing a client. Attorneys Andrew Silverio and Christopher Aguiar muse about the challenges arising when self-funded plans aren’t educated about their benefit offerings, the risk mitigation mechanisms, and the cost containment tools being utilized to ensure the plan’s viability.

Empowering Plans: P163 – ChatGPT: Disrupting the Healthcare Industry

On May 19, 2023
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O'Hara provide an overview of ChatGPT, the artificial intelligence chatbot developed by OpenAI, and describe how it is disrupting the healthcare industry. In particular, they focus on one emerging use for the technology - acting as a virtual assistant for patient care. What are the advantages of using AI in this manner? What are the concerns? Tune in for what will be a topic that we revisit in the coming weeks and months!

Empowering Plans: P162 – Mind the Gap 2.0: Don’t be Afraid to Ask for a Handbook

On May 12, 2023
In this episode of Empowering Plans, Kelly Dempsey and Kevin Brady outline the relevant details provided within our Handbook Gap Free Reviews. They provide a description of the service, the case studies which gave rise to this service and describe why a review of the Handbook is more important now than ever before!