Fall is in the air here in New England but the conference schedule is heating up earlier than ever for me.  I'm doing the nationwide tour and the focus from audience questions is on two areas - health care reform and self funding.  The same people who ask me about reform then follow up with whether self funding is a good move to lower their costs.  The interest in self funding is the highest I have seen in my life time so we here at The Phia Group will continue to preach the virtues of this option and how to make it work right. 

Passion for Subro Blog

Press Release - Inc 500/5000

For the Fourth Year in a Row, The Phia Group, LLC has been named to Inc. Magazine's List of America's Fastest Growing Private Companies

NEW YORK, August 21, 2012 -- Inc. Magazine ranked The Phia Group on its 31st annual Inc. 500|5000 list, an exclusive ranking of the nation's fastest-growing private companies. This is the fourth consecutive year that The Phia Group has made it to the list. The list represents the most comprehensive look at the most important segment of the economy--America's independent entrepreneurs. Companies such as Microsoft, Zappos, Intuit, Jamba Juice, Zipcar, Clif Bar, Vizio, Oracle, and many other well-known names gained early exposure as members of the Inc. 500|5000.

"It is an honor to be on this prestigious list for the fourth year in a row, and we are looking forward to year five! Our consistent growth and reputation is a testament to our staff's passion for savings in the health insurance industry." said Adam V. Russo, Esq. CEO, The Phia Group, LLC "Now, more than ever, we depend on Inc. 500/5000 companies to spur innovation, provide jobs, and drive the economy forward.  Growth companies, not large corporations, are where the action is," says Inc. Magazine Editor Eric Schurenberg.

About Inc.

Founded in 1979 and acquired in 2005 by Mansueto Ventures, Inc. is the only major brand dedicated exclusively to owners and managers of growing private companies, with the aim to deliver real solutions for today's innovative company builders.  Total monthly audience reach for the brand has grown significantly from 2,000,000 in 2010 to over 6,000,000 today.  For more information, visit www.inc.com.

About the Inc. 500|5000 Conference

Each year, Inc. and Inc.com celebrate the remarkable achievements of today's entrepreneurial superstars--the privately held small businesses that drive our economy. The Inc. 500|5000 Conference & Awards Ceremony brings together members of the Inc. community, both a new class of Inc. 500|5000 honorees and the list's alumni, for three days of powerful networking, inspired learning, and momentous celebration. Please join us October 3-5, 2012, at the JW Marriott Desert Ridge Resort & Spa in Phoenix, Arizona. For more information about the 2012 Inc. 500|5000 Conference & Awards Ceremony and to register, visit www.inc500conference.com or call 866-901-3205.

More about The Phia Group, LLC

The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. The Phia Group's overall mission is to reduce the cost of plans through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service.

True to its motto "A Revolutionary Passion for Savings," The Phia Group has become one of the most innovative and fastest growing cost containment firms in the nation, and is a pioneer setting the highest standards in the health care marketplace.

Client Spotlight  - EBA&M 

This month, we would like to place a spotlight on eba&M.   

PGC Legal Issue of the Month

by Chris Aguiar

I have recently  taken to the pages of the The Phia Group's monthly newsletter to notify everyone of the recent chink in the armor of private self funded, ERISA qualified, employee benefit plans brought about the 3rd and 9th Circuits.   Now, I am back this month to remind everyone that despite the recent decisions in, all is not lost.  The rulings in the 3rd and 9th Circuits currently represent a minority opinion in the country.  Most circuits that have ruled on the issue have allowed qualified benefit plans to apply the terms as set forth in the summary plan description.  Is there a better way to show that that the "the kids are alright" then to have a recent decision that goes back to the basics and reminds us that a benefit plan's equitable rights are still strong, albeit a bit weakened?

In Smithey v. Tyson Foods, Inc.,  the Plan participant was involved in a motor vehicle accident and received a mediated settlement of $17,500.00.  The Plan had advanced over $53,000.00 in benefits on behalf of the plaintiff.  Though the plan participant refused to reimburse the Plan, she did hold the funds in trust and filed a declaratory action and eventually a Motion for Summary Judgment that the monetary reimbursement to a health insurance plan was not considered "equitable" under ERISA.  If you are thinking to yourself, "this sounds familiar"; well, that's because it is.  The Plaintiff was attempting to assert the age old argument that the Supreme Court resolved for us back in 2006 when it used Sereboff v. MAMSI to clarify its decision in Great West v. Knudson  that a plan could was entitled to an equitable lien or equitable remedy as long as it sought to recover funds in actual on constructive possession of, rather than impose personal liability on the plan participant. 

And so, the court in Smithey ruled in favor of the benefit plan because the plan participant was in possession of the funds, and the Plan was trying to recover a particular fund from the plaintiff, not simply impose personal liability, and therefore was seeking a valid equitable remedy.

It is sometimes beneficial to go back to basics and view the forest through the trees.  I use this case today to illustrate a bigger point, the Sereboff decision is still the controlling law of the land as it pertains to a plan's ability to impose an equitable remedy; and until the Supreme Court rules on the case of U.S. Airways v. McCutchen, many Federal jurisdictions agree that a plan can have an equitable lien by agreement and will defer to plan terms, rather than reform the terms of the plan and impose equitable limitations on a plan's recovery rights.  It is always, however, very important to remember that one cannot build a house without a foundation.  Comprehensive plan language is absolutely necessary to ensure that a plan can circumvent equitable doctrine.  No matter where in the country you are located, insufficient plan language will almost always lead to reduced recoveries. Additionally, a proactive recovery strategy is undoubtedly the most effective means of maximizing recovery opportunities.  As long as you have the foundation in place, and capable representatives on the ground, you can be sure that you have the tools you need to maximize your recoveries.  Hopefully, the Supreme Court sides with the majority and helps us re-establish a full right of reimbursement.

PGC Issue of the Month - SBC Regulation

by Shauna White

By now, most everyone is aware of the regulations requiring health plans to issue Summary of Benefits and Coverage (SBC). Over the last few months, we have fielded many questions regarding what information needs to be included in the SBC.   As we get closer to deadline, the prevailing question has shifted from "What needs to be in the SBC?" to "What are the rules for distributing the SBC?" If you need the answer to the latter question, please see the information below, courtesy of the DOL:

The final regulations require that the SBC be provided in several instances:

• Upon application. If a plan (including a self-insured group health plan) or an issuer distributes written application materials for enrollment, the SBC must be provided as part of those materials. For this purpose, written application materials include any forms or  requests for information, in paper form or through a website or email, that must be completed for enrollment. If the plan or issuer does not  distribute written application materials for enrollment (in either paper or electronic form), the SBC must be provided no later than the first date on which the participant is eligible to enroll in coverage.

• By first day of coverage (if there are any changes). If there is any change in the information required to be in the SBC that was provided upon application and before the first day of coverage, the plan or issuer must update and provide a current SBC no later than the first day of coverage.

• Special enrollees. The SBC must be provided to special enrollees no later than the date on which a summary plan description is required to be  provided (90 days from enrollment).

• Upon renewal. If a plan or issuer requires participants and beneficiaries to actively elect to maintain coverage during an open season, or provides them with the opportunity to change coverage options in an open season, the plan or issuer must provide the SBC at the same time it distributes open season materials. If there is no requirement to renew (sometimes referred to as an "evergreen" election), and no opportunity to change coverage options, renewal is considered to be automatic and the SBC must be provided no later than 30 days prior to the first day of the new plan or policy year.

• Upon request. The SBC must be provided upon request for an SBC or summary information about the health coverage as soon as practicable but in no event later than seven business days following receipt of the request.

We will be sure to keep you all posted of any changes or updates to this important regulation.

Recovery Case of the Month

by Tianna Pagan