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"A Look Behind... A Look Ahead... Lessons learned in 2013, and predictions for the coming year"
January 08, 2013
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The Phia Group, LLC

January 02, 2014
Quarterly Newsletter
Fourth Quarter 2013
In This Issue
The Book of Russo - From the Desk of the CEO


2014 is now upon us and I can't imagine it being any crazier, both personally and professionally, than 2013; of course, I'll probably say the same thing next year!  Thanks to your concerns and needs, we have many exciting new opportunities coming your way this year.  2014 will be the year of self funding where we see the industry grow to heights never seen before.  With growth comes many potential pit falls, as always, we are here to get you through them.  It will be interesting to see how Obamacare fares in 2014 and what it does to the employer based healthcare system.  I am optimistic that things will work out for us in the end and that we will be stronger for it.  Just remember that through all the chaos, The Phia Group will be your one stop for all of your cost containment and consulting needs.  2013 was great - the prospects are even brighter for this year!!!!  Happy reading!

Letter from the Editor

The snow has finally come, the holidays are here and I am already regretting my decision to buy a rear wheel drive sports car! It may not be Santa's Workshop, but behind the scenes of our industry, this is the time of year when our clients are most busy retaining existing business, acquiring new customers and The Phia Group is preparing for another wild rollercoaster ride in 2014.


In 2010, we all knew we were in for some big years. Indeed, it truly feels as if the last 4 years have been spent tirelessly preparing for the inevitable change that was President Obama's sweeping healthcare law. We hope you'd agree that The Phia Group has been here for you during this tumultuous phase, performing research and conducting calls with the DOL, HHS, IRS, NAIC and others... in an effort to secure guidance for you and your clientele.  


As we all know, crowding out private efficiencies with bureaucratic interests is bound to lead to failures in some capacity. We have seen it time and time again; between delayed regulations and conflicting guidance to misconceived rulings and the epic failure of the government's online enrollment website. In some cases, we were left frustrated and confused, but in others, we've been able to take advantage of the delays and missteps.


Lo and behold, here we still stand, alive and (relatively) well. Perhaps even better? Perhaps, thriving? In my travels this year I have observed a shift to self funding by entities we'd never have previously expected to come our way. Whether it's The Phia Group's existing clients informing me that most of their new business is coming from fully insured entities, or witnessing some of the fully insured carriers refocusing resources towards their self funding arm, it has become apparent that the advantage inherent in self funding is better recognized now than ever before.


The downside of change has always been uncertainty; but from chaos comes new opportunities... The upside is real; as the new rules are seemingly pushing our industry into the spotlight... bringing us into the crosshairs of the cost conscious, seeking options and opportunities to offer unique customized plans with the true cost containment characteristics.


So, it is with optimism that I say, as we enter 2014, I look forward to seeing you all... I look forward to enjoying the spoils of our adventures... and I look forward to sharing more good news with you in the New Year.


Travel starts again in February, with the HCAA event in Las Vegas; I look forward to seeing many of you there. Have a Happy Holiday and have a wonderful New Year!

A Revolutionary Passion for Savings - Administrative Service Agreements Evolve!


Whether you're a TPA, Plan Sponsor, or anyone else involved in the self-funded industry, you know how important it is that a TPA and their health plan clients execute clear, well thought out Administrative Services Agreements so that both parties can properly perform their respective duties and accomplish their mutual goals.  If either entity thinks the other is responsible for a task they are not in actuality assigned, by the time the issue is discovered, it's too late.


To find out how add our ASA to your arsenal, please contact Andrew Milesky at or call directly at 781-535-5636.

Here at The Phia Group, one of our specialties is providing TPAs with Administrative Services Agreements to serve their needs and the needs of their individual clients.


You must utilize our ASA service to ensure that no responsibility is overlooked and to avoid misunderstandings.  For instance, one client third party administrator thought their customer - the benefit plan - was handling reimbursement to their stop loss carrier when third party recoveries occurred.  The plan, meanwhile, thought the TPA handled all stop loss affairs.  Neither entity, therefore, handled reimbursement to stop loss after subrogation resulted in recoupment of funds; an instance that led to an accusation of contractual breach.  Are you confident your ASA covers this issue, and others like it?




The Phia Group prides itself in providing the best Administrative Services Agreement templates to the industry. We include language that helps TPAs properly administer claims while ensuring that both TPAs and the health plans they serve are able to efficiently manage costs while providing language that is both strong and reasonable enough for the parties to avoid conflicts.  Every possible service, responsibility, and role is covered so there can be no confusion regarding who handles what. 




Already have a template "ASA" that merely needs some updating?  Your client requires you to work off of an existing contract?  No worries!  The Phia Group can examine any and all administrative service agreements, provide commentary, make suggestions, and revise the document - transforming it into the perfect contract.


NEW FOR 2014:


We have recently made some changes to our template Administrative Services Agreement; many such changes are geared towards removing ambiguity and ensuring clarity within the Agreement. After all, the relationship between a TPA and health plans it services should be as seamless as possible.


The Administrative Services Agreement is the tool through which both parties can properly accomplish their respective responsibilities, and we know that both health plans and TPAs have better things to worry about than whether their Administrative Services Agreements afford them all the rights they need to accomplish their goals.  


Some self-funded health plans do not know the difference between TPAs; the difference between a group's signing with you or your competitor can come down to whether a TPA offers an Administrative Services Agreement that is desirable to the health plan. In the current business climate, TPAs would be doing themselves a disservice to not have an Administrative Services Agreement to offer to potential clients that is simultaneously reasonable to the health plan and strong enough to ensure that the TPA can administer claims without concern for its own rights.


In the coming year, keep doing what you do best - and leave your ASA to The Phia Group!

Stop The Presses! - Source: The Self-Insurance Institute of America, Inc. (SIIA), 12/5/2013, 


The Self-Insurance Institute of America, Inc. (SIIA) announced that The Phia Group, LLC has upgraded to Diamond member status. Diamond membership (formerly known as Premier membership) signifies the highest level of support for SIIA and demonstrates a company's leadership position within the self-insurance/alternative risk transfer marketplace.


"Our business has been built successfully over the last decade in large part through active SIIA involvement so it makes perfect sense to become a Diamond member," said The Phia Group CEO Adam Russo. "This decision also reflects our appreciation for the association's effective government relations efforts that are especially important given the ongoing legislative/regulatory developments at both federal and state level."


The Phia Group's membership upgrade reflects an ongoing increased interest among major industry players of the importance of supporting the association that is best positioned to protect and promote the self-insurance/ART marketplace.


Diamond Members receive a special package of valuable benefits including: complimentary/discounted conference registrations, complimentary advertisements in The Self-Insurer, guaranteed opportunities for committee participation, invitation to annual planning meeting with SIIA's board of directors, private meeting space at SIIA national conference, banner advertisement on the home page of SIIA's web site, signage/promotion at all SIIA conferences, and more.

From the Blogosphere -
The Stacks


"Following the Hobby Lobby Case Religiously..."   

by Jon Jablon, Esq.


As you likely know, there are various provisions of PPACA that are being debated, criticized, and even ultimately altered by federal regulations, in some instances. The requirement for contraceptive coverage is no exception - to debate and criticisms, that is. Whether it will be ultimately altered is yet to be determined.


PPACA requires that self-funded plans must cover certain contraception for covered Plan Participants. There is, however, an exemption for religious organizations (the same type exempted from being governed solely by ERISA); such organizations may "self-certify" for an exemption, which is a fancy way to say that the organization can ignore the contraceptive mandate by filling out a single form, upon which the organization must simply give its vague indication that it is exempt. If an organization self-certifies, the TPA that administers claims on behalf of the plan offered by that organization required to assume the duties of Plan Administrator in conjunction with providing coverage for contraception for participants of these plans.


Read On





Get to Know... Employee of the Quarter - Kristin Spath



Since starting with Phia Group Consulting in May, Kristin has been nothing but an asset to her department.   She quickly took a lead role in the development of PGC's new Plan Document system and consistently receives nothing but positive feedback from clients, colleagues and managers.  With a background in web design she has added a new and valuable perspective to the project and the Phia as a whole. 


Her supervisors say that "Kristin has only been a part of our team for a short amount of time but she has been an incredible addition. She caught on very quickly and her work is top notch. With her background in web design, she has been a huge asset for the automation project and has taken the lead on this project. She has been working late, taking things home and logging time on the weekends. Kristin has a great attitude and even with the heavy workload of this project she is ALWAYS willing to help out co-workers. She is quickly rising to become one of Phia's best employees."




Phia News
From Left to Right: Soli Anne & Maeve Grace Russo 


The Phia Group would like to congratulate Adam & Kelly Russo on the birth of their second daughter. They welcomed Maeve Grace Russo into the world on Thursday, December 5, 2013, as well as the official formalization of their other daughter, Soli Anne Russo's, adoption as of Monday, December 16, 2013. 





The Phia Group's own Tara O'Connor married Steven Trojano Jr., on September 7, 2013, with a reception at the Canoe Club Ballroom in their hometown of West Bridgewater, MA; and they lived happily ever after...


The Phia Group proudly teamed up with the Salvation Army and enjoyed setting up its very own "Angel Tree!"  The Salvation Army hung upon our tree "tags," each bearing the name and age of a child in need.  The tag also featured that child's gift wish list, hobbies, and interests.  Generous members of The Phia Group team took the tags from the tree and set out to purchase gifts for these very special kids.  The response was overwhelming; resulting in the Salvation Army "reloading" the tree many times.  This experience brought smiles to our faces and joy to our hearts, and once again reminded us that it is better to give than to receive.



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