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Thank You Clients, Partners, Friends...

  

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I'd like to start by thanking all of you that have chosen The Phia Group as your trusted partner.  I know very well that other options are available to you, and we are inspired and thankful everyday that you place your trust in us.  I have always, and will continue to promise, that our team of recovery specialists, plan drafters, paralegals, lawyers, and support staff will do everything in our power to maximize the benefits while lowering the cost of your health benefit programs!

 

We here at The Phia Group plan on being involved members of this industry for the long haul; and as such, with an eye toward the future, we are always looking for new ways to benefit you and your clients.  When you grow, we grow; when you flourish, so do we.  Our goal is to help you succeed.

 

We want to be your "one-stop-shop" for any and all issues relating to employee health plans and benefit programs.  We want to lower costs, tackle claims, recoup funds that belong to your customers, and redesign your benefit plans to ensure every contingency is considered.  The Phia Group's many products emerge from three general service types:

• Consulting Services - Learn With Us... Confront the issues that impact our industry by coordinating relationships, providing guidance, and addressing conflicts that threaten plan operations and viability.

• Plan Drafting Services - Plan With Us...Set the Industry Standard for Plan Language" by combining cutting edge technology, forward thinking creativity, and a client-centric customizable approach.

• Subrogation & Recovery Services - Save With Us... Offer flexible service options driven by client needs , innovative methods to identify more opportunities and master applicable laws, yielding results unmatched by anyone else.

Regardless of the service, when it comes to The Phia Group and the competition, we dare you to compare!

 

I am confident that 2015 will be an exciting year, and I again want to thank you for supporting The Phia Group.  If you would like to discuss how we can better serve you, or you just want to talk about the latest issues impacting our industry, please let me know.  Happy reading!

 

 

To read all of this quarter's newsletter, click here.

 

SBCs - Revamped Services & Pricing Structure

 

On February 14, 2012, HHS, DOL and IRS (the "Departments") published the final rules regarding the summary of benefits and coverage ("SBC"). The regulations provided that all group health plans and health insurance issuers offering group health insurance coverage must provide applicants, enrollees, and policyholders or certificate holders with an accurate SBC. The SBC must be drafted in a manner consistent with the template and instructions provided by the Department of Labor.

 

Since issuance of the SBC regulations, there have been minimal changes to the SBC template format. The Departments intended to add additional coverage examples along with a minimum value statement and a minimum essential coverage statement to the SBC format for the 2014 plan years. However, the addition of the two statements only was approved.

 

Now after three years of minimal changes to the SBC format, the Departments are considering adding coverage examples beyond diabetes and maternity care.  If approved, this change can be anticipated for the 2016 plan years. Many payers struggle now with providing two coverage examples, so adding a third example (or more) would require additional calculations and quality assurance given the calculation complexities involved.

 

In addition, there is a possibility that the SBC format could change for the 2016 plan year. The Departments received feedback that the current eight-page template does not work very well with account-based plans, employer-assistance plans (EAPs) or prescription-only plans. Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) need further explanation of their impact on participant cost-sharing. The Departments are considering how to accommodate these plans or perhaps provide sponsors with guidance on how to address these complexities.

 

The proposed rule should not come as a surprise. The Phia Group makes sure to notify our customers of any upcoming changes and accommodates our services to the new laws and regulations. Therefore, the Phia Group has extended the SBC services to include the following:

 

*      SBC Drafting

*      Existing SBC Review & Revision

*      SBC Template Modification

*      Coverage Example Calculation

*      Minimum Value Calculation

*      Format & Verbiage Compliance Analysis

*      Benefit Listing Compliance

*      Separate Document Detailing Issues & Suggestions for Improvement

 

With imminent change, payers should recognize that SBCs are a real business challenge and take a proactive approach to avoid the last-minute scramble. While safe harbors have protected payers and employers for three years, there is no guarantee how long they will last. Good faith efforts may no longer be good enough. The Phia Group will make sure the SBC is compliant with the new rules, when requested!

 

 

On the Road Again ... 2015 Upcoming Presentations in the 1st Quarter

• February 17th - TABA - College of Knowledge   - Austin, TX

• February 19th - Caprock HealthCare Forum - SIIA's Self-Insured Health Plan Executive Forum

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Source: http://dailycaller.com/2014/12/17/vermonts-giving-up-on-single-payer-health-care-over-ballooning-costs/

Source: http://www.modernhealthcare.com/article/20141222/NEWS/312229951?utm_source=link-20141222-NEWS-312229951&utm_medium=email&utm_campaign=mh-alert

Non Profit Hospitals? http://passionforsubro.com/how-nonprofit-hospitals-are-seizing-patients-wages/

Source: http://www.huffingtonpost.com/2014/12/19/nonprofit-hospitals-sue_n_6356058.html

by Ron E. Peck, Esq.

Sr. Vice President & General Counsel

Status quo is no longer adequate for the self-funded health benefits industry.  The issue is that, while we all know "new" methods to achieve traditional goals (claim processing, payment, provider relations, claim recoupment, cost containment, etc.) is the endgame, no one is certain who is responsible to invent and implement said processes.  Our industry has for too long focused on costs and revenue.  While money is certainly one factor to consider, the other is risk and the value of removing risk from others.  Peace of mind is as valuable as gold and silver to some.  So, while self-funding often results in cost savings, it also comes with risk; and thus the "savings" we create may not be enough to sway some in our direction.  In other words, the benefits of self-funding need to outweigh the risk.  For some, that risk is unbearable, and thus these "risk averse" employers were willing to pay more over time via premium, to avoid risk; thereby securing fully insured policies.

 

The law has done some work for us.  With the advent of The Patient Protection and Affordable Care Act ("PPACA"), commonly called the Affordable Care Act ("ACA") or "ObamaCare," such fully funded insurance became more expensive; so much so that employers who had in the past been willing to pay a little extra (to avoid the risk that comes with self-funding) could no longer afford to fully insure. 

 

4th Quarter Case Study

                           Implant Cost Pro

 

Get to Know... The Employee of the Quarter!

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Get to Know... The Employee of the Year!

 

To read all of our quarterly newsletter, click here.

Elizabeth Wecomes Ryliegh