The Phia Group Introduces PgcReferral@phiagroup.com

PgcReferral@phiagroup.com As 2016 is right around the corner, we’ve seen an influx of employer questions and concerns. Employers seem particularly worried about the ACA reporting requirements. In light of all this uncertainty, we want to remind you that Phia’s consulting t
Continue Reading →

The Problem with Wraps

By Adam V. Russo, Esq. (As published in Thompson Information Services’ Employer’s Guide to Self-Insuring Health Benefits) If you are a long time reader of mine, I would first like to say thank you for being the only person other than my mother to read what I write.  It is
Continue Reading →

Planning Ahead Through Your Plan Document (Part 2)

By Adam V. Russo, Esq. Self-Insuring Health Benefits – Thompson Information Services Adam Russo, Esq. is the co-founder and CEO of The Phia Group, LLC, a cost containment adviser and health plan consulting firm. In addition, Russo is the founder and managing partner of The Law Offices
Continue Reading →

Employers that understand proper utilization can identify the waste and inefficiency in their own employee benefit plans.

By: Sean Donnelly (from The PHia Group, LLC) Some of our client TPAs have been inquiring about methods to drive utilization. Some clients are recognizing that Plans can potentially save a great deal of money by driving Plan Participants to utilization as opposed to traditional methods
Continue Reading →

My HealthGuide Newsletter

News for the Self-Funded Community 2/10/2014 Article Taken From:  MyHealthGuide  Written by: Roy F. Harmon III, Esq. Having reviewed the Plan documents, the Court and both parties now agree that the SPD is incorporated within the Plan. The Supreme Court’s scrutiny of the plan do
Continue Reading →

6 steps to brewing up a self-funded plan

Beer brewing and health plan implementations rarely are considered in the same sentence. But why not? Both have a series of steps to follow, pitfalls to avoid and significant effects on the economy and employment. In 2012, 60% of covered workers were in a self-funded plan. The brewing
Continue Reading →

Express Oil Change, LLC v. ANB Ins. Serv., Inc. 2013 WL 1245748 (N.D. Ala. 2013).

Recently brought to our attention is the case of Express Oil Change, LLC v. ANB Ins. Serv., Inc., 2013 WL 1245748 (N.D. Ala. 2013). In this case, a benefit plan sponsor is suing its broker for failing to preemptively advise the plan regarding differences between the plan’s document la
Continue Reading →

Scheduled to be voted on the floor of the House — Tuesday, April 30:

 This is the “Silent PPO” bill in its fourth iteration; TABA has successfully quashed this legislation in the past three legislative sessions. This year, hoping to neuter our opposition, the bill omits the requirement that TPAs or their employer-clients register as PPOs ba
Continue Reading →

It Pays to Add a Statute of Limitations to Your Plan’s Claims Procedure

ERISA requires that plans contain a reasonable claims procedure. Courts have generally required claimants to exhaust that claims procedure before filing a lawsuit. In addition, if the plan gives the plan administrator discretion to interpret the plan and decide claims, a court will of
Continue Reading →

The Power of Dicta—Make-Whole Relief Under ERISA Comes to the Fourth Circuit

On July 5, 2012, the United States Court of Appeals for the Fourth Circuit Court issued a significant opinion concerning the liability of insurers (and, potentially, employers) that are alleged to have provided misleading or faulty summary plan descriptions (SPDs) to employees.  The c
Continue Reading →