Employee Benefits

Current Challenges to Self-Funding: How to Be Prepared

Presented by Adam V. Russo, Esq., Ron E. Peck, Esq.
Recorded On: Wednesday, October 10, 2012
Duration: 90 minutes
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By Phone: 1-800-677-3789

Self-funded health plans have always exposed employers to more risk and uncertainty than insured plans, in return for cheaper coverage on balance. Today, however, health reform and state regulation are adding even more risk and uncertainty to self-insuring, which could end up spoiling its cost advantage and reducing its viability.

Never before have self-funded plans and their proponents had to navigate such treacherous waters to reach their destination of providing maximum benefits for minimum costs:

  • Proponents of state-run health exchanges and state insurance commissioners want to triple minimum stop-loss attachment points, which would make self-funding impossible for many smaller companies.
  • A new body of case law is imposing much stricter penalties on plans that fail to properly explain benefits.
  • Legal deference to plan administrator expertise in court is set to vanish because under health reform, independent review organizations will have the ability to overturn plan decisions. De novo review by courts is set to increase exponentially as well.

In this 90-minute webinar, The Phia Group’s CEO Adam V. Russo, and Senior Vice President Ron E. Peck will discuss some of the most pressing issues self-funded plans face today and how to prepare for these challenges. Plus, you’ll have the opportunity to ask questions during the live Q&A portion of the webinar.

You’ll learn about these threats to self-funding:

  • State proposals to regulate stop-loss insurance for self-funded health plans
  • Affordable Care Act compliance requirements for self-funded plans
  • Expanded definitions of available penalties on plans for administrative errors
  • Erosion of plan’s discretionary authority and the proliferation of de novo review
  • Regulator interest in self-funding and what it really means
  • Evolving reporting and disclosure requirements, such as requests for information and the future of Form 5500s

Who Should Attend:

  • Anyone interested in self-funding
  • Companies considering self-funding
  • Current self-funded benefit plans and plan administrators
  • Brokers
  • TPAs
  • Industry consultants
  • ASOs
  • Public employers
Adam V. Russo, Esq. Adam V. Russo, Esq.
Adam V. Russo, Esq. is the Co-Founder and CEO of The Phia Group LLC; an innovative cost containment and consulting leader in the health insurance industry. In addition, Attorney Russo is the founder and managing partner of The Law Offices of Russo & Minchoff, a full-service law firm with offices in Boston and Braintree, MA.

Attorney Russo’s practice is devoted to representing employers, plan fiduciaries, third-party administrators and carriers in employment and employee benefits matters throughout the United States. He is a frequent speaker and author on health care and employee benefits topics at webinars, conferences and seminars across the country. Attorney Russo’s industry leading blog, www.passionforsubro.com is regularly updated with news and information relevant to the entire health care industry.

Attorney Russo is the Contributing Editor to Thompson Information Service’s Employer’s Guide to Self-insuring Health Benefits. He is also a member of the Self-Insurance Institute of America, Inc. Government Relations Committee. In addition, Attorney Russo is an advisor to the Board of Directors at the Texas Association of Benefit Administrators, and was named to the National Association of Subrogation Professionals Legislative Task Force. He is also a member of the U.S. Chamber of Commerce’s Corporate Leadership Advisory Council.

Ron E. Peck, Esq. Ron E. Peck, Esq.

Ron Peck is an attorney with The Phia Group, LLC, and has been a member of The Phia Group’s team since 2006.  As an attorney with The Phia Group, Ron has been an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third party recovery disputes, and spearheaded efforts to combat the steadily increasing costs of healthcare.  In addition to his duties as counsel for The Phia Group, Ron leads the company’s consulting, marketing, and legal departments.  Finally, Ron assists in the management of the entire organization.

Ron has lectured at and participated in many industry gatherings such as NASP’s Litigation Skills Conference, HCAA, SIIA, and TABA.  Ron is also frequently called upon to educate plan administrators and stop-loss carriers regarding changing laws and strategies.  Ron’s theories regarding benefit plan administration and healthcare have been published in many industry periodicals, and have received much acclaim.  Prior to joining The Phia Group, Ron was a member of a major pharmaceutical company’s in-house legal team, a general practitioner’s law office, and served as a judicial clerk.  Ron is also currently of-counsel with The Law Offices of Russo & Minchoff.

Ron obtained his Juris Doctorate from Rutgers University School of Law and earned his Bachelor of Science degree in Policy Analysis and Management from Cornell University.  Ron is also a Certified Subrogation Recovery Professional (“CSRP”).