Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… Read More

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Cafeteria Plans (Section 125 Plans)

Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Medigap Plans: Comparing Costs

Ed MacConnell

When selecting a Medigap policy, it’s important to compare offerings from multiple insurance companies, especially if you’ve already chosen a specific standardized plan. While policies with the same letter designation provide identical benefits, premium costs can differ between insurers. For example, Policy A from Company 1 offers the same coverage as Policy A from Company 2, but the two companies may set different pricing. At Total Benefit Solutions, Inc we look at many factors besides price including length of time in market, ease of use and client service availability. When choosing a Medigap, ask what factors the Medigap insurance company uses to set your premium. The following factors may affect… Read More

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UHC Medicare Ending Independent Broker Relationships and Compensation

Ed MacConnell

Beginning June 1, UnitedHealthcare will no longer pay new or renewal commissions on Medicare Prescription Drug Plans. This effectively ends agent participation in the market through UnitedHealthcare products. UnitedHealthcare is also announcing the end of lifetime commissions on its UnitedHealthcare AARP Medicare Supplement products in Florida, Maine, Maryland, New Mexico, and Texas. The end of commissions impacts both new and internal replacements for applications with signature dates on or after June 4, 2025, and an effective date of July 1, 2025, or later. To our Total Benefit Solutions, Inc clients these changes effectively remove our ability to continue working with these plans. Please contact your Total Benefit Solutions, Inc health insurance specialists… Read More

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HRA Solutions : ICHRA vs. QSEHRA: Choosing an HRA that fits

Ed MacConnell

What works? An ICHRA or a QSEHRA? It helps to understand the differences. An ICHRA allows businesses to reimburse employees for health insurance, while a QSEHRA is designed for small businesses with fewer than 50 employees and has annual contribution limits. Read on to determine which option best fits your company’s needs. When comparing an ICHRA vs. a QSEHRA, the key difference is eligibility:  A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is for small businesses with fewer than 50 employees. An Individual Coverage Health Reimbursement Arrangement (ICHRA) is available to businesses of any size, offering greater flexibility. With HRAs growing in popularity, choosing the right option depends on your company’s size, employee needs,… Read More

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How will Aetna’s departure affect ACA exchanges?

Loramei Romeo

Aetna’s decision to withdraw from the Affordable Care Act (ACA) marketplaces in 17 states by the end of 2025 raises questions about the stability and future of these exchanges. While it’s uncertain if other carriers will follow Aetna’s lead, the history of the ACA marketplace has been marked by a dynamic pattern of exits and entries. We understand that navigating the ever-changing regulations and economic challenges can be daunting for consumers seeking health insurance. The future of health insurance exchanges is uncertain, which is why it’s crucial to emphasize policy stability and market adaptability. The ACA exchanges play a vital role in providing access to health insurance, but they do… Read More

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New Federal Rule Cuts Short-Term Health Plans to 4 Months, Affecting Coverage Options

Ed MacConnell

HHS rule applies to short-term limited duration insurance (STLDI) plans sold or issued on or after September 1, 2024. A final rule announced by the Departments of Treasury, Health and Human Services, and Labor in March 2024, has imposed new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The rule – which applies to plans sold or issued on or after September 1, 2024 – limits new STLDI plans to three-month terms, and caps total duration – including renewals – at no more than four months. A “renewal” includes a new policy issued by the same insurer (or another insurer in the same controlled group, meaning they’re treated… Read More

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ACA Individual Market Highmark

Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

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Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

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Small Shifts, Big Impact: Simple Strategies to Elevate Your Overall Well-Being

Loramei Romeo

Feeling your best—inside and out—doesn’t always require a drastic overhaul. Sometimes, the smallest shifts in daily habits can yield the biggest results. The goal isn’t to chase perfection but rather to create a sustainable routine that fosters both physical and mental wellness. From the way you start your mornings to ensuring you have the right safety nets in place, every choice you make contributes to your overall well-being. Here are a few simple yet powerful strategies to help you feel more energized, balanced, and at peace with yourself. Begin Your Day with Purpose Mornings set the tone for the rest of your day, and a chaotic start can leave you… Read More

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Next Year Cost for Pennie Customers May Increase

Loramei Romeo

Pennie has announced that enrollees receiving advance premium tax credits will likely face higher costs in 2026 due to the expiration of enhanced federal tax credits at the end of 2025. This change will result in increased monthly premiums for most enrollees unless Congress acts to extend these credits. Pennie is committed to keeping customers informed through various communications, including postcards, emails, and text messages, to help them understand the upcoming changes and find the lowest costs on high-quality health coverage. The enhanced tax credits, introduced in 2021, have provided significant financial savings, but their expiration means reduced savings for many enrollees starting January 2026. We are dedicated to providing… Read More

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Price Transparency Rules Addressed in New Executive Order

Loramei Romeo

On February 25, 2025, Executive Order 14221 was signed, enhancing health care price transparency rules. This order builds on previous regulations by requiring actual prices for health care services, standardizing pricing data reporting, and strengthening enforcement policies. Employers with fully insured plans must ensure their carriers comply, while those with self-funded plans should contract with third-party administrators to meet disclosure requirements. The new guidance is expected by May 26, 2025, and employers should prepare to update service agreements accordingly. Have Questions? and want to read more about the changes click New Executive Order Addresses Price Transparency Rules for more details. We are dedicated to providing exceptional service, so please do… Read More

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South Jersey Radiology is in the Clover Network

Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025.  New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

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Benefits 101 Comparison HSAs HRAs FSAs

Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Stretching Your Healthcare Dollars

Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Enhancing the security of member portal registrations

Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

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Compliance Checklist for Calendar Year 2025

Loramei Romeo

The calendar year 2025 has released its deadline for small groups (less than 50), some deadlines may change depending on the plan start date that is not January 1st. The calendar shows the Section 6055/6056 filing deadline to the dates with Medicare part d notice. Have Questions? and want to read more about the changes click Calendar Year Compliance Checklist for more details. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Recent Lawsuits Face Scrutiny for Tobacco Surcharges

Loramei Romeo

Recently, there has been an increase in class action lawsuits targeting large group health plan sponsors. These lawsuits claim that the extra insurance premiums charged to tobacco users, known as “tobacco surcharges,” through wellness programs violate HIPAA nondiscrimination rules. This litigation serves as a reminder for employers to thoroughly review their plan designs to ensure compliance with these regulations. Below is a summary of the plaintiffs’ arguments and some key considerations for employers when implementing tobacco-related incentives. Have Questions? and want to read more about the changes click Tobacco Surcharges Face Growing Scrutiny in Recent Lawsuits for more details. We are dedicated to providing exceptional service, so please do not hesitate… Read More

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Updated Guidance Offers More Information on Form 1095-C Reporting Relief

Loramei Romeo

The IRS released Notice 2025-15, providing guidance on an alternative method for furnishing Forms 1095-C and 1095-B under the Affordable Care Act. This new method allows employers to provide these forms only upon request, given they meet specific notice requirements, including clear communication and accessibility on their website. Employers must post the notice by March 3, 2025, and ensure it remains accessible through October 15 of the following year. Despite this change, employers are still required to file all 2024 Forms 1095-C with the IRS electronically by March 31, 2025. Employers should review their current delivery policies and decide whether to adopt this new method while ensuring compliance with any… Read More

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Message for our valued partners from IBX

Loramei Romeo

IBX, mission is to improve the health and well-being of those we serve. We are committed to innovation to reduce costs, provide equitable, holistic health care, and simplify the user experience for everyone we have the privilege to serve. To achieve these objectives, we embarked on an ambitious plan two years ago to transition our business to a more modern, flexible platform. This plan aims to streamline processes, enhance accuracy, and improve plan configurability, resulting in a more modern, personalized, and enhanced user experience. We appreciate your support and partnership in this ambitious endeavor. We acknowledge that some of these changes have presented challenges, and your understanding and support have… Read More

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Kroger pharmacy is back in MA and PDP network

Loramei Romeo

Kroger and affiliated pharmacies have rejoined Medicare Advantage (MA) and Prescription Drug Plan (PDP) network which are effective on February 5, 2025. Kroger is included in the network for all our PDP plans, such as Saver Rx, Extra Rx, and Assurance Rx. Starting February 5, 2025, all claims from Kroger pharmacies will be processed as in-network. Claims made before this date will not be reimbursed. Below is a list of Kroger and its affiliated pharmacies that are now in our MA and PDP network. Bakers Pharmacy Dillon Pharmacy Gene Maddy Kroger Owen’s Pharmacy QFC Pharmacy City Market Fred Meyer Pharmacy Gerbes Pharmacy Mariano’s Pharmacy Payless Pharmacy Ralphs Pharmacy Copps Food… Read More

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Latest Developments in the Johnson & Johnson ERISA Fiduciary Case

Loramei Romeo

The U.S. District Court of New Jersey recently dismissed claims in a class action lawsuit against Johnson & Johnson (J&J) regarding the management of their prescription drug benefits. The plaintiffs alleged that J&J breached its fiduciary responsibilities under ERISA, resulting in higher payments for prescription drugs, premiums, deductibles, coinsurance, and copays, as well as lower wages and limited wage growth. However, the court ruled in J&J’s favor on the fiduciary breach claims, stating that the plaintiff lacked Article III standing due to speculative allegations about higher premiums and insufficient evidence of redressable injury. Despite this, the court did not dismiss the claim that J&J failed to furnish requested plan documents,… Read More

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New Guidance Released for the No Surprises Act and Gag Clause Prohibition

Loramei Romeo

The new guidance on the No Surprises Act (NSA) and gag clause prohibition, detailed in FAQ Part 69, clarifies the requirements for open negotiation, notice, and disclosure for plans, issuers, and providers related to the Independent Dispute Resolution (IDR) process. It addresses the coordination of surprise billing rules and plan sponsor responsibilities regarding gag clauses. The NSA protects against surprise medical bills for out-of-network costs, limiting individual cost-sharing to an amount based on the Qualified Payment Amount (QPA). The federal IDR process resolves disputes on reimbursement amounts, with FAQ 69 addressing recent litigation impacts on QPA calculation and other NSA implementation questions. The gag clause prohibiting compliance requires agreements to… Read More

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