Total Benefit Solutions Inc

Level Funding 101: How Small Businesses Can Beat Rising Insurance Premiums

February 6, 2026Ed MacConnell

If you're a small business owner, you've probably noticed that your group health insurance for employers keeps getting more expensive every year. The 2026 renewals are already showing premium increases that'll make your accountant cringe. But here's something most business owners don't know: you're not stuck choosing between sky-high premiums and dropping coverage altogether. Level funding is the middle ground that's been saving small businesses thousands of dollars: and it's time more employers knew about it. What Exactly Is Level Funding? Think of level funding as the "Goldilocks" of health insurance. It's not fully insured (where you pay fixed premiums and the insurance company takes all the risk), and it's… Read More

Medicare Secondary Payer Rules Explained in Under 3 Minutes

February 4, 2026Ed MacConnell

If you're an employer with Medicare-eligible employees on your group health plan : or you're an employee trying to figure out whether to drop your employer coverage once you hit 65 : you need to understand Medicare Secondary Payer (MSP) rules. These rules determine which insurance pays first when someone has both Medicare and employer-sponsored coverage. Get it wrong, and you could face claim denials, surprise bills, or even compliance penalties. Let's break it down in plain English. What Are Medicare Secondary Payer Rules? Medicare Secondary Payer rules determine the order in which insurance plans pay when someone has both Medicare and other coverage (like group health insurance from an… Read More

Lost Your Job? Here's Your Complete Guide to Health Insurance Options (COBRA vs ACA vs Medicaid Compared)

February 1, 2026Ed MacConnell

Losing your job hits hard enough without worrying about losing your health insurance too. The good news? You've got options, and we're going to walk through every single one so you can make the smartest choice for your situation. Here's the reality: You have 60 days from your last day of coverage to make a decision. That might seem like plenty of time, but trust me: these 60 days fly by when you're dealing with job searches, unemployment paperwork, and everything else that comes with a career transition. The three main paths forward are COBRA (continuing your old employer's plan), ACA Marketplace plans (buying individual coverage), and Medicaid (government assistance… Read More

7 Mistakes You're Making with Group Health Insurance Costs (and How to Fix Them)

January 29, 2026Ed MacConnell

Let's be real: group health insurance for employers isn't cheap. And if you're running a small or mid-sized business, every dollar counts. The frustrating part? Many business owners are overspending on their group health benefits without even realizing it. The good news is that most of these costly mistakes are completely fixable. You just need to know what to look for. We've helped countless employers find affordable group health insurance that actually works for their teams and their budgets. Along the way, we've spotted the same mistakes popping up again and again. Here are the seven biggest ones: and exactly how to fix them. Mistake #1: Choosing a Plan Based… Read More

Medicare Secondary Payer Rules Explained: Your Quick-Start Guide to 2026 Compliance

January 26, 2026Ed MacConnell

If you're an employer offering group health benefits, or an employee trying to figure out how your coverage works alongside Medicare, the Medicare Secondary Payer (MSP) rules are something you absolutely need to understand. And with 2026 shaping up to be a major enforcement year, now's the time to get your compliance ducks in a row. Let's break down what the medicare secondary payer rules actually mean, when Medicare pays second, and what you need to do to stay on the right side of the regulations this year. What Are Medicare Secondary Payer Rules? Here's the deal: Medicare doesn't always pay first for your healthcare costs. In certain situations, another… Read More

Looking For Affordable Group Health Benefits? Here Are 10 Things Small Businesses Should Know

January 22, 2026Ed MacConnell

Running a small business means wearing a dozen hats, and figuring out affordable group health insurance shouldn't require a PhD in healthcare policy. Yet here you are, trying to attract top talent while keeping your budget intact. Good news: group health benefits for small business owners are more accessible than you might think. Whether you've got two employees or twenty, there are options that won't drain your bank account. Let's break down the ten essential things you need to know before making this critical decision. 1. You Don't Need a Big Team to Qualify Here's something that surprises a lot of small business owners: group health insurance typically requires just… Read More

Is "Junk" Insurance Worth It? Understanding Short-Term Health Plans

January 18, 2026January 18, 2026Ed MacConnell

Short-term health insurance plans have earned the nickname "junk insurance" from critics, but that doesn't tell the whole story. While these plans come with serious limitations, they can serve a purpose in very specific situations. The question isn't whether they're inherently good or bad: it's whether they're right for your particular circumstances. Let's cut through the noise and break down exactly what you're getting (and what you're not getting) with short-term health plans, so you can make an informed decision. What Are Short-Term Health Plans? Short-term medical insurance plans are temporary health coverage designed to bridge gaps between more comprehensive insurance policies. Think of them as a Band-Aid solution: they're… Read More

Does Group Health Plan Compliance Really Matter in 2026? Here's the Truth

January 16, 2026Ed MacConnell

Let's cut right to it: if you're an employer offering group health insurance, compliance isn't optional. It's not a "nice to have." It's the law. And in 2026, the requirements are more detailed: and the deadlines more numerous: than ever before. We get it. You're busy running a business. The last thing you want to think about is a mountain of IRS forms, federal attestations, and employee notices. But here's the truth: ignoring group health plans requirements can cost you big time. We're talking fines, penalties, and potential legal headaches that no business owner wants to deal with. So does group health plan compliance really matter in 2026? Absolutely. Let's… Read More

What Is Minimum Essential Coverage (MEC)? Understanding Your Health Plan Options

January 14, 2026Ed MacConnell

If you've ever shopped for health insurance, you've probably come across the term "Minimum Essential Coverage" or MEC. It sounds official. Maybe even a little intimidating. But here's the thing, it's actually a pretty straightforward concept once you break it down. Let's cut through the jargon and talk about what MEC actually is, why it matters in 2026, and how it affects you whether you're an individual looking for coverage or an employer trying to do right by your team. So, What Exactly Is Minimum Essential Coverage? Minimum Essential Coverage is any health insurance plan that meets the requirements set by the Affordable Care Act (ACA). Back when the ACA… Read More

Alternatives to ACA plans

December 29, 2025December 29, 2025Ed MacConnell

Here’s a clear, well‑organized breakdown of the main alternatives to ACA (Affordable Care Act) health insurance plans, grounded in the search results you triggered. — 🌟 Alternatives to ACA Health Insurance Plans People often look for non‑ACA options when they don’t qualify for subsidies or want lower premiums, more flexibility, or year‑round enrollment. The search results highlight several categories of alternatives. — 🧭 Main Categories of ACA Alternatives 1. Short‑Term Health Insurance – Designed for temporary gaps (between jobs, waiting for coverage, etc.) – Lower premiums, fast enrollment – Not ACA‑compliant → can exclude pre‑existing conditions, limit benefits, cap payouts – Available year‑round Sources: — 2. Health Care Sharing Ministries… Read More

Understanding ICHRA & Subsidy Eligibility

December 19, 2025December 19, 2025Aris Herrera

This resource helps employees understand how an Individual Coverage Health Reimbursement Arrangement works and how it may affect eligibility for marketplace subsidies. It explains what affordability means under ACA guidelines, walks through how to determine if an ICHRA is considered affordable, and outlines the guide is designed to make the process easier to understand so individuals can make informed decisions about their health insurance.

Lost Your Job? Here’s Your Complete Guide to Health Insurance Options (COBRA vs ACA vs Medicaid Compared)

December 6, 2025December 23, 2025Ed MacConnell

Losing your job hits hard enough without worrying about losing your health insurance too. The good news? You’ve got options, and we’re going to walk through every single one so you can make the smartest choice for your situation. Here’s the reality: You have 60 days from your last day of coverage to make a decision. That might seem like plenty of time, but trust me: these 60 days fly by when you’re dealing with job searches, unemployment paperwork, and everything else that comes with a career transition. The three main paths forward are COBRA (continuing your old employer’s plan), ACA Marketplace plans (buying individual coverage), and Medicaid (government assistance… Read More

TEMPORARY SEP

December 1, 2025November 28, 2025Aris Herrera

Temporary SEP for year one of the Medicare Plan Finder MA Provider Directory For your awareness, CMS has a new Special Election Period (SEP) for 2026 – Code: DIR SEP. This SEP allows beneficiaries who enrolled directly through the Medicare Plan Finder (MPF) to make a plan change if the MPF Provider Directory included incorrect information and is only valid for 1/1/26-12/31/26 enrollments. The intent of this SEP is to allow an individual who relied on the MPF Provider Directory to make a change to their MA plan election to stay with their preferred providers. To use this SEP, beneficiaries must call 1-800-MEDICARE to have a representative confirm that their… Read More

United Concordia dental

November 28, 2025November 28, 2025Aris Herrera

United Concordia Dental offers a digital member ID that makes accessing your dental plan information quick and easy. With your digital ID, you can view your plan details anytime on your phone, tablet, or computer. Whether you need your member ID number for customer service, submitting claims, or managing your benefits, it’s always available at your fingertips. Download the United Concordia dental or create an account online.

New legislation expands benefit accounts

November 17, 2025November 13, 2025Aris Herrera

Here’s what you need to know about HSA and DC-FSA changes. New legislation in the H.R.1 Bill, more commonly known as the One Big Beautiful Bill Act (OBBBA), expanded the rules around Health Savings Accounts (HSAs), including enrollment eligibility and eligible expenses, and Dependent Care Flexible Spending Accounts (DC-FSAs). Most changes will go into effect Jan. 1, 2026, however one change regarding telehealth services is retroactively effective to Jan. 1, 2025. As a result of this legislation, regulatory guidance will be issued over the next few months, and HSA Bank’s forms, educational resources and more will be updated to reflect these changes. In the meantime, use this summary and guidance… Read More

2026 Medicare Parts A & B Premiums and Deductibles

November 15, 2025November 15, 2025Ed MacConnell

Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025 Your Total Benefit Solutions, Inc experts, can help you compare and choose the best Medicare supplement coverages for you. Contact us today at (215)355-2121 or www.totalbenefits.net Prefer to shop and research on your own? Click here: https://planenroll.com/?purl=Edward-MacConnell Click here to download the fact… Read More

Individual Coverage HRA: Choice and affordability

November 14, 2025November 14, 2025Aris Herrera

Choosing the right health insurance can be overwhelming, but the new Individual coverage HRA(ICHRA) option makes it easier for employers and employees to find affordable, flexible coverage that fits their needs. With an ICHRA, businesses of any size can reimburse employees for the individual health insurance plan that works best for them creating more choice, more control and often more savings. To learn more or explore the ICHRA plan options, click here: Total Benefit Solutions, Inc. – Flex Plan Solutions

Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans

November 11, 2025November 11, 2025Aris Herrera

CMS has just released information about Medicare Part D plans for 2026, including plan availability and premiums for the coming year. As this year’s Medicare open enrollment period approaches, there’s some good news for Medicare Part D enrollees when it comes to monthly PDP premiums – lower on average, according to CMS – even as the total number of PDPs available drops yet again. The headline of CMS’s press release emphasized stability in the Part D marketplace, but a quick review of the data shows that the total number of stand-alone drug plans available in 2026 will fall for the third year in a row, as plan sponsors scale back their PDP offerings (for… Read More

Gag Clause Attestation Due December 31, 2025

November 3, 2025October 28, 2025Aris Herrera

As previously reported, insurance carriers and plan sponsors of group health plans must submit information annually to the Centers for Medicare and Medicaid Services (“CMS”) attesting that their plans do not include prohibited gag clauses by December 31st each year. The next attestation is due by December 31, 2025. A gag clause is a contractual term that directly or indirectly restricts specific data and information that a plan or issuer can make available to another party. These clauses may be found in agreements between a plan or carrier and any of the following parties: A gag clause may also be found in the downstream agreements of the service provider. Carriers and… Read More

Highmark Updated Billing Addresses in Pennsylvania

October 30, 2025October 28, 2025Aris Herrera

What do I need to know? Effective immediately, we’re consolidating billing addresses across all Pennsylvania markets. This change will streamline many steps in the billing process and allow for clearer communication to the market. It applies to clients in the following Highmark companies in small and large group: Clients in Northeastern and Southeastern Pennsylvania aren’t impacted by this change – they’re already using the newer addresses. For clients who pay premium by mail: All Pennsylvania premium payments that are mailed should go the new address: PO Box 382146, Pittsburgh, PA 15251-8146. This address has been updated on invoices and throughout other materials. Premium payments sent to the old address will be… Read More

Allegheny Health Network and Heritage Valley Health System Sign Affiliation Agreement

October 27, 2025October 24, 2025Aris Herrera

Organizations Pledge Expanded Access to High-Quality Care in western Allegheny County and greater Beaver County as Heritage Valley’s Hospitals, Outpatient Clinics and Physician Practices become part of AHN and Highmark Health. Beaver, PA (Oct. 16, 2025) – Officials from Heritage Valley Health System (HVHS), the Heritage Valley Health System Foundation, Highmark Health and Allegheny Health Network (AHN) joined community leaders and hospital employees today to celebrate the signing of an affiliation agreement that will strengthen and expand the services that HVHS provides to residents in western Allegheny County, greater Beaver County and the surrounding region. Pending government approval of the transaction, the affiliation will establish Heritage Valley Beaver and Heritage Valley Sewickley as AHN’s 15th and 16th… Read More

2026 Cost of Living Adjustments

October 24, 2025October 24, 2025Aris Herrera

The IRS has released cost of living adjustments for 2026 under various provisions of the Internal Revenue Code (“Code”). Some of these adjustments may affect your employee benefit plans. Cafeteria Plans – Health Flexible Spending Arrangements Annual contribution limitation For plan years beginning in 2026, the dollar limitation under Code Section 125(i) for voluntary employee salary reductions for contributions to health flexible spending arrangements (“health FSAs”) increased from $3,300 to $3,400. Annual maximum carryover For cafeteria plans that permit the carryover option, the maximum unused amount from a health FSA that can be carried over to the following plan year is $680 for plan years beginning in 2026 (up from… Read More

Navigating Delaware Paid Family and Medical Leave

October 14, 2025October 14, 2025Aris Herrera

Think of Paid Family & Medical Leave (PFML) in Delaware as a 2-lane highway: the State Plan and the Private Plan. The destination is the same no matter which route an employer chooses, but depending upon their circumstances, employers might find that one or the other is an easier trip. Employers who haven’t decided which path to choose will need to do so soon. When considering the Private Plan route, it’s important to stay on top of state-mandated deadlines. The Private Plan application window is similar to an open enrollment window. And it’s open NOW: October 1 through December 1, 2025. This is the last opportunity for a Private Plan to go into effect at the same time… Read More

Video: Health Insurance Open Enrollment

October 8, 2025October 10, 2025Aris Herrera

Medicare Part D Notification Requirements (From IBC)

October 7, 2025October 9, 2025Aris Herrera

Below is an important notice from Independence Blue Cross regarding Medicare Part D notification requirement for 2025-2026 Dear Valued Benefits Administrator: As you may know, employers that offer prescription drug coverage to their Medicare-eligible employees, retirees, and dependents (collectively referred to as “members”) must notify them by October 15, 2025 of whether that coverage is “creditable” or “non-creditable.” We are writing to remind you that requirement and to provide you with information on the statues of Independence Blue Cross (Independence) prescription drug plans. This Requirement is Part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which added a new prescription drug program to Medicare known as… Read More

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