Total Benefit Solutions Inc

New Option for NJ Groups with Out-of-State Employees

March 15, 2022March 14, 2022Ed MacConnell

New Jersey small groups with employees residing out-of-state have few options and brokers struggle to provide viable alternatives for these employers. Horizon has introduced a solution with two new plans that include Blue Card Access on their popular OMNIA platform. Gold & Silver Plans became available in the market July 1 Provides access to 95% of the doctors and 96% of the hospitals nationwide, that includes New York, Pennsylvania, and Delaware. These plans reduce the benefit gap between Tier One and Tier Two benefits. Horizon also leveraged OMNIA relationships to provide a very attractive price point for national access. Questions or concerns about this bulletin? Please contact your Total Benefit… Read More

Annual Out-of-Pocket Maximum Adjustments Announced for 2023

March 14, 2022Ed MacConnell

On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For purposes of employer-sponsored health plans, the final rule includes caps on out-of-pocket dollar limits for non-grandfathered group health… Read More

What is the Medicare Advantage OEP?

February 13, 2022Ed MacConnell

If you’re disappointed with your current Medicare Advantage Plan, the Medicare Advantage Open Enrollment Period (MAOEP) is an annual window to make changes to your existing plan. Frequently, we hear how beneficiaries decide to enroll in a Medicare Advantage Plan without fully understanding how these plans work. It happens when beneficiaries try to take on the task of enrolling in a plan without an agent. Sometimes, a beneficiary may have enlisted the help of an agent who didn’t have their clients’ best interest in mind or simply did not fully understand the needs of the client. Medicare Advantage Open Enrollment Period The Medicare Advantage Open Enrollment Period runs annually between… Read More

WHAT IS MEDICARE PART B?

February 6, 2022Ed MacConnell

Medicare can seem complex on your own. We’re here to help! Medicareful is an easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a licensed sales agent who will guide you through enrollment. Whether it’s a Medicare Supplement, Medicare Advantage Part C Plan, or a Medicare Part D drug plan, we’ve got you covered. https://medicareful.com/totalbenefitsolutions

When Can You Enroll on a Medicare Advantage or Drug Card?

February 6, 2022February 6, 2022Ed MacConnell

COVID‑19 provisions and online OTC test kit ordering

February 4, 2022February 4, 2022Ed MacConnell

From Amerihealth NJ: We recently suspended the prior authorization requirement for transfers from acute in‑network inpatient facilities to post‑acute in‑network facilities for any diagnosis through January 31, 2022. This change will now run through February 28, 2022. Additionally, the public health emergency was recently extended through April 16, 2022. We will continue to provide federally mandated coverage through the end of the public health emergency. OTC COVID‑19 test kit update As previously communicated, we are pleased to work with our clients to ensure coverage of over-the-counter (OTC) COVID‑19 test kits for our members through pharmacy benefits. Members who have pharmacy coverage with us through FutureScripts/Optum can now order OTC tests online via the… Read More

Medicare Part D: Disclosure Notice to CMS

February 4, 2022February 3, 2022Ed MacConnell

2022 Federal Poverty Guidelines Announced

February 3, 2022February 6, 2022Ed MacConnell

Open Enrollment may be over, but consumers may still be able to enroll in Marketplace coverage

February 2, 2022February 2, 2022Ed MacConnell

Member Cost Sharing for Most Telemedicine and Telehealth Visits Will Resume Effective February 3, 2022

February 2, 2022February 2, 2022Ed MacConnell

Aetna: Over-the-counter COVID-19 tests for small group plan sponsors

February 1, 2022February 1, 2022Ed MacConnell

Additional Guidance Addresses ACA Preventive Care Mandate

February 1, 2022February 1, 2022Ed MacConnell

As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying severalAffordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans. As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing. Click the link below to download the bulletin. As always contact your health insurance specialists at Total Benefit Solutions, Inc if you have any additional questions or concerns (215)355-2121 http://www.totalbenefits.net