Total Benefit Solutions Inc

Communications from providers about temporary ID cards

November 13, 2024November 13, 2024Loramei Romeo

Temporary member ID cards were mailed to members from large group with fully insured clients the transition of enhanced operation began in July. The cards contain the new member’s ID number. Our provider communications team has sent out messages to our contracted providers to let them know that these cards should be accepted. Which also includes instructions on how to process bills and how to confirm member’s eligibility when: In order to reinforce this message and give them more guidance, we redistribute this content the week of October 28 after it had previously been disseminated through our regular communication channels. Have Questions? and want to read more about the changes? Provider… Read More

December and January renewals deadlines

November 11, 2024November 11, 2024Loramei Romeo

Clients renewing in December, November 12 is the deadline to complete the enrollments, after this the enrollment will still be accepted but there will be delays with the member ID cards. Which includes small and large groups whether they are fully insured, self-funded clients, with both active and passive renewals. When enrolling later than November 12 after receiving completed enrollment the ID cards will be mailed after ten business days. To access new member ID number online it will take six business days after receiving complete enrollment. Clients renewing in January, Because of the anticipated volume of enrollment changes and new enrollments which adds additional processing time the deadline is… Read More

Small Employer Open Enrollment Period November 15 through December 15

October 24, 2024October 24, 2024Ed MacConnell

While this has been in place for a number of years, we would like to remind you about the Small Employer Open Enrollment Period for fully insured health plans in all states. The Small Employer Open Enrollment Period is the period from November 15 through December 15 each year. During this period, employers that meet the definition of small employer but do not meet the carrier’s participation or contribution requirement will be accepted for a small employer plan with a January 1 effective date. Additionally, select carriers in New York may allow for a December effective date if applicable. Carriers require that employer groups enrolling under the Small Employer Open Enrollment Period submit completed applications… Read More

Adjustments for Annual Out-of-Pocket Maximum Announced for 2026

October 24, 2024October 24, 2024Mirasol Bandong

Payment parameters were published by The Department of Health Services (HHS) for the Annual Notice of Benefit and Payment Parameters for 2026. The guidelines specify the yearly out-of-pocket limits (deductibles, co-payments, and other amounts, but not premiums) for non-grandfathered group medical plans for plan years starting in 2026 for employer-sponsored health plans. The Department also published the proposed Annual Notice of Benefit and Payment Parameters rule for 2026. HHS indicates, besides Departments of Labor and the Treasury, future rulemaking to address the applicability of drug manufacturer support to the annual limitation on cost-sharing is expected, something that will impact employer-sponsored coverage. Group that are non-grandfathered medical plans, out-of-pocket limits should… Read More

Cybersecurity Guidance Regarding Health and Welfare Benefits

October 17, 2024October 17, 2024Mirasol Bandong

In Compliance Assistance Release No. 2024-01, the U.S. Department of Employee Benefits Security Administration (EBSA) affirmed that all ERISA covered health and welfare plans are subject to the cybersecurity guidance which was published in 2021. Regarding cybersecurity best practices on April 2021, EBSA issued a cybersecurity guidance for benefit plan fiduciaries and service providers. ERISA requires plan fiduciaries to take necessary safety measures to reduce cybersecurity risk, EBSA’s three types of guidance are directed at benefit plan sponsors, fiduciaries, record keepers, and participants. With the new guidelines EBSA clarifies that cybersecurity guidance applies to ERISA covered health and welfare plans. EBSA clarifies that ERISA plan sponsors and fiduciaries, as well… Read More

Final 2024 ACA Reporting Instructions and Forms Issued

October 14, 2024October 14, 2024Mirasol Bandong

Forms 1094-C, 1095-C, 1094-B, and 1095-B are among the final instructions and forms that the IRS has made available for calendar year 2024 ACA reporting. As a reminder, since good faith relief from penalties is no longer available, it is crucial to make sure the forms are accurate, timely, and submitted to the IRS. There are no significant changes to the 2024 forms Forms 1094-C/1095-C Applicable large employers (ALEs) must provide Form 1095 to full time employees and Form 1094-C and 1095-Cs will be filed with the IRS. Covered employees or other primary insured individuals in the self-funded health plan must also receive Forms 1095-C from ALEs that offer a… Read More

Departments Issue Final MHPAEA Regulations

October 11, 2024October 11, 2024Mirasol Bandong

The final rules for the Mental Health Parity and Addiction Equity of 2008 (MHPAEA) were released on September 9, 2024, by the Department of Health and Human Services, Labor, and the Treasury in order to guarantee that those seeking treatment for mental health (MH) or substance use disorder (SUD). MHPAEA provides nonquantitative treatment limitations (NQTLs) cannot be applied to MH/SUD unless they are equivalent and applied no more strictly for MH/SUD benefits than for medical/surgical benefits. The final rules amend the definitions of definition of “medical/surgical”, “mental health benefits”, and “substance use disorder benefits” by removing a reference to the state guidelines. The most recent edition of the Diagnostic and Statistical… Read More

Medicare Annual Pre-Enrollment Checklist

September 30, 2024Ed MacConnell

Before making an enrollment decision, it is important that you fully understand your benefits and rules. Download this handy form below when planning your Medicare enrollment. Please contact us at (215)355-2121 to schedule your annual Medicare review.

Big Changes to Medicare Part D for Medicare beneficiaries still working

September 28, 2024Ed MacConnell

Annually. employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage, and… Read More

New Medicare Part-D Changes Affecting Employers for 2024-25

September 13, 2024September 13, 2024Mirasol Bandong

Dear Valued Client: We wanted to alert you to an upcoming change that could have a significant impact on Medicare-eligible employees and dependents who currently have group health coverage. Starting in 2025, Medicare Part D plans will have a $2,000 out-of-pocket limit. As CMS explains, this change, which is part of the Inflation Reduction Act, also includes measures like a $35 cap on insulin and new authority for Medicare to negotiate prices for certain high-cost drugs. The new $2,000 cap for Part D is particularly important because it could alter the status of many employer group health plans that currently provide drug coverage. Each year, employers must determine whether their prescription drug… Read More

2025 Part D Changes and Employer Sponsored Group Health Plans

September 9, 2024September 5, 2024Mirasol Bandong

Employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable… Read More

Ready for another year of helping clients who get their health insurance through Pennie!

September 8, 2024September 8, 2024Ed MacConnell

Ready for another year of helping clients who get their health insurance through Pennie! Open enrollment starts November 1st 2024 and ends January 15th 2025! (215)355-2121 https://lnkd.in/bhhqqAJ

Individual Health Insurance help is available for employer groups!

September 6, 2024September 6, 2024Ed MacConnell

Why do group clients need help with an Individual health insurance expert? Here are some scenarios when groups need individual solutions:

IBC Medicare Members Save money with your IBX Care Card

September 3, 2024September 3, 2024Ed MacConnell

Your IBX Care Card comes preloaded with a quarterly balance. Your card will be automatically reloaded every quarter (every three months). Be sure to spend your allowance each quarter, as any unused balance will not roll over to the next quarter. Please keep your card in a safe location, as you may use the same card for as long as you remain a member of a participating plan. Click here for more information about the IBX Care card for Medicare members or contact us today at (215)355-2121

What is a level funded health insurance plan?

September 1, 2024September 1, 2024Ed MacConnell

A level-funded plan is a type of self-funded plan in which the employer contributes a steady monthly payment to cover costs for administration, claims payments, and stop-loss insurance. Level funding has its advantages when compared to fully insured plans and programs. Level-funded plans often cost less, making it easier for small- and mid-sized employers to offer their employees high-quality health care benefits at a more affordable price. Total Benefit Solutions, Inc offers small- to mid-sized employers an opportunity to have a level-funded plan for their business through a Self-Funded Program. We work with many different carriers who offer level funded programs. These carriers change by State. How does the plan… Read More

Cigna Changes to MA ID cards

August 26, 2024August 23, 2024Mirasol Bandong

As with the 2025 plan year, our Medicare Advantage ID cards will be altered. By utilizing our digital portals to obtain a member’s current PCP, treating providers will be encouraged to use them more efficiently, which will prevent needless treatment delays brought on by the referral process. See what’s changing below, so you’re ready to answer any customer questions this upcoming AEP. What’s changing? 2024 2025 What is staying the same? When are these changes occurring? Members in HMO plans are still required to maintain a PCP New enrollees with a 1/1/2025 effective date will start receiving ID cards without PCP information as soon as 10/15/2024. The PCP network name… Read More

Wellcare PDP Plans: Contract Termination: Important Change!!

August 25, 2024August 24, 2024Ed MacConnell

Total Benefit Solutions, Inc has been notified by Wellcare PDP plans that our contract is being terminated without cause beginning immediately. Due to the changes in coverage mandated by the Inflation Reduction Act, Wellcare is terminating our agreement for the purposes of not paying bew or renewal business commissions. What does that mean for our clients?Beginning immediately, we will no longer be able to enroll new customers onto Wellcare PDP plans. Further moving forward, we will be unable to provide service to our existing clients already on Wellcare or who choose to renew with a Wellcare PDP plan for 2025. Our experts are standing by to answer your questions or… Read More

Important Changes to Medicare Drug Coverage for 2025

August 24, 2024August 31, 2024Ed MacConnell

The Inflation Reduction Act (IRA) has resulted in significant changes to Part D including: Elimination of the Coverage Gap or “donut hole”A new $2,000 out-of-pocket spending capA shift in cost sharing responsibility in the catastrophic coverage phaseA new cost sharing smoothing option called the Medicare Prescription Payment Plan These changes have an enormous impact on your Medicare coverage in 2025 for nearly all those on Medicare including Medicare beneficiaries who are still choosing their employer plans. Please review your ANOC carefully for your 2025 coverage and contact your Total Benefit Solutions Inc health insurance experts if you have any questions or concerns about how these changes impact you and your… Read More

CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration

August 2, 2024August 2, 2024Ed MacConnell

The Centers for Medicare & Medicaid Services (CMS) is releasing preliminary technical Medicare Part D bid information for contract year 2025 to help Part D plan sponsors finalize their Part D and Medicare Advantage (MA) offerings and prepare for Medicare Open Enrollment. Additionally, CMS is announcing a voluntary demonstration to support implementation of the redesigned Part D benefit and improve stability for people with Medicare in 2025. The preliminary average Part D premiums will be released later this summer. CMS will release the 2025 landscape in mid-to-late September, as in past years, once all offerings are finalized. Final average MA premiums and deductibles, along with other key information, are released annually in September with the… Read More

Tower Health is back!

July 26, 2024July 23, 2024Mirasol Bandong

Tower Health is back in Cigna Medicare Advantage network in Pennsylvania! After productive negotiations with Tower Health in Pennsylvania, Cigna is happy to announce that they are back in their Medicare Advantage network effective June 1, 2024. This includes Phoenixville and Pottstown Hospital, all Primary Care Physicians (PCPs), specialists, ancillary providers, and other hospitals that were previously in-network. 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.

New Medicare plans could wind up forcing seniors to switch or buy new plans or face a significant penalty

July 25, 2024July 25, 2024Ed MacConnell

Many seniors who remain working past 65 are still on their employer’s health plan instead of government-run Medicare. However, a new update to Medicare coverage under the Inflation Reduction Act means seniors who delay joining Medicare could face additional hurdles when it comes to drug coverage. Who Does It Affect?Currently, seniors are able to avoid late penalties for Medicare Part D as long as their company’s plan pays on average just as much as the traditional Medicare prescription drug plan. These numbers are scheduled to change drastically in 2025. Starting January 1, most employer plans will no longer be accepted as a way out of the late penalties because they… Read More

Disaster Special Election Periods in several states

July 15, 2024July 12, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, California, Florida, Iowa, Kansas, Maryland, Minnesota, New Mexico, North Carolina, Oregon, Texas and West Virginia and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or on… Read More

Medicare Part D’s new $2,000 annual cap on out-of-pocket prescription costs.

July 3, 2024July 2, 2024Mirasol Bandong

There are significant changes coming to Medicare Part D plans in 2025. In 2024 once your out-of-pocket spending on prescriptions tops about $3,300, you qualify for Medicare’s “catastrophic coverage” and pay nothing for your covered Part D drugs for the rest of the year. (In 2023, once you hit catastrophic coverage, you still owed 5% of your drug costs.) But come 2025, people with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision in the Inflation Reduction Act of 2022. This new rule applies only to medications covered by your Part D plan, though, and does not apply to out-of-pocket spending on… Read More

Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

June 28, 2024June 28, 2024Mirasol Bandong

Please be advised that a state of emergency was extended for certain Florida counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This DST-SEP applies to the Florida counties listed below. Important Compliance Information Who is eligible: This SEP opportunity is ONLY available to beneficiaries who: Details : Impacted Counties: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Orange, Osceola, Pasco, Pinellas,… Read More

man in white medical scrub suit standing beside girl in blue denim jacket

Medicare: Did You Know Part A?

June 26, 2024June 26, 2024Ed MacConnell

If an individual does not qualify for premium free Part A what they pay for Part A will vary depending on how long they or their spouse worked and paid Medicare (FICA) taxes. Have more questions? Ask the Medicare health insurance specialists at Total Benefit Solutions, Inc for more information (215)355-2121.

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: