Insurance Carrier News – Page 14 – Total Benefit Solutions Inc

What is Hospital Indemnity?

May 27, 2014February 8, 2015Ed MacConnell

Hospital Indemnity Plans as a “wrap” Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”. A group Hospital Indemnity plan can fit the bill and provide a comprehensive financial support plan for a family dealing with a medical crisis. It also allows the employee to make a more prudent health plan selection by giving them coverage for any large deductibles, co-pays or cost sharing scenarios. Hospital Indemnity plans are available to individuals too. Download more information on Shelterpoint’s Hospital Indemnity plan Below is a… Read More

Aetna: Important updates to our Pennsylvania Small Group eligibility guidelines

May 1, 2014Ed MacConnell

This briefing is applicable to all brokers writing Pennsylvania based employers We have updated our eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates we have outlined below. We thank you for your continued collaboration. The following applies to Small Group Pennsylvania new business and renewals: The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner. Sole proprietors, owners… Read More

IBC: Individual Dental and Vision PPO’s Now Available!

April 29, 2014April 29, 2014Ed MacConnell

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More

IBC: Special Care program ending

April 24, 2014Ed MacConnell

As you may already know, the Independence Blue Cross Special Care SM* health care plan will terminate on June 30, 2014. Because the Special Care plan is ending, the individuals who are currently enrolled in this plan will be eligible for a special enrollment period to sign up for a plan that is compliant with the Affordable Care Act (ACA). Special Care members qualify for a special enrollment period All Special Care members will be eligible for a special enrollment period , which will allow them to enroll in an individual or family health plan. Members will have from May 1 to August 29, 2014 to enroll in a health plan… Read More

IBC: Specialty Services Bundling Programs now available

April 17, 2014April 17, 2014Ed MacConnell

Independence Blue Cross (IBC) has announced their Specialty Services Bundling Program is now available for fully-insured customers with 51-500 eligible employees or enrolled contracts and for large self-funded customers. For fully-insured Pennsylvania companies with 51-500 Eligibles or Enrolled Contracts: Adding bundles to medical benefit saves customers money The Specialty Services Bundling Program provides competitive product offerings and helps improve the customer experience by giving cost incentives to customers for adding dental, vision, pharmacy, and employer-paid products to their basic medical coverage plans. By promoting products beyond what is requested, customers become aware of how they can save money on IBC offerings and save the time by shopping with IBC… Read More

SHOP for Small Group Customers Buying a plan through SHOP versus direct

April 15, 2014April 14, 2014Ed MacConnell

SHOP for Small Group Customers Buying a plan through SHOP versus direct Buying plans through the Small Business Health Options Program, or SHOP, provides an advantage only for employers with fewer than 25 employees that are eligible for a tax credit provided by the Affordable Care Act (ACA). If customers are not eligible for this tax credit, there is no advantage to purchasing a plan through SHOP. This is because… Click here to download the SHOP bulletin

IBC and DaVita HealthCare Partners Announce Joint Venture

April 14, 2014April 14, 2014Ed MacConnell

Tandigm Health’s innovative coordinated care model will provide higher-quality care, lower costs Independence Blue Cross (Independence) and DaVita HealthCare Partners today announced the creation of Tandigm Health. This unique joint venture, based in Philadelphia, Pa., will help deliver high-quality, affordable care to the region by combining the expertise of one of the country’s largest, most innovative Blue insurers and a nationally recognized pioneer of physician-centric coordinated care. Click here to read the bulletin Click here to read the press release from the IBC website

IBC: Tobacco Status Important Questions and Answers

April 14, 2014Ed MacConnell

Why does IBC collect member-level information about tobacco use? Under the Affordable Care Act (ACA), premium rates for health insurance coverage in the individual and small group markets may be based on family size, geography, age and tobacco use. In order to follow with this guideline and accurately rate each group, Independence Blue Cross (IBC) collects member-level tobacco use information to create group premiums for new and renewing group customers. Click the link below to download the IBC document that covers the most common questions about rating tobacco users in small group in PA. Tobacco Status For Small Group Customers Flyer

Crozer-Keystone Health System No Longer In Network with Cigna-Healthspring MAPD Plans

March 24, 2014Ed MacConnell

Please be advised of a change in the Cigna-HealthSpring provider network which may impact some of your customers. Starting May 1, 2014, Crozer-Keystone Health System will no longer be available to Cigna-HealthSpring members for hospital, home health or ancillary (surgery and other similar treatments) services. In a few days, we will mail the attached letter to the affected membership to advise them of this change. Please note that Crozer-Keystone health system primary care and specialty group doctors are still part of the Cigna-HealthSpring network. Only hospital, home health and ancillary services are leaving the network beginning May 1, 2014. Cigna-HealthSpring members currently under an active treatment plan may continue to… Read More

IBC: Important Changes Regarding Medicare Part B Exclusion

March 18, 2014September 9, 2014Ed MacConnell

From IBC November 2013: We are writing to let you know that we will be contacting your group customers to communicate the Medicare Exclusion and application of this exclusion to their benefit plan. What is the Medicare Exclusion? The Medicare Exclusion applies to members for whom Medicare would be the primary payer but they have not elected to enroll. These members will be responsible for paying their doctor, hospital, or other medical professional the amount Medicare would have paid and any applicable copayments, coinsurance, and deductibles. In turn, their group health benefit plan will only pay the remaining balance on claims submitted as if the member had enrolled in Medicare… Read More

IBC: Small Group Metallic Plans Mapping

March 18, 2014Ed MacConnell

Upon renewal in 2014 small groups will be automatically “mapped” to a new ACA compliant metallic plan. Find your new recommended 2014 Blue Solutions plan using the chart below. To make your renewal even easier we’ve identified the plan that most closely matches your current plan. Or you can choose from among 36 other options to suit your needs. More comprehensive coverage Blue Solutions health plans now cover Essential Health Benefits like pediatric dental and vision. Your health plan also continues to cover doctor visits, hospital admissions, emergency room treatments, maternity care, lab tests, X-rays, prescriptions, and vision benefits for both children and adults. Click the link below to download the… Read More

IBC: Medicare as Secondary Payer

March 17, 2014Ed MacConnell

Medicare Secondary Payer (MSP) requirements determine when Medicare is the primary insurance payer. If your company has 19 or fewer full- and part-time employees, Medicare is almost always primary. If your company is larger, various rules apply to determine whether your group plan is the primary or secondary payer. MSP requirements also apply for Medicare-eligible employees who are disabled or have endstage renal disease. The following information provides a summary of the MSP requirements. This information may help you to correctly target benefits for your Medicare-eligible participants and avoid potentially costly penalties and litigation. You should, of course, also refer to the actual laws and regulations with the assistance of your own legal counsel. Click… Read More

IBC: New Lab Provider Effective July 1-IMPORTANT NOTICE

March 12, 2014Ed MacConnell

Independence Blue Cross (IBC) has selected Laboratory Corporation of America® Holdings (LabCorp), as its exclusive, nationally-based provider of laboratory services, effective July 1, 2014. The change applies to all Personal Choice®/PPO and Keystone Health Plan East product lines, and affects all individual, group commercial, and Medicare members, for services rendered in the Philadelphia five-county area, and in the contiguous counties. Effective July 1, 2014, Quest Diagnostics laboratories will be an out-of-network provider for Personal Choice and Keystone Health Plan East. IBC will continue to contract with certain local and regional laboratories… Click to download the bulletin

IBC: July 1 rate increase for individual medically underwritten plans

March 9, 2014Ed MacConnell

IBC: We want to let you know that the monthly rates for our individual medically underwritten plans will increase in July 2014. We are notifying members muchearlier than is required to give them the opportunity to enroll in a plan that is compliant with the Affordable Care Act (ACA). The reason for the rate increase. We understand that it can be difficult to afford quality health insurance coverage. While we continue to work hard to keep costs down, the cost of health care continues to rise along with our member utilization. This is why it’s necessary for Independence Blue Cross (IBC) to implement an 11.5 percent rate increase. Click the link below to read… Read More

Important: Change to PACE and PACENET Income Limits

March 8, 2014Ed MacConnell

Effective February 7, a new law was passed that greatly benefits Medicare beneficiaries who may be eligible for PACE and PACENET. Although the annual income limits will remain the same, the Medicare Part B premium ($104.90 per month for most beneficiaries) is no longer part of the countable income of a Medicare beneficiary. This new law will result in thousands of additional beneficiaries becoming eligible for prescription drug coverage. What this means for beneficiaries Beneficiaries who may have been over the PACE/PACENET income limits by $1,259 or less, may qualify under the new law and should reapply. If a beneficiary reapplies and now qualifies for PACE/PACENET then the beneficiary is… Read More

Affordable Care Act Video: IBX Answers Five Common Questions

February 25, 2014February 22, 2014Ed MacConnell

Not Sure if you qualify? Ask your Total Benefit Solutions Advisor at (215)355-2121

Affordable Care Act Video: Subsidies and Tax Credits

February 22, 2014February 22, 2014Ed MacConnell

Under the Affordable Care Act, individuals and families may qualify for financial assistants to help pay for health care coverage. Age, family size and total household income are the factors that will determine your eligibility for subsidies and tax credits. Answer a few simple questions to learn if you might qualify for financial support: click here or ask your Total Benefit Solutions Adviser to help you by calling us today at (215)355-2121. This short video from Independence Blue Cross makes it easy to understand how they work.

Total Benefit Solutions Now Offering Online Enrollment with Consult-A-Doctor PLUS

February 21, 2014Ed MacConnell

Healthcare… the way it should be! Are you tired of waiting multiple weeks to go see your doctor, only to find yourself taking time off work so you can drive through traffic and sit in the waiting room for what seems like forever? Have you ever felt overwhelmed by the stress and anxiety of a difficult life situation and wished you had someone you could trust to hold your hand and walk you through to the other side? Then welcome to CADRPlus, an innovative new health care program that gives you unlimited, 24/7 access to doctors and other industry professionals from the comfort and convenience of your phone or computer,… Read More

AmeriHealth New Jersey discontinues “Bill me Later” feature

February 15, 2014February 15, 2014Ed MacConnell

AmeriHealth New Jersey has recently decided to remove the “Bill me Later” feature from AHNJ4U.com for Individual Coverage. “Bill me Later” gave members who enrolled 15 days prior to their desired effective date the option to be billed at a later time. This feature caused a delay in member billing and ID card production, leading to an exponential increase in call volumes. “Bill me Later” has been removed permanently from AHNJ4U.com, but members still have the option to pay by credit card for first time payments. Another alternative is to utilize an ACH payment option for reoccurring payments. If a member chooses to apply with paper checks, they must include… Read More

Important Message from IBC’s Christopher Cashman

February 7, 2014February 8, 2014Ed MacConnell

We received the following message this week from IBC’s EVP and President Commercial Markets Christopher Cashman and wanted to pass it on to our clients: As you know, over the past few weeks we have experienced unprecedented challenges as a result of the work required to enroll more than 170,000 members in our new Affordable Care Act (ACA)-compliant products. This has led to significant delays in several business areas, which we understand have been frustrating for you, your customers, and our members. While other health insurers across the country are facing similar challenges enrolling members with new ACA health plans, we are deeply concerned that we have not met your… Read More

Amerihealth NJ: Individual Health Insurance payment deadline extension

February 7, 2014February 8, 2014Ed MacConnell

From Amerihealth: IHC payment deadline extension ATTENTION: To offer a greater peace of mind for customers purchasing individual coverage through the Federally Facilitated Marketplace or our retail platform, AmeriHealth New Jersey is extending the payment deadline for new IHC members with January 2014 effective dates to February 5, 2014. We are also extending the payment deadline for new IHC members with February 2014 effective dates to March 5, 2014. This change is one more way that we are helping consumers navigate the health care reform environment. If you have any further questions, please contact Total Benefit Solutions (215)355-2121.

IBC 2014 Renewals Important facts to know Q+A

January 21, 2014January 24, 2014Ed MacConnell

There are many changes for small business groups for 2014. These changes affect sole proprietor plans, licensed professionals and small groups. Please take a moment to review this Q&A and let us know if you have any questions. Q. What is an Open Enrollment Period? A. An Open Enrollment is the time during which you are permitted to make changes to your benefit plan. Q. How will the 2014 Open Enrollment Process Work? A. IBC will be sending you, via regular mail, your, 2014 Renewal Package. Total Benefit Solutions will also follow up with another copy via fax or email. The package will include the 2013 rates for your current… Read More

Horizon Blue Cross Important Update on Benefit Waiting Periods

January 15, 2014January 15, 2014Ed MacConnell

Horizon BCBSNJ Group Administration – 90 Day Maximum Waiting Period Horizon BCBSNJ has issued This Letter to Group Administrators about the waiting period changes. We would like to provide you with additional clarification regarding this ACA change. • Groups with one to 99 employees who have a waiting period that exceeds 90 days per Horizon BCBSNJ’s system have been changed to a 90 day waiting period as of January 1, 2014. For example: A March 1 renewing group that has a six month waiting period will have a 90 day waiting period as of January 1, 2014. • Additionally, if a new employee is in the waiting period, as of January 1,… Read More

Amerihealth Important Notice

January 15, 2014Ed MacConnell

From Amerihealth: We have recently identified an issue with member identification cards that were distributed to existing and new business members with a January 2014 effective date. Some member identification cards were printed with incorrect BIN and PCN numbers. We are working to resolve this issue as quickly as possible and will reissue new member identification cards to all affected members. In the interim, if you receive questions from affected customers, you may provide them with the correct BIN and PCN numbers below: BIN – 015814 PCN – 06440000 We apologize for any inconvenience this may cause. If you have any additional questions, please contact your AmeriHealth New Jersey broker… Read More

ACA 90 Day Maximum Waiting Period – Small and Large Group Markets Update

December 30, 2013December 27, 2013Ed MacConnell

Published: Thursday, December 26, 2013 ACA 90 Day Waiting Period Limitation Effective January 1, 2014, a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. Please note the following administrative guidelines per carrier: Aetna Groups in the Small Group Market (applicable in all states – NY, NJ, PA, DE, CT): The carrier will change to a maximum of 60 days at the first renewal on or after January 1, 2014 unless the employer advises the carrier differently. Groups in the Large Group (51+ Employees) Market: The benefit waiting period will change at the first renewal in 2014.… Read More

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