Health Reimbursment Arrangements – Page 3 – Total Benefit Solutions Inc

Choosing the Right Health Insurance: HMO vs. PPO

September 15, 2023September 15, 2023Wendy Lopez

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

Annual Health Insurance Check-Up: Don’t Miss Out!

September 5, 2023September 5, 2023Wendy Lopez

Health insurance is vital for your well-being, providing financial protection and access to essential healthcare. But it’s not a one-time decision. Did you know that reviewing your health insurance plan annually is crucial to ensure it still fits your needs and budget? In this blog, we’ll explore why this check-up is essential and provide key enrollment dates. Plus, we’re here to assist you every step of the way! Why an Annual Review Matters: Enrollment Dates: Let’s talk about the enrollment dates you need to remember: How We Can Help: Navigating health insurance can be complex, but you’re not alone. Our expert team is ready to assist you in reviewing your… Read More

What’s New in the 2023 ACA Open Enrollment?

August 21, 2023August 21, 2023Wendy Lopez

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

Exploring PEOs: Efficiency and Compliance Solutions

August 8, 2023August 14, 2023Wendy Lopez

In today’s business landscape, optimizing operations and compliance is an ongoing challenge. Enter PEOs – Professional Employer Organizations. PEOs offer outsourcing solutions that reshape how companies handle HR and administrative tasks. Let’s dive into the world of PEOs and unveil their potential advantages and drawbacks. A “PEO,” or Professional Employer Organization, forms a strategic partnership where businesses team up with experts to manage HR and admin functions. This collaboration lets companies offload tasks like payroll, benefits, and compliance, ideal for small to mid-sized businesses aiming to streamline while focusing on core activities. Pros of PEOs: Cons of PEOs: In conclusion, PEOs provide a promising avenue for businesses aiming to bolster… Read More

IRS Addresses COVID-19 Testing and HDHP Treatment

August 3, 2023August 3, 2023Wendy Lopez

As a result of the COVID-19 pandemic, high deductible health plans (“HDHPs”) can provide coverage for COVID-19 testing and treatment before the minimum deductible is satisfied without jeopardizing an individual’s ability to have tax-favored contributions made to their health savings account (“HSA”). This relief remains in effect pending future IRS guidance.On June 24, 2023, the IRS issued Notice 2023-37, announcing that this relief will sunset with respect to plan years ending on or before December 31, 2024. In addition, IRS Notice 2023-37 states that HDHPs may continue to provide first-dollar coverage for preventive care with an “A” or “B” rating by the United States Preventive Services Task Force (“USPSTF”), prior… Read More

Unlock Your Best Health: 5 Must-Know Tips & Tools!

August 2, 2023August 2, 2023Wendy Lopez

Five major tips and resources for maintaining overall health and wellness: Remember, it’s important to personalize these tips to your individual needs and consult with healthcare professionals before making significant changes to your lifestyle. We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121. We’re here to answer any questions or address any concerns you may have.

Top 10 Ways to Make Your Health Benefits Work for You

July 31, 2023July 31, 2023Wendy Lopez

Unleash the Full Potential of Your Health Coverage! Are you making the most of your health benefits? The Employee Benefits Security Administration (EBSA) administers crucial health benefit laws that cover employer-based health plans. These laws safeguard your rights to essential information about your health plan, guide you on qualifying for benefits and making claims, ensure continued health benefits during job transitions, and offer protections for special medical conditions. Start by exploring your health coverage options, delving into different plans, and matching them with your needs. Not sure if your plan covers mental health or substance use disorder services? We’ve got you covered with essential information on these benefits too! Your… Read More

How much do employees contribute towards their insurance expenses?

July 5, 2023June 30, 2023Wendy Lopez

Average Contributions Most employees do make a contribution toward their insurance costs. Covered workers, on average, contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its EHBS in 2021. The average contribution for workers at small firms is $7,556, which is more than a third higher than the average for those at large firms ($5,580). Workers at private, for-profit firms contribute a higher percentage of the premium versus those at public firms, regardless of coverage type. A fortunate one-third of employees (33%) at small firms are enrolled in coverage where the employer pays… Read More

What Additional Changes Are Being Made to Part D?

July 3, 2023June 30, 2023Wendy Lopez

As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing. Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty. Also starting in 2024, the calculation of the… Read More

How Is the Medicare Part D Benefit Changing in 2024?

June 29, 2023Wendy Lopez

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

Independence Blue Cross Announcing Value and Select formulary changes effective July 1

June 23, 2023June 23, 2023Wendy Lopez

We want to remind you that we are making changes to the Value and Select Drug Program (Select) formularies for July 1. Updates are made to these formularies on a quarterly basis. A flyer summarizing the changes to each formulary is available by clicking on Value formulary or Select Drug Program. The complete, updated lists for July 1 are available on our website. To view, choose the link to either the Value or Select formulary. The updated list is available under “Formulary drug documents.” Members, as well as their providers, who are impacted by the changes were sent letters in April (60 days in advance). Members are encouraged to talk with their provider about switching… Read More

Revised Form 720

June 21, 2023June 23, 2023Ed MacConnell

The IRS has released a revised Form 720, Quarterly Federal Excise Tax Return, the proper method to file and report PCORI fees. If you owe a PCORI fee, it must be paid using IRS Form 720 by July 31, following the last day of the policy year or plan year. Form 720 and the fee must be submitted on the same date. If your business does not owe a PCORI fee, IRS Form 720 does not need to be completed. Issuers and plan sponsors will only be required to file Form 720 once a year. Per the IRS, “Issuers and plan sponsors who are required to pay the PCORI fee… Read More

12 Tips for Maximizing Your High Deductible

April 6, 2023April 6, 2023Ed MacConnell

Nearly 40% of people have a health care plan with a high deductible. An even higher percentage of people wish they had a lower deductible (who wouldn’t?!). And with medical bills being the leading cause of bankruptcies, it is important to understand how to maximize your high deductible so that you can stay afloat in case something unexpected were to happen. 1. Find Out What’s Free Many routine services are free. Instead of staying home to save money, you could get a free screening for preventative care. Common services covered are colonoscopies, mammograms, and vaccinations. About 90% of people with high deductible plans don’t know that such services are free.… Read More

Individual Coverage HRA: Choice and affordability in employee health benefits

March 6, 2023March 3, 2023Ed MacConnell

How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More

Do HSA’s, FSA’s, or HRA’s carryover or rollover?

February 28, 2023February 22, 2023Ed MacConnell

Health Savings Account (HSA): All funds belong to the employee. Unused balances roll over into the next year. Funds do not expire from year-to-year. Rollover funds do not count towards the contribution limit. Health Flexible Spending Account (FSA): Amounts must be incurred by the end of the plan year and do not usually carry over unless an employer allows up to $610 to carry over into the next year. Amounts that roll do not affect the maximum election that can be made for the plan year. Otherwise, employers may adopt a 2 and half month grace period that allows participants to access unused amounts remaining in their accounts. Health Reimbursement… Read More

Get Your FSA, HRA, HSA Health Accounts Comparison Chart

February 19, 2023February 19, 2023Ed MacConnell

What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!

Broker Change Leads to Better Results

February 15, 2023February 15, 2023Ed MacConnell

Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner… Read More

Do FSA’s and HRA’s have Reimbursable Expenses?

February 15, 2023February 2, 2023Ed MacConnell

Health Flexible Spending Account (FSA) Health Reimbursement Arrangement (HRA) As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

ACA: Special Election Cheat Sheet

February 9, 2023February 9, 2023Ed MacConnell

Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 http://www.totalbenefits.net

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

Turning 26: Your Guide to Health Insurance

September 23, 2022Ed MacConnell

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

June 22, 2022July 14, 2022Ed MacConnell

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

Aetna: Transparency in Coverage Rule Update

June 17, 2022June 16, 2022Ed MacConnell

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

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