Health Savings Accounts – Total Benefit Solutions Inc

New Guidance Released for the No Surprises Act and Gag Clause Prohibition

February 20, 2025February 18, 2025Loramei Romeo

The new guidance on the No Surprises Act (NSA) and gag clause prohibition, detailed in FAQ Part 69, clarifies the requirements for open negotiation, notice, and disclosure for plans, issuers, and providers related to the Independent Dispute Resolution (IDR) process. It addresses the coordination of surprise billing rules and plan sponsor responsibilities regarding gag clauses. The NSA protects against surprise medical bills for out-of-network costs, limiting individual cost-sharing to an amount based on the Qualified Payment Amount (QPA). The federal IDR process resolves disputes on reimbursement amounts, with FAQ 69 addressing recent litigation impacts on QPA calculation and other NSA implementation questions. The gag clause prohibiting compliance requires agreements to… Read More

One Employer or Spouse, Section 105 HRA

February 18, 2025February 14, 2025Loramei Romeo

What is a Section 105 HRA for 1 Employee or Spouse? Employers with small businesses that only have one employee or hire their spouse, Section 105 HRA are designed specifically for them. With Section 105 HRA spouse or employee/s can reimburse for family health insurance and medical expenses tax-free, indirectly the employers also benefit from as a dependent of the spouse/employee or as tax-deductible expenses to the business and employee. IRS Letter Ruling 9409006 and Section 105 of the Internal Revenue Code, Revenue Ruling 71-588 made this plan possible. Any health plan with 2 or more employees he annual and lifetime dollar limit is eliminated because of the Affordable Care… Read More

Annual Update for 2025 for New Jersey Policyholders

February 17, 2025February 17, 2025Loramei Romeo

This letter is intended to provide you with information on New Jesey Temporary Disability Benefits (TDB) changes for 2025. This Annual Update should be included in the employee posting. Please note that this information must not only be posted at the same place of employment, but must also be provided to the employee under the following circumstance: The following NJ TDB changes are applicable January 1, 2025, until December 31, 2025: Maximum Contribution amounts: Maximum Weekly Benefit: 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… Read More

Health FSA Plan Document Section 125

February 13, 2025February 11, 2025Loramei Romeo

Employees have the potential to save up to $1,280, while employers may realize savings of as much as $320. Health Flexible Spending Account (FSA) Plans are designated tax-exempt accounts that permit employees to access up to $3,300 in 2025 in pre-tax funds for out-of-pocket medical, dental, and vision expenses that are not covered by other insurance plans. What is a Health Flexible Spending Account (FSA)? A Health Flexible Spending Account enables employees to set aside pre-tax funds for medical expenses that are not covered by their insurance. These Health FSA plans can also be integrated with a Premium Only Plan (POP) and/or a Dependent Care FSA. The FSA acts as… Read More

Section 125 POP (Premium Only Plan) With HSA Module

February 10, 2025February 10, 2025Loramei Romeo

Section 125 Premium Only Plan can be pre-taxed HAS Savings Employers prefer High Deductible Health Plans (HDHP) and offering their employees’ Health Savings Accounts (HSA). The problem is whether the HSA portion (saving component) qualifies as a pretax payroll deduction through the Section 125 Premium Only Plan. HSA savings component allows to be pre-taxed because a $30 HSA module for the $149 Section 125 Premium Only Plan was developed. Employers can obtain all necessary materials to set up an HSA Section 125 for a fee of $179.00 for the Basic PDF version sent via email, or $229 for the PDF version along with a Deluxe 1-inch Binder delivered by USPS. This… Read More

Premium Only Plan Document (POP) Section 125

February 7, 2025February 6, 2025Loramei Romeo

What is a Section 125 Premium Only Plan?The Revenue Act of 1978 introduce IRS Section 125, which allows employers to reduce payroll taxes by adjusting the payroll process. Also, Section 125 Premium Only Plan employees can choose from pre-tax or tax-free basis pay for their portion of premium insurance rather than after-tax basis, which creates saving for both the employer and employee. How Employees Benefit from a Premium Only Plan.Section 125 premium deductions can save employees 20 or 40% of their pre-tax. The tax savings are on city, state, and federal income taxes, including Social Security and Medicare taxes on money used to pay for their portion of insurance premiums… Read More

Notice For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP)

February 5, 2025February 4, 2025Loramei Romeo

For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP) Hackensack Meridian Health Remains In-Network for Braven Health and Horizon DSNP MembersAs of June 1, 2025, Hackensack Meridian Health (HMH) terminated their hospital from Horizon Hospital Network unless Horizon agrees to increase prices for services and cares at their facilities. This change does not impact Braven Health or Horizon NJ TotalCare (HMO D-SNP). Braven Health and Horizon TotalCare (HMO D-SNP) members can continue using HMH providers and hospitals. Why is this not impacting Braven Health and DSNP and will it soon?Only certain Horizon members are affected by the change in hospital network status. Braven Health and Horizon TotalCare (HMO D-SNP) members… Read More

State Health Coverage Calendar 2024 Reporting Requirements

February 4, 2025February 4, 2025Loramei Romeo

District of Columbia, California, Massachusetts, New Jersey, Rhode Island, and Vermont already released the individual health mandates requirements. Supply the information. The Paperwork Burden Reduction Act upon request for federal forms 1095-C or (1095-B) the employers are allowed to make when: Both federal and state regulations that is applicable should be met. As of this article’s publication federal relief has not implemented in District of Columbia, California, Massachusetts, New Jersey, Rhode Island, and Vermont. Like previous years Forms 1095-C (or 1095-B) should be prepared by employers. Have Questions? and want to read more about the changes click State Health Coverage Reporting Requirements for Calendar Year 2024 for more details. We are dedicated… Read More

Individual Coverage HRA: Choice and affordability

February 4, 2025January 31, 2025Loramei Romeo

QSE-HRA or Qualified Small Employer HRA Companies with fewer than 50 employees are qualified for $199 small employer HRA plan document a group health insurance alternative. What is QSE-HRA? To establish a QSE-HRA for qualified groups with less than 50 employees offering no group health plan the plan documents are available for $199 in Basic PDF email version. Qualified Small Employers can offer Health Reimbursement Arrangement (HRA) if they do not offer a group health plan, HRA uses tax-free dollars to reimburse employees who individual health plans. Employers cannot offer another group health plan to qualify QSE-HRA, which includes any other HRA, Health Care Flexible Spending Accounts (FSA), Limited Health… Read More

Wrap SPD Plan Document for Group Health Insurance

January 31, 2025January 29, 2025Loramei Romeo

Wrap SPD Plan use a Wrap SPD for Your Group Health Plan to Avoid the $110 Per Day Fine Under the Affordable Care Act A Wrap SPD document must be sent within 120 days of the Plan’s effective date if you provide group health insurance, as mandated by the Affordable Care Act and the Department of Labor’s enforcement of the ERISA legislation. $149 one-time charge sent by email in PDF format$50 Optional Deluxe Binder mailed by USPS$30 Optional Supplemental Insurance Rider Wrap Summary Plan Description (SPD) and Why Do I Need One? The following is a concise summary of the Wrap SPD document requirements set out by ERISA and the… Read More

Reminder for Medicare Part D CMS

January 28, 2025January 28, 2025Loramei Romeo

Employers who sponsoring a group health plan, whether they are self-insured or insured, are required to notify the Centers for Medicare and Medicaid Services (CMS) of the creditable (or non-creditable) status of the plan’s prescription drug coverage. Employers must go to CMS’s online reporting system at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html. to provide this information. Just a friendly reminder that notice needs to be given by the following dates: • Within 30 days following the prescription drug plan’s termination. • Within 60 days following the start of each plan year. • Within 30 days following any modification to the prescription drug plan’s creditable coverage status. If an employer-sponsored prescription drug plan’s creditable coverage status changes… Read More

Federal Poverty Guidelines Announced for 2025

January 24, 2025January 24, 2025Loramei Romeo

The 2025 federal poverty guidelines were recently released by the Department of Health & Human Services (HHS), they provide the federal poverty level (FPL) affordability safe harbor for the purposes of the employer mandate under the Affordable Care Act (ACA). The 2025 FPL safe harbor is $117.63/month in the lower 48 states and DC, $146.95/month in Alaska, and $135.22/month in Hawaii for plan years starting on February 1, 2025, or later. To qualify for the FPL affordability safe harbor, a plan may employ poverty rules that are in force six months prior to the start of the plan year. The lower 48 states and DC utilize $113.20/month for plans with… Read More

Important Update Regarding the Distribution of Form 1095-B for Tax Year 2024

January 24, 2025January 24, 2025Loramei Romeo

Horizon BCBSNJ is constantly searching for methods to make working with us more convenient and easier. For this reason, Horizon has modified the way they provide Form 1095-B to their members who are fully insured this year. What is Form 1095-B?The names, residences, Social Security numbers, and number of months that each member of a fully insured health plan was covered from January 1 to December 31 of each calendar year are reported on Form 1095-B. Form 1095-B is explained in greater detail here. How Is Distribution Changing This Year? In previous years, Form 1095-B was sent by mail to all subscribers enrolled in a Horizon fully insured plan. However,… Read More

SJRA and Larchmont Facilities returns to Horizon’s Network

January 3, 2025January 3, 2025Loramei Romeo

South Jersey Radiology Associates (SJRA) which includes Larchmont Medical Imaging has made an agreement with Horizon BCBSNJ. On January 1, 2025, they will return to the network. *SJRA services are regarded as out of network if they are provided between April 1, 2024, and December 31, 2024. There will be no retroactive processing of claims. 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 Jersey Releases 2025 Disability and Family Leave Amounts

December 20, 2024December 20, 2024Loramei Romeo

New Jersey has announced the 2025 contribution rates and benefit level parameters for the Temporary Disability Insurance (TDI) and Family Leave Insurance (FLI) programs. Temporary Disability Insurance 2025 For qualified New Jersey workers who are unable to work due to a non-work-related illness, injury, or other disability, or for specific public health emergencies, TDI offers benefits. Employees must have worked 20 weeks and earned at least $303 per week (Base Week Amount) or earned $15,200 (Alternative Earnings Test) in the four quarters (base year) before taking vacation to be eligible for TDI. 85% of an employee’s average weekly pay, up to a maximum of $1,081, is the weekly TDI benefit… Read More

New PCOR fee Announced

December 20, 2024December 20, 2024Loramei Romeo

The IRS released Notice 2024-83 on December 3, 2024, which states that the PCOR fee which is determined by the adjusted applicable dollar amount used for plan years that starts on or after October 1, 2024, and before October 1, 2025, is $3.47. For self-funded medical plans which includes level funding and some HRAs including ICHRAs for plan years ending in 2024 the PCOR filing deadline is July 31, 2025. For insured policies the carriers are responsible for paying. Employer Action: There are no further required actions for employes with self-funded health plans (or an HRA) as of the moment. Reminders will be sent in mid-2025 for the fee and… Read More

Binder Payment Deadline for January 1 Effective Dates

December 6, 2024December 6, 2024Loramei Romeo

New members with a plan must make their first payment by December 31, 2024, and their plan would be effective on January 1, 2025. The payment is a must to activate their coverage and begin using their benefits. To maintain their coverage, members from Florida and Indiana who are registered in a 2024 Bronze| Silver| Gold (Core) network plan and are subsequently enrolled in a 2025 Premier network plan must make a binder payment by December 31, 2024. Auto Pay is worry free and saves time. To ensure they always make their payment on time, members can set up a monthly recurring payment. Members can register via the Ambetter App… Read More

Gag Clause Prohibition Attestation Under the Consolidated Appropriation Act

November 25, 2024November 25, 2024Loramei Romeo

Under the Consolidate Appropriations Act (CAA), health plans are prohibited from signing contracts that limit the precise data and information they can provide to third parties. Every year, plans are required to provide an attestation confirming that they have not entered any prohibited contractual restrictions. According to Excellus BlueCross BlueShield (Excellus BCBS) we will be completing the attestation on behalf of our fully insured and minimal premium groups for the duration they had with Excellus BCBS coverage in 2024. Please inform these groups that we will be finishing the attestation on their behalf by the deadline of December 31, 2024, if you hear any questions from them regarding gag clause… Read More

Main Line Health may part ways with Medicare Advantage network in Pennsylvania

November 22, 2024November 22, 2024Loramei Romeo

Main Line Health in Pennsylvania has a long relationship with Cigna Healthcare Medicare Advantage (MA). Unfortunately, negotiation has not been reached between Cigna Healthcare Medicare Advantage and Main Line Health in Pennsylvania, because of this effective on January 1, 2025, Main Line Health in Pennsylvania will not be a part of MA network. Customers have been notified via letter. A new Primary Care Physician (PCP) recommendation will be included to customers who are assigned to PCP from Main Line Health. To change to another PCP customers can contact Cigna Healthcare MA. Customers would be reassigned to the recommended PCP if they do not contact Cigna Healthcare. Customers with a PCP… Read More

WellSpan part ways with United Healthcare’s commercial network

November 21, 2024November 21, 2024Loramei Romeo

As of Nov 1, 2024 the facilities, hospitals, and physicians of WellSpan Health are out of network for UnitedHealthcare employer-sponsored commercial plans. WellSpan declined the proposals to extend the contract to ensure continued access to the health system while continuing to negotiate. Also, proposals that would ensure WellSpan Health to be reimbursed at more reasonable rates. WellSpan Health continued to seek unsustainable price increases, with its facilities costing over 30% more than the average of all other hospitals in south-central and eastern Pennsylvania that are members of our commercial network. A cost-effective solution that restores WellSpan Health’s network connectivity is still our top priority, and we will continue to negotiate… Read More

In 2025, would you like more?

November 21, 2024November 21, 2024Loramei Romeo

HSA funds are carried over each year. Why not increase your savings? Additionally, if you contribute to your HAS before the year ends, you can lower your income that is subject to taxes. For self-only coverage, the maximum contribution in 2024 is $4,150, and for family coverage, it is $8,300. Moreover, if you are at least 55, you will receive an additional $1,000 catch-up contribution. Employer contributions, direct transfers, and payroll deductions are all included in the annual cap. We’re sure you are as excited about this as we are! Please reach out if you have any questions. We are dedicated to providing exceptional service, so please do not hesitate… Read More

Guide to more savings and benefits & Letters to MA customers

November 18, 2024November 18, 2024Loramei Romeo

Guide to more savings and benefits The discounts for the Medicare supplements insurance provides savings that can be used by customers to reinvest in additional coverage. The discount is up to 20% with combined household discounts which are, discount for more than one member of the household holds a policy is 14% and discount when a customer lives with one or more people is 6%. The supplemental benefits are fit for client’s needs in cancer treatment, choice accident, dental, vision, hearing, hospital indemnity, lump sum cancer, lump sum heart attack, and stroke. Letters mailed to Medicare Advantage customers There are different versions of Benefits at a Glance (BAAG), letters regarding… 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

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:

Cigna+Oscar Announcement

May 15, 2024May 14, 2024Mirasol Bandong

Oscar and Cigna Healthcare have made the decision not to renew Cigna + Oscar Small Group plans nationally as of December 15, 2024. They will continue to provide coverage for Cigna + Oscar Small Group services through the end of each member’s policy, and specific timing is dependent on each groups’ enrollment date. Dates: As per the federal and state deadlines, Cigna + Oscar will inform plan sponsors and insured persons about the discontinuation. Oscar will stay active in the individual market and concentrate on that area of the company’s operations. To see ARTICLE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated… Read More

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