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.
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The IBX Team has provided us the following update regarding ID Cards for January 1st Customers. Due to the large volume of cards being processed and mailed for January, members may not receive their physical ID cards before January 1. To ensure uninterrupted access to care for members with ID cards processing in the second half of December, letters are being mailed to plan subscribers containing their new member ID numbers and ID numbers for all covered dependents. The sample letter is attached, and it’s important to note these members can access their ID cards on the portal until they receive the physical card. We’re just trying to be proactive… Read More
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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.
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Coverage of PrEP Certain preventive care services must be offered by health insurance companies and non-grandfathered group health plans without any cost-sharing obligations under the Affordable Care Act (ACA). The United States Preventive Services Task Force (USPSTF) and other agencies and advisory groups recommendations form the basis of the list of preventive care services. If a preventive care service or item requirement omits information on the frequency, manner, treatment, or setting to administer the preventive care service, plans and carriers are permitted to employ reasonable medical management practices. Coding and Claims Management Plans and carriers are also reminded by FAQ 68 of the significance of correctly coding claims for preventive… Read More
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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
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In terms of ACA reporting of minimum essential coverage (MEC), you are probably an Applicable Large Employer (ALE) if you had an average of fifty (50) full-time equivalent employees in the previous calendar year or if you are an employer of any size that provides a level funded or self-insured plan. The deadlines are: Employees must submit their 1095-C forms by March 3, 2025, at the latest. IRS-required copies of 1094-C and 1095-C forms are due by March 31, 2025, if filing online, or February 28 if filing on paper. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health… Read More
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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
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We would like to remind you about the Small Employer Open Enrollment Period for fully insured health plans in every state, even though this has been in effect for years. Each year the period for Small Employer Open Enrollment Period is from November 15 to December 15. Employers who fit the carrier’s definition of a small employer but do not fulfill the participation or contribution requirements will be eligible to enroll in a small employer plan with an effective date of January 1. Employer groups participating during the Small Employer Open Enrollment Period must submit completed applications to carriers after November 15th and by noon December 15th. We are dedicated… Read More
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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
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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
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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
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We are excited to announce that as of 12/1/2024, Wellspan Health will continue to be a partner in care for UnitedHealthcare’s DSNP and ISNP members. We have also expanded the DSNP network to include ALL Wellspan Providers. 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 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.
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By December 31st of each year, insurance companies and plans sponsor of group health plans are required to provide the Centers for Medicare and Medicaid Services (CMS) with information certifying that their plan or policies do not include illegal gag provisions. The due date for the subsequent attestation is December 31, 2024. Clients are receiving notifications from carriers and TPAs regarding their plan to adhere to the Gag Clause Prohibition Compliance Attestation. Once more, it appears that the different carriers/TPAs will not handle the attestation requirements the same way. For fully insured plans both the plan and carrier must file attestation if the group health plan is fully insured; however,… Read More
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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
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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
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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
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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
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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
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This is an important announcement for customers in Arizona, Arkansas, Colorado, Florida, Idaho, Mississippi, Nevada, Oklahoma and Texas 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 the declaration date. The SEP… Read More
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The Internal Revenue Service (“IRS”) clarified the tax treatment of several work-life referral (“WLR”) services offered by employers in a new Fact Sheet FAQ. According to the FAQ, the value of the WLR services may be deducted from employees’ salary as a de minimis fringe benefit in cases when they are included in employee assistance programs (“EAPs”) or are otherwise bundled with other services. WLR Programs WLR services are offered to qualified employees through the employer-funded WLR program. WLR services are informative and referral consultations that help staff members locate, engage, and bargain with life-management providers to find answers to personal, professional, or family problems. Generally speaking, unless a part… Read More
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In accordance with a new multi-year agreement between UnitedHealthcare and Mount Sinai Health System, individuals participating in employer-sponsored and individual plans, such as the Oxford Health Plan, will once again have network access to the system’s hospitals. Additionally, the agreement guarantees continuous, uninterrupted access to the doctors at Mount Sinai. for more information click HERE 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.
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Although it does not yet know when the recovery from the Change Healthcare hack last month will be completed, UnitedHealth is testing the system to restore it. This week, the care giant said that it is testing technology for processing medical claims. It already has mostly restored systems for handling drug claims and processing payments. The technology utilized to file and handle insurance claims is provided by Change Healthcare. It works with claims from many insurers and processes around 14 billion transactions annually. Some patients might be directed to different pharmacies where billing issues are less of a concern. Industry executives have stated that delays in patient bills are possible. Progress:… Read More
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Please assist us in answering the required questions in the CAA Pharmacy Data Collection request information that is located in the employer/broker portal. It will make sure that UnitedHealthcare can successfully submit the data report. In order for us to prepare the data for submission to CMS by June 1, 2024, we must get the information by April 10, 2024, thus your prompt answer is extremely important. To read more click HERE 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… Read More
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Did you know that September is Life Insurance Awareness Month? It’s the perfect time to take a closer look at your financial safety net or consider the needs you may have! Life is a journey filled with the unexpected. While we can’t control every twist and turn, we can certainly prepare for them. That’s where life insurance comes into play. It’s more than just a safety net; it’s a shield that safeguards your past, present, and future. Let’s explore the multifaceted benefits that a life insurance policy can bring into your life. 1. Protection for Your Loved Ones At the heart of life insurance lies the protection of your loved… Read More
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