compliance – Total Benefit Solutions Inc

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

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

You can access your PCORI membership report on uhceservices.com

June 19, 2024June 18, 2024Mirasol Bandong

Under the Affordable Care Act (ACA), health insurers, and plan sponsors are responsible for paying the PCORI fee. The Patient-Centered Outcomes Research Institute (PCORI) fee also helps fund research that evaluates and compares health outcomes, clinical effectiveness, and the risks and benefits of medical treatments and services. Sponsors of self-funded (ASO) plans are required to submit Form 720 and pay the PCORI fee to the Internal Revenue Service (IRS) immediately. The payment must be made by July 31 of the year that follows the conclusion of the plan year. A PCORI Membership Report is given to UnitedHealthcare Level Funded groups whose plan year ends in 2023 to help with PCORI fee… Read More

CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

February 21, 2024February 21, 2024Ed MacConnell

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell of Total Benefit Solutions Inc has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

Medicare Part D – CMS Notification Reminder

January 18, 2024January 18, 2024Ed MacConnell

Employers supporting a group health plan, whether through insurance or self-insurance, are required to communicate the creditable or non-creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). This reporting is facilitated through access to CMS’s online reporting system here. To comply with regulations and maintain transparency, follow these key points: Access CMS Online Reporting: Employers (insured or self-insured) should use CMS’s online system to report prescription drug coverage details. Key Deadlines: 1.Within 60 days after the plan year starts. 2.Within 30 days after prescription drug plan termination. 3.Within 30 days after any creditable coverage status change. Example Deadline: For a calendar year… Read More

How should employers distribute Medical Loss Ratio (MLR) Rebate Checks?

October 5, 2023October 6, 2023Ed MacConnell

Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More

Benefits of a PEO: How to Simplify your Business Operations

September 21, 2023September 20, 2023Ed MacConnell

If you’re a small- or mid-sized business owner, you’ve probably come across the term “PEO” in your quest to optimize your company’s operations. PEO stands for Professional Employer Organization, and it’s a dynamic solution designed to assist businesses in various crucial areas, such as payroll administration, human resources, risk management, and employee benefits. In this blog post, we’ll explore the advantages of partnering with a PEO and introduce you to a valuable resource to help you navigate this complex landscape. The Advantages of a PEO As beneficial as PEOs can be, the surge in their numbers can be overwhelming for business owners. The plethora of options often leads to confusion… Read More

How can I get help with my Medicare Part A and Part B premiums?

September 7, 2023June 27, 2023Ed MacConnell

(En español) States must help pay some of the Medicare costs for beneficiaries who have limited income and resources. Under these programs, states help pay for Medicare Part A and Part B premiums, deductibles and copayments. Some of these programs also pay additional Medicare expenses for elderly and disabled people. To find out if you are eligible for state help, contact your local medical assistance office. A representative can tell you the specific requirements and help you apply. If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

HOW PEOS ARE HELPING SMBS MEET MARKET DISRUPTORS HEAD ON

August 19, 2023August 19, 2023Ed MacConnell

The modern world is driven by convenience and customization, SMBs included. Digitization, remote-friendly roles, and a generational shift in the workforce all impact today’s employee experience. When this experience is lacking, it can be costly to companies in more ways than one. click here to read the story from PEO insider Total Benefit Solutions Inc is dedicated to providing a comprehensive selection of solutions for the small business owner including the comparison of PEO’s to the typical employee benefits experience. Contact us today at (215)355-2121 to inquire about the possibility of using a PEO for your organization.

Why Short Term Heath Insurance is not “ JUNK” insurance.

July 29, 2023July 29, 2023Ed MacConnell

Short-term health insurance, also known as temporary health insurance, is a type of health coverage designed to provide temporary medical insurance for a limited duration, typically ranging from a few months to a year. While short-term health insurance may not be suitable for everyone, it does offer certain benefits for specific situations. When people label Short Term health as “ JUNK” it is clear they do not understand that many people still need short term health insurance coverage. The ACA solved many problems when it comes to access to coverage, but first problem is the COBRA prohibition which specifically disallows ACA tax credits for people who can get on COBRA.… 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

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

What is State Mandated Disability or TDB?

March 9, 2023March 9, 2023Ed MacConnell

New Jersey Temporary Disability Benefits (TDB) and Family Leave Insurance (FLI). The New Jersey Temporary Disability Benefits (TDB) law, enacted in 1948 and later amended in 2008 to include Family Leave Insurance (FLI), allows for NJ covered workers to take paid time off for their own non-occupational related injury or illness (under TDB) or to care for a family member with a serious health condition or bond with a new child (under FLI). Which employers are subject to the law? Most New Jersey employers subject to the provisions of the Federal Unemployment Tax Act (FUTA) are also subject to NJ TDB law and are required to provide coverages for their employees working in… Read More

ACA coverage rule for dependents up to age 26

March 4, 2023March 3, 2023Ed MacConnell

One of the most notable changes brought about by the Affordable Care Act (ACA) is the ACA coverage rule for dependents up to age 26. Employers offering health care plans to employees must include this extended coverage. Purpose of the ACA coverage rule for dependents up to age 26 The ACA extended the eligibility for a child to be covered under a parent’s health plan from (usually) age 21 and if a full-time student to age 26 regardless of student status. The goal is to provide peace of mind to parents and their young adult children during a time in life when the dependent is likely to be completing their… Read More

Notice: White House announces COVID-19 PHE and National Emergency will be allowed to expire

March 3, 2023February 16, 2023Ed MacConnell

On January 30, 2023, the White House announced its plan to allow the COVID-19 Public Health Emergency (PHE) and National Emergency periods to expire on May 11, 2023. We have provided example scenarios in the Compliance Alert that demonstrate the impact of the national emergency period expiration. We encourage you to review each example to determine the impact on your specific plan(s). Although we encourage you to review the entire Compliance Alert, we have provided a summary of the content for your review: Public Health Emergency During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing or prior authorization or… Read More

1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients

February 12, 2023February 9, 2023Ed MacConnell

Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.

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

Notification Reminder for Forms 1095-C and 1095-B

February 9, 2023February 9, 2023Ed MacConnell

Under the Affordable Care Act (“ACA”), the deadline for applicable large employers (“ALEs”) to furnish Form 1095-C and 1095-B to certain individuals (such as full-time employees in the case of Form 1095-C) is January 31 with respect to the preceding calendar year. The Internal Revenue Service (“IRS”) released final regulations on December 12, 2022 with respect to ACA reporting requirements. These final regulations provided an automatic extension of 30 days to furnish these statements to individuals. This means that Wednesday, March 2, 2023 is the deadline to furnish individuals with 2022 Forms 1095-C and 1095-B. This extension is automatic; employers or other reporting entities are not required to file a… Read More

Independence: Additional MLR rebates for 2020 to be issued to some policyholders

February 7, 2023February 6, 2023Ed MacConnell

Starting this week, Independence Blue Cross (Independence) will be issuing an additional medical loss ratio (MLR) rebate to affected customers and subscribers for a portion of their 2020 health insurance premiums. The check mailing will continue until the end of February. The additional rebate is being issued following a clarification on MLR calculation provided by the Centers for Medicare & Medicaid Services (CMS). As a result of the clarification, we looked at prior year calculations and determined an additional amount was due for 2020. Any applicable interest has been included in the amount of each check. Click here for the full story As always please contact your Total Benefit Solutions,… Read More

DOL Penalties Increase for 2023

February 2, 2023January 26, 2023Ed MacConnell

The Department of Labor (“DOL”) has published the annual adjustments for 2023 that increase certain penalties applicable to employee benefit plans. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

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

Four Key Changes in the Biden Administration’s Final Rule on Medicare Enrollment and Eligibility

January 13, 2023January 9, 2023Ed MacConnell

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on October 28, 2022, to implement several changes in Medicare enrollment and eligibility that were included in the Consolidated Appropriations Act of 2021 (CAA). These changes are designed to minimize gaps in coverage for people who sign up for Medicare and improve access to care by shortening the gap between Medicare enrollment and coverage; creating new Special Enrollment Periods for individuals whose coverage would otherwise be delayed due to challenging circumstances, such as a natural disaster; and extending coverage of immunosuppressive drugs for certain beneficiaries with end-stage renal disease (ESRD) who would otherwise lose coverage for these drugs… Read More

What Are Medicare Guaranteed Issue Rights?

October 26, 2022July 25, 2022Ed MacConnell

Please contact your Total Benefit Solutions Inc Medicare health insurance specialists today at (215)355-2121 with any questions.

Inflation Reduction Act: Requires Drug Manufacturers to Pay Rebates for Drug Price Increases Above Inflation

October 11, 2022September 7, 2022Ed MacConnell

Requires drug manufacturers to pay a rebate if drug prices increase faster than the rate of inflation (CPI-U) for: Single-source drugs and biologicals covered under Medicare Part B All covered drugs under Medicare Part D except those where average annual cost is <$100 2021 is the base year for measuring cumulative price changes relative to inflation The rebate amount is based on units sold in Medicare multiplied by the amount that a drug’s price in a give year exceeds the inflation-adjusted price Price changes are measured based on the average sales price (for Part B drugs) or the average manufacturer price (for Part D); these measures include prices charged in… Read More

Total Benefit Solutions, Inc appoints with Lasso Medicare Medical Savings Accounts Plans for 2022-2023 Open Enrollment Season

October 11, 2022Ed MacConnell

What is a Medicare Medical Savings Account (MSA) Plan? – A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account. Enrollees of Medicare MSA plans can initially use their savings account to help pay for health care, and then will have coverage through a high-deductible insurance plan once they reach their deductible. Medicare MSA plans can provide Medicare beneficiaries with more control over health care utilization, while still providing coverage against catastrophic health care expenses. Ask your Total Benefit Solutions, Inc. Medicare health insurance specialist of a Medicare Medical Savings Account could be worth considering… Read More

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