Alternative Funding – Total Benefit Solutions Inc

The importance of what Minimum Essential Coverage (MEC) Plan offers and how it works.

May 13, 2025May 12, 2025Loramei Romeo

Minimum Essential Coverage plans are crucial for compliance with the Affordable Care Act, ensuring that employees meet their responsibilities towards full-time workers. The Internal Revenue Service (IRS) can penalize an applicable large employer (ALE) if it does not offer MEC plans to 95% or more of its full-time workers. These plans provide basic healthcare services, focusing on affordability while offering essential benefits. Understanding MEC plans is vital for both employers and employees to navigate the complexities of health insurance. Share your insights or questions about MEC plans. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

Compliance Checklist for Calendar Year 2025

March 26, 2025March 25, 2025Loramei Romeo

The calendar year 2025 has released its deadline for small groups (less than 50), some deadlines may change depending on the plan start date that is not January 1st. The calendar shows the Section 6055/6056 filing deadline to the dates with Medicare part d notice. Have Questions? and want to read more about the changes click Calendar Year Compliance Checklist for more details. 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 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

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

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.

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

A Voluntary Benefits Strategy

August 29, 2023August 13, 2023Ed MacConnell

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees…click here to continue

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.

Pros and Cons of PEO’s

August 13, 2023August 13, 2023Ed MacConnell

A Professional Employer Organization (P.E.O.) is a company that provides comprehensive HR outsourcing services to small and medium-sized businesses. As your independent broker, Total Benefit Solutions, Inc can shop and compare various PEO’s to help determine which one might be the best fit for your organization, if any. Just like we can do with insurance carriers ad TPA’s! We have had a lot of questions about PEO’s so we created these pro and com quick tips to give you a quick overview of the top points about PEO’s that are asked the most often. The professionals at Total Benefit Solutions are independent and can evaluate the PEO offerings of multiple… Read More

Insights into Self-Funding and Deductibles: A Look at Healthcare Trends for Large Firms

July 8, 2023July 7, 2023Ed MacConnell

Self-Funding Popular – Especially for Large Firms Many larger firms self-fund their health plans or pay for some workers’ health services directly – rather than through the use of health insurance. Nearly two-thirds (65%) of covered workers are in self-funded plans. That includes 20% of workers at small firms and 82% at large firms. Deductibles for Most Most employees with health insurance have a cost share before their insurance begins to pay benefits. Among those with single coverage, the average annual deductible is $1,763, similar to the $1,669 average in 2021. For most plan types, the single coverage deductible is higher for employees at small firms. The average is $2,543… Read More

Increases in Premium Found in Health Benefits Survey

July 4, 2023June 28, 2023Ed MacConnell

The latest survey by the Kaiser Family Foundation (KFF) concerning employer-sponsored health benefits found modest increases in employers’ and employees’ costs in 2022. In its 24th Employer Health Benefits Survey (EHBS), KFF found the average annual premiums for employer-sponsored health insurance in 2022 were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years. Small vs. Large Employers In 2022, workers insured through their employers at both… 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

woman with face mask holding an alcohol bottle

Independence Blue Cross: Changes to the Select and Value formularies for July 1

May 1, 2023May 1, 2023Ed MacConnell

Independence Blue Cross (Independence) is making changes to the Select Drug Program (Select) and Value formularies for July 1. Independence routinely updates its prescription drug formularies and reviews the list of drugs requiring prior authorization as part of our procedures for safe prescribing. These changes are approved by our Pharmacy and Therapeutics Committee. Updates are made to the Select and Value formularies quarterly. The updated lists for July 1 will be available on the website on May 1. Select the link to either the Select or Value formulary. The updated list is available under “Formulary drug documents.” Standard changes can include: Members, as well as their providers, who are impacted by the… Read More

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

Understanding the Coding of Health Plans from MEC to Metallic

August 15, 2022July 22, 2022Ed MacConnell

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

Alternative Funding Yields Big Savings

August 4, 2022July 22, 2022Ed MacConnell

The Issue A firm we had worked with for several years had expressed a concern that the cost of their employee benefits package was threatening the financial stability of their firm. With a little over 150 employees, their annual benefits cost was exceeding $1.3 million and increasing at a rate of 8-15% each year. Even more concerning was that the benefits cost represented 32% of the company’s operating revenue. They had contemplated making plan changes including an increase in deductibles, copays and co-insurance limits, but they cared about the well-being of their employees and felt compelled to keep a competitive level of benefits. Our Solution We took the approach that… 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

2022 PCOR Fee Filing Reminder for Self-Insured Plans

June 16, 2022Ed MacConnell

The Patient-Centered Outcomes Research (PCOR) fee filing deadline is August 1, 2022, for all self-funded medical plansand HRAs for plan years ending in 2021. The IRS issued Notice 2022-04 announcing the adjusted fee amount for this year. please download the bulleting below for more details and contact your Total Benefit Solutions, Inc. health insurance specialist at (215)355-2121.

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

May 23, 2022May 23, 2022Ed MacConnell

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees May 23, 2022 This Allied Update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2022. By way of background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which… Read More

Fully Insured vs Level Funding: What’s the Difference?

May 12, 2022May 11, 2022Ed MacConnell

With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More

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