Discount Plans – Total Benefit Solutions Inc

Why Your Hospital Bills Are Total Fiction (And How Reference-Based Pricing Fixes It)

May 7, 2026May 7, 2026Ed MacConnellNo Comments

If you’ve ever opened a hospital bill and felt your heart stop for a second, and not because of the medical condition you were there for, you aren’t alone. We’ve all seen it: a $50 charge for a single Tylenol pill or a $3,000 bill for a fifteen-minute "consultation" that felt more like a quick "hello." Here’s the dirty little secret the healthcare industry doesn't want you to know: those numbers are almost entirely made up. In the world of health insurance and hospital billing, the prices you see on your statement are part of a document called the Chargemaster. Think of the Chargemaster as the "MSRP" (Manufacturer’s Suggested Retail… Read More

The ‘Blue Card’ Hack: How to Get National PPO Access on a Local Budget

May 6, 2026May 7, 2026Ed MacConnellNo Comments

If you’re a small business owner in Pennsylvania or New Jersey, you’ve likely felt the "geographic squeeze." You want to offer your team top-tier health insurance, but as soon as you look at national PPO plans, the premiums start looking like a mortgage payment for a small island. Most employers think they have two choices: pay a fortune for a "name brand" national plan or stick to a local HMO that leaves their remote workers or frequent travelers stranded without coverage. But there’s a third option, a "hack," if you will, that many brokers don’t explain clearly. It’s called the Blue Card PPO program. It’s the secret to getting a… Read More

How to Choose the Best Group Health Benefits for Small Business (Compared)

May 5, 2026May 7, 2026Ed MacConnell

Choosing the right group health insurance for employers can feel like trying to navigate a maze without a map. If you are a small business owner, you already know the stakes. Providing group health benefits for small business is one of your biggest expenses, yet it’s also your most powerful tool for attracting and keeping great employees. In 2026, the landscape of healthcare is shifting faster than ever. With median premium increases hitting double digits (often around 11% or higher), the "standard" way of doing things might not be the best way for your bottom line. We see many business owners stuck in a cycle of "renewal shock," where they… Read More

Level Funded vs. Fully Insured: Which Is Better For Your Trucking Company?

May 4, 2026May 4, 2026Ed MacConnell

If you’re running a trucking company in 2026, you already know that the road isn’t just getting longer: it’s getting more expensive. Between fluctuating fuel costs, maintenance, and the constant battle to keep good drivers behind the wheel, your margins are constantly under pressure. One of the biggest line items on your balance sheet is likely health insurance. For years, the "safe" choice was a traditional fully insured plan. You pay the premium, the insurance company takes the risk, and everyone moves on. But as premiums continue to climb by double digits year after year, many fleet owners are asking: Is there a better way? At Total Benefit Solutions Inc,… Read More

The 3-Tier Strategy: How Keystone Proactive Plans Save Your Team Money

April 27, 2026May 1, 2026Ed MacConnell

Let’s be honest: most people look at their health insurance plan once a year during open enrollment, get a headache from the jargon, and then tuck the ID card into their wallet hoping they never have to use it. But as a business owner or HR manager, you don’t have that luxury. You’re watching premiums climb every single year, and you’re looking for a way to give your employees great coverage without draining the company's bank account. At Total Benefit Solutions, we’ve seen every plan under the sun. Right now, one of the most effective tools in our arsenal for small and mid-sized businesses in the Philadelphia area is the… Read More

7 Mistakes Contractors Make with Group Health Benefits (And How to Fix Them)

April 20, 2026May 1, 2026Ed MacConnell

In the construction world, your reputation is built on the quality of your work and the reliability of your crew. As of April 13, 2026, the labor market for skilled trades remains incredibly tight. Finding a good foreman or a reliable HVAC technician is hard enough; keeping them is an entirely different challenge. One of the most powerful tools you have to retain talent is your benefits package. However, many contractors view health insurance as a "necessary evil": a line item on the P&L statement that only goes up every year. Because of this, we often see business owners in the construction industry make critical errors that cost them tens… Read More

Why Minimum Value Plans are a Game Changer for Home Health Agencies

April 13, 2026May 1, 2026Ed MacConnell

For home health agencies (HHAs) across the United States, the business landscape has never been more challenging. Between shifting Medicare reimbursement models, a persistent shortage of skilled nursing talent, and the ever-present pressure of the Affordable Care Act (ACA) mandates, many agency owners feel like they are being squeezed from every direction. At Total Benefit Solutions Inc, we spend a significant amount of time speaking with agency owners who are struggling to find a balance. They want to provide quality benefits to attract and retain caregivers, but they also need to maintain a bottom line that allows the agency to stay operational. The margins in home health are notoriously thin,… Read More

The Big Insurance Lie: Why your small business is probably overpaying for “peace of mind” (and how to stop)

April 11, 2026May 1, 2026Ed MacConnell

Let’s have a straight-talk conversation. If you are a small business owner, you’ve probably been told that the "safest" way to handle employee benefits is to sign up for a traditional, fully-insured plan from one of the big-name carriers, pay your monthly premium, and put the whole headache out of your mind. They call it "peace of mind." At Total Benefit Solutions Inc, we call it the "Big Insurance Lie." The truth is, many small businesses are overpaying for their health coverage by anywhere from 15% to a staggering 80%. When you consider that health insurance is often the second largest expense on a balance sheet after payroll, that "peace… Read More

The ‘Minimum’ Plan That Doesn’t Mean Minimum Advocacy

April 6, 2026May 1, 2026Ed MacConnell

When you hear the word "minimum," what comes to mind? Usually, it’s the bare essentials. The absolute basement. The least amount you can do to get by without getting in trouble. In the world of employee benefits, a "Minimum Value Plan" (MVP) often carries that same stigma. Many business owners view these plans as a "check-the-box" compliance strategy, a way to avoid those stinging Affordable Care Act (ACA) penalties without breaking the bank. Because these plans sit at the lower end of the cost spectrum, there is a dangerous assumption that the service, support, and advocacy attached to them must also be "minimum." At Total Benefit Solutions, we think that’s… Read More

Reference Based Pricing Explained in Under 3 Minutes: The Secret to Affordable Group Health Insurance

March 30, 2026May 1, 2026Ed MacConnell

If you’re a small to mid-sized business owner, you’ve likely watched your health insurance premiums climb year after year. You’re doing everything right: managing your overhead, growing your team, and taking care of your customers: yet your "second largest expense" keeps eating into your profit margins. It’s frustrating, and frankly, the traditional insurance model feels rigged against you. At Total Benefit Solutions, we don’t believe you should have to choose between providing quality benefits and keeping your business profitable. There is a better way to do this, and it’s called Reference Based Pricing (RBP). If you have three minutes, I can explain exactly how this "secret" works and why it’s… Read More

Don’t Get Burned by ACA Penalties: How Minimum Value Plans Save Your Bottom Line

March 30, 2026May 1, 2026Ed MacConnell

If you’re running a business in 2026, you already know that the IRS doesn’t send "friendly reminders" when it comes to the Affordable Care Act (ACA). They send bills. And lately, those bills have been getting a lot more expensive. At Total Benefit Solutions, we’ve seen too many hard-working business owners get blindsided by the Employer Shared Responsibility (ESR) payments because they thought their "standard" plan covered them. The reality is that just "having insurance" isn't enough to satisfy the federal government. To protect your bottom line, your plan must meet a very specific threshold called Minimum Value (MV). If it doesn't, and even one of your employees goes to… Read More

ACA Employer Mandate penalties are the highest ever

March 20, 2026May 1, 2026Ed MacConnell

ACA Employer Mandate penalties are the highest they have been since passage of the ACA. Here is a quick refresher for appliable large employers (or those close to hitting the 50 FTE threshold) on determining ALE status and tracking hours of its employees.

Medicare Secondary Payer Rules: 7 Mistakes Employers Are Making (And the CMS Penalties You Can’t Ignore in 2026)

March 20, 2026May 1, 2026Ed MacConnell

If you're an employer with 20 or more employees, you need to understand Medicare Secondary Payer rules, because CMS isn't asking nicely anymore. 2026 is shaping up to be a major enforcement year. CMS is tightening scrutiny on employers who mess up Medicare coordination, and the penalties aren't slaps on the wrist. We're talking mandatory reimbursements to Medicare, civil money penalties, and potential lawsuits that can drain your budget faster than any premium increase. The problem? Most employers have no idea they're even at risk until CMS comes knocking. At Total Benefit Solutions, we fight these battles every day, pushing back when carriers get the rules wrong, advocating when employers… 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

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

FAQ 68 Addresses Preventive Care and Mastectomy Coverage

December 24, 2024December 24, 2024Loramei Romeo

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

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

New Medicare Part-D Changes Affecting Employers for 2024-25

September 13, 2024September 13, 2024Mirasol Bandong

Dear Valued Client: We wanted to alert you to an upcoming change that could have a significant impact on Medicare-eligible employees and dependents who currently have group health coverage. Starting in 2025, Medicare Part D plans will have a $2,000 out-of-pocket limit. As CMS explains, this change, which is part of the Inflation Reduction Act, also includes measures like a $35 cap on insulin and new authority for Medicare to negotiate prices for certain high-cost drugs. The new $2,000 cap for Part D is particularly important because it could alter the status of many employer group health plans that currently provide drug coverage. Each year, employers must determine whether their prescription drug… Read More

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

IRS Addresses Tax Treatment Of Work-Life Referral Services

May 7, 2024May 6, 2024Mirasol Bandong

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

Update on Legislation – EmblemHealth

March 29, 2024March 28, 2024Mirasol Bandong

President Joe Biden presented his budget proposal on March 11th, 2024, for the federal fiscal year that would start on October 1st. Along with raising taxes on people earning more than $400,000 annually, the budget would also help extend talks with pharmaceutical corporations to prolong the Medicare program’s financial viability. click HERE to read the whole article. 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.

Claim Processing Delays and Invoice Updates

March 27, 2024March 26, 2024Mirasol Bandong

On February 21, 2024, MVP stopped doing business with Change Healthcare and its subsidiaries, as well as all digital interactions. This was due to a cyber security breach. In compliance with national and state regulations, MVP is implementing innovative business solutions and restoring affected service functionality as needed. Processing Delays for Provider Claims : New York State Department of Financial Services encourage issuers and pharmaceutical benefit managers (PBMs) to take into account granting provider requests to halt or reverse specific administrative processes. MVP is assessing each provider’s request for suspension and tolling individually and determining whether a certification is necessary. To read more click HERE We are dedicated to providing… Read More

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