Health Care Reform – Total Benefit Solutions Inc

Medicare Supplement Plan F or G?

August 20, 2021October 20, 2021Ed MacConnell

Many of our clients ask what is the “best” Medicare supplement that they can buy. While there is no overall “best”, the Medicare Supplement Plan F is generally considered the most comprehensive coverage among Medicare supplements due to the fact that most services are covered without any member co-pay or cost sharing at all. Keep in mind that Medicare supplements, like Plan F do not cover prescriptions and that a beneficiary with Medicare supplement will need to have other coverage for prescription drug coverage. A little known fact about Medicare supplements is that they do not have an annual “open enrollment” period so a beneficiary with a supplement can… Read More

Ways to Save Money on Your Prescription Drugs

November 2, 2018Ed MacConnell

Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More

Important Info! HSA Limits for 2019

November 1, 2018Ed MacConnell

End of Summer Social Media Drive 2018

August 16, 2018Ed MacConnell

Please help us get the word out on social media in August & September You Could Win a $25-$100 Amazon Gift Card!!! While everyone is getting ready for the End of Season BBQs, gearing up for Back-to-School, and trying to fit in as much adventure as possible the next few weeks, we here at Total Benefit Solutions are getting ready for our busiest time of year: Open Enrollments! Your friends and family members may not be concerned with the open enrollment period.. YET, but it is quickly approaching and we’d like to help them! As always, We appreciate all the referrals and recommendations that we get online from everyone, but we… Read More

New Jersey Out-of-Network Bill

July 31, 2018July 31, 2018Ed MacConnell

On June 1, 2018, New Jersey Gov. Murphy passed the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “OON Act”). In general, the OON Act applies to emergency services and other care provided by out-of-network physicians in in-network settings (i.e. hospital-based physicians). It takes effect on September 1, 2018. Click the link below to download the full story: Click to Download For more information or if you have any questions, please feel free to contact your Total Benefit Solutions Account Manager at 215-355-2121

House Passes Bill to Repeal ACA

May 5, 2017May 5, 2017Ed MacConnell

Just six weeks after the House leaders failed to muster the votes to pass an earlier version of the American Health Care Act (AHCA), the House Republicans narrowly passed their health care bill to repeal and replace Obamacare with a 217 to 213 vote on Thursday… Click the link below to download the bulletin with important points: Download House Passes Bill to Repeal Obamacare

Stand-Alone HRAs for Small Employers are Back!

March 1, 2017March 1, 2017Ed MacConnell

Stand-Alone HRAs for Small Employers are Back! The 21st Century Cures Act, signed by President Obama on December 13, 2016, gave small employers a means of providing employees help with their individual insurance premiums and other out-of-pocket qualified medical expenses without violating the provisions of the Affordable Care Act (ACA). Small employers can now provide a specific kind of Health Reimbursement Arrangement (HRA) to help employees with the costs of individual health coverage. According to the statutory language under “Title XVIII – Other Provisions” of the Act, qualified small employer health reimbursement arrangements (QSEHRAs) are not considered “group health plans” and do not have to adhere to ACA market reforms,… Read More

Update on the Status of the ACA

January 17, 2017Ed MacConnell

Update on the Status of the ACA With the impending inauguration, recent actions by the Senate and some confusing media reports, we wanted to provide a short Q&A to help you understand current events and what to expect as we head down the health care reform road in 2017… What’s the latest news? Download the bulletin for an update: Download Update on the Status of the ACA As always please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121 if you have any questions or concerns.

Health Reform: Cost of Living Adjustments, Individual Penalty, HSA limits & more for 2017

November 21, 2016Ed MacConnell

On October 25 and 27, 2016, the IRS released cost of living adjustments for 2017 under various provisions of the Internal Revenue Code (the Code). Some of these adjustments may affect your employee benefit plans. These adjustments include but are not limited to the following: Cafeteria Plans Qualified Transportation Fringe Benefits Requirement To Maintain Minimum Essential Coverage (Individual Penalty) Highly Compensated Non-Grandfathered Plan Cost-Sharing Limits H.S.A. Annual contribution limitation, catch up contribution and minimum deductibles Key Employee Click here to download the bulletin As always if you have any additional questions or concerns, please contact your dedicated Total Benefit Solutions, Inc. account manager at (215)355-2121.

IBC: Plans to remove exclusions for gender reassignment surgery coverage

October 25, 2016October 25, 2016Ed MacConnell

In a July Independence Edge article, we shared that the U.S. Department of Health and Human Services (HHS) had issued a final rule for the nondiscrimination provision (section 1557) of the Affordable Care Act (ACA). While the nondiscrimination provision itself is not new, the final rule provides expanded clarity on coverage for gender reassignment surgery and related services. In addition, it provides guidance on treating individuals consistent with their gender identity, and not denying or limiting health services usually only available to individuals of one gender. Beginning with renewals on or after January 1, 2017, the exclusion for gender reassignment surgery has been removed from all commercial plans. Members… Read More

Opt-Out Bonuses May Affect Affordability

September 14, 2016Ed MacConnell

The IRS recently issued proposed regulations that (among other things) address affordability determinations for individuals who are eligible for employer-sponsored health coverage. Building on earlier guidance, the proposed rules describe the effect an opt-out waiver has on affordability. Should you have any questions, please contact your Total Benefit Solutions account manager directly at (215)355-2121. Click here to download this bulletin

Notice of Subsidies in the Federal Marketplace

July 18, 2016July 18, 2016Ed MacConnell

The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click here to download the bulletin

Total Benefit Solutions: New Starmark Self Insured Plans for Small Groups

July 5, 2016Ed MacConnell

Total Benefit Solutions is proud to announce that we are now appointed with Starmark to provide affordable and predictable self insured medical plans to small businesses. Starmark® administers self-funded health benefit plans exclusively for smaller businesses nationwide. Employers choose from extensive plan design choices to create a self-funded health plan to meet their unique needs and budget, while stop-loss insurance from Trustmark Life Insurance Company provides protection against large covered claims. Click Here To View A Client Testimonial Click here for more information and to watch a short video about these products and how your organization might benefit from a self insured plan.

Notice of Subsidies in the Federal Marketplace

June 20, 2016June 16, 2016Ed MacConnell

The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015…

June 16, 2016Ed MacConnell

The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015. The IRS has also issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year. Please note that for those with an HRA plan, and HRA is ” self insurance” and you are required to file and pay the PCOR fee. Please download the document below for more details and links to specific resources. Download PCOR Fee Filing Reminder for Self-Insured Plans

New ACA Delays/Extensions/Eliminations Chart–Download Free

June 12, 2016Ed MacConnell

With so many different ACA provisions, HR360’s simple new chart provides you and your clients with a clear understanding of the key requirements that have been delayed, extended, or eliminated under the Affordable Care Act. Our business partner, HR360’s simple chart features important ACA delays, extensions, and eliminations, including: Eliminated automatic enrollment provisions Delay of the “Cadillac” tax Extension of information reporting deadlines Download ACA_Delays_Extensions_and_Eliminations

Departments issue new ACA FAQ’s

June 7, 2016June 6, 2016Ed MacConnell

The Departments of Labor, the Treasury, and Health and Human Services (collectively, the “Departments”) have issued the 31st set of Affordable Care Act (“ACA”) frequently asked questions (“FAQs”). This time, the Departments address a wide range of topics including preventive services, disclosure obligations, coverage in connection with approved clinical trials, reference-based pricing, the Mental Health Parity and Addiction Equity Act, and the Women’s Health and Cancer Rights Act. Below is a brief summary of the guidance issued on these topics. Click the link below to download the bulletin. Download Departments Issue 31st set of FAQs

2017 Inflation Adjusted Amounts for HSAs

May 6, 2016May 5, 2016Ed MacConnell

The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2017. Most limits remained the same as 2016 amounts. Click the link below to download the bulletin. 2017 Inflation Adjusted Amounts for HSAs

Health Care Reform: 8 things the IRS wants small employers to know about the health care tax credit

May 5, 2016May 5, 2016Ed MacConnell

The Affordable Care Act’s small business health care tax credit is designed to encourage small employers to offer health insurance coverage to their employees. Click the link below to download the whitepaper 8 things the IRS wants small employers to know about this credit: 8 Things to Know About the Small Business Health Care Tax Credit For more information about the Small Business Health Care Tax Credit contact your Total Benefit Solutions, Inc account manager at (215)355-2121 or visit your ThinkHR library at www.thinkhr.com and log in. Watch a video below about the Small Business Healthcare Tax Credit

Obama administration backs off on ACA rules for 2017 health plans

March 8, 2016Ed MacConnell

CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry. Click here for the full story from Modern Healthcare As always, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about the Affordable Care Act.

GAO Report: PPACA- CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk

February 29, 2016February 26, 2016Ed MacConnell

During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014. The GAO applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though GAO sent fictitious documents, or no documents, to resolve application inconsistencies Click here for the highlight sheet Click here for the full report

New Qualified Transit and Parking Guidance

January 23, 2016January 30, 2016Ed MacConnell

The Consolidated Appropriations Act, 2016 (the “Act”) permanently changed the pre-tax transit benefits to be at parity with parking benefits. As a result, the Act retroactively increased the 2015 transit benefits from $130 to $250. For 2016, the transit and parking pre-tax benefits are $255. Click the link below to read the entire bulletin. New Qualified Transit and Parking Guidance – 012216R

Millions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost

January 6, 2016January 5, 2016Ed MacConnell

Millions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost A recent Kaiser Family Foundation (KFF) analysis found that millions may pay more for not having health insurance in 2016 than the coverage would cost. The ACA’s individual mandate penalty is collected with income taxes and was created to encourage people not to wait until they get sick to buy health insurance. For 2016, the penalty is the greater of two amounts: •$695 plus $347.50 per child, up to a $2,085 max for a family or •2.5 percent of family income in excess of 2015 income tax filing thresholds ($10,300 for an individual, $20,600… Read More

IRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA

January 5, 2016Ed MacConnell

IRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA On December 28, the U.S. Treasury and Internal Revenue Service announced a limited extension of the early 2016 due dates for the 2015 information reporting requirements for employers and insurers under the ACA. This is the first year that employers and insurers are required to report certain information about health coverage to employees, other individuals to the IRS. Specifically, employers will have two additional months beyond the February 1 due date to provide individuals forms for reporting on offers of health coverage and the coverage provided. The deadlines to report this information to the IRS are extended by three… Read More

Employees on Leave May be Full Time for Penalty Purposes

October 7, 2015Ed MacConnell

Informal guidance has been released regarding calculating employees for penalty purposes as full time. Please click the link below to download the bulletin. Download Employees on Leave May be Full-time Employees for Employer Penalty Purposes – 100115R As always, if you have questions regarding this bulletin, please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121.

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