Healthcare reform – Total Benefit Solutions Inc

Who Needs Extra Protection During Flu Season?

September 11, 2023September 11, 2023Ed MacConnell

The flu season is upon us once again, and it’s time to make sure you and your loved ones are protected. The flu is more than just a pesky inconvenience; it can be a serious illness that leads to hospital visits and even death. By getting vaccinated, not only are you protecting yourself from getting sick, but you’re also playing a significant role in preventing the flu from spreading to others. Where to Get Your Flu Shot Getting a flu shot is convenient and accessible. You can receive one at your doctor’s office, your local pharmacy, or various clinics in your area. Plus, if you’re covered by Medicare, you’re in… Read More

How income affects your Medicare drug coverage premiums

September 8, 2023September 8, 2023Ed MacConnell

You could pay a higher monthly premium for Medicare drug coverage (Part D) depending on your income. This includes Part D coverage you get from a Medicare drug plan, a Medicare Advantage Plan with drug coverage, or a Medicare Cost Plan that includes drug coverage. This is true even if your drug coverage is through your employer. Download this bulletin to learn more about extra Medicare drug coverage premiums As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)355-2121

Decoding Medicare Supplement Charts

August 15, 2023August 15, 2023Ed MacConnell

So, you’re on the quest to unravel the complexities of Medicare supplement plans, and in your journey, you’ve stumbled upon the elusive “Medicare Supplement Comparison Chart.” It’s like a mosaic of options, donning a variety of colors and fonts, yet each one is strangely reminiscent of the other. But what exactly are these charts? What secrets do they hold? Well, that’s what we’re here to uncover today. Cracking Open the Chart Imagine this: you’re face-to-face with a Medicare Supplement Comparison Chart. But what’s beneath the surface? Every column you see represents one of the ten available Medigap plans up for grabs – think Plans A, B, C, D, F, G,… Read More

Pennie’s Open Enrollment Period for 2023 Coverage is Around the Corner

October 26, 2022Ed MacConnell

Pennie’s Open Enrollment Period for 2023 Coverage is Around the Corner: Pennie’s Open Enrollment Period will run from November 1, 2022, to January 15, 2023. As a reminder, existing Pennie customers will be receiving auto-renewal notices this week with information on their 2023 plans. Great news! Thanks to the Inflation Reduction Act, enhanced savings continue to be available for Pennie customers and those enrolling in coverage through Pennie! As always if you have any questions or concerns please contact your Pennie health insurance experts at Total Benefit Solutions Inc (215)355-2121

CIGNA Supplemental Benefits Now Available Online

October 26, 2022October 25, 2022Ed MacConnell

CIGNA’s Medicare supplements and dental/vision plans are available to quote and enroll online for your convenience! Just click the link below to get your quotes and as always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 if you have any questions or concerns! Click here

Independence: What are Preventative Plus Providers?

October 17, 2022Ed MacConnell

Preventive Plus Preventive Plus providers are participating freestanding ambulatory surgical centers (ASC) and a select group of gastroenterologists and colorectal surgeons who perform preventative colonoscopy for colorectal cancer screenings at a freestanding ASC. For certain plans, the Member’s cost-share for this service will be $0 when performed by Preventive Plus providers. Please refer to your benefits booklet or contract to determine if your plan includes the Preventive Plus benefit. For updated or more detailed information regarding Preventive Plus providers, visit our website at ibx.com/provider finder, or call Customer Service at 1-800-ASK-BLUE (1-800-275-2583), Monday through Friday, 8 a.m. to 6 p.m. ET For further questions or concerns please contact your Total… Read More

National General/Allstate Welcome Packet

October 10, 2022October 10, 2022Ed MacConnell

Considering Level funding and/or reference based pricing for your group health insurance? Download the brochure below to learn more about it them contact your health insurance specialists at Total Benefit Solutions, Inc today to compare your current plan to level funded and reference based pricing options! The brochure includes information on reading an EOB, Vitality and the healthcare blue book as well. As always we can be reached at (215)355-2121.

How to File a Medicare Appeal

September 30, 2022September 29, 2022Ed MacConnell

Medicare beneficiaries have the right to file an appeal when they or their physicians disagree with a treatment or claim denial. Luckily Medicare provides a step by step instruction guide to filing those appeals. Please click the link below to downlead the Medicare appeals guide. As always please contact your Total Benefit Solutions Inc Medicare health insurance specialist at (215)355-2121 if you have any additional questions or concerns.

A new group health insurance offering for small businesses. Introducing CIGNA + Oscar

September 29, 2022September 29, 2022Ed MacConnell

We’ve partnered with Cigna + Oscar to deliver small business health insurance that brings together Cigna’s most popular provider networks and Oscar’s tech-driven approach to customer service and care navigation. Cigna + Oscar plans are available in the Philadelphia 5 county area beginning with effective dates starting January 1 2023. Your Total Benefit Solutions, Inc health insurance specialists are available to help you quote and compare plans. Call us today to get your quote and compare these newest plans to your current renewal. You might be surprised at the competitive cost and plan designs! (215)355-2121

Final Rules Adopt Administrative Changes to the No Surprises Act

September 26, 2022September 22, 2022Ed MacConnell

On August 26, 2022, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) published final rules on the No Surprises Act, making changes to the administrative duties of insurance carriers, HMOs, third-party administrators, out-of-network healthcare providers, and certain other entities responsible for the Act’s implementation. The new rules, which take effect on October 25, 2022, are narrow in scope, and include the following changes:• During processing of claims under the No Surprises Act, if “down-coding” occurs (i.e., the group medical plan alters or replaces the medical billing codes chosen by the out-of-network healthcare provider, resulting in a lower claim payment), then the final rules impose… Read More

Turning 26: Your Guide to Health Insurance

September 23, 2022Ed MacConnell

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

2022 MLR Rebate Checks to Be Issued Soon to Fully Insured Plans

September 23, 2022September 22, 2022Ed MacConnell

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carrier collects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activities to improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check. If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2022. Click the link below to download the full bulletin.

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

Additional Guidance on New Prescription Drug Reporting Requirement

September 15, 2022September 14, 2022Ed MacConnell

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit informationannually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services(“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Click the link below to download this bulletin. As always please contact your Total benefit Solutions, Inc health insurance specialist at (215)355-2121 if you have any further questions or concerns.

Additional Guidance Issued on Surprise Billing Protections

September 12, 2022September 9, 2022Ed MacConnell

The Consolidated Appropriations Act of 2021 introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, & providers. The Consolidated Appropriations Act of 2021 (CAA) introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, and providers. The federal Departments of Health and Human Services, Labor, and Treasury recently released a document discussing frequently asked questions (FAQs) about these surprise billing protections that provides clarity on a number of topics within the regulations. The key points from this guidance are outlined below. Application to Reference Based Pricing PlansIt has been unclear how the surprise billing rules apply to… Read More

Employer Reporting and Compliance Penalties Chart (2023)

September 9, 2022September 8, 2022Ed MacConnell

Inflation Reduction Act – Health Care Considerations

September 9, 2022September 8, 2022Ed MacConnell

On August 16, 2022, President Biden signed the “Inflation Reduction Act” into law. The legislation includes key health care, tax, and climate change components. Click the link below to download the bulletin which highlights the health care changes ! As always please contact your Total Benefit Solutions, Inc health insurance expert with any additional questions, (215)355-3121.

Over-the-Counter Hearing Aids May Help People with Medicare

September 8, 2022Ed MacConnell

The Food and Drug Administration (FDA) recently finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may make hearing aids more affordable for as many as 30 million adults who believe they have mild to moderate hearing loss, even if they have not had a hearing exam. Last week, the Food and Drug Administration (FDA) finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may… Read More

What is an excepted benefit HRA?

September 7, 2022September 7, 2022Ed MacConnell

Businesses that offer an employer-sponsored group health plan to workers now have another way to save money while designing a health benefit package with more choices for employees – the Excepted Benefit HRA. The new EBHRA is a Health Reimbursement Arrangement designed to pay premiums and related expenses for eligible excepted benefits like dental and vision coverage. And, while an employer is required to offer a traditional group health plan, an employee can participate in the EBHRA even if they decline participating in the employer’s group health plan. That’s going to open up a lot of premium savings for workers who are eligible for coverage under a spouse’s or parent’s… Read More

What is a Qualifying Life Event or QLE?

July 29, 2022July 14, 2022Ed MacConnell

There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More

Case Study Library

July 22, 2022July 22, 2022Ed MacConnell

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

Total Benefit Solutions, Inc partners with GRAVIE

June 20, 2022June 16, 2022Ed MacConnell

What Employers Have to Say: Gravie is Revolutionizing the Industry Gravie is rebuilding health benefits from the bottom up by keeping the focus on who matters most: the consumer. That customer-centered attention might seem obvious, but it’s long overdue in the health benefits industry. The savings and improved outcomes numbers speak for themselves, but if you still need convincing, don’t just take our word for it. Employers from organizations large and small, across industries, and throughout the country have shared how Gravie’s modern and innovative approach to health benefits are impacting their businesses and their employees for the better. Across all our solutions, we are hearing from employers that we’re making their… Read More

Aetna: Transparency in Coverage Rule Update

June 17, 2022June 16, 2022Ed MacConnell

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

Turning 26: Your Guide to Health Insurance

June 15, 2022June 13, 2022Ed MacConnell

Thanks to the Affordable Care Act (ACA), many young people choose to stay on their parent’s health insurance for as long as possible, and with good reason. The historic healthcare law, also known as Obamacare, allows young adults to stay on their parent’s health plan until they turn 26, no matter what. Download our free easy to read guide to getting your own health insurance here. Contact your health insurance experts at Total Benefit Solutions Inc with any additional questions (215)355-2121

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