#healthinsurance – Page 19 – Total Benefit Solutions Inc

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

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.

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.

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

Aetna Client Series: Reimagining Workforce Strategies Webinar

June 13, 2022June 12, 2022Ed MacConnell

Reimagining Workforce Strategies Thursday, June 23 at 2 PM ET Our next Aetna Client Series webinar is on Thursday, June 23 at 2 PM ET featuring: Tanya Taupier, SVP and Senior HRBP – HCB, Aetna and Jannine Zucker, Principal, Deloitte Consulting. This webinar is specifically designed for Aetna clients to hear about relevant thought leadership content. The topic of this webinar will be: Reimagining workforce strategies. Please share this invitation with your clients and join them to learn more about workforce strategies for success. Many organizations are struggling with an urgent talent crisis: The Great Resignation. As businesses search for ways to attract – and retain – talent. They have an opportunity to refocus their thinking on how and… Read More

6 Questions to ask your Benefits Broker

June 10, 2022June 10, 2022Ed MacConnell

Fixed Funding: Innovative plan solutions now available for New Jersey employers

June 10, 2022Ed MacConnell

AmeriHealth New Jersey is excited and proud to announce that it is offering Fixed Funding benefit design options to New Jersey employers, powered by AmeriHealth Administrators. These plans are available now to quote for July 1, 2022 effective dates. Fixed Funding offers innovative benefit designs that are flexible, predictable, and cash‑flow friendly — while providing members access to high‑quality care from an extensive network of doctors and hospitals. These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment. How a Fixed Funding health plan works: Employers have a consistent monthly payment that covers the cost of administrative fees, stop‑loss insurance premiums1, and an estimated cost… Read More

Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

June 10, 2022June 10, 2022Ed MacConnell

COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More

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

Notice Requirements for Group Health Plans

May 16, 2022May 13, 2022Ed MacConnell

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

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

Support for your emotional health

May 12, 2022May 11, 2022Ed MacConnell

Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.

Proposed Regulations to Fix ACA’s Affordability “Family Glitch”

May 10, 2022May 9, 2022Ed MacConnell

individuals are not eligible for premium tax credits in the Marketplace

Medicare Coverage for Treatment of PTSD

May 6, 2022May 5, 2022Ed MacConnell

Post-traumatic stress disorder (PTSD) is a mental condition that can develop after someone directly or indirectly experiences a traumatic event. It doesn’t always occur immediately following the event and may not be caused by an event some would traditionally consider traumatic. This can make identifying or diagnosing PTSD difficult. But, if PTSD isn’t identified and treated, it can be a part of the sufferer’s life for potentially the rest of their life. To Learn more Click Here, or for more information on how Medicare can help with coverages call Total Benefits Solutions at (215) 355-2121

HealthCare.gov Notices New Class of Individual Employer Policies

May 2, 2022Ed MacConnell

hCare.gov managers are signaling that they think individual coverage health reimbursement arrangements matter. The regulators in charge of the federal Affordable Care Act public exchange system today gave ICHRAs official attention, by adding an ICHRA use reporting requirements for the insurers that sell coverage through HealthCare.gov. Click here for the full story on Think Advisor.com

Annual Out-Of-Pocket Maximum Adjustments Announced for 2023

April 26, 2022Ed MacConnell

On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For more information contact your friends at Total Benefits Solutions! Reach out to us at (215)355-2121

HHS Extends Public Health Emergency until July 15

April 25, 2022April 25, 2022Ed MacConnell

On April 12, 2022, the Secretary of Health and Human Services renewed the COVID-19 pandemic Public Health Emergency, effective April 16, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Please download the bulletin below and contact your health insurance experts at Total Benefit Solutions, Inc at (215)355-2121 Download Bulletin

Understanding Your OMNIA Health Plan: OMNIA Tier 1 and Tier 2

April 21, 2022April 21, 2022Ed MacConnell

Do you understand your health insurance metallic tier?

April 19, 2022April 19, 2022Ed MacConnell

Free or Nearly Free Health Coverage Through New Jersey’s Expanded Access”

April 19, 2022April 18, 2022Ed MacConnell

The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the federal poverty level to enroll in a health plan throughout the year. New Jersey’s Governor Phil Murphy and Department of Banking and Insurance Commissioner Marlene Caride have introduced a new “Expanded Access” initiative, which allows residents at certain income levels to continue to enroll in free or nearly free health coverage through Get Covered New Jersey. The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the Federal Poverty Level (FPL) to enroll in a health plan throughout the year. This population will… Read More

Temporary Telehealth Relief for HSA Plans

April 15, 2022April 18, 2022Ed MacConnell

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth servicesfrom April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”)to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make HealthSavings Account (“HSA”) contributions….

New Qualifying Life Event through Pennie for New Customers!

April 11, 2022Ed MacConnell

Depending on a customer’s household income, they may qualify to enroll in coverage through a new Special Enrollment Period and receive financial assistance offered through Pennie! If a customer’s income is equal to or below 150% Federal Poverty Level (see table below), they can enroll in coverage through Pennie at any time of the year. New enrollees will need to take these steps to enroll in coverage under this qualifying life event: Submit a new Pennie application If they meet the criteria in the table below, a Special Enrollment Period (SEP) will automatically open! Once the SEP opens, they will have 60-days to enroll in a plan through Pennie. Once enrolled, coverage will begin the start of… Read More

Employers in Philadelphia Are Required to Provide Paid COVID Relief

April 9, 2022April 5, 2022Ed MacConnell

Employers in Philadelphia, PA with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 related reasons. The new measure became effective on March 9, 2022 and will extend through the end of 2023. It covers employees who are unable to work for the following reasons: To care for self or a family member showing symptoms of COVID-19 To care for self or a family member exposed to COVID-19, in order to self-isolate As a result of childcare or school closures To obtain a COVID-19 test or vaccine, or to recover from injury,… Read More

Family Glitch Solution Proposed

April 6, 2022Ed MacConnell

Family Glitch Solution Proposed The Biden Administration announced today that it would release a proposed rule to fix the family glitch. This proposed rule is a result of President Biden’s Executive Order from 2021 calling on the federal agencies to strengthen the Affordable Care Act. The Department of Treasury is using the proposed rule to revise the definition of “affordability” of employer sponsored coverage as it applies specifically to family members of the employee. Current regulations define employer-based health insurance as “affordable” if the coverage solely for the employee, not for family members, is affordable, making family members ineligible for a premium tax credit. The proposed changes would allow… Read More

Philadelphia Passes New COVID-19 Paid Leave Law

April 5, 2022April 4, 2022Ed MacConnell

Philadelphia has enacted a new law that requires employers to provide paid time off for COVID-19 purposes. The ordinance, which took effect March 9, 2022, applies to employers with at least 25 employees. Covered EmployeesThe ordinance covers employees who: Work in Philadelphia; Normally work in Philadelphia but currently telework from any other location as a result of COVID-19; or Work from multiple locations or from mobile locations, provided that 51% or more of their time is in Philadelphia. There is no waiting period or accrual requirement for leave. Permitted Purposes for COVID-19 LeaveLeave must be allowed for specified COVID-19 reasons relating to an employee’s (or their family members’) exposure to, symptoms of or diagnosis with COVID-19. Leave… Read More

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