Individual Mandate – Total Benefit Solutions Inc

Who Needs Extra Protection During Flu Season?

September 11, 2023September 11, 2023Wendy Lopez

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, 2023Wendy Lopez

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

How To Find a Doctor You Trust

November 9, 2018November 8, 2018Ed MacConnell

How to Find a Doctor You Trust Get a list of in-network providers: Call your insurance company or look at their plan materials for a list of doctors in their network. You’ll usually pay less to see a doctor in your network than a doctor who’s out-of-network. You can also call your Broker and they can help assist you in getting the names of Doctors near you that accept your plan. Do your research: Ask friends and family if they recommend their doctors. You may even be able to read online reviews for doctors in your area. Online reviews are a great way to gauge things such as bedside manner and wait… Read More

“I’m paying for Health Insurance I don’t even use!”

November 9, 2018November 8, 2018Ed MacConnell

You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick! You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More

Confused by Medicare? Learn How Our Approach Leaves You Feeling Confident About Your Choices!

August 23, 2018Ed MacConnell

Congress Passes Tax Reform Bill

December 31, 2017December 31, 2017Ed MacConnell

On December 20, 2017, the House and Senate sent President Trump the Tax Cuts and Jobs Act for signature. The House of Representatives passed their version of the bill on November 16, 2017 while the Senate passed their version on December 2, 2017. Because the versions were not identical, a Tax-Bill Conference Committee was formed from members of the Senate and the House of Representatives to negotiate the text of the combined bill. After the finalized text was approved and released by the committee, the House and Senate each passed the combined bill (which happened on December 20th in the House and December 19th in the Senate) before… Read More

Guidance Issued on QSEHRAs

November 22, 2017November 22, 2017Ed MacConnell

Under the Affordable Care Act, a health reimbursement arrangement (HRA) must be integrated with a group health plan (as it could not meet the market reform provisions on its own) and was not able to reimburse employees for individual premiums. However, on December 13, 2016, President Obama signed into law the “21st Century Cures Act” which established QSEHRAs (a special standalone HRA). Click to Download Guidance Issued on QSEHRAs This guidance is big news for small groups who would prefer to provide a reimbursement as opposed to a group health plan. Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.

2018 Inflation Adjusted Amounts for HSAs

June 2, 2017June 2, 2017Ed MacConnell

The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2018. All limits increased from 2017 amounts. Click to download the bulletin below and as always contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns regarding this notice. Click Here to Download 2018 Inflation Adjusted Amounts for HSAs

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

Relief for Small Employers with HRAs

January 9, 2017Ed MacConnell

On December 13, 2016, President Obama signed into law the “21st Century Cures Act” which allows small employers without group medical plans to reimburse individual premiums and other medical expenses of employees under health reimbursement arrangements (“HRAs”), effective with the 2017 plan year, and provides relief from penalties to all small employers reimbursing individual premiums of employees for earlier plan years. In addition, the Cures Act provides a medical innovation package that funds medical research, accelerates cutting-edge treatments for rare diseases, and makes significant reforms to the mental health system. The Issue An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether… Read More

New Law Exempts Certain Small Employer HRAs From ACA Market Reforms

December 15, 2016December 14, 2016Ed MacConnell

New Law Exempts Certain Small Employer HRAs From ACA Market Reforms Gaddiel Gonzalez-Brown & Brown Consulting President Obama has signed into law the 21st Century Cures Act, which, among other things, allows small employers to offer new “qualified small employer health reimbursement arrangements” to reimburse employees for qualified medical expenses, including individual health insurance premiums, for years after December 31, 2016. Small employers are defined as those with fewer than 50 full-time equivalent employees who do not offer a group health plan. Background Under prior agency guidance, stand-alone HRAs (except for retiree-only HRAs and HRAs consisting solely of excepted benefits) and HRAs used to purchase coverage on the individual… Read More

ACA: Important Implementations & Delays in 2016

July 15, 2016July 17, 2016Ed MacConnell

As our third year of the ACA Open Enrollment Period arrived, it’s time to examine some of the new implementations in 2016. Some of the major components, especially those affecting businesses were delayed or deferred since the passage of the Affordable Care Act in 2010. This year is considered to be a big year due to the “full implementation” of the employer mandate as well as a number of changes, repeals, and moratoriums on other sections of ACA. Some of the key changes are listed below: CHANGES AND IMPLEMENTATIONS Full implementation of the Employer Mandate Currently it is not mandated that employers provide health care to their employees. Moving forward, however, if… Read More

Health Reform: Reduction in Hours First Lawsuit is Filed by Employees

August 3, 2015Ed MacConnell

The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R

Gov. Wolf wants Pa. to operate Obamacare exchange

June 3, 2015June 3, 2015Ed MacConnell

Gov. Wolf this week formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month. Read more at philly.com Remember that your Total Benefit Solutions professionals are trained, licensed, insured and available to help compare, shop and enroll all affordable care act plans on the healthcare Marketplace and off. As always contact us today if you have any questions or concerns at (215)355-2121.

Health Reform: Guidance Issued-Employer Reimbursement of Individual Policies

November 24, 2014January 30, 2015Ed MacConnell

Previously, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (collectively, the “Departments”) explained that HRAs and employer payment plans cannot reimburse individual policies. On November 6, the Departments issued their twenty-second set of FAQs which make clear that: An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Such arrangements are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. Such… Read More

IRS Coordinates Cafeteria Plan Rules with the ACA:Two New Election Changes Allowed

October 10, 2014October 10, 2014Ed MacConnell

Two New Election Changes Allowed Existing cafeteria plan rules make it difficult (if not impossible) for participants to revoke pre-tax salary reduction elections mid-year and enroll in qualified health plan coverage through the Health Insurance Marketplace (the “Marketplace,” sometimes referred to as the “Exchange”). To provide additional flexibility, the IRS issued Notice 2014-55, creating new opportunities for a participant to change mid-year an otherwise irrevocable cafeteria plan election. Click here to Download the Entire Bulletin

Health Reform: Eligibility Programs

September 30, 2014August 24, 2014Ed MacConnell

Medicaid, CHIP, and the Affordable Care Act The Affordable Care Act significantly streamlines the eligibility standards and enrollment processes for Medicaid. It also offers a new opportunity for states to expand Medicaid to all adults ages 19 – 64 with household MAGI at or below 138% of the FPL. States have the option to expand Medicaid eligibility to this new eligibility group. This is known as “Medicaid expansion.” Through Medicaid expansion, the Affordable Care Act provides new opportunities for adults in some states to be covered by Medicaid. However, some states have chosen not to expand Medicaid eligibility to these income levels. Even if a state did not expand Medicaid,… Read More

Health Reform: Guaranteed Renewability

September 24, 2014August 24, 2014Ed MacConnell

Guaranteed Issue and Guaranteed Renewability The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called “guaranteed issue.” Coverage offered through and outside the Marketplaces may restrict guaranteed issue coverage to certain enrollment periods. Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This… Read More

Health Reform: Network Adequacy Standards

September 15, 2014August 24, 2014Ed MacConnell

Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More

Health Reform: What is a Special Enrollment Period?

August 28, 2014August 24, 2014Ed MacConnell

Special Enrollment Periods Under certain circumstances, individuals may enroll in a QHP or change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events or special circumstances. Events that permit an SEP include: Gaining or becoming a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care Gaining status as a citizen, national, or lawfully present individual Loss of coverage (e.g., loss of Medicaid eligibility, QHP no longer available), except if enrollment is terminated based on failure to pay premiums, fraud, or enrollee initiated termination Determination that an individual is newly eligible or ineligible for advance payments of the premium tax… Read More

Health Reform: Individual Responsibility Changes for 2015

August 24, 2014Ed MacConnell

Individual Shared Responsibility Payment Amounts for 2014 and 2015 Tax Years The amount of the individual shared responsibility payment increases between 2014 and 2015. 2014: The annual individual shared responsibility payment is the greater of 1% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or The taxpayer’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285. However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2014. 2015: The annual individual responsibility payment is… Read More

FMLA Proposed Rules To Recognize Same Sex Regardless of Residency

August 22, 2014Ed MacConnell

FMLA Proposed Rules To Recognize Same Sex Regardless of Residency The DOL is proposing to amend the regulatory definition of “spouse” under the Family and Medical Leave Act (“FMLA”) so that “spouse” for purposes of FMLA rights would include a same-sex spouse, regardless of where the employee and spouse live. This means the “place of celebration” will determine whether an individual is a spouse under FMLA, rather than the current rule which uses the “state of residence,” which recognizes a spouse under the law of the state in which the couple resides. Click the link to download the bulletin: 070714-P-ERC-FMLA_Proposed_Rules (1) Please contact you Total Benefit Solutions account manager at (215)355-2121 if… Read More

U.S. Supreme Court Contraceptive Ruling

June 30, 2014Ed MacConnell

In a 5-4 decision that was described by one of the dissenting Justices as a “decision of startling breadth”, the Supreme Court has ruled in Burwell v. Hobby Lobby Stores, Inc. that closely held for-profit corporations are not compelled to provide contraceptive coverage under the Affordable Care Act’s preventive care mandate if they object to that coverage on religious grounds. The decision is a “win” for Hobby Lobby who had challenged the contraceptive mandate saying it forced them to either violate their faith or pay fines. Click here to download the bulletin

Health Care Reform Updates: Updated Model COBRA Election Notice

June 10, 2014Ed MacConnell

Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces). COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

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