What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure
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Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
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From Independence Blue Cross & Amerihealth: Individual customers will receive a communication to prepare for open enrollment this week Independence Blue Cross (Independence) will be sending letters to individual customers to remind them about 2015 Open Enrollment dates, inform them how they can prepare now, and let them know we will send additional details in the coming weeks. Each letter will include a list of upcoming health insurance meetings they can attend, along with a card that will make it easier for them to keep track of their enrollment information. These letters will include the agent’s name and phone number, and encourage individuals to contact their agent with questions.… Read More
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CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More
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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
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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
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What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans. In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More
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Health Reform: SHOP Marketplace Changes for 2015 In 2014, small businesses that offer coverage through an FF-SHOP Marketplace are able to offer their employees a single qualified health plan (QHP). In 2015, small businesses that offer coverage through an FF-SHOP Marketplace may be able to offer their employees a choice of QHPs and qualified dental plans (QDPs). To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible common-law employee on payroll Have 50 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per… Read More
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Health Reform: Affordable Care Act Business/Plan Sponsor Checklist for 2015/2106 This bulletin features a checklist, including descriptions of key topics, to guide you through Affordable Care Act compliance in 2015-2016. Click the link to download the ACA Checklist: ACA Checklist for 2015-2016-082214R Should you have any questions, please contact your Total Benefit Solutions Inc., account manager directly at (215)355-2121.
Continue ReadingChanges to Maximum Out-of-Pocket Limits Under the Affordable Care Act (ACA), all non-grandfathered group health plans regardless of size or funding arrangement, must comply with annual limits on out-of-pocket maximums for in-network covered services that are Essential Health Benefits (EHB)1. These out-of-pocket maximums are also known as a plan’s maximum out-of-pocket (MOOP). Click the link to download the full notice: Changes_to_MOOP_Limits Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.
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Exchange Notification Reminder The very busy renewal date of December 1, 2014, is fast approaching. This notice is to remind you that each employer group must give their employees a Marketplace (Exchange) notification. The first link below is for employer groups that currently do offer coverage. The second link below is for an employer that does NOT offer coverage to employees. Please remember this notification is for the states of Pennsylvania and New Jersey. The form also works for any employer who is based in an FFM (Federal Facilitated Marketplace) State. It is NOT compliant in NY, MD or any other state that provides their own State… Read More
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Calculator May Help Small Businesses Determine SHOP Eligibility The U.S. Department of Health & Human Services has developed a Full-Time Equivalent (FTE) Employee Calculator to help small employers determine whether they qualify for the Small Business Health Options Program (SHOP). Background SHOP is available as an option for qualified small employers to purchase employee health coverage. The federal government is running the program in states that chose not to operate their own SHOP Marketplace (Exchange). For 2014, employers are generally eligible to purchase health coverage through the federally-facilitated SHOP Marketplace if they have 50 or fewer full-time equivalent employees (FTEs), including part-time employees. (For example, 2 part-time employees… Read More
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This briefing is applicable to all brokers writing Pennsylvania based employers We have updated our eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates we have outlined below. We thank you for your continued collaboration. The following applies to Small Group Pennsylvania new business and renewals: The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner. Sole proprietors, owners… Read More
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The IRS has released the 2015 cost-of-living adjustments affecting HSAs and HDHPs. The 2015 IRS HSA limits are increasing for 2015. Click to download the bulletin
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As you may already know, the Independence Blue Cross Special Care SM* health care plan will terminate on June 30, 2014. Because the Special Care plan is ending, the individuals who are currently enrolled in this plan will be eligible for a special enrollment period to sign up for a plan that is compliant with the Affordable Care Act (ACA). Special Care members qualify for a special enrollment period All Special Care members will be eligible for a special enrollment period , which will allow them to enroll in an individual or family health plan. Members will have from May 1 to August 29, 2014 to enroll in a health plan… Read More
Continue ReadingOur friends at Zane Benefits recently shared this comic and I enjoyed it so much I thought you might like it too: Click here to see the rest of the comic on zanebenefits.com Click here to see the rest of the comic on zanebenefits.com
Continue ReadingEd, thank you for your recent endorsements. And especially thank you for helping my wife and I sail through the new Affordable Care Act. You and your team made the complicated seem simple and select the plan best suited for our health insurance needs. Thanks again!! Mike Hilbert Sales Pros for Hire PS- I have already received and paid my April payment and can print temporary insurance cards from the website.
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The Truth Agents/Brokers & FFM Navigators The Patient Protection and Affordable Care Act Shared with permission from B. Ronnell Nolan, HIA, CHRS-President/CEO – HAFA Financial Media Group, LLC, Centennial, CO, compiles this information annually. There are approximately 1.2 million licensed insurance agents nationally. The 1.2 million does not include the staff of licensed agents employed throughout the United States. After adding the staff, imagine the millions of people that Agents represent, educate and protect on a daily basis! With the passing of the ACA, Health Agents for America, Inc. was formed to create a tool box for Agents to use in educating the citizens of their local communities. HAFA is known to… Read More
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For plan years beginning on or after January 1, 2014, a group health plan and an insurance carrier offering group health insurance coverage may not apply any waiting period that exceeds 90 days. This rule applies to both grandfathered and non-grandfathered plans. It should be noted that nothing in the Affordable Care Act requires a group health plan or carrier to have a waiting period Click here to download the bulletin
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Independence Blue Cross (IBC) has selected Laboratory Corporation of America® Holdings (LabCorp), as its exclusive, nationally-based provider of laboratory services, effective July 1, 2014. The change applies to all Personal Choice®/PPO and Keystone Health Plan East product lines, and affects all individual, group commercial, and Medicare members, for services rendered in the Philadelphia five-county area, and in the contiguous counties. Effective July 1, 2014, Quest Diagnostics laboratories will be an out-of-network provider for Personal Choice and Keystone Health Plan East. IBC will continue to contract with certain local and regional laboratories… Click to download the bulletin
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IBC: We want to let you know that the monthly rates for our individual medically underwritten plans will increase in July 2014. We are notifying members muchearlier than is required to give them the opportunity to enroll in a plan that is compliant with the Affordable Care Act (ACA). The reason for the rate increase. We understand that it can be difficult to afford quality health insurance coverage. While we continue to work hard to keep costs down, the cost of health care continues to rise along with our member utilization. This is why it’s necessary for Independence Blue Cross (IBC) to implement an 11.5 percent rate increase. Click the link below to read… Read More
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We love making our clients happy! I received this email just the other day and I wanted to share. This client had an abundance of trouble enrolling through the healthcare.gov website until we got involved: Dear Jennifer – thanks so much for everything! I’m so happy to be insured and I couldn’t have done it without you! Aaron G
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We received this email from one of our clients this week, Kristine Kreisher, and wanted to share: Dear Ed: I spent a month and a half calling Blue Cross, getting the run around, and given incorrect information. I make a phone call/send an email to you both and within a couple hours everything is taken care of and corrected!!! You guys are awesome!!! Thank you soooooo much for getting this all taken care of!!!! Kris Kreisher February 2014 We love happy clients!
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In an effort to meet the enrollment challenges that many are facing under healthcare reform, Total Benefit Solutions Inc has designed a custom form for our clients to use. Using this form and submitting it to Total Benefit Solutions Inc will enable our Marketplace trained and certified licensed independent brokers to assist you in the enrollment process from the registration right through the enrollment! Remember as your independent broker we always work in your best interests, not an insurance company. We represent you, our client and not an insurer or government agency. Click the link below to open the form and get started! When completed, just click the link to… Read More
Continue ReadingHealthcare… the way it should be! Are you tired of waiting multiple weeks to go see your doctor, only to find yourself taking time off work so you can drive through traffic and sit in the waiting room for what seems like forever? Have you ever felt overwhelmed by the stress and anxiety of a difficult life situation and wished you had someone you could trust to hold your hand and walk you through to the other side? Then welcome to CADRPlus, an innovative new health care program that gives you unlimited, 24/7 access to doctors and other industry professionals from the comfort and convenience of your phone or computer,… Read More
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