Health Plan PCORI Fees Are Due July 31

From our partners at Think HR: Do you offer coverage to your employees through a self-insured group health plan? Do you sponsor a Health Reimbursement Arrangement (HRA)? If so, do you know whether your plan or HRA is subject to the annual Patient-Centered Research Outcomes Institute (PCORI) fee? This article answers frequently-asked questions about the PCORI fee, which plans are affected, and what you need to do as the employer sponsor. PCORI fees for 2018 health plans and HRAs are due July 31, 2019. What is the PCORI fee? The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute to study clinical effectiveness and health outcomes. To finance the nonprofit… Read More

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PA. House panel advances bill to create state health insurance exchange

HARRISBURG, Pa. (KYW Newsradio) — A Pennsylvania House committee has advanced legislation that would require the state to create its own health insurance exchange under the Affordable Care Act.  Health care advocates celebrated the news that the Pennsylvania House Insurance Committee has approved a bill that would put oversight of Pennsylvania’s health insurance marketplace in control of the state, instead of Washington. No one is more pleased than Gov. Tom Wolf. Click here for the story

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HSA/HDHP Limits Increase for 2020

On May 28, 2019, the IRS released Revenue Procedure 2019-25 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2020. These limits include: The maximum HSA contribution limit; The minimum deductible amount for HDHPs; and The maximum out-of-pocket expense limit for HDHPs. These limits vary based on whether an individual has self-only or family coverage under an HDHP.  The IRS limits for HSA contributions increase for 2020. Eligible individuals with self-only HDHP coverage will be able to contribute up to $3,550 for 2020, while eligible individuals with family HDHP coverage will be able to contribute up to $7,100 for 2020. The HDHP… Read More

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SSA/RRB Premium Deduction Issue

Members who requested premiums to be deducted from their Social Security -SSA/RRB for 2019 plans will need to send payment directly to Humana due to a system issue with the Social Security Administration. What Happens Next?  Affected members will need to pay their insurance company directly for any deductions that did not take place as scheduled.  These members will not be disenrolled from the plan due to non-payment, but do need to begin paying the balances due to avoid a possible future disenrollment.  Their insurer has mailed affected members a letter with instructions on the various ways to pay their premium.  Please contact your Total Benefit Solutions representative at (215)355-2121… Read More

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IBC: The enhanced Care Cost Estimator tool is now available!

From IBC: The Care Cost Estimator tool is now available for members. This tool is designed to help them better understand their estimated out‑of‑pocket health care costs for a wide range of common inpatient, outpatient, laboratory, and diagnostic procedures, as well as office visits. We are excited to offer members this new tool, which is designed to help them save money and avoid unplanned expenses. Using the Care Cost Estimator, members can search for up to 1,600 procedures and compare providers by estimated price, based on their specific health plan. The tool displays provider details and quality information, such as reviews, allowing members to make more informed decisions about how to… Read More

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Massachusetts Publishes Family & Medical Leave Rules

The Massachusetts Department of Family and Medical Leave (“DFML”) has recently published regulations forpublic comment and a guide for employers. A synopsis of significant, new, and clarifying information follows… In 2018, Massachusetts enacted legislation to create a statewide Paid Family and Medical Leave (“PFML”) program providing benefits beginning in January 1, 2021 and July 1, 2021. With limited exception, all employers with employees in Massachusetts will be required to providepaid family and medical leave benefits to their employees through: • The state program; or• An approved private plan. If providing benefits through the state program, employers will begin to remit premium payments to the state beginning July 1, 2019. Employers… Read More

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Medicare expands telehealth services

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized new guidance that will allow Medicare Advantage plans to expand coverage of telehealth services. Beginning in plan year 2020, Medicare Advantage providers can include telehealth services as part of their basic benefits to enrollees, moving remote doctor visits from an optional add-on to a core service directly funded by the federal government. “Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS administrator Seema Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility… Read More

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Understanding Medicare Part D’s True Out-of-Pocket Limit

Of all the reasons to enroll in Medicare coverage, making health care more affordable is perhaps the biggest for millions of beneficiaries. One of the benefits found in Medicare Advantage plans is a maximum-out-of-pocket (MOOP) limit, but is there anything similar that will help with out-of-pocket costs for Medicare Part D? https://living.medicareful.com/understanding-medicare-part-ds-true-out-of-pocket-limit Questions? As always contact your Total Benefit Solutions Inc, health insurance specialists at (215)355-2121!

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Can Employers Pay Medicare Premiums for Active Employees?

Companies with fewer than 20 employees that offer group health coverage that pays secondary to Medicare (those not subject to the MSP rules) may be able to pay for the Medicare Part B, Part D, and Medicare Supplement Insurance premiums for their active employees. This is known as a Medicare Premium Reimbursement Arrangement. However, this is not an option for companies with 20 or more workers that are subject to the Medicare Secondary Payer provisions. All companies, regardless of size, can pay the health insurance or Medicare premiums for their retired employees, but no company can payfor individual health insurance coverage for their active employees . Our best practice: A… Read More

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Court Strikes Down Association Health Plan Rules

On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret” ERISA when issuing these rules: • expanding the definition of “employers” to include disparate groups of employers with no other commonality of interest other than geographic location; and • bringing working owners without employees within ERISA’s framework. This ruling effectively eliminates the expansion of AHPs to certain employers and working owners who do not meet the original parameters to be a part of an AHP. Click below to download the complete… Read More

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New Rules Could Increase Premiums & Out of Pocket Cost

The Wall Street Journalrecently reported on proposed changes by the Trump Administration “that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act.” As they explain, the two sides continue to bicker about the Affordable Care Act: “Republicans say subsidies for consumers are inflated; Democrats see another effort to sabotage the health law.” The proposed changes they are referring to are found in the Notice of Benefit and Payment Parameters for 2020. This is an annual notice released by the Centers for Medicare and Medicaid Services (CMS) that sets the standards for issuers and exchanges for the coming year.… Read More

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Is Reference Based Pricing Good for Your Group Health Benefit?

Choosing an insurance plan for employees can be challenging due to the flood of options now available. One of the biggest decisions you will have to make as an employer is between fully-insured and self-insured health plans. A fully-insured plan is a more traditional option where the company pays a premium to the insurance carrier. With a self-insured (self-funded) health plan, employers can operate their own insurance plan which can save money and give them more control over their funds. Reference based pricing, or RBP is a fairly new method to price claims option for a self-funded plan. Gaining in popularity because the employer is setting the price bar, NOT… Read More

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Association health plan ruling could result in thousands losing coverage

SHELBY LIVINGSTON : Modern Healthcare . A federal judge’s decision to vacate the Labor Department’s 2018 rule expanding access to association health plans could cause thousands of people covered through such plans to lose their insurance. Whether and how soon that happens depends on the Labor Department’s appeals decision and the likelihood of the judge granting a stay of his order in the interim. A Justice Department spokesperson said March 29 the department disagrees with the ruling and is considering all options, but will “continue to fight for sole proprietors and small businesses so that they can have the freedom to band together to obtain more affordable, quality healthcare coverage.” Since the rule was finalized in… Read More

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Judge blocks Trump’s small-business health insurance plan

WASHINGTON — A federal judge has struck down a small-business health insurance plan widely touted by President Donald Trump, the second setback in a week for the administration’s health care initiatives. U.S. District Judge John D. Bates wrote in his opinion late Thursday that so-called “association health plans” were “clearly an end-run” around consumer protections required by the Obama-era Affordable Care Act. Click here to read the story

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Video: Finding your Primary Care Physician’s Tier

The Keystone Proactive HMO plans have become very popular but the number one question we get is ” how do I know what tier my doctor is in?” Finding your primary doctor’s tier on the Keystone Proactive HMO is actually fairly easy. This short step by step video will show you how! Need additional help? Call your Total Benefit Solutions Inc account manager at (215)355-2121 and we can do it for you or search a full list of physicians, facilities, hospitals or medications for you or your employees! Total Benefit Solutions, Inc. Where we work for your benefit!

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Medicare Won’t Cover This Key Expense…

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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The Future of Employee Benefit Offerings: Student Debt Repayment Assistance

When looking for a job, the benefits offered to an Employee are definitely a big factor in consideration of accepting an offer of employment. Most people are willing to choose a company with a slight pay decrease if the benefit package compensates for the lost wages. With unemployment the lowest it has been since 2000 in the United States, attracting new talent isn’t as easy as it used to be and Employers are looking for ways to snatch up qualified applicants. When you think of benefit packages, you usually think of the basics: Health Insurance (with possibly an HSA, HRA, or FSA included), Dental and Vision coverage. “Good” benefit packages… Read More

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IBC to Reach Agreement with Providers in Our Area!

We are pleased to share that Mercy Health System, St. Mary Medical Center, Saint Francis Healthcare and Independence Blue Cross (Blue Cross) anticipate coming to an agreement on a new, long-term contract this week, meaning there should be no interruption to your care or coverage at the following facilities: Mercy Fitzgerald Hospital Mercy Philadelphia Hospital Nazareth Hospital St. Mary Medical Center Saint Francis Healthcare in Delaware We thank you for your continued support and patience throughout this process, and apologize for any anxiety or inconvenience this negotiation may have caused you or your family – that was never our intention. We look forward to continuing to provide you the care… Read More

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Why Offer an HRA to Your Employees?

Healthcare Reimbursement Arrangement, typically referred to as an HRA, can be utilized by employers to reduce their overall healthcare costs without placing additional financial burden on their employees. An HRA allows the employer to pay for eligible expenses with pre-tax dollars. The employer decides what expenses are eligible, within the IRS guidelines, leaving a lot of flexibility in plan design. Typically an HRA is coupled with a High Deductible Health Plan and the HRA pays for either the entire deductible or a portion of the deductible. With this type of a plan the premium savings often outweigh the potential claims that the employer would have to pay if every employee… Read More

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Benefit Notices By Company Size: Your Cheat Sheet

Ever wonder exactly which benefit notices your company was required to distribute to employees? Ever notice that some of them are only needed when your business is a specific type of business or organization or size? Wonder no more thanks to our partners at HR360! Download your complimentary copy of the 2-19 employee guide below that includes links and descriptions to all of your required notices for employers between 2-19 employees! Have more specific needs or a cheat sheet for a larger organization? Ask us today how partnering with total benefit solutions and HR360 can deliver this type of powerful information that you need, when you need it. Stay ahead… Read More

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MURPHY MOVES NJ TO STATE-BASED HEALTH EXCHANGE TRENTON — New Jersey will move to a state-based health care exchange starting in 2021 as a result of an executive order signed Friday by Gov. Phil Murphy.The Democratic governor made the announcement at Saint Barnabas Medical Center in Livingston on the 9th anniversary of the passage of the Affordable Care Act. He said offering access to high quality, affordable health care is one of society’s greatest responsibilities and a “basic right.

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