Employer Compliance Notice! The “Emergency Family and Medical Leave Expansion Act,” & “Emergency Paid Sick Leave Act.” will affect your business!

In response to the coronavirus (COVID-19) pandemic, Congress enacted a bill providing various forms of relief, including two separate laws mandating that employers give employees paid leave for specified purposes related to COVID-19. The two leave laws are the “Emergency Family and Medical Leave Expansion Act,” and the “Emergency Paid Sick Leave Act.” The leave mandates take effect no later than 15 days after passage (April 2, 2020) and sunset on Dec. 31, 2020.The Emergency Family and Medical Leave Expansion Act. In general, the Emergency Family and Medical Leave Expansion Act amends the federal Family and Medical Leave Act (FMLA) to allow employees to take leave for certain child care… Read More

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Aetna adds benefits during COVID Outbreak

We understand the many challenges you and your clients are facing due to the COVID-19 pandemic.  We continue to monitor this evolving situation and are committed to responding quickly to the COVID-19 pandemic, while also prioritizing the needs of you, your clients and our members. We are pleased to announce that Aetna is waiving cost-sharing and co-pays for inpatient hospital admissions related to COVID-19 for Aetna’s commercially insured members, part of several additional steps to help members access the care that they need during the COVID-19 pandemic.   You can read the complete CVS Health press release here. We will continue to publish updates and information as well as additional questions and… Read More

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Telemedicine and the Coronavirus

As the number of confirmed coronavirus disease 2019 (COVID-19) cases rises daily, hospitals and medical care providers are overwhelmed with phone calls and in-person visits. Telemedicine and telehealth services. Feel free to download this handy guide for you and your employees. While most medical plans include a telemedicine benefit, Total Benefit Solutions does offer a separate Teledoc benefit package for those without health coverage to would like to take advantages of the other services included.  Teledoc is available form under $20 per month. Click here to see the available packages Click to Download Telemedicine and COVID As always contact your Total Benefit Solutions, Inc benefit specialist at (215)355-2121 if you… Read More

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Independence Blue Cross: Employee Eligibility Exception for laid off employees

Employee Eligibility Exception for furloughed or temporarily laid off employees. As a result of the COVID‑19 outbreak, Independence will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of  COVID‑19. This exception applies to fully insured and self-funded business, and is contingent upon the following: Full premium payments continue to be made by the employer.Self‑funded employers must continue to remit invoiced amounts in full. The employer is responsible for collecting employee contributions, if applicable. No reductions to employer contributions will be allowed. Only actively at‑work employees can be added to the plan as new enrollees. Our preferred Stop Loss partner, HM Insurance Group (HMIG) HMIG will honor… Read More

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H.S.A. Bank COVID-19 UPDATES

The safety and well-being of our employees, customers, and partners is HSA Bank’s top priority. We’re actively monitoring the coronavirus disease 2019 (COVID-19) pandemic, and following advice from the Centers for Disease Control and Prevention (CDC) and local health officials. We’re diligently working to ensure continued access to your account information and our services. We have remote work capabilities that will keep our operations running should this pandemic become more widespread. Our Client Assistance Center is currently available 24 hours a day, 7 days a week at 1-800-357-6246. Additionally, we offer click-to-chat during our standard business hours of 8:30 a.m. to 5 p.m. CT, Monday through Friday. And whether you’re at the… Read More

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An Update from us on COVID-19

At Total Benefit Solutions, Inc we’re learning as we go. First and foremost, we wish you and your employees safety and good health.   We wanted you to know that we are up and functional with all of our benefit specialists working remotely for their safety and yours. We are NOT permitted to do face to face meetings at this time due to the governor’s mandated shutdown.   We understand businesses may be forced to make difficult decisions in these uncertain times.   Most employers with 20 or more employees must follow COBRA continuation of coverage notice rules, if they make certain changes to an employee’s health coverage. Smaller employers may… Read More

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DOL Penalties Increase for 2020

The Department of Labor (DOL) published the annual adjustments for 2020 that increase certain penalties applicable to employee benefit plans.  Employer ActionPrivate employers, including non-profits, should ensure employees receive required notices timely (SBC, CHIP, SPD, etc.) to prevent civil penalty assessments. In addition, employers should ensure Form 5500s are properly and timely filed, if applicable. Finally, employers facing document requests from EBSA should ensure documents are provided timely, as requested. Click Here to Download Penalties_Increase_for_2020

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A message from Medicare-Coronavirus

Coronavirus test Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). This test is covered when your doctor or other health care provider orders it, if you got the test on or after February 4, 2020. Your costs in Original Medicare You usually pay nothing for Medicare-covered clinical diagnostic laboratory tests.  Click here to see the full message.

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Notice for Aetna Funding Advantage and Fully-insured clients

In response to the rapidly evolving COVID-19 outbreak, CVS Health announced a series of steps designed to support the health and well-being of your clients Aetna members, ensure patient access to medication, and remove barriers to care.   Effective immediately, your clients small group members will have access to the following resources: • Co-pays for members will be waived for all diagnostic testing related to COVID-19. This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location. Aetna will waive the member costs associated with diagnostic testing at any authorized location for all small group business. • For the next… Read More

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Office Operations Update

As concerns over the spread of COVID-19/Coronavirus continues and the facts on the ground shift daily, we wanted to inform you that Total Benefit Solutions Inc. is taking measures to ensure business operations continue without disruption. At this time, there are no changes to our operations; however, we will provide notification by email should any of our normal policies and processes need to be temporarily changed. Total Benefits  has a wonderful team of employees who are committed to meeting your needs during this very unique time. Thank you for your continued business.

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Deadline Extended for 2019 Forms 1095-C

On December 2, 2019, the IRS issued Notice 2019-63, which provides: • An extension of time, until March 2, 2020, for employers to provide Forms 1095-C to their full-time employees and other individuals; and • An extension of relief from penalties for the 2019 reporting year for employers and other entities that make good-faith efforts to comply with the reporting requirements.

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Employers sponsoring a group health plan need to report

Employers sponsoring a group health plan need to report information on the creditable status of the plan’s prescription drug coverage to CMS within 60 days after the beginning of the plan year. An employer with a calendar year plan must complete this reporting no later than Saturday, February 29, 2020. Employers sponsoring a group health plan need to report information on the creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). In order to provide this information, employers must access CMS’s online reporting system at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html. As a reminder, notice must be provided by the following deadlines:• Within 60 days after the… Read More

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Employer Reminder: Self Insured & HRA forms are coming due!

The IRS requires all employers who offer benefits to provide some level of reporting. This is a reminder that for groups who have an HRA or a self insured health plan you are required to provide forms to your employees and also the IRS. If your company offers a level funded plan you (the employer) are required to do the reporting as the insurers or TPA’s will not usually do it. Clients  who have any of the following should speak with their tax professionals to make certain that they are reporting properly: Aetna AFA Level Funded  plans United Healthcare All Savers Level Funded Plans National General (Group) Self Insured, Level… Read More

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Annual Medicare Part D reporting is required for all employers

Annual Medicare Part D reporting is required for all employers who provide health benefits with prescription drug coverage. The reporting is an online filing to the Centers for Medicare & Medicaid Services (CMS), and it lets CMS know if the prescription drug coverage available on the employer’s health plan is “creditable.” The Medicare Part D reporting helps CMS determine if a person enrolling in a stand-alone Part D plan is subject to a late enrollment penalty. Late enrollment penalties apply for individuals who delay enrollment in a Part D plan upon first becoming eligible unless they have prescription drug coverage elsewhere that is at least as good as the standard… Read More

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Congress Repeals the Cadillac Tax and Health Insurance Tax

Congress has voted to fully repeal the Cadillac (excise) Tax and the Health Insurance Tax. The legislation fully repeals the Cadillac Tax and repeals the HIT effective January 1, 2021, which means the HIT will still be in place for 2020. According to the Congressional Budget Office, repealing the Cadillac Tax will save consumers $197 billion, and the HIT repeal will save consumers $150 billion!   This is a major milestone in efforts to finally end these two ACA taxes and we thank all of you who have taken action to support these repeals.  Please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions… Read More

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Outpatient Surgery vs Inpatient Surgery

UnitedHealthcare’s policy will limit outpatient surgery payments to hospitals Kelly Gooch    UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations, according to Modern Healthcare. The outpatient surgery policy will limit the circumstances under which UnitedHealthcare will pay for certain surgeries in a hospital outpatient setting. Taking effect in November for fully insured groups in most states, UnitedHealthcare will only pay for a surgical procedure performed in an outpatient hospital setting if the insurer determines the site of service for the procedure is medically necessary, UnitedHealthcare told Becker’s Hospital Review. “Medical necessity reviews for… Read More

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Are you 65 and over before December 31st 2019?

It’s Your Last Chance.. The Medicare Access and CHIP Reauthorization Act of 2015 eliminates all Medigap Plans that cover the Medicare Part B deductible. A deductible is an amount of money you must pay out of pocket before your plan will begin covering services. The Part B deductible in 2019 was $185 and is projected to be $197. Medicare Part B covers most of your outpatient services. Things such as Doctor visits, labs and tests, durable medical equipment, and some medications. That means, unless a preventative care visit, you would have to pay out of pocket $197 before your plan would cover you. Why would Congress decide to pass a… Read More

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Proposed Rules Clarify Individual Coverage HRAs

IRS explains application of employer mandate to individual coverage HRAs Federal authorities announced in June that beginning in 2020 employers could offer employees an HRA designed to reimburse individual market medical insurance policies in lieu of group medical insurance. But one piece of the puzzle was missing: How would an employer satisfy the Affordable Care Act’s employer mandate by only offering such an HRA? The IRS has now proposed rules explaining precisely how an employer can satisfy the ACA employer mandate and avoid penalties simply by offering an individual coverage HRA (ICHRA).  Background ICHRAs differ significantly from the familiar and traditional HRAs. The key difference is that a traditional HRA… Read More

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The Ultimate Internet Safety Guide for Seniors

Written By: ERIC C. POSTED: DECEMBER 16, 2018 Every year, seniors are scammed out of tens of billions of dollars, money they’ve spent their entire lives saving only to have it stolen. The elderly have always been a prime target for Internet scams because of a perceived vulnerability, and now because Internet use among seniors is on the rise. A Pew Research Center survey showed that 67% of seniors are now regular Internet users. Internet security is something everyone should prioritize, regardless of age, so it’s important to be aware of current threats and how to deal with them. With so many people online, the magnitude of scams is increasing. Protect Your Computer Hackers are always on… Read More

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New Employer Tool

    Health coverage is a key benefit employers offer workers in order to attract and retain the best and the brightest. Yet employers face numerous complex regulatory rules and administrative burdens in providing health coverage to their employees. Most big employers have entire departments devoted to understanding the rules and administering health coverage. But, many smaller business owners don’t have that luxury. They alone must take on the task of navigating how to provide health coverage to their employees.  This year, the Trump Administration took a big step forward in doing just that by issuing new rules expanding Health Reimbursement Arrangements (HRAs). HRAs are employer-funded accounts that workers can… Read More

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Enrolling on Medicare A and/or B

You can enroll in Medicare Part A and/or Medicare Part B in the following ways: Online at SocialSecurity.gov. By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM. In-person at your local Social Security office.   IIf you work for a small employer,  this post has some information you might find helpful:   https://totalbenefits.net/ibc-important-changes-regarding-medicare-part-b-exclusion/  

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