As previously reported, group health plans will be required to submit information related to air ambulance claims to the Department of Health and Human Services (“HHS”). In a September 2021 proposed rule, the regulators expected that rulemaking would be finalized during 2021, and that plans and carriers would be required to submit the data for calendar year 2022 by March 31, 2023, and the data for calendar year 2023 by March 31, 2024. However, under the statute, the reporting is not due until regulations are final, and the proposed rule has not been finalized. As a result, absent further guidance, there should be no reporting requirement in 2023. HHS has… Read MoreContinue Reading
Get Your FSA, HRA, HSA Health Accounts Comparison Chart
What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!Continue Reading
Thinking about a PEO?
We Can Help You Navigate the World of Professional Employer Organizations (PEOs). PEOs have become a growing solution for small- and mid-sized employers looking to streamline their administrative processes. However, the number of PEOs has risen dramatically, leaving employers with many options and confusion about where to start. What is a PEO?If you are unfamiliar with the term PEO, it is a business entity that helps service other businesses in the areas of payroll administration, human resources, risk management, and employee benefits. Total Benefit Solutions, Inc. can help you find the right PEO in a complex market and select the best fit for your company. We can quote PEO services… Read MoreContinue Reading
The End of the COVID-19 Public Health Emergency: How will vaccines be affected?
On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. Vaccines What’s changing: Nothing. The availability, access, and costs of COVID-19 vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency. What’s the same: As long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status. Although a federal rule temporarily required private insurers to reimburse out-of-network providers for vaccine administration… Read MoreContinue Reading
Stay Up to Date on the Affordability of Employer Coverage and the Family Glitch with These Resources
beginning on January 1, 2023, the new rule on affordability of employer coverage for the family members of employees went into place and changed how affordability is calculated for employees’ family members. To assist employers in understanding this rule change, the Centers for Medicare & Medicaid Services (CMS) created a resource outlining the most important takeaways for employers. Employers can use this resource to understand the family glitch and how it affects them and their employees. You can view this resource here. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
Broker Change Leads to Better Results
Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner… Read MoreContinue Reading
Do FSA’s and HRA’s have Reimbursable Expenses?
Health Flexible Spending Account (FSA) Health Reimbursement Arrangement (HRA) As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
Independence: Advanced Network for Gene‑Based Therapeutics
As part of our comprehensive strategy for managing specialty drugs, Independence is proud to announce the establishment of our Advanced Network for Gene‑Based Therapeutics. This network ensures that our members have access to multi-million-dollar gene‑based therapies, like Luxturna®, Zolgensma®, and Skysona®, delivered in facilities that share our commitment to driving clinical outcomes and value. Click here for the full story.Continue Reading
CIGNA transitioning to digital ID cards
By July 2024, Cigna is planning to fully transition from physical ID cards to digital ID cards. Eligible medical, dental and vision clients with an April 1, 2023, May 1, 2023, and June 1, 2023 new and renewal effective date will be notified of this change on Feb. 7, 2023. We’re excited to announce that we’re transitioning to digital ID cards, so you will no longer automatically receive a physical ID card in the mail. With a digital ID card you never have to worry about losing or misplacing your card(s) again. It’s always right there on myCigna, whenever you need it.* Log in to myCigna.com® or the myCigna® App to get… Read MoreContinue Reading
1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients
Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.Continue Reading
Emergency Periods Related to COVID-19 to End May 11 2023
On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read MoreContinue Reading
Independence: Dental rates modified from the original 2023 prices
The 2023 Independence Blue Cross dental rates for individual and family plans have been modified from the original rates. Your health insurance broker at Total Benefit Solutions Inc can provide your updated rates and also help guide you to choose an alternative dental plan in light of these changes. Please contact us today at (215)355-2121 if you have any questions or concerns regarding these changes.Continue Reading
ACA: Special Election Cheat Sheet
Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 https://www.totalbenefits.netContinue Reading
Notification Reminder for Forms 1095-C and 1095-B
Under the Affordable Care Act (“ACA”), the deadline for applicable large employers (“ALEs”) to furnish Form 1095-C and 1095-B to certain individuals (such as full-time employees in the case of Form 1095-C) is January 31 with respect to the preceding calendar year. The Internal Revenue Service (“IRS”) released final regulations on December 12, 2022 with respect to ACA reporting requirements. These final regulations provided an automatic extension of 30 days to furnish these statements to individuals. This means that Wednesday, March 2, 2023 is the deadline to furnish individuals with 2022 Forms 1095-C and 1095-B. This extension is automatic; employers or other reporting entities are not required to file a… Read MoreContinue Reading
Bright Health Announces Departure from ACA Marketplace
Publish Date: 2/1/2023 Bright Health announced October 11 that it was pulling out of the ACA Marketplace in 15 counties throughout Florida. As a result, 250,000 individuals with Bright Health coverage will be impacted. Some of the impacted individuals will be auto-migrated to Florida Blue as part of this transition. If you are impacted or have any questions or concerns about this please contact your Total Benefit Solutions, Inc health insurance experts at (800)924-6718Continue Reading
Independence: Additional MLR rebates for 2020 to be issued to some policyholders
Starting this week, Independence Blue Cross (Independence) will be issuing an additional medical loss ratio (MLR) rebate to affected customers and subscribers for a portion of their 2020 health insurance premiums. The check mailing will continue until the end of February. The additional rebate is being issued following a clarification on MLR calculation provided by the Centers for Medicare & Medicaid Services (CMS). As a result of the clarification, we looked at prior year calculations and determined an additional amount was due for 2020. Any applicable interest has been included in the amount of each check. Click here for the full story As always please contact your Total Benefit Solutions,… Read MoreContinue Reading
Does a Health Savings Account (HSA) have Reimbursable Expenses?
Employees can use the HSA to pay for Code §213(d) medical expenses, expenses such as expenditures for medical care, to the extent that such amounts are not reimbursed by insurance or any other source. Medicines and drugs (other than insulin) can be qualified medical expenses only if they are prescribed. Under the CARES Act, employers can also allow for reimbursement of OTC drugs. With certain exceptions, qualified medical expenses do not include payments for health insurance premiums or coverage contributions toward self-funded health coverage. However, the expense for coverage under any of the following will be an HSA-qualified medical expenses: HSA funds may not be used to pay insurance premiums… Read MoreContinue Reading
What is Small Business Health Options Program (SHOP)?
The Small Business Health Options Program (SHOP) helps small business owners provide medical and/or dental insurance to their employees. Some smaller employers qualify for tax credits if they enroll in SHOP insurance. A small business can offer SHOP health and/or dental insurance to their employees if they: Small business owners can use an agent or broker to enroll in SHOP insurance, or work with their insurance company. There’s no limited enrollment period for SHOP, so they can apply, pick plans, and enroll employees any time of year. Interested in SHOP for your small business? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
DOL Penalties Increase for 2023
The Department of Labor (“DOL”) has published the annual adjustments for 2023 that increase certain penalties applicable to employee benefit plans. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.Continue Reading
Between jobs? Aging out of a family policy? Waiting for Open Enrollment?
A Short Term Medical plan might be right for you. Short Term Medical plans let you decide how much coverage you want and for how long, with individual and family options available. And you can enjoy quality of life benefits like telemedicine and discounts on a variety of everyday items and services through an Association membership (varies by state). Short Term Medical plans offer plenty of flexibility: Questions about a short term medical plan? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Important information about these plans THESE PLANS PROVIDE LIMITED BENEFITS For complete limitations & exclusions by state for Short Term Medical insurance, click here. Plan… Read MoreContinue Reading
What is the Medicare Advantage Open Enrollment Period (OEP) and why is it important?
The Medicare Advantage Open Enrollment Period (OEP) is different than the annual election period in the fall. The MA OEP happens annually from January 1st to March 31st. The OEP allows beneficiaries who are enrolled in a Medicare Advantage Plan to make a one-time change. Beneficiaries can use the Medicare OEP to: The Medicare OEP does not allow a beneficiary to change from one Part D plan to another Part D plan. The reason for the OEP is that Medicare beneficiaries are often confused about Medicare Advantage plans. They don’t understand how these plans work or they may not realize the plan has a network. Some Medicare beneficiaries try to make their… Read MoreContinue Reading
What is Limited Medical Insurance?
A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read MoreContinue Reading
How does Original Medicare work?
Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage). Services covered by Medicare must be medically necessary. Medicare also covers many preventive services, like shots and screenings. If you go to a doctor or other health care provider that accepts the Medicare-approved amount, your share of costs may be less. If you get a service that Medicare doesn’t cover,… Read MoreContinue Reading
What is Stop Loss Coverage?
Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read MoreContinue Reading
Independence: New drugs added to precertification list for 2023
Effective January 1, 2023, from Independence Blue Cross: (Independence) IBC will add 12 drugs to the list of specialty drugs that require precertification under the medical benefit. With these additions, Independence now requires precertification for a total of 271 drugs before members can receive coverage for them. The drugs being added include several gene replacement therapies and cancer/antineoplastic agents in the U.S. Food and Drug Administration (FDA) pipeline, as well as several biosimilars that recently received FDA approval. The newly added drugs are: beremagene geperpavec* – gene replacement/gene editing therapiesCimerliTM (ranibizumab‑eqrn) – ophthalmic agentsElahereTM (mirvetuximab soravtansine) – antineoplastic agentsFylnetra® (pegfilgrastim‑pbbk)† – neutropeniaHemgenix® (etranacogene dezaparvovec) – gene replacement/gene editing therapies mosunetuzumab* – antineoplastic agents Skysona® (elivaldogene autotemcel) – gene replacement/gene editing therapiesStimufend® (pegfilgrastim‑fpgk)† – neutropeniatofersen* – amyotrophic lateral sclerosis agents tremelimumab* – antineoplastic agentsVegzelma® (bevacizumab‑adcd)† – antineoplastic agentsZynteglo® (betibeglogene autotemcel) – gene replacement/gene editing therapies We often add drugs… Read MoreContinue Reading