Aris Herrera

TEMPORARY SEP

December 1, 2025November 28, 2025Aris HerreraNo Comments

Temporary SEP for year one of the Medicare Plan Finder MA Provider Directory For your awareness, CMS has a new Special Election Period (SEP) for 2026 – Code: DIR SEP. This SEP allows beneficiaries who enrolled directly through the Medicare Plan Finder (MPF) to make a plan change if the MPF Provider Directory included incorrect information and is only valid for 1/1/26-12/31/26 enrollments. The intent of this SEP is to allow an individual who relied on the MPF Provider Directory to make a change to their MA plan election to stay with their preferred providers. To use this SEP, beneficiaries must call 1-800-MEDICARE to have a representative confirm that their… Read More

United Concordia dental

November 28, 2025November 28, 2025Aris Herrera

United Concordia Dental offers a digital member ID that makes accessing your dental plan information quick and easy. With your digital ID, you can view your plan details anytime on your phone, tablet, or computer. Whether you need your member ID number for customer service, submitting claims, or managing your benefits, it’s always available at your fingertips. Download the United Concordia dental or create an account online.

New legislation expands benefit accounts

November 17, 2025November 13, 2025Aris Herrera

Here’s what you need to know about HSA and DC-FSA changes. New legislation in the H.R.1 Bill, more commonly known as the One Big Beautiful Bill Act (OBBBA), expanded the rules around Health Savings Accounts (HSAs), including enrollment eligibility and eligible expenses, and Dependent Care Flexible Spending Accounts (DC-FSAs). Most changes will go into effect Jan. 1, 2026, however one change regarding telehealth services is retroactively effective to Jan. 1, 2025. As a result of this legislation, regulatory guidance will be issued over the next few months, and HSA Bank’s forms, educational resources and more will be updated to reflect these changes. In the meantime, use this summary and guidance… Read More

Individual Coverage HRA: Choice and affordability

November 14, 2025November 14, 2025Aris Herrera

Choosing the right health insurance can be overwhelming, but the new Individual coverage HRA(ICHRA) option makes it easier for employers and employees to find affordable, flexible coverage that fits their needs. With an ICHRA, businesses of any size can reimburse employees for the individual health insurance plan that works best for them creating more choice, more control and often more savings. To learn more or explore the ICHRA plan options, click here: Total Benefit Solutions, Inc. – Flex Plan Solutions

Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans

November 11, 2025November 11, 2025Aris Herrera

CMS has just released information about Medicare Part D plans for 2026, including plan availability and premiums for the coming year. As this year’s Medicare open enrollment period approaches, there’s some good news for Medicare Part D enrollees when it comes to monthly PDP premiums – lower on average, according to CMS – even as the total number of PDPs available drops yet again. The headline of CMS’s press release emphasized stability in the Part D marketplace, but a quick review of the data shows that the total number of stand-alone drug plans available in 2026 will fall for the third year in a row, as plan sponsors scale back their PDP offerings (for… Read More

Gag Clause Attestation Due December 31, 2025

November 3, 2025October 28, 2025Aris Herrera

As previously reported, insurance carriers and plan sponsors of group health plans must submit information annually to the Centers for Medicare and Medicaid Services (“CMS”) attesting that their plans do not include prohibited gag clauses by December 31st each year. The next attestation is due by December 31, 2025. A gag clause is a contractual term that directly or indirectly restricts specific data and information that a plan or issuer can make available to another party. These clauses may be found in agreements between a plan or carrier and any of the following parties: A gag clause may also be found in the downstream agreements of the service provider. Carriers and… Read More

Highmark Updated Billing Addresses in Pennsylvania

October 30, 2025October 28, 2025Aris Herrera

What do I need to know? Effective immediately, we’re consolidating billing addresses across all Pennsylvania markets. This change will streamline many steps in the billing process and allow for clearer communication to the market. It applies to clients in the following Highmark companies in small and large group: Clients in Northeastern and Southeastern Pennsylvania aren’t impacted by this change – they’re already using the newer addresses. For clients who pay premium by mail: All Pennsylvania premium payments that are mailed should go the new address: PO Box 382146, Pittsburgh, PA 15251-8146. This address has been updated on invoices and throughout other materials. Premium payments sent to the old address will be… Read More

Allegheny Health Network and Heritage Valley Health System Sign Affiliation Agreement

October 27, 2025October 24, 2025Aris Herrera

Organizations Pledge Expanded Access to High-Quality Care in western Allegheny County and greater Beaver County as Heritage Valley’s Hospitals, Outpatient Clinics and Physician Practices become part of AHN and Highmark Health. Beaver, PA (Oct. 16, 2025) – Officials from Heritage Valley Health System (HVHS), the Heritage Valley Health System Foundation, Highmark Health and Allegheny Health Network (AHN) joined community leaders and hospital employees today to celebrate the signing of an affiliation agreement that will strengthen and expand the services that HVHS provides to residents in western Allegheny County, greater Beaver County and the surrounding region. Pending government approval of the transaction, the affiliation will establish Heritage Valley Beaver and Heritage Valley Sewickley as AHN’s 15th and 16th… Read More

2026 Cost of Living Adjustments

October 24, 2025October 24, 2025Aris Herrera

The IRS has released cost of living adjustments for 2026 under various provisions of the Internal Revenue Code (“Code”). Some of these adjustments may affect your employee benefit plans. Cafeteria Plans – Health Flexible Spending Arrangements Annual contribution limitation For plan years beginning in 2026, the dollar limitation under Code Section 125(i) for voluntary employee salary reductions for contributions to health flexible spending arrangements (“health FSAs”) increased from $3,300 to $3,400. Annual maximum carryover For cafeteria plans that permit the carryover option, the maximum unused amount from a health FSA that can be carried over to the following plan year is $680 for plan years beginning in 2026 (up from… Read More

Navigating Delaware Paid Family and Medical Leave

October 14, 2025October 14, 2025Aris Herrera

Think of Paid Family & Medical Leave (PFML) in Delaware as a 2-lane highway: the State Plan and the Private Plan. The destination is the same no matter which route an employer chooses, but depending upon their circumstances, employers might find that one or the other is an easier trip. Employers who haven’t decided which path to choose will need to do so soon. When considering the Private Plan route, it’s important to stay on top of state-mandated deadlines. The Private Plan application window is similar to an open enrollment window. And it’s open NOW: October 1 through December 1, 2025. This is the last opportunity for a Private Plan to go into effect at the same time… Read More

Video: Health Insurance Open Enrollment

October 8, 2025October 10, 2025Aris Herrera

Medicare Part D Notification Requirements (From IBC)

October 7, 2025October 9, 2025Aris Herrera

Below is an important notice from Independence Blue Cross regarding Medicare Part D notification requirement for 2025-2026 Dear Valued Benefits Administrator: As you may know, employers that offer prescription drug coverage to their Medicare-eligible employees, retirees, and dependents (collectively referred to as “members”) must notify them by October 15, 2025 of whether that coverage is “creditable” or “non-creditable.” We are writing to remind you that requirement and to provide you with information on the statues of Independence Blue Cross (Independence) prescription drug plans. This Requirement is Part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which added a new prescription drug program to Medicare known as… Read More

Upcoming Important Dates

September 23, 2025September 25, 2025Aris Herrera

Mark Your Calendars! Here Are The Important Upcoming Dates You’ll Want To Keep In Mind. As always if you have any questions or concerns, please don’t hesitate to contact the experts at Total Benefit Solutions, Inc (215)-355-2121

Delaware Amends Paid Family and Medical Leave law

September 16, 2025September 19, 2025Aris Herrera

On July 30, 2025, Governor Matt Meyer signed HB 128 (“the Act”) into law, amending Delaware’s paid family and medical leave law (“PFML”). The Act was effective immediately once it was signed into law. Background Delaware’s PFML law, the Healthy Delaware Families Act, requires certain employers to provide their covered employees with up to $900 per week in paid leave for parental, family caregiving, medical, and qualified military exigency leave. Contributions to the state plan began on January 1, 2025, and benefits will begin on January 1, 2026. The Act amends several provisions of the PFML law, specifically the following:

The Uncertain Future of Medicare’s Stand-Alone Prescription Drug Plan Market

September 2, 2025September 4, 2025Aris Herrera

Ahead of Medicare’s annual mid-year announcement about the national average premium for Part D prescription drug coverage in 2026 and other plan details, two questions loom large for the insurers that sponsor Part D stand-alone prescription drug plans (PDPs) and the 23 million people in traditional Medicare who are currently enrolled in these plans. Will the Trump administration continue Medicare’s Part D premium stabilization demonstration for a second year, and what will the PDP market look like in 2026 and in subsequent years? The answer to the first question could determine whether monthly PDP premiums remain at a relatively affordable level and whether PDP availability remains stable in 2026. The answer to… Read More

Author: Aris Herrera

TEMPORARY SEP

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United Concordia dental

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New legislation expands benefit accounts

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Individual Coverage HRA: Choice and affordability

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Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans

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Gag Clause Attestation Due December 31, 2025

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Highmark Updated Billing Addresses in Pennsylvania

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Allegheny Health Network and Heritage Valley Health System Sign Affiliation Agreement

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2026 Cost of Living Adjustments

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Navigating Delaware Paid Family and Medical Leave

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Video: Health Insurance Open Enrollment

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Medicare Part D Notification Requirements (From IBC)

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Upcoming Important Dates

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Delaware Amends Paid Family and Medical Leave law

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The Uncertain Future of Medicare’s Stand-Alone Prescription Drug Plan Market

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