Author: Ed MacConnell

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

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

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

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

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

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!

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

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

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

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!

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.

Each year, Medicare makes changes to the Part A and B out-of-pocket expenses, monthly premium for Part B, and premium adjustment thresholds for Part B and Part D. Here are the figures for 2020..

PEOs & the Philadelphia Area As you may be aware Independence Blue Cross recently introduced a PEO offering into the Pennsylvania market/Greater Philadelphia area through a partnership with Clear PEO. As a leading independent broker in the Northeast, Total Benefit Solutions, Inc.  has experience with PEOs and helping group clients find the best choices to put you in the strongest possible position to shop and compare PEO’s and traditional health benefits. In fact, Total Benefit Solutions, Inc. has already been partnering with established PEO’s for a number of years in the Pennsylvania market as well as the surrounding area. THE BASICS OF PEOs PEO is an acronym for Professional Employer… Read More

Is your health plan group ERISA compliant? Health plans subject to the Employee Retirement Income Security Act (ERISA) must make available information about the plan to participants. The plan participants have a right to know about plan rules, financial data, plan operation and plan management. Many small employers fail to realize that they need to meet this requirement. The departments of labor have been coming to more employers and asking for this document more often, but typically the DOL audit is the direct result of an employee ( or former employee) grievance. When a member first becomes covered under an ERISA-covered health plan, the individual must receive an SPD (Summary Plan… Read More

Aliera Healthcare is an innovative healthcare organization offering both traditional healthcare and health sharing plans, which are an alternative to traditional insurance. At the core of Aliera plans is a concentration on the patient using our “Core 4” Patient Centered Medical Home Model of Care. Employer Group plans range from ACA compliant ‘Minimum Essential Coverage” to Self-Funded Minimum Value Plans. Our Individual plans are supported by our Healthcare Sharing Ministry Partner, Trinity HealthShare. Click here to find our more about the benefits, rates and programs available and then call us at (215)355-2121!