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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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!

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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

Continue Reading

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!

Continue Reading

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

Continue Reading

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.

Continue Reading

New Jersey Small Employer Stop Loss Bill

A bill has been introduced in New Jersey in both the Senate and Assembly that, if passed, would prohibit insurance carriers or other insurers subject to the insurance laws of New Jersey or any other state from offering, issuing or renewing any stop loss insurance policy of any kind to small employers. Stop loss insurance provides reimbursement for catastrophic, excess or unexpected expenses and is used by small employers to self-insure part of the health insurance coverage they provide for employees. Under New Jersey law, in connection with a group health plan, a small employer means an employer with 2-50 eligible employees on business days during the preceding calendar year. If passed,… Read More

Continue Reading

What are PEO Solutions?

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

Continue Reading

Is your plan subject to the $110 Per Day ERISA Health Plan Documentation penalty?

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

Continue Reading

How Does Level Self Funded Health Insurance Work?

We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding might be a good for for your health plan!

Continue Reading

Important News From Independence Blue Cross: Trinity Health termination

February 11th 2019: For the past several months, we have been negotiating the terms of our agreements with Trinity Health (Trinity), which includes the following entities, as well as their professional providers, subsidiaries, affiliates, and divisions: Mercy Health System of Southeastern Pennsylvania, including Mercy Fitzgerald, Mercy Philadelphia, and Nazareth hospitals St. Mary Medical Center, including St. Mary Rehabilitation Hospital, Saint Francis Healthcare, including Saint Francis Hospital, Wilmington, Delaware. We continue to engage in good‑faith negotiations, but we want to explain how customers and members could be affected if we are unable to reach a new agreement by March 31, 2019. How members would be affected If we are unable to reach a new agreement, Trinity will no longer be… Read More

Continue Reading

Total Benefit Solutions Partners with Aliera Healthcare

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!     

Continue Reading