Ed MacConnell

Individual and Family Open Enrollment-2017 Important Updates

October 25, 2016Ed MacConnell

As many people know by now there are many big changes with individual and family plans for open enrollment 2017. For anyone who is currently enrolled on one of the following your plan will NOT be renewed for 2017 and you will have to pick a new plan and/or a new insurer: Aetna: all plans cancelling in PA/NJ/NC/FL Aetna plans only remain in Delaware in our service area United Healthcare: All ACA plans cancelling. Short term plans are still available Oscar: All plans in NJ cancelling Health Republic: All plans in NJ cancelling Highmark and Capitol Blue Cross: No longer paying broker compensation Geisinger: No longer paying broker compensation Independence Blue… Read More

Total Benefit Solutions participating in CVS Retail Locations During Medicare Open Enrollment

October 9, 2016October 8, 2016Ed MacConnell

Total Benefit Solutions is pleased to announce that we are participating in the Independence Blue Cross Medicare/ CVS Pharmacy retail program for the upcoming open enrollment period. What this means to our clients is that we will be on site at our local CVS Pharmacy during the AEP. Starting on Saturday October 15th and continuing through open enrollment we will be on site nearly each Monday, Wednesday and Friday at the CVS Pharmacy in Feasterville from Noon to 2 PM each day. Please feel free to stop in without an appointment to get your questions answered and pick up your 2017 plan information from Independence Blue Cross. We will… Read More

ACA Individual 2017 Open Enrollment Important Update

October 8, 2016October 27, 2016Ed MacConnell

2017 ACA ” Obamacare” plans open enrollment important update. The annual open enrollment period opens on November 1st 2016 and ends January 31st 2017. Independence Blue Cross will be the only insurer available in 2017 in the Philadelphia 5 County Area. With the passing of the Affordable Care Act changes come annually or even more often. Unfortunately not all of those changes are benefiting the consumer. This year here are some major changes that our clients on Individual Non Medicare plans need to be aware of… If you are a enrolled on an ACA compliant plan with Aetna or United Healthcare your plan is going away. Neither Aetna or United… Read More

HHS Penalties Increase

September 26, 2016Ed MacConnell

On September 6, 2016, the Department of Health and Human Services (“HHS”) issued an interim final regulation that adjusts civil penalties for inflation. The interim final regulation does not follow the usual procedures that offer a notice and comment period. As such, a Notice of Proposed Rulemaking has not been issued and a comment period is not provided due to potential delay in the applicability of the regulation. Click to download this bulletin For more information please contact your Total Benefit Solutions account manager at (215)355-2121

Reminder to Distribute Creditable Coverage Notice

September 18, 2016September 26, 2016Ed MacConnell

Employers who sponsor a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Download medicare-part-d-reminder-to-distribute-creditable-coverage-notice-

Health Republic Insurance of NJ Will Not Offer Coverage for 2017

September 15, 2016September 15, 2016Ed MacConnell

NJDOBI Announces Health Republic Insurance of NJ Will Not Offer Coverage for 2017 On September 12, 2016, the New Jersey Department of Banking and Insurance (NJDOBI) announced that Health Republic Insurance of New Jersey (HRINJ) has consented to be placed in rehabilitation due to its deteriorating financial condition. If approved by the court, the rehabilitation will enable the Department to preserve the assets of the carrier so that consumers continue to receive the care to which they are entitled and medical providers are paid. Under this rehabilitation plan, current policies will remain in force through December 31, 2016, but HRINJ will not offer coverage for 2017. The Department and… Read More

Opt-Out Bonuses May Affect Affordability

September 14, 2016Ed MacConnell

The IRS recently issued proposed regulations that (among other things) address affordability determinations for individuals who are eligible for employer-sponsored health coverage. Building on earlier guidance, the proposed rules describe the effect an opt-out waiver has on affordability. Should you have any questions, please contact your Total Benefit Solutions account manager directly at (215)355-2121. Click here to download this bulletin

Oscar to Withdraw from NJ Market Effective Jan. 1, 2017

September 10, 2016Ed MacConnell

Oscar to Withdraw from NJ Market Effective Jan. 1, 2017 In a recent release, Oscar has announced that they have decided to withdraw their plans from the New Jersey market beginning on January 1, 2017. They have concluded that instability in the market will make it challenging for them to operate effectively and to continue to deliver quality healthcare to all their members across the country. Oscar would like to highlight a few key points in regards to this announcement: Oscar will continue to serve their other existing markets without change, including New York, Long Island, San Antonio, Los Angeles and Orange County. Oscar remains financially stable—they have raised… Read More

Original Medicare: Did You Know?

August 20, 2016Ed MacConnell

Many Medicare beneficiaries are unaware that original Medicare coverage has significant deductibles and co-pays. Part A helps cover medically necessary inpatient care in hospitals. In 2016, for each benefit period (typically 60 days as defined by Medicare) in a year, beneficiaries pay: $1,288 deductible and no coinsurance for a stay of up to 60 days $322 coinsurance per day for days 61-90 of a hospital stay $644 coinsurance per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime) All costs for each inpatient day beyond 150 days At Total Benefit Solutions, Inc we specialize in Medigap programs that are affordable and cover most or… Read More

Aetna to pull out of most Obamacare exchanges

August 16, 2016Ed MacConnell

From cnn.com: The insurer will stop offering policies on the exchanges in 11 of the 15 states where it currently operates, according to a press release it issued Monday evening. Aetna (AET) will only sell Obamacare products in Delaware, Iowa, Nebraska and Virginia… Click here for the story on CNN

Aetna Small Group: New Small Group ACA termination policy effective October 1, 2016

August 14, 2016August 10, 2016Ed MacConnell

New Small Group ACA termination policy effective October 1, 2016 RE: renewal policy changes from Aetna…. Starting October 1, we must receive written confirmation of customer renewal acceptance in advance of the customer renewal date for all Aetna small groups. This means that beginning with all October 1 renewal dates, we must receive written confirmation in advance of the policy renewal date. Written confirmation may include signed renewal acceptance from the customer delivered by mail, fax or email. Note: premium payment received in advance of the renewal date will also be considered renewal acceptance. If we haven’t received written acceptance of the renewal, or renewal alternates, from the customer in this… Read More

Large Employer Mandate – Measurement Periods Defined

August 10, 2016Ed MacConnell

In order to determine “full-time” status for ongoing employees – those who have been employed by their employer for at least one complete Standard Measurement Period (SMP) – employers must establish and identify the measurement and stability period they will use to determine their employees’ “full-time” status. This is a critical component of determining the impact of Variable Hour Employees on a group’s Large Employer status under PPACA’s Pay or Play mandate. Download the bulletin below from our partners at PrimePay. Click to download measurement periods defined

Horizon: groups will be permitted to renew within their existing Pre-ACA plan

July 30, 2016July 30, 2016Ed MacConnell

Horizon BCBSNJ is pleased to advise that for the 4th quarter 2016 renewals, which includes October, November, and December, groups will be permitted to renew within their existing Pre-ACA plan. In the event a group does not opt to stay in their Pre-ACA plan, they will then need to move to an ACA compliant policy with SAPD. This would include an option to select one of Horizon’s new ACA Compliant Omnia Health Plans. If you have any questions, as always contact your Total Benefit Solutions account manager at (215)355-2121

IBC: How to pay your health insurance bill

July 29, 2016July 29, 2016Ed MacConnell

Click to watch this quick video on payment options for Independence Blue Cross individual health insurance plans. As always if you have any questions please contact your dedicated Total Benefit Solutions individual account manager at (215)355-2121.

HR 360:Most Common Summary Plan Description (SPD) Mistakes

July 20, 2016Ed MacConnell

One of the most important documents participants must receive automatically when becoming covered under a health benefit plan that is subject to ERISA (the federal Employee Retirement Income Security Act) is a summary of the plan, called the Summary Plan Description or SPD. The fact is, many employers are confused about this very important ERISA-required disclosure, which can put them at risk. Click this link to download the publication

Notice of Subsidies in the Federal Marketplace

July 18, 2016July 18, 2016Ed MacConnell

The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click here to download the bulletin

ACA: Important Implementations & Delays in 2016

July 15, 2016July 17, 2016Ed MacConnell

As our third year of the ACA Open Enrollment Period arrived, it’s time to examine some of the new implementations in 2016. Some of the major components, especially those affecting businesses were delayed or deferred since the passage of the Affordable Care Act in 2010. This year is considered to be a big year due to the “full implementation” of the employer mandate as well as a number of changes, repeals, and moratoriums on other sections of ACA. Some of the key changes are listed below: CHANGES AND IMPLEMENTATIONS Full implementation of the Employer Mandate Currently it is not mandated that employers provide health care to their employees. Moving forward, however, if… Read More

FAQ Suggests Employers Include Marketplace Options with COBRA Notices

July 15, 2016Ed MacConnell

On June 21, 2016, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) issued the 32nd Affordable Care Act (“ACA”) FAQ describing information that may be appropriate to include with COBRA notices. Many wondered if it were appropriate to provide information and if so, what kind of information could be provided about the Health Insurance Marketplaces/Exchanges (“Marketplaces”) so that COBRA-eligible individuals could consider health coverage alternatives available through the Marketplaces and possibly investigate whether they may be eligible for premium tax credits and cost-sharing reductions. Click the link to download the entire bulletin

Total Benefits & Healthiest You

July 13, 2016July 8, 2016Ed MacConnell

Healthiest You is more than a typical Teledoc benefit. Whenever members have questions or they are simply not feeling well, they can effortlessly connect to a 24×7 telehealth hotline for the diagnosis and treatment of illness, second opinions and consultations. They have board-certified, licensed physicians in every state waiting to provide exceptional care. They can even prescribe medication and save a trip to the doctor’s office, whether members are at home or on the road. Want more information? Click here to see the site.

Think HR Comply: Small Business Support from Total Benefit Solutions

July 11, 2016July 11, 2016Ed MacConnell

We are pleased to introduce to you a our sponsored client service—ThinkHR. If you are involved with employee issues, this will be a value-added benefit that will save you time and money. ThinkHR offers ThinkHR Live, a team of HR experts standing by to answer your questions or provide advice. This phone-based support service is available from 8:00 a.m. to 7:00 p.m. Central each business day. You also have access to ThinkHR Comply, an award-winning online resource center for all of your workforce issues. Download this brochure, it describes the scope of HR topics that are handled by the ThinkHR Live team. The service is provided to all Total Benefit… Read More

Critically Important: Insurance for Serious Illness

July 11, 2016July 8, 2016Ed MacConnell

Good news: You’ve got health insurance (at least, all Americans are required to or pay a penalty). Bad news: It doesn’t cover everything. Especially if something really bad happens, like a heart attack or stroke. Yes, a decent major medical plan will cover many of the health-related expenses related to a serious illness. But you’d likely still be left with significant out-of-pocket costs for deductibles and copayments. Medical insurance also doesn’t usually cover other related costs, such as travel to treatment centers, child care during absences or recovery, home modifications or rehabilitation charges. And if you lose income while you’re unable to work, you could have a tough time paying… Read More

Amerihealth NJ: No Longer Providing COBRA Administration

July 10, 2016July 7, 2016Ed MacConnell

AmeriHealth New Jersey has announced that they will no longer provide administrative services for the continuation of coverage under the Consolidated Omnibus Reconciliation Act (COBRA) and Retiree Billing services. AmeriHealth NJ will discontinue COBRA administration and Retiree Billing services in 2016 for customers on the following schedule: For customers renewing January 1 through July 31, COBRA administration services will end on December 31, 2016. For customers renewing August 1 through December 31, services will end on their 2016 renewal date. Approximately 30 days before COBRA administration services end, COBRA members will be notified that their COBRA plan is being transferred to another service provider, and their COBRA eligibility will continue uninterrupted. … Read More

Limited Benefit Medical Plans

July 10, 2016July 8, 2016Ed MacConnell

Why Consider a Limited Benefit Medical Plan? When it comes to medical benefits, employers used to face two choices — comprehensive employer-paid medical plans or no insurance at all. However, with the inception of the Patient Protection and Affordable Care Act (PPACA), the option not to offer medical insurance no longer exists for some employers. Limited benefit medical plans can be powerful tools for recruiting and retaining employees in situations where traditional medical benefits are not offered or affordable. These plans can also be useful in increasing productivity through reduced absenteeism due to illness, improving employee morale and as a means to provide the level of coverage required by law.… Read More

Reminder: PCORI Fees Due August 1

July 9, 2016July 8, 2016Ed MacConnell

The annual Patient-Centered Outcomes Research Trust Fund (PCORI) fee is due to the IRS August 1, 2016. The fee, charged to certain health insurance policies, is used to support the activities of the Patient-Centered Outcomes Research Institute, a nonprofit, non-governmental organization (NGO) established by the Affordable Care Act (ACA). Fully- and self-insured group health plans ( Including HRA’s) are subject to PCORI fees. A health insurer will pay the fee on behalf of the employer if the plan is fully insured. Click here to read the bulletin from Primepay As always please contact your Total Benefit Solutions dedicated account manager at (215)355-2121 if you have any further questions or concerns.

Now Available from Total Benefit Solutions: Low Cost ERISA Wrap SPD Documents

July 8, 2016July 8, 2016Ed MacConnell

Wrap Summary Plan Description (SPD) If you offer group health insurance you’re now required by ERISA law, enforced by the Department of Labor and now the Affordable Care Act, to distribute a Wrap SPD within 120 days of the Plan’s effective date. The ERISA and ACA required Group Health Insurance Wrap SPD document is now available for a $99 one-time fee. You only update your Wrap SPD document as your benefit options change. The low cost Wrap SPD document is limited to fully insured group health insurance plans only. Here are the Wrap SPD document requirements by ERISA and the Affordable Care Act as succinctly as possible: If… Read More

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