CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry. Click here for the full story from Modern Healthcare As always, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about the Affordable Care Act.
Continue ReadingNavigate HCR: Excessive Waiting Periods
6. Dr Kristin Kahle’s Monday Report – Navigate HCR Welcome back to our series on the ACA Toolkit. Today’s topic is excessive waiting periods. A group health plan or issuer may not impose a waiting period that exceeds 90 days. A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll becomes effective. Eligibility conditions that are based solely on the lapse of time are permissible for no more than 90 days. However, other conditions for eligibility are permissible, as long as they are not designed to avoid compliance with the 90-day waiting period… Read More
Continue ReadingAdding Dental to Your Family’s Health Plan
Adding a great dental plan, like Delta Dental to your family’s benefit plans is now easier than ever! Click on the link below to quote, compare and enroll today! http://totaldentalsolutions.net/
Continue ReadingHR Insights Newsletter March 2016
Click the link to view the March 2016 issue of HR Insights from Think HR View as web page HR Advice When You Need It Have an HR question that needs the human touch? Call the Live Hotline team for answers and advice at 1-855-775-7750 brought to you by Total Benefit Solutions Inc.. ThinkHR provides expert, practical human resource guidance to businesses of all sizes, helping them avoid costly risk and liability and save time. 4457 Willow Road, Ste. 120, Pleasanton, CA 94588 855.271.1050 © 2016, ThinkHR. All rights reserved. T
Continue ReadingGAO Report: PPACA- CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014. The GAO applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though GAO sent fictitious documents, or no documents, to resolve application inconsistencies Click here for the highlight sheet Click here for the full report
Continue ReadingReminder to Notify CMS
Employers sponsoring a group health plan are required to report information on the creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). Download the bulletin below for details and specific links for employer reporting Download Medicare Part D – Reminder
Continue Reading2016 Federal Poverty Guidelines Updated
Large employers may be subject to the employer penalty under the Affordable Care Act if they do not offer affordable, minimum value coverage to all full-time employees and at least one full-time employee receives a subsidy in the Exchange. The Federal Poverty Line (“FPL”) is relevant to this penalty in two ways. Please click the link below to download the bulletin with he new guidelines. 2016 Federal Poverty Guidelines If you have any additional questions regarding this bulletin, or the Affordable Care Act please contact your Total Benefit Solutions, Inc account manager at (215)355-2121.
Continue ReadingHow do I appeal a Marketplace decision?
You can request an appeal of any Marketplace decision, including decisions about Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions Your eligibility for an exemption from the penalty for not having health insurance Untimely (late) notice from the Marketplace about a decision To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons… Read More
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IBC: What is Medicare Video
A Simple video from Independence Blue Cross explaining Medicare. As always please contact Total Benefit Solutions, Inc if you have any questions or concerns about Medicare health insurance or supplements at (215)355-2121.
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Download: Medicare Made Clear
Download Medicare Made Clear: From our partners at United Healthcare and Medicare Made Clear, download the 2016 version of the Show Me Guide for an impartial overview of Medicare plans as well as eligibility, glossary, frequently asked questions and more. A virtual Medicare training in one handy workbook! Download Show Me Guide 2016 As always, if you have any questions about Medicare health plans, eligibility and more, contact you Total Benefit Solutions account manager at (215)355-2121.
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Now Available: Empower Me Benefits Private Exchange
Total Benefit Solutions has partnered with Empower Me Benefits to provide our clients with best in industry benefits technology that‘s customizable for even the smallest employer. The EmpowerMe Benefits Exchange allows you to remain complaint with the Affordable Care Act (ACA), easily manage benefits, and control health care costs with a single solution. The EmpowerMeBenefits Exchange is an online benefit marketplace and benefits administration platform designed specifically to meet the needs of small and mid-sized companies. The Exchange provides employers with an enrollment and administration platform that aids employers in ACA compliance. This web-based solution allows you to offer any medical coverage next to pre-selected ancillary, voluntary, and TPA products.… Read More
Continue ReadingIBC: Distribution of 1095 Tax Forms
Information about distribution of 1095 tax forms Beginning February 8, Independence Blue Cross will begin mailing IRS 1095-B tax forms on a rolling basis to subscribers who purchased plans individually off-exchange and to subscribers of fully insured group employers. The purpose of these forms is for individuals to verify that they had minimum essential health care coverage during the previous calendar year, as required by the Affordable Care Act. We are issuing 1095-B forms to subscribers only, unless we receive a request from a subscriber to issue a duplicate form to an enrolled spouse and/or dependent. What you need to know about 1095 forms It’s important to know that who… Read More
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Medicare Exclusions-Who Pays First?
Medicare primary payer rules are complicated. Especially when it comes to different employer sizes and special circumstances like End Stage Renal Disease and disabilities. Coverage issues can be significantly complex when mixing Medicare and employer coverage, or individual coverage for those who are early Medicare enrollees. Chances are, if you are already enrolled on Medicare, AND you are getting bills from providers, you are already experiencing these problems, or you are encountering a coordination of benefits issue. It’s always best to speak to a professional when encountering these problems, most especially a health insurance professional. If at all possible, before getting enrolled on Medicare. The documents below may help provide… Read More
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New Guidance Tackles Employer Mandate Issues
A number of Employer Mandate updates are included in this bulletin. Please click on the link to download this important update. As always please contact your Total Benefit Solutions, Inc account manager if you have any questions or concerns regarding this release at (215)355-2121. Download Update:Employer Mandate Issues 2016
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Total Benefit Solutions Joins Medicareful
How do I know which Medicare plans are right for me? Medicare Supplement, Medicare Advantage, Part D drug coverage — the options seem endless! Don’t worry, Medicareful is here to help. By entering your zip code, you’ll unlock all of the Medicare plans available in your area. You can navigate them on your own or leave it to our professionals who can guide you to a plan based on your needs. From experience, we know how complex Medicare is and that people who work with trusted independent licensed sales agents are far more confident in their choices. It’s our job to help you find your plan, and we’re happy to do… Read More
Continue ReadingNew Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option
New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV Among 300 Enrollment Options Examined, an HIV Positive Enrollee Could Save $4,000 on Average by Assessing a Fuller Range of Costs A new Kaiser Family Foundation analysis finds that people living with HIV could benefit from looking beyond premium costs when shopping for a health plan in the marketplace – as plans with the lowest premiums are often not the most cost-effective option. People with HIV can find lower cost plans by conducting a more comprehensive cost assessment that includes other factors such as deductibles, drug costs, and out-of-pocket maximums… Click… Read More
Continue ReadingNew Accident & Critical Illness Options
Total Benefit Solutions now offers multiple complementary policies that will help cover the large deductible and copay gaps in today’s ACA plans. These plans include: Critical Illness Plans ( lump sum benefits for a critical illness) Accident Plans ( lump sum benefits in the event of an accident) Hospital Indemnity Plans ( limited benefits based on a specific inpatient hospital stay) Dental Plans Disability Plans ( benefits to replace lost income due to an illness or injury) Click the link below to easily quote, compare and enroll today! Call your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns!
Continue ReadingIRS sets 2016 HSA limits
The IRS said it is raising the maximum allowable contribution to a health savings account by $100 in 2016 — but only for families. The IRS quietly announced last week that the maximum contribution that can be made next year to an HSA linked to a high-deductible plan will be $6,750 for employees with family coverage, up from $6,650 in 2015. The maximum contribution for those with single coverage, however, will remain unchanged at $3,350.
Continue Reading2016 Bucks Happening List
Total Benefit Solutions needs your votes for Bucks County’s best insurance agent in the 2016 Bucks Happening List! Click here to vote today! http://bucks.happeningmag.com/happeninglist/insurance-agent-2016/
Continue ReadingSeveral Health Plans Cutting Broker Commissions for ACA Health Plans
Several Health Plans Cutting Broker Commissions for ACA Health Plans. Why should this concern Total Benefit Solutions clients? Because with insurers like Aetna, Humana, Highmark and United Healthcare removing broker compensation, our only recourse will be to collect a fee from consumers who need and engage our professional services. This of course has a direct effect on our clients as their cost to access services and care increases. Otherwise consumers may be left to fend for themselves in the ACA health insurance Marketplace! Click the link below to download the story. Broker Commissions Article Published on Healthcare Exchange
Continue Reading2015 Compliance Compilation
The attached resource file is a compilation of all of our compliance bulletins for 2015 provided by our business partners at Emerson Reid and your benefits support team. Click the link below to download the entire 2015 compilation: 2015 Compliance Compilation
Continue ReadingNew Guidance Addresses Account Based Plans
IRS Notice 2015-87 provides further guidance on health flexible spending accounts (“health FSAs”) and health reimbursement arrangements (“HRAs”) (and other topics summarized in past articles). Click the link below for more information. New Guidance Addresses Account-Based Plans – 012516
Continue ReadingNew Qualified Transit and Parking Guidance
The Consolidated Appropriations Act, 2016 (the “Act”) permanently changed the pre-tax transit benefits to be at parity with parking benefits. As a result, the Act retroactively increased the 2015 transit benefits from $130 to $250. For 2016, the transit and parking pre-tax benefits are $255. Click the link below to read the entire bulletin. New Qualified Transit and Parking Guidance – 012216R
Continue ReadingMillions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost
Millions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost A recent Kaiser Family Foundation (KFF) analysis found that millions may pay more for not having health insurance in 2016 than the coverage would cost. The ACA’s individual mandate penalty is collected with income taxes and was created to encourage people not to wait until they get sick to buy health insurance. For 2016, the penalty is the greater of two amounts: •$695 plus $347.50 per child, up to a $2,085 max for a family or •2.5 percent of family income in excess of 2015 income tax filing thresholds ($10,300 for an individual, $20,600… Read More
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