Consumers who have complex medical diagnoses that require specialty drugs should carefully examine the health insurance plans offered through the public exchange system to avoid incurring high costs for those drugs. But that task will be complicated by inaccuracies on the public exchange website. That’s the conclusion of an analysis of public exchange plans by Avalere Health. The study, in which researchers went through all available plans looking for “hidden” drug costs, found that silver plans in particular tend to place such drugs in specialty tiers in their 2015 formularies. Avalere said that 17 percent of silver plans contain two or more specialty drug tiers that will drive up out-of-pocket… Read More
Continue ReadingNew NLRB rule puts crunch on small businesses
From Benefits Pro: A new rule by the National Labor Relations Board (NLRB) will make it more difficult for employers, especially small businesses, to mount timely anti-union initiatives when attempts are being made by unions to organize workers. Click here for the full story
Continue ReadingTotal Benefits Introduces New Compliance and Health Reform Education Center
Total Benefits Comply is our new Compliance and Health Reform Education Center where we will keep a copy of our health care reform bulletins throughout the year, in an easy to view format, along with short informative videos. This new resource makes it easier to quickly find the answers to your reform questions and download a short, to the point bulletin. At Total Benefit Solutions Inc., we are dedicated to providing the information and advice that our clients need to remain compliant and make informed healthcare decisions. If you have any further questions please contact you Total Benefit Solutions account manager at (215)355-2121 Click here for Total Benefits Comply.
Continue ReadingGilead makes exclusive deal with CVS for hepatitis C drugs
(Bloomberg) — Gilead Sciences Inc. agreed to make its hepatitis C medicines the exclusive treatments for CVS Health Corp. customers, intensifying a drug-industry rivalry to win patients for the $1,000-a-day medicines. Read the news story by clicking here.
Continue ReadingHR 360: How to Calculate Pay or Play Penalties
HR 360: How to Calculate Pay or Play Penalties: Make sure you are ready for 2015 with our basic step-by-step guidance on calculating pay or play penalties. This attorney-reviewed guide, provided by our partner HR360, makes it easy to understand how to calculate ACA penalties. HR360 is provided as a service to Total Benefit Solutions clients. If you have any additional questions regarding this bulletin, or the Affordable Care Act, please contact your Total Benefit Solutions account manager at (215)355-2121 Download How to Calculate Pay or Play Penalties
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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required
On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members? Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… Read More
Continue ReadingCMS: New Transparency Tool Launched
Today, the Centers for Medicare & Medicaid Services (CMS) increased transparency and oversight of health insurance premiums by launching a new tool designed to help consumers easily review rate increases requested by insurance companies in every state. Under the Affordable Care Act, every premium rate increase of 10 percent or greater for non-grandfathered coverage in the individual and small group markets must be reviewed and made available for public scrutiny. Consumers can visit https://ratereview.healthcare.gov and enter a state or insurance company name into the new consumer friendly tool to find out about proposed or finalized health insurance company rate increases. The tool currently contains information on rate increases for… Read More
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IBC: Important information about member outreach for IRS reporting
From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More
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Additional requirements for 90-day waiting period
Additional requirements for 90-day waiting period Group health plans and health insurance issuers cannot impose waiting periods greater than 90 days. This 90-day waiting period is effective for plan years beginning on or after January 1, 2014. It does not apply to HIPAA Excepted Benefits or retiree-only plans. These regulations allow for a one-month orientation period to determine if the employee is eligible for health coverage. Once the employee is determined eligible, he or she must receive health benefits in no more than 90 days. The start date of an eligible employee, marks the beginning of the one-month maximum orientation period. The orientation period is determined by… Read More
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IBC: Changes to Specialty Pharmacy
Per Independence Blue Cross: Effective January 1, 2015, all covered specialty medications for self-funded and fully insured group members will be provided through the FutureScripts® Specialty Pharmacy Program and distributed exclusively by BriovaRx™ specialty pharmacy — after an initial fill at a retail pharmacy. The Specialty Pharmacy Program was included in Benefit Language Clarification (BLC) -11 , and benefit booklets will be updated to reflect the change. Please contact your Total Benefit Solutions account manager if you have any questions regarding this notice (215)355-2121.
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Total Benefit Solutions Introduces New Individual Health Plan Private Exchange
Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!
Continue ReadingHorizon BCBS: Group Billing Issues
Total Benefit Solutions received the following announcement from Horizon BCBSNJ regarding Small Group January Renewal Billing. We have included the announcement below from Horizon. Please be advised that due to required systemic changes necessary to accommodate modifications mandated by the Affordable Care Act (ACA), there will be a delay in the generation and mailing of Small Group bills for January Renewals. During the delay, you and the customer will not be able to view the statement for that bill period in Member Maintenance. In addition, the Horizon Blue Cross Blue Shield of New Jersey voice response system may quote a lower balance than the actual premium. The bills will be delayed… Read More
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Health Reform: Guidance Issued-Employer Reimbursement of Individual Policies
Previously, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (collectively, the “Departments”) explained that HRAs and employer payment plans cannot reimburse individual policies. On November 6, the Departments issued their twenty-second set of FAQs which make clear that: An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Such arrangements are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. Such… Read More
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Health Reform: Healthcare.Gov Sneak Preview
Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121
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Total Benefit Solutions is your Marketplace Navigator
What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
Continue ReadingIRS Derails Use of MV Plans Without Hospitalization
As you may know, in order to avoid penalties under the Affordable Care Act (“ACA”), large employers must offer their full-time employees coverage that is affordable and meets minimum value (“MV”). Some vendors exclude certain core benefits, such as in-patient hospitalization and/or physician services from their plans (referred to as “Narrow MVPs”) and use the MV Calculator to determine that the Narrow MVPs meet MV under the ACA. The vendors claim the Narrow MVPs insulate employers from penalty exposure and preclude employees from accessing subsidies in the Marketplace. There has been much controversy as to whether the Narrow MVPs do, in fact, satisfy the MV requirement. On November 4, 2014,… Read More
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IBC: Individual customers will receive a communication to prepare for open enrollment this week
From Independence Blue Cross & Amerihealth: Individual customers will receive a communication to prepare for open enrollment this week Independence Blue Cross (Independence) will be sending letters to individual customers to remind them about 2015 Open Enrollment dates, inform them how they can prepare now, and let them know we will send additional details in the coming weeks. Each letter will include a list of upcoming health insurance meetings they can attend, along with a card that will make it easier for them to keep track of their enrollment information. These letters will include the agent’s name and phone number, and encourage individuals to contact their agent with questions.… Read More
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2015 Medicare Part B premiums and deductibles to remain the same as last two years
Premiums, copays and deductibles for other Medicare programs for 2015 also announced Secretary of Health and Human Services Sylvia Burwell announced today that next year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively. This leaves more of seniors’ cost of living adjustment from Social Security in their pockets.
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IRS Coordinates Cafeteria Plan Rules with the ACA:Two New Election Changes Allowed
Two New Election Changes Allowed Existing cafeteria plan rules make it difficult (if not impossible) for participants to revoke pre-tax salary reduction elections mid-year and enroll in qualified health plan coverage through the Health Insurance Marketplace (the “Marketplace,” sometimes referred to as the “Exchange”). To provide additional flexibility, the IRS issued Notice 2014-55, creating new opportunities for a participant to change mid-year an otherwise irrevocable cafeteria plan election. Click here to Download the Entire Bulletin
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Health Reform: CMS finalizes auto-enrollment process for current Marketplace consumers
CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More
Continue ReadingIndependence Blue Cross launches new private exchange for mid- and large-sized employers
Independence Blue Cross launches new private exchange for mid- and large-sized employers Multiple plan options offer flexibility, comprehensive coverage, and a personalized experience Philadelphia, PA – September 15, 2014 – Today, Independence Blue Cross (Independence) announces the introduction of a new private exchange marketplace that will offer medical, pharmacy, dental, and vision to employers with more than 100 employees. Employers can begin to use the Independence private exchange on October 1, 2014 with coverage effective on or after January 1, 2015. Click here to read the release
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Medicare: Medicare & You Online
Did you know? You can go paperless and get your Medicare and You Handbook Online! As always, if you have any questions about Medicare health plans, please contact your Total Benefit Solutions account manager at (800)924-6718 or (215)355-2121.
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Health Reform: Eligibility for the SHOP Marketplace
Eligibility Requirements for the SHOP Marketplaces In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP. To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible employee on payroll Have 25 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year). While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP… Read More
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Aetna: Small Group Medicare Plans Being Discontinued
Aetna Small Group Medicare Plans will be Discontinued January 1, 2015 Total Benefit Solutions Inc received the following notification from Aetna that they will be not be renewing Small Group Medicare plans effective January 1, 2015. We have included a link to the original notification as well as a brief summary below. Please click on the link for the complete announcement and disclaimers from Aetna. Click here to read the rest of the release
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