Affordable Care Act – Page 3 – Total Benefit Solutions Inc

Independence Blue Cross Announcing Teladoc virtual care services available January 1

June 22, 2023Wendy Lopez

We are pleased to announce that Independence Blue Cross has chosen Teladoc Health (Teladoc) as our vendor of choice for telemedicine, telebehavioral health, and teledermatology virtual care services! Teladoc will replace MDLIVE as the provider of these services effective January 1, 2024. Teladoc advantages Teladoc will triple the size of the virtual care provider network, which will help members receive the specific care that meets their needs. Offering services through Teladoc will allow us to expand our existing relationships with Livongo condition management programs, and offer the myStrength behavioral health tool, both of which are owned by Teladoc. MyStrength will replace On To Better Health in our portfolio of products.… Read More

Revised Form 720

June 21, 2023June 23, 2023Ed MacConnell

The IRS has released a revised Form 720, Quarterly Federal Excise Tax Return, the proper method to file and report PCORI fees. If you owe a PCORI fee, it must be paid using IRS Form 720 by July 31, following the last day of the policy year or plan year. Form 720 and the fee must be submitted on the same date. If your business does not owe a PCORI fee, IRS Form 720 does not need to be completed. Issuers and plan sponsors will only be required to file Form 720 once a year. Per the IRS, “Issuers and plan sponsors who are required to pay the PCORI fee… Read More

Medicare Cheat Sheet: Download Today

June 15, 2023June 15, 2023Ed MacConnell

Medicare insurance can seem complex on your own. We’re here to help! Medicareful is our easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a Total Benefit Solutions, Inc. licensed sales agent who will guide you through enrollment. Whether it’s a Medicare Supplement, Medicare Advantage Part C Plan, or a Medicare Part D drug plan, we’ve got you covered. https://medicareful.com/totalbenefitsolutions Download our Medicare cheat sheet below to help you keep track of your most important points while shopping for a Medicare supplement! Contact Total Benefit Solutions, Inc today at 215-355-2121 or www.totalbenefits.net to get started.

2023 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

June 14, 2023June 21, 2023Ed MacConnell

This update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2023. As background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which the applicable plan ended. The PCORTF fees fund the Patient-Centered Outcome Research Institute (PCORI), established by Congress… Read More

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

Guidance Issued on Emergency Period Expiration

April 24, 2023April 24, 2023Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below. It is possible that FAQ 58 will be updated to reflect new dates. The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.** On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

Horizon BCBSNJ Updated COVID-19 Resource Guide

April 11, 2023April 11, 2023Ed MacConnell

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

12 Tips for Maximizing Your High Deductible

April 6, 2023April 6, 2023Ed MacConnell

Nearly 40% of people have a health care plan with a high deductible. An even higher percentage of people wish they had a lower deductible (who wouldn’t?!). And with medical bills being the leading cause of bankruptcies, it is important to understand how to maximize your high deductible so that you can stay afloat in case something unexpected were to happen. 1. Find Out What’s Free Many routine services are free. Instead of staying home to save money, you could get a free screening for preventative care. Common services covered are colonoscopies, mammograms, and vaccinations. About 90% of people with high deductible plans don’t know that such services are free.… Read More

IBC: How to read your new EOB

March 31, 2023March 24, 2023Ed MacConnell

Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find out how much a provider charged for services, what your Independence Blue Cross (IBC) health plan paid, and how much you owe. As always please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any additional questions or concerns!

Independence: Wellness Guidelines for all ages

March 29, 2023March 24, 2023Ed MacConnell

Your health and wellness are important. That’s why we provide you with these wellness guidelines to help you and your family stay healthy. The wellness guidelines are a summary of recommendations from the U.S. Preventive Services Task Force and other nationally recognized sources. We encourage you to take the time to review these guidelines. Use them as a starting point for conversations with your and your family’s health care providers. Your health care provider may recommend alternatives to the information outlined in these wellness guidelines based on your specific needs and the history of health or illness in your family

How to activate your OSCAR account

March 11, 2023March 9, 2023Ed MacConnell

We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your ﬁngertips .

Medicare Advantage plans denying more inpatient claims

March 10, 2023February 23, 2023Ed MacConnell

MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More

What is State Mandated Disability or TDB?

March 9, 2023March 9, 2023Ed MacConnell

New Jersey Temporary Disability Benefits (TDB) and Family Leave Insurance (FLI). The New Jersey Temporary Disability Benefits (TDB) law, enacted in 1948 and later amended in 2008 to include Family Leave Insurance (FLI), allows for NJ covered workers to take paid time off for their own non-occupational related injury or illness (under TDB) or to care for a family member with a serious health condition or bond with a new child (under FLI). Which employers are subject to the law? Most New Jersey employers subject to the provisions of the Federal Unemployment Tax Act (FUTA) are also subject to NJ TDB law and are required to provide coverages for their employees working in… Read More

Individual Coverage HRA: Choice and affordability in employee health benefits

March 6, 2023March 3, 2023Ed MacConnell

How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More

ACA coverage rule for dependents up to age 26

March 4, 2023March 3, 2023Ed MacConnell

One of the most notable changes brought about by the Affordable Care Act (ACA) is the ACA coverage rule for dependents up to age 26. Employers offering health care plans to employees must include this extended coverage. Purpose of the ACA coverage rule for dependents up to age 26 The ACA extended the eligibility for a child to be covered under a parent’s health plan from (usually) age 21 and if a full-time student to age 26 regardless of student status. The goal is to provide peace of mind to parents and their young adult children during a time in life when the dependent is likely to be completing their… Read More

Get Your FSA, HRA, HSA Health Accounts Comparison Chart

February 19, 2023February 19, 2023Ed MacConnell

What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!

Broker Change Leads to Better Results

February 15, 2023February 15, 2023Ed MacConnell

Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner… Read More

1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients

February 12, 2023February 9, 2023Ed MacConnell

Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.

Emergency Periods Related to COVID-19 to End May 11 2023

February 10, 2023February 7, 2023Ed MacConnell

On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read More

ACA: Special Election Cheat Sheet

February 9, 2023February 9, 2023Ed MacConnell

Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 http://www.totalbenefits.net

Notification Reminder for Forms 1095-C and 1095-B

February 9, 2023February 9, 2023Ed MacConnell

Under the Affordable Care Act (“ACA”), the deadline for applicable large employers (“ALEs”) to furnish Form 1095-C and 1095-B to certain individuals (such as full-time employees in the case of Form 1095-C) is January 31 with respect to the preceding calendar year. The Internal Revenue Service (“IRS”) released final regulations on December 12, 2022 with respect to ACA reporting requirements. These final regulations provided an automatic extension of 30 days to furnish these statements to individuals. This means that Wednesday, March 2, 2023 is the deadline to furnish individuals with 2022 Forms 1095-C and 1095-B. This extension is automatic; employers or other reporting entities are not required to file a… Read More

Between jobs? Aging out of a family policy? Waiting for Open Enrollment?

February 1, 2023January 24, 2023Ed MacConnell

A Short Term Medical plan might be right for you. Short Term Medical plans let you decide how much coverage you want and for how long, with individual and family options available. And you can enjoy quality of life benefits like telemedicine and discounts on a variety of everyday items and services through an Association membership (varies by state). Short Term Medical plans offer plenty of flexibility: Questions about a short term medical plan? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Important information about these plans THESE PLANS PROVIDE LIMITED BENEFITS For complete limitations & exclusions by state for Short Term Medical insurance, click here. Plan… Read More

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

What is Stop Loss Coverage?

January 26, 2023January 23, 2023Ed MacConnell

Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read More

What is a drug formulary?

January 14, 2023January 14, 2023Ed MacConnell

The drug formulary is a list of medications that have been selected by an insurance company for their medical effectiveness, positive results, and value. The formulary includes generic medications and a defined list of brand medications. Sometimes it includes specialty mediations. Most formularies will have exclusions, or drugs not covered by your plan. You maximize your benefits when you purchase formulary medications. Your health insurance specialists at Total Benefit Solutions, In. can help you understand your plan’s formulary and how to find or search that list. Contact us today at (215)355-2121 if you have questions about your health insurance plan’s drug coverage.

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