ACA Employer Penalties Increased for 2022

The IRS penalty amounts for non-compliance of the ACA’s Employer Mandate are again increasing in 2022.  4980H(a) Penalty For the 2022 tax year, the 4980H(a) penalty amount is $229.17 a month or $2,750 annualized, per employee. The IRS issues the 4980H(a) penalty when: An employer doesn’t offer Minimum Essential Coverage (MEC) to at least 95% of its full-time employees (and their dependents) for any month during the tax year, and  At least one full-time employee receives a Premium Tax Credit (PTC) for purchasing coverage through the Marketplace. Here’s an example of how the IRS calculates the penalty: If an organization in 2022has 300 full-time employees, and one of these employees receives a PTC for 12 months, the cost of this penalty would be $742,500.The per-employee penalty applies… Read More

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Philadelphia Re-Enacts Emergency Paid Sick Leave Benefits

On March 9, 2022, the Philadelphia City Mayor signed into law an ordinance amending the city’s existing public health emergency leave requiring covered employers to provide continuing paid COVID-19 leave through December 31, 2023. The law became effective on March 9 and is the third iteration of the COVID-19 paid leave mandate. Click the link below to download the bulletin. As always for more information contact your Total Benefit Solutions group account manager at (215)355-2121

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Is my group subject to ERISA or ERISA Exempt?

Many clients often ask the question ” Do I need to comply with ERISA? ” The answer is almost always yes! Just because you are a smaller business does not exempt you from ERISA. This from the US Department of Labor: ERISA applies to private-sector companies that offer pension plans to employees. This includes businesses that: Are structured as partnerships, proprietorships, LLCs, S-corporations and C-corporations. No matter how your employer has structured his or her business, it is covered by ERISA if it is a private entity. Who is not subject to ERISA?In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or… Read More

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Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

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Aetna: Transparency in Coverage Rule Update

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers  We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

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2022 PCOR Fee Filing Reminder for Self-Insured Plans

The Patient-Centered Outcomes Research (PCOR) fee filing deadline is August 1, 2022, for all self-funded medical plansand HRAs for plan years ending in 2021. The IRS issued Notice 2022-04 announcing the adjusted fee amount for this year. please download the bulleting below for more details and contact your Total Benefit Solutions, Inc. health insurance specialist at (215)355-2121.

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Turning 26: Your Guide to Health Insurance

Thanks to the Affordable Care Act (ACA), many young people choose to stay on their parent’s health insurance for as long as possible, and with good reason. The historic healthcare law, also known as Obamacare, allows young adults to stay on their parent’s health plan until they turn 26, no matter what. Download our free easy to read guide to getting your own health insurance here. Contact your health insurance experts at Total Benefit Solutions Inc with any additional questions (215)355-2121

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Aetna Client Series: Reimagining Workforce Strategies Webinar

Reimagining Workforce Strategies Thursday, June 23 at 2 PM ET Our next Aetna Client Series webinar is on Thursday, June 23 at 2 PM ET featuring: Tanya Taupier, SVP and Senior HRBP – HCB, Aetna and Jannine Zucker, Principal, Deloitte Consulting. This webinar is specifically designed for Aetna clients to hear about relevant thought leadership content. The topic of this webinar will be: Reimagining workforce strategies. Please share this invitation with your clients and join them to learn more about workforce strategies for success. Many organizations are struggling with an urgent talent crisis: The Great Resignation. As businesses search for ways to attract – and retain – talent. They have an opportunity to refocus their thinking on how and… Read More

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6 Questions to ask your Benefits Broker

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Fixed Funding: Innovative plan solutions now available for New Jersey employers

AmeriHealth New Jersey is excited and proud to announce that it is offering Fixed Funding benefit design options to New Jersey employers, powered by AmeriHealth Administrators. These plans are available now to quote for July 1, 2022 effective dates. Fixed Funding offers innovative benefit designs that are flexible, predictable, and cash‑flow friendly — while providing members access to high‑quality care from an extensive network of doctors and hospitals. These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment. How a Fixed Funding health plan works: Employers have a consistent monthly payment that covers the cost of administrative fees, stop‑loss insurance premiums1, and an estimated cost… Read More

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Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More

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How Medicare Works Part A

How Medicare Works Medicare is a federal insurance program that provides health insurance for people 65 and older and individuals younger than 65 who may qualify due to certain disabilities. There are four different parts to Medicare — Part A, B, C, and D. Click the icons below to learn more about each part! Medicare Part A Medicare Part A can be thought of as your hospital insurance. It helps to pay for your stay at a health care facility, whether that be a hospital, skilled nursing facility, or nursing home, among others. If you’re admitted as an inpatient, Medicare Part A covers many services like meals, a semi-private room,… Read More

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2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

  2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees May 23, 2022     This Allied Update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2022. By way of 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… Read More

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Notice Requirements for Group Health Plans

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

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Support for your emotional health

Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.

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Proposed Regulations to Fix ACA’s Affordability “Family Glitch”

individuals are not eligible for premium tax credits in the Marketplace

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Understanding Medicare Part B Exemption Secondary Payer Rules

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What is a 5-Star Medicare Plan?

Did you know that Medicare plans come with a handy rating system and that the highest-rated of these plans have a Special Enrollment Period associated with them? Get ready to learn all about 5-star Medicare plans and what makes them special! Click here for more information! As always contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any additional questions or concerns!

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HealthCare.gov Notices New Class of Individual Employer Policies

hCare.gov managers are signaling that they think individual coverage health reimbursement arrangements matter. The regulators in charge of the federal Affordable Care Act public exchange system today gave ICHRAs official attention, by adding an ICHRA use reporting requirements for the insurers that sell coverage through HealthCare.gov. Click here for the full story on Think Advisor.com

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Understanding Your OMNIA Health Plan: OMNIA Tier 1 and Tier 2

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Free or Nearly Free Health Coverage Through New Jersey’s Expanded Access”

The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the federal poverty level to enroll in a health plan throughout the year. New Jersey’s Governor Phil Murphy and Department of Banking and Insurance Commissioner Marlene Caride have introduced a new “Expanded Access” initiative, which allows residents at certain income levels to continue to enroll in free or nearly free health coverage through Get Covered New Jersey.     The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the Federal Poverty Level (FPL) to enroll in a health plan throughout the year. This population will… Read More

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Temporary Telehealth Relief for HSA Plans

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth servicesfrom April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”)to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make HealthSavings Account (“HSA”) contributions….

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Independence is covering OTC COVID‑19 test kits through pharmacy benefits

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HHS Extends Public Health Emergency until April 16, 2022

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Medicare Part D Notification Requirements

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