Opt-Out Bonuses May Affect Affordability

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

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

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

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Large Employer Mandate – Measurement Periods Defined

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

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

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

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IBC: How to pay your health insurance bill

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.  

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

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

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Notice of Subsidies in the Federal Marketplace

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

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Healtcare Reform Law

ACA: Important Implementations & Delays in 2016

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

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FAQ Suggests Employers Include Marketplace Options with COBRA Notices

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

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Total Benefits & Healthiest You

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.  

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Think HR Comply: Small Business Support from Total Benefit Solutions

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

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Critically Important: Insurance for Serious Illness

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

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Reminder: PCORI Fees Due August 1

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.

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

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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Mental Health Parity Triggers

  The Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) requires a group health plan that offers mental health and substance use disorder benefits to be at parity with medical and surgical benefits. As such, financial requirements and treatment limitations for mental health and/or substance use disorder benefits cannot be more restrictive than the medical and/or surgical benefits offered. Click the link below to read the entire bulletin.   Click to read Mental Health Parity Non-Compliance Triggers

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Now Available: Health Advocate Member Advocacy

Total Benefit Solutions clients can now take advantage of enrolling on Health Advocate as a group or as an individual/ family! It’s part of our Benefit Aid packages and it’s so easy you can enroll today by clicking here or ask your Total Benefit Solutions account manager at (215)355-2121 for more information. This video will tell you all about the benefits of Health Advocate!  

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IBC Breaking News: Changes to SEP On-Exchange Verification Process

Changes to SEP On-Exchange Verification Process Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including: Loss of minimum essential coverage Change in primary place of living Birth Marriage Adoption, placement for adoption, placement for foster care, or child support or other court order Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within… Read More

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Notice of Subsidies in the Federal Marketplace

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 the link to download the complete bulletin. Download Notice of Subsidies in the Federal Marketplace

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The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015…

The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015. The IRS has also issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year.  Please note that for those with an HRA plan, and HRA is ” self insurance” and you are required to file and pay the PCOR fee. Please download the document below for more details and links to specific resources. Download PCOR Fee Filing Reminder for Self-Insured Plans

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New ACA Delays/Extensions/Eliminations Chart–Download Free

With so many different ACA provisions, HR360’s simple new chart provides you and your clients with a clear understanding of the key requirements that have been delayed, extended, or eliminated under the Affordable Care Act.  Our business partner, HR360’s simple chart features important ACA delays, extensions, and eliminations, including: Eliminated automatic enrollment provisions Delay of the “Cadillac” tax Extension of information reporting deadlines Download ACA_Delays_Extensions_and_Eliminations

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Departments issue new ACA FAQ’s

The Departments of Labor, the Treasury, and Health and Human Services (collectively, the “Departments”) have issued the 31st set of Affordable Care Act (“ACA”) frequently asked questions (“FAQs”). This time, the Departments address a wide range of topics including preventive services, disclosure obligations, coverage in connection with approved clinical trials, reference-based pricing, the Mental Health Parity and Addiction Equity Act, and the Women’s Health and Cancer Rights Act. Below is a brief summary of the guidance issued on these topics. Click the link below to download the bulletin.   Download Departments Issue 31st set of FAQs

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Checking Your Employee Handbook for Benefit Provisions

Handbooks are important for many reasons such as informing employees of their rights and duties, communicating available resources, and outlining paid time off policies. With respect to health and welfare benefits, here are a few things to consider:   Download Checking Your Employee Handbook for Benefit Provisions

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Employers: Tell Congress to Oppose Eliminating or Capping the Employer Exclusion

NAHU (The National Association of Health Underwriters)  is very concerned about current proposals in Congress that would undermine the employer-sponsored health insurance system by eliminating or placing a cap on the employer tax exclusion for health insurance. Eliminating the exclusion would also eliminate most of the advantages of employer-sponsored insurance while capping it would degrade the benefit and serve as a tax increase for middle-class Americans. Click here to take action

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