Association Health Plans – Total Benefit Solutions Inc

Attention: The coverage for OneTouch diabetic supplies ends August 3

July 11, 2025July 11, 2025Loramei Romeo

As of August 3, significant changes will occur regarding preferred diabetic testing supplies for Medicare Advantage plans. LifeScan OneTouch@ products will no longer be covered, and Ascensia Contour products will be introduced as a new preferred option effective June 1, 2025. Members will still have access to a selection of preferred brands with a $0 copay, including multiple Accu-Chek and Contour products such as: Member that are currently using LifeScan OneTouch supplies will soon receive an important letter from UnitedHealthcare, outlining new options and the need for updated prescription. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance… Read More

Big changes to Medigap plans start January 1, 2026!

June 12, 2025June 18, 2025Loramei Romeo

Attention to all current Medigap groups: As of July 1, 2025, new enrollments for MedigapSecurity and 65 Special products will no longer be accepted. It is crucial for future retirees to be aware that they will need to transition to a MedigapFreedom product. As we approach 2026, it’s essential for businesses and retirees to understand the upcoming changes to Medigap enrollment. If your Medigap group renewal dates fall between January 1 and June 1, 2025, you can continue enrolling future retirees into MedigapSecurity or 65 Special throughout 2025. However, starting January 1, 2026, any future retiree from an existing group will need to select from the MedigapFreedom products. As we… Read More

The 2025 PCORTF Fee is on the horizon!

June 10, 2025June 4, 2025Loramei Romeo

The recent reauthorization of PCORTF fees by the Federal Government will continue to support the Patient-Centered Outcomes Research Institute through 2029. These fees play a crucial role in funding vital health research, which helps inform healthcare decisions and improve patient outcomes. As a reminder, the fee associated with your health plan is due by July 21, 2025. This deadline is crucial as it follows the calendar year immediately after the end of the applicable plan year. Staying compliant with these deadlines is essential for effective health insurance management. For plan years ending on or after October 1, 2023, and before October 1, 2024, the fee will be $3.22 multiplied by… Read More

Tax Favored Accounts Summary Page

June 5, 2025May 23, 2025Loramei Romeo

Cafeteria Plans (Section 125 Plans)

June 2, 2025May 23, 2025Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

IRS requires employers to offer MEC to employees!

May 30, 2025May 19, 2025Loramei Romeo

The IRS mandates that every applicable large employer (ALE) offer MEC plans to their employees to avoid significant penalties. Is your business compliant with MEC requirements? Knowing the rules can save you from penalties. Stay informed about the implications of compliance and the financial impacts of neglecting these requirements. Whether you are a small or medium-sized business, individual, self-employed, a gig worker, or family, Total Benefit Solutions,  can help you find affordable health plans that suit your needs. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available… Read More

Curious about Minimum Essential Coverage? Ask us how MEC plans can work for you!

May 28, 2025May 19, 2025Loramei Romeo

A health plan must provide certain coverage and benefits, to be classified as Minimum Essential Coverage (MEC) by the Affordable Care Act (ACA). Coverage Scope MEC plans are designed to meet ACA standards by covering ten essential healthcare benefits, including hospitalization, preventive services, and mental health care. While they offer significant support, it’s important to note that they may exclude certain services, such as elective surgeries or cosmetic procedures. Cost Structure MEC plans have a unique cost structure, just like other health plans. The MEC plan’s cost structure consist of the following components. Premiums– monthly payment that maintain each member’s coverage. Deductibles– member’s pay out of pocket until they meet… Read More

MEC (minimum essential coverage) and MVP (minimum value plan) differentiation

May 23, 2025May 19, 2025Loramei Romeo

Despite both MEC and MVP plans stem from the ACA they differ significantly from each other. MEC plans meet the ACA’s individual mandate, while MVPs offer substantial coverage to avoid penalties for employers. Both concepts aim to ensure that individuals have access to comprehensive and affordable health care. However, knowing these differences can lead to better health decisions. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

The advantages and disadvantages of MEC plans!

May 21, 2025May 14, 2025Loramei Romeo

After being informed themselves, employers should empower their employees with knowledge about the pros and cons of MEC plans and encourage them to explore their options. Pros: Affordable premiums– lower monthly premiums than more comprehensive health plans. Basic Coverage– coverage for essential health benefits. Regulatory compliance– helps ALEs meet regulatory requirements and avoid tax penalties Cons: Very Limited coverage– it doesn’t cover certain healthcare expenses, such as elective procedures or specialty medications. High-out-of-pocket-costs– In exchange for cheaper premiums, members will face higher deductibles, copayments and coinsurance. Minimal flexibility– limited customization options Limited provider networks– it may limit members’ choice for healthcare providers After weighing the advantages and downsides of a… Read More

Examples of MEC plans

May 15, 2025May 14, 2025Loramei Romeo

The centers for Medicare & Medicaid Services provides MEC recognition to healthcare carriers, creating a reliable list of national health plans. Additionally, any plan that falls under the following categories is considered MEC: Minimum Essential Coverage encompasses various health plans, including employer-sponsored options, individual market plans, and government programs like CHIP and Medicare. Understanding these categories is vital for making informed and effective health insurance decisions. Reach out to us for personalized guidance! We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any… Read More

What is the concept of a MEC plan?

May 14, 2025May 14, 2025Loramei Romeo

MEC stands for minimum essential coverage and is a type of healthcare plan that fulfills the minimum criteria established by ACA, the Affordable Care Act. MEC plans are designed with affordability in mind, providing essential coverage at lower premiums compared to traditional health plans. In a few words, MEC plans are a popular way to provide baseline coverage to businesses, individuals, and families simply looking for standard healthcare. Understanding MEC plans is vital for applicable large employers to ensure compliance and employee health. These plans offer essential benefits while helping businesses avoid tax penalties. Small- and medium-sized businesses must evaluate the pros and cons of MEC plans to ensure the… Read More

The importance of what Minimum Essential Coverage (MEC) Plan offers and how it works.

May 13, 2025May 12, 2025Loramei Romeo

Minimum Essential Coverage plans are crucial for compliance with the Affordable Care Act, ensuring that employees meet their responsibilities towards full-time workers. The Internal Revenue Service (IRS) can penalize an applicable large employer (ALE) if it does not offer MEC plans to 95% or more of its full-time workers. These plans provide basic healthcare services, focusing on affordability while offering essential benefits. Understanding MEC plans is vital for both employers and employees to navigate the complexities of health insurance. Share your insights or questions about MEC plans. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

IRS just announced the 2026 Health Savings Account Contribution Limits

May 12, 2025May 7, 2025Loramei Romeo

As we look ahead to 2026, it’s important to understand the new contribution limits for health plans. The self-only contribution limit has increased to $4,400, while the family limit is now $8,750. Additionally, the annual deductible for high-deductible health plans has also seen increases, with self-only coverage now requiring a deductible of at least $1,700 and family coverage at $3,400. Staying informed about these changes is crucial for optimizing employee benefits and promoting financial well-being. How is your organization adapting to these new health plan regulations? We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121… Read More

ACA Individual Market Highmark

May 8, 2025May 6, 2025Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

May 6, 2025May 6, 2025Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

Updated Guidance Offers More Information on Form 1095-C Reporting Relief

March 7, 2025March 7, 2025Loramei Romeo

The IRS released Notice 2025-15, providing guidance on an alternative method for furnishing Forms 1095-C and 1095-B under the Affordable Care Act. This new method allows employers to provide these forms only upon request, given they meet specific notice requirements, including clear communication and accessibility on their website. Employers must post the notice by March 3, 2025, and ensure it remains accessible through October 15 of the following year. Despite this change, employers are still required to file all 2024 Forms 1095-C with the IRS electronically by March 31, 2025. Employers should review their current delivery policies and decide whether to adopt this new method while ensuring compliance with any… Read More

Latest Developments in the Johnson & Johnson ERISA Fiduciary Case

February 24, 2025February 21, 2025Loramei Romeo

The U.S. District Court of New Jersey recently dismissed claims in a class action lawsuit against Johnson & Johnson (J&J) regarding the management of their prescription drug benefits. The plaintiffs alleged that J&J breached its fiduciary responsibilities under ERISA, resulting in higher payments for prescription drugs, premiums, deductibles, coinsurance, and copays, as well as lower wages and limited wage growth. However, the court ruled in J&J’s favor on the fiduciary breach claims, stating that the plaintiff lacked Article III standing due to speculative allegations about higher premiums and insufficient evidence of redressable injury. Despite this, the court did not dismiss the claim that J&J failed to furnish requested plan documents,… Read More

Armanini, Kolodychak, & Basile L.L.P. Out-of-Network Effective April 4, 2025

February 19, 2025February 19, 2025Loramei Romeo

Armanini, Kolodychak, & Basile L.L.P., a specialized oral surgery group in Erie, PA, has requested to not renew their Highmark contract, effective April 4, 2025, for all members. We are currently negotiating this contract and aim to reach an agreement before April 4; however, there is a significant risk that the group will become out-of-network. Highmark members may still be able to access services at this practice if their dental coverage is in-network and services are billed to their Dental Plan. Members can always find alternative in-network doctors and hospitals by logging in to the member portal online or through the MyHighmark app. Approximately 865 Highmark members have used services at… Read More

One Employer or Spouse, Section 105 HRA

February 18, 2025February 14, 2025Loramei Romeo

What is a Section 105 HRA for 1 Employee or Spouse? Employers with small businesses that only have one employee or hire their spouse, Section 105 HRA are designed specifically for them. With Section 105 HRA spouse or employee/s can reimburse for family health insurance and medical expenses tax-free, indirectly the employers also benefit from as a dependent of the spouse/employee or as tax-deductible expenses to the business and employee. IRS Letter Ruling 9409006 and Section 105 of the Internal Revenue Code, Revenue Ruling 71-588 made this plan possible. Any health plan with 2 or more employees he annual and lifetime dollar limit is eliminated because of the Affordable Care… Read More

Annual Update for 2025 for New Jersey Policyholders

February 17, 2025February 17, 2025Loramei Romeo

This letter is intended to provide you with information on New Jesey Temporary Disability Benefits (TDB) changes for 2025. This Annual Update should be included in the employee posting. Please note that this information must not only be posted at the same place of employment, but must also be provided to the employee under the following circumstance: The following NJ TDB changes are applicable January 1, 2025, until December 31, 2025: Maximum Contribution amounts: Maximum Weekly Benefit: We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are… Read More

Health FSA Plan Document Section 125

February 13, 2025February 11, 2025Loramei Romeo

Employees have the potential to save up to $1,280, while employers may realize savings of as much as $320. Health Flexible Spending Account (FSA) Plans are designated tax-exempt accounts that permit employees to access up to $3,300 in 2025 in pre-tax funds for out-of-pocket medical, dental, and vision expenses that are not covered by other insurance plans. What is a Health Flexible Spending Account (FSA)? A Health Flexible Spending Account enables employees to set aside pre-tax funds for medical expenses that are not covered by their insurance. These Health FSA plans can also be integrated with a Premium Only Plan (POP) and/or a Dependent Care FSA. The FSA acts as… Read More

Section 125 POP (Premium Only Plan) With HSA Module

February 10, 2025February 10, 2025Loramei Romeo

Section 125 Premium Only Plan can be pre-taxed HAS Savings Employers prefer High Deductible Health Plans (HDHP) and offering their employees’ Health Savings Accounts (HSA). The problem is whether the HSA portion (saving component) qualifies as a pretax payroll deduction through the Section 125 Premium Only Plan. HSA savings component allows to be pre-taxed because a $30 HSA module for the $149 Section 125 Premium Only Plan was developed. Employers can obtain all necessary materials to set up an HSA Section 125 for a fee of $179.00 for the Basic PDF version sent via email, or $229 for the PDF version along with a Deluxe 1-inch Binder delivered by USPS. This… Read More

Premium Only Plan Document (POP) Section 125

February 7, 2025February 6, 2025Loramei Romeo

What is a Section 125 Premium Only Plan?The Revenue Act of 1978 introduce IRS Section 125, which allows employers to reduce payroll taxes by adjusting the payroll process. Also, Section 125 Premium Only Plan employees can choose from pre-tax or tax-free basis pay for their portion of premium insurance rather than after-tax basis, which creates saving for both the employer and employee. How Employees Benefit from a Premium Only Plan.Section 125 premium deductions can save employees 20 or 40% of their pre-tax. The tax savings are on city, state, and federal income taxes, including Social Security and Medicare taxes on money used to pay for their portion of insurance premiums… Read More

Notice For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP)

February 5, 2025February 4, 2025Loramei Romeo

For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP) Hackensack Meridian Health Remains In-Network for Braven Health and Horizon DSNP MembersAs of June 1, 2025, Hackensack Meridian Health (HMH) terminated their hospital from Horizon Hospital Network unless Horizon agrees to increase prices for services and cares at their facilities. This change does not impact Braven Health or Horizon NJ TotalCare (HMO D-SNP). Braven Health and Horizon TotalCare (HMO D-SNP) members can continue using HMH providers and hospitals. Why is this not impacting Braven Health and DSNP and will it soon?Only certain Horizon members are affected by the change in hospital network status. Braven Health and Horizon TotalCare (HMO D-SNP) members… Read More

State Health Coverage Calendar 2024 Reporting Requirements

February 4, 2025February 4, 2025Loramei Romeo

District of Columbia, California, Massachusetts, New Jersey, Rhode Island, and Vermont already released the individual health mandates requirements. Supply the information. The Paperwork Burden Reduction Act upon request for federal forms 1095-C or (1095-B) the employers are allowed to make when: Both federal and state regulations that is applicable should be met. As of this article’s publication federal relief has not implemented in District of Columbia, California, Massachusetts, New Jersey, Rhode Island, and Vermont. Like previous years Forms 1095-C (or 1095-B) should be prepared by employers. Have Questions? and want to read more about the changes click State Health Coverage Reporting Requirements for Calendar Year 2024 for more details. We are dedicated… Read More

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