Insurance Carrier News – Total Benefit Solutions Inc

Navigating PCORI Fees for Self-Insured Health Plans and HRAs

August 5, 2025August 4, 2025Loramei Romeo

The Affordable Care Act (ACA) imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). The IRS has provided this helpful chart for more information on whether a type of insurance coverage or arrangement is subject to the fee. Note that self-insured health plans include health reimbursement arrangements (HRAs) and level-funded arrangements. This fee applies to policy or plan years ending on or after October 1, 2012, and before October 1, 2029. Self-insured plan sponsors can satisfy their compliance obligations by completing and filling FORM 720, with its accompanying 720-v payment voucher. Although… Read More

Discover key insights from the recent Medicare Advantage hearing!

August 1, 2025Loramei Romeo

Medicare advantage (MA) has experienced a fast growth in the last few years, which has created a significant opportunity for Congress to upgrade the program to better serve beneficiaries, especially in rural areas. With over half of Medicare beneficiaries now enrolled in MA plans, these individuals enjoy lower healthcare costs, access to supplemental benefits, and improved health outcomes compared to traditional fee-for-service Medicare. Recent hearings have focused on strategies to enhance these benefits while ensuring program integrity and fiscal responsibility. Strengthening Medicare Advantage will not only improve health outcomes for seniors but also provide value for American taxpayers. Therefore, it is crucial to conduct a thorough examination of the program.… Read More

Cigna Healthcare Medicare has officially rebranded to HealthSpring.

July 23, 2025Loramei Romeo

In March 2025, the Cigna Healthcare Medicare business was acquired by Health Care Service Corporation. As Cigna Healthcare Medicare navigates this change, their focus remains on providing continuity and trust in the Medicare options you rely on. They are dedicated to renewing their brand while ensuring the same exceptional products and benefits you have come to expect. The HealthSpring brand is a well-respected name, that reflects Cigna’s commitments to providing quality benefits. With nearly a century of experience, HealthSpring signifies Cigna’s Healthcare Medicare mission to empower members to lead vibrant and healthy lives. By integrating with reputable brands, Cigna Healthcare Medicare ensures that their members receive the best support in… Read More

Stay informed on health legislation like PA Act 1 & HRSA cancer screening coverage!

July 21, 2025July 23, 2025Loramei Romeo

The recent PA state legislation, Act 1, marks a significant advancement in women’s healthcare by mandating health plans to cover supplemental diagnostic radiology services and genetic screenings for those at increased risk of breast cancer and BRCA mutations. This legislation is designed to eliminate out-of-pocket costs for these essential health services, ensuring that women who need these screenings can access them without financial barriers. In response to recent legislative changes, Independence Blue Cross has updated its coverage policies to eliminate cost-sharing for annual supplemental breast cancer screenings and genetic testing for those at increased risk. This change is vital in improving access to preventive care for individuals concerned about breast… Read More

Exiting news! Prior authorization reforms are set to simplify health insurance.

June 27, 2025June 26, 2025Loramei Romeo

On June 23, 2025, health insurance plans revealed significant commitments aimed at simplifying and streamlining prior authorizations for better care access. These initiatives are built on existing efforts to enhance patient connections to necessary care while reducing the administrative burden on healthcare providers. Such changes promise to improve overall patient experience and access to evidence-based treatments, aligning with the industry’s goal of delivering affordable healthcare. In line with state and federal regulations, new commitments across insurance segments aim to enhance health coverage for 257 million Americans. The six key commitments focus on : These steps are crucial for improving the overall health insurance landscape and fostering better patient experiences. We… Read More

The 2025 PCORI Fee is on the horizon!

June 10, 2025July 21, 2025Loramei Romeo

The recent reauthorization of PCORI 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

Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

June 6, 2025June 4, 2025Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… 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.

How will Aetna’s departure affect ACA exchanges?

May 19, 2025Loramei Romeo

Aetna’s decision to withdraw from the Affordable Care Act (ACA) marketplaces in 17 states by the end of 2025 raises questions about the stability and future of these exchanges. While it’s uncertain if other carriers will follow Aetna’s lead, the history of the ACA marketplace has been marked by a dynamic pattern of exits and entries. We understand that navigating the ever-changing regulations and economic challenges can be daunting for consumers seeking health insurance. The future of health insurance exchanges is uncertain, which is why it’s crucial to emphasize policy stability and market adaptability. The ACA exchanges play a vital role in providing access to health insurance, but they do… 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

Price Transparency Rules Addressed in New Executive Order

April 14, 2025April 3, 2025Loramei Romeo

On February 25, 2025, Executive Order 14221 was signed, enhancing health care price transparency rules. This order builds on previous regulations by requiring actual prices for health care services, standardizing pricing data reporting, and strengthening enforcement policies. Employers with fully insured plans must ensure their carriers comply, while those with self-funded plans should contract with third-party administrators to meet disclosure requirements. The new guidance is expected by May 26, 2025, and employers should prepare to update service agreements accordingly. Have Questions? and want to read more about the changes click New Executive Order Addresses Price Transparency Rules for more details. We are dedicated to providing exceptional service, so please do… Read More

South Jersey Radiology is in the Clover Network

April 11, 2025April 11, 2025Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025. New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

Benefits 101 Comparison HSAs HRAs FSAs

April 4, 2025April 3, 2025Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. 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.

Enhancing the security of member portal registrations

March 28, 2025March 25, 2025Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

Compliance Checklist for Calendar Year 2025

March 26, 2025March 25, 2025Loramei Romeo

The calendar year 2025 has released its deadline for small groups (less than 50), some deadlines may change depending on the plan start date that is not January 1st. The calendar shows the Section 6055/6056 filing deadline to the dates with Medicare part d notice. Have Questions? and want to read more about the changes click Calendar Year Compliance Checklist for more details. 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.

Recent Lawsuits Face Scrutiny for Tobacco Surcharges

March 21, 2025March 20, 2025Loramei Romeo

Recently, there has been an increase in class action lawsuits targeting large group health plan sponsors. These lawsuits claim that the extra insurance premiums charged to tobacco users, known as “tobacco surcharges,” through wellness programs violate HIPAA nondiscrimination rules. This litigation serves as a reminder for employers to thoroughly review their plan designs to ensure compliance with these regulations. Below is a summary of the plaintiffs’ arguments and some key considerations for employers when implementing tobacco-related incentives. Have Questions? and want to read more about the changes click Tobacco Surcharges Face Growing Scrutiny in Recent Lawsuits for more details. We are dedicated to providing exceptional service, so please do not hesitate… 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

Message for our valued partners from IBX

March 4, 2025March 4, 2025Loramei Romeo

IBX, mission is to improve the health and well-being of those we serve. We are committed to innovation to reduce costs, provide equitable, holistic health care, and simplify the user experience for everyone we have the privilege to serve. To achieve these objectives, we embarked on an ambitious plan two years ago to transition our business to a more modern, flexible platform. This plan aims to streamline processes, enhance accuracy, and improve plan configurability, resulting in a more modern, personalized, and enhanced user experience. We appreciate your support and partnership in this ambitious endeavor. We acknowledge that some of these changes have presented challenges, and your understanding and support have… Read More

Kroger pharmacy is back in MA and PDP network

February 28, 2025February 28, 2025Loramei Romeo

Kroger and affiliated pharmacies have rejoined Medicare Advantage (MA) and Prescription Drug Plan (PDP) network which are effective on February 5, 2025. Kroger is included in the network for all our PDP plans, such as Saver Rx, Extra Rx, and Assurance Rx. Starting February 5, 2025, all claims from Kroger pharmacies will be processed as in-network. Claims made before this date will not be reimbursed. Below is a list of Kroger and its affiliated pharmacies that are now in our MA and PDP network. Bakers Pharmacy Dillon Pharmacy Gene Maddy Kroger Owen’s Pharmacy QFC Pharmacy City Market Fred Meyer Pharmacy Gerbes Pharmacy Mariano’s Pharmacy Payless Pharmacy Ralphs Pharmacy Copps Food… 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

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