Amerihealth | Total Benefit Solutions Inc

2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

September 22, 2021September 21, 2021Ed MacConnell

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

AmeriHealth New Jersey prepares to comply with new Transparency requirements

August 19, 2021August 19, 2021Ed MacConnell

From Amerihealth NJ: Health care and health insurance are among the most regulated industries in the U.S., making compliance a crucial requirement for success. AmeriHealth New Jersey has a strong track record of compliance to local, state, and federal guidelines, and we are working to comply with the new Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) requirements. We have been focused on transparency for our members for years, and we are now further sharpening our efforts related to transparency and accountability pertaining to the recent legislation for which we have developed an enterprise-wide implementation program to ensure requirements are met. We have a cross-functional team that is… Read More

Amerihealth New Jersey: Using the E-Bill feature VIDEO

July 10, 2021July 9, 2021Ed MacConnell

Watch this short video to learn how to pay for your Amerhealth NJ health insurance online quickly and securely! Click here

Group Business: Independence Blue Cross and AmeriHealth NJ COBRA and Mini-COBRA Premium Assistance

July 9, 2021July 9, 2021Ed MacConnell

COBRA Premium Assistance Available to Eligible Group Members Through September 2021 Under the recently passed American Rescue Plan Act of 2021 (ARPA), eligible group members who elect COBRA (including state‑based “Mini‑COBRA”) continuation coverage due to an involuntary job loss or a reduction in hours within the past year may be eligible for 100 percent coverage of their monthly health insurance premiums. This temporary premium assistance will be provided at no cost to the employer or to the group member through September 30, 2021. Employers should consult the U.S. Department of Labor and IRS websites for more information. Obtaining Mini-COBRA Premium Assistance For groups subject to state continuation plans (referred to as Mini‑COBRA typically for those with 19 or fewer… Read More

2021 Second Quarter Compliance Bulletins Compilation

July 7, 2021July 7, 2021Ed MacConnell

This document is a valuable resource, putting all of the latest health care reform news and updates in one location!

Tax Advantaged Benefit Documents

June 18, 2021June 18, 2021Ed MacConnell

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

What is Blue Card PPO?

June 11, 2021June 18, 2021Ed MacConnell

Many clients ask us about Blue Card PPO and how it works. Blue Card PPO is typically attached to our clients policies who are enrolled on an IBC Personal Choice PPO or National Network PPO or a Horizon Blue Cross plan with National Access. You can tell if you have this on your plan if your card has the PPO Traveling Briefcase ppo logo. It’s important to note that members who have a Keystone HMO, Amerihealth or Horizon HMO or local EPO do NOT have Blue Card PPO. How Does the BlueCard Program Work? BlueCard® PPO Medical Plan The BlueCard Preferred Provider Organization (PPO) medical plan gives you the freedom to… Read More

CMS Announces Medicare Plan Finder Improvements

June 8, 2021June 10, 2021Ed MacConnell

Source: medicare.gov This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to improve and update the Medicare Plan Finder (MPF) and the Health Plan Management System (HPMS). HPMS is the system that Medicare Advantage and Part D plans use to provide data about their plan offerings to Medicare, and the MPF is the online tool that allows beneficiaries to evaluate, compare, and enroll in those plans. The changes will be in place for the start of the Medicare Open Enrollment Period starting on October 15 for 2022 plans. Many of the forthcoming MPF changes reflect suggestions that Medicare Rights and other advocates have made over the years to increase the tool’s… Read More

Family Dental & Vision Plans

June 3, 2021June 3, 2021Ed MacConnell

We have a number of stand-alone dental and vision plans from Davis Vision, VSP and Delta Dental. You can review, compare and enroll on plans in minutes! https://brokers.dentalforeveryone.com/?id=B3F52EA5-F0E3-40B4-B1DB-0F060AE09478

What is Modified Adjusted Gross Income (MAGI)?

June 3, 2021June 3, 2021Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return.

What is a Qualified High Deductible Health Plan?

May 25, 2021May 25, 2021Ed MacConnell

Qualified HDHPs Enrollment in a qualified HDHP is a requirement for establishing and maintaining a health savings account. The chassis for a qualified HDHP is the same as described in Chapter 1, but it must also conform to certain federal guidelines: A qualified HDHP must specify both a minimum annual deductible and a maximum annual out-of-pocket (OOP) expense limit, as set every year by the IRS. The minimum annual deductible is just that—the minimum amount that the insured must pay before the plan pays any benefit. The maximum annual OOP expense limit is the cap on the sum of the annual deductible and all out-of-pocket expenses the insured must pay for covered expenses under the… Read More

What Is a Health Savings Account?

May 21, 2021May 21, 2021Ed MacConnell

A health savings account is a special purpose financial account that allows a consumer to save and pay for medical expenses on a tax-favored basis. Funds deposited into an HSA are not taxed; the funds in the account grow tax free; and the money accumulated in the account can be withdrawn tax free to pay for qualifying medical expenses. In effect, an HSA owner uses the account in a manner similar to a checking account to cover his or her (or his or her family’s) medical expenses. There are no income restrictions or requirements on who may or may not open and contribute to an HSA. The HSA—the account and its funds—belongs… Read More

women friends in masks standing in subway passage

Aetna Small Group (2-100) Insured & Small Group Aetna Funding Advantage FAQ
Health Plan options for business owners during COVID-19 pandemic

May 20, 2021May 21, 2021Ed MacConnell

Aetna is mindful of the many challenges our small business customers and their employees are facing as a result of the COVID-19 pandemic. Many are experiencing slower sales, reductions in hours, layoffs and more. The attached Frequently Asked Questions (FAQ) includes our current responses to questions we know are top of mind for many of Small Group Insured and Small Group Aetna Funding Advantage Self-Insured customers. These responses will remain in effect until June 30, 2021 unless otherwise specified. We will continue to evaluate and update our responses as the situation evolves. Downlaod FAQ: Commercial Small Group COVID-19 FAQ

5 reasons you may want to switch Medigap policies

May 7, 2021May 7, 2021Ed MacConnell

Switching Medigap policies 5 reasons you may want to switch Medigap policies You’re paying for benefits you don’t need. You need more benefits. You want to change your insurance company. You want a policy that costs less. Can I switch policies? In most cases, you will not have a right under federal law to switch Medigap policies, unless one of these applies: You’re eligible under a specific circumstance or guaranteed issue rights You’re within your 6-month Medigap open enrollment period You don’t have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy. Note As of January 1, 2020,… Read More

Update on COVID-19 Vaccine and Vaccine Administration Cost

April 23, 2021April 23, 2021Ed MacConnell

Update on COVID-19 Vaccine and Vaccine Administration Cost Medicare has increased and simplified its payment rate for administration of the COVID-19 vaccine to $40 per dose. This change may impact group health plans with respect to their payment rate to providers. Non-grandfathered group health plans are required to cover, without cost sharing, the COVID-19 vaccine. This obligation extended to coverage associated with administering the vaccine. The federal government continues to pay for the vaccine itself through funding authorized by the CARES Act.For vaccines administered in-network, plans will pay the rate negotiated with in-network providers, and that continues to be true. For vaccines administered out-of-network, however, group health plans must reimburse… Read More

COVID-19 PPE Now a Qualified Medical Expense

April 13, 2021April 13, 2021Ed MacConnell

On March 26, 2021, the IRS issued IRS Announcement 2021-7, which clarifies that amounts paid for certain personal protective equipment (“COVID-19 PPE”) used to prevent the spread of COVID-19, including masks, hand sanitizer and sanitizing wipes can be treated as amounts paid for medical care under § 213(d) of the Internal Revenue Code. Accordingly, because these amounts are expenses for medical care under § 213(d) of the Internal Revenue Code, these amounts can also be eligible expenses under a health flexible spending account (health FSA), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and Archer medical savings accounts (Archer MSAs). Note, that if the amount is paid or reimbursed under… Read More

Heard of Reference Based Pricing Health Insurance?

April 12, 2021April 13, 2021Ed MacConnell

Reference-based pricing is a payment system that replaces or enhances a health plan’s traditional “usual and customary” pricing for contracted claims. Rather than calculating the average charge of providers in a geographic area or a pre-contracted cost, a health plan utilizing reference-based pricing instead arbitrates its allowable amount for medical claims based on its chosen method (most commonly Medicare rates, or a certain percentage above those rates), which is a price that the payor deems reasonable. In other words the employer, the payor brings their rates with them into the health care agreement, not the other way around. This represents a much more independent framework for determining sensible health care… Read More

How Does Level Self Funded Health Insurance Work?

April 7, 2021April 7, 2021Ed MacConnell

We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding your group’s health insurance might be a good for for your health plan! Contact your Total Benefit Solutions Account manager at (215)355-2121.

Does Medicare Cover Oral Surgery?

April 5, 2021April 2, 2021Ed MacConnell

From our partners at HealthLine: If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs. While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage. Let’s explore which types of oral surgery Medicare covers and why. Click here for the full story. Questions about this story or Medicare coverages? Please contact your health insurance specialists at Total Benefit Benefit Solutions, Inc (215)355-2121

Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

April 3, 2021April 2, 2021Ed MacConnell

there are millions of uninsured people who could be getting subsidized coverage on the ACA Marketplaces, but have not taken advantage of this financial help. In many cases, it may be that the financial help available to them is not sufficient to make the premium or the deductible affordable

ARPA Extends Open Enrollment for Individual Coverage in PA

April 1, 2021April 1, 2021Ed MacConnell

Pennie (PA Individual Exchange) has communicated that they will be extending the open enrollment period from May 15 until August 15, 2021. This extension is to help consumers be able to take advantage of the benefits of the American Rescue Plan. Some of the key benefits of this plan are below: There is no longer a cap on who is eligible for Pennie’s income-based tax credits, which help reduce monthly premium costs. Previously only people whose household income was under 400% of federal poverty level (about $51,000 for an individual), could qualify for a tax credit. Now, anyone may be eligible for a tax credit. The size of the tax… Read More

Enrollment Period at Get Covered New Jersey Extended

March 31, 2021March 31, 2021Ed MacConnell

More information on the American Rescue Plan Act changes may be found on the Get Covered New Jersey website. Contact your Total Benefit Solutions, Inc health insurance specialist to get enrolled or if you have any questions or concerns at (215)355-2121

What is Minimum Essential Coverage or MEC health insurance?

March 30, 2021March 31, 2021Ed MacConnell

The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More

Health Insurance: What Do You Pay for?

March 23, 2021March 26, 2021Ed MacConnell

What Is a Monthly Premium? Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year. For individual ACA compliant plans, premiums are based on a pre-approved age based grid. When you enter a age on the grid, your premium will increase on your bill. What Are Out-of-Pocket Costs? Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a… Read More

Category: Amerihealth