Insurance Carrier News – Page 11 – Total Benefit Solutions Inc

IBC: Plans to remove exclusions for gender reassignment surgery coverage

October 25, 2016October 25, 2016Ed MacConnell

In a July Independence Edge article, we shared that the U.S. Department of Health and Human Services (HHS) had issued a final rule for the nondiscrimination provision (section 1557) of the Affordable Care Act (ACA). While the nondiscrimination provision itself is not new, the final rule provides expanded clarity on coverage for gender reassignment surgery and related services. In addition, it provides guidance on treating individuals consistent with their gender identity, and not denying or limiting health services usually only available to individuals of one gender. Beginning with renewals on or after January 1, 2017, the exclusion for gender reassignment surgery has been removed from all commercial plans. Members… Read More

Individual and Family Open Enrollment-2017 Important Updates

October 25, 2016Ed MacConnell

As many people know by now there are many big changes with individual and family plans for open enrollment 2017. For anyone who is currently enrolled on one of the following your plan will NOT be renewed for 2017 and you will have to pick a new plan and/or a new insurer: Aetna: all plans cancelling in PA/NJ/NC/FL Aetna plans only remain in Delaware in our service area United Healthcare: All ACA plans cancelling. Short term plans are still available Oscar: All plans in NJ cancelling Health Republic: All plans in NJ cancelling Highmark and Capitol Blue Cross: No longer paying broker compensation Geisinger: No longer paying broker compensation Independence Blue… Read More

Total Benefit Solutions participating in CVS Retail Locations During Medicare Open Enrollment

October 9, 2016October 8, 2016Ed MacConnell

Total Benefit Solutions is pleased to announce that we are participating in the Independence Blue Cross Medicare/ CVS Pharmacy retail program for the upcoming open enrollment period. What this means to our clients is that we will be on site at our local CVS Pharmacy during the AEP. Starting on Saturday October 15th and continuing through open enrollment we will be on site nearly each Monday, Wednesday and Friday at the CVS Pharmacy in Feasterville from Noon to 2 PM each day. Please feel free to stop in without an appointment to get your questions answered and pick up your 2017 plan information from Independence Blue Cross. We will… Read More

ACA Individual 2017 Open Enrollment Important Update

October 8, 2016October 27, 2016Ed MacConnell

2017 ACA ” Obamacare” plans open enrollment important update. The annual open enrollment period opens on November 1st 2016 and ends January 31st 2017. Independence Blue Cross will be the only insurer available in 2017 in the Philadelphia 5 County Area. With the passing of the Affordable Care Act changes come annually or even more often. Unfortunately not all of those changes are benefiting the consumer. This year here are some major changes that our clients on Individual Non Medicare plans need to be aware of… If you are a enrolled on an ACA compliant plan with Aetna or United Healthcare your plan is going away. Neither Aetna or United… Read More

Reminder to Distribute Creditable Coverage Notice

September 18, 2016September 26, 2016Ed MacConnell

Employers who sponsor a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Download medicare-part-d-reminder-to-distribute-creditable-coverage-notice-

Health Republic Insurance of NJ Will Not Offer Coverage for 2017

September 15, 2016September 15, 2016Ed MacConnell

NJDOBI Announces Health Republic Insurance of NJ Will Not Offer Coverage for 2017 On September 12, 2016, the New Jersey Department of Banking and Insurance (NJDOBI) announced that Health Republic Insurance of New Jersey (HRINJ) has consented to be placed in rehabilitation due to its deteriorating financial condition. If approved by the court, the rehabilitation will enable the Department to preserve the assets of the carrier so that consumers continue to receive the care to which they are entitled and medical providers are paid. Under this rehabilitation plan, current policies will remain in force through December 31, 2016, but HRINJ will not offer coverage for 2017. The Department and… Read More

Oscar to Withdraw from NJ Market Effective Jan. 1, 2017

September 10, 2016Ed MacConnell

Oscar to Withdraw from NJ Market Effective Jan. 1, 2017 In a recent release, Oscar has announced that they have decided to withdraw their plans from the New Jersey market beginning on January 1, 2017. They have concluded that instability in the market will make it challenging for them to operate effectively and to continue to deliver quality healthcare to all their members across the country. Oscar would like to highlight a few key points in regards to this announcement: Oscar will continue to serve their other existing markets without change, including New York, Long Island, San Antonio, Los Angeles and Orange County. Oscar remains financially stable—they have raised… Read More

Aetna to pull out of most Obamacare exchanges

August 16, 2016Ed MacConnell

From cnn.com: The insurer will stop offering policies on the exchanges in 11 of the 15 states where it currently operates, according to a press release it issued Monday evening. Aetna (AET) will only sell Obamacare products in Delaware, Iowa, Nebraska and Virginia… Click here for the story on CNN

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

August 14, 2016August 10, 2016Ed MacConnell

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

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

July 30, 2016July 30, 2016Ed MacConnell

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

IBC: How to pay your health insurance bill

July 29, 2016July 29, 2016Ed MacConnell

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.

Critically Important: Insurance for Serious Illness

July 11, 2016July 8, 2016Ed MacConnell

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

Amerihealth NJ: No Longer Providing COBRA Administration

July 10, 2016July 7, 2016Ed MacConnell

AmeriHealth New Jersey has announced that they will no longer provide administrative services for the continuation of coverage under the Consolidated Omnibus Reconciliation Act (COBRA) and Retiree Billing services. AmeriHealth NJ will discontinue COBRA administration and Retiree Billing services in 2016 for customers on the following schedule: For customers renewing January 1 through July 31, COBRA administration services will end on December 31, 2016. For customers renewing August 1 through December 31, services will end on their 2016 renewal date. Approximately 30 days before COBRA administration services end, COBRA members will be notified that their COBRA plan is being transferred to another service provider, and their COBRA eligibility will continue uninterrupted. … Read More

IBC: Launch of identity theft protection services for group customers and their members

June 22, 2016June 20, 2016Ed MacConnell

Starting in June 2016, Independence Blue Cross is pleased to offer identity theft protection services to our commercial group customers for their employees with Independence coverage. Identity theft protection options Identity theft protection services will be provided by Experian® and include two options: ProtectMyIDTM is for adults. Eligible subscribers and their adult dependents can enroll individually. FamilySecureSM is for children under the age of 18. A parent or legal guardian can activate membership and enroll all children. Employers who choose to offer these new services to their employees simply opt in using the IBXpress employer website. If they choose not to offer these services, they do not need to take… Read More

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

June 20, 2016Ed MacConnell

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

UnitedHealthcare and Optum take action to support Orlando shooting tragedy

June 16, 2016Ed MacConnell

Those Grieving Over Orlando Can Get Free Mental Health Services Thanks To This Insurance Company: UnitedHealthcare and Optum, two health benefits companies of UnitedHealth Group, are offering free mental health services for anyone affected by the shooting in Orlando that killed 49 people over the weekend. The resources are available to anyone in the country, whether they are insured by the group or not. Optum will operate a 24/7 helpline, and users can speak to a trained mental health professional for as long as they need. click here for more information

Medicare and Employer Coverage

May 14, 2016May 13, 2016Ed MacConnell

From the Medicare Rights Center download this excellent Q&A about Medicare Coverage, the guidelines and how it may or may not integrate with employer coverage. Part-2-QA-Current-Employer-Insurance Have more questions about Medicare and your employer coverage? Call your Total Benefit Solutions, Inc account manager today at (215)355-2121. Learn more on Medicare Interactive.

8 things to know about Medigap policies

May 7, 2016Ed MacConnell

Medicare Supplements or Medigap Plans A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy… Read More

Reminder to Notify CMS

February 27, 2016February 26, 2016Ed MacConnell

Employers sponsoring a group health plan are required to report information on the creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). Download the bulletin below for details and specific links for employer reporting Download Medicare Part D – Reminder

IBC: What is Medicare Video

February 14, 2016November 9, 2021Ed MacConnell

A Simple video from Independence Blue Cross explaining Medicare. As always please contact Total Benefit Solutions, Inc if you have any questions or concerns about Medicare health insurance or supplements at (215)355-2121.

IBC: Distribution of 1095 Tax Forms

February 11, 2016February 11, 2016Ed MacConnell

Information about distribution of 1095 tax forms Beginning February 8, Independence Blue Cross will begin mailing IRS 1095-B tax forms on a rolling basis to subscribers who purchased plans individually off-exchange and to subscribers of fully insured group employers. The purpose of these forms is for individuals to verify that they had minimum essential health care coverage during the previous calendar year, as required by the Affordable Care Act. We are issuing 1095-B forms to subscribers only, unless we receive a request from a subscriber to issue a duplicate form to an enrolled spouse and/or dependent. What you need to know about 1095 forms It’s important to know that who… Read More

Medicare Exclusions-Who Pays First?

February 6, 2016February 6, 2016Ed MacConnell

Medicare primary payer rules are complicated. Especially when it comes to different employer sizes and special circumstances like End Stage Renal Disease and disabilities. Coverage issues can be significantly complex when mixing Medicare and employer coverage, or individual coverage for those who are early Medicare enrollees. Chances are, if you are already enrolled on Medicare, AND you are getting bills from providers, you are already experiencing these problems, or you are encountering a coordination of benefits issue. It’s always best to speak to a professional when encountering these problems, most especially a health insurance professional. If at all possible, before getting enrolled on Medicare. The documents below may help provide… Read More

Total Benefit Solutions Joins Medicareful

February 5, 2016March 1, 2016Ed MacConnell

How do I know which Medicare plans are right for me? Medicare Supplement, Medicare Advantage, Part D drug coverage — the options seem endless! Don’t worry, Medicareful is here to help. By entering your zip code, you’ll unlock all of the Medicare plans available in your area. You can navigate them on your own or leave it to our professionals who can guide you to a plan based on your needs. From experience, we know how complex Medicare is and that people who work with trusted independent licensed sales agents are far more confident in their choices. It’s our job to help you find your plan, and we’re happy to do… Read More

Aflac Workforce Survey and CDHP

February 4, 2016Ed MacConnell

IRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA

January 5, 2016Ed MacConnell

IRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA On December 28, the U.S. Treasury and Internal Revenue Service announced a limited extension of the early 2016 due dates for the 2015 information reporting requirements for employers and insurers under the ACA. This is the first year that employers and insurers are required to report certain information about health coverage to employees, other individuals to the IRS. Specifically, employers will have two additional months beyond the February 1 due date to provide individuals forms for reporting on offers of health coverage and the coverage provided. The deadlines to report this information to the IRS are extended by three… Read More

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