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
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Medicare Exclusions-Who Pays First?
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
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Total Benefit Solutions Joins Medicareful
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
Continue ReadingIRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA
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
Continue ReadingAetna and Coventry System Issues
January 4, 2016-From Aetna: We’re working to resolve system issues affecting member status for 2016. First payment deadline extended to 1/31/16 We are working to correct data issues that are causing some members to be incorrectly listed as inactive for 2016. While we work to correct the issues, we have extended the first payment deadline for members with a valid application, enrollment, or renewal with us until January 31, 2016.
Continue ReadingMedicare Premiums and Deductibles Updated for 2016!
As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90. Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first… Read More
Continue ReadingEBN: Small Employers look to Alternative Funding Solutions
In the wake of the health care reform, alternative funding solutions for health benefits continue to gain traction among small to mid-size groups. Pending changes to small group rules in January 2016 are driving demand for the funding solutions. Most prominently, groups with 50-100 employees will be subject to community rating legislation that governs how rates are developed and the type of coverage offered. Most states are also changing the definition of employee to the federal full-time employee definition, broadening the scope to include union employees that may have been excluded under previous small employer definitions. Here’s how the new rules will affect small to midsize groups, including potential financial impact, solutions available to mitigate… Read More
Continue ReadingVideo: Independence Blue Cross Medicare Plans
Enjoy the latest TV Commercial from Independence Blue Cross about their Medicare supplement plans. Remember, Independence Blue Cross is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if IBC has a plan that’s a good fit for you.
Continue ReadingIBC: 2015 SHOP Updates
For 2015, the Small business Health Options Program (SHOP) platform manages more processes and information. As a result, the involvement of insurance carriers has been reduced. Understanding how it will work this year will help you work with employers to decide if they should purchase coverage through SHOP or directly from Independence Blue Cross (Independence). Like last year, groups may still only offer one plan option to all employees. However, the application and setup processes are now managed entirely through SHOP instead of by insurance carriers. This means certain Independence benefits are no longer available. Independence will continue to provide member identification cards, process member claims, and provide member services to answer questions. Click the link below to download… Read More
Continue ReadingTake Advantage of Medicare’s Free Preventive Services
Many seniors are unaware that preventive tests, screenings and counseling sessions are now available for free, with no copays or deductibles, thanks to the Affordable Care Act. More than 60 million people took advantage of these services, at no cost to themselves, during the first three years after the services became free in 2011, according to government reports. Click the link below to download a list from Medicare for Dummies of Medicare preventative services. Medicares-preventive-services-chart13 Questions about Medicare eligibility, open enrollment, supplements, health plans or PDP drug cards? Total Benefit Solutions, Inc. has a dedicated team of Medicare health plan professionals who are trained, annually re-certified, licensed and… Read More
Continue ReadingHealth Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax
Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More
Continue ReadingIBC Updated List of Proactive Hospitals
Download the document to get the latest list of Keystone Proactive hospitals and their tier assignment. The document also has a link to the most up to date IBC list online. Download the 2015 Keystone Proactive Hospital List
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CMS has uploaded a new video Medicare & You: Cervical cancer
Get information about how Medicare can help you detect cervical and vaginal cancer.
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingAetna & Coventry Formulary Changes
Changes to your drug lists – starting July 1, 2015 Regularly, Aetna Pharmacy and Coventry Prescription Management Services, Inc. update drug lists based on the latest medical findings, information from the Food and Drug Administration (FDA), drug makers and cost arrangements, which include manufacturer rebates. Members are being notified They sending letters to clients about drug list changes for 2015. Click to read the 2015 Aetna Drug Changes Letter or 2015 Coventry Drug List Changes Letter. Impacted members with Aetna or Coventry pharmacy benefits will also receive a notification. Understanding the preferred drugs benefit They call drugs “preferred” because the members’ copay may be lower than the copay for non-preferred drugs. Members typically pay lower… Read More
Continue ReadingAssurant To Leave Health Insurance Market
We want to share a recent announcement made by Assurant Health’s parent company, Assurant, Inc. Following a strategic review of its portfolio of businesses, Assurant has decided to focus on housing and lifestyle specialty protection products and services. See the links below for further information: assurant memo AIZ-NewsRelease-FINAL As alwas contact your Total Benefit Solutions Inc account manager at (215)355-2121 if you have any questions or concerns
Continue ReadingUHC: Introducing Plans with Rate Caps and Wellness Rewards
United Healthcare: Introducing All Savers Plans. Would your small group be interested in a medical plan with a rate increase cap in year two? Does a plan with a free “fitbit” type device sound like a great way to integrate wellness into your health benefits? What if I told you that your employees could earn money back towards their deductibles by meeting small, simple daily wellness goals? Finally, an insurance carrier has introduced a plan for your health conscious group that gives you a direct advantage in the rates because you are working towards better overall health! United Healthcare has introduced the All Savers level funding plans with Motion Credit.… Read More
Continue ReadingIBC: Formulary Changes and Updates April 2015
Independence Blue Cross has announced a significant update to their drug formulary. There are also many medications now requiring preauthorizations. Please download the attached formulary update or more information and the pre-authorization form if you need it to fill your medications. IBC Formulary Changes effective 4-1-15 Future Scripts Brand to generic : The form for preauthorization for brand names with generic equivalents. As always, please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121 for more information.
Continue ReadingIf an employee turns age 65 this month and enrolls in Medicare Part A, can he still receive/contribute funds into an HSA?
Question: If an employee turns age 65 this month and enrolls in Medicare Part A, can he still receive/contribute funds into an HSA until the end of the year or must he enroll in a different plan now? Answer: If an employee is enrolled in Medicare, then beginning with the first month the employee is enrolled in Medicare, he can no longer contribute to the health savings account (HSA). However, the money that is already there is still his. Note that whether or not the employee is eligible to make new HSA contributions, existing HSA account funds are not affected. Even if the employee is no longer HSA-eligible, he or… Read More
Continue ReadingGroup Health Plan Notices 2015 CALENDAR
Group Health Plan Notices 2015 CALENDAR From our partners at HR360: This calendar/checklist is designed to help companies review the key reporting and notice requirements that may apply to their employer-sponsored group health plans under ERISA , the Affordable cxare Act, Medicare and more. Please note that this list is for general reference purposes only and is not all-inclusive. Note: ERISA and benefit requirements are complex, and your plan’s responsibilities may vary depending on the individual circumstances surrounding your company’s plan. Employers who have questions are encouraged to consult with their plan administrators, the U.S. Department of Labor’s Employee Benefits Security Administration, the Internal Revenue Service, or a knowledgeable employment law attorney… Read More
Continue ReadingRelief for Small Employers Reimbursing Individual Policies
An employer cannot offer employees cash to reimburse the purchase of an individual policy, whether or not the employer treats the money as pre-tax or post-tax to the employee. Such arrangements (called “employer payment plans”) are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. These arrangements may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). Click the link below to read the bulletin: Relief for Small Employers Reimbursing Individual Policies – 031915R
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IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015
IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015 IRS Notice 2015-17 provides limited transition relief from the assessment of excise taxes for small employers who reimburse, or directly pay, the premium for an employee’s individual health insurance policy. Prohibited Plans An “employer payment plan” is an arrangement under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy, or an arrangement under which the employer uses its funds to directly pay the premium for an individual health insurance policy covering the employee. Pursuant to prior agency guidance, employer payment plans are… Read More
Continue ReadingHow do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?
Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross have a unique ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More
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