health insurance choices

2021 Second Quarter Compliance Bulletins Compilation

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

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Alternatives to Health Insurance Benefits

 Sometimes clients offer other alternative benefits to their employees. The reasons for doing this are many but depending on the earnings of their workforce, offering a group medical plan will eliminate any health insurance subsidy. In those cases offering a group health insurance benefit can come off as a penalty for the employees. By offering alternative benefits our experts can help the employees enrolled on a subsidized health insurance plan and still get good if not great benefits from their employer!  ICHRA: with an ICHRA the employer can give the employees money towards their health insurance purchase.  The ICHRA allows the employer to do so with untaxed dollars and the… Read More

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What is Blue Card PPO?

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

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Top 10 Questions to Ask Your Benefits Broker

Analyzing these ten critical questions in relation to your organization’s needs will help you make a more informed decision about your benefits broker

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What is a Qualified High Deductible Health Plan?

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

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Get Dental and Vision Quotes Now!

Enjoy next-day coverage on most dental insurance plans. There are no enrollment fees with any plans. Preventive visits, such as exams and cleanings, are covered at 100% with network providers.

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5 reasons you may want to switch Medigap policies

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

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Update on COVID-19 Vaccine and Vaccine Administration Cost

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

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COVID-19 PPE Now a Qualified Medical Expense

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

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Heard of Reference Based Pricing Health Insurance?

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

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How Does Level Self Funded Health Insurance Work?

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.

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Does Medicare Cover Oral Surgery?

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  

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

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

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ARPA Extends Open Enrollment for Individual Coverage in PA

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

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Enrollment Period at Get Covered New Jersey Extended

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

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COBRA Subsidy in the works

          Photo by AllGo – An App For Plus Size People on Unsplash A COBRA subsidy is included in early drafts of the proposed fiscal year 2021 budget reconciliation package. If finalized, the COBRA subsidy would apply to workers who have lost group coverage during the COVID-19 pandemic due to involuntary termination or reduction in hours of employment. Download this bulletin below for more information and as always contact your Total Benefit Solutions, Inc health insurance specialist with any questions at (215)355-2121. Download COBRA Subsidy in the Works

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Are you an applicable large employer, or not? That’s the question!

Calculating Your FTE Count Are you an applicable large employer, or not? That’s the question! To answer this question you’ll need to add up your full-time employees plus the full-time equivalent of part-time employees. For some businesses, this may have been simple, but not for all. This is how you determine your FTE count. Full-Time Employees: Any employee who works an average of at least 30 hours per week in a given month. Or at least 130 hours of service in a given month. Full-Time Equivalent: The full-time equivalent of part-time employees is the number of hours worked by all your part-time employees in a given month divided by 120. For example: two employees… Read More

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What is a Direct Primary Care plan?

Photo by CDC on Unsplash What is Direct Primary Care (DPC)? DPC is a non-insurance healthcare model where a flat monthly fee is paid for a defined set of primary care services. Direct Primary Care membership typically includes timely and unlimited access to your physician via in-office visit or over the phone. The model is structured to emphasize the patient-physician relationship to lower care costs, promote better employee health, and better patient experience. Benefits include: Increased Access to Healthcare. Breaks down the barriers to healthcare like confusing narrow networks, high deductibles and limited enrollment period. Detect Diseases and Treat Sooner. Encourages the early detection of illnesses, which reduces expenses for both… Read More

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What is a minimum essential coverage (MEC) plan?

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

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Review us on Google

 At Total Benefit Solutions we strive to provide our clients with the best service and support when shopping, enrolling and servicing their health insurance all year long. We appreciate having the opportunity and as always “We Work for Your Benefit”.  If you have worked with us, please help us get some feedback by  reviewing us on Google.  You’ll need to be logged in to your Google account to do so. Click here to rate us!

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What is my Max Out of Pocket?

In health insurance, you may have heard of the “maximum out-of-pocket  or MOOP.” Here’s a quick overview of how it works, including which costs count towards it, and what happens after your maximum out-of-pocket (MOOP)  is met. Max Out of Pocket Presentation

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United Concordia Enrollment Forms 2017

    United Concordia small group enrollment forms for 2017   To enroll you on United Concordia they will require the following: The rate sheet with the benefit plan circled and the sheet signed at the bottom by the business manager or owner The completed employee applications for each employee enrolling. The form needs to be complete with each dependent’s name, date of birth, etc. A company check for the first month’s premium payable to United Concordia Companies Inc. or UCCI A completed employer application form. Complete what you can and we’ll finish the rest together. Download The New Group Enrollment Kit for 2017 You can fax everything to our… Read More

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