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
Continue ReadingDoes 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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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
Continue ReadingWhat 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
Continue ReadingReview 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!
Continue ReadingWhat 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
Continue ReadingHow To Find a Doctor You Trust
How to Find a Doctor You Trust Get a list of in-network providers: Call your insurance company or look at their plan materials for a list of doctors in their network. You’ll usually pay less to see a doctor in your network than a doctor who’s out-of-network. You can also call your Broker and they can help assist you in getting the names of Doctors near you that accept your plan. Do your research: Ask friends and family if they recommend their doctors. You may even be able to read online reviews for doctors in your area. Online reviews are a great way to gauge things such as bedside manner and wait… Read More
Continue Reading“I’m paying for Health Insurance I don’t even use!”
You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick! You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More
Continue ReadingWays to Save Money on Your Prescription Drugs
Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More
Continue ReadingHouse Passes Legislation to Change HSAs
The House of Representatives passed two pieces of legislation that, among other things, purport to improve and “modernize” health savings accounts (“HSAs”). While the bills call for significant changes to the current rules affecting HSAs, the specific details are very different. Both pieces of legislation have been sent to the Senate for consideration. Whether the Senate will take up these bills, let alone approve them “as is,” remains uncertain. There appears to be some bi-partisan agreement to loosen the current HSA rules, which means it is possible that we may see changes to these arrangements, which could be effective as early as January 1, 2019. When more information is available, we will… Read More
Continue ReadingIntroducing Xpress Healthcare with Aetna Dental Access!
Total Benefit Solutions offers Xpress Healthcare with a great dental discount & more for Individuals, Families and Seniors! Click Here to shop, compare & enroll!
Continue ReadingVideo: New Individual Dental & Vision Choices
Click here to shop, compare and enroll!
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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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Now Available: Empower Me Benefits Private Exchange
Total Benefit Solutions has partnered with Empower Me Benefits to provide our clients with best in industry benefits technology that‘s customizable for even the smallest employer. The EmpowerMe Benefits Exchange allows you to remain complaint with the Affordable Care Act (ACA), easily manage benefits, and control health care costs with a single solution. The EmpowerMeBenefits Exchange is an online benefit marketplace and benefits administration platform designed specifically to meet the needs of small and mid-sized companies. The Exchange provides employers with an enrollment and administration platform that aids employers in ACA compliance. This web-based solution allows you to offer any medical coverage next to pre-selected ancillary, voluntary, and TPA products.… 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 ReadingTotal Benefit Solutions New Individual Dental & Vision Choices
As always at Total Benefit Solutions Inc, we are looking for ways to help our clients get the coverages they need. With our new dental and vision enrollment portal we can now offer individual dental and vision plans from top notch insurers like Delta Dental and Davis Vision. Easy to quote and easy to enroll! Try it today and see for yourself by clicking here
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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2014 Compliance Bulletin Compilation
Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year! Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.
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Total Benefit Solutions Introduces New Individual Health Plan Private Exchange
Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!
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Health Reform: Healthcare.Gov Sneak Preview
Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121
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Total Benefit Solutions is your Marketplace Navigator
What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
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Dental Plans: United Concordia Will Now Offer one of the Country’s Largest Networks
United Concordia Will Now Offer one of the Country’s Largest Dental Networks United Concordia, Dental Network of America®, LLC and DenteMax®, LLC have entered into a network sharing agreement to provide greater access and deeper discounts to our members and clients. This agreement will take effect for United Concordia for 2015 business. Click here to read more…
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