Final Rules Adopt Administrative Changes to the No Surprises Act

On August 26, 2022, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) published final rules on the No Surprises Act, making changes to the administrative duties of insurance carriers, HMOs, third-party administrators, out-of-network healthcare providers, and certain other entities responsible for the Act’s implementation. The new rules, which take effect on October 25, 2022, are narrow in scope, and include the following changes:• During processing of claims under the No Surprises Act, if “down-coding” occurs (i.e., the group medical plan alters or replaces the medical billing codes chosen by the out-of-network healthcare provider, resulting in a lower claim payment), then the final rules impose… Read More

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Understanding the Coding of Health Plans from MEC to Metallic

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

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Aetna: Understanding the Evolution of Primary Care and What it Means for your Workforce

The evolutions of primary care has a great impact on employers and their workforce. As primary care looks to meet current consumer trends, employers and payers must think creatively to support their employees. Virtual, advanced, and multi-disciplinary sites are just the start. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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What is a 5-Star Medicare Plan?

Did you know that Medicare plans come with a handy rating system and that the highest-rated of these plans have a Special Enrollment Period associated with them? Get ready to learn all about 5-star Medicare plans and what makes them special! Click here for more information! As always contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any additional questions or concerns!

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Alternatives to Health Insurance Benefits

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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 Modified Adjusted Gross Income (MAGI)?

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What is a Qualified High Deductible Health Plan?

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UCR vs MAC Dental plans. What’s the difference?

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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

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