Financial Planning and Wellness – Page 4 – Total Benefit Solutions Inc

Required Attestation regarding the Gag Clause by December 31, 2024

November 14, 2024November 14, 2024Loramei Romeo

By December 31st of each year, insurance companies and plans sponsor of group health plans are required to provide the Centers for Medicare and Medicaid Services (CMS) with information certifying that their plan or policies do not include illegal gag provisions. The due date for the subsequent attestation is December 31, 2024. Clients are receiving notifications from carriers and TPAs regarding their plan to adhere to the Gag Clause Prohibition Compliance Attestation. Once more, it appears that the different carriers/TPAs will not handle the attestation requirements the same way. For fully insured plans both the plan and carrier must file attestation if the group health plan is fully insured; however,… Read More

Communications from providers about temporary ID cards

November 13, 2024November 13, 2024Loramei Romeo

Temporary member ID cards were mailed to members from large group with fully insured clients the transition of enhanced operation began in July. The cards contain the new member’s ID number. Our provider communications team has sent out messages to our contracted providers to let them know that these cards should be accepted. Which also includes instructions on how to process bills and how to confirm member’s eligibility when: In order to reinforce this message and give them more guidance, we redistribute this content the week of October 28 after it had previously been disseminated through our regular communication channels. Have Questions? and want to read more about the changes? Provider… Read More

December and January renewals deadlines

November 11, 2024November 11, 2024Loramei Romeo

Clients renewing in December, November 12 is the deadline to complete the enrollments, after this the enrollment will still be accepted but there will be delays with the member ID cards. Which includes small and large groups whether they are fully insured, self-funded clients, with both active and passive renewals. When enrolling later than November 12 after receiving completed enrollment the ID cards will be mailed after ten business days. To access new member ID number online it will take six business days after receiving complete enrollment. Clients renewing in January, Because of the anticipated volume of enrollment changes and new enrollments which adds additional processing time the deadline is… Read More

Small Employer Open Enrollment Period November 15 through December 15

October 24, 2024October 24, 2024Ed MacConnell

While this has been in place for a number of years, we would like to remind you about the Small Employer Open Enrollment Period for fully insured health plans in all states. The Small Employer Open Enrollment Period is the period from November 15 through December 15 each year. During this period, employers that meet the definition of small employer but do not meet the carrier’s participation or contribution requirement will be accepted for a small employer plan with a January 1 effective date. Additionally, select carriers in New York may allow for a December effective date if applicable. Carriers require that employer groups enrolling under the Small Employer Open Enrollment Period submit completed applications… Read More

Adjustments for Annual Out-of-Pocket Maximum Announced for 2026

October 24, 2024October 24, 2024Mirasol Bandong

Payment parameters were published by The Department of Health Services (HHS) for the Annual Notice of Benefit and Payment Parameters for 2026. The guidelines specify the yearly out-of-pocket limits (deductibles, co-payments, and other amounts, but not premiums) for non-grandfathered group medical plans for plan years starting in 2026 for employer-sponsored health plans. The Department also published the proposed Annual Notice of Benefit and Payment Parameters rule for 2026. HHS indicates, besides Departments of Labor and the Treasury, future rulemaking to address the applicability of drug manufacturer support to the annual limitation on cost-sharing is expected, something that will impact employer-sponsored coverage. Group that are non-grandfathered medical plans, out-of-pocket limits should… Read More

Cybersecurity Guidance Regarding Health and Welfare Benefits

October 17, 2024October 17, 2024Mirasol Bandong

In Compliance Assistance Release No. 2024-01, the U.S. Department of Employee Benefits Security Administration (EBSA) affirmed that all ERISA covered health and welfare plans are subject to the cybersecurity guidance which was published in 2021. Regarding cybersecurity best practices on April 2021, EBSA issued a cybersecurity guidance for benefit plan fiduciaries and service providers. ERISA requires plan fiduciaries to take necessary safety measures to reduce cybersecurity risk, EBSA’s three types of guidance are directed at benefit plan sponsors, fiduciaries, record keepers, and participants. With the new guidelines EBSA clarifies that cybersecurity guidance applies to ERISA covered health and welfare plans. EBSA clarifies that ERISA plan sponsors and fiduciaries, as well… Read More

Final 2024 ACA Reporting Instructions and Forms Issued

October 14, 2024October 14, 2024Mirasol Bandong

Forms 1094-C, 1095-C, 1094-B, and 1095-B are among the final instructions and forms that the IRS has made available for calendar year 2024 ACA reporting. As a reminder, since good faith relief from penalties is no longer available, it is crucial to make sure the forms are accurate, timely, and submitted to the IRS. There are no significant changes to the 2024 forms Forms 1094-C/1095-C Applicable large employers (ALEs) must provide Form 1095 to full time employees and Form 1094-C and 1095-Cs will be filed with the IRS. Covered employees or other primary insured individuals in the self-funded health plan must also receive Forms 1095-C from ALEs that offer a… Read More

Departments Issue Final MHPAEA Regulations

October 11, 2024October 11, 2024Mirasol Bandong

The final rules for the Mental Health Parity and Addiction Equity of 2008 (MHPAEA) were released on September 9, 2024, by the Department of Health and Human Services, Labor, and the Treasury in order to guarantee that those seeking treatment for mental health (MH) or substance use disorder (SUD). MHPAEA provides nonquantitative treatment limitations (NQTLs) cannot be applied to MH/SUD unless they are equivalent and applied no more strictly for MH/SUD benefits than for medical/surgical benefits. The final rules amend the definitions of definition of “medical/surgical”, “mental health benefits”, and “substance use disorder benefits” by removing a reference to the state guidelines. The most recent edition of the Diagnostic and Statistical… Read More

Tower Health is back!

July 26, 2024July 23, 2024Mirasol Bandong

Tower Health is back in Cigna Medicare Advantage network in Pennsylvania! After productive negotiations with Tower Health in Pennsylvania, Cigna is happy to announce that they are back in their Medicare Advantage network effective June 1, 2024. This includes Phoenixville and Pottstown Hospital, all Primary Care Physicians (PCPs), specialists, ancillary providers, and other hospitals that were previously in-network. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Disaster Special Election Periods in several states

July 15, 2024July 12, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, California, Florida, Iowa, Kansas, Maryland, Minnesota, New Mexico, North Carolina, Oregon, Texas and West Virginia and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or on… Read More

Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

June 28, 2024June 28, 2024Mirasol Bandong

Please be advised that a state of emergency was extended for certain Florida counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This DST-SEP applies to the Florida counties listed below. Important Compliance Information Who is eligible: This SEP opportunity is ONLY available to beneficiaries who: Details : Impacted Counties: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Orange, Osceola, Pasco, Pinellas,… Read More

Disaster Special Election Periods in several states

June 24, 2024June 20, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, Arkansas, Colorado, Florida, Idaho, Mississippi, Nevada, Oklahoma and Texas and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or on the declaration date. The SEP… Read More

You can access your PCORI membership report on uhceservices.com

June 19, 2024June 18, 2024Mirasol Bandong

Under the Affordable Care Act (ACA), health insurers, and plan sponsors are responsible for paying the PCORI fee. The Patient-Centered Outcomes Research Institute (PCORI) fee also helps fund research that evaluates and compares health outcomes, clinical effectiveness, and the risks and benefits of medical treatments and services. Sponsors of self-funded (ASO) plans are required to submit Form 720 and pay the PCORI fee to the Internal Revenue Service (IRS) immediately. The payment must be made by July 31 of the year that follows the conclusion of the plan year. A PCORI Membership Report is given to UnitedHealthcare Level Funded groups whose plan year ends in 2023 to help with PCORI fee… Read More

IRS Addresses Tax Treatment Of Work-Life Referral Services

May 7, 2024May 6, 2024Mirasol Bandong

The Internal Revenue Service (“IRS”) clarified the tax treatment of several work-life referral (“WLR”) services offered by employers in a new Fact Sheet FAQ. According to the FAQ, the value of the WLR services may be deducted from employees’ salary as a de minimis fringe benefit in cases when they are included in employee assistance programs (“EAPs”) or are otherwise bundled with other services. WLR Programs WLR services are offered to qualified employees through the employer-funded WLR program. WLR services are informative and referral consultations that help staff members locate, engage, and bargain with life-management providers to find answers to personal, professional, or family problems. Generally speaking, unless a part… Read More

Health Care Cyberattack

March 26, 2024June 27, 2024Mirasol Bandong

Although it does not yet know when the recovery from the Change Healthcare hack last month will be completed, UnitedHealth is testing the system to restore it. This week, the care giant said that it is testing technology for processing medical claims. It already has mostly restored systems for handling drug claims and processing payments. The technology utilized to file and handle insurance claims is provided by Change Healthcare. It works with claims from many insurers and processes around 14 billion transactions annually. Some patients might be directed to different pharmacies where billing issues are less of a concern. Industry executives have stated that delays in patient bills are possible. Progress:… Read More

UnitedHealthcare – RxDC Information Required by Deadline

March 22, 2024March 21, 2024Mirasol Bandong

Please assist us in answering the required questions in the CAA Pharmacy Data Collection request information that is located in the employer/broker portal. It will make sure that UnitedHealthcare can successfully submit the data report. In order for us to prepare the data for submission to CMS by June 1, 2024, we must get the information by April 10, 2024, thus your prompt answer is extremely important. To read more click HERE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions… Read More

IRS News Release: Nutrition, Wellness, and General Health Expenses

March 19, 2024Mirasol Bandong

The Internal Revenue Service (IRS) is informing taxpayers that costs associated with wellness, diet, and overall health are unlikely to be covered by Internal Revenue Code section 213 reimbursement for medical expenses. The IRS published a press statement and a list of commonly asked questions the IRS: The IRS is worried that individuals might not be aware of the situations in which spending related to diet or wellness can qualify as medical costs. The IRS reminded people in a news release on March 6, 2024, that personal expenses cannot be reimbursed through FSAs, HSAs, or HRAs in a way that is tax-favored. Employers should be wary of vendors who advertise… Read More

Unlocking the Power of Life Insurance

September 9, 2023September 8, 2023Ed MacConnell

Did you know that September is Life Insurance Awareness Month? It’s the perfect time to take a closer look at your financial safety net or consider the needs you may have! Life is a journey filled with the unexpected. While we can’t control every twist and turn, we can certainly prepare for them. That’s where life insurance comes into play. It’s more than just a safety net; it’s a shield that safeguards your past, present, and future. Let’s explore the multifaceted benefits that a life insurance policy can bring into your life. 1. Protection for Your Loved Ones At the heart of life insurance lies the protection of your loved… Read More

Category: Financial Planning and Wellness

Required Attestation regarding the Gag Clause by December 31, 2024

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Communications from providers about temporary ID cards

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December and January renewals deadlines

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Small Employer Open Enrollment Period November 15 through December 15

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Adjustments for Annual Out-of-Pocket Maximum Announced for 2026

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Cybersecurity Guidance Regarding Health and Welfare Benefits

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Final 2024 ACA Reporting Instructions and Forms Issued

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Departments Issue Final MHPAEA Regulations

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Tower Health is back!

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Disaster Special Election Periods in several states

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Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

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Disaster Special Election Periods in several states

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You can access your PCORI membership report on uhceservices.com

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IRS Addresses Tax Treatment Of Work-Life Referral Services

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Health Care Cyberattack

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UnitedHealthcare – RxDC Information Required by Deadline

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IRS News Release: Nutrition, Wellness, and General Health Expenses

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Unlocking the Power of Life Insurance

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