Communications from providers about temporary ID cards

Loramei 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

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December and January renewals deadlines

Loramei 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

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

Mirasol 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

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Cybersecurity Guidance Regarding Health and Welfare Benefits

Mirasol 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

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Final 2024 ACA Reporting Instructions and Forms Issued

Mirasol 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

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Tower Health is back!

Mirasol 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.

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Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

Mirasol 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

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Disaster Special Election Periods in several states

Mirasol 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

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You can access your PCORI membership report on uhceservices.com

Mirasol 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

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IRS Addresses Tax Treatment Of Work-Life Referral Services

Mirasol 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

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UnitedHealthcare – RxDC Information Required by Deadline

Mirasol 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

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