2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

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How is COBRA health insurance affected if I am disabled?

  In certain circumstances, if a disabled individual  and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months.  The criteria for this 11-month disability extension is a complex area of COBRA law.  We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at phig@cms.hhs.gov. In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee’s employment hours.  Second, the covered employee must be determined under title II or title XVI of the… Read More

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What Are Medicare Guaranteed Issue Rights?

Guaranteed Issue Rights (Also Called “Medigap Protections”)  are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a  Medicare Advantage Plan (Part C)  and still buy a Medigap policy if you change… Read More

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AmeriHealth New Jersey prepares to comply with new Transparency requirements

From Amerihealth NJ: Health care and health insurance are among the most regulated industries in the U.S., making compliance a crucial requirement for success. AmeriHealth New Jersey has a strong track record of compliance to local, state, and federal guidelines, and we are working to comply with the new Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) requirements. We have been focused on transparency for our members for years, and we are now further sharpening our efforts related to transparency and accountability pertaining to the recent legislation for which we have developed an enterprise-wide implementation program to ensure requirements are met. We have a cross-functional team that is… Read More

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Royal Caribbean Travel Insurance Requirements – We’ve Got You Covered!

  Beginning August 1, 2021 and going through to December 31, 2021, Royal Caribbean Cruises departing from ports out of Florida will require unvaccinated passengers age 12 years and older to procure valid travel insurance prior to boarding. Coverage requirements include $25,000 per person in medical coverage and $50,000 per person for emergency medical evacuation with no COVID-19 exclusions. Don’t let this requirement halt your travel plans!  We have Trip Protection and global health insurance plans provide coverage that meet these requirements, as well as offering additional coverage like baggage loss/delay benefits and trip cancellation/interruption benefits. If you have any questions please contact your Total Benefit Solutions, Inc health insurance… Read More

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MHPNJ : Important Plan Cancellation Status Information

Affiliated Physicians and Employers Master Trust (“APEMT”) and Members Health Plan New Jersey (“MHPNJ”) want to take the time to let you know they value the support that you have provided them over the years. APEMT/MHPNJ (the “Plan”) is ceasing to write business and is beginning an orderly wind down of the Plan. The financial deficiency the Plan has been facing for the past several months has not been sufficiently cured in the time period prescribed by New Jersey law. Therefore, the Board of Trustees on behalf of the Plan is implementing an orderly wind down of the plan. Please be advised that you must terminate their coverage with the Plan and seek new… Read More

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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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Independence: Using the e-bill feature

From Independence Blue Cross: There’s an easy way to simplify your administration and reduce costs —make secure eBill payments through our employer portal at ibx.com, anytime and anywhere… Download ebill bulletin    

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Achieve Well-being Rewards

Independence Blue Cross (Independence) offers a new way to help your employees achieve their health goals. Reward employees for completing activitiesNothing helps motivate action like the promise of rewards!*Achieve Well-being tools available on ibx.com and on the IBX mobile app create personalized action plans that make it easy for your employees to earn tokens and badges for completing their well-being goals.New for 2021, your employees can now receive a $150 gift card by completing the following required activities: Annual check-up with PCPFlu shotGet digitally engagedMember portal registrationMDLIVE.com registrationWell-being profileOpt-in to digital messaging at ibx.com Once your employees complete all six activities through the Achieve Well-being tool they can redeem a… Read More

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Independence: Small Group Forms

  Independence Blue Cross keeps most of the forms small business health insurance customers need on a regular basis online and easy to access. Click here to get the latest forms from ibx.com  Please contact Total Benefit Solutions, Inc. if the form you need is not available or you have any questions or concerns!

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Supreme Court Dismisses Latest Challenge to the ACA

The “individual mandate” provision of the ACA as originally enacted in 2010 required most U.S. residents to obtain minimum essential health insurance coverage or pay a monetary penalty. The individual mandate penalty withstood a legal challenge in 2012 when the Supreme Court ruled itwas a valid exercise of Congress’ taxing power. However, Congress effectively eliminated the individual mandate penalty by reducing it to zero effective January 1, 2019. Download Supreme Court Dismisses Latest Challenge to the ACA

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Tax Advantaged Benefit Documents

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

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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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IRS Guidance Clarifies DCAP Relief

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates  to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

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CMS Announces Medicare Plan Finder Improvements

Source: medicare.gov   This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to improve and update the Medicare Plan Finder (MPF) and the Health Plan Management System (HPMS). HPMS is the system that Medicare Advantage and Part D plans use to provide data about their plan offerings to Medicare, and the MPF is the online tool that allows beneficiaries to evaluate, compare, and enroll in those plans. The changes will be in place for the start of the Medicare Open Enrollment Period starting on October 15 for 2022 plans. Many of the forthcoming MPF changes reflect suggestions that Medicare Rights and other advocates have made over the years to increase the tool’s… Read More

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Family Dental & Vision Plans

We have a number of stand-alone dental and vision plans from Davis Vision, VSP and Delta Dental. You can review, compare and enroll on plans in minutes! https://brokers.dentalforeveryone.com/?id=B3F52EA5-F0E3-40B4-B1DB-0F060AE09478

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What is Modified Adjusted Gross Income (MAGI)?

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return. 

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What is Balance Billing?

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Ask your health insurance experts at Total Benefit Solutions today how to avoid balance billing charges!

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PEOPLE RISK MANAGEMENT

Employees are usually a business’s biggest asset. Conversely, those same employees are also the biggest risk. If you have employees,you have employee-centric exposures, also known as people risks. These risks are rapidly increasing and evolving, and what were onceconsidered minor problems are now potentially disastrous for businesses.  Download HR Solutions

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Aetna Small Group (2-100) Insured & Small Group Aetna Funding Advantage FAQ
Health Plan options for business owners during COVID-19 pandemic

Aetna is mindful of the many challenges our small business customers and their employees are facing as a result of the COVID-19 pandemic. Many are experiencing slower sales, reductions in hours, layoffs and more. The attached Frequently Asked Questions (FAQ) includes our current responses to questions we know are top of mind for many of Small Group Insured and Small Group Aetna Funding Advantage Self-Insured customers. These responses will remain in effect until June 30, 2021 unless otherwise specified. We will continue to evaluate and update our responses as the situation evolves. Downlaod FAQ: Commercial Small Group COVID-19 FAQ

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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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Health FSA Annual Limit & Changes

  Takes Effect: Each plan year beginning on or after January 1, 2013. Quick Facts: Salary reduction contributions to a health flexible spending account (health FSA) are limited to a total dollar amount per plan year: For plan year beginning in 2013 or 2014: $2,500. For plan year beginning in 2015 or 2016: $2,550. For plan year beginning in 2017: $2,600. For plan year beginning in 2018: $2,650. For plan year beginning in 2019: $2,700. For plan year beginning in 2020 or 2021: $2,750. In case of a “short” plan year of fewer than 12 months, the limit is prorated. Details: The Affordable Care Act amends § 125 of the… Read More

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