Health Insurance – Page 10 – Total Benefit Solutions Inc

Health Insurance Fee to be Reduced for 65% of the Self-Employed Insured

July 14, 2022July 1, 2022Ed MacConnell

Health insurance fees for 5.61 million households, among the self-employed insured of the national health insurance, will be slashed by an average of 36,000 won per month starting September. On the other hand, 273,000 subscribers, including the elderly, who have been registered as the dependent of the employee insured and thus have not been paying health insurance premiums will have to start paying health insurance fee from September. The gist of the amendment of the health insurance scheme is to reduce the amount of health insurance fees the self-employed insured has to pay. There has been criticism that the self-employed insured has to pay a greater amount of health insurance… Read More

Horizon BSBSNJ to Withdraw HMO Plans From Individual and Small Employer Markets

July 13, 2022July 14, 2022Ed MacConnell

Horizon has announced a change to their product portfolio and have elected to withdraw their HMO plans from the Individual and Small Employer Health Benefits Plan (SEH) markets. The New Jersey Department of Banking and Insurance (DOBI) has given its approval for Horizon to withdraw its HMO plans from the markets under the authority of N.J.S.A 17B:27A-6 and N.J.A.C. 11:20-18.5 (for Individual plans) and N.J.S.A. 17B:27A–23e and N.J.A.C. 11:21-16 (for small employer plans). This withdrawal will affect Individual members enrolled in the Horizon HMO Gold plan, and group clients and their employees who are enrolled in the Horizon HMO Platinum plan. Brokers with affected small group clients, and those affected… Read More

Get The Most From Your Dental Benefits with Beam Benefit’s Carryover Policy

July 12, 2022June 30, 2022Ed MacConnell

If you don’t use up your annual maximum, they don’t have to go to waste — you may be able to put them to use in the future! This means you’ll have more dollars at your disposal for dental procedures in the following years. Each year your benefits will cover a certain dollar amount in claims. When you use less than half of this maximum, a portion of it will “carry over” to the next year. This means it’s added to your annual maximum in future years. Have any questions or concerns about enrolling your group in Beam Benefit’s Dental Plan? Please contact your Total Benefit Solutions Inc health insurance… Read More

Affordability of Health Coverage

July 11, 2022June 30, 2022Ed MacConnell

Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

Pennie: Losing Medical Assistance Coverage When The Public Health Emergency Comes to an End?

July 1, 2022June 24, 2022Ed MacConnell

Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has maintained coverage for most Medical Assistance (MA) recipients unless they moved out-of-state, passed away, or requested to be disenrolled.  When the federal PHE comes to an end, anyone who is found to be no longer eligible during the renewal process for Medical Assistance or who fails to complete their MA renewal will be disenrolled from Medical Assistance coverage – that is where Pennie comes in! Pennie and the Department of Human Services (DHS) are working to ensure that qualified Pennsylvanians can access coverage either through Medical Assistance (MA), the Children’s Health Insurance Program (CHIP), or affordable, high-quality coverage available… Read More

Is my group subject to ERISA or ERISA Exempt?

June 29, 2022Ed MacConnell

Many clients often ask the question ” Do I need to comply with ERISA? ” The answer is almost always yes! Just because you are a smaller business does not exempt you from ERISA. This from the US Department of Labor: ERISA applies to private-sector companies that offer pension plans to employees. This includes businesses that: Are structured as partnerships, proprietorships, LLCs, S-corporations and C-corporations. No matter how your employer has structured his or her business, it is covered by ERISA if it is a private entity. Who is not subject to ERISA?In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or… Read More

Mental Health Conditions Can Trigger FMLA

June 27, 2022June 24, 2022Ed MacConnell

The Wage and Hour Division of the U.S. Department of Labor released a Fact Sheet related to mental health conditions and the Family and Medical Leave Act, clarifying what constitutes a serious mental health condition. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

What is the IRMAA Surcharge?

June 23, 2022July 7, 2022Ed MacConnell

What is the IRMAA Surcharge? The income-related monthly adjustment amount (IRMAA) sliding scale is a set of statutory percentage-based tables used to adjust Medicare Part B and Part D prescription drug coverage premiums. The higher the beneficiary’s range of modified adjusted gross income (MAGI), the higher the IRMAA. Want to apply for relief from the IRMAA charges? The form required is posted below, just download and complete the form!

Horizon NJ: Covid-19 Resource Guide Update

June 23, 2022June 23, 2022Ed MacConnell

Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

June 22, 2022July 14, 2022Ed MacConnell

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

INFLATION NOW TOPPING LIST OF EMPLOYER’S PANDEMIC CHALLENGES

June 20, 2022June 18, 2022Ed MacConnell

Employers have faced many challenges since the start of the pandemic, and now wage inflation may be at the top of the list. Using the law of supply and demand, as the supply of talent decreases, candidates can demand more money. The good news, according to the Department of Labor, the unemployment rate fell to 4.6% in October 2021, a new pandemic low. Click the link below to download the full bulletin. As always please contact your Total Benefit Solutions, Inc group account manager if you have any further questions or concerns.

Aetna: Transparency in Coverage Rule Update

June 17, 2022June 16, 2022Ed MacConnell

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

6 Questions to ask your Benefits Broker

June 10, 2022June 10, 2022Ed MacConnell

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

May 23, 2022May 23, 2022Ed MacConnell

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees May 23, 2022 This Allied Update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2022. By way of background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which… Read More

Notice Requirements for Group Health Plans

May 16, 2022May 13, 2022Ed MacConnell

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

Fully Insured vs Level Funding: What’s the Difference?

May 12, 2022May 11, 2022Ed MacConnell

With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More

Support for your emotional health

May 12, 2022May 11, 2022Ed MacConnell

Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.

Proposed Regulations to Fix ACA’s Affordability “Family Glitch”

May 10, 2022May 9, 2022Ed MacConnell

individuals are not eligible for premium tax credits in the Marketplace

What is a 5-Star Medicare Plan?

May 5, 2022May 5, 2022Ed MacConnell

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!

HealthCare.gov Notices New Class of Individual Employer Policies

May 2, 2022Ed MacConnell

hCare.gov managers are signaling that they think individual coverage health reimbursement arrangements matter. The regulators in charge of the federal Affordable Care Act public exchange system today gave ICHRAs official attention, by adding an ICHRA use reporting requirements for the insurers that sell coverage through HealthCare.gov. Click here for the full story on Think Advisor.com

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