Healthcare Compliance: 2023 Q4 Digest

Wendy Lopez

Stay ahead in healthcare compliance with the 2023 Fourth Quarter Compliance Digest, a consolidated resource featuring all Q4 bulletins from October to December. This document is your one-stop-shop for the latest in health care reform, simplifying the complexities of compliance. Key Features: Up-to-Date Information: Get the latest developments in healthcare compliance from Q4 2023. Convenience in One Document: Access all relevant information in a single, downloadable PDF. Streamlined Access: Easily download the digest for quick and efficient access to essential updates. To explore further, download the PDF below: We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists… Read More

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Cigna Healthcare and Tower Health Contract Updates

Wendy Lopez

In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More

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Alert: Chicago Employers, Brace for Paid Leave Shifts in 2024

Wendy Lopez

In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More

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Key Reminders for Individual Health Plan Payments

Wendy Lopez

In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More

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Ambetter Health Members: Ensure Coverage for January 2024!

Wendy Lopez

As we approach the end of the year, we want to remind you of a crucial deadline to ensure uninterrupted coverage for the upcoming year. Payment Deadline: December 31, 2023: Ambetter Health members must make their January premium payment by December 31, 2023, to guarantee seamless coverage for the start of 2024. To make this process quick and convenient, we recommend using Quick Pay option for a fast, one-time payment. For Assistance: If you have any questions or require assistance, don’t hesitate to reach out to your dedicated Ambetter Health Account Executive. You can contact them at 1-855-700-7985, selecting option 3. Alternatively, you can email ambettersales@centene.com. Ensuring your premium payment is processed… Read More

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Case Study: Achieving Success Through Broker Change

Wendy Lopez

In the dynamic landscape of employee benefits, staying complacent can hinder progress and cost an organization significant financial resource. At Total Benefit Solutions, we take pride in our proactive approach to addressing complex employee benefit challenges. In this blog post, we highlight a case study that exemplifies our commitment to providing innovative solutions and delivering tangible results for our clients. Broker Change Leads to Better Results The Challenge: A mid-sized group prospect approached us with a pressing issue – dissatisfaction with their current benefits broker. Faced with a 17% health insurance renewal, the client felt that their existing broker was not adequately exploring cost containment strategies. Seeking guidance, they turned… Read More

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House Passes Health Care Transparency Law

Wendy Lopez

In a significant move towards increased transparency and cost reduction in the healthcare sector, the U.S. House of Representatives voted 320-71 to pass the Lower Costs, More Transparency Act on December 11, 2023. The bipartisan legislation aims to address the pressing issue of rising healthcare costs by implementing crucial changes, particularly affecting employers sponsoring group health plans. Transparency in Coverage Regulations The bill codifies existing transparency in coverage regulations, requiring the posting of machine-readable files (MRF) and making certain cost information available. Notably, changes include specific timing for posting the MRF, scheduled for the 10th day of each month. If enacted, this provision would come into effect for the first… Read More

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ACA Compliance: Key Calendars for 2024 Revealed!

Wendy Lopez

Stay ahead of the compliance curve with crucial information on Affordable Care Act (ACA) deadlines for 2024. In our latest update, we’ve compiled comprehensive compliance calendars tailored for both small groups (less than 50 employees) and larger groups (50 or more employees). It’s your go-to resource for understanding and meeting important deadlines to ensure a seamless compliance journey. 2024 Small Group Compliance Deadlines: For fully and self-insured groups operating on a calendar year plan, we’ve outlined essential deadline dates for 2024. Please note that some reporting deadlines may vary for plans with a start date other than January 1st. Whether you have a small group or a larger organization, staying… Read More

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DOL Settlements Prompt Life Insurance Carriers to Adopt Claim Reforms

Wendy Lopez

Recent settlements between the Department of Labor (DOL) and major life insurance carriers have brought attention to the denial of claims due to missing evidence of insurability (EOI). These agreements spotlight the potential liabilities faced by carriers and employers even after collecting employee premiums for coverage. Employers commonly offer basic life insurance coverage without charge, while employees can purchase additional coverage through payroll deductions. Approval for supplemental coverage often depends on carriers accepting evidence of insurability (EOI) submitted by the insured individual. DOL Investigations: The DOL’s investigations revealed that carriers, such as Prudential and United, consistently denied claims for missing EOIs despite collecting premiums. Employers, tasked with collecting EOIs and… Read More

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2024 Benefits Breakdown: Your Wallet Will Thank You!

Wendy Lopez

As we step into the new year, the IRS has unveiled the much-anticipated cost of living adjustments for 2024 under various provisions of the Internal Revenue Code. These adjustments bring changes that may impact your employee benefit plans. Let’s delve into some key areas affected by these adjustments. Cafeteria Plans – Health Flexible Spending Arrangements: For plan years beginning in 2024, the annual contribution limitation under Code Section 125(i) for voluntary employee salary reductions to health flexible spending arrangements (health FSAs) has increased to $3,200 from $3,050. Additionally, for plans allowing the carryover option, the maximum unused amount from a health FSA plan year that begins in 2024 and can… Read More

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Massachusetts Paid Family and Medical Leave Updates for 2024

Wendy Lopez

The Massachusetts Department of Family and Medical Leave (DFML) has announced significant changes to the Massachusetts Paid Family and Medical Leave (PFML) program, effective January 1, 2024. These updates include adjustments to the contribution rate, State Average Weekly Wage, and maximum weekly benefit amount. Employees can also supplement their PFML benefits with accrued paid leave, beginning on November 1, 2023. Contribution Rate Changes In 2024, the contribution rate on eligible wages will increase from 0.63% in 2023 to 0.88%. Individual contributions are capped by the Social Security income limit, which is expected to rise significantly. Employer and Employee Contributions Employers with a minimum of 25 covered individuals in Massachusetts will… Read More

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Open Enrollment 2023: Key Reminders and Deadline

Wendy Lopez

Are you ready for Open Enrollment? If not, don’t worry – we’ve got you covered with all the key information you need to make the most of this opportunity to secure health coverage for you and your loved ones. Open Enrollment for 2023 is just around the corner, beginning on November 1. However, it’s crucial to mark your calendars with the DEADLINE REMINDER: December 15th is the last day to enroll for coverage that kicks in on January 1st. For current Pennie customers, here are some important reminders: For those who are potential Pennie customers, here’s what you need to know: Why choose Pennie for your health coverage? Pennie offers… Read More

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Updated No Surprises Act and IDR Guidance

Wendy Lopez

Recent developments in healthcare legislation have brought changes to the No Surprises Act’s independent dispute resolution (IDR) process. Issued by the Departments of Labor, the Treasury, and Health and Human Services (HHS), FAQ Part 62 provides essential updates regarding the qualifying payment amount (QPA) calculation methodology and the disclosure requirements for out-of-network (OON) air ambulance services. Moreover, the federal IDR portal has reopened, streamlining the resolution of billing disputes. The No Surprises Act Overview The No Surprises Act, a part of the Consolidated Appropriations Act, 2021, aims to protect patients from surprise medical bills. It places limits on out-of-network cost-sharing and bans balance billing in various situations, such as emergency… Read More

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Total Benefits: Your Trusted Guide to Cost-Efficient Coverage

Wendy Lopez

In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More

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New Federal Rules: HHS 2023 Penalty Hike

Wendy Lopez

In the world of healthcare compliance, staying up to date with federal regulations and guidelines is crucial to avoid costly penalties. One such regulation that affects healthcare providers and group health plans is the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, commonly known as the “Inflation Adjustment Act.” This act directs federal agencies to adjust civil monetary penalties to account for inflation. In a recent development, the Department of Health and Human Services (HHS) issued final rules on October 6, 2023, updating the civil monetary penalties for inflation. Understanding the Updated Penalties The adjusted penalties are applicable to penalties assessed on or after October 6, 2023. It’s… Read More

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Court Vacates Coupon Cost-Sharing Rule

Wendy Lopez

On September 29, 2023, a significant legal development occurred that could affect how health insurance carriers and group health plans handle manufacturer coupons for prescription drugs. The District Court for the District of Columbia vacated a rule issued by the Department of Health and Human Services (HHS) that allowed, but did not mandate, the inclusion of manufacturer coupons in calculating the cost-sharing for health plans. In this blog post, we’ll explore the background of this issue, the 2019 HHS rule, and the subsequent legal decisions that have led to this recent development. HHS’s 2019 Rule In 2019, HHS issued a rule to clarify this matter. The rule stated that plans… Read More

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Affordable Dental Insurance: A Key Player in Oral Health

Wendy Lopez

Dental health is a crucial aspect of overall well-being, and a recent survey has shed light on the satisfaction levels of Americans with their dental insurance plans. The results, published in a press release by AHIP (America’s Health Insurance Plans) on September 26, 2023, provide an insightful perspective on the state of dental insurance in the United States. The survey, conducted by Global Strategy Group (GSG) on behalf of AHIP, focused on individuals who have dental insurance and have visited dental specialists, including dentists, oral surgeons, and orthodontists, in the past year. The findings from the survey paint a positive picture of Americans’ experiences with their dental insurance plans. Key… Read More

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Financial Support Soars for Mental Health Integration

Wendy Lopez

Mental health is an essential component of overall well-being, and every American deserves access to quality mental health and substance use disorder treatment. Access to mental health care can be a transformative step in managing and coping with mental health concerns, allowing individuals to lead more fulfilling lives. This article explores the importance of integrating mental health services into other care settings and highlights the Collaborative Care Model (CoCM) as a promising approach to enhance access to mental health care. Expanding Access Through Integration Integrating mental health into broader healthcare settings is a pivotal strategy to increase accessibility and support for patients. The Collaborative Care Model, often abbreviated as CoCM,… Read More

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The Secrets to Patient Loyalty in Healthcare

Wendy Lopez

The healthcare industry is undergoing a transformation like never before. In an era of insurgent competitors and changing payment models, the COVID-19 pandemic acted as a pressure test, accelerating the pace of disruption and digital adoption. Now, there’s a unique opportunity for healthcare to make loyalty central to its mission. From earning consumer trust to establishing brand relevance, the industry is evolving in profound ways, reshaping patient experiences to boost retention and a sense of belonging. Both healthcare providers and payers are re-engineering how they connect with their customers to earn their loyalty during this time of unprecedented change. At first glance, the concept of “loyalty” in healthcare may seem… Read More

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Small Business, Big Benefits: Health Coverage for All

Wendy Lopez

In the United States, the landscape of healthcare is a complex one, with various options available to individuals and families. One of the most significant sources of health coverage for Americans is employer-provided coverage. This type of coverage is a health plan, or a selection of health plans and other benefits, purchased by an employer and offered to eligible employees and their dependents. It’s a system that plays a crucial role in ensuring that millions of hardworking individuals and their families have access to quality healthcare. Affordable Access to Care The primary advantage of employer-provided coverage is its affordability. Employees’ contributions to their health coverage are tax-free, which means that… Read More

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2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?

Wendy Lopez

In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More

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The Value of Employee Health Benefits

Wendy Lopez

In today’s world, where healthcare costs can be a significant burden on individuals and families, employer-provided health coverage stands out as a vital resource. More than half of all Americans – over 180 million hardworking individuals and their families – rely on their jobs to secure access to healthcare. In this blog, we’ll explore the invaluable benefits of employer-provided coverage and how it offers affordable access to care, improved health, and peace of mind. Affordable Access to Care Healthcare expenses can quickly add up, and without insurance, it can be a daunting task to manage them. However, for millions of Americans, the path to affordable healthcare begins with their employers.… Read More

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Medicaid Redetermination Updates: Your Next Steps

Wendy Lopez

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

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No Child Left Uninsured: Innovative Solutions in Healthcare

Wendy Lopez

Millions of children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for their health and well-being. However, the redetermination process can sometimes pose challenges for their parents. In this article, we explore the innovative efforts undertaken by health insurance providers to ensure that children maintain access to healthcare, regardless of their parents’ circumstances. Medicaid plays a crucial role in American healthcare, improving the health and financial security of millions of individuals daily. It’s particularly vital for the 42 million children enrolled in Medicaid or CHIP. While parents may face hurdles during the Medicaid redetermination process, children often remain eligible for these programs or can transition to CHIP. Health… Read More

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2024 Healthcare Premiums Revealed: The Impact Factors

Wendy Lopez

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

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