Pennie Health Insurance – Total Benefit Solutions Inc

Next Year Cost for Pennie Customers May Increase

April 29, 2025April 29, 2025Loramei Romeo

Pennie has announced that enrollees receiving advance premium tax credits will likely face higher costs in 2026 due to the expiration of enhanced federal tax credits at the end of 2025. This change will result in increased monthly premiums for most enrollees unless Congress acts to extend these credits. Pennie is committed to keeping customers informed through various communications, including postcards, emails, and text messages, to help them understand the upcoming changes and find the lowest costs on high-quality health coverage. The enhanced tax credits, introduced in 2021, have provided significant financial savings, but their expiration means reduced savings for many enrollees starting January 2026. We are dedicated to providing… Read More

South Jersey Radiology is in the Clover Network

April 11, 2025April 11, 2025Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025. New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… 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

2025 Part D Changes and Employer Sponsored Group Health Plans

September 9, 2024September 5, 2024Mirasol Bandong

Employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable… Read More

Ready for another year of helping clients who get their health insurance through Pennie!

September 8, 2024September 8, 2024Ed MacConnell

Ready for another year of helping clients who get their health insurance through Pennie! Open enrollment starts November 1st 2024 and ends January 15th 2025! (215)355-2121 https://lnkd.in/bhhqqAJ

Cigna Changes to MA ID cards

August 26, 2024August 23, 2024Mirasol Bandong

As with the 2025 plan year, our Medicare Advantage ID cards will be altered. By utilizing our digital portals to obtain a member’s current PCP, treating providers will be encouraged to use them more efficiently, which will prevent needless treatment delays brought on by the referral process. See what’s changing below, so you’re ready to answer any customer questions this upcoming AEP. What’s changing? 2024 2025 What is staying the same? When are these changes occurring? Members in HMO plans are still required to maintain a PCP New enrollees with a 1/1/2025 effective date will start receiving ID cards without PCP information as soon as 10/15/2024. The PCP network name… 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

Cigna+Oscar Announcement

May 15, 2024May 14, 2024Mirasol Bandong

Oscar and Cigna Healthcare have made the decision not to renew Cigna + Oscar Small Group plans nationally as of December 15, 2024. They will continue to provide coverage for Cigna + Oscar Small Group services through the end of each member’s policy, and specific timing is dependent on each groups’ enrollment date. Dates: As per the federal and state deadlines, Cigna + Oscar will inform plan sponsors and insured persons about the discontinuation. Oscar will stay active in the individual market and concentrate on that area of the company’s operations. To see ARTICLE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated… Read More

2025 Medicare Advantage and Part D Rate Announcement

April 11, 2024Mirasol Bandong

The Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The objectives set forth by CMS for Medicare and Part D align with our overall program vision for the agency, which includes advancing health justice, promoting affordability and the Medicare program’s sustainability, and driving comprehensive, person-centered care. Medicare Advantage and Part D Rate Announcement 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… Read More

Update on Legislation – EmblemHealth

March 29, 2024March 28, 2024Mirasol Bandong

President Joe Biden presented his budget proposal on March 11th, 2024, for the federal fiscal year that would start on October 1st. Along with raising taxes on people earning more than $400,000 annually, the budget would also help extend talks with pharmaceutical corporations to prolong the Medicare program’s financial viability. click HERE to read the whole article. 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.

United Healthcare and Mount Sinai Renew Relationship

March 28, 2024March 27, 2024Mirasol Bandong

In accordance with a new multi-year agreement between UnitedHealthcare and Mount Sinai Health System, individuals participating in employer-sponsored and individual plans, such as the Oxford Health Plan, will once again have network access to the system’s hospitals. Additionally, the agreement guarantees continuous, uninterrupted access to the doctors at Mount Sinai. for more information 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 or address any concerns you may have.

Cleveland Clinic will remain in our MA network in Florida and Ohio

March 25, 2024March 21, 2024Mirasol Bandong

We are pleased to announce that Cleveland Clinic will stay part of our Medicare Advantage (MA) network in Florida and Ohio after successful negotiations! This covers all specialists, ancillary providers, hospitals, and primary care physicians (PCPs). Once a contractual agreement is achieved, Cleveland Clinic services will continue to be accessible without interruption. Customers will receive letters in the upcoming weeks letting them know that Cleveland Clinic is still in network and that they don’t need to take any action right now. The PCP assignments at Cleveland Clinic are all still the same. Have any questions? call us at (215) 355-2121 or click Cigna healthcare provider directory to view the most… Read More

CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

February 21, 2024February 21, 2024Ed MacConnell

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell of Total Benefit Solutions Inc has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

Medicare: Your Essential Guide

February 7, 2024February 7, 2024Ed MacConnell

Understanding Medicare is crucial for making informed decisions about your healthcare coverage. Whether you choose Original Medicare or Medicare Advantage (Part C), knowing the basics empowers you to select the plan that best suits your needs. Original Medicare comprises Part A and Part B, covering hospital stays, doctor visits, and other essential services. Supplemental plans like Medicare Part D for prescription drugs and Medigap for additional coverage can enhance your benefits and reduce out-of-pocket expenses. Alternatively, Medicare Advantage plans offer a comprehensive alternative, bundling Parts A, B, and often D into a single package. These plans may extend coverage to dental, vision, and other services, providing a more holistic approach… Read More

Navigating the Basics of Medicare: Understanding the Four Parts

February 5, 2024February 5, 2024Ed MacConnell

Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. 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… Read More

ACA’s Contraceptive Coverage: New FAQs Guide

January 29, 2024January 29, 2024Ed MacConnell

On January 22, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a fresh set of Frequently Asked Questions (FAQs), shedding light on the Affordable Care Act (ACA)’s imperative for non-grandfathered medical plans to include specific preventive services, notably contraceptives, without imposing any cost-sharing on individuals. The aim of these FAQs is to address concerns from stakeholders, facilitating a better understanding of the contraceptive coverage mandate and encouraging compliance through an alternative method. For detailed insights and further information, download the PDF below. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

Special Election Period may be available to members affected by severe weather

January 24, 2024January 29, 2024Ed MacConnell

The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP). For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit. Who is eligible? Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and What does this mean for beneficiaries? Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More

Horizon Members Get 15% Off YMCA Memberships!

January 24, 2024January 24, 2024Ed MacConnell

Exciting news for Horizon members in New Jersey! We’re thrilled to share that you can now enjoy a 15 percent discount on monthly memberships at select New Jersey YMCAs. Plus, for new YMCA members, the initiation fee is completely waived when you present your Horizon member ID card. This fantastic offer is valid until December 31, 2024, providing you ample time to take advantage of the savings and embrace a healthier lifestyle. Whether you’re a fitness enthusiast or looking to kickstart your wellness journey, this exclusive discount is designed to make your YMCA experience even more accessible. Remember, this exclusive discount is a limited-time offer, so make the most of… Read More

Aetna: Small Business Updates

January 23, 2024January 23, 2024Ed MacConnell

As the year wraps up, businesses with 2 – 50 employees enrolled in Aetna Funding AdvantageSM groups need to act quickly. We’re filing 1095-B tax forms on your behalf, but it’s crucial to ensure your information is accurate. Deadline: End of December The federal deadline for 1095-B tax forms is approaching. Both businesses and customers must verify and update their details by the end of December to avoid potential IRS rejections. Why It Matters Accurate information on these forms is vital for complying with tax regulations. 1095-B forms provide essential health coverage details, impacting Affordable Care Act compliance. Any discrepancies could lead to filing complications. Review and update your information… Read More

Medicare Part D – CMS Notification Reminder

January 18, 2024January 18, 2024Ed MacConnell

Employers supporting a group health plan, whether through insurance or self-insurance, are required to communicate the creditable or non-creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). This reporting is facilitated through access to CMS’s online reporting system here. To comply with regulations and maintain transparency, follow these key points: Access CMS Online Reporting: Employers (insured or self-insured) should use CMS’s online system to report prescription drug coverage details. Key Deadlines: 1.Within 60 days after the plan year starts. 2.Within 30 days after prescription drug plan termination. 3.Within 30 days after any creditable coverage status change. Example Deadline: For a calendar year… Read More

DOL’s 2024 Penalty Adjustments

January 17, 2024January 17, 2024Ed MacConnell

The Department of Labor (DOL) has released its annual adjustments for 2024, impacting penalties for employee benefit plans. Here’s a quick guide for employers: Key Points: 1. Employee Notices: Private employers must ensure timely delivery of required notices (SBC, CHIP, SPD, etc.) to avoid civil penalties. 2. Form 5500 Filings: File Form 5500 accurately and on time to prevent penalties associated with non-compliance. 3. Document Requests from EBSA: Respond promptly to document requests from EBSA to avoid potential penalties. Annual Penalty Adjustments for 2024 The updated penalties listed below are applicable to ERISA-covered health and welfare plans. Compliance is essential in 2024—act now to secure your organization against penalties and… Read More

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