What is the Summary of Benefits and Coverage (SBC)?

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You’ll get the “Summary of Benefits and Coverage” (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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Blue KC: Enhanced ACA Subsidies to Extend Through 2025

The American Rescue Plan Act of 2021 has provided enhanced ACA premium subsidies for people who purchased a plan through the Marketplace. It did so by removing the income cap, which limited subsidies to households with incomes from 100% to 400% of the federal poverty line. With no income cap, premiums have been limited to just 8.5% of income – for everyone. The Inflation Reduction Act, which was signed into law on August 16, extends these subsidies for three years for millions of Americans who buy individual coverage under the ACA. This bill will “save millions of people an average of $800 a year on health insurance premiums,” said Chiquita… Read More

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What is a Qualified Health Plan?

An insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage.” As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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What is cost sharing?

The share of costs covered by your insurance that you out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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Can consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?

Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

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Get connected with the IBX Smartphone App

Download the free IBX app for your iPhone or Android to help you make the most of your Independence Blue Cross health plan. With new and improved features, the IBX app gives you easy access to your health care coverage 24/7, wherever you are. As always contact your Total Benefit Solutions, Inc health insurance professionals if you have any questions about this bulletin. Click here to read more.

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Open Enrollment Tips from Total Benefit Solutions!

As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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Get assistance with your PENNIE health insurance account

Already on the health insurance Marketplace and need some help? Assigning Total Benefit Solutions, Inc is easy! Download the document and follow the steps. We will get notified and start helping you right away! Need more direction? Give us a call (215)355-2121 

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What is a Health Maintenance Organization (HMO)?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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What is the Marketplace?

Shorthand for the “Health Insurance Marketplace®,” a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. In most states, the federal government runs the Marketplace (sometimes know as the “exchange”) for individuals and families. On the web, it’s found at HealthCare.gov. Some states run their own Marketplace at different websites. Fill out a Marketplace application and you’ll find out if you qualify for lower monthly premiums or savings on out-of-pocket costs based on your income. You may find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can shop for and enroll in affordable medical insurance online, by phone,… Read More

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What is a premium?

The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. When shopping for a plan, keep in mind that the plan with the lowest monthly premium may not be the best match for you. If you need much health care, a plan with slightly higher premium but a lower deductible may save you a lot of money. After you enroll in a plan, you must pay your first… Read More

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Can consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?

Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. Please contact your trusted Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

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Turning 26: Your Guide to Health Insurance

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

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What is an Out-of-Pocket Maximum/Limit?

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs covered benefits. The out-of-pocket limit doesn’t include: Your monthly premiums Anything you spend for services your plan doesn’t cover Out-of-network care and services Costs above the allowed amount for a service that a provider may charge The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year. For the 2022 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,700 for an individual and $17,400… Read More

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Additional Guidance on New Prescription Drug Reporting Requirement

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit informationannually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services(“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Click the link below to download this bulletin. As always please contact your Total benefit Solutions, Inc health insurance specialist at (215)355-2121 if you have any further questions or concerns.

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IBC: Understanding your network

The type of health plan you choose determines the network of providers you can visit. In-network providers are the doctors and hospitals in your plan’s network. You’ll save the most money by visiting network providers. Out-of-network providers are those not in your plan’s network. You may pay more for out-of-network services, and some services may not be covered at all. Know your options — before you need them When you need care and your primary care doctor isn’t available, remember you have other options that don’t involve a trip to the emergency room. Using virtual care, retail clinics, or urgent care centers can save you time and money. https://www.ibx.com/get-care/find-doctors-and-healthcare-providers/where-to-go-for-care Click here for links to your network and more… Read More

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What is a Health Savings Account (HSA)?

A type of savings account that lets your set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums. While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan (including a Marketplace plan) that only covers preventive services… Read More

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Understanding the Coding of Health Plans from MEC to Metallic

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

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What is a Qualifying Life Event or QLE?

There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More

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Case Study Library

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

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How To Reconcile Your Premium Tax Credit

If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you will have to “reconcile” when you file your federal taxes. This means you will compare these two figures: the amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower) and the premium tax credit you actually qualify for based on your final income for the year. Here is a step-by-step guide to reconciling you premium tax credit. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions… Read More

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What does ” Guaranteed Issue” health insurance mean?

Guaranteed issue A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Not all health insurance plans are guaranteed issue. Have any questions about your health insurance? Contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 https://www.totalbenefits.net

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

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

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