For 2015, the Small business Health Options Program (SHOP) platform manages more processes and information. As a result, the involvement of insurance carriers has been reduced. Understanding how it will work this year will help you work with employers to decide if they should purchase coverage through SHOP or directly from Independence Blue Cross (Independence). Like last year, groups may still only offer one plan option to all employees. However, the application and setup processes are now managed entirely through SHOP instead of by insurance carriers. This means certain Independence benefits are no longer available. Independence will continue to provide member identification cards, process member claims, and provide member services to answer questions. Click the link below to download… Read More
Continue ReadingHealth Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax
Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More
Continue ReadingWho can use the SHOP Marketplace?
What is the SHOP? The Small Business Health Options Program (SHOP) Marketplace helps small businesses provide health coverage to their employees. The SHOP Marketplace is open to employers with 50 or fewer full-time equivalent employees (FTEs), including non-profit organizations. You can enroll in SHOP at any point throughout the year. Click the link below to download a handy “who can” to see if your business or organization can use or benefit from the SHOP. As always please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions about the SHOP or any Affordable Care Act concerns. Click here to download “WHO CAN USE THE SHOP”
Continue ReadingDownload our Mid-Year Compliance Bulletin Compilation
Our Mid-year Compliance Bulletin Compilation is now available, featuring all of our released compliance bulletins for January through June. This document acts a resource for you to have all of the latest health reform information and updates in one place. You can click on a bulletin title in the table of contents and it will bring directly to the corresponding page. Click the link below to download the document. 2015_Compliance_Compilation_mid_year
Continue ReadingSupreme Court Upholds Subsidies
Supreme Court Upholds Subsidies On June 25, 2015, the Supreme Court confirmed in a 6-3 decision that premium tax credits and cost-sharing subsidies (referred to as “subsidies”) are available in the federal Health Insurance Marketplaces (also referred to as the “Exchange”). This ruling effectively removes any challenges to the ability of Exchanges to offer subsidies to qualified individuals. Please click the link below to read the entire bulletin. Supreme Court Upholds Subsidies – 062515R Remember,Total Benefit Solutions can help all people get enrolled on a qualified health plan, on or off the healthcare.gov marketplace. Call us today for more information at (215)355-2121.
Continue ReadingHealth reform: Breaking News-Supreme Court Upholds Affordable Care Act Subsidies
Obamacare lives on after Supreme Court ruling – CNN.com Washington (CNN)Obamacare has survived — again. In a major win for the Obama administration, the Supreme Court held in a 6-3 decision that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal exchanges. Click here to read the story on CNN Click here for the live SCOTUS Blog
Continue ReadingForm 5500 Filing Reminder
For calendar year-end plans, the 2014 Form 5500 is due to be filed electronically no later than July 31, 2015. ERISA requires that Form 5500 be filed with the Department of Labor for most health and welfare plans (for example, medical, dental, and life insurance plans) by the last day of the seventh month following the end of plan year unless an extension (Form5558) is completed and mailed to the IRS. Click here to read the Form 5500 Filing Reminder Click here to watch the Brainshark Video
Continue ReadingCMS has approved applications from DE and PA to create state-based Health Insurance Marketplaces.
HR News Alert from HR360.com Brought to you by Total Benefit Solutions Inc June 17, 2015 Approval Dependent on Certain ConditionsThe Centers for Medicare and Medicaid Services (CMS) has conditionally approved applications from Delaware and Pennsylvania to create state-based Health Insurance Marketplaces.Background Exchanges (also known as Health Insurance Marketplaces) provide an option for individuals to buy private health insurance. The Exchanges also operate the Small Business Health Options Program (SHOP) as an option for qualified small employers to purchase employee health coverage. The U.S. Department of Health and Human Services (HHS) has issued final rules relating to Exchanges which include standards for their establishment and operation (among other things). The… Read More
Continue ReadingProtections for LGBT Workers
The EEOC has explained on its website that lesbian, gay, bisexual, and transgender (“LGBT”) individuals may bring valid sex discrimination claims against employers. A memorandum lists insurance issues involving benefits for same-sex couples as an issue of particular interest to the EEOC. Click Here to Download Protections for LGBT Workers – 060815R
Continue ReadingHealth Reform Q&A: Can an S-Corporation offer health benefits to the shareholders and not the other employees?
At Total Benefit Solutions we often get e-mailed questions from our clients, friends and business partners. Some of them we like to post because they are asked so often. This question is one question that comes up a lot. Q- I represent an S Corp. There are 4 employees. 2 are the sole-shareholder and his wife. Then there are 2 unrelated employees. All work 30 hours or more per week. The sole shareholder and wife are covered by an employer health insurance plan. The company pays 100% of the premiums. Health insurance is not offered to the other 2 employees. Is this still permissible? A-No. In the past, an… Read More
Continue ReadingGuidance Issued on Coverage for Preventive Items and Services
Frequently asked questions (FAQs), prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury were issued on May 12, 2015 with respect to the Affordable Care Act (ACA) requirement for a non-grandfathered group health plan to provide coverage for in-network preventive items and services (including contraception)without any cost-sharing requirements, as summarized in the attached bulletin. Click here to download the FAQ bulletin
Continue ReadingReminder: PCORI Fees Due by July 31 for Employers Sponsoring HRAs and Other Self-Insured Plans
Reminder: PCORI Fees Due by July 31 for Employers Sponsoring HRAs and Other Self-Insured Plans Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due July 31 from employers that sponsor certain self-insured health plans, including health reimbursement arrangements (HRAs) that are not treated as excepted benefits. The fee, which is required under Health Care Reform, applies to plan years ending on or after October 1, 2012, and before October 1, 2019. Calculating the Fee For plan years ending on or after October 1, 2014 and before October 1, 2015, the fee for an employer sponsoring an applicable self-insured plan is $2.08 (two dollars for plan years ending on… Read More
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingGov. Wolf wants Pa. to operate Obamacare exchange
Gov. Wolf this week formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month. Read more at philly.com Remember that your Total Benefit Solutions professionals are trained, licensed, insured and available to help compare, shop and enroll all affordable care act plans on the healthcare Marketplace and off. As always contact us today if you have any questions or concerns at (215)355-2121.
Continue ReadingFAQs Further Clarify New Embedded Out-of-Pocket Requirement
As reported earlier, starting with the 2016 plan year, the self-only annual limitation on cost sharing for non-grandfathered plans ($6,850 for 2016) applies to each individual, even if the individual is enrolled in family coverage. On May 26, 2015, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued new FAQs further clarifying this new rule, confirming that it applies to all non-grandfathered group health plans, including self-insured plans, large group health plans, and high deductible health plans. Click the link below to download the bulletin for further guidance. FAQs Further Clarify New Embedded Out-of-Pocket Requirement – 060115R
Continue ReadingEmployer Reporting Guide for Large Employers 6055 and 6056 Reporting for Large Employers
Beginning with calendar year (CY) 2015, an applicable large employer (ALE or “large employer,” as referenced in this summary) must use Forms 1094-C and 1095-C to report the information required under Internal Revenue Code (Code) sections 6055 and 6056 about offers of health coverage to full-time employees’ (FTEs) and individuals’ enrollment in health coverage. This guide, brought to you by our partners at Emerson Reid will help you as an employer determine the following: Do I need to report? If so, report what? If so, report when? And on what forms? Please click the link below to download our employer reporting guide. As always, if you have any… Read More
Continue ReadingCadillac Tax Preliminary Guidance: Part II
The IRS issued Notice 2015-16 to begin the process of developing regulatory guidance regarding the excise tax on high cost employer-sponsored health coverage, commonly known as the “Cadillac Tax.” Beginning January 1, 2018, a 40% excise tax will apply on the cost of applicable coverage that exceeds prescribed thresholds (described later in this article). Click the link below to download the bulletin: Cadillac Tax Part II
Continue ReadingUHC: Introducing Plans with Rate Caps and Wellness Rewards
United Healthcare: Introducing All Savers Plans. Would your small group be interested in a medical plan with a rate increase cap in year two? Does a plan with a free “fitbit” type device sound like a great way to integrate wellness into your health benefits? What if I told you that your employees could earn money back towards their deductibles by meeting small, simple daily wellness goals? Finally, an insurance carrier has introduced a plan for your health conscious group that gives you a direct advantage in the rates because you are working towards better overall health! United Healthcare has introduced the All Savers level funding plans with Motion Credit.… Read More
Continue ReadingHealth Reform: Q+A: Are we able to give a bonus to employees to sign up for health insurance?
The following question came to us recently from a small group client. Send us your question and we may use yours in the future! Question: Are we able to give a signing up bonus to encourage employees to sign up for health insurance or will that be an issue with health care reform? Answer: An employer may provide bonuses at its discretion as long as the amount is reported as taxable compensation. Federal law prohibits employers from providing incentives to certain employees (such as Medicare-eligible persons) to discourage them from enrolling for group health coverage, but there is no prohibition against incentives to encourage enrollment. The bonus would be taxable compensation… Read More
Continue ReadingHealth Care Reform: 2016 Cost-Sharing Limits, Reinsurance Fee,and Other Changes Related to the Exchange
On February 27, 2015, the Department of Health and Human Services (“HHS”) changed cost-sharing and transitional reinsurance program fee limits and released standards for health insurers and the Exchange (a.k.a. the Health Insurance Marketplace). This article identifies a few items of note for employers. 2016 Cost-Sharing Limits, Reinsurance Fee, and Other Changes Related to the Exchange – 040915R
Continue ReadingGroup Health Plan Notices 2015 CALENDAR
Group Health Plan Notices 2015 CALENDAR From our partners at HR360: This calendar/checklist is designed to help companies review the key reporting and notice requirements that may apply to their employer-sponsored group health plans under ERISA , the Affordable cxare Act, Medicare and more. Please note that this list is for general reference purposes only and is not all-inclusive. Note: ERISA and benefit requirements are complex, and your plan’s responsibilities may vary depending on the individual circumstances surrounding your company’s plan. Employers who have questions are encouraged to consult with their plan administrators, the U.S. Department of Labor’s Employee Benefits Security Administration, the Internal Revenue Service, or a knowledgeable employment law attorney… Read More
Continue ReadingHealth Advocate: Medical Health Advisor
Total Benefit Solutions, Inc now offers the Medical Health Advisor benefit! Watch this short video and ask us how your organization can benefit from offering this personal health advocate service to your employees!
Continue ReadingTotal Benefits Partners With Primepay for ACA Compliant Reporting Services
Employer Reporting Requirements and Forms: Total Benefit Solutions Inc. has partnered up with PrimePay for affordable care act reporting. Click the to download the ACA reporting requirements grid that includes a handy link to the required forms including the IRS reporting flyer and the 1095-B and 1095-C forms . ACA Reporting Requirements About Primepay-Total Benefit Solutions Ask your Total Benefit Solutions Account Manager today for more information (215)355-2121
Continue ReadingHow do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?
Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross have a unique ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More
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