A recent analysis shows that more than 2 million marketplace enrollees who are eligible for cost-sharing reductions (CSRs) are foregoing this extra level of financial assistance by enrolling in plans that do not qualify. Consumers can receive CSRs only if they enroll in a silver level plan through their marketplace. Many of those who chose not to receive CSRs are likely enrolling in bronze plans with lower premiums but higher out-of-pocket costs. It’s important to communicate the benefits and trade-offs of receiving CSRs to the consumers you are assisting, especially those with significant health care needs. To learn more about cost-sharing reductions, check out this helpful resource from the Center on Budget… Read More
Continue ReadingHealth Reform: Draft 2015 Form 1095-C and Instructions, Increased Penalties, and Electronic Filing Steps Issued
On August 7, 2015, the IRS issued revised draft 2015 Form 1095-C with instructions. The forms and instructions are substantially the same as those applicable to the 2014 year, but the penalties have been revised. Click here to download this important update for all applicable large employers. As always if you have any questions or concerns about your organization’s health care reform compliance, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121
Continue ReadingNew Law Clarifies Employer Mandate and HSA Eligibility for Veterans
On July 31, 2015, President Obama signed into law H.S. 3236, Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. Notably, the law makes changes affecting the employer mandate and HSA eligibility as to individuals who are (or were formerly) service members. Click here to download the bulletin
Continue ReadingVideo: Are you eligible for a special enrollment period?
You might think that you have to wait for the annual open enrollment period to get enrolled. Think again! You may be eligible for a special enrollment period. Watch this short video to learn more, and then call us at (215)355-2121!
Continue ReadingVideo: Learn about the Premium Saver Plan
Group Supplemental Health Insurance – Gap Insurance What is the Premium Saver? The Premium Saver is an employer sponsored group supplemental insurance plan which is designed to help reduce the cost of group medical coverage. Combining the Premium Saver with certain major medical plans can deliver coverage groups want and can afford. How does the Premium Saver pay claims? It’s simple! The Premium Saver pays off of the underlying major medical plan EOB, and it pays benefits directly to the provider. When the insured goes in-network they always receive the carrier’s in-network discounts. What coverage does the Premium Saver provide? Supplemental Deductible and Co-Insurance Premium Saver plans have a supplemental… Read More
Continue ReadingCIGNA Webinar: 2 Distinct forms of ACA Reporting
From CIGNA-Informed on Reform Series. You’ll want to use the “maximize” or full screen feature to view the video in the bottom right hand corner of the menu bar.
Continue ReadingIRS Webinar Series Offered on ACA Provisions
The IRS is hosting a series of educational webinars to help you understand the Affordable Care Act’s employer provisions and related requirements. The IRS designed these webinars for business owners, tax managers, employee benefits managers, and health coverage providers. Employer Shared Responsibility and Information Reporting Learn about the ACA’s employer shared responsibility provisions and information reporting requirements for employers and providers of minimum essential coverage. August 20, 1:00 – 2:30 p.m. September 16, 1:30 – 3:00 p.m. Employer-Sponsored Health Coverage Information Reporting Requirements for Applicable Large Employers Learn about employer-sponsored health coverage information reporting requirements for applicable large employers, including who is required to report, what information the… Read More
Continue ReadingShould an Employer with 51-100 Full-time Employees Change Its Policy Year to Delay Compliance with Certain ACA Provisions?
Employers may be able to change their policy, not plan, year to delay compliance with some of the provision in the Affordable Care Act. Should you have any questions, please contact your Total Benefit Solutions Account Manager directly at (215)355-2121. Please click the link below to download this bulletin. Changing_Policy_Year_to_Delay_Compliance_-_072915E1
Continue ReadingHealth Reform: Reduction in Hours First Lawsuit is Filed by Employees
The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R
Continue ReadingHealth Reform: Is Your Company Ready for the New Reporting Requirements?
Health Reform: Is Your Company Ready for the New Reporting Requirements? In 2016, employers with at least 50 full-time employees (FTEs) must provide Forms 1095-C to their employees and to the IRS. This new requirement applies to both insured and self-insured medical plans. The forms require, in part, tracking per each month in 2015 per each FTE: the tier of health plan coverage offered (e.g., employee-only, employee+spouse, or no coverage offered); the self-only premium an employee must pay for the lowest-cost plan that provides minimum value; and the reason why an employer would not be subject to a penalty for a particular month (e.g., employee is in a waiting period or the affordability… Read More
Continue ReadingIBC: 2015 SHOP Updates
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 ReadingVideo: Turning 26? Here’s when to apply for health insurance
Video: Turning 26? Here’s when to apply for health insurance If you are turning 26 and still on your parent’s health insurance plan, first of all, happy birthday! And secondly, congratulations! You can now purchase your very own health insurance. In fact, once you turn 26, your parent’s can no longer cover you under their health plan. Remember, Independence Blue Cross is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if IBC has a plan that’s a good fit for you, or click here for… 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 ReadingIRS Releases Draft 2015 Forms 1094-C and 1095-C
Last week, the IRS issued draft 2015 Forms 1094-C and 1095-C. The forms are substantially the same as the 2014 forms,except for a couple of changes. Please click the link below to read the bulletin. IRS Releases Draft 2015 Forms 1094-C and 1095-C – 062615R Not sure what forms you need? Fee free to contact your Total Benefit Solutions account manager at (215)355-2121 or check our health care reform compliance center.
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
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