Individual Mandate | Total Benefit Solutions Inc

2021 Second Quarter Compliance Bulletins Compilation

July 7, 2021July 7, 2021Ed MacConnell

This document is a valuable resource, putting all of the latest health care reform news and updates in one location!

Achieve Well-being Rewards

July 1, 2021June 30, 2021Ed MacConnell

Independence Blue Cross (Independence) offers a new way to help your employees achieve their health goals. Reward employees for completing activitiesNothing helps motivate action like the promise of rewards!*Achieve Well-being tools available on ibx.com and on the IBX mobile app create personalized action plans that make it easy for your employees to earn tokens and badges for completing their well-being goals.New for 2021, your employees can now receive a $150 gift card by completing the following required activities: Annual check-up with PCPFlu shotGet digitally engagedMember portal registrationMDLIVE.com registrationWell-being profileOpt-in to digital messaging at ibx.com Once your employees complete all six activities through the Achieve Well-being tool they can redeem a… Read More

Supreme Court Dismisses Latest Challenge to the ACA

June 29, 2021June 29, 2021Ed MacConnell

The “individual mandate” provision of the ACA as originally enacted in 2010 required most U.S. residents to obtain minimum essential health insurance coverage or pay a monetary penalty. The individual mandate penalty withstood a legal challenge in 2012 when the Supreme Court ruled itwas a valid exercise of Congress’ taxing power. However, Congress effectively eliminated the individual mandate penalty by reducing it to zero effective January 1, 2019. Download Supreme Court Dismisses Latest Challenge to the ACA

What does the health insurance term “Play or Pay” mean?

June 24, 2021June 23, 2021Ed MacConnell

Play or Pay is a two-prong test that applies to Applicable Large Employers (ALEs) with 50 or more full-time employees (including full-time-equivalents): First, does the employer offer basic health coverage to most full-time employees and their children? If not, the employer is at risk for a large penalty.For employers that pass the ﬁrst prong without a penalty, the second test is whether the employer offers all full-time employees and their children affordable coverage providing minimum value. If not, the employer is at risk for a different (smaller) penalty. The two penalty types — called “A” and “B” for the sections in the law — are designed in tandem so that… Read More

SCOTUS Upholds Affordable Care Act Ruling

June 22, 2021June 22, 2021Ed MacConnell

The Supreme Court has dismissed a challenge to ObamaCare, leaving the industry as is for employers and individuals. By a 7-2 vote on Thursday, the justices left the entire law intact in ruling that Texas and two individuals had no right to bring their lawsuit in federal court. The Supreme Court of the United States heard oral arguments on November 10, 2020, as to the question of whether the Affordable Care Act’s Individual Mandate provision is constitutional. This case, California vs. Texas is the latest challenge against the Affordable Care Act (ACA) and the second time the Justices addressed the constitutionality of the Individual Mandate portion of that law.… Read More

Tax Advantaged Benefit Documents

June 18, 2021June 18, 2021Ed MacConnell

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

Alternatives to Health Insurance Benefits

June 13, 2021June 18, 2021Ed MacConnell

Sometimes clients offer other alternative benefits to their employees. The reasons for doing this are many but depending on the earnings of their workforce, offering a group medical plan will eliminate any health insurance subsidy. In those cases offering a group health insurance benefit can come off as a penalty for the employees. By offering alternative benefits our experts can help the employees enrolled on a subsidized health insurance plan and still get good if not great benefits from their employer! ICHRA: with an ICHRA the employer can give the employees money towards their health insurance purchase. The ICHRA allows the employer to do so with untaxed dollars and the… Read More

IRS Guidance Clarifies DCAP Relief

June 9, 2021June 10, 2021Ed MacConnell

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

What is Modified Adjusted Gross Income (MAGI)?

June 3, 2021June 3, 2021Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return.

What is Balance Billing?

June 2, 2021June 3, 2021Ed MacConnell

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Ask your health insurance experts at Total Benefit Solutions today how to avoid balance billing charges!

What is a Qualified High Deductible Health Plan?

May 25, 2021May 25, 2021Ed MacConnell

Qualified HDHPs Enrollment in a qualified HDHP is a requirement for establishing and maintaining a health savings account. The chassis for a qualified HDHP is the same as described in Chapter 1, but it must also conform to certain federal guidelines: A qualified HDHP must specify both a minimum annual deductible and a maximum annual out-of-pocket (OOP) expense limit, as set every year by the IRS. The minimum annual deductible is just that—the minimum amount that the insured must pay before the plan pays any benefit. The maximum annual OOP expense limit is the cap on the sum of the annual deductible and all out-of-pocket expenses the insured must pay for covered expenses under the… Read More

What Is a Health Savings Account?

May 21, 2021May 21, 2021Ed MacConnell

A health savings account is a special purpose financial account that allows a consumer to save and pay for medical expenses on a tax-favored basis. Funds deposited into an HSA are not taxed; the funds in the account grow tax free; and the money accumulated in the account can be withdrawn tax free to pay for qualifying medical expenses. In effect, an HSA owner uses the account in a manner similar to a checking account to cover his or her (or his or her family’s) medical expenses. There are no income restrictions or requirements on who may or may not open and contribute to an HSA. The HSA—the account and its funds—belongs… Read More

women friends in masks standing in subway passage

Aetna Small Group (2-100) Insured & Small Group Aetna Funding Advantage FAQ
Health Plan options for business owners during COVID-19 pandemic

May 20, 2021May 21, 2021Ed MacConnell

Aetna is mindful of the many challenges our small business customers and their employees are facing as a result of the COVID-19 pandemic. Many are experiencing slower sales, reductions in hours, layoffs and more. The attached Frequently Asked Questions (FAQ) includes our current responses to questions we know are top of mind for many of Small Group Insured and Small Group Aetna Funding Advantage Self-Insured customers. These responses will remain in effect until June 30, 2021 unless otherwise specified. We will continue to evaluate and update our responses as the situation evolves. Downlaod FAQ: Commercial Small Group COVID-19 FAQ

IRS Announces New Inflation Adjusted HSA and HRA numbers for 2022

May 14, 2021May 14, 2021Ed MacConnell

These new rates will take effect for the calendar year 2022. Please reach out to your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 if you have any questions or concerns about this notice.

What Is Medicare Supplement Insurance?

May 12, 2021May 14, 2021Ed MacConnell

Medicare coverage can be complex. Some of the rules of Medicare coverage can change without the beneficiary even knowing. Who even knows when their employer crosses an enrollment threshold? Best advice is to always speak to a health insurance specialist who is certified and experienced in the many facets of health insurance including the intersections between Medicare and Employer coverage. Contacting Total Benefit Solutions, Inc is the first step!

IBC: MLR Additional Rebates

May 7, 2021May 10, 2021Ed MacConnell

Notice from Independence Blue Cross: Health insurance premium rebates for 2017 Small Group policyholders and 2018 Consumer policyholders As a result of a United States Supreme Court decision last year, Independence received additional payment from the Federal Government that impacted our Medical Loss Ratio (MLR) for 2017 and 2018. Beginning the week of May 17, Small Group policyholders from 2017 and Consumer policyholders from 2018 will receive checks that are a rebate for a portion of their health insurance premiums for that year. What is MLR? The Affordable Care Act requires that all health insurers spend a percentage of each premium dollar received towards paying claims, clinical services, and activities that improve health care quality for… Read More

Update on COVID-19 Vaccine and Vaccine Administration Cost

April 23, 2021April 23, 2021Ed MacConnell

Update on COVID-19 Vaccine and Vaccine Administration Cost Medicare has increased and simplified its payment rate for administration of the COVID-19 vaccine to $40 per dose. This change may impact group health plans with respect to their payment rate to providers. Non-grandfathered group health plans are required to cover, without cost sharing, the COVID-19 vaccine. This obligation extended to coverage associated with administering the vaccine. The federal government continues to pay for the vaccine itself through funding authorized by the CARES Act.For vaccines administered in-network, plans will pay the rate negotiated with in-network providers, and that continues to be true. For vaccines administered out-of-network, however, group health plans must reimburse… Read More

Heard of Reference Based Pricing Health Insurance?

April 12, 2021April 13, 2021Ed MacConnell

Reference-based pricing is a payment system that replaces or enhances a health plan’s traditional “usual and customary” pricing for contracted claims. Rather than calculating the average charge of providers in a geographic area or a pre-contracted cost, a health plan utilizing reference-based pricing instead arbitrates its allowable amount for medical claims based on its chosen method (most commonly Medicare rates, or a certain percentage above those rates), which is a price that the payor deems reasonable. In other words the employer, the payor brings their rates with them into the health care agreement, not the other way around. This represents a much more independent framework for determining sensible health care… Read More

How Does Level Self Funded Health Insurance Work?

April 7, 2021April 7, 2021Ed MacConnell

We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding your group’s health insurance might be a good for for your health plan! Contact your Total Benefit Solutions Account manager at (215)355-2121.

Does Medicare Cover Oral Surgery?

April 5, 2021April 2, 2021Ed MacConnell

From our partners at HealthLine: If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs. While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage. Let’s explore which types of oral surgery Medicare covers and why. Click here for the full story. Questions about this story or Medicare coverages? Please contact your health insurance specialists at Total Benefit Benefit Solutions, Inc (215)355-2121

ARPA Extends Open Enrollment for Individual Coverage in PA

April 1, 2021April 1, 2021Ed MacConnell

Pennie (PA Individual Exchange) has communicated that they will be extending the open enrollment period from May 15 until August 15, 2021. This extension is to help consumers be able to take advantage of the benefits of the American Rescue Plan. Some of the key benefits of this plan are below: There is no longer a cap on who is eligible for Pennie’s income-based tax credits, which help reduce monthly premium costs. Previously only people whose household income was under 400% of federal poverty level (about $51,000 for an individual), could qualify for a tax credit. Now, anyone may be eligible for a tax credit. The size of the tax… Read More

Enrollment Period at Get Covered New Jersey Extended

March 31, 2021March 31, 2021Ed MacConnell

More information on the American Rescue Plan Act changes may be found on the Get Covered New Jersey website. Contact your Total Benefit Solutions, Inc health insurance specialist to get enrolled or if you have any questions or concerns at (215)355-2121

What is Minimum Essential Coverage or MEC health insurance?

March 30, 2021March 31, 2021Ed MacConnell

The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More

Health Insurance: What Do You Pay for?

March 23, 2021March 26, 2021Ed MacConnell

What Is a Monthly Premium? Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year. For individual ACA compliant plans, premiums are based on a pre-approved age based grid. When you enter a age on the grid, your premium will increase on your bill. What Are Out-of-Pocket Costs? Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a… Read More

Category: Individual Mandate