The Driver’s Dilemma: Why You’re Not ‘Stuck’ Without Health Insurance (Even If You’re 1099)

Ed MacConnellNo Comments

Meet Sal. Sal has been driving for Uber and Lyft in the Philadelphia area for three years. He loves the flexibility, being his own boss means he never misses his daughter’s soccer games. But there’s one thing that keeps Sal up at night: the "Driver’s Dilemma." As a 1099 independent contractor, Sal doesn’t have an HR department. He doesn’t have a benefits package waiting for him in an app menu. For a long time, Sal believed he was "stuck" either paying full price for a plan that cost more than his car payment or crossing his fingers and hoping he didn’t get sick. If you’re a driver, delivery person, or… Read More

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ICHRA Admin: Who’s Actually the Best? A No-Nonsense Comparison for 2026

Ed MacConnell

Internal Note for Ed Hey Ed, Buckle up, because the ICHRA vendor landscape in 2026 is starting to look like a high-speed tech race, but with more compliance paperwork. Here’s the skinny on why I picked these specific players for the blog. If you’re dealing with a small shop (under 50 lives), PeopleKeep is still the automated king of “set it and forget it.” But if you’re hunting whales (200+ employees), SureCo and Remodel Health are the heavy hitters because they actually know how to talk to a CFO without making their head explode. The most important part for us? Broker friendliness. I’ve highlighted who actually respects our AOR status… Read More

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Blue Card PPO

Blue Card PPO: The “Don’t Leave Home Without It” of Health Insurance

Ed MacConnell

WordPress Category: Medicare We’ve all been there. You’re packing your bags for a long-awaited cross-country trip or perhaps moving your oldest child into their first college dorm three states away. Amidst the excitement of travel or the bittersweet goodbyes, a nagging thought usually creeps in: "What happens if someone gets sick?" In the world of health insurance, being "out of network" can feel like being stranded on a deserted island without a map. Suddenly, a simple urgent care visit for a sinus infection turns into a financial nightmare because your plan only "likes" doctors within a twenty-mile radius of your house. That’s where the Blue Card PPO comes in. If… Read More

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The Ultimate Guide to Ozempic Coverage: How to Fight Denials and Win Your Appeal

Ed MacConnell

If you feel like you’re in a constant wrestling match with your insurance company over Ozempic, you’re not alone. It’s April 2026, and while GLP-1 medications like Ozempic, Wegovy, and Mounjaro have revolutionized healthcare, they’ve also created a massive administrative headache for patients and employers alike. At Total Benefit Solutions Inc., we see these "denial letters" every single day. Most people open them, feel defeated, and assume the fight is over. But here’s the truth: a "no" from an insurance company is often just the beginning of a negotiation. As independent advocates, we’ve learned that the secret to winning isn't just asking nicely, it’s about knowing the rules of the… Read More

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7 Mistakes Contractors Make with Group Health Benefits (And How to Fix Them)

Ed MacConnell

In the construction world, your reputation is built on the quality of your work and the reliability of your crew. As of April 13, 2026, the labor market for skilled trades remains incredibly tight. Finding a good foreman or a reliable HVAC technician is hard enough; keeping them is an entirely different challenge. One of the most powerful tools you have to retain talent is your benefits package. However, many contractors view health insurance as a "necessary evil": a line item on the P&L statement that only goes up every year. Because of this, we often see business owners in the construction industry make critical errors that cost them tens… Read More

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Delaware Paid Leave: What Small Businesses Need to Know in 2026

Ed MacConnell

If you’re a business owner in the First State, you’ve likely spent the last few months (or years) hearing whispers about the "Healthy Delaware Families Act." Well, the future is officially here. As of January 1, 2026, the Delaware Paid Family and Medical Leave (PFML) program is fully operational, and benefits are being paid out to eligible employees across the state. At Total Benefit Solutions Inc, we’ve been fielding calls daily from small business owners who are somewhere between confused and concerned. I get it. Managing a business is hard enough without having to navigate new state mandates, payroll deductions, and employee leave requirements. But here’s the good news: This… Read More

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The Big Insurance Lie: Why your small business is probably overpaying for “peace of mind” (and how to stop)

Ed MacConnell

Let’s have a straight-talk conversation. If you are a small business owner, you’ve probably been told that the "safest" way to handle employee benefits is to sign up for a traditional, fully-insured plan from one of the big-name carriers, pay your monthly premium, and put the whole headache out of your mind. They call it "peace of mind." At Total Benefit Solutions Inc, we call it the "Big Insurance Lie." The truth is, many small businesses are overpaying for their health coverage by anywhere from 15% to a staggering 80%. When you consider that health insurance is often the second largest expense on a balance sheet after payroll, that "peace… Read More

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MVP vs. MEC: The Compliance Difference That Could Cost You Thousands

Ed MacConnell

If you’ve been following our blog recently, you know we’ve been diving deep into the world of Minimum Value Plans (MVP). We’ve talked about compliance and why your plan needs to actually meet these standards. But here is where things usually get messy for HR managers and business owners: the alphabet soup of the ACA. Specifically, the difference between MEC (Minimum Essential Coverage) and MVP (Minimum Value Plan). To the untrained eye, they sound like the same thing. They both start with "Minimum," they both deal with health insurance, and they both keep the IRS off your back, right? Not exactly. Confusing these two isn't just a minor clerical error;… Read More

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HRAs Growing for Small Businesses

Lily Dalton

Health Reimbursement Arrangements (HRAs) are becoming an increasingly popular option for small businesses looking to provide affordable healthcare benefits. These employer-funded accounts allow companies to contribute tax-free dollars that employees can use to cover qualified medical expenses or purchase individual health insurance. There are several types of HRAs available, including the General HRA, which works alongside group insurance to cover out-of-pocket costs like co-pays, dental, and vision; the Individual Coverage HRA (ICHRA), which reimburses employees for insurance they purchase on their own; and the Qualified Small Employer HRA (QSEHRA), designed specifically for businesses with fewer than 50 employees that do not offer group plans. One of the main advantages of… Read More

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ACA Employer Mandate penalties are the highest ever

Ed MacConnell

ACA Employer Mandate penalties are the highest they have been since passage of the ACA. Here is a quick refresher for appliable large employers (or those close to hitting the 50 FTE threshold) on determining ALE status and tracking hours of its employees.

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Lost Your Job? Here’s Your Complete Guide to Health Insurance Options (COBRA vs ACA vs Medicaid Compared)

Ed MacConnell

Losing your job hits hard enough without worrying about losing your health insurance too. The good news? You’ve got options, and we’re going to walk through every single one so you can make the smartest choice for your situation. Here’s the reality: You have 60 days from your last day of coverage to make a decision. That might seem like plenty of time, but trust me: these 60 days fly by when you’re dealing with job searches, unemployment paperwork, and everything else that comes with a career transition. The three main paths forward are COBRA (continuing your old employer’s plan), ACA Marketplace plans (buying individual coverage), and Medicaid (government assistance… Read More

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Stay informed on health legislation like PA Act 1 & HRSA cancer screening coverage!

Loramei Romeo

The recent PA state legislation, Act 1, marks a significant advancement in women’s healthcare by mandating health plans to cover supplemental diagnostic radiology services and genetic screenings for those at increased risk of breast cancer and BRCA mutations. This legislation is designed to eliminate out-of-pocket costs for these essential health services, ensuring that women who need these screenings can access them without financial barriers. In response to recent legislative changes, Independence Blue Cross has updated its coverage policies to eliminate cost-sharing for annual supplemental breast cancer screenings and genetic testing for those at increased risk. This change is vital in improving access to preventive care for individuals concerned about breast… Read More

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ACA Individual Market Highmark

Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

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Next Year Cost for Pennie Customers May Increase

Loramei 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

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Benefits 101 Comparison HSAs HRAs FSAs

Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. 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.

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Notice For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP)

Loramei Romeo

For: Braven Health and Horizon NJ TotalCare (HMO D-SNIP) Hackensack Meridian Health Remains In-Network for Braven Health and Horizon DSNP MembersAs of June 1, 2025, Hackensack Meridian Health (HMH) terminated their hospital from Horizon Hospital Network unless Horizon agrees to increase prices for services and cares at their facilities. This change does not impact Braven Health or Horizon NJ TotalCare (HMO D-SNP). Braven Health and Horizon TotalCare (HMO D-SNP) members can continue using HMH providers and hospitals. Why is this not impacting Braven Health and DSNP and will it soon?Only certain Horizon members are affected by the change in hospital network status. Braven Health and Horizon TotalCare (HMO D-SNP) members… Read More

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Reminder for Medicare Part D CMS

Loramei Romeo

Employers who sponsoring a group health plan, whether they are self-insured or insured, are required to notify the Centers for Medicare and Medicaid Services (CMS) of the creditable (or non-creditable) status of the plan’s prescription drug coverage. Employers must go to CMS’s online reporting system at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html. to provide this information. Just a friendly reminder that notice needs to be given by the following dates: • Within 30 days following the prescription drug plan’s termination. • Within 60 days following the start of each plan year. • Within 30 days following any modification to the prescription drug plan’s creditable coverage status. If an employer-sponsored prescription drug plan’s creditable coverage status changes… Read More

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Horizon and Braven Health Prescription Drug Benefits

Loramei Romeo

IMPORTANT NOTICE: Horizon and Braven Health Prescription Drug Benefits GLP-1 medications like Ozempic and Mounjaro are covered by the prescription drug benefits of Horizon Medicare Blue Rx (PDP) and Braven Health Medicare Advantage plans. GLP-1 medications are used to treat obesity and type 2 diabetes. Medicare, however, only covers these medications for diabetes. Prior authorization is also required for GLP-1 medications. This implies that before we agree to cover the medication, the member or their practitioner must obtain plan approval. To guarantee pharmaceutical safety and assist in directing the proper use of specific medications, prior permission is implemented. The medication may not be covered by the plan if the member DOES… Read More

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Federal Poverty Guidelines Announced for 2025

Loramei Romeo

The 2025 federal poverty guidelines were recently released by the Department of Health & Human Services (HHS), they provide the federal poverty level (FPL) affordability safe harbor for the purposes of the employer mandate under the Affordable Care Act (ACA). The 2025 FPL safe harbor is $117.63/month in the lower 48 states and DC, $146.95/month in Alaska, and $135.22/month in Hawaii for plan years starting on February 1, 2025, or later. To qualify for the FPL affordability safe harbor, a plan may employ poverty rules that are in force six months prior to the start of the plan year. The lower 48 states and DC utilize $113.20/month for plans with… Read More

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Important Update Regarding the Distribution of Form 1095-B for Tax Year 2024

Loramei Romeo

Horizon BCBSNJ is constantly searching for methods to make working with us more convenient and easier. For this reason, Horizon has modified the way they provide Form 1095-B to their members who are fully insured this year. What is Form 1095-B?The names, residences, Social Security numbers, and number of months that each member of a fully insured health plan was covered from January 1 to December 31 of each calendar year are reported on Form 1095-B. Form 1095-B is explained in greater detail here. How Is Distribution Changing This Year?  In previous years, Form 1095-B was sent by mail to all subscribers enrolled in a Horizon fully insured plan. However,… Read More

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Main Line Health and Lifeline Medical Associates

Loramei Romeo

Highmark Medicare Advantage participants will no longer have in-network access to Main Line Health providers and facilities as of January 1, 2025. In the beginning of October, Highmark notified members who were affected by this disruption that Main Line Health might become out-of-network. Members should contact the member services number shown on the back of their ID card if they have any issues concerning continuity of care or how to locate another in-network provider or facility. For FEP, ACA, and CHIP members of Highmark, Main Line Health remains in-network. Lifeline Medical Associates (DE): Highmark ACA Members’ Out-of-Network Date Is Extended to March 2, 2025, Subject to Ongoing Negotiations We spoke… Read More

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