Departments issue new ACA FAQ’s

The Departments of Labor, the Treasury, and Health and Human Services (collectively, the “Departments”) have issued the 31st set of Affordable Care Act (“ACA”) frequently asked questions (“FAQs”). This time, the Departments address a wide range of topics including preventive services, disclosure obligations, coverage in connection with approved clinical trials, reference-based pricing, the Mental Health Parity and Addiction Equity Act, and the Women’s Health and Cancer Rights Act. Below is a brief summary of the guidance issued on these topics. Click the link below to download the bulletin.   Download Departments Issue 31st set of FAQs

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Nondiscrimination regs cover TPAs, dental and more

  Nondiscrimination regs cover TPAs, dental and more The U.S. Department of Health and Human Services (HHS) has completed nondiscrimination regulations that might have a major effect on insurers that sell public exchange plans but might not have much of an effect on others. The HHS Office for Civil Rights (OCR) and the HHS Office of the Secretary posted a 362-page preview version of the final regulations today. The official version of the final rule, which is based on a draft released in September, is set to appear Wednesday in the Federal Register. Read the story at Life & Health Pro

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2017 Inflation Adjusted Amounts for HSAs

The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2017.  Most limits remained the same as 2016 amounts. Click the link below to download the bulletin. 2017 Inflation Adjusted Amounts for HSAs

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Health Care Reform: 8 things the IRS wants small employers to know about the health care tax credit

  The Affordable Care Act’s small business health care tax credit is designed to encourage small employers to offer health insurance coverage to their employees. Click the link below to download the whitepaper 8 things the IRS wants small employers to know about this credit: 8 Things to Know About the Small Business Health Care Tax Credit For more information about the Small Business Health Care Tax Credit contact your Total Benefit Solutions, Inc account manager at (215)355-2121 or visit your ThinkHR library at www.thinkhr.com and log in.     Watch a video below about the Small Business Healthcare Tax Credit

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Obama administration backs off on ACA rules for 2017 health plans

CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry.   Click here for the full story from Modern Healthcare   As always, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about the Affordable Care Act.

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GAO Report: PPACA- CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk

During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014. The GAO applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though GAO sent fictitious documents, or no documents, to resolve application inconsistencies   Click here for the highlight sheet Click here for the full report

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2016 Federal Poverty Guidelines Updated

Large employers may be subject to the employer penalty under the Affordable Care Act if they do not offer affordable, minimum value coverage to all full-time employees and at least one full-time employee receives a subsidy in the Exchange. The Federal Poverty Line (“FPL”) is relevant to this penalty in two ways. Please click the link below to download the bulletin with he new guidelines. 2016 Federal Poverty Guidelines If you have any additional questions regarding this bulletin, or the Affordable Care Act please contact your Total Benefit Solutions, Inc account manager at (215)355-2121.

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IBC: Distribution of 1095 Tax Forms

Information about distribution of 1095 tax forms Beginning February 8, Independence Blue Cross will begin mailing IRS 1095-B tax forms on a rolling basis to subscribers who purchased plans individually off-exchange and to subscribers of fully insured group employers. The purpose of these forms is for individuals to verify that they had minimum essential health care coverage during the previous calendar year, as required by the Affordable Care Act. We are issuing 1095-B forms to subscribers only, unless we receive a request from a subscriber to issue a duplicate form to an enrolled spouse and/or dependent. What you need to know about 1095 forms It’s important to know that who… Read More

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New Guidance Tackles Employer Mandate Issues

  A number of Employer Mandate updates are included in this bulletin. Please click on the link to download this important update. As always please contact your Total Benefit Solutions, Inc account manager if you have any questions or concerns regarding this release at (215)355-2121. Download Update:Employer Mandate Issues 2016                

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Several Health Plans Cutting Broker Commissions for ACA Health Plans

Several Health Plans Cutting Broker Commissions for ACA Health Plans. Why should this concern Total Benefit Solutions clients? Because with insurers like Aetna, Humana, Highmark  and United Healthcare removing broker compensation, our only recourse will be to collect a fee from consumers who need and engage our professional services. This of course has a direct effect on our clients as their cost to access services and care increases. Otherwise consumers may be left to fend for themselves in the ACA health insurance Marketplace! Click the link below to download the story.   Broker Commissions Article Published on Healthcare Exchange

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2016 Health Insurance Open Enrollment Begins

2016 Individual and Family Plans Open Enrollment for 2016 Open enrollment opens on November 1st 2015 and ends on January 21st 2016. As the 2016 Open Enrollment Period gets ready to explode, we will be updating this page regularly with plan benefits, rates and information as they become available. Remember Total Benefit Solutions dedicated, licensed, certified and insured representatives can help anyone enroll on the healthcare Marketplace, or off!   Full Service Client Intake Form: Click here to get started. This is not an application for insurance. This form will provide the information that is needed to determine Marketplace eligibility and must be entered on Healthcare.gov We understand that Health Care… Read More

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Health Reform Video: What Counts as Income in the Marketplace?

  What Counts as Income when applying for a Marketplace subsidy? This short video may help:     As always contact your Total Benefit Solutions account manager at (215)355-2121 for help applying for a subsidy and health plan on or off the Marketplace.

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Key Facts You Need to Know About: Cost-Sharing Reductions

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

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New 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

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Video: 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!    

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Health 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

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Video: 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

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Health 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

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Aetna: TV Commercial “Aetna works for my life”

    Enjoy the latest TV Commercial from Aetna. Remember, Aetna 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 Aetna has a plan that’s a good fit for you.  

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Download 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

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Supreme 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.

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CMS 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

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Lost 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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Lost 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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Gov. 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.

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