How Does Level Self Funded Health Insurance Work?

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.

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Does Medicare Cover Oral Surgery?

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  

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Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

there are millions of uninsured people who could be getting subsidized coverage on the ACA Marketplaces, but have not taken advantage of this financial help. In many cases, it may be that the financial help available to them is not sufficient to make the premium or the deductible affordable

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ARPA Extends Open Enrollment for Individual Coverage in PA

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

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Enrollment Period at Get Covered New Jersey Extended

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

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What is Minimum Essential Coverage or MEC health insurance?

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

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Health Insurance: What Do You Pay for?

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

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Departments Issue Guidance Re: FFCRA and CARES Act

On February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued FAQ 44 addressing health coverage issues related to COVID-19. Briefly, the new FAQs focus on diagnostic testing and coverage for testing and clarify previous guidance in FAQs.Background Section 6001 of the FFCRA requires group health plans (including grandfathered health plans) and health insurance issuers to provide coverage for certain items and services related to testing or the diagnosis of COVID-19 without any cost-sharing requirements, prior authorization or othermedical requirements. Section 3201 of the CARES Act amended Section 6001 of the FFCRA to include a broader range of diagnostic items and services… Read More

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New COBRA Subsidy Begins April 1st under COVID Relief

Congress passed the American Rescue Plan Act of 2021 (“the Act”) on March 10, 2021 and it was signed into law on March 11, 2021. The Act includes a 100% COBRA subsidy available to certain COBRA qualified beneficiaries who lose group health plan coverage as the result of an involuntary termination or reduction in hours. This is different from the original House legislation, which included an 85% subsidy (with the COBRA beneficiary responsible for 15% of the COBRA premiums). Employers will be able to claim a credit against payroll taxes to reimburse the cost of the subsidy. The COBRA subsidy begins April 1, 2021 (the first day of the month… Read More

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What is a benefit Third Party Administrator (TPA)?

A Third-Party Administrator (TPA) is an organization that processes insurance claims or specific aspects of employee benefit plans for other organizations. Using a TPA is a generally a way to outsource claims processing. Employers that self-insure their health insurance benefits often outsource to a TPA. Using a TPA can be a smart business decision whether you want expertise in particular areas or avoid the costs and liabilities of doing it in house. But not always self insured employers need a TPA. Third party administrators also handle many aspects of other employee benefit plans such as the processing of retirement plans.  Most employers who provide health insurance plans use a TPA… Read More

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What is a Direct Primary Care plan?

Photo by CDC on Unsplash What is Direct Primary Care (DPC)? DPC is a non-insurance healthcare model where a flat monthly fee is paid for a defined set of primary care services. Direct Primary Care membership typically includes timely and unlimited access to your physician via in-office visit or over the phone. The model is structured to emphasize the patient-physician relationship to lower care costs, promote better employee health, and better patient experience. Benefits include: Increased Access to Healthcare. Breaks down the barriers to healthcare like confusing narrow networks, high deductibles and limited enrollment period. Detect Diseases and Treat Sooner. Encourages the early detection of illnesses, which reduces expenses for both… Read More

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What is a minimum essential coverage (MEC) plan?

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

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Review us on Google

 At Total Benefit Solutions we strive to provide our clients with the best service and support when shopping, enrolling and servicing their health insurance all year long. We appreciate having the opportunity and as always “We Work for Your Benefit”.  If you have worked with us, please help us get some feedback by  reviewing us on Google.  You’ll need to be logged in to your Google account to do so. Click here to rate us!

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Pennie is Pennsylvania’s new official destination for shopping for quality health insurance plans and accessing financial assistance, if eligible.

Pennie is Pennsylvania’s new official destination for shopping for quality health insurance plans and accessing financial assistance, if eligible. When is open enrollment? Open enrollment is November 1, 2020, to January 15, 2021. During this time period, anyone living legally in Pennsylvania can apply for health insurance through Pennie. Individuals with qualifying life events can enroll at any time of the year. Who can help you enroll? They have several options to assist you in enrolling in a health insurance plan. Don’t try completing the enrollment process by yourself, the experts at Total Benefit Solutions, Inc are Pennie-certified Brokers. Where can I learn more about financial assistance and if I… Read More

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HSA/HDHP Limits Increase for 2020

On May 28, 2019, the IRS released Revenue Procedure 2019-25 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2020. These limits include: The maximum HSA contribution limit; The minimum deductible amount for HDHPs; and The maximum out-of-pocket expense limit for HDHPs. These limits vary based on whether an individual has self-only or family coverage under an HDHP.  The IRS limits for HSA contributions increase for 2020. Eligible individuals with self-only HDHP coverage will be able to contribute up to $3,550 for 2020, while eligible individuals with family HDHP coverage will be able to contribute up to $7,100 for 2020. The HDHP… Read More

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Court Strikes Down Association Health Plan Rules

On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret” ERISA when issuing these rules: • expanding the definition of “employers” to include disparate groups of employers with no other commonality of interest other than geographic location; and • bringing working owners without employees within ERISA’s framework. This ruling effectively eliminates the expansion of AHPs to certain employers and working owners who do not meet the original parameters to be a part of an AHP. Click below to download the complete… Read More

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Important News From Independence Blue Cross: Trinity Health termination

February 11th 2019: For the past several months, we have been negotiating the terms of our agreements with Trinity Health (Trinity), which includes the following entities, as well as their professional providers, subsidiaries, affiliates, and divisions: Mercy Health System of Southeastern Pennsylvania, including Mercy Fitzgerald, Mercy Philadelphia, and Nazareth hospitals St. Mary Medical Center, including St. Mary Rehabilitation Hospital, Saint Francis Healthcare, including Saint Francis Hospital, Wilmington, Delaware. We continue to engage in good‑faith negotiations, but we want to explain how customers and members could be affected if we are unable to reach a new agreement by March 31, 2019. How members would be affected If we are unable to reach a new agreement, Trinity will no longer be… Read More

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Important Info! HSA Limits for 2019

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What is an HRA and How It May See A Major Change Soon..

Before we get into how rules for HRAs may be changing, we should discuss what an HRA is and how it works. A Health Reimbursement Account (sometimes referred to a Health Reimbursement Arrangement) is an employer-funded group health plan that reimburses employees, tax-free, for qualified medical expenses up to a certain amount per year. This type of policy does not replace Medical Insurance and is usually coupled with a High-Deductible policy. Unlike an Health Savings Account (HSA), the Employee can not help to fund the account.  Like HSAs though, there are maximum allowed contributions. In 2018, an Employer can fund an HRA up to $5,050 for a Single Employee and $10,250… Read More

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How do you calculate the number of full time equivalent employees?

How do I calculate the number of full time equivalent (FTE) employees?” Employers ask us all the time how the go about figuring how many FTE’s or Full Time Equivalents they have for ACA compliance purposes. Because the Affordable Care Act’s Employer Mandate (Employer Shared Responsibility Payments or the Play or Pay ) only applies to “applicable large employers,” defined as employing 50+ FTE employees. What if you don’t have 50 employees? So if you do not have 50 employees or anywhere close to it, you can rest assured, you don’t have to calculate.  The employers who typically have the biggest challenges are the employers who have a large number of part… Read More

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Total Benefit Solutions featured in the Southampton Spirit

Total Benefit Solutions: A Committed Team Focused On ‘Clients First’ For Health Insurance by Tianna Grosch Looking for affordable health insurance but not sure where to start? Seeking the correct health insurance with benefits fit to your needs can be a daunting task, one that you should leave in the hands of caring and compassionate professionals. Total Benefit Solutions, Inc. (TBS) is the right place to get the advice and assistance you need in order to make the best enrollment decision whether you’re a family, senior or company. Ed and Kathleen MacConnell began this agency inspired by their own difficulties in receiving insurance coverage for their daughter Katelin, who was… Read More

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IBC 2019 Member Renewal Notices

October 25th: Independence Blue Cross Member Renewal Letter details Due to the subsidy disruption in some counties, Independence will be sending renewal notices in 2 waves. On October 25th 2018: • Members who do not receive a subsidy will receive their renewal notices for 2019. The notice will include benefit and premium updates for 2019 and provide a personalized URL for a website that enables them to renew plans as-is (EZ Button), or make a change to their current plan. • Members who have a subsidy will receive a letter advising that Independence is waiting for more information from the federal government regarding their subsidy dollars. Upon receipt of this information, the renewal notices will be sent.… Read More

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Do You Qualify For A Special Enrollment Period?

Have you lost your health insurance coverage due to a change in employment, a move, or another life event? Since the 2018 Open Enrollment Period is over, you can only enroll in or change a Health Insurance Marketplace plan if you have a life event that qualifies you for a Special Enrollment Period. Below are Life Events that can grant you a Special Enrollment Period. If you have any questions or would like to talk to someone here about a quote, give us a call at 215-355-2121 or click here. Life changes that can qualify you for a Special Enrollment Period -Changes in household- You may qualify for a Special Enrollment… Read More

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