Cigna+Oscar Announcement

Oscar and Cigna Healthcare have made the decision not to renew Cigna + Oscar Small Group plans nationally as of December 15, 2024. They will continue to provide coverage for Cigna + Oscar Small Group services through the end of each member’s policy, and specific timing is dependent on each groups’ enrollment date. Dates: As per the federal and state deadlines, Cigna + Oscar will inform plan sponsors and insured persons about the discontinuation. Oscar will stay active in the individual market and concentrate on that area of the company’s operations. To see ARTICLE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated… Read More

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IRS Addresses Tax Treatment Of Work-Life Referral Services

The Internal Revenue Service (“IRS”) clarified the tax treatment of several work-life referral (“WLR”) services offered by employers in a new Fact Sheet FAQ. According to the FAQ, the value of the WLR services may be deducted from employees’ salary as a de minimis fringe benefit in cases when they are included in employee assistance programs (“EAPs”) or are otherwise bundled with other services. WLR Programs WLR services are offered to qualified employees through the employer-funded WLR program. WLR services are informative and referral consultations that help staff members locate, engage, and bargain with life-management providers to find answers to personal, professional, or family problems. Generally speaking, unless a part… Read More

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Medicare Supplement plan closure

AmeriHealth will stop accepting new enrollments for any Medicare Supplement plans as of April 1, 2024, the date the plans go into effect. Medicare Supplement Plans A, C, D, F, G, G-HD, and N were provided by AmeriHealth. Members who are presently enrolled in these plans will continue to receive services from AmeriHealth, guaranteeing that their coverage will not be stopped. To read more about the article click HERE 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… Read More

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2025 Medicare Advantage and Part D Rate Announcement

The Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The objectives set forth by CMS for Medicare and Part D align with our overall program vision for the agency, which includes advancing health justice, promoting affordability and the Medicare program’s sustainability, and driving comprehensive, person-centered care. Medicare Advantage and Part D Rate Announcement 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… Read More

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Claim Processing Delays and Invoice Updates

On February 21, 2024, MVP stopped doing business with Change Healthcare and its subsidiaries, as well as all digital interactions. This was due to a cyber security breach. In compliance with national and state regulations, MVP is implementing innovative business solutions and restoring affected service functionality as needed. Processing Delays for Provider Claims : New York State Department of Financial Services encourage issuers and pharmaceutical benefit managers (PBMs) to take into account granting provider requests to halt or reverse specific administrative processes. MVP is assessing each provider’s request for suspension and tolling individually and determining whether a certification is necessary. To read more click HERE We are dedicated to providing… Read More

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Health Care Cyberattack

Although it does not yet know when the recovery from the Change Healthcare hack last month will be completed, UnitedHealth is testing the system to restore it. This week, the care giant said that it is testing technology for processing medical claims. It already has mostly restored systems for handling drug claims and processing payments. The technology utilized to file and handle insurance claims is provided by Change Healthcare. It works with claims from many insurers and processes around 14 billion transactions annually. Some patients might be directed to different pharmacies where billing issues are less of a concern. Industry executives have stated that delays in patient bills are possible. Progress:… Read More

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UnitedHealthcare – RxDC Information Required by Deadline

Please assist us in answering the required questions in the CAA Pharmacy Data Collection request information that is located in the employer/broker portal. It will make sure that UnitedHealthcare can successfully submit the data report. In order for us to prepare the data for submission to CMS by June 1, 2024, we must get the information by April 10, 2024, thus your prompt answer is extremely important. To read more click HERE 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… Read More

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Aetna – Data Collection Requirement for Rx Data Collection Reporting Submission

The deadline for submitting Prescription Drug Data Collection (RxDC) reporting for the reference year 2023 is June 1, 2024. Certain data items that were not necessary for the first submission must be included in this one. As a result, Aetna has created a procedure to help our plan sponsors submit these reports. Important Update: Data Collection Requirement for Prescription Drug Data Collection Reporting Submission Read more HERE 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… Read More

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FTC to send nearly $100 million in refunds to consumers of Benefytt’s fraudulent health plans

Refunds are being sent by the Federal Trade Commission to customers it claims purchased fraudulent health plans that Benefytt Technologies misrepresented as Obamacare plans or  Affordable Care Act. Benefytt, which operated under several identities, including Health Insurance Innovations, used deceptive websites and aggressive marketing to trick people looking for health insurance into purchasing fake policies that came with expensive monthly premiums, according to the FTC’s August 2022 complaint. “Benefytt pocketed millions selling sham insurance to seniors and other consumers looking for health coverage,” Samuel Levine, director of the FTC’s Bureau of Consumer Protection, said in a statement at the time the original complaint was filed.  Qualified for the refund: Click HERE to… Read More

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IRS News Release: Nutrition, Wellness, and General Health Expenses

The Internal Revenue Service (IRS) is informing taxpayers that costs associated with wellness, diet, and overall health are unlikely to be covered by Internal Revenue Code section 213 reimbursement for medical expenses. The IRS published a press statement and a list of commonly asked questions the IRS: The IRS is worried that individuals might not be aware of the situations in which spending related to diet or wellness can qualify as medical costs. The IRS reminded people in a news release on March 6, 2024, that personal expenses cannot be reimbursed through FSAs, HSAs, or HRAs in a way that is tax-favored. Employers should be wary of vendors who advertise… Read More

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CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell  of  Total Benefit Solutions Inc  has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

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Medicare: Your Essential Guide

Understanding Medicare is crucial for making informed decisions about your healthcare coverage. Whether you choose Original Medicare or Medicare Advantage (Part C), knowing the basics empowers you to select the plan that best suits your needs. Original Medicare comprises Part A and Part B, covering hospital stays, doctor visits, and other essential services. Supplemental plans like Medicare Part D for prescription drugs and Medigap for additional coverage can enhance your benefits and reduce out-of-pocket expenses. Alternatively, Medicare Advantage plans offer a comprehensive alternative, bundling Parts A, B, and often D into a single package. These plans may extend coverage to dental, vision, and other services, providing a more holistic approach… Read More

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Navigating the Basics of Medicare: Understanding the Four Parts

Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. 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… Read More

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ACA’s Contraceptive Coverage: New FAQs Guide

On January 22, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a fresh set of Frequently Asked Questions (FAQs), shedding light on the Affordable Care Act (ACA)’s imperative for non-grandfathered medical plans to include specific preventive services, notably contraceptives, without imposing any cost-sharing on individuals. The aim of these FAQs is to address concerns from stakeholders, facilitating a better understanding of the contraceptive coverage mandate and encouraging compliance through an alternative method. For detailed insights and further information, download the PDF below. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

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Horizon Members Get 15% Off YMCA Memberships!

Exciting news for Horizon members in New Jersey! We’re thrilled to share that you can now enjoy a 15 percent discount on monthly memberships at select New Jersey YMCAs. Plus, for new YMCA members, the initiation fee is completely waived when you present your Horizon member ID card. This fantastic offer is valid until December 31, 2024, providing you ample time to take advantage of the savings and embrace a healthier lifestyle. Whether you’re a fitness enthusiast or looking to kickstart your wellness journey, this exclusive discount is designed to make your YMCA experience even more accessible. Remember, this exclusive discount is a limited-time offer, so make the most of… Read More

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Aetna: Small Business Updates

As the year wraps up, businesses with 2 – 50 employees enrolled in Aetna Funding AdvantageSM groups need to act quickly. We’re filing 1095-B tax forms on your behalf, but it’s crucial to ensure your information is accurate. Deadline: End of December The federal deadline for 1095-B tax forms is approaching. Both businesses and customers must verify and update their details by the end of December to avoid potential IRS rejections. Why It Matters Accurate information on these forms is vital for complying with tax regulations. 1095-B forms provide essential health coverage details, impacting Affordable Care Act compliance. Any discrepancies could lead to filing complications. Review and update your information… Read More

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DOL’s 2024 Penalty Adjustments

The Department of Labor (DOL) has released its annual adjustments for 2024, impacting penalties for employee benefit plans. Here’s a quick guide for employers: Key Points: 1. Employee Notices: Private employers must ensure timely delivery of required notices (SBC, CHIP, SPD, etc.) to avoid civil penalties. 2. Form 5500 Filings: File Form 5500 accurately and on time to prevent penalties associated with non-compliance. 3. Document Requests from EBSA: Respond promptly to document requests from EBSA to avoid potential penalties. Annual Penalty Adjustments for 2024 The updated penalties listed below are applicable to ERISA-covered health and welfare plans. Compliance is essential in 2024—act now to secure your organization against penalties and… Read More

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Case Study: A Voluntary Benefits Strategy

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More

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2023 State Health Insurance Mandates: A Quick Overview

Five states—California, Massachusetts, New Jersey, Rhode Island, and Vermont—along with the District of Columbia have implemented individual health insurance mandates, each with unique obligations. It’s crucial to understand and comply with both federal and state mandates for comprehensive adherence to regulations. State Obligations: These states require the submission of information on health insurance coverage to residents, with filings made to specific state agencies. Importantly, state requirements may differ from federal obligations, necessitating compliance with both sets of regulations. Key Deadlines for 2023 State Reporting: Note that state reporting deadlines may change, and the information presented is current as of the publication date. Stay updated for any changes. For a deeper… Read More

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Wellcare: Suspension of MAPD Plans in FL & NC

We need to inform you of a critical development affecting MAPD plans in Florida and North Carolina. Starting January 12, 2024, all enrollment and marketing activities for plans under Florida MAPD PPO Contract (H5199) and North Carolina MAPD PPO Contract (H7175) are temporarily halted. These contracts will not be renewed for Plan Year 2025 and will conclude on December 31, 2024. Key Points: Current members of these contracts’ plans DO NOT need to be transferred to alternate plans until the Annual Enrollment Period begins in October 2024. Existing members will stay enrolled in their plans for the entire Plan Year 2024. Uninterrupted access to full plan benefits continues throughout Plan… Read More

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Empire BCBS Now Anthem BCBS!

In a momentous move, Empire BlueCross BlueShield has officially transformed into Anthem Blue Cross and Blue Shield, marking a significant milestone for the renowned health insurance provider. The company is thrilled to announce the launch of Anthem Blue Cross and Blue Shield in both their downstate and upstate markets, reinforcing their commitment to enhancing the overall customer experience. The transition to the Anthem brand is not merely a change in name; it represents a strategic effort to simplify operations and reduce complexities in the market. Anthem is a nationally recognized name, offering a host of advantages for members residing out of state who are affiliated with New York-based companies. By… Read More

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Important Updates: Plan Changes for 2024

As we transition into 2024, it’s crucial for you to be aware of recent changes in your healthcare coverage. If you were auto-renewed for Plan Year 2024 after being enrolled in the Marketplace for Plan Year 2023, read on for key information. Auto-Reenrollment: Clients not actively selecting a Plan Year 2024 plan by December 15, 2023, were auto-renewed with coverage effective from January 1, 2024. This info was visible on HealthCare.gov and partner sites starting December 16, 2023. Exploring Options: Consider exploring other coverage options or adjusting your Plan Year 2024 selection. Changing plans or enrolling between December 16, 2023, and January 16, 2024, ensures an effective date of February… Read More

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Healthcare Compliance: 2023 Q4 Digest

Stay ahead in healthcare compliance with the 2023 Fourth Quarter Compliance Digest, a consolidated resource featuring all Q4 bulletins from October to December. This document is your one-stop-shop for the latest in health care reform, simplifying the complexities of compliance. Key Features: Up-to-Date Information: Get the latest developments in healthcare compliance from Q4 2023. Convenience in One Document: Access all relevant information in a single, downloadable PDF. Streamlined Access: Easily download the digest for quick and efficient access to essential updates. To explore further, download the PDF below: We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists… Read More

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Cigna Healthcare and Tower Health Contract Updates

In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More

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