Marketplace Health Insurance – Page 9 – Total Benefit Solutions Inc

Notice of Subsidies in the Federal Marketplace

July 18, 2016July 18, 2016Ed MacConnell

The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click here to download the bulletin

ACA: Important Implementations & Delays in 2016

July 15, 2016July 17, 2016Ed MacConnell

As our third year of the ACA Open Enrollment Period arrived, it’s time to examine some of the new implementations in 2016. Some of the major components, especially those affecting businesses were delayed or deferred since the passage of the Affordable Care Act in 2010. This year is considered to be a big year due to the “full implementation” of the employer mandate as well as a number of changes, repeals, and moratoriums on other sections of ACA. Some of the key changes are listed below: CHANGES AND IMPLEMENTATIONS Full implementation of the Employer Mandate Currently it is not mandated that employers provide health care to their employees. Moving forward, however, if… Read More

FAQ Suggests Employers Include Marketplace Options with COBRA Notices

July 15, 2016Ed MacConnell

On June 21, 2016, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) issued the 32nd Affordable Care Act (“ACA”) FAQ describing information that may be appropriate to include with COBRA notices. Many wondered if it were appropriate to provide information and if so, what kind of information could be provided about the Health Insurance Marketplaces/Exchanges (“Marketplaces”) so that COBRA-eligible individuals could consider health coverage alternatives available through the Marketplaces and possibly investigate whether they may be eligible for premium tax credits and cost-sharing reductions. Click the link to download the entire bulletin

Think HR Comply: Small Business Support from Total Benefit Solutions

July 11, 2016July 11, 2016Ed MacConnell

We are pleased to introduce to you a our sponsored client service—ThinkHR. If you are involved with employee issues, this will be a value-added benefit that will save you time and money. ThinkHR offers ThinkHR Live, a team of HR experts standing by to answer your questions or provide advice. This phone-based support service is available from 8:00 a.m. to 7:00 p.m. Central each business day. You also have access to ThinkHR Comply, an award-winning online resource center for all of your workforce issues. Download this brochure, it describes the scope of HR topics that are handled by the ThinkHR Live team. The service is provided to all Total Benefit… Read More

Critically Important: Insurance for Serious Illness

July 11, 2016July 8, 2016Ed MacConnell

Good news: You’ve got health insurance (at least, all Americans are required to or pay a penalty). Bad news: It doesn’t cover everything. Especially if something really bad happens, like a heart attack or stroke. Yes, a decent major medical plan will cover many of the health-related expenses related to a serious illness. But you’d likely still be left with significant out-of-pocket costs for deductibles and copayments. Medical insurance also doesn’t usually cover other related costs, such as travel to treatment centers, child care during absences or recovery, home modifications or rehabilitation charges. And if you lose income while you’re unable to work, you could have a tough time paying… Read More

Reminder: PCORI Fees Due August 1

July 9, 2016July 8, 2016Ed MacConnell

The annual Patient-Centered Outcomes Research Trust Fund (PCORI) fee is due to the IRS August 1, 2016. The fee, charged to certain health insurance policies, is used to support the activities of the Patient-Centered Outcomes Research Institute, a nonprofit, non-governmental organization (NGO) established by the Affordable Care Act (ACA). Fully- and self-insured group health plans ( Including HRA’s) are subject to PCORI fees. A health insurer will pay the fee on behalf of the employer if the plan is fully insured. Click here to read the bulletin from Primepay As always please contact your Total Benefit Solutions dedicated account manager at (215)355-2121 if you have any further questions or concerns.

Now Available: Health Advocate Member Advocacy

June 21, 2016June 21, 2016Ed MacConnell

Total Benefit Solutions clients can now take advantage of enrolling on Health Advocate as a group or as an individual/ family! It’s part of our Benefit Aid packages and it’s so easy you can enroll today by clicking here or ask your Total Benefit Solutions account manager at (215)355-2121 for more information. This video will tell you all about the benefits of Health Advocate!

IBC Breaking News: Changes to SEP On-Exchange Verification Process

June 20, 2016Ed MacConnell

Changes to SEP On-Exchange Verification Process Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including: Loss of minimum essential coverage Change in primary place of living Birth Marriage Adoption, placement for adoption, placement for foster care, or child support or other court order Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within… Read More

Notice of Subsidies in the Federal Marketplace

June 20, 2016June 16, 2016Ed MacConnell

New ACA Delays/Extensions/Eliminations Chart–Download Free

June 12, 2016Ed MacConnell

With so many different ACA provisions, HR360’s simple new chart provides you and your clients with a clear understanding of the key requirements that have been delayed, extended, or eliminated under the Affordable Care Act. Our business partner, HR360’s simple chart features important ACA delays, extensions, and eliminations, including: Eliminated automatic enrollment provisions Delay of the “Cadillac” tax Extension of information reporting deadlines Download ACA_Delays_Extensions_and_Eliminations

Departments issue new ACA FAQ’s

June 7, 2016June 6, 2016Ed MacConnell

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

Nondiscrimination regs cover TPAs, dental and more

May 13, 2016May 13, 2016Ed MacConnell

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

2017 Inflation Adjusted Amounts for HSAs

May 6, 2016May 5, 2016Ed MacConnell

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

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

May 5, 2016May 5, 2016Ed MacConnell

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

Obama administration backs off on ACA rules for 2017 health plans

March 8, 2016Ed MacConnell

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.

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

February 29, 2016February 26, 2016Ed MacConnell

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

2016 Federal Poverty Guidelines Updated

February 18, 2016Ed MacConnell

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.

Now Available: Empower Me Benefits Private Exchange

February 13, 2016February 13, 2016Ed MacConnell

Total Benefit Solutions has partnered with Empower Me Benefits to provide our clients with best in industry benefits technology that‘s customizable for even the smallest employer. The EmpowerMe Benefits Exchange allows you to remain complaint with the Affordable Care Act (ACA), easily manage benefits, and control health care costs with a single solution. The EmpowerMeBenefits Exchange is an online benefit marketplace and benefits administration platform designed specifically to meet the needs of small and mid-sized companies. The Exchange provides employers with an enrollment and administration platform that aids employers in ACA compliance. This web-based solution allows you to offer any medical coverage next to pre-selected ancillary, voluntary, and TPA products.… Read More

IBC: Distribution of 1095 Tax Forms

February 11, 2016February 11, 2016Ed MacConnell

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

New Guidance Tackles Employer Mandate Issues

February 6, 2016February 6, 2016Ed MacConnell

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

Several Health Plans Cutting Broker Commissions for ACA Health Plans

January 30, 2016January 30, 2016Ed MacConnell

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

2016 Health Insurance Open Enrollment Begins

October 31, 2015Ed MacConnell

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

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

October 24, 2015October 24, 2015Ed MacConnell

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.

Small Group Definition Changes Per the PACE Act

October 19, 2015October 22, 2015Ed MacConnell

On Wednesday, October 7, 2015, President Obama signed into law H.R. 1624, the Protecting Affordable Coverage for Employees (PACE) Act, legislation that will give states the ability to define the size of a small group for health insurance purposes. The law repeals the mandated small group expansion of groups of up to 50 employees to groups of up to 100 employees that was to go into effect on January 1, 2016. This law gives states the flexibility to determine the size of their small group market instead of being forced into the national standard. No action is needed if states want to retain their respective definition. There is no announcement… Read More

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

August 31, 2015August 27, 2015Ed MacConnell

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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