Companies with fewer than 20 employees that offer group health coverage that pays secondary to Medicare (those not subject to the MSP rules) may be able to pay for the Medicare Part B, Part D, and Medicare Supplement Insurance premiums for their active employees. This is known as a Medicare Premium Reimbursement Arrangement. However, this is not an option for companies with 20 or more workers that are subject to the Medicare Secondary Payer provisions. All companies, regardless of size, can pay the health insurance or Medicare premiums for their retired employees, but no company can payfor individual health insurance coverage for their active employees . Our best practice: A… Read More
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
A bill has been introduced in New Jersey in both the Senate and Assembly that, if passed, would prohibit insurance carriers or other insurers subject to the insurance laws of New Jersey or any other state from offering, issuing or renewing any stop loss insurance policy of any kind to small employers. Stop loss insurance provides reimbursement for catastrophic, excess or unexpected expenses and is used by small employers to self-insure part of the health insurance coverage they provide for employees. Under New Jersey law, in connection with a group health plan, a small employer means an employer with 2-50 eligible employees on business days during the preceding calendar year. If passed,… Read More
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
CMS Change to LIS/Dual Special Enrollment Period
More than 23 cents of every healthcare dollar goes to Prescription drugs
If companies could give employees tax free money to buy health insurance on their own, how many would do so?
We’re about to find out
One of the benefits of getting your Health Insurance through the Marketplace is the tax credit applied to your premium, which makes your costs much more affordable. However, when determining how much your tax credit will be, you use an estimate on your income for the following year. Life is always changing, so if your income changes, if your Family size changes or even being offered Healthcare in some other way it is IMPORTANT to alert the Marketplace of these changes or you may end up owing money back to the Government when you file your taxes at the end of the year. Here we will talk about which types… Read More
How to Find a Doctor You Trust Get a list of in-network providers: Call your insurance company or look at their plan materials for a list of doctors in their network. You’ll usually pay less to see a doctor in your network than a doctor who’s out-of-network. You can also call your Broker and they can help assist you in getting the names of Doctors near you that accept your plan. Do your research: Ask friends and family if they recommend their doctors. You may even be able to read online reviews for doctors in your area. Online reviews are a great way to gauge things such as bedside manner and wait… Read More
You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick! You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More
The Departments of Treasury, Labor, and Health and Human Services (collectively, the “Departments”) issued proposed guidance that, if finalized, creates a mechanism for employers to offer Health Reimbursement Arrangements (HRAs) in connection with individual health insurance coverage. The proposed regulations add two new HRA options for employers to consider: • HRA integrated with individual health insurance coverage. Beginning with the first plan year on or after January 1, 2020, permit integration of an HRA with individual health insurance coverage provided certain conditions are met. • Excepted Benefit HRA. Beginning with the first plan year on or after January 1, 2020, employers that offer traditional group health plan coverage may consider offering… Read More
Total Benefit Solutions is proud to announce our partnership with ELAP services to provide our clients with the very best in reference based pricing benefit plans. Wondering if reference based pricing would be a good for your organization? Call us today to find out how it works at (215)355-2121!
Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More
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
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
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
Health Savings Accounts and You Health Savings Accounts (HSAs) aren’t new. They’ve been around since late 2003. Initially they were created along with the Medicare Prescription Drug, Improvement, and Modernization Act to replace the Medical Saving Account System. Initially these plans were designed to help with Drug Costs under Medicare policies; However, as Insurance Premiums increased, more and more Employer and Individual Policies offered High-Deductible Plans to help curb costs. Due to that, HSAs were thrown into the spotlight as a way to use Pre-Tax Dollars to cover out-of-pocket Medical costs. In 2017, a reported 22million Americans have an HSA. Each year, that number continues to climb. Many people still have a… Read More
President Trump Signs Prescription Drug Gag Clause Legislation On Wednesday, President Trump signed into law S. 2553, the Know the Lowest Price Act, and S. 2554, the Patient Right to Know Drug Price Act. The legislation was passed by the House and Senate last month with bipartisan support and will ban “gag clauses” that prevent pharmacists from telling customers when they can save money on their prescriptions by paying out of pocket for the retail price of the drug, rather than using their insurance and making the co-payment. These bills comprise portions of President Trump’s “America First” prescription drug initiative that were released as part of a blueprint to lower drug prices in May.… Read More
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
Recently a number of clients have received notices and/or checks for their organizations’s Medical Loss Ratio, or MLR rebates. Below is some helpful information from SHRM for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant… Read More
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