New rules about who is exempt from overtime and who must earn it will be a jolt for many companies around the nation. However, the cost and implications won’t be limited to how employees are paid. “Much of the attention is focused on the impact on employees’ wages,” Jaqueline Breslin writes forBenefitsPro. “But, these changes will also have a huge influence on employee benefits policies as employers decide on their approaches to stay compliant with the new regulations.” Click here for the full story.
Continue ReadingTotal Benefit Solutions: New Starmark Self Insured Plans for Small Groups
Total Benefit Solutions is proud to announce that we are now appointed with Starmark to provide affordable and predictable self insured medical plans to small businesses. Starmark® administers self-funded health benefit plans exclusively for smaller businesses nationwide. Employers choose from extensive plan design choices to create a self-funded health plan to meet their unique needs and budget, while stop-loss insurance from Trustmark Life Insurance Company provides protection against large covered claims. Click Here To View A Client Testimonial Click here for more information and to watch a short video about these products and how your organization might benefit from a self insured plan.
Continue ReadingMental Health Parity Triggers
The Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) requires a group health plan that offers mental health and substance use disorder benefits to be at parity with medical and surgical benefits. As such, financial requirements and treatment limitations for mental health and/or substance use disorder benefits cannot be more restrictive than the medical and/or surgical benefits offered. Click the link below to read the entire bulletin. Click to read Mental Health Parity Non-Compliance Triggers
Continue ReadingNew Federal Overtime Rules Guide
New Federal Overtime Rules Guide from our partners at HR360: The federal Fair Labor Standards Act (FLSA) provides an exemption from both minimum wage and overtime pay for employees employed as bona fide executive, administrative, and professional employees (white collar employees).Download New Federal OT Rules Guide
Continue ReadingDid You Know About Medicare’s Preventative Services?
Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early, when treatment works best, and can keep you from getting certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health. The Affordable Care Act makes many improvements to Medicare. If you have Original Medicare, you can get a yearly “Wellness” visit and many other covered preventive services! Click here to download Medicare’s Preventative Services Guide Click below to watch a video from Medicare about the preventative services benefits.
Continue ReadingIBC: Launch of identity theft protection services for group customers and their members
Starting in June 2016, Independence Blue Cross is pleased to offer identity theft protection services to our commercial group customers for their employees with Independence coverage. Identity theft protection options Identity theft protection services will be provided by Experian® and include two options: ProtectMyIDTM is for adults. Eligible subscribers and their adult dependents can enroll individually. FamilySecureSM is for children under the age of 18. A parent or legal guardian can activate membership and enroll all children. Employers who choose to offer these new services to their employees simply opt in using the IBXpress employer website. If they choose not to offer these services, they do not need to take… Read More
Continue ReadingFinal Regulations Shed Light on Wellness Programs
The Genetic Information Nondiscrimination Act (GINA) Title II prohibits all employers with at least 15 employees from using genetic information (which includes the current and past health status of a spouse and children) in making decisions about employment. On May 17, 2016, the EEOC announced final regulations under the ADA and GINA Title II regarding wellness programs. These regulations are similar to the proposed rules issued last year and more restrictive than the existing HIPAA rules. All three rules need to be carefully looked at when implementing incentive-based programs. Click the link below for the full bulletin. Download Final Regulations Shed Light on Wellness Programs –
Continue ReadingNow Available: Health Advocate Member Advocacy
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!
Continue ReadingIBC Breaking News: Changes to SEP On-Exchange Verification Process
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
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Notice of Subsidies in the Federal Marketplace
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 the link to download the complete bulletin. Download Notice of Subsidies in the Federal Marketplace
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For calendar year plans, the 2015 plan year Form 5500 is due to be filed electronically no later than August 1, 2016.
For calendar year plans, the 2015 plan year Form 5500 is due to be filed electronically no later than August 1, 2016. Please click the link below to download the complete bulletin. Download Form 5500 Filing Reminder –
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The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015…
The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015. The IRS has also issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year. Please note that for those with an HRA plan, and HRA is ” self insurance” and you are required to file and pay the PCOR fee. Please download the document below for more details and links to specific resources. Download PCOR Fee Filing Reminder for Self-Insured Plans
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New ACA Delays/Extensions/Eliminations Chart–Download Free
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
Continue ReadingDepartments 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
Continue ReadingChecking Your Employee Handbook for Benefit Provisions
Handbooks are important for many reasons such as informing employees of their rights and duties, communicating available resources, and outlining paid time off policies. With respect to health and welfare benefits, here are a few things to consider: Download Checking Your Employee Handbook for Benefit Provisions
Continue ReadingEmployers: Tell Congress to Oppose Eliminating or Capping the Employer Exclusion
NAHU (The National Association of Health Underwriters) is very concerned about current proposals in Congress that would undermine the employer-sponsored health insurance system by eliminating or placing a cap on the employer tax exclusion for health insurance. Eliminating the exclusion would also eliminate most of the advantages of employer-sponsored insurance while capping it would degrade the benefit and serve as a tax increase for middle-class Americans. Click here to take action
Continue ReadingNondiscrimination 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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8 things to know about Medigap policies
Medicare Supplements or Medigap Plans A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy… Read More
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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
Continue ReadingHealth 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
Continue ReadingForm 1095-C Notification Reminder and Frequently Asked Questions
Form 1095-C Notification Reminder and Frequently Asked Questions 2015 Forms 1095-C must be furnished to individuals by March 31, 2016. Generally, if Forms 1094-C and/or 1095-C are incorrect and incomplete, a penalty may apply if not corrected by the due date and the employer cannot show reasonable cause. Briefly, the amount of penalties can range from $50/form with a $500,000 maximum penalty/year to $250/form with a maximum penalty of $3M/year. Click here to download Form 1095-C Notification Reminder and Frequently Asked Questions – 031516R As always please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121 if you have any questions or concerns about this bulletin, or any other… Read More
Continue ReadingObama 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.
Continue ReadingGAO 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
Continue ReadingReminder to Notify CMS
Employers sponsoring a group health plan are required to report information on the creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). Download the bulletin below for details and specific links for employer reporting Download Medicare Part D – Reminder
Continue Reading2016 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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