Healthcare Reform – Page 20 – Total Benefit Solutions Inc

IBC: Important information about member outreach for IRS reporting

December 17, 2014December 14, 2014Ed MacConnell

From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More

Additional requirements for 90-day waiting period

December 16, 2014December 17, 2014Ed MacConnell

Additional requirements for 90-day waiting period Group health plans and health insurance issuers cannot impose waiting periods greater than 90 days. This 90-day waiting period is effective for plan years beginning on or after January 1, 2014. It does not apply to HIPAA Excepted Benefits or retiree-only plans. These regulations allow for a one-month orientation period to determine if the employee is eligible for health coverage. Once the employee is determined eligible, he or she must receive health benefits in no more than 90 days. The start date of an eligible employee, marks the beginning of the one-month maximum orientation period. The orientation period is determined by… Read More

Total Benefit Solutions Introduces New Individual Health Plan Private Exchange

December 13, 2014Ed MacConnell

Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!

Health Reform: Guidance Issued-Employer Reimbursement of Individual Policies

November 24, 2014January 30, 2015Ed MacConnell

Previously, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (collectively, the “Departments”) explained that HRAs and employer payment plans cannot reimburse individual policies. On November 6, the Departments issued their twenty-second set of FAQs which make clear that: An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Such arrangements are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. Such… Read More

Health Reform: Healthcare.Gov Sneak Preview

November 10, 2014Ed MacConnell

Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121

Total Benefit Solutions is your Marketplace Navigator

November 9, 2014November 8, 2014Ed MacConnell

What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure

2015 Health Reform: Prepare for Health Insurance Open Enrollment

November 8, 2014November 8, 2014Ed MacConnell

Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More

IRS Derails Use of MV Plans Without Hospitalization

November 8, 2014Ed MacConnell

As you may know, in order to avoid penalties under the Affordable Care Act (“ACA”), large employers must offer their full-time employees coverage that is affordable and meets minimum value (“MV”). Some vendors exclude certain core benefits, such as in-patient hospitalization and/or physician services from their plans (referred to as “Narrow MVPs”) and use the MV Calculator to determine that the Narrow MVPs meet MV under the ACA. The vendors claim the Narrow MVPs insulate employers from penalty exposure and preclude employees from accessing subsidies in the Marketplace. There has been much controversy as to whether the Narrow MVPs do, in fact, satisfy the MV requirement. On November 4, 2014,… Read More

IBC: Individual customers will receive a communication to prepare for open enrollment this week

October 22, 2014October 22, 2014Ed MacConnell

From Independence Blue Cross & Amerihealth: Individual customers will receive a communication to prepare for open enrollment this week Independence Blue Cross (Independence) will be sending letters to individual customers to remind them about 2015 Open Enrollment dates, inform them how they can prepare now, and let them know we will send additional details in the coming weeks. Each letter will include a list of upcoming health insurance meetings they can attend, along with a card that will make it easier for them to keep track of their enrollment information. These letters will include the agent’s name and phone number, and encourage individuals to contact their agent with questions.… Read More

2015 Medicare Part B premiums and deductibles to remain the same as last two years

October 10, 2014October 10, 2014Ed MacConnell

Premiums, copays and deductibles for other Medicare programs for 2015 also announced Secretary of Health and Human Services Sylvia Burwell announced today that next year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively. This leaves more of seniors’ cost of living adjustment from Social Security in their pockets.

IRS Coordinates Cafeteria Plan Rules with the ACA:Two New Election Changes Allowed

October 10, 2014October 10, 2014Ed MacConnell

Two New Election Changes Allowed Existing cafeteria plan rules make it difficult (if not impossible) for participants to revoke pre-tax salary reduction elections mid-year and enroll in qualified health plan coverage through the Health Insurance Marketplace (the “Marketplace,” sometimes referred to as the “Exchange”). To provide additional flexibility, the IRS issued Notice 2014-55, creating new opportunities for a participant to change mid-year an otherwise irrevocable cafeteria plan election. Click here to Download the Entire Bulletin

Health Reform: CMS finalizes auto-enrollment process for current Marketplace consumers

October 8, 2014October 8, 2014Ed MacConnell

CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More

Independence Blue Cross launches new private exchange for mid- and large-sized employers

October 8, 2014Ed MacConnell

Independence Blue Cross launches new private exchange for mid- and large-sized employers Multiple plan options offer flexibility, comprehensive coverage, and a personalized experience Philadelphia, PA – September 15, 2014 – Today, Independence Blue Cross (Independence) announces the introduction of a new private exchange marketplace that will offer medical, pharmacy, dental, and vision to employers with more than 100 employees. Employers can begin to use the Independence private exchange on October 1, 2014 with coverage effective on or after January 1, 2015. Click here to read the release

Health Reform: Eligibility for the SHOP Marketplace

October 3, 2014March 18, 2015Ed MacConnell

Eligibility Requirements for the SHOP Marketplaces In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP. To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible employee on payroll Have 25 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year). While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP… Read More

Health Reform: Eligibility Programs

September 30, 2014August 24, 2014Ed MacConnell

Medicaid, CHIP, and the Affordable Care Act The Affordable Care Act significantly streamlines the eligibility standards and enrollment processes for Medicaid. It also offers a new opportunity for states to expand Medicaid to all adults ages 19 – 64 with household MAGI at or below 138% of the FPL. States have the option to expand Medicaid eligibility to this new eligibility group. This is known as “Medicaid expansion.” Through Medicaid expansion, the Affordable Care Act provides new opportunities for adults in some states to be covered by Medicaid. However, some states have chosen not to expand Medicaid eligibility to these income levels. Even if a state did not expand Medicaid,… Read More

IBC: New Cost Care Estimator

September 25, 2014Ed MacConnell

Independence Blue Cross (Independence) is excited to announce the addition of the Care Cost Estimator (CCE) to our consumer transparency tools. The new online CCE tool will help educate members about covered services, treatment options, and anticipated out-of-pocket costs as they apply to their specific health plan. The CCE tool is available at www.ibxpress.com beginning on September 12, 2014, for PPO members who have migrated to our new operating platform. For customers who have not yet migrated, the CCE tool will become available to PPO members on your renewal date, in conjunction with the migration. To access the CCE tool, members must log in to their account at www.ibxpress.com, where they… Read More

Health Reform: Guaranteed Renewability

September 24, 2014August 24, 2014Ed MacConnell

Guaranteed Issue and Guaranteed Renewability The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called “guaranteed issue.” Coverage offered through and outside the Marketplaces may restrict guaranteed issue coverage to certain enrollment periods. Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This… Read More

Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace

September 19, 2014September 15, 2014Ed MacConnell

‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More

Health Reform: Small Business Health Care Tax Credit

September 18, 2014August 24, 2014Ed MacConnell

Small Business Health Care Tax Credit Many small businesses are eligible for the Small Business Health Care Tax Credit to assist with the cost of health insurance coverage. To qualify, businesses must: Have an average of fewer than 25 FTE employees (based on a 40 hour work week and excluding owners, owners’ family members, and seasonal employees) Have average annual employee wages below $50,000 (augmented to reflect cost-of-living adjustments (COLA) as of 2014) (business owner salaries are not included in this calculation) Pay a uniform percentage or amount (at least 50%) of the cost of single coverage of each employee’s health insurance The tax credit is generally available only for… Read More

HR360: Employers Must Provide Exchange Notice at Time of Hiring

September 17, 2014September 15, 2014Ed MacConnell

Employers are required to provide an Exchange Notice (also referred to as a “Notice of Coverage Options”) to each new employee at the time of hiring as of October 1, 2013. For 2014, the notice can be provided within 14 days of an employee’s start date. Click below to read the bulletin from HR360: HR360_notice at time of hiring If you have any questions about the HR360 subscription, or exchange notices, please contact your Total Benefit Solutions account manager at (215)355-2121.

Health Reform: Broker Handling of Confidential Tax Information

September 16, 2014August 24, 2014Ed MacConnell

Agent and Broker Handling of Federal Tax Information Federal Tax Information (FTI) is classified as confidential and may not be used or disclosed except as expressly authorized by the Internal Revenue Code, which may require written consent of a taxpayer in certain situations. As an agent or broker operating in an Individual Marketplace, it is possible that we may encounter FTI when assisting with eligibility appeals. If you are an agent or broker and also a tax return preparer or work closely (e.g., share an office) with a tax return preparer (even if a small number of clients) we are subject to the tax return preparer disclosure rules set forth… Read More

Medicare: What are the STAR ratings?

September 15, 2014September 15, 2014Ed MacConnell

Many of our clients ask us what the STAR ratings for each health plan really mean. Medicare.gov gives us the answer as: The Overall Star Rating combines scores for the types of services each plan offers: What is being measured? For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories: Staying healthy: screenings, tests, and vaccines: Includes whether members got various screening tests, a yearly flu shot, and other check-ups that help them stay healthy. Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition. Member experience with the health plan: Includes… Read More

Wellworks for You Monthly Newsletter

September 15, 2014Ed MacConnell

Our partnership with Wellworks enables us to offer services to our clients for designing and implementing comprehensive wellness programs. We truly believe that corporate wellness programs can deliver benefits to both employers and employees.From a financial standpoint, wellness programs can drive down health care utilization and costs. But more importantly, wellness programs can produce employees that healthy, satisfied, and productive employees and families. Some of the key highlights of this solution include onsite preventative screenings, wellness challenges, rewards, a monthly wellness newsletter, and more. Click the link to download a monthly newsletter: Wellworks_Newsletter_September2014_V2 Click the link below to get a quick look at the small business packages available to you now: http://totalbenefits.net/wp-content/uploads/2014/01/Wellworks-1.pdf If… Read More

Health Reform: Network Adequacy Standards

September 15, 2014August 24, 2014Ed MacConnell

Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More

What is Small Group Defined Contribution-Private Exchange Solution?

September 12, 2014Ed MacConnell

What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans. In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More

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