Healthcare Reform – Page 8 – Total Benefit Solutions Inc

Understanding the Health Care Provisions in the Inflation Reduction Act

September 19, 2022August 16, 2022Ed MacConnell

The Inflation Reduction Act includes several landmark health care provisions that would lower prescription drug costs for people with Medicare, reduce Medicare drug spending and extend enhanced subsidies for Affordable Care Act marketplace coverage. On Thursday, August 11, a panel of KFF experts held a web briefing to explain these provisions and how they would affect people and federal health spending, followed by a Question and Answer session. Click here to open article and view Web Event video. The legislation for the first time would require the U.S. Secretary of Health and Human Services to negotiate directly with drug manufacturers over the price of some high-cost drugs in the Medicare… Read More

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

Additional Guidance on New Prescription Drug Reporting Requirement

September 15, 2022September 14, 2022Ed MacConnell

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit informationannually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services(“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Click the link below to download this bulletin. As always please contact your Total benefit Solutions, Inc health insurance specialist at (215)355-2121 if you have any further questions or concerns.

New FAQ Addresses NSA and TiC Rules

September 14, 2022Ed MacConnell

he Departments of Labor, Health and Human Services and the Treasury (collectively, “the Departments”) issued FAQ Part 55, providing guidance as it relates to certain aspects of the No Surprises Act (“NSA”) and the Transparency in Coverage (“TiC”) final regulations. FAQ 55 includes 23 questions and answers. The guidance is lengthy and very detailed. Below you will find some of the key highlights of the guidance. Please download the bulletin below for details and contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 with any additional questions or concerns.

Further Guidance Issued on Contraceptive Coverage

September 12, 2022August 15, 2022Ed MacConnell

On July 28, 2022, the Departments of Labor, Health and Human Services and the Treasury (collectively, “the Departments”) issued FAQ Part to clarify protections for contraceptive coverage under the Affordable Care Act (the “ACA”). In January 2022, the Departments had issued guidance on the ACA Preventive Care Mandate, including contraception. The Departments issued FAQ Part 54: In response to reports that individuals continue to experience difficulty accessing contraceptive coverage without cost sharing; To clarify application of the contraceptive coverage requirements to fertility awareness-based methods and to emergency contraceptive; and To address federal preemption of state law. Employers sponsoring non-grandfathered group health plans should review the various preventive care requirements effective… Read More

IBC: Understanding your network

September 9, 2022July 22, 2022Ed MacConnell

The type of health plan you choose determines the network of providers you can visit. In-network providers are the doctors and hospitals in your plan’s network. You’ll save the most money by visiting network providers. Out-of-network providers are those not in your plan’s network. You may pay more for out-of-network services, and some services may not be covered at all. Know your options — before you need them When you need care and your primary care doctor isn’t available, remember you have other options that don’t involve a trip to the emergency room. Using virtual care, retail clinics, or urgent care centers can save you time and money. https://www.ibx.com/get-care/find-doctors-and-healthcare-providers/where-to-go-for-care Click here for links to your network and more… Read More

IRS Announces 2023 ACA Affordability Indexed Amount

August 25, 2022August 8, 2022Ed MacConnell

The IRS recently announced in Revenue Procedure 2022-34 that the Affordable Care Act (“ACA”) affordability indexed amount under the Employer Shared Responsibility Payment (“ESRP”) requirements will be 9.12% for plan years that begin in 2023. This is a notable decrease from the 2022 percentage amount (9.61%) and below the original 9.5% threshold. Rev. Proc. 2022-34 establishes the indexed “required contribution percentage” used to determine whether an individual is eligible for “affordable” employer-sponsored health coverage under Section 36B (related to qualification for premium tax credits when buying ACA Marketplace coverage). However, the IRS explained in IRS Notice 2015-87 that a percentage change under Section 36B will correspond to a similar change… Read More

New Prescription Drug Reporting Requirement

August 18, 2022August 2, 2022Ed MacConnell

As previously reported in December 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Employers with fully insured or self-funded (includes level funded) group health plans, including grandfathered plans, church plans subject to the Internal Revenue Code, and governmental plans. The term “group… Read More

Understanding the Coding of Health Plans from MEC to Metallic

August 15, 2022July 22, 2022Ed MacConnell

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

What is a Qualifying Life Event or QLE?

July 29, 2022July 14, 2022Ed MacConnell

There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More

Case Study Library

July 22, 2022July 22, 2022Ed MacConnell

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

Aetna: Understanding the Evolution of Primary Care and What it Means for your Workforce

July 19, 2022July 6, 2022Ed MacConnell

The evolutions of primary care has a great impact on employers and their workforce. As primary care looks to meet current consumer trends, employers and payers must think creatively to support their employees. Virtual, advanced, and multi-disciplinary sites are just the start. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

Updated FAQ’s on the ACA and Health Insurance

July 17, 2022Ed MacConnell

Kaiser Family Foundation ‘s database of frequently asked questions is searchable by topic. Click here to view the FAQ database.

What does ” Guaranteed Issue” health insurance mean?

July 14, 2022Ed MacConnell

Guaranteed issue A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Not all health insurance plans are guaranteed issue. Have any questions about your health insurance? Contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 http://www.totalbenefits.net

Horizon BSBSNJ to Withdraw HMO Plans From Individual and Small Employer Markets

July 13, 2022July 14, 2022Ed MacConnell

Horizon has announced a change to their product portfolio and have elected to withdraw their HMO plans from the Individual and Small Employer Health Benefits Plan (SEH) markets. The New Jersey Department of Banking and Insurance (DOBI) has given its approval for Horizon to withdraw its HMO plans from the markets under the authority of N.J.S.A 17B:27A-6 and N.J.A.C. 11:20-18.5 (for Individual plans) and N.J.S.A. 17B:27A–23e and N.J.A.C. 11:21-16 (for small employer plans). This withdrawal will affect Individual members enrolled in the Horizon HMO Gold plan, and group clients and their employees who are enrolled in the Horizon HMO Platinum plan. Brokers with affected small group clients, and those affected… Read More

Affordability of Health Coverage

July 11, 2022June 30, 2022Ed MacConnell

Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

ACA Employer Penalties Increased for 2022

July 6, 2022Ed MacConnell

The IRS penalty amounts for non-compliance of the ACA’s Employer Mandate are again increasing in 2022. 4980H(a) Penalty For the 2022 tax year, the 4980H(a) penalty amount is $229.17 a month or $2,750 annualized, per employee. The IRS issues the 4980H(a) penalty when: An employer doesn’t offer Minimum Essential Coverage (MEC) to at least 95% of its full-time employees (and their dependents) for any month during the tax year, and At least one full-time employee receives a Premium Tax Credit (PTC) for purchasing coverage through the Marketplace. Here’s an example of how the IRS calculates the penalty: If an organization in 2022has 300 full-time employees, and one of these employees receives a PTC for 12 months, the cost of this penalty would be $742,500.The per-employee penalty applies… Read More

Is my group subject to ERISA or ERISA Exempt?

June 29, 2022Ed MacConnell

Many clients often ask the question ” Do I need to comply with ERISA? ” The answer is almost always yes! Just because you are a smaller business does not exempt you from ERISA. This from the US Department of Labor: ERISA applies to private-sector companies that offer pension plans to employees. This includes businesses that: Are structured as partnerships, proprietorships, LLCs, S-corporations and C-corporations. No matter how your employer has structured his or her business, it is covered by ERISA if it is a private entity. Who is not subject to ERISA?In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or… Read More

Mental Health Conditions Can Trigger FMLA

June 27, 2022June 24, 2022Ed MacConnell

The Wage and Hour Division of the U.S. Department of Labor released a Fact Sheet related to mental health conditions and the Family and Medical Leave Act, clarifying what constitutes a serious mental health condition. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

June 22, 2022July 14, 2022Ed MacConnell

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

INFLATION NOW TOPPING LIST OF EMPLOYER’S PANDEMIC CHALLENGES

June 20, 2022June 18, 2022Ed MacConnell

Employers have faced many challenges since the start of the pandemic, and now wage inflation may be at the top of the list. Using the law of supply and demand, as the supply of talent decreases, candidates can demand more money. The good news, according to the Department of Labor, the unemployment rate fell to 4.6% in October 2021, a new pandemic low. Click the link below to download the full bulletin. As always please contact your Total Benefit Solutions, Inc group account manager if you have any further questions or concerns.

Aetna: Transparency in Coverage Rule Update

June 17, 2022June 16, 2022Ed MacConnell

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

2022 PCOR Fee Filing Reminder for Self-Insured Plans

June 16, 2022Ed MacConnell

The Patient-Centered Outcomes Research (PCOR) fee filing deadline is August 1, 2022, for all self-funded medical plansand HRAs for plan years ending in 2021. The IRS issued Notice 2022-04 announcing the adjusted fee amount for this year. please download the bulleting below for more details and contact your Total Benefit Solutions, Inc. health insurance specialist at (215)355-2121.

Download the latest guide to COBRA and Mini COBRA

June 14, 2022June 12, 2022Ed MacConnell

COBRA can be confusing for small and larger employees alike. Our quick guide to COBRA is here to make it easier. it’s simple and free to download! COBRA is not only an employer mandate but can also effect people on the health insurance marketplace! Take a look and then ask your Total Benefit Solutions, Inc health insurance specialists how COBRA effects you or your group.

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: