Insurance – Total Benefit Solutions Inc

Big changes to Medigap plans start January 1, 2026!

June 12, 2025June 11, 2025Loramei RomeoNo Comments

Attention to all current Medigap groups: As of July 1, 2025, new enrollments for MedigapSecurity and 65 Special products will no longer be accepted. It is crucial for future retirees to be aware that they will need to transition to a MedigapFreedom product. As we approach 2026, it’s essential for businesses and retirees to understand the upcoming changes to Medigap enrollment. If your Medigap group renewal dates fall between January 1 and June 1, 2025, you can continue enrolling future retirees into MedigapSecurity or 65 Special throughout 2025. However, starting January 1, 2026, any future retiree from an existing group will need to select from the MedigapFreedom products. As we… Read More

The 2025 PCORTF Fee is on the horizon!

June 10, 2025June 4, 2025Loramei Romeo

The recent reauthorization of PCORTF fees by the Federal Government will continue to support the Patient-Centered Outcomes Research Institute through 2029. These fees play a crucial role in funding vital health research, which helps inform healthcare decisions and improve patient outcomes. As a reminder, the fee associated with your health plan is due by July 21, 2025. This deadline is crucial as it follows the calendar year immediately after the end of the applicable plan year. Staying compliant with these deadlines is essential for effective health insurance management. For plan years ending on or after October 1, 2023, and before October 1, 2024, the fee will be $3.22 multiplied by… Read More

Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

June 6, 2025June 4, 2025Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… Read More

Tax Favored Accounts Summary Page

June 5, 2025May 23, 2025Loramei Romeo

Cafeteria Plans (Section 125 Plans)

June 2, 2025May 23, 2025Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Curious about Minimum Essential Coverage? Ask us how MEC plans can work for you!

May 28, 2025May 19, 2025Loramei Romeo

A health plan must provide certain coverage and benefits, to be classified as Minimum Essential Coverage (MEC) by the Affordable Care Act (ACA). Coverage Scope MEC plans are designed to meet ACA standards by covering ten essential healthcare benefits, including hospitalization, preventive services, and mental health care. While they offer significant support, it’s important to note that they may exclude certain services, such as elective surgeries or cosmetic procedures. Cost Structure MEC plans have a unique cost structure, just like other health plans. The MEC plan’s cost structure consist of the following components. Premiums– monthly payment that maintain each member’s coverage. Deductibles– member’s pay out of pocket until they meet… Read More

The Three MEC plans categories

May 26, 2025May 15, 2025Loramei Romeo

All MEC plans fall under one of three categories. No matter the category, all MEC plans are ACA- compliant and will help your business provide affordable employee benefits. However, it is important to know the difference between categories, to choose the best option for your team. Standard MEC plans stand out for their cost-effectiveness, offering fully covered preventative services and prescription discounts. Enhanced MEC plans provide critical benefits such as preventive services, low-copay visits, and telehealth options. The highest-level MEC plans offers fully covered preventative services, low-copay visits, and prescription discounts. Whether you lean towards a standard plan for budgetary reasons, an enhanced plan for added benefits, or the highest-level… Read More

MEC (minimum essential coverage) and MVP (minimum value plan) differentiation

May 23, 2025May 19, 2025Loramei Romeo

Despite both MEC and MVP plans stem from the ACA they differ significantly from each other. MEC plans meet the ACA’s individual mandate, while MVPs offer substantial coverage to avoid penalties for employers. Both concepts aim to ensure that individuals have access to comprehensive and affordable health care. However, knowing these differences can lead to better health decisions. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

The advantages and disadvantages of MEC plans!

May 21, 2025May 14, 2025Loramei Romeo

After being informed themselves, employers should empower their employees with knowledge about the pros and cons of MEC plans and encourage them to explore their options. Pros: Affordable premiums– lower monthly premiums than more comprehensive health plans. Basic Coverage– coverage for essential health benefits. Regulatory compliance– helps ALEs meet regulatory requirements and avoid tax penalties Cons: Very Limited coverage– it doesn’t cover certain healthcare expenses, such as elective procedures or specialty medications. High-out-of-pocket-costs– In exchange for cheaper premiums, members will face higher deductibles, copayments and coinsurance. Minimal flexibility– limited customization options Limited provider networks– it may limit members’ choice for healthcare providers After weighing the advantages and downsides of a… Read More

Examples of MEC plans

May 15, 2025May 14, 2025Loramei Romeo

The centers for Medicare & Medicaid Services provides MEC recognition to healthcare carriers, creating a reliable list of national health plans. Additionally, any plan that falls under the following categories is considered MEC: Minimum Essential Coverage encompasses various health plans, including employer-sponsored options, individual market plans, and government programs like CHIP and Medicare. Understanding these categories is vital for making informed and effective health insurance decisions. Reach out to us for personalized guidance! We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any… Read More

The importance of what Minimum Essential Coverage (MEC) Plan offers and how it works.

May 13, 2025May 12, 2025Loramei Romeo

Minimum Essential Coverage plans are crucial for compliance with the Affordable Care Act, ensuring that employees meet their responsibilities towards full-time workers. The Internal Revenue Service (IRS) can penalize an applicable large employer (ALE) if it does not offer MEC plans to 95% or more of its full-time workers. These plans provide basic healthcare services, focusing on affordability while offering essential benefits. Understanding MEC plans is vital for both employers and employees to navigate the complexities of health insurance. Share your insights or questions about MEC plans. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

IRS just announced the 2026 Health Savings Account Contribution Limits

May 12, 2025May 7, 2025Loramei Romeo

As we look ahead to 2026, it’s important to understand the new contribution limits for health plans. The self-only contribution limit has increased to $4,400, while the family limit is now $8,750. Additionally, the annual deductible for high-deductible health plans has also seen increases, with self-only coverage now requiring a deductible of at least $1,700 and family coverage at $3,400. Staying informed about these changes is crucial for optimizing employee benefits and promoting financial well-being. How is your organization adapting to these new health plan regulations? We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121… Read More

ACA Individual Market Highmark

May 8, 2025May 6, 2025Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

May 6, 2025May 6, 2025Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

Price Transparency Rules Addressed in New Executive Order

April 14, 2025April 3, 2025Loramei Romeo

On February 25, 2025, Executive Order 14221 was signed, enhancing health care price transparency rules. This order builds on previous regulations by requiring actual prices for health care services, standardizing pricing data reporting, and strengthening enforcement policies. Employers with fully insured plans must ensure their carriers comply, while those with self-funded plans should contract with third-party administrators to meet disclosure requirements. The new guidance is expected by May 26, 2025, and employers should prepare to update service agreements accordingly. Have Questions? and want to read more about the changes click New Executive Order Addresses Price Transparency Rules for more details. We are dedicated to providing exceptional service, so please do… Read More

South Jersey Radiology is in the Clover Network

April 11, 2025April 11, 2025Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025. New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

Stretching Your Healthcare Dollars

April 2, 2025April 3, 2025Loramei Romeo

Enhancing the security of member portal registrations

March 28, 2025March 25, 2025Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

Compliance Checklist for Calendar Year 2025

March 26, 2025March 25, 2025Loramei Romeo

The calendar year 2025 has released its deadline for small groups (less than 50), some deadlines may change depending on the plan start date that is not January 1st. The calendar shows the Section 6055/6056 filing deadline to the dates with Medicare part d notice. Have Questions? and want to read more about the changes click Calendar Year Compliance Checklist for more details. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Updated Guidance Offers More Information on Form 1095-C Reporting Relief

March 7, 2025March 7, 2025Loramei Romeo

The IRS released Notice 2025-15, providing guidance on an alternative method for furnishing Forms 1095-C and 1095-B under the Affordable Care Act. This new method allows employers to provide these forms only upon request, given they meet specific notice requirements, including clear communication and accessibility on their website. Employers must post the notice by March 3, 2025, and ensure it remains accessible through October 15 of the following year. Despite this change, employers are still required to file all 2024 Forms 1095-C with the IRS electronically by March 31, 2025. Employers should review their current delivery policies and decide whether to adopt this new method while ensuring compliance with any… Read More

Latest Developments in the Johnson & Johnson ERISA Fiduciary Case

February 24, 2025February 21, 2025Loramei Romeo

The U.S. District Court of New Jersey recently dismissed claims in a class action lawsuit against Johnson & Johnson (J&J) regarding the management of their prescription drug benefits. The plaintiffs alleged that J&J breached its fiduciary responsibilities under ERISA, resulting in higher payments for prescription drugs, premiums, deductibles, coinsurance, and copays, as well as lower wages and limited wage growth. However, the court ruled in J&J’s favor on the fiduciary breach claims, stating that the plaintiff lacked Article III standing due to speculative allegations about higher premiums and insufficient evidence of redressable injury. Despite this, the court did not dismiss the claim that J&J failed to furnish requested plan documents,… Read More

New Guidance Released for the No Surprises Act and Gag Clause Prohibition

February 20, 2025February 18, 2025Loramei Romeo

The new guidance on the No Surprises Act (NSA) and gag clause prohibition, detailed in FAQ Part 69, clarifies the requirements for open negotiation, notice, and disclosure for plans, issuers, and providers related to the Independent Dispute Resolution (IDR) process. It addresses the coordination of surprise billing rules and plan sponsor responsibilities regarding gag clauses. The NSA protects against surprise medical bills for out-of-network costs, limiting individual cost-sharing to an amount based on the Qualified Payment Amount (QPA). The federal IDR process resolves disputes on reimbursement amounts, with FAQ 69 addressing recent litigation impacts on QPA calculation and other NSA implementation questions. The gag clause prohibiting compliance requires agreements to… Read More

One Employer or Spouse, Section 105 HRA

February 18, 2025February 14, 2025Loramei Romeo

What is a Section 105 HRA for 1 Employee or Spouse? Employers with small businesses that only have one employee or hire their spouse, Section 105 HRA are designed specifically for them. With Section 105 HRA spouse or employee/s can reimburse for family health insurance and medical expenses tax-free, indirectly the employers also benefit from as a dependent of the spouse/employee or as tax-deductible expenses to the business and employee. IRS Letter Ruling 9409006 and Section 105 of the Internal Revenue Code, Revenue Ruling 71-588 made this plan possible. Any health plan with 2 or more employees he annual and lifetime dollar limit is eliminated because of the Affordable Care… Read More

Annual Update for 2025 for New Jersey Policyholders

February 17, 2025February 17, 2025Loramei Romeo

This letter is intended to provide you with information on New Jesey Temporary Disability Benefits (TDB) changes for 2025. This Annual Update should be included in the employee posting. Please note that this information must not only be posted at the same place of employment, but must also be provided to the employee under the following circumstance: The following NJ TDB changes are applicable January 1, 2025, until December 31, 2025: Maximum Contribution amounts: Maximum Weekly Benefit: We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are… Read More

Health FSA Plan Document Section 125

February 13, 2025February 11, 2025Loramei Romeo

Employees have the potential to save up to $1,280, while employers may realize savings of as much as $320. Health Flexible Spending Account (FSA) Plans are designated tax-exempt accounts that permit employees to access up to $3,300 in 2025 in pre-tax funds for out-of-pocket medical, dental, and vision expenses that are not covered by other insurance plans. What is a Health Flexible Spending Account (FSA)? A Health Flexible Spending Account enables employees to set aside pre-tax funds for medical expenses that are not covered by their insurance. These Health FSA plans can also be integrated with a Premium Only Plan (POP) and/or a Dependent Care FSA. The FSA acts as… Read More

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