What are Commuter or Transit Benefits (Section 132)?

Commuter or Transit Benefits (Section 132) Parking & mass transit expenses may be paid for with pre-tax dollars through a commuter plan. This plan is a straightforward way for participants to reduce their commuting costs and for employers to gain additional payroll tax reductions. Some states, like NY and NJ have mandated the inclusion of commuter benefit plans over the last few years. A commuter benefit plan is typically offered as one component of a Flexible Spending Account (Section 125) What expenses qualify as commuter/transit benefits? Commuter highway vehicle: A commuter vehicle is any highway vehicle that seats at least 6 adults (not including the driver). In addition, you must reasonably… Read More

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How Does Level Self Funded Health Insurance Work?

We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding your group’s health insurance might be a good for for your health plan! Contact your Total Benefit Solutions Account manager at (215)355-2121.

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Does Medicare Cover Oral Surgery?

From our partners at HealthLine: If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs. While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage. Let’s explore which types of oral surgery Medicare covers and why.   Click here for the full story. Questions about this story or Medicare coverages? Please contact your health insurance specialists at Total Benefit  Benefit Solutions, Inc (215)355-2121  

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ARPA Extends Open Enrollment for Individual Coverage in PA

Pennie (PA Individual Exchange) has communicated that they will be extending the open enrollment period from May 15 until August 15, 2021. This extension is to help consumers be able to take advantage of the benefits of the American Rescue Plan. Some of the key benefits of this plan are below: There is no longer a cap on who is eligible for Pennie’s income-based tax credits, which help reduce monthly premium costs. Previously only people whose household income was under 400% of federal poverty level (about $51,000 for an individual), could qualify for a tax credit. Now, anyone may be eligible for a tax credit. The size of the tax… Read More

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Enrollment Period at Get Covered New Jersey Extended

More information on the American Rescue Plan Act changes may be found on the Get Covered New Jersey website. Contact your Total Benefit Solutions, Inc health insurance specialist to get enrolled or if you have any questions or concerns at (215)355-2121

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What is Minimum Essential Coverage or MEC health insurance?

The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More

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Health Insurance: What Do You Pay for?

What Is a Monthly Premium? Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year. For individual ACA compliant plans, premiums are based on a pre-approved age based grid.  When you enter a age on the grid, your premium will increase on your bill. What Are Out-of-Pocket Costs? Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a… Read More

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Departments Issue Guidance Re: FFCRA and CARES Act

On February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued FAQ 44 addressing health coverage issues related to COVID-19. Briefly, the new FAQs focus on diagnostic testing and coverage for testing and clarify previous guidance in FAQs.Background Section 6001 of the FFCRA requires group health plans (including grandfathered health plans) and health insurance issuers to provide coverage for certain items and services related to testing or the diagnosis of COVID-19 without any cost-sharing requirements, prior authorization or othermedical requirements. Section 3201 of the CARES Act amended Section 6001 of the FFCRA to include a broader range of diagnostic items and services… Read More

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New COBRA Subsidy Begins April 1st under COVID Relief

Congress passed the American Rescue Plan Act of 2021 (“the Act”) on March 10, 2021 and it was signed into law on March 11, 2021. The Act includes a 100% COBRA subsidy available to certain COBRA qualified beneficiaries who lose group health plan coverage as the result of an involuntary termination or reduction in hours. This is different from the original House legislation, which included an 85% subsidy (with the COBRA beneficiary responsible for 15% of the COBRA premiums). Employers will be able to claim a credit against payroll taxes to reimburse the cost of the subsidy. The COBRA subsidy begins April 1, 2021 (the first day of the month… Read More

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What is a benefit Third Party Administrator (TPA)?

A Third-Party Administrator (TPA) is an organization that processes insurance claims or specific aspects of employee benefit plans for other organizations. Using a TPA is a generally a way to outsource claims processing. Employers that self-insure their health insurance benefits often outsource to a TPA. Using a TPA can be a smart business decision whether you want expertise in particular areas or avoid the costs and liabilities of doing it in house. But not always self insured employers need a TPA. Third party administrators also handle many aspects of other employee benefit plans such as the processing of retirement plans.  Most employers who provide health insurance plans use a TPA… Read More

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Pandemic Aid Package Includes Relief From High Premiums

  From KHN: As President Joe Biden’s pandemic relief package steams through Congress, Democrats have hitched a ride for a top health care priority: strengthening the Affordable Care Act with some of the most significant changes to insurance affordability in more than a decade. The bill would spend $34 billion to help Americans who buy insurance on the marketplaces created by the ACA through 2022, when the benefits would expire. The Senate sent its relief package, one of the largest in congressional history, back to the House where it could come up as early as Tuesday. It is expected to pass and then go to Biden for his signature. Highlights… Read More

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COBRA Subsidy in the works

          Photo by AllGo – An App For Plus Size People on Unsplash A COBRA subsidy is included in early drafts of the proposed fiscal year 2021 budget reconciliation package. If finalized, the COBRA subsidy would apply to workers who have lost group coverage during the COVID-19 pandemic due to involuntary termination or reduction in hours of employment. Download this bulletin below for more information and as always contact your Total Benefit Solutions, Inc health insurance specialist with any questions at (215)355-2121. Download COBRA Subsidy in the Works

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How to read your Explanation of Benefits EOB

Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find outhow much a provider charged for services, what your health plan paid, and how much you owe. While the attached sample below  is from a specific health insurance company they all follow the same format.  Reading your EOB is especially important if you are submitting your claims for reimbursement through an HRA or health reimbursement arrangement. Need more information or help  with your EOB or claims? Reach out to your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Download How to read your EOB

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What is a Direct Primary Care plan?

Photo by CDC on Unsplash What is Direct Primary Care (DPC)? DPC is a non-insurance healthcare model where a flat monthly fee is paid for a defined set of primary care services. Direct Primary Care membership typically includes timely and unlimited access to your physician via in-office visit or over the phone. The model is structured to emphasize the patient-physician relationship to lower care costs, promote better employee health, and better patient experience. Benefits include: Increased Access to Healthcare. Breaks down the barriers to healthcare like confusing narrow networks, high deductibles and limited enrollment period. Detect Diseases and Treat Sooner. Encourages the early detection of illnesses, which reduces expenses for both… Read More

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What is a minimum essential coverage (MEC) plan?

The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More

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Pennie is Pennsylvania’s new official destination for shopping for quality health insurance plans and accessing financial assistance, if eligible.

Pennie is Pennsylvania’s new official destination for shopping for quality health insurance plans and accessing financial assistance, if eligible. When is open enrollment? Open enrollment is November 1, 2020, to January 15, 2021. During this time period, anyone living legally in Pennsylvania can apply for health insurance through Pennie. Individuals with qualifying life events can enroll at any time of the year. Who can help you enroll? They have several options to assist you in enrolling in a health insurance plan. Don’t try completing the enrollment process by yourself, the experts at Total Benefit Solutions, Inc are Pennie-certified Brokers. Where can I learn more about financial assistance and if I… Read More

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HSA/HDHP Limits Increase for 2020

On May 28, 2019, the IRS released Revenue Procedure 2019-25 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2020. These limits include: The maximum HSA contribution limit; The minimum deductible amount for HDHPs; and The maximum out-of-pocket expense limit for HDHPs. These limits vary based on whether an individual has self-only or family coverage under an HDHP.  The IRS limits for HSA contributions increase for 2020. Eligible individuals with self-only HDHP coverage will be able to contribute up to $3,550 for 2020, while eligible individuals with family HDHP coverage will be able to contribute up to $7,100 for 2020. The HDHP… Read More

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Court Strikes Down Association Health Plan Rules

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

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IBC to Reach Agreement with Providers in Our Area!

We are pleased to share that Mercy Health System, St. Mary Medical Center, Saint Francis Healthcare and Independence Blue Cross (Blue Cross) anticipate coming to an agreement on a new, long-term contract this week, meaning there should be no interruption to your care or coverage at the following facilities: Mercy Fitzgerald Hospital Mercy Philadelphia Hospital Nazareth Hospital St. Mary Medical Center Saint Francis Healthcare in Delaware We thank you for your continued support and patience throughout this process, and apologize for any anxiety or inconvenience this negotiation may have caused you or your family – that was never our intention. We look forward to continuing to provide you the care… Read More

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New Jersey Small Employer Stop Loss Bill

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

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Important News From Independence Blue Cross: Trinity Health termination

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

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Walgreens agrees to pay $269 million in fraud accord

Walgreens Boots Alliance agreed to pay $269.2 million to settle U.S. claims that the drugstore chain defrauded a federally funded health care program over insulin drugs and a consumer-discount initiative. The two settlements, announced Tuesday, cover allegations over improper billing. In the first one, the company agreed to pay $209.2 million to resolve claims it billed Medicare, Medicaid and other programs for hundreds of thousands of insulin pens it distributed to people who didn’t need them. In the second, Walgreens said it would pay $60 million for overbilling Medicaid by not disclosing lower prices it offered in a discount program. To read more, click here.

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