Independence Medicare Advantage plans receive 5 stars from CMS

  We are pleased to share that Independence Medicare Advantage health and prescription drug plans have been rated among the nation’s best by the Centers for Medicare & Medicaid Services (CMS)! Independence’s Keystone 65 HMO and Select Option Rx PDP plans earned a prestigious 5 out of 5 stars in the CMS 2022 Star Ratings. The organization’s Personal Choice 65SM PPO plan also received 4.5 stars, CMS’s second‑highest rating. Published annually, the CMS Star Ratings provide a scorecard on Medicare Advantage health and prescription drug plans’ quality and performance measures such as member compliance with preventative care and screening recommendations, chronic condition management, customer service, access to care, and more. Earning 5 stars is a significant accomplishment that reflects an… Read More

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HHS Issues Guidance Addressing HIPAA & COVID-19 Vaccinations

The Department of Health and Human Services (“HHS”) issued guidance in the form of questions and answers addressing how the HIPAA Privacy Rule applies in regardto COVID-19 vaccinations. The guidance makes clear that HIPAA’s privacy rules are not an obstacle to an employer that would like to establish a vaccination requirement for itsemployees and customers. Click to Download HHS Issues Guidance Addressing HIPAA and COVID-19 Vaccinations As always contact your Total Benefit Solutions, Inc health insurance specialists if you have any further questions or concerns at (215)355-2121.

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What is NY HCRA and who does it apply to?

  New York Health Care Reform Act (NY HCRA) became effective January 1, 1997. It collects public funds for Indigent Care and Graduate Medical Education (GME, also known as PEP) through a system of surcharges and regional assessments. The State of New York has contracted Blue Cross/Blue Shield of Central NY to administer this legislation as the Public Goods Pool. Click the link to download the detailed explanation What is NY HCRA and who does it apply to Questions about self funding health insurance? Contact your Total Benefit Solutions health insurance specialists at (215)355-2121 

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Total Benefit Solutions Acquires Tower Group Associates

Total Benefit Solutions, Inc of Feasterville PA has acquired Tower Group Associates (www.Towerfp.com & 856-627-1126)  formerly of Voorhees , New Jersey effective October 2021 Tower Group Associates clients are asked to reach out to Total Benefit Solutions, Inc at (215)355-2121. “Tower Group Associates has a long standing reputation as one of the top health insurance servicing forms in the Philadelphia area. We are proud to have the opportunity to became one of the same team expressed Edward MacConnell, President of Total Benefit Solutions Inc..  We are looking forward to working with the Tower team of specialist, brokers and clients. For more information contact Total Benefit Solutions, Inc at (215)355-2121.

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Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia

We scored Philadelphia Health Insurance Agencies on more than 25 variables across five categories, and analyzed the results to give you a hand-picked list of the best. Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia by expertise.com

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Medicare Part D Notification Requirements

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drugcoverage provided under the plan is “creditable” or “noncreditable.”This notification must be provided prior to October 15th each year. Also, following the plan’s annualrenewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. Employers should send these notices no later than October15, 2021 if they haven’t done so already. Have questions about this notice? Contact your Total Benefit Solutions Inc health insurance specialists at (215)355-2121. Click here to download Medicare Part D Notification Requirements  

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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

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How is COBRA health insurance affected if I am disabled?

  In certain circumstances, if a disabled individual  and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months.  The criteria for this 11-month disability extension is a complex area of COBRA law.  We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at phig@cms.hhs.gov. In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee’s employment hours.  Second, the covered employee must be determined under title II or title XVI of the… Read More

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Dental & Vision Plans for Families

  Getting a quality dental plan when you are self employed or don’t have employer coverage can be a real challenge.  But don’t worry! The professionals at Total Benefit Solutions, Inc work for your benefit! We have provided this easy to use online portal to help you shop, compare and enroll on a great plan of your choice!  We can walk through the options with you or you can enroll on the portal on your own, whatever you choose! Questions about these dental benefits? Just give us a call (215)355-2121.  Click here to find and compare dental and vision plans!   

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What Are Medicare Guaranteed Issue Rights?

Guaranteed Issue Rights (Also Called “Medigap Protections”)  are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a  Medicare Advantage Plan (Part C)  and still buy a Medigap policy if you change… Read More

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When can I buy a Medigap plan?

    Buy a policy when you’re first eligible  The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the first month you have   Medicare Part B (Medical Insurance)  and you’re 65 or older. It can’t be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more due to past or present health problems.… Read More

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Medicare Supplement Plan F or G?

  Many of our clients ask what is the “best” Medicare supplement that they can buy. While there is no overall “best”, the Medicare Supplement Plan F is generally considered the most comprehensive coverage among Medicare supplements due to the fact that most services are covered without any member co-pay or cost sharing at all. Keep in mind that Medicare supplements, like Plan F do not cover prescriptions and that a beneficiary with Medicare supplement will need to have other coverage for prescription drug coverage.  A little known fact about Medicare supplements is that they do not have an annual “open enrollment” period so a beneficiary with a supplement can… Read More

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AmeriHealth New Jersey prepares to comply with new Transparency requirements

From Amerihealth NJ: Health care and health insurance are among the most regulated industries in the U.S., making compliance a crucial requirement for success. AmeriHealth New Jersey has a strong track record of compliance to local, state, and federal guidelines, and we are working to comply with the new Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) requirements. We have been focused on transparency for our members for years, and we are now further sharpening our efforts related to transparency and accountability pertaining to the recent legislation for which we have developed an enterprise-wide implementation program to ensure requirements are met. We have a cross-functional team that is… Read More

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HHS Extends Public Health Emergency until October 18, 2021

  On July 19, 2021, the Secretary of Health and Human Services (“HHS”), announced that the administration will renew the COVID-19 pandemic Public Health Emergency, scheduled to expire on July 20, 2021. This will once again extend the period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. As previously noted, in a letter sent to state governors, HHS indicated that the agency expects that the Public Health Emergency will likely remain in place for all of 2021. While not formal agency action, it appears that HHS intends to continue to renew the Public Health Emergency through, at least, the end… Read More

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COBRA Subsidy Termination Notice Reminder

AEIs must be provided with a notice of expiration of the COBRA subsidy between August 16 and September 15, 2021. The notice must explain the date that the premium assistance will expire and that the individual may be eligible for coverage without any premium assistance through COBRA, a group health plan, the Marketplace, or Medicare/Medicaid.

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2021 Second Quarter Compliance Bulletins Compilation

This document is a valuable resource, putting all of the latest health care reform news and updates in one location! 

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Independence: Using the e-bill feature

From Independence Blue Cross: There’s an easy way to simplify your administration and reduce costs —make secure eBill payments through our employer portal at ibx.com, anytime and anywhere… Download ebill bulletin    

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Achieve Well-being Rewards

Independence Blue Cross (Independence) offers a new way to help your employees achieve their health goals. Reward employees for completing activitiesNothing helps motivate action like the promise of rewards!*Achieve Well-being tools available on ibx.com and on the IBX mobile app create personalized action plans that make it easy for your employees to earn tokens and badges for completing their well-being goals.New for 2021, your employees can now receive a $150 gift card by completing the following required activities: Annual check-up with PCPFlu shotGet digitally engagedMember portal registrationMDLIVE.com registrationWell-being profileOpt-in to digital messaging at ibx.com Once your employees complete all six activities through the Achieve Well-being tool they can redeem a… Read More

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Independence: Small Group Forms

  Independence Blue Cross keeps most of the forms small business health insurance customers need on a regular basis online and easy to access. Click here to get the latest forms from ibx.com  Please contact Total Benefit Solutions, Inc. if the form you need is not available or you have any questions or concerns!

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What is your SBC? Understanding Your Health Insurance Plan.

Summary of Benefits and Coverage (SBC) An SBC covers the basics of your health plan. It’s an easy-to-read summary that lets you make comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. Your health insurance experts at Total Benefit Solutions, Inc can show you how to use your SBC to compare plans before making any decisions! Contact us at (215)355-2121.

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New Mandatory Preventive Items and Services

  Most plans will be required to cover new preventive items and services beginning later this year, or in 2022 or 2023 (depending on the plan year), including ones related to Hepatitis B virus infection screenings and colon cancer screenings. Non-grandfathered group health plans must provide coverage for in-network preventive items and services and may not impose any cost-sharing requirements (such as a copayment, coinsurance, or deductible) with respect to those items or services. Click to Download New Mandatory Preventive Items and Services – 2021 Update

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Tax Advantaged Benefit Documents

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

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Alternatives to Health Insurance Benefits

 Sometimes clients offer other alternative benefits to their employees. The reasons for doing this are many but depending on the earnings of their workforce, offering a group medical plan will eliminate any health insurance subsidy. In those cases offering a group health insurance benefit can come off as a penalty for the employees. By offering alternative benefits our experts can help the employees enrolled on a subsidized health insurance plan and still get good if not great benefits from their employer!  ICHRA: with an ICHRA the employer can give the employees money towards their health insurance purchase.  The ICHRA allows the employer to do so with untaxed dollars and the… Read More

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What is Blue Card PPO?

Many clients ask us about Blue Card PPO and how it works. Blue Card PPO is typically attached to our clients policies who are enrolled on an IBC Personal Choice PPO or National Network PPO or a Horizon Blue Cross plan with National Access. You can tell if you have this on your plan if your card has the PPO Traveling Briefcase ppo logo.   It’s important to note that members who have a Keystone HMO, Amerihealth or Horizon HMO or local EPO do NOT have Blue Card PPO.  How Does the BlueCard Program Work? BlueCard® PPO Medical Plan The BlueCard Preferred Provider Organization (PPO) medical plan gives you the freedom to… Read More

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