Independence Blue Cross (Independence) recently received approval from the Pennsylvania Insurance Department to increase monthly premium rates effective July 1, 2023 for: The following plans did not have a rate increase: H with Rx, F(HD), N, and G(HD). Please review the 2023 Mid-Year Medigap Rate Increase – Medigap Security & Security 65 document for more information on call scripting and see below for related links for rate change letters and rate sheets.Continue Reading
Members receive letter about NationsBenefits security breach
Some Aetna Medicare plans include benefits administered by a company called NationsBenefits or one of its affiliates (“the company”). Specifically, the company administers the hearing aid benefit, as well as the Extra Benefits Card benefit, on some plans. Recently, NationsBenefits learned that a third-party vendor they used to securely exchange files with certain health plans, experienced a data security incident. The security breach impacted members whose plans include the NationsHearing hearing aid benefit or the Nations Extra Benefits Card benefit. What you need to know: Member communication: Impacted members will receive a letter from NationsBenefits. View a sample of the member letter. Letters began mailing on April 27. The letter explains what happened, what… Read MoreContinue Reading
Independence: Annual Medicare Secondary Payer Group Size Collection Process
Independence Blue Cross (Independence) is required to collect information from group customers with 300 or fewer employees regarding their employer size to ensure proper coordination of benefits and reporting under the Medicare Secondary Payer (MSP) laws. This information is used by The Centers for Medicare & Medicaid Services (CMS) to determine whether Independence or Medicare is the primary payer of claims for Medicare-eligible employees. We are mailing MSP notification letters this week to customers directing them to our MSP group size webpage, where they will find additional information on MSP and can complete a required survey. The survey must be completed by December 31. Customers will need their CID number (provided on the… Read MoreContinue Reading
The Benefits of Short-Term Health Insurance
Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read MoreContinue Reading
Independence Blue Cross: Changes to the Select and Value formularies for July 1
Independence Blue Cross (Independence) is making changes to the Select Drug Program (Select) and Value formularies for July 1. Independence routinely updates its prescription drug formularies and reviews the list of drugs requiring prior authorization as part of our procedures for safe prescribing. These changes are approved by our Pharmacy and Therapeutics Committee. Updates are made to the Select and Value formularies quarterly. The updated lists for July 1 will be available on the website on May 1. Select the link to either the Select or Value formulary. The updated list is available under “Formulary drug documents.” Standard changes can include: Members, as well as their providers, who are impacted by the… Read MoreContinue Reading
Horizon BCBSNJ Small Group to Add a Surcharge for Premium Payments Made With Credit Cards
Effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. During the COVID-19 Public Health Emergency (PHE), Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) changed how they accepted premium payments from their Small Group customers to allow the use of credit cards. With the PHE ending, effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. Small Group Customers Still Have No-Cost Payment OptionsHorizon BCBSNJ offers… Read MoreContinue Reading
2023 First Quarter Compliance Digest
Download the 2023 First Quarter Compliance Digest, featuring all of the released compliance bulletins for January through March. This document is a valuable resource, putting all of the latest health care reform news and updates in one location. As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.Continue Reading
IBC: Employer Portal Handbook
Not sure how to use your IBC billing and enrollment portal? Download this helpful guide. As always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any further questions or concerns.Continue Reading
The health plan categories: Bronze, Silver, Gold, & Platinum
Plans in the Marketplace are presented in 4 health plan categories: Bronze, Silver, Gold, and Platinum. FYI: Health plan categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. How you and your insurance plan split costs Which health plan category is right for you? Bronze Silver Gold Platinum Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
10 Things to Know About Medicaid Managed Care
Managed care is the dominant delivery system for Medicaid enrollees. With 72% of Medicaid beneficiaries enrolled in comprehensive managed care organizations (MCOs) nationally, plans have played a key role in responding to the COVID-19 pandemic and are expected to work with states in conducting outreach and providing support to enrollees during the unwinding of the continuous enrollment requirement. While managed care is the dominant Medicaid delivery system, states decide which populations and services to include in managed care arrangements which leads to considerable variation across states. Additionally, while we can track state requirements for Medicaid managed care plans, plans have flexibility in certain areas including in setting provider payment rates… Read MoreContinue Reading
What is cost sharing reduction (CSR)?
A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
Did You Know? Cigna + Oscar plans in Pennsylvania offering you a simple, non-tiered network?
That’s right! ? Cigna + Oscar plans in Pennsylvania utilize Cigna‘s Open Access Plus Network. Offering you a simple, non-tiered network. This includes facilities you know and use, such as: View the full Pennsylvania network here. Please contact your health insurance specialists at Total Benefit Solutions, Inc iat (215)355-2121 f you have any further questions or concerns about Oscar heath!Continue Reading
ACA special enrollment period opens soon for people losing Medicaid coverage
The Centers for Medicare and Medicaid Services (CMS) will open an ACA special enrollment period (SEP) for people losing Medicaid coverage due to the end of the COVID-19 public health emergency (PHE). The PHE ends May 11. The ACA SEP aims to maintain continuity of coverage as people transition from Medicaid into a Marketplace-qualified health plan. It runs March 31 to July 31, 2023. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
The End of COVID-19 Public Health Emergency: How will telemedicine be affected?
On Jan. 30, 2023, the Biden Administration announce it will end the public health emergency (and national emergency) declarations on May 11, 2023. Telemedicine What’s changing: Some flexibilities associated with providing health care via telehealth during the public health emergency will end. What’s the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent. Have any questions regarding this notice?… Read MoreContinue Reading
Allstate Benefits Level Funded Plan Member Kit
Considering Level funding and/or reference based pricing for your group health insurance? Download the brochure below to learn more about it them contact your health insurance specialists at Total Benefit Solutions, Inc today to compare your current plan to level funded and reference based pricing options! The brochure includes information on reading an EOB, Vitality and the healthcare blue book as well. As always we can be reached at (215)355-2121. Employee-eKit-with-Healthcare-Bluebook-Member-FlyerDownloadContinue Reading
What is an agent and broker?
A trained insurance professional who can help you enroll in a health insurance plan. Agents may work or a single health insurance company; brokers may represent several companies. You won’t pay anything additional if you enroll with an agent or broker. As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.Continue Reading
What is State Mandated Disability or TDB?
New Jersey Temporary Disability Benefits (TDB) and Family Leave Insurance (FLI). The New Jersey Temporary Disability Benefits (TDB) law, enacted in 1948 and later amended in 2008 to include Family Leave Insurance (FLI), allows for NJ covered workers to take paid time off for their own non-occupational related injury or illness (under TDB) or to care for a family member with a serious health condition or bond with a new child (under FLI). Which employers are subject to the law? Most New Jersey employers subject to the provisions of the Federal Unemployment Tax Act (FUTA) are also subject to NJ TDB law and are required to provide coverages for their employees working in… Read MoreContinue Reading
The End of COVID-19 Public Health Emergency: How will COVID treatments be affected?
On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. COVID Treatment What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government). Medicare beneficiaries may fact cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing. What’s the same: Any pharmaceutical treatment doses (e.g., Paxlovid) purchased… Read MoreContinue Reading
What is a bronze health plan?
One of 4 plan categories (also known as “metal levels”) in the Health Insurance Marketplace®. Bronze plans usually have the lowest monthly premiums but the highest costs when you get care. They can be a good choice if you usually use few medical services and mostly want protection from very high costs if you get seriously sick or injured. Note: Bronze plan deductibles can be very high. This means you could have to pay thousands of dollars of health care costs yourself before your plan starts to pay its share. All health plans in all categories provide free preventive services, and some plans offer other services at low or no… Read MoreContinue Reading
Notice: White House announces COVID-19 PHE and National Emergency will be allowed to expire
On January 30, 2023, the White House announced its plan to allow the COVID-19 Public Health Emergency (PHE) and National Emergency periods to expire on May 11, 2023. We have provided example scenarios in the Compliance Alert that demonstrate the impact of the national emergency period expiration. We encourage you to review each example to determine the impact on your specific plan(s). Although we encourage you to review the entire Compliance Alert, we have provided a summary of the content for your review: Public Health Emergency During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing or prior authorization or… Read MoreContinue Reading
What is the tax filing requirement?
The minimum amount (or threshold) of income requiring you to file a federal tax return. 2022 filing requirements for most taxpayers: Gross income of at least $12,950 (individuals) or $25,900 (married filing jointly). Different thresholds apply for dependents, people 65 and older, and those who use other tax filing statuses (like married filing separately). Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.Continue Reading
The End of COVID-19 Public Health Emergency: How will PCR and rapid tests be affected?
On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. PCR and rapid tests ordered or administered by a health professional What’s changing: Although most insured people will still have coverage of COVID tests ordered or administered by a health professional, these tests may no longer be free. What’s the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and therefore will continue to pay full price for tests unless they can get tested through a free clinic or community health center. Have any questions regarding this notice? Don’t… Read MoreContinue Reading
Do HSA’s, FSA’s, or HRA’s carryover or rollover?
Health Savings Account (HSA): All funds belong to the employee. Unused balances roll over into the next year. Funds do not expire from year-to-year. Rollover funds do not count towards the contribution limit. Health Flexible Spending Account (FSA): Amounts must be incurred by the end of the plan year and do not usually carry over unless an employer allows up to $610 to carry over into the next year. Amounts that roll do not affect the maximum election that can be made for the plan year. Otherwise, employers may adopt a 2 and half month grace period that allows participants to access unused amounts remaining in their accounts. Health Reimbursement… Read MoreContinue Reading
Small Group – Form 1095-B: Who receives it and why
Form 1095-B is a health insurance tax form used to report certain information to the IRS and taxpayers about individuals who are covered by Minimum Essential Coverage (MEC). What are the IRS reporting requirements? The ACA requires individuals to obtain and report that they had MEC or otherwise qualify for an exemption from the requirement. However, there is no longer an individual tax penalty following the 2017 Tax Cuts and Jobs Act. Individuals may need Form 1095-B to demonstrate MEC for nontax-related purposes. The ACA also requires certain employers to offer all full-time employees and their dependents MEC to meet affordability and minimum value standards. This is known as the… Read MoreContinue Reading
The End of the COVID-19 Public Health Emergency: How will at-home COVID tests be affected?
On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. At-home COVID tests What’s changing: At-home (or over-the counter) tests may become more costly for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive free, at-home tests. Those with private insurance and Medicare Advantage (private Medicare plans) no longer will be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them. For those on Medicaid, at-home tests will be covered at no-cost through September 2024. After that date, home test coverage will vary by state. A temporary Medicaid… Read MoreContinue Reading