Individual Health Insurance | Total Benefit Solutions Inc

2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

September 22, 2021September 21, 2021Ed MacConnell

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

How is COBRA health insurance affected if I am disabled?

September 21, 2021September 21, 2021Ed MacConnell

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

2021 Second Quarter Compliance Bulletins Compilation

July 7, 2021July 7, 2021Ed MacConnell

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

Independence: Small Group Forms

June 30, 2021June 30, 2021Ed MacConnell

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!

Tax Advantaged Benefit Documents

June 18, 2021June 18, 2021Ed MacConnell

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.

Alternatives to Health Insurance Benefits

June 13, 2021June 18, 2021Ed MacConnell

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

Family Dental & Vision Plans

June 3, 2021June 3, 2021Ed MacConnell

We have a number of stand-alone dental and vision plans from Davis Vision, VSP and Delta Dental. You can review, compare and enroll on plans in minutes! https://brokers.dentalforeveryone.com/?id=B3F52EA5-F0E3-40B4-B1DB-0F060AE09478

What is Modified Adjusted Gross Income (MAGI)?

June 3, 2021June 3, 2021Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return.

What is a Qualified High Deductible Health Plan?

May 25, 2021May 25, 2021Ed MacConnell

Qualified HDHPs Enrollment in a qualified HDHP is a requirement for establishing and maintaining a health savings account. The chassis for a qualified HDHP is the same as described in Chapter 1, but it must also conform to certain federal guidelines: A qualified HDHP must specify both a minimum annual deductible and a maximum annual out-of-pocket (OOP) expense limit, as set every year by the IRS. The minimum annual deductible is just that—the minimum amount that the insured must pay before the plan pays any benefit. The maximum annual OOP expense limit is the cap on the sum of the annual deductible and all out-of-pocket expenses the insured must pay for covered expenses under the… Read More

What Is Medicare Supplement Insurance?

May 12, 2021May 14, 2021Ed MacConnell

Medicare coverage can be complex. Some of the rules of Medicare coverage can change without the beneficiary even knowing. Who even knows when their employer crosses an enrollment threshold? Best advice is to always speak to a health insurance specialist who is certified and experienced in the many facets of health insurance including the intersections between Medicare and Employer coverage. Contacting Total Benefit Solutions, Inc is the first step!

5 reasons you may want to switch Medigap policies

May 7, 2021May 7, 2021Ed MacConnell

Switching Medigap policies 5 reasons you may want to switch Medigap policies You’re paying for benefits you don’t need. You need more benefits. You want to change your insurance company. You want a policy that costs less. Can I switch policies? In most cases, you will not have a right under federal law to switch Medigap policies, unless one of these applies: You’re eligible under a specific circumstance or guaranteed issue rights You’re within your 6-month Medigap open enrollment period You don’t have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy. Note As of January 1, 2020,… Read More

Update on COVID-19 Vaccine and Vaccine Administration Cost

April 23, 2021April 23, 2021Ed MacConnell

Update on COVID-19 Vaccine and Vaccine Administration Cost Medicare has increased and simplified its payment rate for administration of the COVID-19 vaccine to $40 per dose. This change may impact group health plans with respect to their payment rate to providers. Non-grandfathered group health plans are required to cover, without cost sharing, the COVID-19 vaccine. This obligation extended to coverage associated with administering the vaccine. The federal government continues to pay for the vaccine itself through funding authorized by the CARES Act.For vaccines administered in-network, plans will pay the rate negotiated with in-network providers, and that continues to be true. For vaccines administered out-of-network, however, group health plans must reimburse… Read More

COVID-19 PPE Now a Qualified Medical Expense

April 13, 2021April 13, 2021Ed MacConnell

On March 26, 2021, the IRS issued IRS Announcement 2021-7, which clarifies that amounts paid for certain personal protective equipment (“COVID-19 PPE”) used to prevent the spread of COVID-19, including masks, hand sanitizer and sanitizing wipes can be treated as amounts paid for medical care under § 213(d) of the Internal Revenue Code. Accordingly, because these amounts are expenses for medical care under § 213(d) of the Internal Revenue Code, these amounts can also be eligible expenses under a health flexible spending account (health FSA), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and Archer medical savings accounts (Archer MSAs). Note, that if the amount is paid or reimbursed under… Read More

How Does Level Self Funded Health Insurance Work?

April 7, 2021April 7, 2021Ed MacConnell

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.

PPE and Health FSA/HRA

April 6, 2021April 2, 2021Ed MacConnell

The IRS announced that amounts paid for personal protective equipment such as masks, hand sanitizer and sanitizing wipes for the primary purpose of preventing the spread of COVID-19 are considered amounts paid for medical care under section 213 of the Internal Revenue Code. These items are now allowed to be reimbursed from a health FSA. The IRS notice recognizes all forms of PPE as expenses medical care and does not limit the PPE to just disposable or non-disposable items. Reimbursements are permitted for expenses incurred on or after 1/1/2020 and they must be properly documented for reimbursement. If plan terms do not allow the reimbursement of PPE but the plan… Read More

Does Medicare Cover Oral Surgery?

April 5, 2021April 2, 2021Ed MacConnell

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

Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

April 3, 2021April 2, 2021Ed MacConnell

there are millions of uninsured people who could be getting subsidized coverage on the ACA Marketplaces, but have not taken advantage of this financial help. In many cases, it may be that the financial help available to them is not sufficient to make the premium or the deductible affordable

ARPA Extends Open Enrollment for Individual Coverage in PA

April 1, 2021April 1, 2021Ed MacConnell

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

Enrollment Period at Get Covered New Jersey Extended

March 31, 2021March 31, 2021Ed MacConnell

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

What is Minimum Essential Coverage or MEC health insurance?

March 30, 2021March 31, 2021Ed MacConnell

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

Departments Issue Guidance Re: FFCRA and CARES Act

March 16, 2021March 16, 2021Ed MacConnell

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

Pandemic Aid Package Includes Relief From High Premiums

March 10, 2021March 10, 2021Ed MacConnell

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

HSA/HDHP Limits Increase for 2020

June 9, 2019June 9, 2019Ed MacConnell

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

Important News From Independence Blue Cross: Trinity Health termination

February 17, 2019February 17, 2019Ed MacConnell

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

Category: Individual Health Insurance