New Federal Rules: HHS 2023 Penalty Hike

Wendy Lopez

In the world of healthcare compliance, staying up to date with federal regulations and guidelines is crucial to avoid costly penalties. One such regulation that affects healthcare providers and group health plans is the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, commonly known as the “Inflation Adjustment Act.” This act directs federal agencies to adjust civil monetary penalties to account for inflation. In a recent development, the Department of Health and Human Services (HHS) issued final rules on October 6, 2023, updating the civil monetary penalties for inflation. Understanding the Updated Penalties The adjusted penalties are applicable to penalties assessed on or after October 6, 2023. It’s… Read More

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Court Vacates Coupon Cost-Sharing Rule

Wendy Lopez

On September 29, 2023, a significant legal development occurred that could affect how health insurance carriers and group health plans handle manufacturer coupons for prescription drugs. The District Court for the District of Columbia vacated a rule issued by the Department of Health and Human Services (HHS) that allowed, but did not mandate, the inclusion of manufacturer coupons in calculating the cost-sharing for health plans. In this blog post, we’ll explore the background of this issue, the 2019 HHS rule, and the subsequent legal decisions that have led to this recent development. HHS’s 2019 Rule In 2019, HHS issued a rule to clarify this matter. The rule stated that plans… Read More

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Affordable Dental Insurance: A Key Player in Oral Health

Wendy Lopez

Dental health is a crucial aspect of overall well-being, and a recent survey has shed light on the satisfaction levels of Americans with their dental insurance plans. The results, published in a press release by AHIP (America’s Health Insurance Plans) on September 26, 2023, provide an insightful perspective on the state of dental insurance in the United States. The survey, conducted by Global Strategy Group (GSG) on behalf of AHIP, focused on individuals who have dental insurance and have visited dental specialists, including dentists, oral surgeons, and orthodontists, in the past year. The findings from the survey paint a positive picture of Americans’ experiences with their dental insurance plans. Key… Read More

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Financial Support Soars for Mental Health Integration

Wendy Lopez

Mental health is an essential component of overall well-being, and every American deserves access to quality mental health and substance use disorder treatment. Access to mental health care can be a transformative step in managing and coping with mental health concerns, allowing individuals to lead more fulfilling lives. This article explores the importance of integrating mental health services into other care settings and highlights the Collaborative Care Model (CoCM) as a promising approach to enhance access to mental health care. Expanding Access Through Integration Integrating mental health into broader healthcare settings is a pivotal strategy to increase accessibility and support for patients. The Collaborative Care Model, often abbreviated as CoCM,… Read More

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The Secrets to Patient Loyalty in Healthcare

Wendy Lopez

The healthcare industry is undergoing a transformation like never before. In an era of insurgent competitors and changing payment models, the COVID-19 pandemic acted as a pressure test, accelerating the pace of disruption and digital adoption. Now, there’s a unique opportunity for healthcare to make loyalty central to its mission. From earning consumer trust to establishing brand relevance, the industry is evolving in profound ways, reshaping patient experiences to boost retention and a sense of belonging. Both healthcare providers and payers are re-engineering how they connect with their customers to earn their loyalty during this time of unprecedented change. At first glance, the concept of “loyalty” in healthcare may seem… Read More

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Small Business, Big Benefits: Health Coverage for All

Wendy Lopez

In the United States, the landscape of healthcare is a complex one, with various options available to individuals and families. One of the most significant sources of health coverage for Americans is employer-provided coverage. This type of coverage is a health plan, or a selection of health plans and other benefits, purchased by an employer and offered to eligible employees and their dependents. It’s a system that plays a crucial role in ensuring that millions of hardworking individuals and their families have access to quality healthcare. Affordable Access to Care The primary advantage of employer-provided coverage is its affordability. Employees’ contributions to their health coverage are tax-free, which means that… Read More

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2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?

Wendy Lopez

In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More

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The Value of Employee Health Benefits

Wendy Lopez

In today’s world, where healthcare costs can be a significant burden on individuals and families, employer-provided health coverage stands out as a vital resource. More than half of all Americans – over 180 million hardworking individuals and their families – rely on their jobs to secure access to healthcare. In this blog, we’ll explore the invaluable benefits of employer-provided coverage and how it offers affordable access to care, improved health, and peace of mind. Affordable Access to Care Healthcare expenses can quickly add up, and without insurance, it can be a daunting task to manage them. However, for millions of Americans, the path to affordable healthcare begins with their employers.… Read More

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Medicaid Redetermination Updates: Your Next Steps

Wendy Lopez

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

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No Child Left Uninsured: Innovative Solutions in Healthcare

Wendy Lopez

Millions of children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for their health and well-being. However, the redetermination process can sometimes pose challenges for their parents. In this article, we explore the innovative efforts undertaken by health insurance providers to ensure that children maintain access to healthcare, regardless of their parents’ circumstances. Medicaid plays a crucial role in American healthcare, improving the health and financial security of millions of individuals daily. It’s particularly vital for the 42 million children enrolled in Medicaid or CHIP. While parents may face hurdles during the Medicaid redetermination process, children often remain eligible for these programs or can transition to CHIP. Health… Read More

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2024 Healthcare Premiums Revealed: The Impact Factors

Wendy Lopez

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

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2024 ACA Affordability Shake-Up: Are You Ready?

Wendy Lopez

Are you ready for some important news regarding the Affordable Care Act (ACA)? The IRS has just released an update that could impact your organization’s healthcare offerings. In this blog post, we’ll break down the latest announcement and what it means for employers and employees alike. If you’re interested in diving deeper, be sure to download our PDF for more information. IRS Announces 2024 ACA Affordability Indexed Amount The IRS recently made an important announcement in Revenue Procedure 2023-29 regarding the Affordable Care Act’s (ACA) affordability indexed amount under the Employer Shared Responsibility Payment (ESRP) requirements. This announcement is significant for employers as it affects the calculation of penalties related… Read More

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Understanding the Updates to the Davis Bacon and Related Acts

Wendy Lopez

On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More

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Benefits Notices: What Employers Need to Know

Wendy Lopez

As an employer, it is important to be aware of the various benefits notices that you are required to provide to your employees. These notices are designed to inform employees of their rights and benefits under various laws and regulations. Failure to provide these notices can result in penalties and legal action. One of the notices that employers with 1-19 employees are required to provide is the Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice. This notice is provided to Medicare-eligible individuals who are offered prescription drug coverage under the employer’s group health plan. It must be provided annually prior to October 15th, upon request, and at… Read More

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Voluntary Benefits: Customized Coverage for Your Team

Wendy Lopez

Unlocking the Power of Voluntary Benefits In today’s competitive job market, employers aim to attract and retain top talent by offering comprehensive benefits beyond the basics. Enter voluntary benefits – a customizable solution that benefits both employers and employees. What Are Voluntary Benefits? Voluntary benefits are offerings that employers provide for purchase by employees. They empower employees to tailor their benefits to their needs, offering flexibility and convenience. Here are their key characteristics: A Variety of Benefits Voluntary benefits offer a wide array of options, including: Advantages for Employers and Employees Employers benefit from: Employees enjoy: While voluntary benefits may not suit everyone, employers should assess their package and consult… Read More

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Unlocking Change: Pennie’s First Health Equity Report

Wendy Lopez

Are you interested in delving into the intricate landscape of health coverage equity in the Keystone State? Look no further! Pennie is proud to present its inaugural Health Equity report, and it’s available for you to download right now. This comprehensive report goes beyond the surface, delving deep into the heart of healthcare disparities across Pennsylvania. Here’s what you can expect to find within its pages: Addressing Health Coverage Inequities Together: The report lays out a roadmap for collective action to combat the existing health coverage inequities. Discover how Pennie is dedicated to working with communities to bridge these gaps. Setting the Baseline for Change: To measure progress effectively, it’s… Read More

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Elevate Your Productivity with Better BenAdmin

Wendy Lopez

In a fast-paced world, time is of the essence. We’re all too familiar with the feeling of being buried under a mountain of administrative tasks, wishing for an extra set of hands or a few more hours in the day. Well, wish no more! Enter Better BenAdmin, the game-changer powered by EBM (Efficiency-Boosting Machine). Seamless Schedule Management Scheduling headaches? Not anymore. Better BenAdmin effortlessly handles your calendar, ensuring that appointments are well-organized and conflicts are a thing of the past. No more double-bookings or time wasted on manual scheduling. Effortless Email Handling Say goodbye to the endless email backlog. Better BenAdmin sorts, filters, and responds to emails with precision and… Read More

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Choosing the Right Health Insurance: HMO vs. PPO

Wendy Lopez

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

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Annual Health Insurance Check-Up: Don’t Miss Out!

Wendy Lopez

Health insurance is vital for your well-being, providing financial protection and access to essential healthcare. But it’s not a one-time decision. Did you know that reviewing your health insurance plan annually is crucial to ensure it still fits your needs and budget? In this blog, we’ll explore why this check-up is essential and provide key enrollment dates. Plus, we’re here to assist you every step of the way! Why an Annual Review Matters: Enrollment Dates: Let’s talk about the enrollment dates you need to remember: How We Can Help: Navigating health insurance can be complex, but you’re not alone. Our expert team is ready to assist you in reviewing your… Read More

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Reasons Why You Need a Health Insurance Broker

Wendy Lopez

Navigating the world of health insurance can feel like a daunting journey through an intricate maze. That’s where a trusted health insurance broker comes in, acting as your guiding light and advocate. Here’s why you need one in your corner: 1. Expert Guidance: Your Healthcare GPS: Think of a health insurance broker as your personal healthcare GPS. They simplify the bewildering maze of insurance options, helping you choose the path that suits your needs best. With their expertise, you won’t feel lost in the insurance wilderness. 2. Advocacy: Your Fighter: Insurance claims, disputes, and paperwork can be a real hassle. But with a broker, you have a dedicated champion in… Read More

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Open Enrollment 2023: Your Top 5 FAQs Answered

Wendy Lopez

Everything You Need to Know About Open Enrollment Are you ready for open enrollment? It’s that time of year when you have the opportunity to review and make changes to your health insurance plan. To help you navigate this important period, we’ve compiled a list of the top five frequently asked questions about open enrollment in 2023. Let’s dive in! 1. When is open enrollment?In Pennsylvania, open enrollment for individual health coverage typically runs from November 1 through January 15. The timing of open enrollment can vary depending on the organization or employer. It’s crucial to check with your specific company or health insurance provider to determine the exact dates… Read More

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Are You Up To Date on Your Preventive Services?

Wendy Lopez

Medicare covers a full range of preventive services to help keep you healthy and find problems early when treatment works best. Ask your doctor what services are right for you and use the document below to track appointment dates, times, and other important information. Download our Medicare check list sheet below to help you keep track of your Preventive Services! If you have any questions or concerns, please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)-355-2121.

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What’s New in the 2023 ACA Open Enrollment?

Wendy Lopez

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

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Exploring PEOs: Efficiency and Compliance Solutions

Wendy Lopez

In today’s business landscape, optimizing operations and compliance is an ongoing challenge. Enter PEOs – Professional Employer Organizations. PEOs offer outsourcing solutions that reshape how companies handle HR and administrative tasks. Let’s dive into the world of PEOs and unveil their potential advantages and drawbacks. A “PEO,” or Professional Employer Organization, forms a strategic partnership where businesses team up with experts to manage HR and admin functions. This collaboration lets companies offload tasks like payroll, benefits, and compliance, ideal for small to mid-sized businesses aiming to streamline while focusing on core activities. Pros of PEOs: Cons of PEOs: In conclusion, PEOs provide a promising avenue for businesses aiming to bolster… Read More

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IRS Addresses COVID-19 Testing and HDHP Treatment

Wendy Lopez

As a result of the COVID-19 pandemic, high deductible health plans (“HDHPs”) can provide coverage for COVID-19 testing and treatment before the minimum deductible is satisfied without jeopardizing an individual’s ability to have tax-favored contributions made to their health savings account (“HSA”). This relief remains in effect pending future IRS guidance.On June 24, 2023, the IRS issued Notice 2023-37, announcing that this relief will sunset with respect to plan years ending on or before December 31, 2024. In addition, IRS Notice 2023-37 states that HDHPs may continue to provide first-dollar coverage for preventive care with an “A” or “B” rating by the United States Preventive Services Task Force (“USPSTF”), prior… Read More

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