Individual Health Insurance – Page 4 – Total Benefit Solutions Inc

What is a Family Premium?

December 16, 2022December 9, 2022Ed MacConnell

Under the Affordability for Employer Coverage for Family Members of Employees IRS rule, “family members” are individuals who will be on the same federal income tax return — so, an individual, plus their spouse if married and filing jointly, plus any dependents that they (and their spouse, if applicable) claim. The “family premium” is the premium for the lowest-cost employer plan that would cover all members of the tax household who are offered coverage by the employer. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Using your health insurance coverage & getting emergency care

December 6, 2022December 6, 2022Ed MacConnell

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital. I’m having an emergency. Should I go straight to the hospital or do I need to call my insurer first? In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network. What does it mean that insurance companies can’t charge me more? Insurance plans can’t make you pay… Read More

What Marketplace health insurance plans cover

December 5, 2022November 30, 2022Ed MacConnell

All plans offered in the Marketplace cover these 10 essential health benefits: Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is the Children’s Health Insurance Program (CHIP)?

November 23, 2022November 23, 2022Ed MacConnell

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. You can apply any time. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Blue KC: Enhanced ACA Subsidies to Extend Through 2025

November 17, 2022October 20, 2022Ed MacConnell

The American Rescue Plan Act of 2021 has provided enhanced ACA premium subsidies for people who purchased a plan through the Marketplace. It did so by removing the income cap, which limited subsidies to households with incomes from 100% to 400% of the federal poverty line. With no income cap, premiums have been limited to just 8.5% of income – for everyone. The Inflation Reduction Act, which was signed into law on August 16, extends these subsidies for three years for millions of Americans who buy individual coverage under the ACA. This bill will “save millions of people an average of $800 a year on health insurance premiums,” said Chiquita… Read More

What is a Qualified Health Plan?

November 10, 2022September 23, 2022Ed MacConnell

An insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage.” As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a Special Enrollment Period (SEP) and what qualifies a consumer for an SEP?

November 8, 2022September 23, 2022Ed MacConnell

A Special Enrollment Period (SEP) is a time outside the annual Open Enrollment period when individuals may enroll in or change qualified health plans (QHPs). Individuals qualify for SEPs based on certain life events. Note that consumers can also qualify for an SEP during Open Enrollment; in certain situations, such as an SEP due to the birth of a child, an SEP during Open Enrollment can allow qualifying consumers’ coverage to start sooner than it would have if they had enrolled during Open Enrollment without the SEP. Events that permit an SEP include: Loss of qualifying health coverage (Note: This SEP does not include loss of coverage due to nonpayment… Read More

Can consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?

November 2, 2022September 23, 2022Ed MacConnell

Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

Open Enrollment Tips from Total Benefit Solutions!

November 1, 2022October 26, 2022Ed MacConnell

As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Can consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?

September 27, 2022September 1, 2022Ed MacConnell

Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. Please contact your trusted Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

What is a Health Savings Account (HSA)?

August 29, 2022August 9, 2022Ed MacConnell

A type of savings account that lets your set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums. While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan (including a Marketplace plan) that only covers preventive services… Read More

What is coinsurance?

August 3, 2022July 19, 2022Ed MacConnell

Coinsurance is usually a percentage of the cost for a service that you would pay. For example, if your coinsurance is 20% for covered services, your plan would pay 80% of the covered charges, and you would pay the coinsurance of 20%. Call your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

Case Study Library

July 22, 2022July 22, 2022Ed MacConnell

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

Health Insurance Fee to be Reduced for 65% of the Self-Employed Insured

July 14, 2022July 1, 2022Ed MacConnell

Health insurance fees for 5.61 million households, among the self-employed insured of the national health insurance, will be slashed by an average of 36,000 won per month starting September. On the other hand, 273,000 subscribers, including the elderly, who have been registered as the dependent of the employee insured and thus have not been paying health insurance premiums will have to start paying health insurance fee from September. The gist of the amendment of the health insurance scheme is to reduce the amount of health insurance fees the self-employed insured has to pay. There has been criticism that the self-employed insured has to pay a greater amount of health insurance… Read More

Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

July 8, 2022June 29, 2022Ed MacConnell

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

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