Total Benefit Solutions – Page 11 – Total Benefit Solutions Inc

IRS Announces 2023 ACA Affordability Indexed Amount

August 25, 2022August 8, 2022Ed MacConnell

The IRS recently announced in Revenue Procedure 2022-34 that the Affordable Care Act (“ACA”) affordability indexed amount under the Employer Shared Responsibility Payment (“ESRP”) requirements will be 9.12% for plan years that begin in 2023. This is a notable decrease from the 2022 percentage amount (9.61%) and below the original 9.5% threshold. Rev. Proc. 2022-34 establishes the indexed “required contribution percentage” used to determine whether an individual is eligible for “affordable” employer-sponsored health coverage under Section 36B (related to qualification for premium tax credits when buying ACA Marketplace coverage). However, the IRS explained in IRS Notice 2015-87 that a percentage change under Section 36B will correspond to a similar change… Read More

What is copayment?

August 24, 2022August 4, 2022Ed MacConnell

A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20. If you’ve paid your deductible: You pay $20, usually at the time of the visit. If you haven’t met your deductible: You pay $100, the full allowable amount for the visit Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests. and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have… Read More

Medigap Quick Facts

August 23, 2022August 3, 2022Ed MacConnell

What is it? A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Play types offered: Insurance companies can sell only a “standardized” policy identified in most states by letters. Independence Blue Cross offers Plans A, B, F, F-HD, G, G-HD, and N. Medical Coverage: No selection of a PCP is required; members are able to choose any doctor or hospital as long as they accept Original Medicare. This also allows for no referrals and no network. Prescription Drug Coverage:… Read More

What is the Part D Senior Savings Model?

August 19, 2022August 19, 2022Ed MacConnell

The Part D Senior Savings Model allows participating Part D prescription drug plans to offer a broad set of formulary insulins at a maximum $35.00 copayment per month’s supply, throughout the deductible, initial coverage, and coverage gap phases of their Part D drug coverage. This means that participating Part D plans offer enrollees predictable, stable copayments for insulin to help enrollees save money on their drug costs. If you have any questions, please contact your Total Benefit Solutions Inc Medicare specialists at (215)355-2121.

New Prescription Drug Reporting Requirement

August 18, 2022August 2, 2022Ed MacConnell

As previously reported in December 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Employers with fully insured or self-funded (includes level funded) group health plans, including grandfathered plans, church plans subject to the Internal Revenue Code, and governmental plans. The term “group… Read More

Important Notice Regarding United Healthcare and US Digestive Health

August 17, 2022August 1, 2022Ed MacConnell

USDH has over 150 providers and 25 locations across Central Southeastern, and Southwestern Pennsylvania that remain at the forefront of treatment protocols, attracting the most accomplished specialists and brightest medical minds in the field, and utilizing cutting edge technologies so that our patients receive high-quality care and the best possible health outcomes. USDH is currently negotiating with United Healthcare for a new contract that covers the care we provide patients with United Healthcare employer-sponsored, Exchange, and Medicare Advantage health plans. If we do not reach a new agreement, our doctors and facilities will be forced out of United Healthcare’s network effective September 1, 2022. The contract that has governed our… Read More

MACRA: Medicare Access and CHIP Reauthorization Act of 2015

August 16, 2022July 29, 2022Ed MacConnell

Since January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are no longer available to people who were “new to Medicare” on or after January 1, 2020. For this situation, people “new to Medicare” are people who turned 65 on or after January 1, 2020, and people who got Medicare Part A (Hospital Insurance) on or after January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or you were covered by one of these plans before January 1, 2020, you will be… Read More

Understanding the Coding of Health Plans from MEC to Metallic

August 15, 2022July 22, 2022Ed MacConnell

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

Aetna AFA now allows PEO Employers!

August 11, 2022July 28, 2022Ed MacConnell

From Aetna: We’re now treating small businesses who use the services of a PEO ( Professional Employer Organization) the same as any other group. This excludes any group headquartered in California or New York, or any group currently on an Aetna PEO master health plan. Here are some important details: 1. We no longer require small businesses to terminate their PEO relationship or fill out extra forms for us during the new business process.2.The entire group must move to Aetna –small businesses can’t move some employees to Aetna and leave the rest on the PEO master health plan. What does this mean to groups? If your company is already part… Read More

What is a Self-Insured Plan?

August 10, 2022July 27, 2022Ed MacConnell

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. Please contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

Health Insurance Shopping?

August 9, 2022Ed MacConnell

The professionals at Total Benefit Solutions, Inc are here to help you find the right coverage for you or your small business! our health insurance experts Are certified, licensed and experienced to help you deal with ACA plans (Obamacare), Medicare supplements, short term medical and small group health plans too! Call us today at (215)355-2121.

What are HDHPs & HSAs?

August 9, 2022July 22, 2022Ed MacConnell

One way to manage your health care expenses is by enrolling in a High Deductible Health Plan (HDHP) in combination with opening a Health Savings Account (HSA). How High Deductible Health Plans and Health Savings Accounts can reduce your costs: If you enroll in an HDHP, you may pay a lower monthly premium but have a higher deductible (meaning you pay for more of your health care items and services before the insurance plan pays). If you combine your HDHP with an HSA, you can pay that deductible, plus other qualified medical expenses, using money you set aside in your tax-free HSA. So if you have an HDHP and don’t… Read More

Best Time to Buy a Medigap Policy

August 8, 2022July 27, 2022Ed MacConnell

The best time to buy a Medigap policy is during the Medigap Open Enrollment Period. The Medigap Open Enrollment Period lasts for 6 months and begins on the first day of the month a beneficiary turns 65 or enrolls in Part B, whichever is later. Under 65 Medicare beneficiaries get a second Medigap Open Enrollment Period when they turn 65. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare health insurance choices. Call us today at (215)355-2121.

Premium Formulary Adoption Swells Among Large Group Clients

August 5, 2022July 22, 2022Ed MacConnell

The Premium formulary is an option for large group clients wanting access to a formulary that manages traditional, non-specialty drug costs without compromising clinical outcomes. In many cases it saved early adopters nearly 10% per member per month on their plan’s traditional drug spend. Overall, members saved on drug costs without rigorous additional step therapies, prior authorizations, or other invasive utilization management strategies. Members transitioning to the Premium formulary will receive communications about the change, potential disruptions to their drug therapies, and clinically appropriate and cost-effective alternatives. Blue KC will continue to make quarterly updates to the Premium formulary and will send subsequent member communications about those changes and appropriate… Read More

Alternative Funding Yields Big Savings

August 4, 2022July 22, 2022Ed MacConnell

The Issue A firm we had worked with for several years had expressed a concern that the cost of their employee benefits package was threatening the financial stability of their firm. With a little over 150 employees, their annual benefits cost was exceeding $1.3 million and increasing at a rate of 8-15% each year. Even more concerning was that the benefits cost represented 32% of the company’s operating revenue. They had contemplated making plan changes including an increase in deductibles, copays and co-insurance limits, but they cared about the well-being of their employees and felt compelled to keep a competitive level of benefits. Our Solution We took the approach that… 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.

Independence Blue Cross: Care Cost Estimator

August 2, 2022July 19, 2022Ed MacConnell

Did you know that you can estimate your out-of-pocket costs before you schedule a doctor’s appointment or medical procedure? You can, with the new Care Cost Estimator tool. It also lets you compare providers by price, based on your specific health plan. The Care Cost Estimator tool will display: Provider details Quality information, such as reviews Your estimated out-of-pocket costs for a wide range of common procedures and office visits Click here to learn how to get started with the Care Cost Estimator. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions or concerns at (215)355-2121.

New Mandatory Preventive Items and Services, 2022 Updates

August 1, 2022July 19, 2022Ed MacConnell

The United States Preventive Services Task Force recommendations have been updated and most plans will be required to cover new preventive items and services beginning later this year or in 2023 (depending on the plan year). These new items/services include ones related to condoms, double-electric breast pumps, suicide risk screening for adolescents, and diabetes screenings for certain populations. Non-grandfathered group health plans must provide coverage for in-network preventive items and services and may not impost any cost-sharing requirements (such as a copayment, coinsurance, or deductible) with respect to those items or services. Employers sponsoring non-grandfathered group health plans should review the various preventive care requirements effective for their upcoming plan… Read More

What is a Qualifying Life Event or QLE?

July 29, 2022July 14, 2022Ed MacConnell

There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More

What is the Employer Shared Responsibility Provision?

July 28, 2022July 15, 2022Ed MacConnell

Under the Affordable Care Act, governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. The estimator is specifically designed to help you determine if the employer shared responsibility provision (IRC Section 4980H) applies to you and, if it does, will help you determine the maximum amount of the employer shared responsibility payment that could apply to you under either section 4980H(a) or 4980H(b) based on the number of full-time employees that you report. The provision applies to employers called applicable large employers that employ on average at least 50 full-time employees (including FTEs)… Read More

Medicare & Coronavirus

July 27, 2022July 14, 2022Ed MacConnell

Medicare covers the COVID-19 vaccine at no cost to you. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Be sure to bring your Medicare card. To learn more about Medicare and the COVID-19 vaccine and boosters, click here. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You may need to give them your Medicare Number for billing, but there’s… Read More

What is a High Deductible Health Plan (HDHP)?

July 26, 2022July 26, 2022Ed MacConnell

A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes. For 2022, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $7,050 for an… Read More

HHS Extends Public Health Emergency Until October 13

July 26, 2022Ed MacConnell

On July 15, 2022, the Secretary of Health and Human Services (“HHS”) renewed the COVID-19 pandemic Public Health Emergency, effective July 15, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 testing and vaccinations and other plan requirements. State and local emergency measures may expire at different times and could impact employee benefit plans (such as insured group health plans) and other state/or local programs (such as paid leave) differently than the timeframes… Read More

What’s Not Covered by Part A & Part B?

July 25, 2022July 14, 2022Ed MacConnell

Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include: Long-Term Care (also called custodial care ) Most dental care Eye exams related to prescribing glasses Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting them Routine foot care To find out if Medicare covers a test, item, or service you need, click here. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare Health Insurance choices. Call us today at (215)355-2121.

Tower Financial Group

July 24, 2022July 28, 2022Ed MacConnell

In July 2021 Total Benefit Solutions reached an agreement with the Tower Group to handle the client services for their brokers and accounts. Your Tower Group Representative, Stephanie has continued to work with Total Benefit Solutions, Inc. Please contact Total Benefit Solutions Inc at (215)355-2121 or Stephanie Spancake at (856) 403-8278 or stephanie@totalbenefits.net for any services you need. Thank you! Click here if you are not automatically redirected.

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: