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Case Study Library
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!
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How To Reconcile Your Premium Tax Credit
If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you will have to “reconcile” when you file your federal taxes. This means you will compare these two figures: the amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower) and the premium tax credit you actually qualify for based on your final income for the year. Here is a step-by-step guide to reconciling you premium tax credit. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions… Read More
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Section 125 Tax-Saving POP plan document
In this video, we feature our most popular product, the $99 Section 125 Tax-Saving POP plan document package (Core 125). It explains how employees save up to 40% in taxes while employers eliminate on average 8% of matching payroll tax when the company has a Section 125 POP (Cafeteria) plan document in place, as required by the IRS to pre-tax benefits. As always contact your Total Benefit Solutions, Inc group health insurance specialists at (215)355-2121 to find out more! Click here for more information or to order a document online.
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Consolidated Appropriations Act Updates
In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, contains new requirements for cost transparency and provides protections for consumers against surprise medical billing. CareFirst BlueCross BlueShield (CareFirst) has implemented several changes in response to the No Surprises Act. For more information, click here. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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HHS to Extend Public Health Emergency Once Again
The Department of Health and Human Services (HHS) has repeatedly renewed the public health emergency since it was originally declared in January 2020. The most recent extension was set to expire July 15. However, it will now be extended again, commencing on Friday, July 15. The administration will give states 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to certain programs and regulatory authorities. HHS last extended the public health emergency in May of 2022. The designation of a public health emergency allows regulators to clear the way for vaccines, therapeutics, and diagnostics for use against the coronavirus. Should the designation expire, people… Read More
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Time to Prepare for Medicare Part D Notice Requirements
An important deadline is approaching quickly – October 15 for the Medicare Part D notice requirement. The creditable-coverage notice must be given to all Part D-eligible individuals who are covered under, or apply for, an employer’s prescription drug benefits plan. This requirement applies to Medicare beneficiaries who are active employees and those who are retired, as well as Medicare beneficiaries who are covered as spouses under active or retiree coverage. Click here for a video explaining Medicare Part D notices. Please contact your Total Benefit Solutions Inc Medicare health insurance specialists at (215)355-2121 if you have any questions or concerns.
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New Mental Health Hotline
Starting July 16, 2022, the first nationwide three-digit mental health crisis hotline goes live. This hotline is designed to be easy to remember and by dialing 988, an individual in crisis will be connected to trained mental health counselors. This is a free service. The program will be funded by the federal government which has provided over $280 million, not only for the hotline but to help states create systems that will do much more, including mobile mental health crisis teams that can be sent to people’s homes and emergency mental health centers. The hotline is designed not only for individuals in crisis with thoughts of suicide but for all… Read More
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Aetna: Understanding the Evolution of Primary Care and What it Means for your Workforce
The evolutions of primary care has a great impact on employers and their workforce. As primary care looks to meet current consumer trends, employers and payers must think creatively to support their employees. Virtual, advanced, and multi-disciplinary sites are just the start. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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Horizon Grandmothering Extended into 2023 for Pre-ACA Plans
Horizon will once again enable Small Employer group customers that offer health plans that preceded the Affordable Care Act (“pre-ACA plans”) and renew between October 1 and December 31, 2022, to renew within those pre-ACA plans. Because we receive the highest volume of renewals during the fourth quarter, our decision to grandmother pre-ACA plans will ensure a smooth renewal process for our customers. As we near October 1, 2022, Horizon will communicate the details and dates for the renewal process. Until then, click here to learn more. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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Updated FAQ’s on the ACA and Health Insurance
Kaiser Family Foundation ‘s database of frequently asked questions is searchable by topic. Click here to view the FAQ database.
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COVID-19 Vaccines Now Available for Young Children
A recent CDC announcement recommends that children six months through five years of age should get an age-appropriate dose of the Pfizer‑BioNTech or Moderna COVID-19 vaccine. Independence covers the cost of administering vaccines and booster shots with no cost-share (such as co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given. For Medicare Advantage members, the cost and administration of the vaccine and booster shots will be covered by Original Medicare so long as the health care provider administering the vaccine participates in the Medicare program. Please click here to learn more about the COVID-19 vaccines and boosters. As always, please contact your Total Benefit Solutions Inc health… Read More
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Health Insurance Fee to be Reduced for 65% of the Self-Employed Insured
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
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Get The Most From Your Dental Benefits with Beam Benefit’s Carryover Policy
If you don’t use up your annual maximum, they don’t have to go to waste — you may be able to put them to use in the future! This means you’ll have more dollars at your disposal for dental procedures in the following years. Each year your benefits will cover a certain dollar amount in claims. When you use less than half of this maximum, a portion of it will “carry over” to the next year. This means it’s added to your annual maximum in future years. Have any questions or concerns about enrolling your group in Beam Benefit’s Dental Plan? Please contact your Total Benefit Solutions Inc health insurance… Read More
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Affordability of Health Coverage
Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More
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Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency
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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Delaware Enacts New Paid Family and Medical Leave Requirement
The Healthy Delaware Families Act was recently signed into law, which provides paid leave for three categories of leave: parental leave, medical leave and family caregiving leave. Employers with 10-24 employees are only subject to the parental leave provisions. Employers with 25 or more employees are subject to all leave provisions. Employers with fewer than 10 employees are not obligated to participate in the leave program, although an employer can opt-in for a 3-year participation period. Click here to download for more information. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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Health Insurance Broker Change Leads to Better Results
Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More
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Beam Dental Expands Benefits Portfolio, Rebrands to Beam Benefits
Beam Dental, a digitally-native employee benefits company, today announced the addition of voluntary life, accident and hospital indemnity products to its benefits portfolio. With these new products, Beam continues its evolution as a one-stop-shop for ancillary benefits and has rebranded to Beam Benefits. The change is accompanied by a refreshed brand identity and new website. Click here for more information. As always, please contact your Total Benefit Solutions Inc health insurance specialists with questions or concerns at (215)355-2121.
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Pennie: Losing Medical Assistance Coverage When The Public Health Emergency Comes to an End?
Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has maintained coverage for most Medical Assistance (MA) recipients unless they moved out-of-state, passed away, or requested to be disenrolled. When the federal PHE comes to an end, anyone who is found to be no longer eligible during the renewal process for Medical Assistance or who fails to complete their MA renewal will be disenrolled from Medical Assistance coverage – that is where Pennie comes in! Pennie and the Department of Human Services (DHS) are working to ensure that qualified Pennsylvanians can access coverage either through Medical Assistance (MA), the Children’s Health Insurance Program (CHIP), or affordable, high-quality coverage available… Read More
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Is my group subject to ERISA or ERISA Exempt?
Many clients often ask the question ” Do I need to comply with ERISA? ” The answer is almost always yes! Just because you are a smaller business does not exempt you from ERISA. This from the US Department of Labor: ERISA applies to private-sector companies that offer pension plans to employees. This includes businesses that: Are structured as partnerships, proprietorships, LLCs, S-corporations and C-corporations. No matter how your employer has structured his or her business, it is covered by ERISA if it is a private entity. Who is not subject to ERISA?In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or… Read More
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Beam Introduces Innovative, Prevention-Focused Brush Bucks Dental Plan
Beam Dental, one of the fastest-growing dental benefits providers in the country, has unveiled its new Brush Bucks plan designed to save employers and members money while providing fully covered preventative care. The plan gives employees 100% coverage for diagnostic and preventative services*, which can include routine dental cleanings, fluoride treatments, and X-rays. Each member will also receive a $150 annual maximum — called Brush Bucks — to manage unexpected costs, such as fillings, implants, and other basic and major procedures. The plan does not include a deductible. Find out more about Beam’s Brush Bucks Dental Plan here. As always, please contact your Total Benefit Solutions Inc health insurance specialist… Read More
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IRS Announces Medical Mileage Rate Increase
To offset high gas prices, on June 9, 2022, the Internal Revenue Service (IRS) announced an increase in the 2022 standard medical mileage rate for the final six months of 2022. Effective July 1, 2022, the new rate for when an automobile is used to obtain medical care is 22 cents per mile for the remainder of 2022, which is an increase from the rate of 18 cents per mile effective January 1 – June 30, 2022. Mileage to and from a medical service is generally an eligible expense under a Healthcare Flexible Spending Account, Health Reimbursement Arrangement, or Health Savings Account. Click here to learn more. As always, please… Read More
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Mental Health Conditions Can Trigger FMLA
The Wage and Hour Division of the U.S. Department of Labor released a Fact Sheet related to mental health conditions and the Family and Medical Leave Act, clarifying what constitutes a serious mental health condition. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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Horizon NJ: Covid-19 Resource Guide Update
Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.
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