Total Benefit Solutions – Page 14 – Total Benefit Solutions Inc

Philadelphia Passes New COVID-19 Paid Leave Law

April 5, 2022April 4, 2022Ed MacConnell

Philadelphia has enacted a new law that requires employers to provide paid time off for COVID-19 purposes. The ordinance, which took effect March 9, 2022, applies to employers with at least 25 employees. Covered EmployeesThe ordinance covers employees who: Work in Philadelphia; Normally work in Philadelphia but currently telework from any other location as a result of COVID-19; or Work from multiple locations or from mobile locations, provided that 51% or more of their time is in Philadelphia. There is no waiting period or accrual requirement for leave. Permitted Purposes for COVID-19 LeaveLeave must be allowed for specified COVID-19 reasons relating to an employee’s (or their family members’) exposure to, symptoms of or diagnosis with COVID-19. Leave… Read More

IRS Raises ACA Mandate Penalties for 2022

April 5, 2022Ed MacConnell

The IRS penalty amounts for non-compliance of the ACA’s Employer Mandate are rising in 2022. Below is a list of the new penalty amounts and how the IRS will assess them. 4980H(a) Penalty For the 2022 tax year, the 4980H(a) penalty amount is $229.17 a month or $2,750 annualized, per employee. The IRS issues the 4980H(a) penalty when: An employer doesn’t offer Minimum Essential Coverage (MEC) to at least 95% of its full-time employees (and their dependents) for any month during the tax year, and At least one full-time employee receives a Premium Tax Credit (PTC) for purchasing coverage through the Marketplace. Here’s an illustration of how the IRS calculates the penalty: If an organization in 2022has 300 full-time employees, and one of these employees receives a PTC for 12 months,… Read More

Independence: Changes to the Value and Select formularies for April 1

April 4, 2022April 4, 2022Ed MacConnell

Changes to the Value and Select formularies for April 1 Independence Blue Cross is making changes to the Value and Select Drug Program® (Select) formularies effective April 1, 2022. Updates are made to the Value and Select formularies quarterly.The updated lists for April 1 are available now on our website. Select the appropriate link to view the Value or Select formulary. The updated list can be found under “Formulary drug documents.” Changes that result in positive member experiences happen quarterly in January, April, July, and October. Examples of these changes include new drugs and generics being added to the formularies, tier changes that can result in lowering member cost‑share, and utilization management removal.Negative formulary changes… Read More

HHS Adjusts Civil Monetary Penalties Again for HIPAA, MSP, and SBC Violations

April 4, 2022Ed MacConnell

HHS has announced adjustments of civil monetary penalties for statutes within its jurisdiction. The latest amounts are based on a cost-of-living increase of 1.06222%. These adjustments are effective for penalties assessed on or after March 17, 2022, for violations occurring on or after November 2, 2015. Here are highlights of the adjustments potentially affecting employer-sponsored health plans: HIPAA Administrative Simplification. HIPAA administrative simplification encompasses standards for privacy, security, breach notification, and electronic health care transactions. HIPAA has four tiers of violations that reflect increasing levels of culpability, with minimum and maximum penalty amounts within each tier and an annual cap on penalties for multiple violations of an identical provision. The indexed… Read More

Temporary Telehealth Relief for HSA Plans

March 31, 2022Ed MacConnell

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth services from April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”) to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make Health Savings Account (“HSA”) contributions….

What is reference-based pricing?

March 28, 2022March 28, 2022Ed MacConnell

What is reference-based pricing? Some employers are moving away from offering conventional health coverage with a provider network and instead are using reference-based pricing for some or all of services they cover. Under reference-based pricing, the employer (supported by a third party administrator [TPA] or other vendor) pays a set a price for each health care service instead of negotiating prices with providers. When a provider bills for the service, the payer remits the set amount. Some payers use reference-based pricing software to determine the price they will pay for a health care service. Although reference-based pricing software programs vary, the methodology includes collecting data on prevailing costs for medical… Read More

How does level funding health insurance work?

March 17, 2022March 17, 2022Ed MacConnell

Level funding (also called alternate funding) is a group health insurance product available to employers. It behaves just like a fully-insured product, and allows some groups to get coverage at more competitive rates than traditional fully insured ACA plans. How does level funding work? An employer pays a set monthly cost into an account, like a ” premium”. This “premium” money is then used to pay claims for employee health care. If there’s any money left in the account at the end of the plan year, it goes back to the employer. If employee claims spending exceeds the funds in the account, the health insurer covers the difference. If there are any large… Read More

IBC Increasing Medigap Rates

March 15, 2022Ed MacConnell

Independence Blue Cross recently received approval from the Pennsylvania Insurance Department to increase our monthly premium rates for MedigapSecurity plans A, B, C, D, F, F High-Deductible, G, G High-Deductible, and N. These rates will become effective April 1, 2022. MEDIGAPSECURITY PREMIUM UPDATED RATE SHEET Monthly Premium If you have … Beginning April 1, 2022, you will pay … MedigapSecurity – Plan A $164.95 MedigapSecurity – Plan B $195.65 MedigapSecurity – Plan C $224.55 MedigapSecurity – Plan D $204.95 MedigapSecurity – Plan F $224.70 MedigapSecurity – Plan F High Deductible $109.00 MedigapSecurity – Plan G $205.10 MedigapSecurity – Plan G High Deductible $91.95 MedigapSecurity – Plan N $181.30 Questions… Read More

New Option for NJ Groups with Out-of-State Employees

March 15, 2022March 14, 2022Ed MacConnell

New Jersey small groups with employees residing out-of-state have few options and brokers struggle to provide viable alternatives for these employers. Horizon has introduced a solution with two new plans that include Blue Card Access on their popular OMNIA platform. Gold & Silver Plans became available in the market July 1 Provides access to 95% of the doctors and 96% of the hospitals nationwide, that includes New York, Pennsylvania, and Delaware. These plans reduce the benefit gap between Tier One and Tier Two benefits. Horizon also leveraged OMNIA relationships to provide a very attractive price point for national access. Questions or concerns about this bulletin? Please contact your Total Benefit… Read More

Annual Out-of-Pocket Maximum Adjustments Announced for 2023

March 14, 2022Ed MacConnell

On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For purposes of employer-sponsored health plans, the final rule includes caps on out-of-pocket dollar limits for non-grandfathered group health… Read More

What is the Medicare Advantage OEP?

February 13, 2022Ed MacConnell

If you’re disappointed with your current Medicare Advantage Plan, the Medicare Advantage Open Enrollment Period (MAOEP) is an annual window to make changes to your existing plan. Frequently, we hear how beneficiaries decide to enroll in a Medicare Advantage Plan without fully understanding how these plans work. It happens when beneficiaries try to take on the task of enrolling in a plan without an agent. Sometimes, a beneficiary may have enlisted the help of an agent who didn’t have their clients’ best interest in mind or simply did not fully understand the needs of the client. Medicare Advantage Open Enrollment Period The Medicare Advantage Open Enrollment Period runs annually between… Read More

WHAT IS MEDICARE PART B?

February 6, 2022Ed MacConnell

Medicare can seem complex on your own. We’re here to help! Medicareful is an easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a licensed sales agent who will guide you through enrollment. Whether it’s a Medicare Supplement, Medicare Advantage Part C Plan, or a Medicare Part D drug plan, we’ve got you covered. https://medicareful.com/totalbenefitsolutions

When Can You Enroll on a Medicare Advantage or Drug Card?

February 6, 2022February 6, 2022Ed MacConnell

COVID‑19 provisions and online OTC test kit ordering

February 4, 2022February 4, 2022Ed MacConnell

From Amerihealth NJ: We recently suspended the prior authorization requirement for transfers from acute in‑network inpatient facilities to post‑acute in‑network facilities for any diagnosis through January 31, 2022. This change will now run through February 28, 2022. Additionally, the public health emergency was recently extended through April 16, 2022. We will continue to provide federally mandated coverage through the end of the public health emergency. OTC COVID‑19 test kit update As previously communicated, we are pleased to work with our clients to ensure coverage of over-the-counter (OTC) COVID‑19 test kits for our members through pharmacy benefits. Members who have pharmacy coverage with us through FutureScripts/Optum can now order OTC tests online via the… Read More

Medicare Part D: Disclosure Notice to CMS

February 4, 2022February 3, 2022Ed MacConnell

2022 Federal Poverty Guidelines Announced

February 3, 2022February 6, 2022Ed MacConnell

Open Enrollment may be over, but consumers may still be able to enroll in Marketplace coverage

February 2, 2022February 2, 2022Ed MacConnell

Member Cost Sharing for Most Telemedicine and Telehealth Visits Will Resume Effective February 3, 2022

February 2, 2022February 2, 2022Ed MacConnell

Aetna: Over-the-counter COVID-19 tests for small group plan sponsors

February 1, 2022February 1, 2022Ed MacConnell

Additional Guidance Addresses ACA Preventive Care Mandate

February 1, 2022February 1, 2022Ed MacConnell

As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying severalAffordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans. As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing. Click the link below to download the bulletin. As always contact your health insurance specialists at Total Benefit Solutions, Inc if you have any additional questions or concerns (215)355-2121 http://www.totalbenefits.net