CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry. Click here for the full story from Modern Healthcare As always, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about the Affordable Care Act.
Continue Reading2016 Federal Poverty Guidelines Updated
Large employers may be subject to the employer penalty under the Affordable Care Act if they do not offer affordable, minimum value coverage to all full-time employees and at least one full-time employee receives a subsidy in the Exchange. The Federal Poverty Line (“FPL”) is relevant to this penalty in two ways. Please click the link below to download the bulletin with he new guidelines. 2016 Federal Poverty Guidelines If you have any additional questions regarding this bulletin, or the Affordable Care Act please contact your Total Benefit Solutions, Inc account manager at (215)355-2121.
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Download: Medicare Made Clear
Download Medicare Made Clear: From our partners at United Healthcare and Medicare Made Clear, download the 2016 version of the Show Me Guide for an impartial overview of Medicare plans as well as eligibility, glossary, frequently asked questions and more. A virtual Medicare training in one handy workbook! Download Show Me Guide 2016 As always, if you have any questions about Medicare health plans, eligibility and more, contact you Total Benefit Solutions account manager at (215)355-2121.
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Now Available: Empower Me Benefits Private Exchange
Total Benefit Solutions has partnered with Empower Me Benefits to provide our clients with best in industry benefits technology that‘s customizable for even the smallest employer. The EmpowerMe Benefits Exchange allows you to remain complaint with the Affordable Care Act (ACA), easily manage benefits, and control health care costs with a single solution. The EmpowerMeBenefits Exchange is an online benefit marketplace and benefits administration platform designed specifically to meet the needs of small and mid-sized companies. The Exchange provides employers with an enrollment and administration platform that aids employers in ACA compliance. This web-based solution allows you to offer any medical coverage next to pre-selected ancillary, voluntary, and TPA products.… Read More
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New Guidance Tackles Employer Mandate Issues
A number of Employer Mandate updates are included in this bulletin. Please click on the link to download this important update. As always please contact your Total Benefit Solutions, Inc account manager if you have any questions or concerns regarding this release at (215)355-2121. Download Update:Employer Mandate Issues 2016
Continue ReadingSeveral Health Plans Cutting Broker Commissions for ACA Health Plans
Several Health Plans Cutting Broker Commissions for ACA Health Plans. Why should this concern Total Benefit Solutions clients? Because with insurers like Aetna, Humana, Highmark and United Healthcare removing broker compensation, our only recourse will be to collect a fee from consumers who need and engage our professional services. This of course has a direct effect on our clients as their cost to access services and care increases. Otherwise consumers may be left to fend for themselves in the ACA health insurance Marketplace! Click the link below to download the story. Broker Commissions Article Published on Healthcare Exchange
Continue Reading2015 Compliance Compilation
The attached resource file is a compilation of all of our compliance bulletins for 2015 provided by our business partners at Emerson Reid and your benefits support team. Click the link below to download the entire 2015 compilation: 2015 Compliance Compilation
Continue Reading2016 Health Insurance Open Enrollment Begins
2016 Individual and Family Plans Open Enrollment for 2016 Open enrollment opens on November 1st 2015 and ends on January 21st 2016. As the 2016 Open Enrollment Period gets ready to explode, we will be updating this page regularly with plan benefits, rates and information as they become available. Remember Total Benefit Solutions dedicated, licensed, certified and insured representatives can help anyone enroll on the healthcare Marketplace, or off! Full Service Client Intake Form: Click here to get started. This is not an application for insurance. This form will provide the information that is needed to determine Marketplace eligibility and must be entered on Healthcare.gov We understand that Health Care… Read More
Continue ReadingTotal Benefit Solutions Introduces the All Check Compliance Tool!
Total Benefit Solutions, Inc. in partnership with Benefit Mall introduces All Check! Want to know how to easily calculate your FTE’s ( Full Time Equivilents)? Not sure if you need to provide the Notice of Exchange? Unsure about your Health Care Tax Credit Eligibilty? Want to get an idea what your overall ACA compliance obligations might be? Let Total Benefit Solutions and All Check do the work. How? It;s simple. Download the input sheet, complete and return to your Total Benefit Solutions, Inc account manager and we will crunch the numbers and send you a customized report just like the sample! Click Here to Download The Input Sheet Sample_ComplianceReport.2147.21136.20150903 … Read More
Continue ReadingNew Law Clarifies Employer Mandate and HSA Eligibility for Veterans
On July 31, 2015, President Obama signed into law H.S. 3236, Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. Notably, the law makes changes affecting the employer mandate and HSA eligibility as to individuals who are (or were formerly) service members. Click here to download the bulletin
Continue ReadingTotal Benefit Solutions Joins Geriatric Advisory Council
Total Benefit Solutions is proud to announce that we have become a founding member of the Greater Philadelphia chapter of the Geriatric Advisory Council to better serve the needs of our senior clients. The Geriatric Advisory Council is a professional organization comprised of local businesses and non-profit organizations who are focused on eldercare and senior related issues.The council was formed with the mission of assisting seniors and their caregivers by providing FREE educational resources along with targeted referrals to help caregivers provide the quality of life care that their loved ones need and deserve. Click here to learn more about the GAC and the professional resources available.
Continue ReadingVideo: Are you eligible for a special enrollment period?
You might think that you have to wait for the annual open enrollment period to get enrolled. Think again! You may be eligible for a special enrollment period. Watch this short video to learn more, and then call us at (215)355-2121!
Continue ReadingVideo: Learn about the Premium Saver Plan
Group Supplemental Health Insurance – Gap Insurance What is the Premium Saver? The Premium Saver is an employer sponsored group supplemental insurance plan which is designed to help reduce the cost of group medical coverage. Combining the Premium Saver with certain major medical plans can deliver coverage groups want and can afford. How does the Premium Saver pay claims? It’s simple! The Premium Saver pays off of the underlying major medical plan EOB, and it pays benefits directly to the provider. When the insured goes in-network they always receive the carrier’s in-network discounts. What coverage does the Premium Saver provide? Supplemental Deductible and Co-Insurance Premium Saver plans have a supplemental… Read More
Continue ReadingWebinar: The Top 5 Reasons to Have (and use) an Employee Handbook
Webinar: The Top 5 Reasons to Have (and use) an Employee Handbook Now Available from our partners at Think HR Click here to watch the video of the webinar and download the slides.
Continue ReadingEBN: Small Employers look to Alternative Funding Solutions
In the wake of the health care reform, alternative funding solutions for health benefits continue to gain traction among small to mid-size groups. Pending changes to small group rules in January 2016 are driving demand for the funding solutions. Most prominently, groups with 50-100 employees will be subject to community rating legislation that governs how rates are developed and the type of coverage offered. Most states are also changing the definition of employee to the federal full-time employee definition, broadening the scope to include union employees that may have been excluded under previous small employer definitions. Here’s how the new rules will affect small to midsize groups, including potential financial impact, solutions available to mitigate… Read More
Continue ReadingHealthiest You – Wellness and Mobile App Overview
Healthiest You is now available through Total Benefit Solutions Inc. Ask us today how you and your employees can benefit from this type of wellness benefit! Below is the latest video on their mobile app.
Continue ReadingNew Law Protects New York City Workers
Stop Credit Discrimination in Employment Act Takes Effect Sept. 3 The Stop Credit Discrimination in Employment Act, signed into law by New York City’s mayor on May 6, 2015, amends the city’s Human Rights Law and prohibits discrimination based on consumer credit history. Effective September 3, 2015, this law bans employers, labor organizations and employment agencies from using an employee’s consumer credit history for any employment decision, including hiring, compensation, or the terms, conditions or privileges of employment. New York City is one of several jurisdictions that has enacted credit check bans.
Continue ReadingHealth Reform: Reduction in Hours First Lawsuit is Filed by Employees
The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R
Continue ReadingVideo: Independence Blue Cross Medicare Plans
Enjoy the latest TV Commercial from Independence Blue Cross about their Medicare supplement plans. Remember, Independence Blue Cross is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if IBC has a plan that’s a good fit for you.
Continue ReadingHealth Reform: Is Your Company Ready for the New Reporting Requirements?
Health Reform: Is Your Company Ready for the New Reporting Requirements? In 2016, employers with at least 50 full-time employees (FTEs) must provide Forms 1095-C to their employees and to the IRS. This new requirement applies to both insured and self-insured medical plans. The forms require, in part, tracking per each month in 2015 per each FTE: the tier of health plan coverage offered (e.g., employee-only, employee+spouse, or no coverage offered); the self-only premium an employee must pay for the lowest-cost plan that provides minimum value; and the reason why an employer would not be subject to a penalty for a particular month (e.g., employee is in a waiting period or the affordability… Read More
Continue ReadingIBC: 2015 SHOP Updates
For 2015, the Small business Health Options Program (SHOP) platform manages more processes and information. As a result, the involvement of insurance carriers has been reduced. Understanding how it will work this year will help you work with employers to decide if they should purchase coverage through SHOP or directly from Independence Blue Cross (Independence). Like last year, groups may still only offer one plan option to all employees. However, the application and setup processes are now managed entirely through SHOP instead of by insurance carriers. This means certain Independence benefits are no longer available. Independence will continue to provide member identification cards, process member claims, and provide member services to answer questions. Click the link below to download… Read More
Continue ReadingTake Advantage of Medicare’s Free Preventive Services
Many seniors are unaware that preventive tests, screenings and counseling sessions are now available for free, with no copays or deductibles, thanks to the Affordable Care Act. More than 60 million people took advantage of these services, at no cost to themselves, during the first three years after the services became free in 2011, according to government reports. Click the link below to download a list from Medicare for Dummies of Medicare preventative services. Medicares-preventive-services-chart13 Questions about Medicare eligibility, open enrollment, supplements, health plans or PDP drug cards? Total Benefit Solutions, Inc. has a dedicated team of Medicare health plan professionals who are trained, annually re-certified, licensed and… Read More
Continue ReadingVideo: Turning 26? Here’s when to apply for health insurance
Video: Turning 26? Here’s when to apply for health insurance If you are turning 26 and still on your parent’s health insurance plan, first of all, happy birthday! And secondly, congratulations! You can now purchase your very own health insurance. In fact, once you turn 26, your parent’s can no longer cover you under their health plan. Remember, Independence Blue Cross is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if IBC has a plan that’s a good fit for you, or click here for… Read More
Continue ReadingHealth Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax
Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More
Continue ReadingFraud, Waste & Abuse-Did You Know?
Fraud, Waste & Abuse: did you know? As a nation, we spend over $2.7 trillion on healthcare every year, and it is estimated that tens of billions are lost each year to FWA. One recent study estimated that fraud and abuse added as much as $98 billion to annual spending on Medicare and Medicaid. It affects not only the cost but quality of care received. Combating healthcare fraud in Medicare and Medicaid is an important priority for the Federal Government. The Centers for Medicare & Medicaid Services (CMS), the Federal agency responsible for administering these programs, takes its role in leading anti-fraud efforts very seriously and has issued strict requirements… Read More
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