Total Benefit Solutions – Page 6 – Total Benefit Solutions Inc

House Passes Health Care Transparency Law

December 18, 2023December 15, 2023Ed MacConnell

In a significant move towards increased transparency and cost reduction in the healthcare sector, the U.S. House of Representatives voted 320-71 to pass the Lower Costs, More Transparency Act on December 11, 2023. The bipartisan legislation aims to address the pressing issue of rising healthcare costs by implementing crucial changes, particularly affecting employers sponsoring group health plans. Transparency in Coverage Regulations The bill codifies existing transparency in coverage regulations, requiring the posting of machine-readable files (MRF) and making certain cost information available. Notably, changes include specific timing for posting the MRF, scheduled for the 10th day of each month. If enacted, this provision would come into effect for the first… Read More

ACA Compliance: Key Calendars for 2024 Revealed!

December 14, 2023December 14, 2023Ed MacConnell

Stay ahead of the compliance curve with crucial information on Affordable Care Act (ACA) deadlines for 2024. In our latest update, we’ve compiled comprehensive compliance calendars tailored for both small groups (less than 50 employees) and larger groups (50 or more employees). It’s your go-to resource for understanding and meeting important deadlines to ensure a seamless compliance journey. 2024 Small Group Compliance Deadlines: For fully and self-insured groups operating on a calendar year plan, we’ve outlined essential deadline dates for 2024. Please note that some reporting deadlines may vary for plans with a start date other than January 1st. Whether you have a small group or a larger organization, staying… Read More

DOL Settlements Prompt Life Insurance Carriers to Adopt Claim Reforms

December 8, 2023December 8, 2023Ed MacConnell

Recent settlements between the Department of Labor (DOL) and major life insurance carriers have brought attention to the denial of claims due to missing evidence of insurability (EOI). These agreements spotlight the potential liabilities faced by carriers and employers even after collecting employee premiums for coverage. Employers commonly offer basic life insurance coverage without charge, while employees can purchase additional coverage through payroll deductions. Approval for supplemental coverage often depends on carriers accepting evidence of insurability (EOI) submitted by the insured individual. DOL Investigations: The DOL’s investigations revealed that carriers, such as Prudential and United, consistently denied claims for missing EOIs despite collecting premiums. Employers, tasked with collecting EOIs and… Read More

2024 Benefits Breakdown: Your Wallet Will Thank You!

December 7, 2023December 7, 2023Ed MacConnell

As we step into the new year, the IRS has unveiled the much-anticipated cost of living adjustments for 2024 under various provisions of the Internal Revenue Code. These adjustments bring changes that may impact your employee benefit plans. Let’s delve into some key areas affected by these adjustments. Cafeteria Plans – Health Flexible Spending Arrangements: For plan years beginning in 2024, the annual contribution limitation under Code Section 125(i) for voluntary employee salary reductions to health flexible spending arrangements (health FSAs) has increased to $3,200 from $3,050. Additionally, for plans allowing the carryover option, the maximum unused amount from a health FSA plan year that begins in 2024 and can… Read More

Updated No Surprises Act and IDR Guidance

November 3, 2023November 6, 2023Ed MacConnell

Recent developments in healthcare legislation have brought changes to the No Surprises Act’s independent dispute resolution (IDR) process. Issued by the Departments of Labor, the Treasury, and Health and Human Services (HHS), FAQ Part 62 provides essential updates regarding the qualifying payment amount (QPA) calculation methodology and the disclosure requirements for out-of-network (OON) air ambulance services. Moreover, the federal IDR portal has reopened, streamlining the resolution of billing disputes. The No Surprises Act Overview The No Surprises Act, a part of the Consolidated Appropriations Act, 2021, aims to protect patients from surprise medical bills. It places limits on out-of-network cost-sharing and bans balance billing in various situations, such as emergency… Read More

What is the Part D Donut Hole in 2024?

November 1, 2023November 1, 2023Ed MacConnell

The Medicare Donut Hole, officially called the Coverage Gap, refers to a stage in Medicare Part D plans where beneficiaries have to pay more for prescription drugs. Historically, after reaching a certain spending threshold, beneficiaries faced higher out-of-pocket costs for drugs until catastrophic coverage began. The Donut Hole was designed to encourage the use of more cost-effective medications and generic alternatives. As of 2024, the Donut Hole is not completely ending, but the percentage beneficiaries pay for prescriptions during this stage has been reduced. When a beneficiary and their plan have spent a total of $5,030 in 2024, they enter the Donut Hole. In this phase, they pay 25% of… Read More

Total Benefits: Your Trusted Guide to Cost-Efficient Coverage

October 26, 2023October 25, 2023Ed MacConnell

In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More

New Federal Rules: HHS 2023 Penalty Hike

October 25, 2023October 25, 2023Ed MacConnell

In the world of healthcare compliance, staying up to date with federal regulations and guidelines is crucial to avoid costly penalties. One such regulation that affects healthcare providers and group health plans is the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, commonly known as the “Inflation Adjustment Act.” This act directs federal agencies to adjust civil monetary penalties to account for inflation. In a recent development, the Department of Health and Human Services (HHS) issued final rules on October 6, 2023, updating the civil monetary penalties for inflation. Understanding the Updated Penalties The adjusted penalties are applicable to penalties assessed on or after October 6, 2023. It’s… Read More

Court Vacates Coupon Cost-Sharing Rule

October 24, 2023October 24, 2023Ed MacConnell

On September 29, 2023, a significant legal development occurred that could affect how health insurance carriers and group health plans handle manufacturer coupons for prescription drugs. The District Court for the District of Columbia vacated a rule issued by the Department of Health and Human Services (HHS) that allowed, but did not mandate, the inclusion of manufacturer coupons in calculating the cost-sharing for health plans. In this blog post, we’ll explore the background of this issue, the 2019 HHS rule, and the subsequent legal decisions that have led to this recent development. HHS’s 2019 Rule In 2019, HHS issued a rule to clarify this matter. The rule stated that plans… Read More

Affordable Dental Insurance: A Key Player in Oral Health

October 20, 2023October 20, 2023Ed MacConnell

Dental health is a crucial aspect of overall well-being, and a recent survey has shed light on the satisfaction levels of Americans with their dental insurance plans. The results, published in a press release by AHIP (America’s Health Insurance Plans) on September 26, 2023, provide an insightful perspective on the state of dental insurance in the United States. The survey, conducted by Global Strategy Group (GSG) on behalf of AHIP, focused on individuals who have dental insurance and have visited dental specialists, including dentists, oral surgeons, and orthodontists, in the past year. The findings from the survey paint a positive picture of Americans’ experiences with their dental insurance plans. Key… Read More

Financial Support Soars for Mental Health Integration

October 19, 2023October 19, 2023Ed MacConnell

Mental health is an essential component of overall well-being, and every American deserves access to quality mental health and substance use disorder treatment. Access to mental health care can be a transformative step in managing and coping with mental health concerns, allowing individuals to lead more fulfilling lives. This article explores the importance of integrating mental health services into other care settings and highlights the Collaborative Care Model (CoCM) as a promising approach to enhance access to mental health care. Expanding Access Through Integration Integrating mental health into broader healthcare settings is a pivotal strategy to increase accessibility and support for patients. The Collaborative Care Model, often abbreviated as CoCM,… Read More

The Secrets to Patient Loyalty in Healthcare

October 18, 2023October 18, 2023Ed MacConnell

The healthcare industry is undergoing a transformation like never before. In an era of insurgent competitors and changing payment models, the COVID-19 pandemic acted as a pressure test, accelerating the pace of disruption and digital adoption. Now, there’s a unique opportunity for healthcare to make loyalty central to its mission. From earning consumer trust to establishing brand relevance, the industry is evolving in profound ways, reshaping patient experiences to boost retention and a sense of belonging. Both healthcare providers and payers are re-engineering how they connect with their customers to earn their loyalty during this time of unprecedented change. At first glance, the concept of “loyalty” in healthcare may seem… Read More

Small Business, Big Benefits: Health Coverage for All

October 17, 2023October 17, 2023Ed MacConnell

In the United States, the landscape of healthcare is a complex one, with various options available to individuals and families. One of the most significant sources of health coverage for Americans is employer-provided coverage. This type of coverage is a health plan, or a selection of health plans and other benefits, purchased by an employer and offered to eligible employees and their dependents. It’s a system that plays a crucial role in ensuring that millions of hardworking individuals and their families have access to quality healthcare. Affordable Access to Care The primary advantage of employer-provided coverage is its affordability. Employees’ contributions to their health coverage are tax-free, which means that… Read More

2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?

October 13, 2023October 13, 2023Ed MacConnell

In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More

The Value of Employee Health Benefits

October 12, 2023October 12, 2023Ed MacConnell

In today’s world, where healthcare costs can be a significant burden on individuals and families, employer-provided health coverage stands out as a vital resource. More than half of all Americans – over 180 million hardworking individuals and their families – rely on their jobs to secure access to healthcare. In this blog, we’ll explore the invaluable benefits of employer-provided coverage and how it offers affordable access to care, improved health, and peace of mind. Affordable Access to Care Healthcare expenses can quickly add up, and without insurance, it can be a daunting task to manage them. However, for millions of Americans, the path to affordable healthcare begins with their employers.… Read More

Medicaid Redetermination Updates: Your Next Steps

October 10, 2023October 10, 2023Ed MacConnell

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

Medicare Supplement Insights: Protecting Your Wallet

October 9, 2023October 9, 2023Ed MacConnell

In a world where healthcare costs are a growing concern for many, Medicare Supplement coverage has emerged as a reliable solution to bridge the gaps in original Medicare. As we delve into the latest data from 2021, including insights from the National Association of Insurance Commissioners (NAIC), the California Department of Managed Health Care, and the Medicare Current Beneficiary Survey (MCBS) from 2020, a compelling narrative about the significance of Medicare Supplement plans unfolds. Key Takeaways: 1. A Majority Embrace Medicare Supplement: In 2020, a staggering 54% of original Medicare enrollees without additional insurance coverage, such as Medicaid or employer-provided insurance, turned to Medicare Supplement policies for added peace of… Read More

No Child Left Uninsured: Innovative Solutions in Healthcare

October 6, 2023October 10, 2023Ed MacConnell

Millions of children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for their health and well-being. However, the redetermination process can sometimes pose challenges for their parents. In this article, we explore the innovative efforts undertaken by health insurance providers to ensure that children maintain access to healthcare, regardless of their parents’ circumstances. Medicaid plays a crucial role in American healthcare, improving the health and financial security of millions of individuals daily. It’s particularly vital for the 42 million children enrolled in Medicaid or CHIP. While parents may face hurdles during the Medicaid redetermination process, children often remain eligible for these programs or can transition to CHIP. Health… Read More

2024 Healthcare Premiums Revealed: The Impact Factors

October 4, 2023October 4, 2023Ed MacConnell

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

2024 ACA Affordability Shake-Up: Are You Ready?

October 2, 2023October 2, 2023Ed MacConnell

Are you ready for some important news regarding the Affordable Care Act (ACA)? The IRS has just released an update that could impact your organization’s healthcare offerings. In this blog post, we’ll break down the latest announcement and what it means for employers and employees alike. If you’re interested in diving deeper, be sure to download our PDF for more information. IRS Announces 2024 ACA Affordability Indexed Amount The IRS recently made an important announcement in Revenue Procedure 2023-29 regarding the Affordable Care Act’s (ACA) affordability indexed amount under the Employer Shared Responsibility Payment (ESRP) requirements. This announcement is significant for employers as it affects the calculation of penalties related… Read More

Understanding the Updates to the Davis Bacon and Related Acts

September 28, 2023September 28, 2023Ed MacConnell

On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More

Benefits Notices: What Employers Need to Know

September 27, 2023September 27, 2023Ed MacConnell

As an employer, it is important to be aware of the various benefits notices that you are required to provide to your employees. These notices are designed to inform employees of their rights and benefits under various laws and regulations. Failure to provide these notices can result in penalties and legal action. One of the notices that employers with 1-19 employees are required to provide is the Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice. This notice is provided to Medicare-eligible individuals who are offered prescription drug coverage under the employer’s group health plan. It must be provided annually prior to October 15th, upon request, and at… Read More

Voluntary Benefits: Customized Coverage for Your Team

September 26, 2023September 26, 2023Ed MacConnell

Unlocking the Power of Voluntary Benefits In today’s competitive job market, employers aim to attract and retain top talent by offering comprehensive benefits beyond the basics. Enter voluntary benefits – a customizable solution that benefits both employers and employees. What Are Voluntary Benefits? Voluntary benefits are offerings that employers provide for purchase by employees. They empower employees to tailor their benefits to their needs, offering flexibility and convenience. Here are their key characteristics: A Variety of Benefits Voluntary benefits offer a wide array of options, including: Advantages for Employers and Employees Employers benefit from: Employees enjoy: While voluntary benefits may not suit everyone, employers should assess their package and consult… Read More

COBRA and Medicare: Complementary Health Insurance Explained

September 21, 2023September 21, 2023Ed MacConnell

In today’s rapidly changing job landscape, it’s not uncommon for individuals to find themselves eligible for both Medicare and COBRA simultaneously. This dual eligibility can be a bit bewildering, but understanding how these two crucial insurance options interact is vital to making informed decisions that could impact your finances and peace of mind. Let’s delve into the intricacies of how COBRA works with Medicare and explore the options available to you. COBRA Unveiled First, let’s demystify COBRA. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal program designed to provide a safety net for workers and their families. It allows you to maintain the health coverage provided by your… Read More

Benefits of a PEO: How to Simplify your Business Operations

September 21, 2023September 20, 2023Ed MacConnell

If you’re a small- or mid-sized business owner, you’ve probably come across the term “PEO” in your quest to optimize your company’s operations. PEO stands for Professional Employer Organization, and it’s a dynamic solution designed to assist businesses in various crucial areas, such as payroll administration, human resources, risk management, and employee benefits. In this blog post, we’ll explore the advantages of partnering with a PEO and introduce you to a valuable resource to help you navigate this complex landscape. The Advantages of a PEO As beneficial as PEOs can be, the surge in their numbers can be overwhelming for business owners. The plethora of options often leads to confusion… Read More

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