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.
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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
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: 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 ReadingInstant Quotes for Individual Dental and Vision
Total Benefit Solutions is proud to announce our new individual dental and vision plans with Delta Dental and VSP Vision and more! Click the link below to quote, compare and enroll instantly! Click here now get instant dental and vision quotes You don’t have to do it alone. Call us at (215)355-2121 and one of our trained, licensed and certified account managers will answer your questions and help you through the process.
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingGroup Health Plan Notices 2015 CALENDAR
Group Health Plan Notices 2015 CALENDAR From our partners at HR360: This calendar/checklist is designed to help companies review the key reporting and notice requirements that may apply to their employer-sponsored group health plans under ERISA , the Affordable cxare Act, Medicare and more. Please note that this list is for general reference purposes only and is not all-inclusive. Note: ERISA and benefit requirements are complex, and your plan’s responsibilities may vary depending on the individual circumstances surrounding your company’s plan. Employers who have questions are encouraged to consult with their plan administrators, the U.S. Department of Labor’s Employee Benefits Security Administration, the Internal Revenue Service, or a knowledgeable employment law attorney… Read More
Continue ReadingHealth Advocate: Medical Health Advisor
Total Benefit Solutions, Inc now offers the Medical Health Advisor benefit! Watch this short video and ask us how your organization can benefit from offering this personal health advocate service to your employees!
Continue ReadingHow do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?
Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross have a unique ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More
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2014 Compliance Bulletin Compilation
Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year! Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.
Continue ReadingHR 360: How to Calculate Pay or Play Penalties
HR 360: How to Calculate Pay or Play Penalties: Make sure you are ready for 2015 with our basic step-by-step guidance on calculating pay or play penalties. This attorney-reviewed guide, provided by our partner HR360, makes it easy to understand how to calculate ACA penalties. HR360 is provided as a service to Total Benefit Solutions clients. If you have any additional questions regarding this bulletin, or the Affordable Care Act, please contact your Total Benefit Solutions account manager at (215)355-2121 Download How to Calculate Pay or Play Penalties
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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required
On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members? Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… Read More
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Total Benefit Solutions Introduces New Individual Health Plan Private Exchange
Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!
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Health Reform: Guidance Issued-Employer Reimbursement of Individual Policies
Previously, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (collectively, the “Departments”) explained that HRAs and employer payment plans cannot reimburse individual policies. On November 6, the Departments issued their twenty-second set of FAQs which make clear that: An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Such arrangements are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. Such… Read More
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Health Reform: Healthcare.Gov Sneak Preview
Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121
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Total Benefit Solutions is your Marketplace Navigator
What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
Continue ReadingIRS Derails Use of MV Plans Without Hospitalization
As you may know, in order to avoid penalties under the Affordable Care Act (“ACA”), large employers must offer their full-time employees coverage that is affordable and meets minimum value (“MV”). Some vendors exclude certain core benefits, such as in-patient hospitalization and/or physician services from their plans (referred to as “Narrow MVPs”) and use the MV Calculator to determine that the Narrow MVPs meet MV under the ACA. The vendors claim the Narrow MVPs insulate employers from penalty exposure and preclude employees from accessing subsidies in the Marketplace. There has been much controversy as to whether the Narrow MVPs do, in fact, satisfy the MV requirement. On November 4, 2014,… Read More
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Health Reform: CMS finalizes auto-enrollment process for current Marketplace consumers
CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More
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Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace
‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More
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What is Small Group Defined Contribution-Private Exchange Solution?
What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans. In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More
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What is Critical Illness Insurance?
Why Critical Illness as a “wrap” plan Because: They’re more affordable than you might think. They’re available for employer groups, individuals and seniors. They make selecting a health plan easier. They provide peace of mind against a catastrophic event and large out of pocket expenses. They’re person and portable, it doesn’t matter where you get your health insurance from, having your own critical illness plan makes it better. Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”, meaning they are not regulated by the affordable… Read More
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