Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia

We scored Philadelphia Health Insurance Agencies on more than 25 variables across five categories, and analyzed the results to give you a hand-picked list of the best. Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia by expertise.com

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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

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How is COBRA health insurance affected if I am disabled?

  In certain circumstances, if a disabled individual  and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months.  The criteria for this 11-month disability extension is a complex area of COBRA law.  We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at phig@cms.hhs.gov. In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee’s employment hours.  Second, the covered employee must be determined under title II or title XVI of the… Read More

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CMS Extends Open Enrollment Period

On September 17, 2021, the Centers for Medicare & Medicaid Services (CMS) finalized a series of provisions that follow through on President Biden’s commitment to build on the Affordable Care Act, expand health coverage access for Americans and advance health equity. The provisions are the third installment of the payment notice for 2022.   There are several important policy updates that Marketplace agents and brokers should be aware of prior to the beginning of the plan year 2022 Open Enrollment Period (OEP). These provisions include: An extension of the OEP from November 1, 2021, to January 15, 2022, annually for Marketplaces on the federal platform. Clarification for Special Enrollment Period… Read More

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Dental & Vision Plans for Families

  Getting a quality dental plan when you are self employed or don’t have employer coverage can be a real challenge.  But don’t worry! The professionals at Total Benefit Solutions, Inc work for your benefit! We have provided this easy to use online portal to help you shop, compare and enroll on a great plan of your choice!  We can walk through the options with you or you can enroll on the portal on your own, whatever you choose! Questions about these dental benefits? Just give us a call (215)355-2121.  Click here to find and compare dental and vision plans!   

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Medicare Supplement Plan F or G?

  Many of our clients ask what is the “best” Medicare supplement that they can buy. While there is no overall “best”, the Medicare Supplement Plan F is generally considered the most comprehensive coverage among Medicare supplements due to the fact that most services are covered without any member co-pay or cost sharing at all. Keep in mind that Medicare supplements, like Plan F do not cover prescriptions and that a beneficiary with Medicare supplement will need to have other coverage for prescription drug coverage.  A little known fact about Medicare supplements is that they do not have an annual “open enrollment” period so a beneficiary with a supplement can… Read More

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UHC: Watch – Understanding The No Surprises Act and 2021 Consolidated Appropriations Act

Experts from UnitedHealthcare recently updated self-funded health plan sponsors and consultants on The No Surprises Act, and related compliance requirements, including: Consumer price transparency Mental health parity Implications and obligations for plans sponsors, including qualified payments, health plan ID cards, advanced EOBs and potential impact of out-of-network utilization and independent dispute resolution UHC: Understanding The No Surprises Act and 2021 Consolidated Appropriations Act – Presentation & Materials

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COBRA Subsidy Termination Notice Reminder

AEIs must be provided with a notice of expiration of the COBRA subsidy between August 16 and September 15, 2021. The notice must explain the date that the premium assistance will expire and that the individual may be eligible for coverage without any premium assistance through COBRA, a group health plan, the Marketplace, or Medicare/Medicaid.

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Royal Caribbean Travel Insurance Requirements – We’ve Got You Covered!

  Beginning August 1, 2021 and going through to December 31, 2021, Royal Caribbean Cruises departing from ports out of Florida will require unvaccinated passengers age 12 years and older to procure valid travel insurance prior to boarding. Coverage requirements include $25,000 per person in medical coverage and $50,000 per person for emergency medical evacuation with no COVID-19 exclusions. Don’t let this requirement halt your travel plans!  We have Trip Protection and global health insurance plans provide coverage that meet these requirements, as well as offering additional coverage like baggage loss/delay benefits and trip cancellation/interruption benefits. If you have any questions please contact your Total Benefit Solutions, Inc health insurance… Read More

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Supreme Court Dismisses Latest Challenge to the ACA

The “individual mandate” provision of the ACA as originally enacted in 2010 required most U.S. residents to obtain minimum essential health insurance coverage or pay a monetary penalty. The individual mandate penalty withstood a legal challenge in 2012 when the Supreme Court ruled itwas a valid exercise of Congress’ taxing power. However, Congress effectively eliminated the individual mandate penalty by reducing it to zero effective January 1, 2019. Download Supreme Court Dismisses Latest Challenge to the ACA

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SCOTUS Upholds Affordable Care Act Ruling

  The Supreme Court has dismissed a challenge to ObamaCare, leaving the industry as is for employers and individuals. By a 7-2 vote on Thursday, the justices left the entire law intact in ruling that Texas and two individuals had no right to bring their lawsuit in federal court. The Supreme Court of the United States heard oral arguments on November 10, 2020, as to the question of whether the Affordable Care Act’s Individual Mandate provision is constitutional. This case, California vs. Texas is the latest challenge against the Affordable Care Act (ACA) and the second time the Justices addressed the constitutionality of the Individual Mandate portion of that law.… Read More

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New Mandatory Preventive Items and Services

  Most plans will be required to cover new preventive items and services beginning later this year, or in 2022 or 2023 (depending on the plan year), including ones related to Hepatitis B virus infection screenings and colon cancer screenings. Non-grandfathered group health plans must provide coverage for in-network preventive items and services and may not impose any cost-sharing requirements (such as a copayment, coinsurance, or deductible) with respect to those items or services. Click to Download New Mandatory Preventive Items and Services – 2021 Update

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Tax Advantaged Benefit Documents

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

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Alternatives to Health Insurance Benefits

 Sometimes clients offer other alternative benefits to their employees. The reasons for doing this are many but depending on the earnings of their workforce, offering a group medical plan will eliminate any health insurance subsidy. In those cases offering a group health insurance benefit can come off as a penalty for the employees. By offering alternative benefits our experts can help the employees enrolled on a subsidized health insurance plan and still get good if not great benefits from their employer!  ICHRA: with an ICHRA the employer can give the employees money towards their health insurance purchase.  The ICHRA allows the employer to do so with untaxed dollars and the… Read More

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What is Blue Card PPO?

Many clients ask us about Blue Card PPO and how it works. Blue Card PPO is typically attached to our clients policies who are enrolled on an IBC Personal Choice PPO or National Network PPO or a Horizon Blue Cross plan with National Access. You can tell if you have this on your plan if your card has the PPO Traveling Briefcase ppo logo.   It’s important to note that members who have a Keystone HMO, Amerihealth or Horizon HMO or local EPO do NOT have Blue Card PPO.  How Does the BlueCard Program Work? BlueCard® PPO Medical Plan The BlueCard Preferred Provider Organization (PPO) medical plan gives you the freedom to… Read More

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Top 10 Questions to Ask Your Benefits Broker

Analyzing these ten critical questions in relation to your organization’s needs will help you make a more informed decision about your benefits broker

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IRS Guidance Clarifies DCAP Relief

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates  to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

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CMS Announces Medicare Plan Finder Improvements

Source: medicare.gov   This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to improve and update the Medicare Plan Finder (MPF) and the Health Plan Management System (HPMS). HPMS is the system that Medicare Advantage and Part D plans use to provide data about their plan offerings to Medicare, and the MPF is the online tool that allows beneficiaries to evaluate, compare, and enroll in those plans. The changes will be in place for the start of the Medicare Open Enrollment Period starting on October 15 for 2022 plans. Many of the forthcoming MPF changes reflect suggestions that Medicare Rights and other advocates have made over the years to increase the tool’s… Read More

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Can Employers Ask for Proof of Vaccination?

From our partners at TOTAL HIPAA: As states reopen and companies invite employees back into the workplace, an employee’s vaccination status will become an important factor in minimizing workplace health risks and returning business to normal operations.  Can employers implement a mandatory vaccination program? What do laws like the Americans with Disabilities Act (ADA) and federal agencies like the Equal Employment Opportunity Commission (EEOC) have to say about this? Click the link below to read the rest at Total HIPAA… Can Employers Ask for Proof of Vaccination?

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Family Dental & Vision Plans

We have a number of stand-alone dental and vision plans from Davis Vision, VSP and Delta Dental. You can review, compare and enroll on plans in minutes! https://brokers.dentalforeveryone.com/?id=B3F52EA5-F0E3-40B4-B1DB-0F060AE09478

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What is Modified Adjusted Gross Income (MAGI)?

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return. 

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What is Balance Billing?

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Ask your health insurance experts at Total Benefit Solutions today how to avoid balance billing charges!

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PEOPLE RISK MANAGEMENT

Employees are usually a business’s biggest asset. Conversely, those same employees are also the biggest risk. If you have employees,you have employee-centric exposures, also known as people risks. These risks are rapidly increasing and evolving, and what were onceconsidered minor problems are now potentially disastrous for businesses.  Download HR Solutions

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What is a Qualified High Deductible Health Plan?

Qualified HDHPs Enrollment in a qualified HDHP is a requirement for establishing and maintaining a health savings account. The chassis for a qualified HDHP is the same as described in Chapter 1, but it must also conform to certain federal guidelines: A qualified HDHP must specify both a minimum annual deductible and a maximum annual out-of-pocket (OOP) expense limit, as set every year by the IRS. The minimum annual deductible is just that—the minimum amount that the insured must pay before the plan pays any benefit. The maximum annual OOP expense limit is the cap on the sum of the annual deductible and all out-of-pocket expenses the insured must pay for covered expenses under the… Read More

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What Is a Health Savings Account?

A health savings account is a special purpose financial account that allows a consumer to save and pay for medical expenses on a tax-favored basis. Funds deposited into an HSA are not taxed; the funds in the account grow tax free; and the money accumulated in the account can be withdrawn tax free to pay for qualifying medical expenses. In effect, an HSA owner uses the account in a manner similar to a checking account to cover his or her (or his or her family’s) medical expenses. There are no income restrictions or requirements on who may or may not open and contribute to an HSA. The HSA—the account and its funds—belongs… Read More

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