#aca – Total Benefit Solutions Inc

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

May 23, 2022May 23, 2022Ed MacConnellNo Comments

2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees May 23, 2022 This Allied Update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2022. By way of background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which… Read More

Notice Requirements for Group Health Plans

May 16, 2022May 13, 2022Ed MacConnell

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

2023 Inflation Adjusted Amounts for HSAs

May 11, 2022Ed MacConnell

The IRS released the inflation adjustments for health savings accounts (“HSAs”) and their accompanying high deductiblehealth plans (“HDHPs”) effective for calendar year 2023, and the maximum amount that may be made newly available forexcepted benefit health reimbursement arrangements (“HRAs”). All limits have increased from the 2022 amounts, somesignificantly.

Proposed Regulations to Fix ACA’s Affordability “Family Glitch”

May 10, 2022May 9, 2022Ed MacConnell

individuals are not eligible for premium tax credits in the Marketplace

Talk to your doctor about Keystone proactive plans

May 9, 2022Ed MacConnell

Understanding Medicare Part B Exemption Secondary Payer Rules

May 9, 2022May 9, 2022Ed MacConnell

What is a 5-Star Medicare Plan?

May 5, 2022May 5, 2022Ed MacConnell

Did you know that Medicare plans come with a handy rating system and that the highest-rated of these plans have a Special Enrollment Period associated with them? Get ready to learn all about 5-star Medicare plans and what makes them special! Click here for more information! As always contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any additional questions or concerns!

Annual Out-Of-Pocket Maximum Adjustments Announced for 2023

April 26, 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 more information contact your friends at Total Benefits Solutions! Reach out to us at (215)355-2121

HHS Extends Public Health Emergency until July 15

April 25, 2022April 25, 2022Ed MacConnell

On April 12, 2022, the Secretary of Health and Human Services renewed the COVID-19 pandemic Public Health Emergency, effective April 16, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Please download the bulletin below and contact your health insurance experts at Total Benefit Solutions, Inc at (215)355-2121 Download Bulletin

Free or Nearly Free Health Coverage Through New Jersey’s Expanded Access”

April 19, 2022April 18, 2022Ed MacConnell

The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the federal poverty level to enroll in a health plan throughout the year. New Jersey’s Governor Phil Murphy and Department of Banking and Insurance Commissioner Marlene Caride have introduced a new “Expanded Access” initiative, which allows residents at certain income levels to continue to enroll in free or nearly free health coverage through Get Covered New Jersey. The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the Federal Poverty Level (FPL) to enroll in a health plan throughout the year. This population will… Read More

New Qualifying Life Event through Pennie for New Customers!

April 11, 2022Ed MacConnell

Depending on a customer’s household income, they may qualify to enroll in coverage through a new Special Enrollment Period and receive financial assistance offered through Pennie! If a customer’s income is equal to or below 150% Federal Poverty Level (see table below), they can enroll in coverage through Pennie at any time of the year. New enrollees will need to take these steps to enroll in coverage under this qualifying life event: Submit a new Pennie application If they meet the criteria in the table below, a Special Enrollment Period (SEP) will automatically open! Once the SEP opens, they will have 60-days to enroll in a plan through Pennie. Once enrolled, coverage will begin the start of… Read More

Family Glitch Solution Proposed

April 6, 2022Ed MacConnell

Family Glitch Solution Proposed The Biden Administration announced today that it would release a proposed rule to fix the family glitch. This proposed rule is a result of President Biden’s Executive Order from 2021 calling on the federal agencies to strengthen the Affordable Care Act. The Department of Treasury is using the proposed rule to revise the definition of “affordability” of employer sponsored coverage as it applies specifically to family members of the employee. Current regulations define employer-based health insurance as “affordable” if the coverage solely for the employee, not for family members, is affordable, making family members ineligible for a premium tax credit. The proposed changes would allow… 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….

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

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

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 https://www.totalbenefits.net