#aca – Page 17 – Total Benefit Solutions Inc

IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015

February 20, 2015Ed MacConnell

IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015 IRS Notice 2015-17 provides limited transition relief from the assessment of excise taxes for small employers who reimburse, or directly pay, the premium for an employee’s individual health insurance policy. Prohibited Plans An “employer payment plan” is an arrangement under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy, or an arrangement under which the employer uses its funds to directly pay the premium for an individual health insurance policy covering the employee. Pursuant to prior agency guidance, employer payment plans are… Read More

CMS Announces Special Enrollment Period for Tax Season

February 20, 2015Ed MacConnell

CMS Announces Special Enrollment Period for Tax Season Contact: press@cms.hhs.gov CMS Announces Special Enrollment Period for Tax Season Eligible consumers have from March 15 through April 30 to enroll in coverage The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015… Read More

New tax form for individuals with coverage from the Health Insurance Marketplace

January 23, 2015January 28, 2015Ed MacConnell

Beginning in January 2015, the Health Insurance Marketplace Health and Human Services will be issuing a new 1095-A tax form to individuals who purchased coverage through the Health Insurance Marketplace. If you or anyone in your household enrolled in a health plan through http://www.healthcare.gov you should receive the new tax form in the mail. You should use this form when filing your 2014 federal income tax return. For more information visit www.IRS.gov/ACA or www.healthcare.gov/taxes or contact your tax advisor. The following publications are also available: Health Care Law: What’s New for Individuals & Families This is a large publication with many details. 3 Tips: The Marketplace and taxes Regarding your tax forms and… Read More

Updated Healthcare Reform Calculators

January 21, 2015Ed MacConnell

Total Benefit Solutions Inc. has updated our healthcare reform calculators on our website, http://www.totalbenefits.net Calculators include: How much tax credit is my small group eligible for? What are the conditions required to get the tax credit? Pay or Play Mandate penalty-What is my risk as a group? Individual Subsidy Calculator Click here to get to our healthcare reform calculators.

IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required

January 6, 2015Ed MacConnell

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

What is Small Group Defined Contribution-Private Exchange Solution?

September 12, 2014Ed MacConnell

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

What is Critical Illness Insurance?

June 30, 2014February 8, 2015Ed MacConnell

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

SHOP Rules Finalized, Enrollment Forms Simplified

July 25, 2013February 6, 2022Ed MacConnell

The Small Business Health Options Program’s (SHOP) place along the Affordable Care Act’s (ACA) timeline. It’s now being packaged for mass consumption and soon will be stocked on store shelves across all 50 states. Click here to read more…

New York Health Exchanges Offer 50% Drop in Premiums

July 24, 2013February 6, 2022Ed MacConnell

Empire State approves plans to be sold by 17 insurers and lower expected premiums may ease fears that next year’s implementation of the biggest parts of the Affordable Care Act would send prices soaring… Click here to read the story

IBC: Important change to claims processing for PPO plans

July 22, 2013February 6, 2022Ed MacConnell

Independence Blue Cross (IBC) will begin notifying customers later this week regarding a change in how claims for certain out-of-network providers will be processed under their IBC Personal Choice® PPO health plan. This change impacts fully insured, self-funded, and Individual commercial Personal Choice® PPO plans only. There is no impact to Medicare plans. Effective November 1, 2013, members who have claims submitted by providers who participate in the Highmark Blue Shield (Highmark) professional provider network inside IBC’s five-county service area will be subject to higher out-of-pocket costs and may also be subject to balance billing. Currently, claims submitted by a participating Highmark professional provider are processed as out of network and applied… Read More

Health Reform: Research Filing Fees Due July 31

July 20, 2013February 6, 2022Ed MacConnell

The Research Fee filing deadline is July 31, 2013 for self-funded medical plans and HRAs Insurance carriers will report and pay the Fee for fully insured plans. If an employer has several self-insured arrangements with the same plan year, they are subject to a single fee. An HRA integrated with a self-funded plan providing major medical coverage will not incur a separate fee specific to the HRA if the HRA and plan are established or maintained by the same plan sponsor. Click below to download the bulletin Research Fees Due Interested in our free Health Care Reform Checklist? send an email

Health Reform: Aetna to distribute MLR rebates

July 19, 2013February 6, 2022Ed MacConnell

By August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. For group plans, rebate checks will be sent to the policyholder, with few exceptions. Please click the link below to download the bulletin. Click to download

NJDOBI Issues Amendments to Rating Rules under PPACA

July 19, 2013February 6, 2022Ed MacConnell

NJDOBI Issues Amendments to IHC and SEH Rating Rules under PPACA For rates applicable to all rating periods beginning on or after January 1, 2014, carriers are directed to: Formulate rates in the IHC market to achieve a required 300 percent maximum ratio between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the State. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over; Formulate rates in the SEH market without regard to gender. Age factor categories should be in… Read More

Health Insurance Marketplaces (Exchanges): Informational Video

July 17, 2013February 6, 2022Ed MacConnell

Beginning in 2014, individuals and small businesses with up to 50 employees can purchase insurance through online exchanges, also called “health insurance marketplaces.” Each exchange will offer a choice of health plans that meet certain benefit and cost standards. In 2016, businesses with up to 100 employees will be able to participate. Coventry Health/Aetna recently released this easy to understand video that may help you understand the new exchange or” marketplace” system of buying health insurance. Click here to watch the six minute long video.

Medicare: What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)?

July 17, 2013February 6, 2022Ed MacConnell

Q:What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)? A: Business income has increased for doctors because many people on Medicare are now using free screenings and an annual “wellness visit” provided through the Affordable Care Act (ACA). Through Oct. 6, 2011, the government said, 20.5 million people enrolled in Medicare had received the free screenings or the annual visit, which is also free. Medicare is now offering a 10 percent bonus payment on the fees charged for primary care services, and a 10 percent bonus payment to surgeons who work in areas where there are shortages of doctors. For 2013 and 2014, Medicaid payments… Read More

Total Benefit Solutions Newest Brochure

July 11, 2013February 6, 2022Ed MacConnell

Download our latest brochure to read all about the valuable services we provide for our clients! Download our latest employee benefits brochure

PPACA employer mandate delayed until 2015

July 2, 2013February 6, 2022Ed MacConnell

PPACA employer mandate delayed until 2015 The Obama administration unexpectedly announced Tuesday it is delaying the employer mandate under the Patient Protection and Affordable Care Act until 2015. The mandate — which requires mid-sized and large employers to offer health insurance coverage to their workers — was one of the main requirements of the health care overhaul that was set to go into effect Jan. 1, 2014. But the Treasury Department announced Tuesday that it would delay its enforcement an entire year after hearing numerous concerns from employers about the challenges of its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement… Read More

Prodigy Learning Center’s Executive Director is a Happy Client

June 15, 2013February 6, 2022Ed MacConnell

Hi Ed, I just wanted to let you know how great (our account manager) has been with our insurance issues. She has been so helpful to me. I don’t know if people take the time to tell you when your staff is doing a great job, but I wanted to let you know. She is great!! Thanks. Christine Viteo, R.N. Executive Director Prodigy Learning Center Philadelphia, Pa.19132

EMA Group to become Total Benefit Solutions Inc!

June 15, 2013February 6, 2022Ed MacConnell

The health insurance industry is on its way to a major overhaul by the end of this year. With the implementation of the Patient Protection and Affordable Care Act (PPACA), nearly every American will be affected by the new law and many already have. With this in mind, we have decided to refocus our efforts to better serve our clients in alignment with the new world of health benefits. We are proud to announce that beginning August 1, 2013; EMA Group Inc. will be known as Total Benefit Solutions Inc. Although our name is changing; our commitment to provide top notch guidance and support to our clients will never change.… Read More

IBC Requesting tobacco data

June 15, 2013February 6, 2022Ed MacConnell

Under the Affordable Care Act (ACA) and effective January 1, 2014, insurers are permitted to use the following four categories to determine premiums: Age Family Size Geography Tobacco To comply with this provision, IBC will be implementing a new process to collect tobacco usage as part of their rating methodology for groups with 2-50 employees and sole proprietors. Over the next several days, IBC will send letters to employers with January 1, 2014 renewal dates to gather this information. In the mailing, there will be a letter and a Tobacco Use Form, that must be completed for each of their employees and dependents age 21 and over… Read More

Heathcare Reform: Important New Guidance on Affordability

June 6, 2013February 6, 2022Ed MacConnell

In order to receive a subsidy in the Health Insurance Marketplace (formerly referred to as the Exchange), generally an individual must not be eligible for affordable coverage under an eligible employer sponsored plan that provides minimum value. Additionally, large employers looking to avoid penalty exposure must offer all full-time employees (and their dependents) affordable coverage that meets minimum value. Although final regulations were published back in February, further clarification was needed on the health benefits considered in determining the share of benefit costs paid by a plan. Click the link below to read the rest of the article. Minimum Value and Affordability-060513R

Health Reform: Cost Sharing Limits

June 6, 2013February 6, 2022Ed MacConnell

Effective the first plan year that begins on or after January 1, 2014, all non-grandfathered group health plans (both insured and self-insured) , regardless of size, must comply with annual cost-sharing limitations on out-of-pocket maximums. Click the link below to download and review the entire notice. Health Reform-cost sharing limits

Health Reform: Contraceptive Coverage and Non-Profit Organizations

June 4, 2013February 6, 2022Ed MacConnell

Under the ACA, most health plans must cover women’s preventive services, including contraception, without charging a co-pay or deductible. The interim final rules provided that group health plans established or maintained by religious employers were exempt from these requirements. Guidance issued subsequent to the final rules established a temporary enforcement safe harbor for group health plans established or maintained by certain non-profit organizations that have religious objections to contraceptive coverage. The safe harbor is in effect until the first plan year that begins on or after August 1, 2013. Please click the link below to download and review the guidance. Health reform- contraceptive coverage and Non Profits

Health Reform: Exchange Notice Requirements

June 3, 2013February 6, 2022Ed MacConnell

Open enrollment for health insurance coverage through the Exchange (now referred to as the Health Insurance Marketplace) begins October 1, 2013. The Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section that requires employers to provide each employee at the time of hiring, as well as current employees, a written notice that includes information regarding the new Health Insurance Marketplace. Earlier materials referred to this notice as the “Exchange Notice,” however, it is now referred to as the “Notice of Coverage Options. Click the link below to download and view the notice. Health Reform-Exchange Notice

Health Reform Update: Shop Exchanges

June 3, 2013February 6, 2022Ed MacConnell

Individuals and small employers will be able to purchase private health insurance through a new marketplace called “The Exchange” beginning in 2014. Each state that chooses to operate an Exchange must also establish a Small Business Health Options Program (“SHOP”) that assists eligible small businesses in providing health insurance options for their employees. Click the link below to download and review the entire notice. Health reform-Shop Exchange Facts

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