Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 http://www.totalbenefits.net
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Under the Affordable Care Act (“ACA”), the deadline for applicable large employers (“ALEs”) to furnish Form 1095-C and 1095-B to certain individuals (such as full-time employees in the case of Form 1095-C) is January 31 with respect to the preceding calendar year. The Internal Revenue Service (“IRS”) released final regulations on December 12, 2022 with respect to ACA reporting requirements. These final regulations provided an automatic extension of 30 days to furnish these statements to individuals. This means that Wednesday, March 2, 2023 is the deadline to furnish individuals with 2022 Forms 1095-C and 1095-B. This extension is automatic; employers or other reporting entities are not required to file a… Read More
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Publish Date: 2/1/2023 Bright Health announced October 11 that it was pulling out of the ACA Marketplace in 15 counties throughout Florida. As a result, 250,000 individuals with Bright Health coverage will be impacted. Some of the impacted individuals will be auto-migrated to Florida Blue as part of this transition. If you are impacted or have any questions or concerns about this please contact your Total Benefit Solutions, Inc health insurance experts at (800)924-6718
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Starting this week, Independence Blue Cross (Independence) will be issuing an additional medical loss ratio (MLR) rebate to affected customers and subscribers for a portion of their 2020 health insurance premiums. The check mailing will continue until the end of February. The additional rebate is being issued following a clarification on MLR calculation provided by the Centers for Medicare & Medicaid Services (CMS). As a result of the clarification, we looked at prior year calculations and determined an additional amount was due for 2020. Any applicable interest has been included in the amount of each check. Click here for the full story As always please contact your Total Benefit Solutions,… Read More
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Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read More
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Effective January 1, 2023, from Independence Blue Cross: (Independence) IBC will add 12 drugs to the list of specialty drugs that require precertification under the medical benefit. With these additions, Independence now requires precertification for a total of 271 drugs before members can receive coverage for them. The drugs being added include several gene replacement therapies and cancer/antineoplastic agents in the U.S. Food and Drug Administration (FDA) pipeline, as well as several biosimilars that recently received FDA approval. The newly added drugs are: beremagene geperpavec* – gene replacement/gene editing therapiesCimerliTM (ranibizumab‑eqrn) – ophthalmic agentsElahereTM (mirvetuximab soravtansine) – antineoplastic agentsFylnetra® (pegfilgrastim‑pbbk)† – neutropeniaHemgenix® (etranacogene dezaparvovec) – gene replacement/gene editing therapies mosunetuzumab* – antineoplastic agents Skysona® (elivaldogene autotemcel) – gene replacement/gene editing therapiesStimufend® (pegfilgrastim‑fpgk)† – neutropeniatofersen* – amyotrophic lateral sclerosis agents tremelimumab* – antineoplastic agentsVegzelma® (bevacizumab‑adcd)† – antineoplastic agentsZynteglo® (betibeglogene autotemcel) – gene replacement/gene editing therapies We often add drugs… Read More
Continue ReadingThe drug formulary is a list of medications that have been selected by an insurance company for their medical effectiveness, positive results, and value. The formulary includes generic medications and a defined list of brand medications. Sometimes it includes specialty mediations. Most formularies will have exclusions, or drugs not covered by your plan. You maximize your benefits when you purchase formulary medications. Your health insurance specialists at Total Benefit Solutions, In. can help you understand your plan’s formulary and how to find or search that list. Contact us today at (215)355-2121 if you have questions about your health insurance plan’s drug coverage.
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The 2023 commercial and ACA member guides and Medicare Advantage member handbook are now available. Clients will receive these documents through a variety of touchpoints. Please keep them handy as a quick reference to Blue KC plan benefits and features and to share them with clients as needed. Employer/Group Medicare Advantage ACA Individual and Family Plans Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
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On December 12, 2022, the Internal Revenue Service (“IRS”) released final regulations with respect the ACA reporting requirements. These rules are substantially similar to the proposed rule issues in November last year. The final rule: Applicable large employers (“ALEs”) have until March 2, 2023 (rather than January 31, 2023) to furnish Forms 1095-C for calendar year 2022 to full-time employees and other individuals. The final rule does not extend the deadline to file completed Forms 1094-C and 1095-C (and Forms 1094-B and 1095-B) with the IRS. The due date remains March 31, 2023 (or February 28, 2023 for paper filing if filing fewer than 250 forms). On December 15, 2022,… Read More
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Premiums for ACA Marketplace benchmark silver plans are increasing on average across the U.S. in 2023 after four years of slight declines. However, premiums changes vary by location and by metal level, with premiums decreasing in some cases. As most enrollees receive significant premium subsidies on the ACA Marketplaces, the net premium amount an exchange enrollee pays depends on their income and the difference in the cost between the benchmark plan (second-lowest-cost silver plan) and the premium for the plan they choose. The American Rescue Plan Act (ARPA) increased and expanded subsidies temporarily in 2021 and 2022 and the Inflation Reduction Act (IRA) extends those enhanced and expanded subsidies through… Read More
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Ed MacConnell, who runs employee benefits firm Total Solutions, Inc. in Feasterville, believes that the emergency payment feature could potentially be used for unforeseen medical expenses
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The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost. As a result, ACA small employer groups, non-ACA small employer groups (including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023. Click here to read for more information. As always, please contact your Total Benefit Solutions health insurance specialists today with any questions at (215)355-2121.
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Today, Oscar announced that it is no longer accepting new membership in the state of Florida, beginning December 13 at midnight. We’re committed to building a great business that continues to provide innovative, affordable coverage for many years to come. To do that, we need to grow responsibly so that we can ensure our members receive the same level of care and service that we hold ourselves accountable for providing
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Health Insurance Premium Payment (HIPP) Program The Health Insurance Premium Payment (HIPP) Program is a program developed to help Pennsylvania families, who have at least one person enrolled in Medical Assistance (MA), pay for private health insurance through an employer. HIPP is administered by Pennsylvania’s Department of Human Services (DHS). It was designed as a cost containment program in order to save taxpayers money by purchasing cost effective employment related health insurance available to a Medical Assistance recipient. Read more by clicking here As always if you have any additional questions please contact your group health insurance specialist at Total Benefit Solutions , Inc (215)355-2121.
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The American Rescue Plan Act of 2021 has provided enhanced ACA premium subsidies for people who purchased a plan through the Marketplace. It did so by removing the income cap, which limited subsidies to households with incomes from 100% to 400% of the federal poverty line. With no income cap, premiums have been limited to just 8.5% of income – for everyone. The Inflation Reduction Act, which was signed into law on August 16, extends these subsidies for three years for millions of Americans who buy individual coverage under the ACA. This bill will “save millions of people an average of $800 a year on health insurance premiums,” said Chiquita… Read More
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The total amount you may have to pay for health plan coverage, which is estimated before you actually have the coverage and have health expenses under the coverage. Generally, your total cost is your premium + deductible + out-of-pocket costs + any copayments/coinsurance. When you preview plans at Healthcare.gov, you’ll see an estimate of your total costs, but your actual expenses will likely vary. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists at (215)355-2121.
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An insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage.” As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
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Pennie’s Open Enrollment Period for 2023 Coverage is Around the Corner: Pennie’s Open Enrollment Period will run from November 1, 2022, to January 15, 2023. As a reminder, existing Pennie customers will be receiving auto-renewal notices this week with information on their 2023 plans. Great news! Thanks to the Inflation Reduction Act, enhanced savings continue to be available for Pennie customers and those enrolling in coverage through Pennie! As always if you have any questions or concerns please contact your Pennie health insurance experts at Total Benefit Solutions Inc (215)355-2121
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CIGNA’s Medicare supplements and dental/vision plans are available to quote and enroll online for your convenience! Just click the link below to get your quotes and as always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 if you have any questions or concerns! Click here
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Shorthand for the “Health Insurance Marketplace®,” a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. In most states, the federal government runs the Marketplace (sometimes know as the “exchange”) for individuals and families. On the web, it’s found at HealthCare.gov. Some states run their own Marketplace at different websites. Fill out a Marketplace application and you’ll find out if you qualify for lower monthly premiums or savings on out-of-pocket costs based on your income. You may find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can shop for and enroll in affordable medical insurance online, by phone,… Read More
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Preventive Plus Preventive Plus providers are participating freestanding ambulatory surgical centers (ASC) and a select group of gastroenterologists and colorectal surgeons who perform preventative colonoscopy for colorectal cancer screenings at a freestanding ASC. For certain plans, the Member’s cost-share for this service will be $0 when performed by Preventive Plus providers. Please refer to your benefits booklet or contract to determine if your plan includes the Preventive Plus benefit. For updated or more detailed information regarding Preventive Plus providers, visit our website at ibx.com/provider finder, or call Customer Service at 1-800-ASK-BLUE (1-800-275-2583), Monday through Friday, 8 a.m. to 6 p.m. ET For further questions or concerns please contact your Total… Read More
Continue ReadingHumana Neighborhood Centers give participants a safe, friendly place to enjoy personalized health and wellness programming, connect with peers and get compassionate customer service from our world-class support team. Whether they’re visiting one of our in-person centers or taking part in our virtual offerings, members can always expect a warm, welcoming experience that provides whole human care. Watch the video below and contact your Total Benefit Solutions, Inc health insurance and supplememnt specialists for more information at (215)355-2121. Click here for more about Humana Neighborhood Centers
Continue ReadingWhat is a Medicare Medical Savings Account (MSA) Plan? – A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account. Enrollees of Medicare MSA plans can initially use their savings account to help pay for health care, and then will have coverage through a high-deductible insurance plan once they reach their deductible. Medicare MSA plans can provide Medicare beneficiaries with more control over health care utilization, while still providing coverage against catastrophic health care expenses. Ask your Total Benefit Solutions, Inc. Medicare health insurance specialist of a Medicare Medical Savings Account could be worth considering… Read More
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Considering Level funding and/or reference based pricing for your group health insurance? Download the brochure below to learn more about it them contact your health insurance specialists at Total Benefit Solutions, Inc today to compare your current plan to level funded and reference based pricing options! The brochure includes information on reading an EOB, Vitality and the healthcare blue book as well. As always we can be reached at (215)355-2121.
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The professionals at Total Benefit Solutions, Inc are here to help you find the right coverage for you or your small business! our health insurance experts Are certified, licensed and experienced to help you deal with ACA plans (Obamacare), Medicare supplements, short term medical and small group health plans too! Call us today at (215)355-2121.
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