A new group health insurance offering for small businesses. Introducing CIGNA + Oscar

We’ve partnered with Cigna + Oscar to deliver small business health insurance that brings together Cigna’s most popular provider networks and Oscar’s tech-driven approach to customer service and care navigation. Cigna + Oscar plans are available in the Philadelphia 5 county area beginning with effective dates starting January 1 2023. Your Total Benefit Solutions, Inc health insurance specialists are available to help you quote and compare plans. Call us today to get your quote and compare these newest plans to your current renewal. You might be surprised at the competitive cost and plan designs! (215)355-2121

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Final Rules Adopt Administrative Changes to the No Surprises Act

On August 26, 2022, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) published final rules on the No Surprises Act, making changes to the administrative duties of insurance carriers, HMOs, third-party administrators, out-of-network healthcare providers, and certain other entities responsible for the Act’s implementation. The new rules, which take effect on October 25, 2022, are narrow in scope, and include the following changes:• During processing of claims under the No Surprises Act, if “down-coding” occurs (i.e., the group medical plan alters or replaces the medical billing codes chosen by the out-of-network healthcare provider, resulting in a lower claim payment), then the final rules impose… Read More

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Turning 26: Your Guide to Health Insurance

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

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2022 MLR Rebate Checks to Be Issued Soon 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 carrier collects 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 activities to 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, 2022. Click the link below to download the full bulletin.

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Additional Guidance on New Prescription Drug Reporting Requirement

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit informationannually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services(“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Click the link below to download this bulletin. As always please contact your Total benefit Solutions, Inc health insurance specialist at (215)355-2121 if you have any further questions or concerns.

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New FAQ Addresses NSA and TiC Rules

he Departments of Labor, Health and Human Services and the Treasury (collectively, “the Departments”) issued FAQ Part 55, providing guidance as it relates to certain aspects of the No Surprises Act (“NSA”) and the Transparency in Coverage (“TiC”) final regulations. FAQ 55 includes 23 questions and answers. The guidance is lengthy and very detailed. Below you will find some of the key highlights of the guidance. Please download the bulletin below for details and contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 with any additional questions or concerns.

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Additional Guidance Issued on Surprise Billing Protections

The Consolidated Appropriations Act of 2021 introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, & providers. The Consolidated Appropriations Act of 2021 (CAA) introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, and providers. The federal Departments of Health and Human Services, Labor, and Treasury recently released a document discussing frequently asked questions (FAQs) about these surprise billing protections that provides clarity on a number of topics within the regulations. The key points from this guidance are outlined below. Application to Reference Based Pricing PlansIt has been unclear how the surprise billing rules apply to… Read More

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Inflation Reduction Act – Health Care Considerations

On August 16, 2022, President Biden signed the “Inflation Reduction Act” into law. The legislation includes key health care, tax, and climate change components. Click the link below to download the bulletin which highlights the health care changes ! As always please contact your Total Benefit Solutions, Inc health insurance expert with any additional questions, (215)355-3121.

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IBC: Understanding your network

The type of health plan you choose determines the network of providers you can visit. In-network providers are the doctors and hospitals in your plan’s network. You’ll save the most money by visiting network providers. Out-of-network providers are those not in your plan’s network. You may pay more for out-of-network services, and some services may not be covered at all. Know your options — before you need them When you need care and your primary care doctor isn’t available, remember you have other options that don’t involve a trip to the emergency room. Using virtual care, retail clinics, or urgent care centers can save you time and money. https://www.ibx.com/get-care/find-doctors-and-healthcare-providers/where-to-go-for-care Click here for links to your network and more… Read More

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Over-the-Counter Hearing Aids May Help People with Medicare

The Food and Drug Administration (FDA) recently finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may make hearing aids more affordable for as many as 30 million adults who believe they have mild to moderate hearing loss, even if they have not had a hearing exam. Last week, the Food and Drug Administration (FDA) finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may… Read More

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What is an excepted benefit HRA?

Businesses that offer an employer-sponsored group health plan to workers now have another way to save money while designing a health benefit package with more choices for employees – the Excepted Benefit HRA. The new EBHRA is a Health Reimbursement Arrangement designed to pay premiums and related expenses for eligible excepted benefits like dental and vision coverage. And, while an employer is required to offer a traditional group health plan, an employee can participate in the EBHRA even if they decline participating in the employer’s group health plan. That’s going to open up a lot of premium savings for workers who are eligible for coverage under a spouse’s or parent’s… Read More

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New Philadelphia Employee Commuter Transit Benefit Programs

On June 22, 2022, Mayor Jim Kenney signed the Employee Commuter Transit Benefit Ordinance into law (the “Ordinance”). The Ordinance adds new commutertransit benefit programs in Philadelphia that require certain employers to provide a mass transit and bicycle commuter benefit program, beginning on December 31, 2022. Who Does this Apply to?Covered Employers are employers that employ at least 50 Covered Employees. Covered Employees are those who work at least 30 hours per week within the geographic boundaries of Philadelphia for the same employer within the previous 12 months. Click the link below to download the bulletin. As always please reach out to your Total Benefit Solutions, Inc group benefit specialists… Read More

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Understanding the Coding of Health Plans from MEC to Metallic

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

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Independence Blue Cross and Amerihealth: Behind on your health insurance payments?

Please do not assume that your payment is on the way or has been made and that the insurance company will handle it. Our health insurance specialists can assist you with a conference call. Getting reinstated after a cancellation is a long and difficult process and is not always available! If your payments are behind we need to ask for termination suppression BEFORE you are cancelled. First, Please always contact the Billing Department at 215-567-3357 or 1-800-444-6301. When calling, please have your group name, billing account number and address for verification purposes. The Billing Department will not approve an account for termination suppression due to checks mailed, promise to pay… Read More

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What is a Qualifying Life Event or QLE?

There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More

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Case Study Library

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

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Section 125 Tax-Saving POP plan document

In this video, we feature our most popular product, the $99 Section 125 Tax-Saving POP plan document package (Core 125). It explains how employees save up to 40% in taxes while employers eliminate on average 8% of matching payroll tax when the company has a Section 125 POP (Cafeteria) plan document in place, as required by the IRS to pre-tax benefits. As always contact your Total Benefit Solutions, Inc group health insurance specialists at (215)355-2121 to find out more! Click here for more information or to order a document online.

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What does ” Guaranteed Issue” health insurance mean?

Guaranteed issue A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Not all health insurance plans are guaranteed issue. Have any questions about your health insurance? Contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 https://www.totalbenefits.net

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Horizon BSBSNJ to Withdraw HMO Plans From Individual and Small Employer Markets

Horizon has announced a change to their product portfolio and have elected to withdraw their HMO plans from the Individual and Small Employer Health Benefits Plan (SEH) markets. The New Jersey Department of Banking and Insurance (DOBI) has given its approval for Horizon to withdraw its HMO plans from the markets under the authority of N.J.S.A 17B:27A-6 and N.J.A.C. 11:20-18.5 (for Individual plans) and N.J.S.A. 17B:27A–23e and N.J.A.C. 11:21-16 (for small employer plans). This withdrawal will affect Individual members enrolled in the Horizon HMO Gold plan, and group clients and their employees who are enrolled in the Horizon HMO Platinum plan. Brokers with affected small group clients, and those affected… Read More

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Health Insurance Broker Change Leads to Better Results

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

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