We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your fingertips .
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Medicare Advantage plans denying more inpatient claims
MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More
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Individual Coverage HRA: Choice and affordability in employee health benefits
How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More
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ACA coverage rule for dependents up to age 26
One of the most notable changes brought about by the Affordable Care Act (ACA) is the ACA coverage rule for dependents up to age 26. Employers offering health care plans to employees must include this extended coverage. Purpose of the ACA coverage rule for dependents up to age 26 The ACA extended the eligibility for a child to be covered under a parent’s health plan from (usually) age 21 and if a full-time student to age 26 regardless of student status. The goal is to provide peace of mind to parents and their young adult children during a time in life when the dependent is likely to be completing their… Read More
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Get Your FSA, HRA, HSA Health Accounts Comparison Chart
What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!
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Broker Change Leads to Better Results
Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. 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… Read More
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1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients
Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.
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Emergency Periods Related to COVID-19 to End May 11 2023
On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read More
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Independence: Dental rates modified from the original 2023 prices
The 2023 Independence Blue Cross dental rates for individual and family plans have been modified from the original rates. Your health insurance broker at Total Benefit Solutions Inc can provide your updated rates and also help guide you to choose an alternative dental plan in light of these changes. Please contact us today at (215)355-2121 if you have any questions or concerns regarding these changes.
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ACA: Special Election Cheat Sheet
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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Notification Reminder for Forms 1095-C and 1095-B
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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Bright Health Announces Departure from ACA Marketplace
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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Independence: Additional MLR rebates for 2020 to be issued to some policyholders
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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Between jobs? Aging out of a family policy? Waiting for Open Enrollment?
A Short Term Medical plan might be right for you. Short Term Medical plans let you decide how much coverage you want and for how long, with individual and family options available. And you can enjoy quality of life benefits like telemedicine and discounts on a variety of everyday items and services through an Association membership (varies by state). Short Term Medical plans offer plenty of flexibility: Questions about a short term medical plan? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Important information about these plans THESE PLANS PROVIDE LIMITED BENEFITS For complete limitations & exclusions by state for Short Term Medical insurance, click here. Plan… Read More
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What is Stop Loss Coverage?
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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Independence: New drugs added to precertification list for 2023
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 ReadingWhat is a drug formulary?
The 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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Total Benefit Solutions Inc., In The News!
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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Oscar no longer accepting new members in Florida
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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What is HIPP and can it help my company or our employees?
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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Get assistance with your PENNIE health insurance account
Already on the health insurance Marketplace and need some help? Assigning Total Benefit Solutions, Inc is easy! Download the document and follow the steps. We will get notified and start helping you right away! Need more direction? Give us a call (215)355-2121
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Pennie’s Open Enrollment Period for 2023 Coverage is Around the Corner
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 Supplemental Benefits Now Available Online
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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Independence: What are Preventative Plus Providers?
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
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Health Insurance Shopping Is Confusing!
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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