IRS has provided a limited extension of time for employers to provide Forms 1095-C

  The IRS has provided a limited extension of time for employers to provide Forms 1095-C (and carriers to provide Forms 1095-B) to individuals (but NOT to the IRS). Rather than January 31, 2017, the new deadline will be March 2, 2017.  Download Extension of Deadline for 2016 Forms 1095-C

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Health Reform: Cost of Living Adjustments, Individual Penalty, HSA limits & more for 2017

    On October 25 and 27, 2016, the IRS released cost of living adjustments for 2017 under various provisions of the Internal Revenue Code (the Code). Some of these adjustments may affect your employee benefit plans. These adjustments include but are not limited to the following: Cafeteria Plans Qualified Transportation Fringe Benefits Requirement To Maintain Minimum Essential Coverage (Individual Penalty) Highly Compensated Non-Grandfathered Plan Cost-Sharing Limits H.S.A. Annual contribution limitation, catch up contribution and minimum deductibles Key Employee   Click here to download the bulletin   As always if you have any additional questions or concerns, please contact your dedicated Total Benefit Solutions, Inc. account manager at (215)355-2121.

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Health Reform: IRS Extends Due Date for Furnishing Form 1095-B/C.

IRS Extends Due Date for Furnishing Form 1095-B/C. As applicable large employers and employers with self-funded health plans are working on their Affordable Care Act compliance preparations, the IRS announced an extension of a key ACA deadline. Notice 2016-70 extends the due date for furnishing Form 1095-B and Form 1095-C from January 31, 2017 to March 2, 2017.  The Notice also extends transition relief from penalties if an employer makes a “good faith effort” to comply with reporting requirements. This relief is welcome news for employers who are still working on their compliance approach. A copy of the notice can be downloaded here.

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Election Results and the ACA

With the outcome of the 2016 elections now official, the Republicans will hold the majority in both chambers of Congress and control of the White House beginning in 2017. Since President-elect Trump ran on a platform of “Replace and Repeal” of the Affordable Care Act (ACA), we anticipate that acting on this campaign promise will be one of the top priorities of the new Trump administration. We anticipate there will be significant disruption for individuals, employers, brokers and carriers across the country. Click here to read the latest bulletin

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IBC: Plans to remove exclusions for gender reassignment surgery coverage

  In a July Independence Edge article, we shared that the U.S. Department of Health and Human Services (HHS) had issued a final rule for the nondiscrimination provision (section 1557) of the Affordable Care Act (ACA). While the nondiscrimination provision itself is not new, the final rule provides expanded clarity on coverage for gender reassignment surgery and related services. In addition, it provides guidance on treating individuals consistent with their gender identity, and not denying or limiting health services usually only available to individuals of one gender. Beginning with renewals on or after January 1, 2017, the exclusion for gender reassignment surgery has been removed from all commercial plans. Members… Read More

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Individual and Family Open Enrollment-2017 Important Updates

As many people know by now there are many big changes with individual and family plans for open enrollment 2017. For anyone who is currently enrolled on one of the following your plan will NOT be renewed for 2017 and you will have to pick a new plan and/or a new insurer: Aetna: all plans cancelling  in PA/NJ/NC/FL  Aetna plans only remain in Delaware in our service area United Healthcare: All ACA plans cancelling. Short term plans are still available Oscar: All plans in NJ cancelling Health Republic: All plans in NJ cancelling Highmark and Capitol Blue Cross: No longer paying broker compensation Geisinger: No longer paying broker compensation Independence Blue… Read More

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ACA Individual 2017 Open Enrollment Important Update

2017 ACA ” Obamacare” plans open enrollment important update. The annual open enrollment period opens on November 1st 2016 and ends January 31st 2017. Independence Blue Cross will be the only insurer available in 2017 in the Philadelphia 5 County Area. With the passing of the Affordable Care Act changes come annually or even more often. Unfortunately not all of those changes are benefiting the consumer. This year here are some major changes that our clients on Individual Non Medicare plans need to be aware of… If you are a enrolled on an ACA compliant plan with Aetna or United Healthcare your plan is going away. Neither Aetna or United… Read More

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HHS Penalties Increase

  On September 6, 2016, the Department of Health and Human Services (“HHS”) issued an interim final regulation that adjusts civil penalties for inflation. The interim final regulation does not follow the usual procedures that offer a notice and comment period. As such, a Notice of Proposed Rulemaking has not been issued and a comment period is not provided due to potential delay in the applicability of the regulation. Click to download this bulletin For more information please contact your Total Benefit Solutions account manager at (215)355-2121

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Opt-Out Bonuses May Affect Affordability

The IRS recently issued proposed regulations that (among other things) address affordability determinations for individuals who are eligible for employer-sponsored health coverage. Building on earlier guidance, the proposed rules describe the effect an opt-out waiver has on affordability. Should you have any questions, please contact your Total Benefit Solutions account manager directly at (215)355-2121. Click here to download this bulletin

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IBC: How to pay your health insurance bill

Click to watch this quick video on payment options for Independence Blue Cross individual health insurance plans.  As always if you have any questions please contact your dedicated Total Benefit Solutions individual account manager at (215)355-2121.  

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HR 360:Most Common Summary Plan Description (SPD) Mistakes

One of the most important documents participants must receive automatically when becoming covered under a health benefit plan that is subject to ERISA (the federal Employee Retirement Income Security Act) is a summary of the plan, called the Summary Plan Description or SPD. The fact is, many employers are confused about this very important ERISA-required disclosure, which can put them at risk. Click this link to download the publication

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Notice of Subsidies in the Federal Marketplace

The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click here to download the bulletin

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Healtcare Reform Law

ACA: Important Implementations & Delays in 2016

As our third year of the ACA Open Enrollment Period arrived, it’s time to examine some of the new implementations in 2016. Some of the major components, especially those affecting businesses were delayed or deferred since the passage of the Affordable Care Act in 2010. This year is considered to be a big year due to the “full implementation” of the employer mandate as well as a number of changes, repeals, and moratoriums on other sections of ACA. Some of the key changes are listed below: CHANGES AND IMPLEMENTATIONS Full implementation of the Employer Mandate Currently it is not mandated that employers provide health care to their employees. Moving forward, however, if… Read More

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FAQ Suggests Employers Include Marketplace Options with COBRA Notices

On June 21, 2016, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) issued the 32nd Affordable Care Act (“ACA”) FAQ describing information that may be appropriate to include with COBRA notices. Many wondered if it were appropriate to provide information and if so, what kind of information could be provided about the Health Insurance Marketplaces/Exchanges (“Marketplaces”) so that COBRA-eligible individuals could consider health coverage alternatives available through the Marketplaces and possibly investigate whether they may be eligible for premium tax credits and cost-sharing reductions. Click the link to download the entire bulletin

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Total Benefits & Healthiest You

Healthiest You is more than a typical Teledoc benefit. Whenever members have questions or they are simply not feeling well, they can effortlessly connect to a 24×7 telehealth hotline for the diagnosis and treatment of illness, second opinions and consultations. They have board-certified, licensed physicians in every state waiting to provide exceptional care. They can even prescribe medication and save a trip to the doctor’s office, whether members are at home or on the road. Want more information? Click here to see the site.  

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Critically Important: Insurance for Serious Illness

Good news: You’ve got health insurance (at least, all Americans are required to or pay a penalty). Bad news: It doesn’t cover everything. Especially if something really bad happens, like a heart attack or stroke. Yes, a decent major medical plan will cover many of the health-related expenses related to a serious illness. But you’d likely still be left with significant out-of-pocket costs for deductibles and copayments. Medical insurance also doesn’t usually cover other related costs, such as travel to treatment centers, child care during absences or recovery, home modifications or rehabilitation charges. And if you lose income while you’re unable to work, you could have a tough time paying… Read More

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Limited Benefit Medical Plans

Why Consider a Limited Benefit Medical Plan? When it comes to medical benefits, employers used to face two choices — comprehensive employer-paid medical plans or no insurance at all. However, with the inception of the Patient Protection and Affordable Care Act (PPACA), the option not to offer medical insurance no longer exists for some employers. Limited benefit medical plans can be powerful tools for recruiting and retaining employees in situations where traditional medical benefits are not offered or affordable. These plans can also be useful in increasing productivity through reduced absenteeism due to illness, improving employee morale and as a means to provide the level of coverage required by law.… Read More

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Reminder: PCORI Fees Due August 1

The annual Patient-Centered Outcomes Research Trust Fund (PCORI) fee is due to the IRS August 1, 2016. The fee, charged to certain health insurance policies, is used to support the activities of the Patient-Centered Outcomes Research Institute, a nonprofit, non-governmental organization (NGO) established by the Affordable Care Act (ACA).  Fully- and self-insured group health plans ( Including HRA’s) are subject to PCORI fees.  A health insurer will pay the fee on behalf of the employer if the plan is fully insured. Click here to read the bulletin from Primepay As always please contact your Total Benefit Solutions dedicated account manager at (215)355-2121 if you have any further questions or concerns.

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Now Available from Total Benefit Solutions: Low Cost ERISA Wrap SPD Documents

Wrap Summary Plan Description (SPD) If you offer group health insurance you’re now required by ERISA law, enforced by the Department of Labor and now the Affordable Care Act, to distribute a Wrap SPD within 120 days of the Plan’s effective date. The ERISA and ACA required Group Health Insurance Wrap SPD document is now available for a $99 one-time fee. You only update your Wrap SPD document as your benefit options change. The low cost Wrap SPD document is limited to fully insured group health insurance plans only.     Here are the Wrap SPD document requirements by ERISA and the Affordable Care Act as succinctly as possible: If… Read More

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Paylocity:4 Ways the New Overtime Rules Could Affect Employee Benefit Plans

New rules about who is exempt from overtime and who must earn it will be a jolt for many companies around the nation. However, the cost and implications won’t be limited to how employees are paid. “Much of the attention is focused on the impact on employees’ wages,” Jaqueline Breslin writes forBenefitsPro. “But, these changes will also have a huge influence on employee benefits policies as employers decide on their approaches to stay compliant with the new regulations.” Click here for the full story.

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Total Benefit Solutions: New Starmark Self Insured Plans for Small Groups

Total Benefit Solutions is proud to announce that we are now appointed with Starmark to provide affordable and predictable self insured medical plans to small businesses. Starmark® administers self-funded health benefit plans exclusively for smaller businesses nationwide. Employers choose from extensive plan design choices to create a self-funded health plan to meet their unique needs and budget, while stop-loss insurance from Trustmark Life Insurance Company provides protection against large covered claims. Click Here To View A Client Testimonial Click here for more information and to watch a short video about these products and how your organization might benefit from a self insured plan.

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Did You Know About Medicare’s Preventative Services?

Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early, when treatment works best, and can keep you from getting certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health. The Affordable Care Act makes many improvements to Medicare. If you have Original Medicare, you can get a yearly “Wellness” visit and many other covered preventive services! Click here to download Medicare’s Preventative Services Guide Click below to watch a video from Medicare about the preventative services benefits.

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IBC Breaking News: Changes to SEP On-Exchange Verification Process

Changes to SEP On-Exchange Verification Process Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including: Loss of minimum essential coverage Change in primary place of living Birth Marriage Adoption, placement for adoption, placement for foster care, or child support or other court order Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within… Read More

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Notice of Subsidies in the Federal Marketplace

The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click the link to download the complete bulletin. Download Notice of Subsidies in the Federal Marketplace

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The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015…

The PCOR filing deadline is August 1, 2016 for all self-funded medical plans and HRAs for plan years ending in 2015. The IRS has also issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year.  Please note that for those with an HRA plan, and HRA is ” self insurance” and you are required to file and pay the PCOR fee. Please download the document below for more details and links to specific resources. Download PCOR Fee Filing Reminder for Self-Insured Plans

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