ACA’s Contraceptive Coverage: New FAQs Guide

On January 22, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a fresh set of Frequently Asked Questions (FAQs), shedding light on the Affordable Care Act (ACA)’s imperative for non-grandfathered medical plans to include specific preventive services, notably contraceptives, without imposing any cost-sharing on individuals. The aim of these FAQs is to address concerns from stakeholders, facilitating a better understanding of the contraceptive coverage mandate and encouraging compliance through an alternative method. For detailed insights and further information, download the PDF below. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

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2024 ACA Affordability Shake-Up: Are You Ready?

Are you ready for some important news regarding the Affordable Care Act (ACA)? The IRS has just released an update that could impact your organization’s healthcare offerings. In this blog post, we’ll break down the latest announcement and what it means for employers and employees alike. If you’re interested in diving deeper, be sure to download our PDF for more information. IRS Announces 2024 ACA Affordability Indexed Amount The IRS recently made an important announcement in Revenue Procedure 2023-29 regarding the Affordable Care Act’s (ACA) affordability indexed amount under the Employer Shared Responsibility Payment (ESRP) requirements. This announcement is significant for employers as it affects the calculation of penalties related… Read More

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What’s New in the 2023 ACA Open Enrollment?

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

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Stay Up to Date on the Affordability of Employer Coverage and the Family Glitch with These Resources

beginning on January 1, 2023, the new rule on affordability of employer coverage for the family members of employees went into place and changed how affordability is calculated for employees’ family members. To assist employers in understanding this rule change, the Centers for Medicare & Medicaid Services (CMS) created a resource outlining the most important takeaways for employers. Employers can use this resource to understand the family glitch and how it affects them and their employees. You can view this resource here. 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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Blue KC: Enhanced ACA Subsidies to Extend Through 2025

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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What is a Qualified Health Plan?

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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What is the Marketplace?

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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IRS Announces 2023 ACA Affordability Indexed Amount

The IRS recently announced in Revenue Procedure 2022-34 that the Affordable Care Act (“ACA”) affordability indexed amount under the Employer Shared Responsibility Payment (“ESRP”) requirements will be 9.12% for plan years that begin in 2023. This is a notable decrease from the 2022 percentage amount (9.61%) and below the original 9.5% threshold. Rev. Proc. 2022-34 establishes the indexed “required contribution percentage” used to determine whether an individual is eligible for “affordable” employer-sponsored health coverage under Section 36B (related to qualification for premium tax credits when buying ACA Marketplace coverage). However, the IRS explained in IRS Notice 2015-87 that a percentage change under Section 36B will correspond to a similar change… Read More

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What is the Employer Shared Responsibility Provision?

Under the Affordable Care Act, governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. The estimator is specifically designed to help you determine if the employer shared responsibility provision (IRC Section 4980H) applies to you and, if it does, will help you determine the maximum amount of the employer shared responsibility payment that could apply to you under either section 4980H(a) or 4980H(b) based on the number of full-time employees that you report. The provision applies to employers called applicable large employers that employ on average at least 50 full-time employees (including FTEs)… Read More

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Horizon Grandmothering Extended into 2023 for Pre-ACA Plans

Horizon will once again enable Small Employer group customers that offer health plans that preceded the Affordable Care Act (“pre-ACA plans”) and renew between October 1 and December 31, 2022, to renew within those pre-ACA plans. Because we receive the highest volume of renewals during the fourth quarter, our decision to grandmother pre-ACA plans will ensure a smooth renewal process for our customers. As we near October 1, 2022, Horizon will communicate the details and dates for the renewal process. Until then, click here to learn more. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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Affordability of Health Coverage

Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More

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Supreme Court Dismisses Latest Challenge to the ACA

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HSA/HDHP Limits Increase for 2020

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Court Strikes Down Association Health Plan Rules

On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret” ERISA when issuing these rules: • expanding the definition of “employers” to include disparate groups of employers with no other commonality of interest other than geographic location; and • bringing working owners without employees within ERISA’s framework. This ruling effectively eliminates the expansion of AHPs to certain employers and working owners who do not meet the original parameters to be a part of an AHP. Click below to download the complete… Read More

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Medicare Won’t Cover This Key Expense…

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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The Future of Employee Benefit Offerings: Student Debt Repayment Assistance

When looking for a job, the benefits offered to an Employee are definitely a big factor in consideration of accepting an offer of employment. Most people are willing to choose a company with a slight pay decrease if the benefit package compensates for the lost wages. With unemployment the lowest it has been since 2000 in the United States, attracting new talent isn’t as easy as it used to be and Employers are looking for ways to snatch up qualified applicants. When you think of benefit packages, you usually think of the basics: Health Insurance (with possibly an HSA, HRA, or FSA included), Dental and Vision coverage. “Good” benefit packages… Read More

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Why Offer an HRA to Your Employees?

Healthcare Reimbursement Arrangement, typically referred to as an HRA, can be utilized by employers to reduce their overall healthcare costs without placing additional financial burden on their employees. An HRA allows the employer to pay for eligible expenses with pre-tax dollars. The employer decides what expenses are eligible, within the IRS guidelines, leaving a lot of flexibility in plan design. Typically an HRA is coupled with a High Deductible Health Plan and the HRA pays for either the entire deductible or a portion of the deductible. With this type of a plan the premium savings often outweigh the potential claims that the employer would have to pay if every employee… Read More

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New Jersey Small Employer Stop Loss Bill

A bill has been introduced in New Jersey in both the Senate and Assembly that, if passed, would prohibit insurance carriers or other insurers subject to the insurance laws of New Jersey or any other state from offering, issuing or renewing any stop loss insurance policy of any kind to small employers. Stop loss insurance provides reimbursement for catastrophic, excess or unexpected expenses and is used by small employers to self-insure part of the health insurance coverage they provide for employees. Under New Jersey law, in connection with a group health plan, a small employer means an employer with 2-50 eligible employees on business days during the preceding calendar year. If passed,… Read More

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Change of Income? When and How to Notify the Marketplace.

One of the benefits of getting your Health Insurance through the Marketplace is the tax credit applied to your premium, which makes your costs much more affordable. However, when determining how much your tax credit will be, you use an estimate on your income for the following year. Life is always changing, so if your income changes, if your Family size changes or even being offered Healthcare in some other way it is IMPORTANT to alert the Marketplace of these changes or you may end up owing money back to the Government when you file your taxes at the end of the year. Here we will talk about which types… Read More

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Quick Update: Retirement Plan Contribution Limits and ACA Reminders & Numbers

                                 Important Open Enrollment Information While we highly suggest those of you applying for Healthcare Coverage through the Marketplace speak with a Trained and Licensed Broker to make sure you are getting the right coverage for your particular situation, we know some of you prefer to apply directly. So with that in mind, we wanted to send out a reminder that every Sunday from 12am until 12pm during Open Enrollment (Except December 9th), scheduled maintenance will happen on the Healthcare.gov site. This means during those periods you may not be able to access the site to… Read More

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What is an HRA and How It May See A Major Change Soon..

Before we get into how rules for HRAs may be changing, we should discuss what an HRA is and how it works. A Health Reimbursement Account (sometimes referred to a Health Reimbursement Arrangement) is an employer-funded group health plan that reimburses employees, tax-free, for qualified medical expenses up to a certain amount per year. This type of policy does not replace Medical Insurance and is usually coupled with a High-Deductible policy. Unlike an Health Savings Account (HSA), the Employee can not help to fund the account.  Like HSAs though, there are maximum allowed contributions. In 2018, an Employer can fund an HRA up to $5,050 for a Single Employee and $10,250… Read More

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“Can I use my HSA for…….?”

Health Savings Accounts and You Health Savings Accounts (HSAs) aren’t new. They’ve been around since late 2003. Initially they were created along with the Medicare Prescription Drug, Improvement, and Modernization Act  to replace the Medical Saving Account System. Initially these plans were designed to help with Drug Costs under Medicare policies; However, as Insurance Premiums increased, more and more Employer and Individual Policies offered High-Deductible Plans to help curb costs. Due to that, HSAs were thrown into the spotlight as a way to use Pre-Tax Dollars to cover out-of-pocket Medical costs. In 2017, a reported 22million Americans have an HSA. Each year, that number continues to climb. Many people still have a… Read More

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President Trump Signs Prescription Drug Gag Clause Legislation

President Trump Signs Prescription Drug Gag Clause Legislation On Wednesday, President Trump signed into law S. 2553, the Know the Lowest Price Act, and S. 2554, the Patient Right to Know Drug Price Act. The legislation was passed by the House and Senate last month with bipartisan support and will ban “gag clauses” that prevent pharmacists from telling customers when they can save money on their prescriptions by paying out of pocket for the retail price of the drug, rather than using their insurance and making the co-payment. These bills comprise portions of President Trump’s “America First” prescription drug initiative that were released as part of a blueprint to lower drug prices in May.… Read More

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Social Media Drive Winner Announcement!

  Back in August we announced an End of Summer Social Media Drive Contest. The rules were very simple: If you left us a review, you were eligible to be entered into a drawing for an Amazon gift card valued from $25-$100… For each review you left us on one of our platforms (Google, Yelp, Facebook, Angie’s List, Linkedin, etc) you earned $25 towards that giftcard (up to four review max per person). The contest ran from August 1st, 2018 until September 30th, 2018, but today we finally got our winner. Our Front Office Coordinator, Samantha, joined me for the  random drawing. Please watch the short video below to find… Read More

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How to Protect Yourself from Medical Bankruptcy

According to a CNBC report, an estimated 2 million people were adversely affected by bankruptcies due to medical costs. In 2009, President Obama declared that someone files bankruptcies every 30seconds (or  about 1million people are affected per year!). A popular Facebook meme, shown to the left said the number was 643,000 people a year. Healthcare costs make any of these stats seem realistic, but why are they so different? One reason is that people gather information from different studies made during different years. Even though most of the information comes within the last decade, there are tons of factors that affect our economy. In 2007, 822,590 consumer bankruptcies were filed, but for 2010,… Read More

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