#Benefits – Total Benefit Solutions Inc

Case Study: A Voluntary Benefits Strategy

January 15, 2024January 12, 2024Wendy Lopez

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More

What Does the Medicare Part D Benefit Look Like in 2023?

June 28, 2023June 29, 2023Wendy Lopez

The standard design of the Medicare Part D benefit currently has four distinct phases, where the share of drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies (Figure 1). (The Part D enrollee shares reflect costs paid by enrollees who are not receiving low-income subsidies.) If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

Aetna members can soon use their OTC benefit at CVS

June 27, 2023June 27, 2023Wendy Lopez

Starting July 1, members who have an over-the-counter (OTC) benefit administered by OTC Health Solutions, can purchase eligible OTC items in person at all CVS stores (except for CVS pharmacies inside Target or Schnuck stores), in addition to ordering them by phone and online. This will make it even easier for members to take advantage of this popular benefit. Members can use the store locator link, or call 1-833-331-1573 (TTY: 711) to find a store. Contact your Total Benefit Solutions, Inc health insurance specialist at (215)-355-2121 if you have any questions or concerns.

What is Modified Adjusted Gross Income (MAGI)?

December 12, 2022November 29, 2022Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

What is Medicaid?

December 7, 2022November 29, 2022Ed MacConnell

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. Medicaid benefits, and program names, vary somewhat between states. You can apply anytime. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

What is the Summary of Benefits and Coverage (SBC)?

November 30, 2022November 22, 2022Ed MacConnell

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You’ll get the “Summary of Benefits and Coverage” (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Inflation Reduction Act: Expands Eligibility for Full Benefits Under the Medicare Part D Low-Income Subsidy Program

October 25, 2022September 9, 2022Ed MacConnell

The Part D Low-Income Subsidy (LIS) Program helps beneficiaries with their Part D premiums, deductibles, and cost sharing. Beneficiaries qualify for full or partial benefits depending on their income and resources. Current law: Beneficiaries qualify for full LIS benefits if they have income up to 135% of poverty and lower resources (up to $9,900 individual, $15,600 couple in 2022) Beneficiaries qualify for partial LIS benefits if they have income between 135-150% of poverty and higher resources (up to $15,510 individual, $30,950 couple in 2022) Inflation Reduction Act: Expands eligibility for full LIS benefits to individuals with incomes between 135% and 150% of poverty and higher resources (at or below the… Read More

Open Enrollment Tips!

September 20, 2022August 15, 2022Ed MacConnell

As always, please contact your Total Benefit Solutions health insurance specialists at today at (215)355-2121.

What is an Out-of-Pocket Maximum/Limit?

September 16, 2022August 15, 2022Ed MacConnell

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs covered benefits. The out-of-pocket limit doesn’t include: Your monthly premiums Anything you spend for services your plan doesn’t cover Out-of-network care and services Costs above the allowed amount for a service that a provider may charge The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year. For the 2022 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,700 for an individual and $17,400… Read More

Further Guidance Issued on Contraceptive Coverage

September 12, 2022August 15, 2022Ed MacConnell

On July 28, 2022, the Departments of Labor, Health and Human Services and the Treasury (collectively, “the Departments”) issued FAQ Part to clarify protections for contraceptive coverage under the Affordable Care Act (the “ACA”). In January 2022, the Departments had issued guidance on the ACA Preventive Care Mandate, including contraception. The Departments issued FAQ Part 54: In response to reports that individuals continue to experience difficulty accessing contraceptive coverage without cost sharing; To clarify application of the contraceptive coverage requirements to fertility awareness-based methods and to emergency contraceptive; and To address federal preemption of state law. Employers sponsoring non-grandfathered group health plans should review the various preventive care requirements effective… Read More

Defined Contribution Plans

August 31, 2022August 9, 2022Ed MacConnell

The Issue As one of our long-time group insurance customers grew over the years, their workforce became more diverse and the management team found it difficult to accommodate each employee’s unique insurance needs. As much as the team wanted to provide the necessary coverage for the employees, they also required some control over the employee benefits budget. They came to us for advice. The Solution We proposed that this employer consider a defined contribution strategy. Defined contribution plans build benefit portfolios around a specific dollar amount, rather than around a specific plan or plans. In this way, the management team could select an amount that the company would contribute toward… Read More

New Prescription Drug Reporting Requirement

August 18, 2022August 2, 2022Ed MacConnell

As previously reported in December 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually 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. Employers with fully insured or self-funded (includes level funded) group health plans, including grandfathered plans, church plans subject to the Internal Revenue Code, and governmental plans. The term “group… Read More

Alternative Funding Yields Big Savings

August 4, 2022July 22, 2022Ed MacConnell

The Issue A firm we had worked with for several years had expressed a concern that the cost of their employee benefits package was threatening the financial stability of their firm. With a little over 150 employees, their annual benefits cost was exceeding $1.3 million and increasing at a rate of 8-15% each year. Even more concerning was that the benefits cost represented 32% of the company’s operating revenue. They had contemplated making plan changes including an increase in deductibles, copays and co-insurance limits, but they cared about the well-being of their employees and felt compelled to keep a competitive level of benefits. Our Solution We took the approach that… Read More

Get The Most From Your Dental Benefits with Beam Benefit’s Carryover Policy

July 12, 2022June 30, 2022Ed MacConnell

If you don’t use up your annual maximum, they don’t have to go to waste — you may be able to put them to use in the future! This means you’ll have more dollars at your disposal for dental procedures in the following years. Each year your benefits will cover a certain dollar amount in claims. When you use less than half of this maximum, a portion of it will “carry over” to the next year. This means it’s added to your annual maximum in future years. Have any questions or concerns about enrolling your group in Beam Benefit’s Dental Plan? Please contact your Total Benefit Solutions Inc health insurance… Read More

Beam Dental Expands Benefits Portfolio, Rebrands to Beam Benefits

July 6, 2022June 28, 2022Ed MacConnell

Beam Dental, a digitally-native employee benefits company, today announced the addition of voluntary life, accident and hospital indemnity products to its benefits portfolio. With these new products, Beam continues its evolution as a one-stop-shop for ancillary benefits and has rebranded to Beam Benefits. The change is accompanied by a refreshed brand identity and new website. Click here for more information. As always, please contact your Total Benefit Solutions Inc health insurance specialists with questions or concerns at (215)355-2121.

Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

June 22, 2022July 14, 2022Ed MacConnell

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

If companies could give employees tax free money to buy health insurance on their own, how many would do so?

December 14, 2018Ed MacConnell

If companies could give employees tax free money to buy health insurance on their own, how many would do so?

We’re about to find out

“I’m paying for Health Insurance I don’t even use!”

November 9, 2018November 8, 2018Ed MacConnell

You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick! You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More

There are two new HRA options to offer Employees!

November 8, 2018Ed MacConnell

The Departments of Treasury, Labor, and Health and Human Services (collectively, the “Departments”) issued proposed guidance that, if finalized, creates a mechanism for employers to offer Health Reimbursement Arrangements (HRAs) in connection with individual health insurance coverage. The proposed regulations add two new HRA options for employers to consider: • HRA integrated with individual health insurance coverage. Beginning with the first plan year on or after January 1, 2020, permit integration of an HRA with individual health insurance coverage provided certain conditions are met. • Excepted Benefit HRA. Beginning with the first plan year on or after January 1, 2020, employers that offer traditional group health plan coverage may consider offering… Read More

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

October 30, 2018Ed MacConnell

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

“Can I use my HSA for…….?”

October 16, 2018Ed MacConnell

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

President Trump Signs Prescription Drug Gag Clause Legislation

October 16, 2018Ed MacConnell

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

Social Media Drive Winner Announcement!

October 11, 2018October 11, 2018Ed MacConnell

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

How to Protect Yourself from Medical Bankruptcy

October 2, 2018October 2, 2018Ed MacConnell

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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