Medicare & Coronavirus

Medicare covers the COVID-19 vaccine at no cost to you. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Be sure to bring your Medicare card. To learn more about Medicare and the COVID-19 vaccine and boosters, click here. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You may need to give them your Medicare Number for billing, but there’s… Read More

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HHS Extends Public Health Emergency Until October 13

On July 15, 2022, the Secretary of Health and Human Services (“HHS”) renewed the COVID-19 pandemic Public Health Emergency, effective July 15, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 testing and vaccinations and other plan requirements. State and local emergency measures may expire at different times and could impact employee benefit plans (such as insured group health plans) and other state/or local programs (such as paid leave) differently than the timeframes… Read More

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HHS to Extend Public Health Emergency Once Again

The Department of Health and Human Services (HHS) has repeatedly renewed the public health emergency since it was originally declared in January 2020. The most recent extension was set to expire July 15. However, it will now be extended again, commencing on Friday, July 15. The administration will give states 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to certain programs and regulatory authorities. HHS last extended the public health emergency in May of 2022. The designation of a public health emergency allows regulators to clear the way for vaccines, therapeutics, and diagnostics for use against the coronavirus. Should the designation expire, people… Read More

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COVID-19 Vaccines Now Available for Young Children

A recent CDC announcement recommends that children six months through five years of age should get an age-appropriate dose of the Pfizer‑BioNTech or Moderna COVID-19 vaccine. Independence covers the cost of administering vaccines and booster shots with no cost-share (such as co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given. For Medicare Advantage members, the cost and administration of the vaccine and booster shots will be covered by Original Medicare so long as the health care provider administering the vaccine participates in the Medicare program. Please click here to learn more about the COVID-19 vaccines and boosters. As always, please contact your Total Benefit Solutions Inc health… Read More

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Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

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Philadelphia Re-Enacts Emergency Paid Sick Leave Benefits

On March 9, 2022, the Philadelphia City Mayor signed into law an ordinance amending the city’s existing public health emergency leave requiring covered employers to provide continuing paid COVID-19 leave through December 31, 2023. The law became effective on March 9 and is the third iteration of the COVID-19 paid leave mandate. Click the link below to download the bulletin. As always for more information contact your Total Benefit Solutions group account manager at (215)355-2121

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Horizon NJ: Covid-19 Resource Guide Update

Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. 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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INFLATION NOW TOPPING LIST OF EMPLOYER’S PANDEMIC CHALLENGES

Employers have faced many challenges since the start of the pandemic, and now wage inflation may be at the top of the list. Using the law of supply and demand, as the supply of talent decreases, candidates can demand more money. The good news, according to the Department of Labor, the unemployment rate fell to 4.6% in October 2021, a new pandemic low. Click the link below to download the full bulletin. As always please contact your Total Benefit Solutions, Inc group account manager if you have any further questions or concerns.

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Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More

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Employers in Philadelphia Are Required to Provide Paid COVID Relief  

Employers in Philadelphia, PA with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 related reasons. The new measure became effective on March 9, 2022 and will extend through the end of 2023. It covers employees who are unable to work for the following reasons: To care for self or a family member showing symptoms of COVID-19 To care for self or a family member exposed to COVID-19, in order to self-isolate As a result of childcare or school closures To obtain a COVID-19 test or vaccine, or to recover from injury,… Read More

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Philadelphia Passes New COVID-19 Paid Leave Law

Philadelphia has enacted a new law that requires employers to provide paid time off for COVID-19 purposes. The ordinance, which took effect March 9, 2022, applies to employers with at least 25 employees. Covered EmployeesThe ordinance covers employees who: Work in Philadelphia; Normally work in Philadelphia but currently telework from any other location as a result of COVID-19; or Work from multiple locations or from mobile locations, provided that 51% or more of their time is in Philadelphia. There is no waiting period or accrual requirement for leave. Permitted Purposes for COVID-19 LeaveLeave must be allowed for specified COVID-19 reasons relating to an employee’s (or their family members’) exposure to, symptoms of or diagnosis with COVID-19. Leave… Read More

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Independence is covering OTC COVID‑19 test kits through pharmacy benefits

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SCOTUS Upholds Affordable Care Act Ruling

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New Mandatory Preventive Items and Services

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Tax Advantaged Benefit Documents

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

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Alternatives to Health Insurance Benefits

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What is Blue Card PPO?

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