Health Savings Account (HSA): All funds belong to the employee. Unused balances roll over into the next year. Funds do not expire from year-to-year. Rollover funds do not count towards the contribution limit. Health Flexible Spending Account (FSA): Amounts must be incurred by the end of the plan year and do not usually carry over unless an employer allows up to $610 to carry over into the next year. Amounts that roll do not affect the maximum election that can be made for the plan year. Otherwise, employers may adopt a 2 and half month grace period that allows participants to access unused amounts remaining in their accounts. Health Reimbursement… Read More
Continue ReadingSmall Group – Form 1095-B: Who receives it and why
Form 1095-B is a health insurance tax form used to report certain information to the IRS and taxpayers about individuals who are covered by Minimum Essential Coverage (MEC). What are the IRS reporting requirements? The ACA requires individuals to obtain and report that they had MEC or otherwise qualify for an exemption from the requirement. However, there is no longer an individual tax penalty following the 2017 Tax Cuts and Jobs Act. Individuals may need Form 1095-B to demonstrate MEC for nontax-related purposes. The ACA also requires certain employers to offer all full-time employees and their dependents MEC to meet affordability and minimum value standards. This is known as the… Read More
Continue ReadingAir Ambulance Reporting Update
As previously reported, group health plans will be required to submit information related to air ambulance claims to the Department of Health and Human Services (“HHS”). In a September 2021 proposed rule, the regulators expected that rulemaking would be finalized during 2021, and that plans and carriers would be required to submit the data for calendar year 2022 by March 31, 2023, and the data for calendar year 2023 by March 31, 2024. However, under the statute, the reporting is not due until regulations are final, and the proposed rule has not been finalized. As a result, absent further guidance, there should be no reporting requirement in 2023. HHS has… Read More
Continue ReadingStay 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.
Continue ReadingWhat is Small Business Health Options Program (SHOP)?
The Small Business Health Options Program (SHOP) helps small business owners provide medical and/or dental insurance to their employees. Some smaller employers qualify for tax credits if they enroll in SHOP insurance. A small business can offer SHOP health and/or dental insurance to their employees if they: Small business owners can use an agent or broker to enroll in SHOP insurance, or work with their insurance company. There’s no limited enrollment period for SHOP, so they can apply, pick plans, and enroll employees any time of year. Interested in SHOP for your small business? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
Continue ReadingDOL Penalties Increase for 2023
The Department of Labor (“DOL”) has published the annual adjustments for 2023 that increase certain penalties applicable to employee benefit plans. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.
Continue ReadingExplore Blue KC Small Group Dental Plans and Rates for New Business
Oral health is a key component of overall health and dental coverage, starting with regular checkups, can help prevent health issues and medical costs down the road. Blue KC small employer group dental coverage offers a selection of plans – with no waiting period – an extensive local and national provider network, competitive rates, plus a rewards program. Don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.
Continue ReadingBlue KC: 2023 member guides and handbooks now available
The 2023 commercial and ACA member guides and Medicare Advantage member handbook are now available. Clients will receive these documents through a variety of touchpoints. Please keep them handy as a quick reference to Blue KC plan benefits and features and to share them with clients as needed. Employer/Group Medicare Advantage ACA Individual and Family Plans Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
Continue ReadingAnnual Out-of-Pocket Maximum Adjustments Announced for 2024
On December 13, 2022, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2024 (“the Notice”). For purposes of employer-sponsored health plans, the guidance includes the caps on out-of-pocket dollar limits for non-grandfathered group health plans with plan years that begin in 2024. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
Continue ReadingPrescription drug list updates effective January 1, 2023
The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost. As a result, ACA small employer groups, non-ACA small employer groups (including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023. Click here to read for more information. As always, please contact your Total Benefit Solutions health insurance specialists today with any questions at (215)355-2121.
Continue ReadingWhat is a Health Reimbursement Arrangement (HRA)?
Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the arrangement. Health Reimbursement Arrangements are sometimes called Health Reimbursement Accounts. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
Continue ReadingBeam Teams with Angle Health to Deliver Dynamic Employee Benefits
Beam Dental is partnered with Angle Health, a digital-first healthcare benefits providers for the modern employee. Through the partnership with Beam, Angle can now attach best-in-class dental benefits to their innovative healthcare products, creating a more comprehensive and robust benefits package for employers. “There is tremendous activity and innovation in the small group health space right now. Angle is an exciting addition to this space,” said Andy Hutter, Beam’s Director of Digital Distribution. “Angle’s vision for modernizing healthcare aligns well with Beam’s own vision, and we are very excited to deliver a powerful combination of innovative coverage to the market.” Beam is changing and modernizing the dental insurance industry by… Read More
Continue ReadingWhat is medical underwriting?
A process used by insurance companies to try to figure out your health status when you’re applying for health insurance coverage to determine whether to offer you coverage, at what price, and with what exclusions or limits. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
Continue ReadingBlue KC: Employer/Group Open Enrollment Dates – Mark Your Calendar
Blue KC is pleased to offer two open enrollment deadlines – one for physical ID cards and one for digital ID cards – to provide flexibility to new and renewing groups. Benefit information and open enrollment files/eligibility updates must be submitted to Blue KC based on the following schedule to ensure new ID cards are available to members by January 1, 2023: November 1, 2022 – Paperwork Deadline November 21, 2022 – Eligibility File – Physical ID Card December 16, 2022 – Eligibility File – Digital ID Card Please note: Small groups that make plan changes after this timeframe will receive updated ID cards once their plan changes have been… Read More
Continue ReadingNew Jersey New Poster Requirements
On August 1, 2022, the New Jersey Division on Civil Rights (DCR) finalized regulations to increase the visibility and effectiveness of posters required by the State of New Jersey. Among other things, these regulations require employers to display posters informing people of their rights under New Jersey’s Law Against Discrimination (“NJLAD”) and Family Leave Act (“NJFLA”). The regulations went into effect immediately. The NJLAD protects New Jersey employees from discrimination in the workplace. It prohibits all employers in the State of New Jersey from discriminating against and harassing employees (and prospective employees) based on their protected status (including, but not limited to, race, national origin, age, sex, gender identification, sexual… Read More
Continue ReadingCan consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?
Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. Please contact your trusted Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.
Continue ReadingOpen Enrollment Tips!
As always, please contact your Total Benefit Solutions health insurance specialists at today at (215)355-2121.
Continue ReadingThe Employer Shared Responsibility Provision Estimator
The Taxpayer Advocate Service developed the Employer Shared Responsibility Provision (ESRP) Estimator to help employers understand how the provision works and learns how the provision may apply to them. The provision applies to applicable large employers – generally, that means employers that had an average of at least 50 full-time employees (including full-time equivalent employees-FTEs), during the preceding calendar year. If you are an employer, you can use the estimator to determine: The number of your full-time employees, including FTEs, Whether you might be an applicable large employers, and If you are an applicable large employer, an estimate of the maximum amount of the potential liability for the employer shared… Read More
Continue ReadingDefined Contribution Plans
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
Continue ReadingWhat 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
Continue Reading“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
Continue ReadingPresident 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
Continue ReadingSocial 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
Continue ReadingHow 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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