What 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.

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Beam 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

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What 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.

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Blue 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

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Additional Guidance on New Prescription Drug Reporting Requirement

As previously reported in 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 requirements that proves some helpful clarification. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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New 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

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Can 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.

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Open Enrollment Tips!

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

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The 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

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Further Guidance Issued on Contraceptive Coverage

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

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IRS Health Savings Account Adjusted Amounts for 2023

The IRS has released the 2023 cost-of-living adjustments for Health Savings Account (HSA) contribution limits, HDHP deductibles, and out-of-pocket maximums. To read the official IRS release, click here. As always, please contact your Total Benefit Solutions health insurance specialists at (215)355-2121.

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What is a health insurance deductible?

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest. Many plans pay for certain services, like a checkup or disease management programs, before you’ve met your deductible. Check your plan details. All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible. Some plans have separate deductibles for certain services, like prescription drugs. Family plans often have both an… Read More

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Defined 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

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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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New Prescription Drug Reporting Requirement

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

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What is a Self-Insured Plan?

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. Please contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

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Premium Formulary Adoption Swells Among Large Group Clients

The Premium formulary is an option for large group clients wanting access to a formulary that manages traditional, non-specialty drug costs without compromising clinical outcomes. In many cases it saved early adopters nearly 10% per member per month on their plan’s traditional drug spend. Overall, members saved on drug costs without rigorous additional step therapies, prior authorizations, or other invasive utilization management strategies. Members transitioning to the Premium formulary will receive communications about the change, potential disruptions to their drug therapies, and clinically appropriate and cost-effective alternatives. Blue KC will continue to make quarterly updates to the Premium formulary and will send subsequent member communications about those changes and appropriate… 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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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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10 Companies with Innovative Benefits Packages

From retirement and health plans to unlimited paid time off, work flexibility and hot new benefits such as student loan repayment and professional development, these 10 companies are leading the pack when it comes to innovation in the field. Here’s what they are doing differently.         Netflix Their unique offering: Unlimited paid time off Perks include: Up to one year of paid time off to new mothers and fathers, and unlimited-time-off for vacation and sick days. Why they do it: “Netflix’s continued success hinges on us competing for and keeping the most talented individuals in their field. Experience shows people perform better at work when they’re not worrying about home,”… Read More

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

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

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There are two new HRA options to offer Employees!

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

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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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5 Affordable Self-Employed Health Insurance Options When You’re on a Budget

5 Affordable Self-Employed Health Insurance Options When You’re on a Budget When you are self-employed, finding affordable health insurance options isn’t easy. There are more types of insurance policies now more than ever; However not all of those choices are affordable.  So, how can you find good coverage when you’re on a budget? Continue reading below for some great options to make sure you get the benefits you need at a price you can afford!   1. Telemedicine Services and Secure Doctor Consultations A budget-friendly health insurance alternative that’s gaining popularity are Telemedicine Services.  Telemedicine services are just like they sound, it’s a medical service that allows you to speak to… Read More

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