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 MoreContinue Reading
Small 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 MoreContinue Reading
Air 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 MoreContinue Reading
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.Continue Reading
What 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 Reading
DOL 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 Reading
Explore 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 Reading
Blue 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 Reading
Annual 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 Reading
Prescription 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 Reading
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.Continue Reading
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 MoreContinue Reading
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.Continue Reading
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 MoreContinue Reading
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.Continue Reading
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 MoreContinue Reading
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.Continue Reading
Open Enrollment Tips!
As always, please contact your Total Benefit Solutions health insurance specialists at today at (215)355-2121.Continue Reading
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 MoreContinue Reading
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 MoreContinue Reading
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.Continue Reading
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 MoreContinue Reading
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 MoreContinue Reading
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 MoreContinue Reading
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 MoreContinue Reading