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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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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