2022 Federal Poverty Guidelines Announced

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SHOP Rules Finalized, Enrollment Forms Simplified

The Small Business Health Options Program’s (SHOP) place along the Affordable Care Act’s (ACA) timeline. It’s now being packaged for mass consumption and soon will be stocked on store shelves across all 50 states. Click here to read more…

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New York Health Exchanges Offer 50% Drop in Premiums

Empire State approves plans to be sold by 17 insurers and lower expected premiums may ease fears that next year’s implementation of the biggest parts of the Affordable Care Act would send prices soaring… Click here to read the story

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IBC: Important change to claims processing for PPO plans

Independence Blue Cross (IBC) will begin notifying customers later this week regarding a change in how claims for certain out-of-network providers will be processed under their IBC Personal Choice® PPO health plan. This change impacts fully insured, self-funded, and Individual commercial Personal Choice® PPO plans only. There is no impact to Medicare plans. Effective November 1, 2013, members who have claims submitted by providers who participate in the Highmark Blue Shield (Highmark) professional provider network inside IBC’s five-county service area will be subject to higher out-of-pocket costs and may also be subject to balance billing. Currently, claims submitted by a participating Highmark professional provider are processed as out of network and applied… Read More

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Health Reform: Research Filing Fees Due July 31

The Research Fee filing deadline is July 31, 2013 for self-funded medical plans and HRAs  Insurance carriers will report and pay the Fee for fully insured plans.  If an employer has several self-insured arrangements with the same plan year, they are subject to a single fee.  An HRA integrated with a self-funded plan providing major medical coverage will not incur a separate fee specific to the HRA if the HRA and plan are established or maintained by the same plan sponsor.  Click below to download the bulletin   Research Fees Due    Interested in our free Health Care Reform Checklist? send an email  

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Health Reform: Aetna to distribute MLR rebates

By August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. For group plans, rebate checks will be sent to the policyholder, with few exceptions. Please click the link below to download the bulletin. Click to download

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NJDOBI Issues Amendments to Rating Rules under PPACA

NJDOBI Issues Amendments to IHC and SEH Rating Rules under PPACA For rates applicable to all rating periods beginning on or after January 1, 2014, carriers are directed to: Formulate rates in the IHC market to achieve a required 300 percent maximum ratio between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the State. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over; Formulate rates in the SEH market without regard to gender. Age factor categories should be in… Read More

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Healtcare Reform Law

Health Insurance Marketplaces (Exchanges): Informational Video

Beginning in 2014, individuals and small businesses with up to 50 employees can purchase insurance through online exchanges, also called “health insurance marketplaces.” Each exchange will offer a choice of health plans that meet certain benefit and cost standards. In 2016, businesses with up to 100 employees will be able to participate. Coventry Health/Aetna recently released this easy to understand video that may help you understand the new exchange or” marketplace” system of buying health insurance. Click here to watch the six minute long video.

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Medicare: What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)?

Q:What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)? A: Business income has increased for doctors because many people on Medicare are now using free screenings and an annual “wellness visit” provided through the Affordable Care Act (ACA). Through Oct. 6, 2011, the government said, 20.5 million people enrolled in Medicare had received the free screenings or the annual visit, which is also free. Medicare is now offering a 10 percent bonus payment on the fees charged for primary care services, and a 10 percent bonus payment to surgeons who work in areas where there are shortages of doctors. For 2013 and 2014, Medicaid payments… Read More

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Total Benefit Solutions Newest Brochure

  Download our latest brochure to read all about the valuable services we provide for our clients! Download our latest employee benefits brochure

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PPACA employer mandate delayed until 2015

PPACA employer mandate delayed until 2015 The Obama administration unexpectedly announced Tuesday it is delaying the employer mandate under the Patient Protection and Affordable Care Act until 2015. The mandate — which requires mid-sized and large employers to offer health insurance coverage to their workers — was one of the main requirements of the health care overhaul that was set to go into effect Jan. 1, 2014. But the Treasury Department announced Tuesday that it would delay its enforcement an entire year after hearing numerous concerns from employers about the challenges of its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement… Read More

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Prodigy Learning Center’s Executive Director is a Happy Client

Hi Ed, I just wanted to let you know how great (our account manager) has been with our insurance issues. She has been so helpful to me. I don’t know if people take the time to tell you when your staff is doing a great job, but I wanted to let you know. She is great!!   Thanks. Christine Viteo, R.N. Executive Director Prodigy Learning Center Philadelphia, Pa.19132

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EMA Group to become Total Benefit Solutions Inc!

The health insurance industry is on its way to a major overhaul by the end of this year. With the implementation of the Patient Protection and Affordable Care Act (PPACA), nearly every American will be affected by the new law and many already have.  With this in mind, we have decided to refocus our efforts to better serve our clients in alignment with the new world of health benefits. We are proud to announce that beginning August 1, 2013; EMA Group Inc. will be known as Total Benefit Solutions Inc.  Although our name is changing; our commitment to provide top notch guidance and support to our clients will never change.… Read More

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IBC Requesting tobacco data

Under the Affordable Care Act (ACA) and effective January 1, 2014, insurers are permitted to use the following four categories to determine premiums:   Age Family Size Geography Tobacco   To comply with this provision, IBC will be implementing a new process to collect tobacco usage as part of their rating methodology for groups with 2-50 employees and sole proprietors.   Over the next several days, IBC will send letters to employers with January 1, 2014 renewal dates to gather this information. In the mailing, there will be a letter and a Tobacco Use Form, that must be completed for each of their employees and dependents age 21 and over… Read More

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Healtcare Reform Law

First PCORI Fees Due by July 31, 2013

Revised IRS Form 720 Now Available for Employers Sponsoring HRAs and Other Self-Insured Plans to Report and Pay PCORI Fees   First PCORI Fees Due by July 31, 2013 The IRS has revised Form 720, Quarterly Federal Excise Tax Return, for employers sponsoring certain self-insured health plans to report and pay new fees imposed under Health Care Reform to fund the Patient-Centered Outcomes Research Institute (PCORI). The fees, which must be reported annually on the second quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under a plan. Affected Self-Insured Plans PCORI fees are imposed on plan sponsors of… Read More

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Heathcare Reform: Important New Guidance on Affordability

In order to receive a subsidy in the Health Insurance Marketplace (formerly referred to as the Exchange), generally an individual must not be eligible for affordable coverage under an eligible employer sponsored plan that provides minimum value. Additionally, large employers looking to avoid penalty exposure must offer all full-time employees (and their dependents) affordable coverage that meets minimum value. Although final regulations were published back in February, further clarification was needed on the health benefits considered in determining the share of benefit costs paid by a plan.  Click the link below to read the rest of the article.   Minimum Value and Affordability-060513R

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Healtcare Reform Law

Health Reform: Cost Sharing Limits

Effective the first plan year that begins on or after January 1, 2014, all non-grandfathered group health plans (both insured and self-insured) , regardless of size, must comply with annual cost-sharing limitations on out-of-pocket maximums. Click the link below to download and review the entire notice. Health Reform-cost sharing limits

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Healtcare Reform Law

Health Reform: Contraceptive Coverage and Non-Profit Organizations

Under the ACA, most health plans must cover women’s preventive services, including contraception, without charging a co-pay or deductible. The interim final rules provided that group health plans established or maintained by religious employers were exempt from these requirements. Guidance issued subsequent to the final rules established a temporary enforcement safe harbor for group health plans established or maintained by certain non-profit organizations that have religious objections to contraceptive coverage. The safe harbor is in effect until the first plan year that begins on or after August 1, 2013. Please click the link below to download and review the guidance. Health reform- contraceptive coverage and Non Profits

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Healtcare Reform Law

Health Reform: Exchange Notice Requirements

Open enrollment for health insurance coverage through the Exchange (now referred to as the Health Insurance Marketplace) begins October 1, 2013. The Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section that requires employers to provide each employee at the time of hiring, as well as current employees, a written notice that includes information regarding the new Health Insurance Marketplace. Earlier materials referred to this notice as the “Exchange Notice,” however, it is now referred to as the “Notice of Coverage Options. Click the link below to download and view the notice. Health Reform-Exchange Notice

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Healtcare Reform Law

Health Reform Update: Shop Exchanges

Individuals and small employers will be able to purchase private health insurance through a new marketplace called “The Exchange” beginning in 2014. Each state that chooses to operate an Exchange must also establish a Small Business Health Options Program (“SHOP”) that assists eligible small businesses in providing health insurance options for their employees. Click the link below to download and review the entire notice.   Health reform-Shop Exchange Facts

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Healtcare Reform Law

Exchange Notice Must Be Provided to Current and New Employees

Following a delay in the original effective date, employers will need to comply with the new requirement to provide each employee a written notice with information about a Health Insurance Exchange (also known as a Marketplace) beginning this fall.   Employers are required to provide the written notice to each current employee not later than October 1, 2013, and to each new employee at the time of hiring beginning October 1, 2013(for 2014, a notice will be considered provided “at the time of hiring” if it is provided within 14 days of an employee’s start date). Model language that employers may use to satisfy the notice requirement is available from the U.S. Department… Read More

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Is There a List of Providers Who Have Been Excluded From Medicare Because of Fraud?

  Yes. The Department of Health and Human Services and its Office of the Inspector General excluded a total of 3,131 individuals and entities from participation in federal health care programs in 2012. Click here to read the story.

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89 charged in Medicare fraud busts in 8 cities

  WASHINGTON (AP) — Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. Click here for the story.

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Healtcare Reform Law

New Guidance on SBC’s

Under health care reform, plan participants and beneficiaries must be provided a 4-page summary of benefits and coverage (“SBC”) and uniform glossary. This requirement is effective for open enrollment periods that begin on or after September 23, 2012. For participants and beneficiaries who enroll in group health plan coverage outside of open enrollment (e.g., newly eligible individuals and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012. This requirement is an ongoing one and, as open enrollment season approaches, the Departments of Labor, Health and Human Services, and Treasury have issued updated guidance and… Read More

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IBC-Important update-changes to group plan selection requirements

We would like to share some important updates and reminders about the Summary of Benefits and Coverage (SBC), under the Affordable Care Act (ACA), including information about off-anniversary benefit changes, obtaining SBCs through our brochure and giveaway system (BAGS), and SBC postcards that are sent to members. Under the ACA both group health plans (customers) and health insurance issuers (health insurers) are required to provide the SBC to participants under certain circumstances. ACA 60-day notification requirement for off-anniversary benefit changes For customers who make off-anniversary material modifications (e.g., benefit changes) that affect the content of the SBC, participants in the customer’s group health plan must receive notification of the change… Read More

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