group medicare – Total Benefit Solutions Inc

Medicare Exclusions-Who Pays First?

February 6, 2016February 6, 2016Ed MacConnell

Medicare primary payer rules are complicated. Especially when it comes to different employer sizes and special circumstances like End Stage Renal Disease and disabilities. Coverage issues can be significantly complex when mixing Medicare and employer coverage, or individual coverage for those who are early Medicare enrollees. Chances are, if you are already enrolled on Medicare, AND you are getting bills from providers, you are already experiencing these problems, or you are encountering a coordination of benefits issue. It’s always best to speak to a professional when encountering these problems, most especially a health insurance professional. If at all possible, before getting enrolled on Medicare. The documents below may help provide… Read More

IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required

January 6, 2015Ed MacConnell

On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members? Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… Read More

Medicare: Medicare & You Online

October 3, 2014October 2, 2014Ed MacConnell

Did you know? You can go paperless and get your Medicare and You Handbook Online! As always, if you have any questions about Medicare health plans, please contact your Total Benefit Solutions account manager at (800)924-6718 or (215)355-2121.

Informal Guidance Clarifies Rules HSA Eligibility and Health FSA Carryovers

May 17, 2014May 16, 2014Ed MacConnell

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. One of the outstanding questions around the carryover provision is the effect it has on HSA eligibility. Recently, the Office of Chief Counsel for the Internal Revenue Service issued a memorandum that informally addresses the interaction of the carryover on HSA eligibility and provides some solutions that may allow an individual retain… Read More

IBC: Medicare as Secondary Payer

March 17, 2014Ed MacConnell

Medicare Secondary Payer (MSP) requirements determine when Medicare is the primary insurance payer. If your company has 19 or fewer full- and part-time employees, Medicare is almost always primary. If your company is larger, various rules apply to determine whether your group plan is the primary or secondary payer. MSP requirements also apply for Medicare-eligible employees who are disabled or have endstage renal disease. The following information provides a summary of the MSP requirements. This information may help you to correctly target benefits for your Medicare-eligible participants and avoid potentially costly penalties and litigation. You should, of course, also refer to the actual laws and regulations with the assistance of your own legal counsel. Click… Read More

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: