CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell of Total Benefit Solutions Inc has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More
Continue Reading2023 RxDC Reporting Instructions Released
The Centers for Medicare and Medicaid Services (“CMS”) recently updated its Prescription Drugs Data Collection (“RxDC”) reporting instructions for 2023 data. There are some noticeable differences. As previously reported, group health plan sponsors (typically employers) are required to submit information to CMS on prescription drugs and health care spending on an annual basis (“RxDC reporting”). The first reporting deadline for calendar years 2020 and 2021 was December 27, 2022 (extended to January 31, 2023). The next deadline for reporting on calendar year 2023 is June 1, 2024, which, despite being a Saturday, is a firm date. It should be noted that carriers, pharmacy benefit managers (“PBMs”), and third-party administrators (“TPAs”)… Read More
Continue ReadingCheapest Health Insurance in Pennsylvania (2024 Plans)
Premium costs on Pennsylvania’s health insurance marketplace, Pennie vary by Catastrophic, Bronze, Silver or Gold tier. In Pennsylvania, Highmark Blue Cross Blue Shield offers the most affordable Bronze and Catastrophic plans, while UPMC Health Plan and Jefferson Health Plans provide the lowest-priced Gold and Silver plans in 2024, respectively. Of course, just because one plan costs less to buy does not make it the best plan to meet your needs. The health insurance experts at Total Benefit Solutions, Inc can shop the entire market for you, taking into account the healthcare needs of your family and guide you to the best plan for you. Contact us today at (215)355-2121.
Continue ReadingNavigating the Basics of Medicare: Understanding the Four Parts
Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact… Read More
Continue ReadingSpecial Election Period may be available to members affected by severe weather
The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP). For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit. Who is eligible? Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and What does this mean for beneficiaries? Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More
Continue ReadingCase Study: A Voluntary Benefits Strategy
The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More
Continue ReadingIBC’s Latest Updates: Weight Loss Drug Policy
The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More
Continue ReadingCigna Healthcare and Tower Health Contract Updates
In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More
Continue ReadingAlert: Chicago Employers, Brace for Paid Leave Shifts in 2024
In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More
Continue ReadingKey Reminders for Individual Health Plan Payments
In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More
Continue ReadingAmbetter Health Members: Ensure Coverage for January 2024!
As we approach the end of the year, we want to remind you of a crucial deadline to ensure uninterrupted coverage for the upcoming year. Payment Deadline: December 31, 2023: Ambetter Health members must make their January premium payment by December 31, 2023, to guarantee seamless coverage for the start of 2024. To make this process quick and convenient, we recommend using Quick Pay option for a fast, one-time payment. For Assistance: If you have any questions or require assistance, don’t hesitate to reach out to your dedicated Ambetter Health Account Executive. You can contact them at 1-855-700-7985, selecting option 3. Alternatively, you can email ambettersales@centene.com. Ensuring your premium payment is processed… Read More
Continue ReadingTotal Benefits: Your Trusted Guide to Cost-Efficient Coverage
In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More
Continue ReadingSmall Business, Big Benefits: Health Coverage for All
In the United States, the landscape of healthcare is a complex one, with various options available to individuals and families. One of the most significant sources of health coverage for Americans is employer-provided coverage. This type of coverage is a health plan, or a selection of health plans and other benefits, purchased by an employer and offered to eligible employees and their dependents. It’s a system that plays a crucial role in ensuring that millions of hardworking individuals and their families have access to quality healthcare. Affordable Access to Care The primary advantage of employer-provided coverage is its affordability. Employees’ contributions to their health coverage are tax-free, which means that… Read More
Continue ReadingMedicaid Redetermination Updates: Your Next Steps
The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More
Continue ReadingMLR Rebate Checks Unveiled: A Must-Read for Employers
Every year, insurance carriers are required to meet specific Medical Loss Ratio (MLR) thresholds, ensuring that a significant portion of collected premiums goes toward medical care and improving healthcare quality. For the large group market, this threshold stands at 85 cents for every premium dollar collected, while in the small group market, it’s 80 cents. If these thresholds are not met, employers are in for a timely financial boost, in the form of premium credits or checks. MLR Rebate Deadline: September 30, 2023 The clock is ticking. If your insurance carrier falls short of the MLR threshold, they are obligated to distribute MLR checks to employers by September 30, 2023.… Read More
Continue ReadingUnderstanding the Updates to the Davis Bacon and Related Acts
On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More
Continue ReadingBenefits Notices: What Employers Need to Know
As an employer, it is important to be aware of the various benefits notices that you are required to provide to your employees. These notices are designed to inform employees of their rights and benefits under various laws and regulations. Failure to provide these notices can result in penalties and legal action. One of the notices that employers with 1-19 employees are required to provide is the Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice. This notice is provided to Medicare-eligible individuals who are offered prescription drug coverage under the employer’s group health plan. It must be provided annually prior to October 15th, upon request, and at… Read More
Continue ReadingVoluntary Benefits: Customized Coverage for Your Team
Unlocking the Power of Voluntary Benefits In today’s competitive job market, employers aim to attract and retain top talent by offering comprehensive benefits beyond the basics. Enter voluntary benefits – a customizable solution that benefits both employers and employees. What Are Voluntary Benefits? Voluntary benefits are offerings that employers provide for purchase by employees. They empower employees to tailor their benefits to their needs, offering flexibility and convenience. Here are their key characteristics: A Variety of Benefits Voluntary benefits offer a wide array of options, including: Advantages for Employers and Employees Employers benefit from: Employees enjoy: While voluntary benefits may not suit everyone, employers should assess their package and consult… Read More
Continue ReadingEmployer’s Guide to Medicare Compliance
Medicare is a critical healthcare program in the US, covering seniors and certain disabled individuals. Employers offering group health insurance to Medicare-eligible individuals must meet specific requirements. In this blog, we’ll discuss three key Medicare requirements for employers: Employers must ensure compliance with these Medicare regulations to provide necessary healthcare information and process claims correctly. This ensures employees receive the coverage they’re entitled to. For comprehensive information and resources, refer to our PDF document below. Meeting these obligations supports employee well-being and eases healthcare coverage complexities. As always, if you have any questions or concerns about this bulletin, please contact your Medicare health insurance experts at Total Benefit Solutions, Inc.… Read More
Continue ReadingBenefits of a PEO: How to Simplify your Business Operations
If you’re a small- or mid-sized business owner, you’ve probably come across the term “PEO” in your quest to optimize your company’s operations. PEO stands for Professional Employer Organization, and it’s a dynamic solution designed to assist businesses in various crucial areas, such as payroll administration, human resources, risk management, and employee benefits. In this blog post, we’ll explore the advantages of partnering with a PEO and introduce you to a valuable resource to help you navigate this complex landscape. The Advantages of a PEO As beneficial as PEOs can be, the surge in their numbers can be overwhelming for business owners. The plethora of options often leads to confusion… Read More
Continue ReadingMedicare Part D Notification Requirements
Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Also, following the plan’s annual renewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. This information summarizes these requirements in more detail. What are the Notification Requirements About? Medicare Part D, the Medicare prescription drug program, generally imposes a lifetime penalty for late enrollment if an individual delays enrolling in Part D after initial eligibility… Read More
Continue ReadingElevate Your Productivity with Better BenAdmin
In a fast-paced world, time is of the essence. We’re all too familiar with the feeling of being buried under a mountain of administrative tasks, wishing for an extra set of hands or a few more hours in the day. Well, wish no more! Enter Better BenAdmin, the game-changer powered by EBM (Efficiency-Boosting Machine). Seamless Schedule Management Scheduling headaches? Not anymore. Better BenAdmin effortlessly handles your calendar, ensuring that appointments are well-organized and conflicts are a thing of the past. No more double-bookings or time wasted on manual scheduling. Effortless Email Handling Say goodbye to the endless email backlog. Better BenAdmin sorts, filters, and responds to emails with precision and… Read More
Continue ReadingReasons Why You Need a Health Insurance Broker
Navigating the world of health insurance can feel like a daunting journey through an intricate maze. That’s where a trusted health insurance broker comes in, acting as your guiding light and advocate. Here’s why you need one in your corner: 1. Expert Guidance: Your Healthcare GPS: Think of a health insurance broker as your personal healthcare GPS. They simplify the bewildering maze of insurance options, helping you choose the path that suits your needs best. With their expertise, you won’t feel lost in the insurance wilderness. 2. Advocacy: Your Fighter: Insurance claims, disputes, and paperwork can be a real hassle. But with a broker, you have a dedicated champion in… Read More
Continue ReadingMedicare Covers Diabetes Supplies & Services for Your Health
Discover the power of Medicare, a federal health insurance program in the US designed for individuals aged 65 and older, as well as certain younger people with disabilities, providing access to essential medical services and supplies. Don’t miss the invaluable “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” booklet available on Medicare.gov/publications. This comprehensive guide highlights coverage options for individuals with diabetes, including supplies and services, preventive programs, and access methods. Plus, it features a must-have checklist for your next doctor’s visit, empowering you to ask the right questions about treatments, preventive services, covered supplies, and lifestyle recommendations. Take control of your diabetes management and overall well-being with this… Read More
Continue ReadingMedicare Diabetes Prevention Program
If you have been diagnosed with prediabetes, it’s essential to take proactive steps to manage your condition and reduce the risk of developing type 2 diabetes. The good news is that there are programs available designed specifically to assist individuals like you in preventing or delaying the onset of type 2 diabetes. These programs often encompass a comprehensive approach that includes education, lifestyle modifications, and support systems tailored to your specific needs. Let us help, don’t miss this opportunity to take control of your health and potentially prevent the development of type 2 diabetes. Download this PDF for more information! As always if you have any questions or concerns about… Read More
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