United Healthcare Members can now get up to eight COVID-19 at home tests at no cost

Members can now get up to eight COVID-19 at home tests at no cost to them On Jan. 10, 2022, the Departments of Labor, Treasury and Health and Human Services released guidance to support the Administration’s directive that health insurers and group health plans cover, subject to certain criteria, the cost of FDA-authorized or approved over-the-counter (OTC) COVID-19 at home tests beginning on Jan. 15, 2022.  On Jan. 15, 2022, UnitedHealthcare began covering most commercial individual and group health plan members’ FDA-authorized or approved OTC COVID-19 at home tests without a doctor’s prescription or clinical assessment. This COVID-19 at home test benefit includes up to 8 tests per member per… Read More

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Expanding Coverage for COVID-19 Testing

On January 10, 2022, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued FAQ Part 51 requiring group healthplans to cover, without cost-sharing, over-the-counter (“OTC”) COVID-19 diagnostic tests obtained without the involvement of a health care provider. This provision iseffective for OTC COVID-19 tests purchased on or after January 15, 2022, and continues for the duration of the Public Health Emergency (currently set to expire January16, 2022 – however another 90-day extension is expected). Group health insurance plans (and health insurance carriers) must cover diagnostic OTC COVID-19 tests obtained without the involvement of a health care provider without cost-sharing, prior authorization, or other medical… Read More

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New PCOR Fee Announced

On December 21, 2021, the IRS released Notice 2022-04, announcing that the adjusted applicable dollar amount used to determine the PCOR fee for plan years ending on or after October 1, 2021 and before October 1, 2022 is $2.79. The PCOR filing deadline is August 1, 2022 for all self-funded medical plans and some HRAs for plan years (including short plan years) ending in 2021. Carriers are responsible for paying the fee for insured policies. Click to Download New PCOR Fees    

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OSHA’s Emergency Temporary Standard: Guidance on Mandatory COVID-19 Vaccination/Testing

UPDATE: On December 17, 2021, in a 2-1 decision, the 6th Circuit Court of Appeals allowed the Occupational Safety and Health Administration’s (“OSHA”) Vaccinationand Testing Emergency Temporary Standard (“ETS”) to move forward by lifting an earlier court’s stay that had put the ETS on hold. In response to the court’s decision, OSHA has initiated an aggressive implementation and enforcement schedule. While OSHA expects covered employers to begin complying immediately, the agency has said it will delayenforcement of the vaccination requirements of the ETS until January 10, 2022, and will wait until February 9, 2022, to start enforcing the optional testing component of theETS. Both of those dates are quickly approaching.… Read More

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Pennsylvania Individual Open Enrollment Deadline

Please be advised the open enrollment period for individual coverage in Pennsylvania will end on 12/15/2021 for a January 1, 2022 effective date. As a reminder Emerson Reid must receive all individual applications by 2:00 PM EST on Tuesday, December 14, 2021. This deadline is necessary in order for us to submit them to the carriers and for the carriers to review and process them during this high-volume time. On-Exchange Enrollments submitted from now through 12/15 will receive a 01/01 effective date. Off-Exchange Enrollments submitted from now through 12/15 will receive a 01/01 effective date. Please be aware any applications submitted  after this time will not be guaranteed to receive… Read More

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Small Employer Open Enrollment Period

The Small Employer Open Enrollment Period is November 15 through December 15. While this has been in place for a number of years, We would like to remind you about the Small Employer Open Enrollment Period for fully-insured health plans in all states.The Small Employer Open Enrollment Period is the period from November 15 through December 15 each year. During this period, employers that meet the definition of small employer but do not meet the 75% Participation Requirement or the 10% Contribution Requirement will be accepted for a small employer plan with a January 1 effective date.  Carriers require that employer groups enrolling under the Small Employer Open Enrollment Period submit completed… Read More

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CMS Extends Open Enrollment Period

On September 17, 2021, the Centers for Medicare & Medicaid Services (CMS) finalized a series of provisions that follow through on President Biden’s commitment to build on the Affordable Care Act, expand health coverage access for Americans and advance health equity. The provisions are the third installment of the payment notice for 2022.   There are several important policy updates that Marketplace agents and brokers should be aware of prior to the beginning of the plan year 2022 Open Enrollment Period (OEP). These provisions include: An extension of the OEP from November 1, 2021, to January 15, 2022, annually for Marketplaces on the federal platform. Clarification for Special Enrollment Period… Read More

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Anthem Blue Cross: New agreement with Trinity Health System extends access through 2025

August 20, 2021 We notified you last month that the previous agreement with Trinity Health System ended August 1. They have reached a new agreement that will assure continued access to affordable healthcare at Trinity Health hospitals, physicians, and affiliated care providers through 2025. We will continue our collaborative work to serve the community and look for innovative ways to help solve challenges together. Questions? reach out to your Total Benefit Solutions group account manager at (215)355-2121 https://www.totalbenefits.net

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Ways to Save Money on Your Prescription Drugs

Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More

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Important Info! HSA Limits for 2019

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Aetna Funding Advantage (AFA) is a new self-funded option for small groups

Aetna Funding Advantage (AFA) is a self-funded option that provides all of the financial and plan design flexibility of a traditional arrangement with special features designed to help companies with as few as 2 employees achieve even greater savings on their health insurance. Ask us today if self funding could be a good fit for your organization! Call your Total Benefit Solutions Inc. account manager at (215)355-2121 for more information! Learn more here: AFA-Customer-Flyer New! Minute Clinic Benefit! $0 Copay Minute Clinic Visits Flyer More Documents for downloading: Springboard Marketplace Your Online Administration and Enrollment Portal AFA AppleWatch Wellness Flyer AFA Sample Usage Reports Aetna & Teledoc for AFA AETNA… Read More

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Congress Passes Tax Reform Bill

    On December 20, 2017, the House and Senate sent President Trump the Tax Cuts and Jobs Act for signature. The House of Representatives passed their version of the bill on November 16, 2017 while the Senate passed their version on December 2, 2017. Because the versions were not identical, a Tax-Bill Conference Committee was formed from members of the Senate and the House of Representatives to negotiate the text of the combined bill. After the finalized text was approved and released by the committee, the House and Senate each passed the combined bill (which happened on December 20th in the House and December 19th in the Senate) before… Read More

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Aetna Funding Advantage for Small Businesses

Aetna Funding Advantage (AFA) is a new self-funded option that provides all of the financial and plan design flexibility of a traditional arrangement with special features designed to help companies with as few as 2 employees achieve even greater savings on their health insurance. The benefits of self-funding have traditionally been considered by larger companies. But Aetna Funding Advantage has changed that. It is specifically designed to be attractive and affordable for small businesses like yours. Watch this short video and download the documents below for some information. As always please contact your Total Benefit Solutions dedicated account manager at (215)355-2121 if you have any questions, concerns or would like to learn… Read More

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Guidance Issued on QSEHRAs

  Under the Affordable Care Act, a health reimbursement arrangement (HRA) must be integrated with a group health plan (as it could not meet the market reform provisions on its own) and was not able to reimburse employees for individual premiums. However, on December 13, 2016, President Obama signed into law the “21st Century Cures Act” which established QSEHRAs (a special standalone HRA). Click to Download Guidance Issued on QSEHRAs This guidance is big news for small groups who would prefer to provide a reimbursement as opposed to a group health plan. Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.  

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2018 Individual Health Insurance Open Enrollment: PA Independence Individual Consumer Plans and Rates

  Individual Health Insurance Open Enrollment 2018! Don’t do it yourself! Our dedicated professionals are here to help you take the fits out of the benefit planning process!  One mistake and you could be stuck with a bad plan all year! We work with all available plans both on the healthcare.gov marketplace and off! Have your own expert help you! Our experts are trained to help you Choose between on and off exchange options Maximize any subsidy eligibility. Help you understand the cost sharing subsidies Help you choose the plan that is the best fit for you Explain the differences between the plan design and your out of pocket expectations Fill… Read More

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The Mental Health Parity and Addiction Equity Act

The Mental Health Parity and Addiction Equity Act (MHPAEA) applies to employers with at least 51 employees offering a group health plan that includes any mental health and substance use disorder (MH/SUD) benefits. MHPAEA also applies to non-grandfathered insured plans in the small group market. Download the bulletin below for more information. As always please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns. Download Mental Health Parity  

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2018 Inflation Adjusted Amounts for HSAs

The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2018. All limits increased from 2017 amounts. Click to download the bulletin below and as always contact your Total Benefit Solutions account manager at (215)355-2121  if you have any questions or concerns regarding this notice.   Click Here to Download 2018 Inflation Adjusted Amounts for HSAs

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Recent Developments Regarding the Employer Mandate

Applicable large employers (ALEs) may be resting easy, having had no notification from the IRS of 2015 or 2016 assessments under the Employer Mandate of the Affordable Care Act (the ACA) and having reasonably expected that the Republican-led administration would limit or choose not to enforce this mandate. With the status of health care reform uncertain, the IRS has taken additional steps regarding the mandate, once again updating its website with FAQs on Employer Mandate penalties that build on information released in January (before the change in administration). Briefly, the guidance is included in the bulletin. Download the bulletin here

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House Passes Bill to Repeal ACA

Just six weeks after the House leaders failed to muster the votes to pass an earlier version of the American Health Care Act (AHCA), the House Republicans narrowly passed their health care bill to repeal and replace Obamacare with a 217 to 213 vote on Thursday… Click the link below to download the bulletin with important points: Download House Passes Bill to Repeal Obamacare

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Video: Our New Online Enrollment System

Watch this short video to get a quick overview of our new employee enrollment system with Ease Central!   As always please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions about our new enrollment system with Ease Central!

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Small Businesses May Be Able to Keep Existing Health Coverage Through Calendar Year 2018

Small Businesses May Be Able to Keep Existing Health Coverage Through Calendar Year 2018   A previously extended transitional policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been extended further—to policy years beginning on or before October 1, 2018, provided that all policies end by December 31, 2018. Health insurance issuers that renew coverage under the extended policy are required to provide standard notices to affected small businesses for each policy year. Extended Transitional Policy At the option of the states, issuers that have renewed policies under the transitional policy continually since 2014 may be permitted to… Read More

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Trump Issues Executive Order To Curb Some Parts Of ACA.

Trump Issues Executive Order To Curb Some Parts Of ACA. The New York Times  (1/20, Davis, Pear, Subscription Publication) reported that on Friday, President Donald Trump issued an executive order  to government agencies directing them “to scale back as many aspects of the Affordable Care Act as possible, moving within hours of being sworn in to fulfill his pledge to eviscerate Barack Obama’s signature health care law.” According to the Times, the one-page order “has symbolic as well as substantive significance, allowing Mr. Trump to claim he acted immediately to do away with a health care law he has repeatedly called disastrous, even while it remains in place and he… Read More

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Health Reform: 4th Quarter 2016 Compliance Compilation

Download a digest of our fourth quarter compliance bulletins. This digest includes the following bulletins:  Transitional Reinsurance Fee Form Now Available 10/14/2016 Final 2016 Forms 1094-C and 1095-C Available 10/25/2016 November 2017 Cost of Living Adjustments 11/01/2016 Relief Extended for Premium Reimbursement Programs for Student Employees 11/02/2016 Updates Regarding the NJ Small Employer Health Benefits Program 11/07/2016 Election Results and the ACA: Preliminary Thoughts 11/10/2016 16 Extension of Deadline for 2016 Forms 1095-C 11/21/2016 Adjusted PCOR Fee for Fifth Filing Year Released 11/22/2016 December Beware of Phishing Email Disguised as HIPAA Privacy Audit Letter 12/13/2016   Click here to download the 4th quarter compliance compilation

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