Have you enrolled? Open enrollment is ending soon! Do you know when? Watch this video from Humana and learn more, then call your Total Benefit Solutions Advisor at (215)355-2121 and get enrolled without any further delay!
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Total Benefit Solutions Now Offering Online Enrollment with Consult-A-Doctor PLUS
Healthcare… the way it should be! Are you tired of waiting multiple weeks to go see your doctor, only to find yourself taking time off work so you can drive through traffic and sit in the waiting room for what seems like forever? Have you ever felt overwhelmed by the stress and anxiety of a difficult life situation and wished you had someone you could trust to hold your hand and walk you through to the other side? Then welcome to CADRPlus, an innovative new health care program that gives you unlimited, 24/7 access to doctors and other industry professionals from the comfort and convenience of your phone or computer,… Read More
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Health Reform: Final Rule Issued Regarding Health Insurance Provider Fee
Beginning in 2014, a health insurance provider fee applies to covered entities engaged in the business of providing health insurance for United States health risks. United States health risks include the health risk of a U.S. citizen or a resident alien including those living abroad. Thus, insurers issuing expatriate policies covering a U.S. citizen or resident alien living abroad are subject to the fee. Medical, dental and vision carriers in the insured marketplace are subject to this fee. This fee does not apply to self-insured employer-sponsored plans. Click the link below to download the bulletin. Final Rule Issued Regarding Health Insurance Provider Fee
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Relief for Vision, Dental and EAP Benefits and New Wraparound Coverage
The Departments of Labor, Treasury and HHS issued a proposed rule that provides helpful guidance regarding certain excepted benefits, including vision benefits, dental benefits, employee assistance programs (EAPs) and certain wraparound programs. Click the link below to download the bulletin. Relief for Excepted Benefits-012414R
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Health Reform: Final Regulations Issued on Employer Penalty
On February 10, 2014, the IRS released final regulations implementing the Employer Shared Responsibility provision under the Affordable Care Act (ACA) for 2015 (the “employer penalty”). This guidance is lengthy and provides helpful clarification in many areas. We are in the process of reviewing the guidance, but you will find some key aspects of this rule below: The employer penalty will apply to employers with 100 or more full-time equivalent employees starting in 2015. For employers with 50-99 full-time equivalent employees, there is a one-year delay and the employer penalty provision will start in 2016. Click the link below to download the bulletin. Final Regulations Issued on Employer Penalty – 021114R
Continue ReadingHusband & Wife 2 Person Groups No Longer Eligible for Group Coverage
Effective January 1, 2014 for new business and as existing groups renew thereafter, Husband and Wife only and Partner only businesses are no longer eligible for Small Group coverage. There are differences on how each state* will handle immediate family members who are also employees. Sole Proprietors Sole proprietors, owners and their immediate family members forming a business are not considered employees and may only buy insurance through the Individual Marketplace. Sole proprietors reporting on Schedule C cannot form a group health plan without having at least one non-spouse common-law employee.** * The FFM states (e.g., NJ, PA, DE) will abide by the above within the SHOP (Small Group Exchange Marketplace). In… Read More
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How Does The Individual Mandate Work?
Beginning January 1, 2014, taxpayers (with certain limited exemptions) will be assessed a tax for any months during which they or their dependents lack minimum essential coverage. An individual has three choices: (1) qualify for an exemption, (2) get minimum essential coverage (with or without government assistance if under the Exchange), or (3) pay the individual mandate. Click here for the full story
Continue ReadingSHOP 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
Continue ReadingIBC: 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
Continue ReadingHealth 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
Continue ReadingNJDOBI 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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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.
Continue ReadingMedicare: 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
Continue ReadingTotal 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
Continue ReadingPPACA 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
Continue ReadingProdigy 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
Continue ReadingEMA 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
Continue ReadingIBC 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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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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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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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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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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