guidance health insurance self insured HRA – Page 3

Guidance Issued on Emergency Period Expiration

April 24, 2023April 24, 2023Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below. It is possible that FAQ 58 will be updated to reflect new dates. The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.** On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

Horizon BCBSNJ Updated COVID-19 Resource Guide

April 11, 2023April 11, 2023Ed MacConnell

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

Independence: Wellness Guidelines for all ages

March 29, 2023March 24, 2023Ed MacConnell

Your health and wellness are important. That’s why we provide you with these wellness guidelines to help you and your family stay healthy. The wellness guidelines are a summary of recommendations from the U.S. Preventive Services Task Force and other nationally recognized sources. We encourage you to take the time to review these guidelines. Use them as a starting point for conversations with your and your family’s health care providers. Your health care provider may recommend alternatives to the information outlined in these wellness guidelines based on your specific needs and the history of health or illness in your family

Did You Know? Cigna + Oscar plans in Pennsylvania offering you a simple, non-tiered network?

March 21, 2023March 21, 2023Ed MacConnell

That’s right! ? Cigna + Oscar plans in Pennsylvania utilize Cigna‘s Open Access Plus Network. Offering you a simple, non-tiered network. This includes facilities you know and use, such as: View the full Pennsylvania network here. Please contact your health insurance specialists at Total Benefit Solutions, Inc iat (215)355-2121 f you have any further questions or concerns about Oscar heath!

How to activate your OSCAR account

March 11, 2023March 9, 2023Ed MacConnell

We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your ﬁngertips .

Medicare Advantage plans denying more inpatient claims

March 10, 2023February 23, 2023Ed MacConnell

MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More

Individual Coverage HRA: Choice and affordability in employee health benefits

March 6, 2023March 3, 2023Ed MacConnell

How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More

ACA coverage rule for dependents up to age 26

March 4, 2023March 3, 2023Ed MacConnell

One of the most notable changes brought about by the Affordable Care Act (ACA) is the ACA coverage rule for dependents up to age 26. Employers offering health care plans to employees must include this extended coverage. Purpose of the ACA coverage rule for dependents up to age 26 The ACA extended the eligibility for a child to be covered under a parent’s health plan from (usually) age 21 and if a full-time student to age 26 regardless of student status. The goal is to provide peace of mind to parents and their young adult children during a time in life when the dependent is likely to be completing their… Read More

Get Your FSA, HRA, HSA Health Accounts Comparison Chart

February 19, 2023February 19, 2023Ed MacConnell

What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!

Broker Change Leads to Better Results

February 15, 2023February 15, 2023Ed MacConnell

Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner… Read More

CIGNA transitioning to digital ID cards

February 13, 2023February 7, 2023Ed MacConnell

By July 2024, Cigna is planning to fully transition from physical ID cards to digital ID cards. Eligible medical, dental and vision clients with an April 1, 2023, May 1, 2023, and June 1, 2023 new and renewal effective date will be notified of this change on Feb. 7, 2023. We’re excited to announce that we’re transitioning to digital ID cards, so you will no longer automatically receive a physical ID card in the mail. With a digital ID card you never have to worry about losing or misplacing your card(s) again. It’s always right there on myCigna, whenever you need it.* Log in to myCigna.com® or the myCigna® App to get… Read More

1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients

February 12, 2023February 9, 2023Ed MacConnell

Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.

Emergency Periods Related to COVID-19 to End May 11 2023

February 10, 2023February 7, 2023Ed MacConnell

On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read More

ACA: Special Election Cheat Sheet

February 9, 2023February 9, 2023Ed MacConnell

Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 http://www.totalbenefits.net

Between jobs? Aging out of a family policy? Waiting for Open Enrollment?

February 1, 2023January 24, 2023Ed MacConnell

A Short Term Medical plan might be right for you. Short Term Medical plans let you decide how much coverage you want and for how long, with individual and family options available. And you can enjoy quality of life benefits like telemedicine and discounts on a variety of everyday items and services through an Association membership (varies by state). Short Term Medical plans offer plenty of flexibility: Questions about a short term medical plan? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Important information about these plans THESE PLANS PROVIDE LIMITED BENEFITS For complete limitations & exclusions by state for Short Term Medical insurance, click here. Plan… Read More

What is Stop Loss Coverage?

January 26, 2023January 23, 2023Ed MacConnell

Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read More

Independence: New drugs added to precertification list for 2023

January 25, 2023January 25, 2023Ed MacConnell

Effective January 1, 2023, from Independence Blue Cross: (Independence) IBC will add 12 drugs to the list of specialty drugs that require precertification under the medical benefit. With these additions, Independence now requires precertification for a total of 271 drugs before members can receive coverage for them. The drugs being added include several gene replacement therapies and cancer/antineoplastic agents in the U.S. Food and Drug Administration (FDA) pipeline, as well as several biosimilars that recently received FDA approval. The newly added drugs are: beremagene geperpavec* – gene replacement/gene editing therapiesCimerliTM (ranibizumab‑eqrn) – ophthalmic agentsElahereTM (mirvetuximab soravtansine) – antineoplastic agentsFylnetra® (pegfilgrastim‑pbbk)† – neutropeniaHemgenix® (etranacogene dezaparvovec) – gene replacement/gene editing therapies mosunetuzumab* – antineoplastic agents Skysona® (elivaldogene autotemcel) – gene replacement/gene editing therapiesStimufend® (pegfilgrastim‑fpgk)† – neutropeniatofersen* – amyotrophic lateral sclerosis agents tremelimumab* – antineoplastic agentsVegzelma® (bevacizumab‑adcd)† – antineoplastic agentsZynteglo® (betibeglogene autotemcel) – gene replacement/gene editing therapies We often add drugs… Read More

woman walking on pathway while strolling luggage

Did you know that Total Benefit Solutions, Inc does Travel Health Insurance?

January 8, 2023January 8, 2023Ed MacConnell

A record number of Americans traveled abroad in 2016 for leisure, business, study abroad and missionary work- to the tune of 67 million. Given recent epidemics, natural disasters and security threats around the world- coupled with your run-of-the-mill medical issues- travelers have more reason than ever to ensure their health and safety are fully insured prior to embarking on their trips. Americans are dedicating more and more time to preparing for their trips and researching the coverage options available to them, and with good reason. What Will a Good Travel Medical Policy Do for You? Travel medical insurance policies are designed to pick up where your primary domestic health plan… Read More

Total Benefit Solutions Inc., In The News!

January 5, 2023January 5, 2023Ed MacConnell

Ed MacConnell, who runs employee benefits firm Total Solutions, Inc. in Feasterville, believes that the emergency payment feature could potentially be used for unforeseen medical expenses

Get assistance with your PENNIE health insurance account

October 31, 2022August 16, 2022Ed MacConnell

Already on the health insurance Marketplace and need some help? Assigning Total Benefit Solutions, Inc is easy! Download the document and follow the steps. We will get notified and start helping you right away! Need more direction? Give us a call (215)355-2121

Independence: What are Preventative Plus Providers?

October 17, 2022Ed MacConnell

Preventive Plus Preventive Plus providers are participating freestanding ambulatory surgical centers (ASC) and a select group of gastroenterologists and colorectal surgeons who perform preventative colonoscopy for colorectal cancer screenings at a freestanding ASC. For certain plans, the Member’s cost-share for this service will be $0 when performed by Preventive Plus providers. Please refer to your benefits booklet or contract to determine if your plan includes the Preventive Plus benefit. For updated or more detailed information regarding Preventive Plus providers, visit our website at ibx.com/provider finder, or call Customer Service at 1-800-ASK-BLUE (1-800-275-2583), Monday through Friday, 8 a.m. to 6 p.m. ET For further questions or concerns please contact your Total… Read More

National General/Allstate Welcome Packet

October 10, 2022October 10, 2022Ed MacConnell

Considering Level funding and/or reference based pricing for your group health insurance? Download the brochure below to learn more about it them contact your health insurance specialists at Total Benefit Solutions, Inc today to compare your current plan to level funded and reference based pricing options! The brochure includes information on reading an EOB, Vitality and the healthcare blue book as well. As always we can be reached at (215)355-2121.

Health Insurance Shopping Is Confusing!

October 10, 2022August 22, 2022Ed MacConnell

The professionals at Total Benefit Solutions, Inc are here to help you find the right coverage for you or your small business! our health insurance experts Are certified, licensed and experienced to help you deal with ACA plans (Obamacare), Medicare supplements, short term medical and small group health plans too! Call us today at (215)355-2121.

Final Rules Adopt Administrative Changes to the No Surprises Act

September 26, 2022September 22, 2022Ed MacConnell

On August 26, 2022, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) published final rules on the No Surprises Act, making changes to the administrative duties of insurance carriers, HMOs, third-party administrators, out-of-network healthcare providers, and certain other entities responsible for the Act’s implementation. The new rules, which take effect on October 25, 2022, are narrow in scope, and include the following changes:• During processing of claims under the No Surprises Act, if “down-coding” occurs (i.e., the group medical plan alters or replaces the medical billing codes chosen by the out-of-network healthcare provider, resulting in a lower claim payment), then the final rules impose… Read More

Turning 26: Your Guide to Health Insurance

September 23, 2022Ed MacConnell

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

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