HR 360: How to Calculate Pay or Play Penalties: Make sure you are ready for 2015 with our basic step-by-step guidance on calculating pay or play penalties. This attorney-reviewed guide, provided by our partner HR360, makes it easy to understand how to calculate ACA penalties. HR360 is provided as a service to Total Benefit Solutions clients. If you have any additional questions regarding this bulletin, or the Affordable Care Act, please contact your Total Benefit Solutions account manager at (215)355-2121 Download How to Calculate Pay or Play Penalties
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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required
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
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IBC: Important information about member outreach for IRS reporting
From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More
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Additional requirements for 90-day waiting period
Additional requirements for 90-day waiting period Group health plans and health insurance issuers cannot impose waiting periods greater than 90 days. This 90-day waiting period is effective for plan years beginning on or after January 1, 2014. It does not apply to HIPAA Excepted Benefits or retiree-only plans. These regulations allow for a one-month orientation period to determine if the employee is eligible for health coverage. Once the employee is determined eligible, he or she must receive health benefits in no more than 90 days. The start date of an eligible employee, marks the beginning of the one-month maximum orientation period. The orientation period is determined by… Read More
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Total Benefit Solutions Introduces New Individual Health Plan Private Exchange
Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!
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Health Reform: Guidance Issued-Employer Reimbursement of Individual Policies
Previously, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (collectively, the “Departments”) explained that HRAs and employer payment plans cannot reimburse individual policies. On November 6, the Departments issued their twenty-second set of FAQs which make clear that: An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether the employer treats the money as pre-tax or post-tax to the employee. Such arrangements are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. Such… Read More
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Health Reform: Healthcare.Gov Sneak Preview
Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121
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Total Benefit Solutions is your Marketplace Navigator
What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
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IBC: Individual customers will receive a communication to prepare for open enrollment this week
From Independence Blue Cross & Amerihealth: Individual customers will receive a communication to prepare for open enrollment this week Independence Blue Cross (Independence) will be sending letters to individual customers to remind them about 2015 Open Enrollment dates, inform them how they can prepare now, and let them know we will send additional details in the coming weeks. Each letter will include a list of upcoming health insurance meetings they can attend, along with a card that will make it easier for them to keep track of their enrollment information. These letters will include the agent’s name and phone number, and encourage individuals to contact their agent with questions.… Read More
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Health Reform: CMS finalizes auto-enrollment process for current Marketplace consumers
CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More
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Health Reform: Eligibility for the SHOP Marketplace
Eligibility Requirements for the SHOP Marketplaces In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP. To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible employee on payroll Have 25 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year). While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP… Read More
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IBC: New Cost Care Estimator
Independence Blue Cross (Independence) is excited to announce the addition of the Care Cost Estimator (CCE) to our consumer transparency tools. The new online CCE tool will help educate members about covered services, treatment options, and anticipated out-of-pocket costs as they apply to their specific health plan. The CCE tool is available at www.ibxpress.com beginning on September 12, 2014, for PPO members who have migrated to our new operating platform. For customers who have not yet migrated, the CCE tool will become available to PPO members on your renewal date, in conjunction with the migration. To access the CCE tool, members must log in to their account at www.ibxpress.com, where they… Read More
Continue ReadingHealth Reform: Guaranteed Renewability
Guaranteed Issue and Guaranteed Renewability The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called “guaranteed issue.” Coverage offered through and outside the Marketplaces may restrict guaranteed issue coverage to certain enrollment periods. Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This… Read More
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Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace
‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More
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Health Reform: Broker Handling of Confidential Tax Information
Agent and Broker Handling of Federal Tax Information Federal Tax Information (FTI) is classified as confidential and may not be used or disclosed except as expressly authorized by the Internal Revenue Code, which may require written consent of a taxpayer in certain situations. As an agent or broker operating in an Individual Marketplace, it is possible that we may encounter FTI when assisting with eligibility appeals. If you are an agent or broker and also a tax return preparer or work closely (e.g., share an office) with a tax return preparer (even if a small number of clients) we are subject to the tax return preparer disclosure rules set forth… Read More
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Health Reform: Network Adequacy Standards
Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More
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What is Small Group Defined Contribution-Private Exchange Solution?
What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans. In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More
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Amerihealth NJ: Effective Immediately Ending Spousal 2 Person Groups
We received this e-mail today without any further guidance.: EFFECTIVE IMMEDIATELY: C-Corp Owner/Spouse orEmployee/Spouse groups no longer eligible for small group coverage. AmeriHealth New Jersey will no longer accept or renew Owner/Spouse or Employee/Spouse groups, including C Corporations. If you have any questions, please contact your AmeriHealth New Jersey broker representative. Click the link below to download the entire message. Amerihealth 2 person groups notification
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Dental Plans: United Concordia Will Now Offer one of the Country’s Largest Networks
United Concordia Will Now Offer one of the Country’s Largest Dental Networks United Concordia, Dental Network of America®, LLC and DenteMax®, LLC have entered into a network sharing agreement to provide greater access and deeper discounts to our members and clients. This agreement will take effect for United Concordia for 2015 business. Click here to read more…
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Health Reform: Certain Affordable Care Act Provisions Will No Longer Apply to U.S. Territories
The Department of Health and Human Services (HHS) notified U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) that the following Affordable Care Act provisions will no longer apply to insured plans sitused in the territories. Please click the link below to read the entire bulletin. Certain ACA Provisions Will No Longer Apply to U.S. Territories-082614R If you have any further questions please contact your Total Benefit Solutions account manager at (215)355-2121.
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Health Reform: Treatment of Interns for Employer Penalty Purposes
If large employers do not offer affordable, minimum value coverage to all “full-time employees” they can be penalized beginning in 2015. A full-time employee (“FTE”) is an employee under the common law standard who works on average at least 30 hours per week, determined monthly. Under the common law standard, an employment relationship exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only as to the result to be accomplished by the work, but also as to the details and means by which that result is accomplished. Under this standard, an employment relationship exists… Read More
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Health Reform: SHOP Marketplace Changes for 2015
Health Reform: SHOP Marketplace Changes for 2015 In 2014, small businesses that offer coverage through an FF-SHOP Marketplace are able to offer their employees a single qualified health plan (QHP). In 2015, small businesses that offer coverage through an FF-SHOP Marketplace may be able to offer their employees a choice of QHPs and qualified dental plans (QDPs). To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible common-law employee on payroll Have 50 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per… Read More
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Health Reform: What is a Special Enrollment Period?
Special Enrollment Periods Under certain circumstances, individuals may enroll in a QHP or change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events or special circumstances. Events that permit an SEP include: Gaining or becoming a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care Gaining status as a citizen, national, or lawfully present individual Loss of coverage (e.g., loss of Medicaid eligibility, QHP no longer available), except if enrollment is terminated based on failure to pay premiums, fraud, or enrollee initiated termination Determination that an individual is newly eligible or ineligible for advance payments of the premium tax… Read More
Continue ReadingTop 3 Consumer Worries About 2015 Open Enrollment
With open enrollment 2015 for individual health insurance coming up in November, employees and clients are worried about the cost of health insurance, the number of uninsured, and Marketplace glitches. This is according to a new survey by Bankrate.com. Click here to read the story on the Zane Benefits website.
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