If Pennie Customers Missed the Deadline to Enroll Because of COVID-19 Impacts – They Now Have Until January 31st to Enroll!

Pennie understands that many Pennsylvanians have been impacted recently due to the increase of COVID-19 cases. Because of this, we would like to offer Pennie customers a Special Enrollment Period (SEP) if they experienced any of the following: The customer, or a member of their household, tested positive for COVID-19 within the fifteen (15) days prior to, and including, the January 15, 2022 open enrollment deadline. The location where the customer accesses services necessary to enroll, such as a public library or a community center with internet access, was closed due to COVID-19 within the fifteen (15) days prior to, and including, the January 15, 2022 open enrollment deadline. The customer could not… Read More

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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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Supreme Court Ends Vaccination Emergency

In a 6-3 decision issued on January 13, 2022, the Supreme Court reimposed a legal stay that prevents OSHA from enforcing its vaccination Emergency Temporary Standard(ETS). And while the matter is being sent back to the 6th Circuit Court of Appeals for further review, the conclusions drawn by the Court almost certainly means the end of the ETS. What does this mean for employers?Employers will no longer have to comply with the ETS, which means that they will now have greater latitude to decide what COVID-related practices are best for their workplaces.   Download Supreme Court Effectively Ends OSHA Vaccination Emergency   As always feel free to contact your Total… 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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What is a missing tooth clause?

It’s estimated that 69% of adults from 35 to 44 years old have lost at least one permanent tooth. When a person loses a tooth — whether because of a severe cavity, mouth injury, or another issue — a dentist can replace it with a dental implant, bridge, crown, or dentures. These procedures are considered “major” by most dental insurance companies, meaning they’re more costly (both for them and the member) than a routine cleaning or even a filling.  Under a dental plan with a missing tooth clause, insurance won’t cover the cost of the replacement procedure if the tooth was extracted or fell out before the current coverage began for… Read More

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Additional Medicare Tax for High Earners

Employers are required to withhold an Additional Medicare Tax at a rate of 0.9% on wages or compensation paid to anemployee above the following threshold amounts for the employee’s filing status:   Filing Status Threshold Amount Married Filing Jointly $250,000 Married Filing Separately  $125,000 Head of Household (with qualifying person)Single  $200,000 Qualifying Widow(er) with dependent child $200,000              Click below to read the rest of the details including Employer notices. As always if you have any questions please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 Download Additional Medicare Tax for High Earners

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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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Final 2021 Instructions for Forms 1094-C and 1095-C Issued

  The IRS released final Instructions for Forms 1094-C and 1095-C for calendar year 2021 reporting. Background Applicable large employers (“ALEs”) must furnish Form 1095-C to full-time employees and file Form 1094-C and all 1095-Cs with the IRS. ALEs offering a self-insured group health plan must also furnish Forms 1095-C to covered employees or other primary insured individuals in the self-funded health plan (e.g., covered part-time employees, COBRA qualified beneficiaries). ALEs, in coordination with their payroll or other reporting vendors, should have records to determine each employee’s status as an ACA FTE or not an ACA FTE for each month during 2021 in preparation to complete, furnish and file these… Read More

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Build Back Better Legislation Includes Benefit Provisions

During the last week of October 2021, the Biden administration announced a new framework for the budget reconciliation package, known as the Build Back Better Act (H.R. 5376). Subsequently, the U.S. House of Representatives released the legislative text and a section-by-section summary of the new framework. The legislation is still being negotiated, and the timing for when a vote is expected is uncertain. If the proposed legislation is enacted into law in its current form, the following provisions would have notable impacts on employer-sponsored health and welfare benefit programs. Increased employer contributions to avoid penalties under the ACA employer mandate The 9.61% affordability percentage for 2022 would be reduced to 8.5% (with… Read More

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Winter Action Plan to Battle COVID-19

On December 2, 2021, the Biden administration issued a nine-pronged plan to combat COVID-19 as the winter months approach and the new Omicron variant poses risk of new infections. The plan covers: Boosters for adults Vaccinations to protect children and keep schools open Expanded free at-home testing International travel protections Workplace protections Rapid response teams to battle rising cases Supplying treatment pills to help prevent hospitalizations and death Continued commitment to global vaccination efforts Steps to ensure preparation for all scenarios Aspects of this plan will affect employers and group health plans, as follows: Expanded free at-home testing. The Departments of Labor, Health and Human Services, and the Treasury (collectively, the… 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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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

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How is COBRA health insurance affected if I am disabled?

  In certain circumstances, if a disabled individual  and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months.  The criteria for this 11-month disability extension is a complex area of COBRA law.  We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at phig@cms.hhs.gov. In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee’s employment hours.  Second, the covered employee must be determined under title II or title XVI of the… 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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Dental & Vision Plans for Families

  Getting a quality dental plan when you are self employed or don’t have employer coverage can be a real challenge.  But don’t worry! The professionals at Total Benefit Solutions, Inc work for your benefit! We have provided this easy to use online portal to help you shop, compare and enroll on a great plan of your choice!  We can walk through the options with you or you can enroll on the portal on your own, whatever you choose! Questions about these dental benefits? Just give us a call (215)355-2121.  Click here to find and compare dental and vision plans!   

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What Are Medicare Guaranteed Issue Rights?

Guaranteed Issue Rights (Also Called “Medigap Protections”)  are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a  Medicare Advantage Plan (Part C)  and still buy a Medigap policy if you change… 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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Medicare Supplement Plan F or G?

  Many of our clients ask what is the “best” Medicare supplement that they can buy. While there is no overall “best”, the Medicare Supplement Plan F is generally considered the most comprehensive coverage among Medicare supplements due to the fact that most services are covered without any member co-pay or cost sharing at all. Keep in mind that Medicare supplements, like Plan F do not cover prescriptions and that a beneficiary with Medicare supplement will need to have other coverage for prescription drug coverage.  A little known fact about Medicare supplements is that they do not have an annual “open enrollment” period so a beneficiary with a supplement can… Read More

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AmeriHealth New Jersey prepares to comply with new Transparency requirements

From Amerihealth NJ: Health care and health insurance are among the most regulated industries in the U.S., making compliance a crucial requirement for success. AmeriHealth New Jersey has a strong track record of compliance to local, state, and federal guidelines, and we are working to comply with the new Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) requirements. We have been focused on transparency for our members for years, and we are now further sharpening our efforts related to transparency and accountability pertaining to the recent legislation for which we have developed an enterprise-wide implementation program to ensure requirements are met. We have a cross-functional team that is… Read More

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UHC: Watch – Understanding The No Surprises Act and 2021 Consolidated Appropriations Act

Experts from UnitedHealthcare recently updated self-funded health plan sponsors and consultants on The No Surprises Act, and related compliance requirements, including: Consumer price transparency Mental health parity Implications and obligations for plans sponsors, including qualified payments, health plan ID cards, advanced EOBs and potential impact of out-of-network utilization and independent dispute resolution UHC: Understanding The No Surprises Act and 2021 Consolidated Appropriations Act – Presentation & Materials

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HHS Extends Public Health Emergency until October 18, 2021

  On July 19, 2021, the Secretary of Health and Human Services (“HHS”), announced that the administration will renew the COVID-19 pandemic Public Health Emergency, scheduled to expire on July 20, 2021. This will once again extend the period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. As previously noted, in a letter sent to state governors, HHS indicated that the agency expects that the Public Health Emergency will likely remain in place for all of 2021. While not formal agency action, it appears that HHS intends to continue to renew the Public Health Emergency through, at least, the end… Read More

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COBRA Subsidy Termination Notice Reminder

AEIs must be provided with a notice of expiration of the COBRA subsidy between August 16 and September 15, 2021. The notice must explain the date that the premium assistance will expire and that the individual may be eligible for coverage without any premium assistance through COBRA, a group health plan, the Marketplace, or Medicare/Medicaid.

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