Medicare Part D Notification Requirements

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drugcoverage provided under the plan is “creditable” or “noncreditable.”This notification must be provided prior to October 15th each year. Also, following the plan’s annualrenewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. Employers should send these notices no later than October15, 2021 if they haven’t done so already. Have questions about this notice? Contact your Total Benefit Solutions Inc health insurance specialists at (215)355-2121. Click here to download Medicare Part D Notification Requirements  

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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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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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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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How To Find a Doctor You Trust

How to Find a Doctor You Trust Get a list of in-network providers: Call your insurance company or look at their plan materials for a list of doctors in their network. You’ll usually pay less to see a doctor in your network than a doctor who’s out-of-network. You can also call your Broker and they can help assist you in getting the names of Doctors near you that accept your plan. Do your research: Ask friends and family if they recommend their doctors. You may even be able to read online reviews for doctors in your area. Online reviews are a great way to gauge things such as bedside manner and wait… Read More

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“I’m paying for Health Insurance I don’t even use!”

You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick!  You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More

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Important Info! HSA Limits for 2019

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IBC 2019 Member Renewal Notices

October 25th: Independence Blue Cross Member Renewal Letter details Due to the subsidy disruption in some counties, Independence will be sending renewal notices in 2 waves. On October 25th 2018: • Members who do not receive a subsidy will receive their renewal notices for 2019. The notice will include benefit and premium updates for 2019 and provide a personalized URL for a website that enables them to renew plans as-is (EZ Button), or make a change to their current plan. • Members who have a subsidy will receive a letter advising that Independence is waiting for more information from the federal government regarding their subsidy dollars. Upon receipt of this information, the renewal notices will be sent.… Read More

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End of Summer Social Media Drive 2018

Please help us get the word out on social media in August & September You Could Win a $25-$100 Amazon Gift Card!!! While everyone is getting ready for the End of Season BBQs, gearing up for Back-to-School, and trying to fit in as much adventure as possible the next few weeks, we here at Total Benefit Solutions are getting ready for our busiest time of year: Open Enrollments! Your friends and family members may not be concerned with the open enrollment period.. YET, but it is quickly approaching and we’d like to help them! As always, We appreciate all the referrals and recommendations that we get online from everyone, but we… Read More

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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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The IRS Code has numerous provisions designed to help employers

Employer Strategies and Solutions to Substantially Reduce:   the high cost of Health Insurance; the cost for Out-of-Pocket Medical Expenses; the cost for Dependent Day Care Expenses; the cost for Parking and Transit Expenses; cost of Self-Employed Healthcare Expenses; Employer Matching Payroll Taxes by 8%; Employee Income Taxes by 30%. The IRS Code has numerous provisions designed to help employers provide essential benefits to their employees tax-free. This saves the employee approximately 30% in income taxes on expenses they’re already paying for, and because the employees have reduced their taxable income, the employer realizes a reduced matching payroll tax liability of approximately 8%. Everybody saves money. To take advantage of… Read More

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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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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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Breaking News: CMS Announces Open Enrollment Dates and More

CMS issued final rule to increase choices and encourage stability in health insurance markets for 2018 The Centers for Medicare & Medicaid Services (CMS) issued the final Market Stabilization rule to help lower premiums and stabilize individual and small group markets, and to increase choices for Americans. Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits.*  The CMS rule is designed to provide some relief for patients and issuers now. “CMS is committed to ensuring access to high quality affordable healthcare for all Americans and… Read More

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Stand-Alone HRAs for Small Employers are Back!

Stand-Alone HRAs for Small Employers are Back! The 21st Century Cures Act, signed by President Obama on December 13, 2016, gave small employers a means of providing employees help with their individual insurance premiums and other out-of-pocket qualified medical expenses without violating the provisions of the Affordable Care Act (ACA). Small employers can now provide a specific kind of Health Reimbursement Arrangement (HRA) to help employees with the costs of individual health coverage. According to the statutory language under “Title XVIII – Other Provisions” of the Act, qualified small employer health reimbursement arrangements (QSEHRAs) are not considered “group health plans” and do not have to adhere to ACA market reforms,… Read More

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Trump’s First Executive Order Addresses the ACA

  Trump’s First Executive Order Addresses the ACA On January 20, 2017, President Trump issued an Executive Order to minimize the economic burden of the Affordable Care Act (“ACA”). This Order identifies the new administration’s policy for addressing and enforcing the ACA while Congressional Republicans craft legislation to repeal and replace it. The Order directs the agencies responsible for administration and enforcement of the ACA to exercise the authority and discretion available to them: Download Trump’s First Executive Order Addresses the ACA As always please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any additional questions or concerns.

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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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Update on the Status of the ACA

Update on the Status of the ACA With the impending inauguration, recent actions by the Senate and some confusing media reports, we wanted to provide a short Q&A to help you understand current events and what to expect as we head down the health care reform road in 2017… What’s the latest news? Download the bulletin for an update: Download Update on the Status of the ACA   As always please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121 if you have any questions or concerns.

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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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