Notice Requirements for Group Health Plans

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

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Fully Insured vs Level Funding: What’s the Difference?

With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More

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Annual Out-Of-Pocket Maximum Adjustments Announced for 2023

On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For more information contact your friends at Total Benefits Solutions! Reach out to us at (215)355-2121

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Additional Guidance Addresses ACA Preventive Care Mandate

As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying severalAffordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans. As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing. Click the link below to download the bulletin. As always contact your health insurance specialists at Total Benefit Solutions, Inc if you have any additional questions or concerns (215)355-2121 https://www.totalbenefits.net

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Independence is covering OTC COVID‑19 test kits through pharmacy benefits

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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

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How is COBRA health insurance affected if I am disabled?

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AmeriHealth New Jersey prepares to comply with new Transparency requirements

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