On June 21, 2016, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) issued the 32nd Affordable Care Act (“ACA”) FAQ describing information that may be appropriate to include with COBRA notices. Many wondered if it were appropriate to provide information and if so, what kind of information could be provided about the Health Insurance Marketplaces/Exchanges (“Marketplaces”) so that COBRA-eligible individuals could consider health coverage alternatives available through the Marketplaces and possibly investigate whether they may be eligible for premium tax credits and cost-sharing reductions. Click the link to download the entire bulletin
Continue ReadingTotal Benefits & Healthiest You
Healthiest You is more than a typical Teledoc benefit. Whenever members have questions or they are simply not feeling well, they can effortlessly connect to a 24×7 telehealth hotline for the diagnosis and treatment of illness, second opinions and consultations. They have board-certified, licensed physicians in every state waiting to provide exceptional care. They can even prescribe medication and save a trip to the doctor’s office, whether members are at home or on the road. Want more information? Click here to see the site.
Continue ReadingCritically Important: Insurance for Serious Illness
Good news: You’ve got health insurance (at least, all Americans are required to or pay a penalty). Bad news: It doesn’t cover everything. Especially if something really bad happens, like a heart attack or stroke. Yes, a decent major medical plan will cover many of the health-related expenses related to a serious illness. But you’d likely still be left with significant out-of-pocket costs for deductibles and copayments. Medical insurance also doesn’t usually cover other related costs, such as travel to treatment centers, child care during absences or recovery, home modifications or rehabilitation charges. And if you lose income while you’re unable to work, you could have a tough time paying… Read More
Continue ReadingTotal Benefit Solutions: New Starmark Self Insured Plans for Small Groups
Total Benefit Solutions is proud to announce that we are now appointed with Starmark to provide affordable and predictable self insured medical plans to small businesses. Starmark® administers self-funded health benefit plans exclusively for smaller businesses nationwide. Employers choose from extensive plan design choices to create a self-funded health plan to meet their unique needs and budget, while stop-loss insurance from Trustmark Life Insurance Company provides protection against large covered claims. Click Here To View A Client Testimonial Click here for more information and to watch a short video about these products and how your organization might benefit from a self insured plan.
Continue ReadingIBC Breaking News: Changes to SEP On-Exchange Verification Process
Changes to SEP On-Exchange Verification Process Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including: Loss of minimum essential coverage Change in primary place of living Birth Marriage Adoption, placement for adoption, placement for foster care, or child support or other court order Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within… Read More
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Notice of Subsidies in the Federal Marketplace
The Affordable Care Act (“ACA”) requires each Health Insurance Marketplace (“Marketplace”) to notify any employer whose employee was determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not: • enrolled in employer sponsored coverage, or • eligible for employer coverage that is affordable and meets minimum value requirements. In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin issuing these notices to employers. State-based Marketplaces began this notification process in 2015. Click the link to download the complete bulletin. Download Notice of Subsidies in the Federal Marketplace
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Medicare and Employer Coverage
From the Medicare Rights Center download this excellent Q&A about Medicare Coverage, the guidelines and how it may or may not integrate with employer coverage. Part-2-QA-Current-Employer-Insurance Have more questions about Medicare and your employer coverage? Call your Total Benefit Solutions, Inc account manager today at (215)355-2121. Learn more on Medicare Interactive.
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2017 Inflation Adjusted Amounts for HSAs
The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2017. Most limits remained the same as 2016 amounts. Click the link below to download the bulletin. 2017 Inflation Adjusted Amounts for HSAs
Continue ReadingHealth Care Reform: 8 things the IRS wants small employers to know about the health care tax credit
The Affordable Care Act’s small business health care tax credit is designed to encourage small employers to offer health insurance coverage to their employees. Click the link below to download the whitepaper 8 things the IRS wants small employers to know about this credit: 8 Things to Know About the Small Business Health Care Tax Credit For more information about the Small Business Health Care Tax Credit contact your Total Benefit Solutions, Inc account manager at (215)355-2121 or visit your ThinkHR library at www.thinkhr.com and log in. Watch a video below about the Small Business Healthcare Tax Credit
Continue ReadingObama administration backs off on ACA rules for 2017 health plans
CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry. Click here for the full story from Modern Healthcare As always, please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about the Affordable Care Act.
Continue ReadingGAO Report: PPACA- CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014. The GAO applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though GAO sent fictitious documents, or no documents, to resolve application inconsistencies Click here for the highlight sheet Click here for the full report
Continue Reading2016 Federal Poverty Guidelines Updated
Large employers may be subject to the employer penalty under the Affordable Care Act if they do not offer affordable, minimum value coverage to all full-time employees and at least one full-time employee receives a subsidy in the Exchange. The Federal Poverty Line (“FPL”) is relevant to this penalty in two ways. Please click the link below to download the bulletin with he new guidelines. 2016 Federal Poverty Guidelines If you have any additional questions regarding this bulletin, or the Affordable Care Act please contact your Total Benefit Solutions, Inc account manager at (215)355-2121.
Continue ReadingHow do I appeal a Marketplace decision?
You can request an appeal of any Marketplace decision, including decisions about Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions Your eligibility for an exemption from the penalty for not having health insurance Untimely (late) notice from the Marketplace about a decision To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons… Read More
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New Guidance Tackles Employer Mandate Issues
A number of Employer Mandate updates are included in this bulletin. Please click on the link to download this important update. As always please contact your Total Benefit Solutions, Inc account manager if you have any questions or concerns regarding this release at (215)355-2121. Download Update:Employer Mandate Issues 2016
Continue Reading2015 Compliance Compilation
The attached resource file is a compilation of all of our compliance bulletins for 2015 provided by our business partners at Emerson Reid and your benefits support team. Click the link below to download the entire 2015 compilation: 2015 Compliance Compilation
Continue ReadingNew Qualified Transit and Parking Guidance
The Consolidated Appropriations Act, 2016 (the “Act”) permanently changed the pre-tax transit benefits to be at parity with parking benefits. As a result, the Act retroactively increased the 2015 transit benefits from $130 to $250. For 2016, the transit and parking pre-tax benefits are $255. Click the link below to read the entire bulletin. New Qualified Transit and Parking Guidance – 012216R
Continue ReadingIRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA
IRS Extends Employers’ and Insurers’ Reporting Deadlines Under the ACA On December 28, the U.S. Treasury and Internal Revenue Service announced a limited extension of the early 2016 due dates for the 2015 information reporting requirements for employers and insurers under the ACA. This is the first year that employers and insurers are required to report certain information about health coverage to employees, other individuals to the IRS. Specifically, employers will have two additional months beyond the February 1 due date to provide individuals forms for reporting on offers of health coverage and the coverage provided. The deadlines to report this information to the IRS are extended by three… Read More
Continue Reading2016 Health Insurance Open Enrollment Begins
2016 Individual and Family Plans Open Enrollment for 2016 Open enrollment opens on November 1st 2015 and ends on January 21st 2016. As the 2016 Open Enrollment Period gets ready to explode, we will be updating this page regularly with plan benefits, rates and information as they become available. Remember Total Benefit Solutions dedicated, licensed, certified and insured representatives can help anyone enroll on the healthcare Marketplace, or off! Full Service Client Intake Form: Click here to get started. This is not an application for insurance. This form will provide the information that is needed to determine Marketplace eligibility and must be entered on Healthcare.gov We understand that Health Care… Read More
Continue ReadingHealth Reform Video: What Counts as Income in the Marketplace?
What Counts as Income when applying for a Marketplace subsidy? This short video may help: As always contact your Total Benefit Solutions account manager at (215)355-2121 for help applying for a subsidy and health plan on or off the Marketplace.
Continue ReadingSmall Group Definition Changes Per the PACE Act
On Wednesday, October 7, 2015, President Obama signed into law H.R. 1624, the Protecting Affordable Coverage for Employees (PACE) Act, legislation that will give states the ability to define the size of a small group for health insurance purposes. The law repeals the mandated small group expansion of groups of up to 50 employees to groups of up to 100 employees that was to go into effect on January 1, 2016. This law gives states the flexibility to determine the size of their small group market instead of being forced into the national standard. No action is needed if states want to retain their respective definition. There is no announcement… Read More
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Health Reform: PACE Act halts small group expansion
In what only be called good news for employers with 50-99 employees, On October 7, 2015, the President signed into law bipartisan legislation, the Protecting Affordable Coverage for Employees (“PACE”) Act, which maintains the “50 or fewer” definition of a small employer. The PACE Act contains language that permits a state to use the expanded small group definition (employers with 100 or fewer employees). At this point, it is unclear whether states will retain the “50 or fewer” definition or opt to expand the small group market. Click here to view The PACE Act Halts Small Group Expansion Bulletin As always please contact your Total Benefit Solutions account manager at (215)355-2121… Read More
Continue ReadingTotal Benefit Solutions Introduces the All Check Compliance Tool!
Total Benefit Solutions, Inc. in partnership with Benefit Mall introduces All Check! Want to know how to easily calculate your FTE’s ( Full Time Equivilents)? Not sure if you need to provide the Notice of Exchange? Unsure about your Health Care Tax Credit Eligibilty? Want to get an idea what your overall ACA compliance obligations might be? Let Total Benefit Solutions and All Check do the work. How? It;s simple. Download the input sheet, complete and return to your Total Benefit Solutions, Inc account manager and we will crunch the numbers and send you a customized report just like the sample! Click Here to Download The Input Sheet Sample_ComplianceReport.2147.21136.20150903 … Read More
Continue ReadingKey Facts You Need to Know About: Cost-Sharing Reductions
A recent analysis shows that more than 2 million marketplace enrollees who are eligible for cost-sharing reductions (CSRs) are foregoing this extra level of financial assistance by enrolling in plans that do not qualify. Consumers can receive CSRs only if they enroll in a silver level plan through their marketplace. Many of those who chose not to receive CSRs are likely enrolling in bronze plans with lower premiums but higher out-of-pocket costs. It’s important to communicate the benefits and trade-offs of receiving CSRs to the consumers you are assisting, especially those with significant health care needs. To learn more about cost-sharing reductions, check out this helpful resource from the Center on Budget… Read More
Continue ReadingVideo: Are you eligible for a special enrollment period?
You might think that you have to wait for the annual open enrollment period to get enrolled. Think again! You may be eligible for a special enrollment period. Watch this short video to learn more, and then call us at (215)355-2121!
Continue ReadingEBN: Small Employers look to Alternative Funding Solutions
In the wake of the health care reform, alternative funding solutions for health benefits continue to gain traction among small to mid-size groups. Pending changes to small group rules in January 2016 are driving demand for the funding solutions. Most prominently, groups with 50-100 employees will be subject to community rating legislation that governs how rates are developed and the type of coverage offered. Most states are also changing the definition of employee to the federal full-time employee definition, broadening the scope to include union employees that may have been excluded under previous small employer definitions. Here’s how the new rules will affect small to midsize groups, including potential financial impact, solutions available to mitigate… Read More
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