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 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 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
Continue ReadingHealth Reform: Reduction in Hours First Lawsuit is Filed by Employees
The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R
Continue ReadingAetna: TV Commercial “Aetna works for my life”
Enjoy the latest TV Commercial from Aetna. Remember, Aetna is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if Aetna has a plan that’s a good fit for you.
Continue ReadingWho can use the SHOP Marketplace?
What is the SHOP? The Small Business Health Options Program (SHOP) Marketplace helps small businesses provide health coverage to their employees. The SHOP Marketplace is open to employers with 50 or fewer full-time equivalent employees (FTEs), including non-profit organizations. You can enroll in SHOP at any point throughout the year. Click the link below to download a handy “who can” to see if your business or organization can use or benefit from the SHOP. As always please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions about the SHOP or any Affordable Care Act concerns. Click here to download “WHO CAN USE THE SHOP”
Continue ReadingHealth reform: CMS releases SHOP HOW-TO video for employees
CMS releases SHOP video for employees The SHOP enrollment for employees video has been posted by CMS. Please keep in mind that the employer group needs to be set up on the SHOP first. Please contact your Total Benefit Solutions, Inc account manager if you have any questions about setting your organization up as a SHOP employer. Total Benefit Solutions, Inc is a certified SHOP independent broker. Click the video below to watch the video.
Continue ReadingDownload our Mid-Year Compliance Bulletin Compilation
Our Mid-year Compliance Bulletin Compilation is now available, featuring all of our released compliance bulletins for January through June. This document acts a resource for you to have all of the latest health reform information and updates in one place. You can click on a bulletin title in the table of contents and it will bring directly to the corresponding page. Click the link below to download the document. 2015_Compliance_Compilation_mid_year
Continue ReadingIBC Updated List of Proactive Hospitals
Download the document to get the latest list of Keystone Proactive hospitals and their tier assignment. The document also has a link to the most up to date IBC list online. Download the 2015 Keystone Proactive Hospital List
Continue ReadingHealth reform: Breaking News-Supreme Court Upholds Affordable Care Act Subsidies
Obamacare lives on after Supreme Court ruling – CNN.com Washington (CNN)Obamacare has survived — again. In a major win for the Obama administration, the Supreme Court held in a 6-3 decision that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal exchanges. Click here to read the story on CNN Click here for the live SCOTUS Blog
Continue ReadingCMS has approved applications from DE and PA to create state-based Health Insurance Marketplaces.
HR News Alert from HR360.com Brought to you by Total Benefit Solutions Inc June 17, 2015 Approval Dependent on Certain ConditionsThe Centers for Medicare and Medicaid Services (CMS) has conditionally approved applications from Delaware and Pennsylvania to create state-based Health Insurance Marketplaces.Background Exchanges (also known as Health Insurance Marketplaces) provide an option for individuals to buy private health insurance. The Exchanges also operate the Small Business Health Options Program (SHOP) as an option for qualified small employers to purchase employee health coverage. The U.S. Department of Health and Human Services (HHS) has issued final rules relating to Exchanges which include standards for their establishment and operation (among other things). The… Read More
Continue ReadingGuidance Issued on Coverage for Preventive Items and Services
Frequently asked questions (FAQs), prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury were issued on May 12, 2015 with respect to the Affordable Care Act (ACA) requirement for a non-grandfathered group health plan to provide coverage for in-network preventive items and services (including contraception)without any cost-sharing requirements, as summarized in the attached bulletin. Click here to download the FAQ bulletin
Continue ReadingReminder: PCORI Fees Due by July 31 for Employers Sponsoring HRAs and Other Self-Insured Plans
Reminder: PCORI Fees Due by July 31 for Employers Sponsoring HRAs and Other Self-Insured Plans Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due July 31 from employers that sponsor certain self-insured health plans, including health reimbursement arrangements (HRAs) that are not treated as excepted benefits. The fee, which is required under Health Care Reform, applies to plan years ending on or after October 1, 2012, and before October 1, 2019. Calculating the Fee For plan years ending on or after October 1, 2014 and before October 1, 2015, the fee for an employer sponsoring an applicable self-insured plan is $2.08 (two dollars for plan years ending on… Read More
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingGov. Wolf wants Pa. to operate Obamacare exchange
Gov. Wolf this week formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month. Read more at philly.com Remember that your Total Benefit Solutions professionals are trained, licensed, insured and available to help compare, shop and enroll all affordable care act plans on the healthcare Marketplace and off. As always contact us today if you have any questions or concerns at (215)355-2121.
Continue ReadingPPACA dropouts cut enrollment by 1.5 million
(Bloomberg) — About 1.5 million people dropped off health insurance coverage rolls this year after failing to pay for policies they picked on the Obamacare marketplaces. That left 10.2 million covered by Affordable Care Act policies as of March 31, up from 6.3 million at the end of 2014, the Centers for Medicare & Medicaid Services said today. Eighty- five percent got subsidies to help them afford coverage. Click here to read the story.
Continue ReadingFAQs Further Clarify New Embedded Out-of-Pocket Requirement
As reported earlier, starting with the 2016 plan year, the self-only annual limitation on cost sharing for non-grandfathered plans ($6,850 for 2016) applies to each individual, even if the individual is enrolled in family coverage. On May 26, 2015, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued new FAQs further clarifying this new rule, confirming that it applies to all non-grandfathered group health plans, including self-insured plans, large group health plans, and high deductible health plans. Click the link below to download the bulletin for further guidance. FAQs Further Clarify New Embedded Out-of-Pocket Requirement – 060115R
Continue ReadingCadillac Tax Preliminary Guidance: Part II
The IRS issued Notice 2015-16 to begin the process of developing regulatory guidance regarding the excise tax on high cost employer-sponsored health coverage, commonly known as the “Cadillac Tax.” Beginning January 1, 2018, a 40% excise tax will apply on the cost of applicable coverage that exceeds prescribed thresholds (described later in this article). Click the link below to download the bulletin: Cadillac Tax Part II
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