The following question came to us recently from a small group client. Send us your question and we may use yours in the future! Question: Are we able to give a signing up bonus to encourage employees to sign up for health insurance or will that be an issue with health care reform? Answer: An employer may provide bonuses at its discretion as long as the amount is reported as taxable compensation. Federal law prohibits employers from providing incentives to certain employees (such as Medicare-eligible persons) to discourage them from enrolling for group health coverage, but there is no prohibition against incentives to encourage enrollment. The bonus would be taxable compensation… Read More
Continue ReadingHealth Care Reform: 2016 Cost-Sharing Limits, Reinsurance Fee,and Other Changes Related to the Exchange
On February 27, 2015, the Department of Health and Human Services (“HHS”) changed cost-sharing and transitional reinsurance program fee limits and released standards for health insurers and the Exchange (a.k.a. the Health Insurance Marketplace). This article identifies a few items of note for employers. 2016 Cost-Sharing Limits, Reinsurance Fee, and Other Changes Related to the Exchange – 040915R
Continue ReadingHealth Advocate: Medical Health Advisor
Total Benefit Solutions, Inc now offers the Medical Health Advisor benefit! Watch this short video and ask us how your organization can benefit from offering this personal health advocate service to your employees!
Continue ReadingTotal Benefits Partners With Primepay for ACA Compliant Reporting Services
Employer Reporting Requirements and Forms: Total Benefit Solutions Inc. has partnered up with PrimePay for affordable care act reporting. Click the to download the ACA reporting requirements grid that includes a handy link to the required forms including the IRS reporting flyer and the 1095-B and 1095-C forms . ACA Reporting Requirements About Primepay-Total Benefit Solutions Ask your Total Benefit Solutions Account Manager today for more information (215)355-2121
Continue ReadingRelief for Small Employers Reimbursing Individual Policies
An employer cannot offer employees cash to reimburse the purchase of an individual policy, whether or not the employer treats the money as pre-tax or post-tax to the employee. Such arrangements (called “employer payment plans”) are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. These arrangements may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). Click the link below to read the bulletin: Relief for Small Employers Reimbursing Individual Policies – 031915R
Continue ReadingFinal FMLA Rules Regarding Same-Sex Spouses
The DOL amended the regulatory definition of “spouse” under the Family and Medical Leave Act (“FMLA”) so that “spouse” for purposes of FMLA rights includes a same-sex spouse, regardless of where the employee and spouse live. This means the “place of celebration” will determine whether an individual is a “spouse” under FMLA. This change is effective March 27, 2015. Current FMLA regulations use a “state of residence rule,” recognizing a spouse under the law of the state in which the couple resides. Click here to download the bulletin: Final FMLA Rules Regarding Same-Sex Spouses
Continue ReadingHow do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?
Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross have a unique ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More
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New tax form for individuals with coverage from the Health Insurance Marketplace
Beginning in January 2015, the Health Insurance Marketplace Health and Human Services will be issuing a new 1095-A tax form to individuals who purchased coverage through the Health Insurance Marketplace. If you or anyone in your household enrolled in a health plan through http://www.healthcare.gov you should receive the new tax form in the mail. You should use this form when filing your 2014 federal income tax return. For more information visit www.IRS.gov/ACA or www.healthcare.gov/taxes or contact your tax advisor. The following publications are also available: Health Care Law: What’s New for Individuals & Families This is a large publication with many details. 3 Tips: The Marketplace and taxes Regarding your tax forms and… Read More
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Updated Healthcare Reform Calculators
Total Benefit Solutions Inc. has updated our healthcare reform calculators on our website, http://www.totalbenefits.net Calculators include: How much tax credit is my small group eligible for? What are the conditions required to get the tax credit? Pay or Play Mandate penalty-What is my risk as a group? Individual Subsidy Calculator Click here to get to our healthcare reform calculators.
Continue ReadingHR 360: How to Calculate Pay or Play Penalties
HR 360: How to Calculate Pay or Play Penalties: Make sure you are ready for 2015 with our basic step-by-step guidance on calculating pay or play penalties. This attorney-reviewed guide, provided by our partner HR360, makes it easy to understand how to calculate ACA penalties. HR360 is provided as a service to Total Benefit Solutions clients. If you have any additional questions regarding this bulletin, or the Affordable Care Act, please contact your Total Benefit Solutions account manager at (215)355-2121 Download How to Calculate Pay or Play Penalties
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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required
On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members? Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… Read More
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IBC: Important information about member outreach for IRS reporting
From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More
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Additional requirements for 90-day waiting period
Additional requirements for 90-day waiting period Group health plans and health insurance issuers cannot impose waiting periods greater than 90 days. This 90-day waiting period is effective for plan years beginning on or after January 1, 2014. It does not apply to HIPAA Excepted Benefits or retiree-only plans. These regulations allow for a one-month orientation period to determine if the employee is eligible for health coverage. Once the employee is determined eligible, he or she must receive health benefits in no more than 90 days. The start date of an eligible employee, marks the beginning of the one-month maximum orientation period. The orientation period is determined by… Read More
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Total Benefit Solutions Introduces New Individual Health Plan Private Exchange
Total Benefit Solutions is proud to announce that our newest development, in partnership with RX health is now available. Our new site, the Total Benefit Solutions Exchange can help consumers compare, choose and enroll on a new health insurance plan either on the healthcare marketplace or off. It can help find your subsidy, secure it and get enrolled! https://totalbenefits.rxhealthinsurance.com/Shopping/14/1/ Log on today, get enrolled and stay legal!
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
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IBC: Individual customers will receive a communication to prepare for open enrollment this week
From Independence Blue Cross & Amerihealth: Individual customers will receive a communication to prepare for open enrollment this week Independence Blue Cross (Independence) will be sending letters to individual customers to remind them about 2015 Open Enrollment dates, inform them how they can prepare now, and let them know we will send additional details in the coming weeks. Each letter will include a list of upcoming health insurance meetings they can attend, along with a card that will make it easier for them to keep track of their enrollment information. These letters will include the agent’s name and phone number, and encourage individuals to contact their agent with questions.… Read More
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Health Reform: CMS finalizes auto-enrollment process for current Marketplace consumers
CMS finalizes auto-enrollment process for current Marketplace consumers CMS finalized its policy regarding how current Health Insurance Marketplace individual customers will renew their plans in 2015. Individuals who do not make an active 2015 plan selection will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year. Individuals are encouraged to return to the Marketplace to determine their current and accurate 2015 premium tax credit or cost-share reduction financial assistance. Click here to read the entire release. As always if you have any questions, concerns or need assistance enrolling, contact your Total Benefit Solutions ACA… Read More
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Health Reform: Eligibility for the SHOP Marketplace
Eligibility Requirements for the SHOP Marketplaces In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP. To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible employee on payroll Have 25 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year). While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP… Read More
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Health Reform: Eligibility Programs
Medicaid, CHIP, and the Affordable Care Act The Affordable Care Act significantly streamlines the eligibility standards and enrollment processes for Medicaid. It also offers a new opportunity for states to expand Medicaid to all adults ages 19 – 64 with household MAGI at or below 138% of the FPL. States have the option to expand Medicaid eligibility to this new eligibility group. This is known as “Medicaid expansion.” Through Medicaid expansion, the Affordable Care Act provides new opportunities for adults in some states to be covered by Medicaid. However, some states have chosen not to expand Medicaid eligibility to these income levels. Even if a state did not expand Medicaid,… Read More
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IBC: New Cost Care Estimator
Independence Blue Cross (Independence) is excited to announce the addition of the Care Cost Estimator (CCE) to our consumer transparency tools. The new online CCE tool will help educate members about covered services, treatment options, and anticipated out-of-pocket costs as they apply to their specific health plan. The CCE tool is available at www.ibxpress.com beginning on September 12, 2014, for PPO members who have migrated to our new operating platform. For customers who have not yet migrated, the CCE tool will become available to PPO members on your renewal date, in conjunction with the migration. To access the CCE tool, members must log in to their account at www.ibxpress.com, where they… Read More
Continue ReadingHealth Reform: Guaranteed Renewability
Guaranteed Issue and Guaranteed Renewability The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called “guaranteed issue.” Coverage offered through and outside the Marketplaces may restrict guaranteed issue coverage to certain enrollment periods. Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This… Read More
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Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace
‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More
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Health Reform: Small Business Health Care Tax Credit
Small Business Health Care Tax Credit Many small businesses are eligible for the Small Business Health Care Tax Credit to assist with the cost of health insurance coverage. To qualify, businesses must: Have an average of fewer than 25 FTE employees (based on a 40 hour work week and excluding owners, owners’ family members, and seasonal employees) Have average annual employee wages below $50,000 (augmented to reflect cost-of-living adjustments (COLA) as of 2014) (business owner salaries are not included in this calculation) Pay a uniform percentage or amount (at least 50%) of the cost of single coverage of each employee’s health insurance The tax credit is generally available only for… Read More
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HR360: Employers Must Provide Exchange Notice at Time of Hiring
Employers are required to provide an Exchange Notice (also referred to as a “Notice of Coverage Options”) to each new employee at the time of hiring as of October 1, 2013. For 2014, the notice can be provided within 14 days of an employee’s start date. Click below to read the bulletin from HR360: HR360_notice at time of hiring If you have any questions about the HR360 subscription, or exchange notices, please contact your Total Benefit Solutions account manager at (215)355-2121.
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Health Reform: Certain Affordable Care Act Provisions Will No Longer Apply to U.S. Territories
The Department of Health and Human Services (HHS) notified U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) that the following Affordable Care Act provisions will no longer apply to insured plans sitused in the territories. Please click the link below to read the entire bulletin. Certain ACA Provisions Will No Longer Apply to U.S. Territories-082614R If you have any further questions please contact your Total Benefit Solutions account manager at (215)355-2121.
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