Health Reform: SHOP Marketplace Changes for 2015

Health Reform: SHOP Marketplace Changes for 2015 In 2014, small businesses that offer coverage through an FF-SHOP Marketplace are able to offer their employees a single qualified health plan (QHP). In 2015, small businesses that offer coverage through an FF-SHOP Marketplace may be able to offer their employees a choice of QHPs and qualified dental plans (QDPs). 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 common-law employee on payroll Have 50 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… Read More

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Health Reform: What is a Special Enrollment Period?

Special Enrollment Periods Under certain circumstances, individuals may enroll in a QHP or change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events or special circumstances. Events that permit an SEP include: Gaining or becoming a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care Gaining status as a citizen, national, or lawfully present individual Loss of coverage (e.g., loss of Medicaid eligibility, QHP no longer available), except if enrollment is terminated based on failure to pay premiums, fraud, or enrollee initiated termination Determination that an individual is newly eligible or ineligible for advance payments of the premium tax… Read More

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Health Reform: ACA Checklist for 2015/2106

Health Reform: Affordable Care Act Business/Plan Sponsor Checklist for 2015/2106   This bulletin features a checklist, including descriptions of key topics, to guide you through Affordable Care Act compliance in 2015-2016. Click the link to download the ACA Checklist: ACA Checklist for 2015-2016-082214R Should you have any questions, please contact your Total Benefit Solutions Inc., account manager directly at (215)355-2121.

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Health Reform: 2015 Annual Open Enrollment Period

Annual Open Enrollment & Effective Dates The annual open enrollment period (AEP) for 2015 begins on November 15th 2014 and ends on February 14th 2015. The open enrollment period is the time when you can change, or purchase a new qualified health plan (QHP) on a guaranteed enrollment basis. You do not need a special election period, or a life change event to enroll during the annual open enrollment period. The chart below illustrates the effective dates for enrollments taken during the annual open enrollment period.             Effective Dates for 2015 Annual Open Enrollment Period

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FMLA Proposed Rules To Recognize Same Sex Regardless of Residency

FMLA Proposed Rules To Recognize Same Sex Regardless of Residency  The DOL is proposing to amend the regulatory definition of  “spouse” under the Family and Medical Leave Act (“FMLA”) so that “spouse” for purposes of FMLA rights would include 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, rather than the current rule which uses the “state of residence,” which recognizes a spouse under the law of the  state in which the couple resides. Click the link to download the bulletin: 070714-P-ERC-FMLA_Proposed_Rules (1) Please contact you Total Benefit Solutions account manager at (215)355-2121 if… Read More

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IRS: Further Guidance on Employer Payment Plans

New Guidance on Employer Payment Plans The IRS issued an FAQ addressing the potential consequences of an arrangement where an employer reimburses employees for the purchase of individual health insurance premiums on a tax-favored basis (referred to as an “employer payment plan”). For this purpose, individual health insurance premiums includes individual coverage purchased either inside or outside of the Health Insurance Marketplace. The FAQ follows up on earlier guidance describing these types of arrangements (Notice 2013-54). Click the link for more information: 060214_P_ERC_Employer_Payment_Plans (1)

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Horizon: Changes to 2015 MOOP’s

Changes to Maximum Out-of-Pocket Limits Under the Affordable Care Act (ACA), all non-grandfathered group health plans regardless of size or funding arrangement, must comply with annual limits on out-of-pocket maximums for in-network covered services that are Essential Health Benefits (EHB)1. These out-of-pocket maximums are also known as a plan’s maximum out-of-pocket (MOOP). Click the link to download the full notice: Changes_to_MOOP_Limits Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.

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Exchange Notification Reminder

Exchange Notification Reminder  The very busy renewal date of December 1, 2014, is fast approaching. This notice is to remind you that each employer group must give their employees a Marketplace (Exchange) notification.       The first link below is for employer groups that currently do offer coverage. The second link below is for an employer that does NOT offer coverage to employees.  Please remember this notification is for the states of Pennsylvania and New Jersey. The form also works for any employer who is based in an FFM (Federal Facilitated Marketplace) State. It is NOT compliant in NY, MD or any other state that provides their own State… Read More

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Will you get financial help when you purchase health insurance?

Will you get financial help when you purchase health insurance?   This handy new brochure from Humana is simple to understand. Download it today for a better understanding of your situation. You may qualify for help buying your health insurance. As always, contact us at Total Benefit Solutions Inc if you have any questions or concerns. We can be reached at (215)355-2121. Click here to download

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What is HR360?

What is HR360? HR360 is the premier online human resources library that features the most current federal and state laws for health care reform, COBRA, FMLA, and hiring and terminating employees. Clients of Total Benefit Solutions have HR360 as a complimentary resource. Watch this short video below and ask us today for your free trial membership, or how your organization can benefit from using Total Benefit Solutions Inc., and HR360. Call us for more information at 1(800)924-6718.

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U.S. Supreme Court Contraceptive Ruling

In a 5-4 decision that was described by one of the dissenting Justices as a “decision of startling breadth”, the Supreme Court has ruled in Burwell v. Hobby Lobby Stores, Inc. that closely held for-profit corporations are not compelled to provide contraceptive coverage under the Affordable Care Act’s preventive care mandate if they object to that coverage on religious grounds. The decision is a “win” for Hobby Lobby who had challenged the contraceptive mandate saying it forced them to either violate their faith or pay fines.   Click here to download the bulletin

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Health Care Reform Updates: Updated Model COBRA Election Notice

    Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice  is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces).   COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

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Clarification on IBC Pharmacy Changes

A number of clients have asked about changes to the IBC pharmacy network. Based on these questions we have found out that indeed there are a few. The changes are related specifically to Walgreens and Rite Aid. The changes only affect the following customers: Clients who have chosen one of the Bronze plans Clients who have enrolled on one of the proactive suite of plans. Rite Aid and Walgreens are not in network for these customers. We asked IBC for further clarification and we received this from a previous press release: Starting in 2014, IBC will introduce a new pharmacy network called the FutureScripts Preferred Pharmacy Network. This network is… Read More

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Introducing the AFLAC Individual Dental Plans

  Introducing AFLAC Individual Dental     Ask us today for more informtion on an AFLAC Individual Dental plan. Just call our office at (215)355-2121 and a dedicated member of our client service team will be happy to answer your questions or send you detailed benefit information.

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What is Hospital Indemnity?

Hospital Indemnity Plans as a “wrap” Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”. A group Hospital Indemnity plan can fit the bill and provide a comprehensive financial support plan for a family dealing with a medical crisis. It also allows the employee to make a more prudent health plan selection by giving them coverage for any large deductibles, co-pays or cost sharing scenarios. Hospital Indemnity plans are available to individuals too. Download more information on Shelterpoint’s Hospital Indemnity plan   Below is a… Read More

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IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

From Health Care Reform Digest: Since the IRS and Treasury published Notice 2013-54 in September 2013, pre-tax employer reimbursement of an employee’s individual health insurance premiums has been a hot topic of conversation.  Historically, many employers have provided this type of benefit in lieu of offering a group health plan – a strategy that now needs to be reevaluated as a result of regulations implementing the Patient Protection and Affordable Care Act (PPACA).   Q1.  What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health… Read More

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Comparative Effectiveness Fee Reminder

The Comparative Effectiveness Research Fee is now known as the Patient-Centered Outcomes Research Institute (PCORI) Fee. The Patient Protection and Affordable Care Act (the Act) imposes a new Patient-Centered Outcomes Research Institute (PCORI) fee, formerly the comparative effectiveness research fee, on plan sponsors and issuers of individual and group policies. The first year of the fee is $1 per covered life per year, the second year the fee adjusts to $2 per covered life and then it’s indexed to national health expenditures thereafter until it ends in 2019. Click here to download this bulleting regarding the timely payment of the fees.   Purpose of the Fee The assessed fees are to… Read More

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19th Set of FAQ’s Released on Affordable Care Act

Frequently asked questions (“FAQs”), prepared jointly by the Departments of Labor (“DOL”), Health and Human Services (“HHS”), and the Treasury (collectively, the “Departments”),were issued with respect to various Affordable Care Act (“ACA”) requirements, including their effect on COBRA and CHIPRA notices…Topics Include:   Updated COBRA And CHIPRA Notices Out-Of-Pocket Maximum Requirements Generic Drugs Balance Billing Reference-Based Pricing Coverage Of Preventive Services Health FSA Carryover And Excepted Benefits Effect of Carryover on Excepted Benefits Determination Summary Of Benefits And Coverage   Click here to download the bulletin from our partners at Emerson Reid.  

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Informal Guidance Clarifies Rules HSA Eligibility and Health FSA Carryovers

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. One of the outstanding questions around the carryover provision is the effect it has on HSA eligibility. Recently, the Office of Chief Counsel for the Internal Revenue Service issued a memorandum that informally addresses the interaction of the carryover on HSA eligibility and provides some solutions that may allow an individual retain… Read More

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Calculator May Help Small Businesses Determine SHOP Eligibility

Calculator May Help Small Businesses Determine SHOP Eligibility   The U.S. Department of Health & Human Services has developed a Full-Time Equivalent (FTE) Employee Calculator to help small employers determine whether they qualify for the Small Business Health Options Program (SHOP).   Background SHOP is available as an option for qualified small employers to purchase employee health coverage. The federal government is running the program in states that chose not to operate their own SHOP Marketplace (Exchange). For 2014, employers are generally eligible to purchase health coverage through the federally-facilitated SHOP Marketplace if they have 50 or fewer full-time equivalent employees (FTEs), including part-time employees. (For example, 2 part-time employees… Read More

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Aetna: Important updates to our Pennsylvania Small Group eligibility guidelines

This briefing is applicable to all brokers writing Pennsylvania based employers We have updated our eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates we have outlined below. We thank you for your continued collaboration. The following applies to Small Group Pennsylvania new business and renewals: The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner. Sole proprietors, owners… Read More

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IBC: Individual Dental and Vision PPO’s Now Available!

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More

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SHOP for Small Group Customers Buying a plan through SHOP versus direct

SHOP for Small Group Customers Buying a plan through SHOP versus direct   Buying plans through the Small Business Health Options Program, or SHOP, provides an advantage only for employers with fewer than 25 employees that are eligible for a tax credit provided by the Affordable Care Act (ACA). If customers are not eligible for this tax credit, there is no advantage to purchasing a plan through SHOP. This is because… Click here to download the SHOP bulletin

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IBC: Tobacco Status Important Questions and Answers

Why does IBC collect member-level information about tobacco use? Under the Affordable Care Act (ACA), premium rates for health insurance coverage in the individual and small group markets may be based on family size, geography, age and tobacco use. In order to follow with this guideline and accurately rate each group, Independence Blue Cross (IBC) collects member-level tobacco use information to create group premiums for new and renewing group customers. Click the link below to download the IBC document that covers the most common questions about rating tobacco users in small group in PA. Tobacco Status For Small Group Customers Flyer

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HR360: Job Description Builder

HR360: Job Description Builder A well-developed job description will help you review employee performance, and hire the best candidates. Our online Job Description Builder is so simple to use. With our efficient tool, you can transform a blank page into a professionally-developed job description in minutes. Just follow these simple steps: Choose from our comprehensive library of job descriptions Check off tasks and activities as well as skills associated with the job Select from the list of physical demands or the job/ work environment or add your own. Print out a complete job description in Word or in an Excel Spreadsheet—it’s that easy!   HR360 is a web based subscription service… Read More

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