#healthinsurance – Total Benefit Solutions Inc

Highmark – Important Update Regarding Plan Availability on External Enrollment Platforms

August 29, 2025August 29, 2025Ed MacConnell

At Highmark, we value the trust you place in us and are committed to providing timely and transparent information. As we look ahead to 2026, we want to inform you that we are adjusting plan availability on external quoting and enrollment platforms. This decision has been carefully considered to ensure that our broker partners are prioritizing plans that offer a long-tenure with Highmark. Further details regarding our 2026 plan offerings will be shared as we approach AEP. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are… Read More

Trump Administration Issues Final Rule Impacting the ACA’s Marketplace

August 12, 2025August 29, 2025Loramei Romeo

On June 25, 2025, the U.S. Department of Health and Human Services (HHS) published a final rule to implement newstandards for the Affordable Care Act’s (ACA) Marketplaces (or Exchanges). According to HHS, improper Exchangeenrollments, enabled by weakened verification processes and expanded premium subsidies, have triggered “widespreadfraud.” The final rule’s changes are intended to address these problems with the goal of improving health care affordabilityand access while maintaining fiscal responsibility. Key ChangesMany of the final rule’s changes are effective 60 days after its publication date, or Aug. 25, 2025, although some provisionshave a later effective date. Also, some changes are temporary measures that sunset at the end of the 2026 plan… Read More

Navigating PCORI Fees for Self-Insured Health Plans and HRAs

August 5, 2025August 4, 2025Loramei Romeo

The Affordable Care Act (ACA) imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). The IRS has provided this helpful chart for more information on whether a type of insurance coverage or arrangement is subject to the fee. Note that self-insured health plans include health reimbursement arrangements (HRAs) and level-funded arrangements. This fee applies to policy or plan years ending on or after October 1, 2012, and before October 1, 2029. Self-insured plan sponsors can satisfy their compliance obligations by completing and filling FORM 720, with its accompanying 720-v payment voucher. Although… Read More

Discover key insights from the recent Medicare Advantage hearing!

August 1, 2025Loramei Romeo

Medicare advantage (MA) has experienced a fast growth in the last few years, which has created a significant opportunity for Congress to upgrade the program to better serve beneficiaries, especially in rural areas. With over half of Medicare beneficiaries now enrolled in MA plans, these individuals enjoy lower healthcare costs, access to supplemental benefits, and improved health outcomes compared to traditional fee-for-service Medicare. Recent hearings have focused on strategies to enhance these benefits while ensuring program integrity and fiscal responsibility. Strengthening Medicare Advantage will not only improve health outcomes for seniors but also provide value for American taxpayers. Therefore, it is crucial to conduct a thorough examination of the program.… Read More

Cigna Healthcare Medicare has officially rebranded to HealthSpring.

July 23, 2025Loramei Romeo

In March 2025, the Cigna Healthcare Medicare business was acquired by Health Care Service Corporation. As Cigna Healthcare Medicare navigates this change, their focus remains on providing continuity and trust in the Medicare options you rely on. They are dedicated to renewing their brand while ensuring the same exceptional products and benefits you have come to expect. The HealthSpring brand is a well-respected name, that reflects Cigna’s commitments to providing quality benefits. With nearly a century of experience, HealthSpring signifies Cigna’s Healthcare Medicare mission to empower members to lead vibrant and healthy lives. By integrating with reputable brands, Cigna Healthcare Medicare ensures that their members receive the best support in… Read More

Stay informed on health legislation like PA Act 1 & HRSA cancer screening coverage!

July 21, 2025July 23, 2025Loramei Romeo

The recent PA state legislation, Act 1, marks a significant advancement in women’s healthcare by mandating health plans to cover supplemental diagnostic radiology services and genetic screenings for those at increased risk of breast cancer and BRCA mutations. This legislation is designed to eliminate out-of-pocket costs for these essential health services, ensuring that women who need these screenings can access them without financial barriers. In response to recent legislative changes, Independence Blue Cross has updated its coverage policies to eliminate cost-sharing for annual supplemental breast cancer screenings and genetic testing for those at increased risk. This change is vital in improving access to preventive care for individuals concerned about breast… Read More

Attention: The coverage for OneTouch diabetic supplies ends August 3

July 11, 2025July 11, 2025Loramei Romeo

As of August 3, significant changes will occur regarding preferred diabetic testing supplies for Medicare Advantage plans. LifeScan OneTouch@ products will no longer be covered, and Ascensia Contour products will be introduced as a new preferred option effective June 1, 2025. Members will still have access to a selection of preferred brands with a $0 copay, including multiple Accu-Chek and Contour products such as: Member that are currently using LifeScan OneTouch supplies will soon receive an important letter from UnitedHealthcare, outlining new options and the need for updated prescription. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance… Read More

Exiting news! Prior authorization reforms are set to simplify health insurance.

June 27, 2025June 26, 2025Loramei Romeo

On June 23, 2025, health insurance plans revealed significant commitments aimed at simplifying and streamlining prior authorizations for better care access. These initiatives are built on existing efforts to enhance patient connections to necessary care while reducing the administrative burden on healthcare providers. Such changes promise to improve overall patient experience and access to evidence-based treatments, aligning with the industry’s goal of delivering affordable healthcare. In line with state and federal regulations, new commitments across insurance segments aim to enhance health coverage for 257 million Americans. The six key commitments focus on : These steps are crucial for improving the overall health insurance landscape and fostering better patient experiences. We… Read More

Big changes to Medigap plans start January 1, 2026!

June 12, 2025June 18, 2025Loramei Romeo

Attention to all current Medigap groups: As of July 1, 2025, new enrollments for MedigapSecurity and 65 Special products will no longer be accepted. It is crucial for future retirees to be aware that they will need to transition to a MedigapFreedom product. As we approach 2026, it’s essential for businesses and retirees to understand the upcoming changes to Medigap enrollment. If your Medigap group renewal dates fall between January 1 and June 1, 2025, you can continue enrolling future retirees into MedigapSecurity or 65 Special throughout 2025. However, starting January 1, 2026, any future retiree from an existing group will need to select from the MedigapFreedom products. As we… Read More

The 2025 PCORI Fee is on the horizon!

June 10, 2025July 21, 2025Loramei Romeo

The recent reauthorization of PCORI fees by the Federal Government will continue to support the Patient-Centered Outcomes Research Institute through 2029. These fees play a crucial role in funding vital health research, which helps inform healthcare decisions and improve patient outcomes. As a reminder, the fee associated with your health plan is due by July 21, 2025. This deadline is crucial as it follows the calendar year immediately after the end of the applicable plan year. Staying compliant with these deadlines is essential for effective health insurance management. For plan years ending on or after October 1, 2023, and before October 1, 2024, the fee will be $3.22 multiplied by… Read More

What It Takes to Stay Balanced While Running a Business

June 9, 2025May 29, 2025Loramei Romeo

Running a small business might be the most exhilarating decision you’ve ever made, but no one tells you it’s also an emotional woodchipper. Deadlines, payroll, unpaid invoices, looming tax forms — the pressure doesn’t clock out when you do. And the worst part? Most of the stress feels invisible, yet it colors every interaction, every strategy session, every hour of sleep you don’t get. But you don’t have to white-knuckle it through madness. There are ways to claw back a little peace. Maybe not perfect peace, but enough to make it through Thursday without screaming into a closet. Prioritize Self-Care Let’s start with the basics, the stuff you already know… Read More

Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

June 6, 2025June 4, 2025Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… Read More

Tax Favored Accounts Summary Page

June 5, 2025May 23, 2025Loramei Romeo

Cafeteria Plans (Section 125 Plans)

June 2, 2025May 23, 2025Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

How will Aetna’s departure affect ACA exchanges?

May 19, 2025Loramei Romeo

Aetna’s decision to withdraw from the Affordable Care Act (ACA) marketplaces in 17 states by the end of 2025 raises questions about the stability and future of these exchanges. While it’s uncertain if other carriers will follow Aetna’s lead, the history of the ACA marketplace has been marked by a dynamic pattern of exits and entries. We understand that navigating the ever-changing regulations and economic challenges can be daunting for consumers seeking health insurance. The future of health insurance exchanges is uncertain, which is why it’s crucial to emphasize policy stability and market adaptability. The ACA exchanges play a vital role in providing access to health insurance, but they do… Read More

IRS just announced the 2026 Health Savings Account Contribution Limits

May 12, 2025May 7, 2025Loramei Romeo

As we look ahead to 2026, it’s important to understand the new contribution limits for health plans. The self-only contribution limit has increased to $4,400, while the family limit is now $8,750. Additionally, the annual deductible for high-deductible health plans has also seen increases, with self-only coverage now requiring a deductible of at least $1,700 and family coverage at $3,400. Staying informed about these changes is crucial for optimizing employee benefits and promoting financial well-being. How is your organization adapting to these new health plan regulations? We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121… Read More

ACA Individual Market Highmark

May 8, 2025May 6, 2025Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

May 6, 2025May 6, 2025Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

Small Shifts, Big Impact: Simple Strategies to Elevate Your Overall Well-Being

May 5, 2025May 1, 2025Loramei Romeo

Feeling your best—inside and out—doesn’t always require a drastic overhaul. Sometimes, the smallest shifts in daily habits can yield the biggest results. The goal isn’t to chase perfection but rather to create a sustainable routine that fosters both physical and mental wellness. From the way you start your mornings to ensuring you have the right safety nets in place, every choice you make contributes to your overall well-being. Here are a few simple yet powerful strategies to help you feel more energized, balanced, and at peace with yourself. Begin Your Day with Purpose Mornings set the tone for the rest of your day, and a chaotic start can leave you… Read More

Next Year Cost for Pennie Customers May Increase

April 29, 2025April 29, 2025Loramei Romeo

Pennie has announced that enrollees receiving advance premium tax credits will likely face higher costs in 2026 due to the expiration of enhanced federal tax credits at the end of 2025. This change will result in increased monthly premiums for most enrollees unless Congress acts to extend these credits. Pennie is committed to keeping customers informed through various communications, including postcards, emails, and text messages, to help them understand the upcoming changes and find the lowest costs on high-quality health coverage. The enhanced tax credits, introduced in 2021, have provided significant financial savings, but their expiration means reduced savings for many enrollees starting January 2026. We are dedicated to providing… Read More

Price Transparency Rules Addressed in New Executive Order

April 14, 2025April 3, 2025Loramei Romeo

On February 25, 2025, Executive Order 14221 was signed, enhancing health care price transparency rules. This order builds on previous regulations by requiring actual prices for health care services, standardizing pricing data reporting, and strengthening enforcement policies. Employers with fully insured plans must ensure their carriers comply, while those with self-funded plans should contract with third-party administrators to meet disclosure requirements. The new guidance is expected by May 26, 2025, and employers should prepare to update service agreements accordingly. Have Questions? and want to read more about the changes click New Executive Order Addresses Price Transparency Rules for more details. We are dedicated to providing exceptional service, so please do… Read More

South Jersey Radiology is in the Clover Network

April 11, 2025April 11, 2025Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025. New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

Benefits 101 Comparison HSAs HRAs FSAs

April 4, 2025April 3, 2025Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Stretching Your Healthcare Dollars

April 2, 2025April 3, 2025Loramei Romeo

Enhancing the security of member portal registrations

March 28, 2025March 25, 2025Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

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