Horizon Grandmothering Extended into 2023 for Pre-ACA Plans

Horizon will once again enable Small Employer group customers that offer health plans that preceded the Affordable Care Act (“pre-ACA plans”) and renew between October 1 and December 31, 2022, to renew within those pre-ACA plans. Because we receive the highest volume of renewals during the fourth quarter, our decision to grandmother pre-ACA plans will ensure a smooth renewal process for our customers. As we near October 1, 2022, Horizon will communicate the details and dates for the renewal process. Until then, click here to learn more. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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Updated FAQ’s on the ACA and Health Insurance

Kaiser Family Foundation ‘s database of frequently asked questions is searchable by topic. Click here to view the FAQ database.

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COVID-19 Vaccines Now Available for Young Children

A recent CDC announcement recommends that children six months through five years of age should get an age-appropriate dose of the Pfizer‑BioNTech or Moderna COVID-19 vaccine. Independence covers the cost of administering vaccines and booster shots with no cost-share (such as co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given. For Medicare Advantage members, the cost and administration of the vaccine and booster shots will be covered by Original Medicare so long as the health care provider administering the vaccine participates in the Medicare program. Please click here to learn more about the COVID-19 vaccines and boosters. As always, please contact your Total Benefit Solutions Inc health… Read More

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What does ” Guaranteed Issue” health insurance mean?

Guaranteed issue A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Not all health insurance plans are guaranteed issue. Have any questions about your health insurance? Contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 http://www.totalbenefits.net

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Health Insurance Fee to be Reduced for 65% of the Self-Employed Insured

Health insurance fees for 5.61 million households, among the self-employed insured of the national health insurance, will be slashed by an average of 36,000 won per month starting September. On the other hand, 273,000 subscribers, including the elderly, who have been registered as the dependent of the employee insured and thus have not been paying health insurance premiums will have to start paying health insurance fee from September. The gist of the amendment of the health insurance scheme is to reduce the amount of health insurance fees the self-employed insured has to pay. There has been criticism that the self-employed insured has to pay a greater amount of health insurance… Read More

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Get The Most From Your Dental Benefits with Beam Benefit’s Carryover Policy

If you don’t use up your annual maximum, they don’t have to go to waste — you may be able to put them to use in the future! This means you’ll have more dollars at your disposal for dental procedures in the following years. Each year your benefits will cover a certain dollar amount in claims. When you use less than half of this maximum, a portion of it will “carry over” to the next year. This means it’s added to your annual maximum in future years. Have any questions or concerns about enrolling your group in Beam Benefit’s Dental Plan? Please contact your Total Benefit Solutions Inc health insurance… Read More

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Affordability of Health Coverage

Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More

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Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

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Delaware Enacts New Paid Family and Medical Leave Requirement

The Healthy Delaware Families Act was recently signed into law, which provides paid leave for three categories of leave: parental leave, medical leave and family caregiving leave. Employers with 10-24 employees are only subject to the parental leave provisions. Employers with 25 or more employees are subject to all leave provisions. Employers with fewer than 10 employees are not obligated to participate in the leave program, although an employer can opt-in for a 3-year participation period. Click here to download for more information. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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Health Insurance Broker Change Leads to Better Results

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

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Beam Dental Expands Benefits Portfolio, Rebrands to Beam Benefits

Beam Dental, a digitally-native employee benefits company, today announced the addition of voluntary life, accident and hospital indemnity products to its benefits portfolio. With these new products, Beam continues its evolution as a one-stop-shop for ancillary benefits and has rebranded to Beam Benefits. The change is accompanied by a refreshed brand identity and new website. Click here for more information. As always, please contact your Total Benefit Solutions Inc health insurance specialists with questions or concerns at (215)355-2121.

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Philadelphia Re-Enacts Emergency Paid Sick Leave Benefits

On March 9, 2022, the Philadelphia City Mayor signed into law an ordinance amending the city’s existing public health emergency leave requiring covered employers to provide continuing paid COVID-19 leave through December 31, 2023. The law became effective on March 9 and is the third iteration of the COVID-19 paid leave mandate. Click the link below to download the bulletin. As always for more information contact your Total Benefit Solutions group account manager at (215)355-2121

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Pennie: Losing Medical Assistance Coverage When The Public Health Emergency Comes to an End?

Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has maintained coverage for most Medical Assistance (MA) recipients unless they moved out-of-state, passed away, or requested to be disenrolled.   When the federal PHE comes to an end, anyone who is found to be no longer eligible during the renewal process for Medical Assistance or who fails to complete their MA renewal will be disenrolled from Medical Assistance coverage – that is where Pennie comes in!  Pennie and the Department of Human Services (DHS) are working to ensure that qualified Pennsylvanians can access coverage either through Medical Assistance (MA), the Children’s Health Insurance Program (CHIP), or affordable, high-quality coverage available… Read More

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Is my group subject to ERISA or ERISA Exempt?

Many clients often ask the question ” Do I need to comply with ERISA? ” The answer is almost always yes! Just because you are a smaller business does not exempt you from ERISA. This from the US Department of Labor: ERISA applies to private-sector companies that offer pension plans to employees. This includes businesses that: Are structured as partnerships, proprietorships, LLCs, S-corporations and C-corporations. No matter how your employer has structured his or her business, it is covered by ERISA if it is a private entity. Who is not subject to ERISA?In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or… Read More

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Beam Introduces Innovative, Prevention-Focused Brush Bucks Dental Plan

Beam Dental, one of the fastest-growing dental benefits providers in the country, has unveiled its new Brush Bucks plan designed to save employers and members money while providing fully covered preventative care. The plan gives employees 100% coverage for diagnostic and preventative services*, which can include routine dental cleanings, fluoride treatments, and X-rays. Each member will also receive a $150 annual maximum — called Brush Bucks — to manage unexpected costs, such as fillings, implants, and other basic and major procedures. The plan does not include a deductible. Find out more about Beam’s Brush Bucks Dental Plan here. As always, please contact your Total Benefit Solutions Inc health insurance specialist… Read More

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IRS Announces Medical Mileage Rate Increase

To offset high gas prices, on June 9, 2022, the Internal Revenue Service (IRS) announced an increase in the 2022 standard medical mileage rate for the final six months of 2022. Effective July 1, 2022, the new rate for when an automobile is used to obtain medical care is 22 cents per mile for the remainder of 2022, which is an increase from the rate of 18 cents per mile effective January 1 – June 30, 2022. Mileage to and from a medical service is generally an eligible expense under a Healthcare Flexible Spending Account, Health Reimbursement Arrangement, or Health Savings Account. Click here to learn more. As always, please… Read More

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Mental Health Conditions Can Trigger FMLA

The Wage and Hour Division of the U.S. Department of Labor released a Fact Sheet related to mental health conditions and the Family and Medical Leave Act, clarifying what constitutes a serious mental health condition. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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What is the IRMAA Surcharge?

What is the IRMAA Surcharge? The income-related monthly adjustment amount (IRMAA) sliding scale is a set of statutory percentage-based tables used to adjust Medicare Part B and Part D prescription drug coverage premiums. The higher the beneficiary’s range of modified adjusted gross income (MAGI), the higher the IRMAA. Want to apply for relief from the IRMAA charges? The form required is posted below, just download and complete the form!

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Horizon NJ: Covid-19 Resource Guide Update

Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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Health Insurance Nondiscrimination Rules Small Business Owners Need to Know

Group health plans and tax-favored accounts—including health savings accounts (HSAs), health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs)—are subject to numerous nondiscrimination provisions under federal law. The most common nondiscrimination provisions are described. Please download the entire bulletin for details. As always please contact your Total Benefit Solutions, Inc group account manager at (215)355-2121 with any questions or concerns. This bulletin covers the following topics: Overview General Rules Section 125 Nondiscrimination Rules for Cafeteria Plans Section 105 Nondiscrimination Rules for Self-Insured Plans HIPAA Nondiscrimination Rules Nondiscrimination Rules Related to Medicare-Eligible Individuals Other Nondiscrimination Rules Additional Information

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Aetna: Transparency in Coverage Rule Update

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Health plans must generate two MRFs that contain Negotiated rates for in-network providers Billed charges and allowed amounts paid for out-of-network providers  We’ll publish this information on Aetna.com on July 1, 2022 for fully insured (51-100) and small group Aetna Funding AdvantageSM (2-100) groups. By posting the MRFs for small small group Aetna Funding Advantage clients, we’re taking work off their plate. Aetna will update the files each month and this link will remain active with the most up-to-date information.

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2022 PCOR Fee Filing Reminder for Self-Insured Plans

The Patient-Centered Outcomes Research (PCOR) fee filing deadline is August 1, 2022, for all self-funded medical plansand HRAs for plan years ending in 2021. The IRS issued Notice 2022-04 announcing the adjusted fee amount for this year. please download the bulleting below for more details and contact your Total Benefit Solutions, Inc. health insurance specialist at (215)355-2121.

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Turning 26: Your Guide to Health Insurance

Thanks to the Affordable Care Act (ACA), many young people choose to stay on their parent’s health insurance for as long as possible, and with good reason. The historic healthcare law, also known as Obamacare, allows young adults to stay on their parent’s health plan until they turn 26, no matter what. Download our free easy to read guide to getting your own health insurance here. Contact your health insurance experts at Total Benefit Solutions Inc with any additional questions (215)355-2121

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Aetna Client Series: Reimagining Workforce Strategies Webinar

Reimagining Workforce Strategies Thursday, June 23 at 2 PM ET Our next Aetna Client Series webinar is on Thursday, June 23 at 2 PM ET featuring: Tanya Taupier, SVP and Senior HRBP – HCB, Aetna and Jannine Zucker, Principal, Deloitte Consulting. This webinar is specifically designed for Aetna clients to hear about relevant thought leadership content. The topic of this webinar will be: Reimagining workforce strategies. Please share this invitation with your clients and join them to learn more about workforce strategies for success. Many organizations are struggling with an urgent talent crisis: The Great Resignation. As businesses search for ways to attract – and retain – talent. They have an opportunity to refocus their thinking on how and… Read More

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6 Questions to ask your Benefits Broker

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