Case Study: A Voluntary Benefits Strategy

Wendy Lopez

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More

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Empire BCBS Now Anthem BCBS!

Wendy Lopez

In a momentous move, Empire BlueCross BlueShield has officially transformed into Anthem Blue Cross and Blue Shield, marking a significant milestone for the renowned health insurance provider. The company is thrilled to announce the launch of Anthem Blue Cross and Blue Shield in both their downstate and upstate markets, reinforcing their commitment to enhancing the overall customer experience. The transition to the Anthem brand is not merely a change in name; it represents a strategic effort to simplify operations and reduce complexities in the market. Anthem is a nationally recognized name, offering a host of advantages for members residing out of state who are affiliated with New York-based companies. By… Read More

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IBC’s Latest Updates: Weight Loss Drug Policy

Wendy Lopez

The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More

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Important Updates: Plan Changes for 2024

Wendy Lopez

As we transition into 2024, it’s crucial for you to be aware of recent changes in your healthcare coverage. If you were auto-renewed for Plan Year 2024 after being enrolled in the Marketplace for Plan Year 2023, read on for key information. Auto-Reenrollment: Clients not actively selecting a Plan Year 2024 plan by December 15, 2023, were auto-renewed with coverage effective from January 1, 2024. This info was visible on HealthCare.gov and partner sites starting December 16, 2023. Exploring Options: Consider exploring other coverage options or adjusting your Plan Year 2024 selection. Changing plans or enrolling between December 16, 2023, and January 16, 2024, ensures an effective date of February… Read More

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Healthcare Compliance: 2023 Q4 Digest

Wendy Lopez

Stay ahead in healthcare compliance with the 2023 Fourth Quarter Compliance Digest, a consolidated resource featuring all Q4 bulletins from October to December. This document is your one-stop-shop for the latest in health care reform, simplifying the complexities of compliance. Key Features: Up-to-Date Information: Get the latest developments in healthcare compliance from Q4 2023. Convenience in One Document: Access all relevant information in a single, downloadable PDF. Streamlined Access: Easily download the digest for quick and efficient access to essential updates. To explore further, download the PDF below: We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists… Read More

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Cigna Healthcare and Tower Health Contract Updates

Wendy Lopez

In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More

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Alert: Chicago Employers, Brace for Paid Leave Shifts in 2024

Wendy Lopez

In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More

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Key Reminders for Individual Health Plan Payments

Wendy Lopez

In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More

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Ambetter Health Members: Ensure Coverage for January 2024!

Wendy Lopez

As we approach the end of the year, we want to remind you of a crucial deadline to ensure uninterrupted coverage for the upcoming year. Payment Deadline: December 31, 2023: Ambetter Health members must make their January premium payment by December 31, 2023, to guarantee seamless coverage for the start of 2024. To make this process quick and convenient, we recommend using Quick Pay option for a fast, one-time payment. For Assistance: If you have any questions or require assistance, don’t hesitate to reach out to your dedicated Ambetter Health Account Executive. You can contact them at 1-855-700-7985, selecting option 3. Alternatively, you can email ambettersales@centene.com. Ensuring your premium payment is processed… Read More

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Case Study: Achieving Success Through Broker Change

Wendy Lopez

In the dynamic landscape of employee benefits, staying complacent can hinder progress and cost an organization significant financial resource. At Total Benefit Solutions, we take pride in our proactive approach to addressing complex employee benefit challenges. In this blog post, we highlight a case study that exemplifies our commitment to providing innovative solutions and delivering tangible results for our clients. Broker Change Leads to Better Results The Challenge: A mid-sized group prospect approached us with a pressing issue – dissatisfaction with their current benefits broker. Faced with a 17% health insurance renewal, the client felt that their existing broker was not adequately exploring cost containment strategies. Seeking guidance, they turned… Read More

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ACA Compliance: Key Calendars for 2024 Revealed!

Wendy Lopez

Stay ahead of the compliance curve with crucial information on Affordable Care Act (ACA) deadlines for 2024. In our latest update, we’ve compiled comprehensive compliance calendars tailored for both small groups (less than 50 employees) and larger groups (50 or more employees). It’s your go-to resource for understanding and meeting important deadlines to ensure a seamless compliance journey. 2024 Small Group Compliance Deadlines: For fully and self-insured groups operating on a calendar year plan, we’ve outlined essential deadline dates for 2024. Please note that some reporting deadlines may vary for plans with a start date other than January 1st. Whether you have a small group or a larger organization, staying… Read More

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Decisions for someone who is nearing age 65

Ed MacConnell

As you near age 65, you need to learn about Medicare coverage choices and make several important enrollment decisions. This fact sheet will give you a list of the steps you shouldtake and tell you about resources to help you make your Medicare enrollment decisions. There can be penalties if you do not enroll on time, so it is best to complete these tasksat least 3 months BEFORE you turn 65. Please note you can enroll on Medicare Parts A & B with Medicare about 90 days before your 65th birthday. IF YOU ARE STILL WORKING and your company has less than 20 employees you still MUST enroll on Medicare… Read More

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What is the Part D Donut Hole in 2024?

Ed MacConnell

The Medicare Donut Hole, officially called the Coverage Gap, refers to a stage in Medicare Part D plans where beneficiaries have to pay more for prescription drugs. Historically, after reaching a certain spending threshold, beneficiaries faced higher out-of-pocket costs for drugs until catastrophic coverage began. The Donut Hole was designed to encourage the use of more cost-effective medications and generic alternatives. As of 2024, the Donut Hole is not completely ending, but the percentage beneficiaries pay for prescriptions during this stage has been reduced. When a beneficiary and their plan have spent a total of $5,030 in 2024, they enter the Donut Hole. In this phase, they pay 25% of… Read More

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Total Benefits: Your Trusted Guide to Cost-Efficient Coverage

Wendy Lopez

In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More

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New Federal Rules: HHS 2023 Penalty Hike

Wendy Lopez

In the world of healthcare compliance, staying up to date with federal regulations and guidelines is crucial to avoid costly penalties. One such regulation that affects healthcare providers and group health plans is the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, commonly known as the “Inflation Adjustment Act.” This act directs federal agencies to adjust civil monetary penalties to account for inflation. In a recent development, the Department of Health and Human Services (HHS) issued final rules on October 6, 2023, updating the civil monetary penalties for inflation. Understanding the Updated Penalties The adjusted penalties are applicable to penalties assessed on or after October 6, 2023. It’s… Read More

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Court Vacates Coupon Cost-Sharing Rule

Wendy Lopez

On September 29, 2023, a significant legal development occurred that could affect how health insurance carriers and group health plans handle manufacturer coupons for prescription drugs. The District Court for the District of Columbia vacated a rule issued by the Department of Health and Human Services (HHS) that allowed, but did not mandate, the inclusion of manufacturer coupons in calculating the cost-sharing for health plans. In this blog post, we’ll explore the background of this issue, the 2019 HHS rule, and the subsequent legal decisions that have led to this recent development. HHS’s 2019 Rule In 2019, HHS issued a rule to clarify this matter. The rule stated that plans… Read More

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Affordable Dental Insurance: A Key Player in Oral Health

Wendy Lopez

Dental health is a crucial aspect of overall well-being, and a recent survey has shed light on the satisfaction levels of Americans with their dental insurance plans. The results, published in a press release by AHIP (America’s Health Insurance Plans) on September 26, 2023, provide an insightful perspective on the state of dental insurance in the United States. The survey, conducted by Global Strategy Group (GSG) on behalf of AHIP, focused on individuals who have dental insurance and have visited dental specialists, including dentists, oral surgeons, and orthodontists, in the past year. The findings from the survey paint a positive picture of Americans’ experiences with their dental insurance plans. Key… Read More

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Financial Support Soars for Mental Health Integration

Wendy Lopez

Mental health is an essential component of overall well-being, and every American deserves access to quality mental health and substance use disorder treatment. Access to mental health care can be a transformative step in managing and coping with mental health concerns, allowing individuals to lead more fulfilling lives. This article explores the importance of integrating mental health services into other care settings and highlights the Collaborative Care Model (CoCM) as a promising approach to enhance access to mental health care. Expanding Access Through Integration Integrating mental health into broader healthcare settings is a pivotal strategy to increase accessibility and support for patients. The Collaborative Care Model, often abbreviated as CoCM,… Read More

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Small Business, Big Benefits: Health Coverage for All

Wendy Lopez

In the United States, the landscape of healthcare is a complex one, with various options available to individuals and families. One of the most significant sources of health coverage for Americans is employer-provided coverage. This type of coverage is a health plan, or a selection of health plans and other benefits, purchased by an employer and offered to eligible employees and their dependents. It’s a system that plays a crucial role in ensuring that millions of hardworking individuals and their families have access to quality healthcare. Affordable Access to Care The primary advantage of employer-provided coverage is its affordability. Employees’ contributions to their health coverage are tax-free, which means that… Read More

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2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?

Wendy Lopez

In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More

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Medicaid Redetermination Updates: Your Next Steps

Wendy Lopez

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

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Medicare Supplement Insights: Protecting Your Wallet

Wendy Lopez

In a world where healthcare costs are a growing concern for many, Medicare Supplement coverage has emerged as a reliable solution to bridge the gaps in original Medicare. As we delve into the latest data from 2021, including insights from the National Association of Insurance Commissioners (NAIC), the California Department of Managed Health Care, and the Medicare Current Beneficiary Survey (MCBS) from 2020, a compelling narrative about the significance of Medicare Supplement plans unfolds. Key Takeaways: 1. A Majority Embrace Medicare Supplement: In 2020, a staggering 54% of original Medicare enrollees without additional insurance coverage, such as Medicaid or employer-provided insurance, turned to Medicare Supplement policies for added peace of… Read More

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No Child Left Uninsured: Innovative Solutions in Healthcare

Wendy Lopez

Millions of children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for their health and well-being. However, the redetermination process can sometimes pose challenges for their parents. In this article, we explore the innovative efforts undertaken by health insurance providers to ensure that children maintain access to healthcare, regardless of their parents’ circumstances. Medicaid plays a crucial role in American healthcare, improving the health and financial security of millions of individuals daily. It’s particularly vital for the 42 million children enrolled in Medicaid or CHIP. While parents may face hurdles during the Medicaid redetermination process, children often remain eligible for these programs or can transition to CHIP. Health… Read More

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How should employers distribute Medical Loss Ratio (MLR) Rebate Checks?

Ed MacConnell

Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More

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2024 Healthcare Premiums Revealed: The Impact Factors

Wendy Lopez

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

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