#healthinsurance – Page 9 – Total Benefit Solutions Inc

2023 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

June 14, 2023June 21, 2023Ed MacConnell

This update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2023. As background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which the applicable plan ended. The PCORTF fees fund the Patient-Centered Outcome Research Institute (PCORI), established by Congress… Read More

Video: Medicare Supplements vs. Medicare Advantage Plans. What’s the difference?

June 13, 2023June 13, 2023Ed MacConnell

Alert: 2023 mid-year IBC Group Medigap rate increase

May 22, 2023May 22, 2023Ed MacConnell

Independence Blue Cross (Independence) recently received approval from the Pennsylvania Insurance Department to increase monthly premium rates effective July 1, 2023 for: The following plans did not have a rate increase: H with Rx, F(HD), N, and G(HD). Please review the 2023 Mid-Year Medigap Rate Increase – Medigap Security & Security 65 document for more information on call scripting and see below for related links for rate change letters and rate sheets.

Members receive letter about NationsBenefits security breach

May 7, 2023May 7, 2023Ed MacConnell

Some Aetna Medicare plans include benefits administered by a company called NationsBenefits or one of its affiliates (“the company”). Specifically, the company administers the hearing aid benefit, as well as the Extra Benefits Card benefit, on some plans. Recently, NationsBenefits learned that a third-party vendor they used to securely exchange files with certain health plans, experienced a data security incident. The security breach impacted members whose plans include the NationsHearing hearing aid benefit or the Nations Extra Benefits Card benefit. What you need to know: Member communication: Impacted members will receive a letter from NationsBenefits. View a sample of the member letter. Letters began mailing on April 27. The letter explains what happened, what… Read More

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

woman with face mask holding an alcohol bottle

Independence Blue Cross: Changes to the Select and Value formularies for July 1

May 1, 2023May 1, 2023Ed MacConnell

Independence Blue Cross (Independence) is making changes to the Select Drug Program (Select) and Value formularies for July 1. Independence routinely updates its prescription drug formularies and reviews the list of drugs requiring prior authorization as part of our procedures for safe prescribing. These changes are approved by our Pharmacy and Therapeutics Committee. Updates are made to the Select and Value formularies quarterly. The updated lists for July 1 will be available on the website on May 1. Select the link to either the Select or Value formulary. The updated list is available under “Formulary drug documents.” Standard changes can include: Members, as well as their providers, who are impacted by the… Read More

Horizon BCBSNJ Small Group to Add a Surcharge for Premium Payments Made With Credit Cards

May 1, 2023May 1, 2023Ed MacConnell

Effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. During the COVID-19 Public Health Emergency (PHE), Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) changed how they accepted premium payments from their Small Group customers to allow the use of credit cards. With the PHE ending, effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. Small Group Customers Still Have No-Cost Payment OptionsHorizon BCBSNJ offers… Read More

Guidance Issued on Emergency Period Expiration

April 24, 2023April 24, 2023Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below. It is possible that FAQ 58 will be updated to reflect new dates. The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.** On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

Horizon BCBSNJ Updated COVID-19 Resource Guide

April 11, 2023April 11, 2023Ed MacConnell

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

2023 First Quarter Compliance Digest

April 7, 2023April 6, 2023Ed MacConnell

Download the 2023 First Quarter Compliance Digest, featuring all of the released compliance bulletins for January through March. This document is a valuable resource, putting all of the latest health care reform news and updates in one location. As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

12 Tips for Maximizing Your High Deductible

April 6, 2023April 6, 2023Ed MacConnell

Nearly 40% of people have a health care plan with a high deductible. An even higher percentage of people wish they had a lower deductible (who wouldn’t?!). And with medical bills being the leading cause of bankruptcies, it is important to understand how to maximize your high deductible so that you can stay afloat in case something unexpected were to happen. 1. Find Out What’s Free Many routine services are free. Instead of staying home to save money, you could get a free screening for preventative care. Common services covered are colonoscopies, mammograms, and vaccinations. About 90% of people with high deductible plans don’t know that such services are free.… Read More

IBC: How to read your new EOB

March 31, 2023March 24, 2023Ed MacConnell

Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find out how much a provider charged for services, what your Independence Blue Cross (IBC) health plan paid, and how much you owe. As always please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any additional questions or concerns!

Independence: Wellness Guidelines for all ages

March 29, 2023March 24, 2023Ed MacConnell

Your health and wellness are important. That’s why we provide you with these wellness guidelines to help you and your family stay healthy. The wellness guidelines are a summary of recommendations from the U.S. Preventive Services Task Force and other nationally recognized sources. We encourage you to take the time to review these guidelines. Use them as a starting point for conversations with your and your family’s health care providers. Your health care provider may recommend alternatives to the information outlined in these wellness guidelines based on your specific needs and the history of health or illness in your family

IBC: Employer Portal Handbook

March 28, 2023March 24, 2023Ed MacConnell

Not sure how to use your IBC billing and enrollment portal? Download this helpful guide. As always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any further questions or concerns.

The health plan categories: Bronze, Silver, Gold, & Platinum

March 24, 2023March 23, 2023Ed MacConnell

Plans in the Marketplace are presented in 4 health plan categories: Bronze, Silver, Gold, and Platinum. FYI: Health plan categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. How you and your insurance plan split costs Which health plan category is right for you? Bronze Silver Gold Platinum Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

10 Things to Know About Medicaid Managed Care

March 23, 2023March 16, 2023Ed MacConnell

Managed care is the dominant delivery system for Medicaid enrollees. With 72% of Medicaid beneficiaries enrolled in comprehensive managed care organizations (MCOs) nationally, plans have played a key role in responding to the COVID-19 pandemic and are expected to work with states in conducting outreach and providing support to enrollees during the unwinding of the continuous enrollment requirement. While managed care is the dominant Medicaid delivery system, states decide which populations and services to include in managed care arrangements which leads to considerable variation across states. Additionally, while we can track state requirements for Medicaid managed care plans, plans have flexibility in certain areas including in setting provider payment rates… Read More

What is cost sharing reduction (CSR)?

March 22, 2023Ed MacConnell

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Did You Know? Cigna + Oscar plans in Pennsylvania offering you a simple, non-tiered network?

March 21, 2023March 21, 2023Ed MacConnell

That’s right! ? Cigna + Oscar plans in Pennsylvania utilize Cigna‘s Open Access Plus Network. Offering you a simple, non-tiered network. This includes facilities you know and use, such as: View the full Pennsylvania network here. Please contact your health insurance specialists at Total Benefit Solutions, Inc iat (215)355-2121 f you have any further questions or concerns about Oscar heath!

ACA special enrollment period opens soon for people losing Medicaid coverage

March 17, 2023March 16, 2023Ed MacConnell

The Centers for Medicare and Medicaid Services (CMS) will open an ACA special enrollment period (SEP) for people losing Medicaid coverage due to the end of the COVID-19 public health emergency (PHE). The PHE ends May 11. The ACA SEP aims to maintain continuity of coverage as people transition from Medicaid into a Marketplace-qualified health plan. It runs March 31 to July 31, 2023. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

The End of COVID-19 Public Health Emergency: How will telemedicine be affected?

March 16, 2023February 13, 2023Ed MacConnell

On Jan. 30, 2023, the Biden Administration announce it will end the public health emergency (and national emergency) declarations on May 11, 2023. Telemedicine What’s changing: Some flexibilities associated with providing health care via telehealth during the public health emergency will end. What’s the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent. Have any questions regarding this notice?… Read More

What is an agent and broker?

March 13, 2023February 24, 2023Ed MacConnell

A trained insurance professional who can help you enroll in a health insurance plan. Agents may work or a single health insurance company; brokers may represent several companies. You won’t pay anything additional if you enroll with an agent or broker. As always, don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

How to activate your OSCAR account

March 11, 2023March 9, 2023Ed MacConnell

We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your ﬁngertips .

Medicare Advantage plans denying more inpatient claims

March 10, 2023February 23, 2023Ed MacConnell

MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More

What is State Mandated Disability or TDB?

March 9, 2023March 9, 2023Ed MacConnell

New Jersey Temporary Disability Benefits (TDB) and Family Leave Insurance (FLI). The New Jersey Temporary Disability Benefits (TDB) law, enacted in 1948 and later amended in 2008 to include Family Leave Insurance (FLI), allows for NJ covered workers to take paid time off for their own non-occupational related injury or illness (under TDB) or to care for a family member with a serious health condition or bond with a new child (under FLI). Which employers are subject to the law? Most New Jersey employers subject to the provisions of the Federal Unemployment Tax Act (FUTA) are also subject to NJ TDB law and are required to provide coverages for their employees working in… Read More

The End of COVID-19 Public Health Emergency: How will COVID treatments be affected?

March 8, 2023February 10, 2023Ed MacConnell

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. COVID Treatment What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government). Medicare beneficiaries may fact cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing. What’s the same: Any pharmaceutical treatment doses (e.g., Paxlovid) purchased… Read More

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