#healthinsurancebuckscounty – Page 5 – Total Benefit Solutions Inc

Guaranteed Issue Rights

September 7, 2022July 29, 2022Ed MacConnell

Guaranteed Issue (GI) rights are rights the beneficiary has in certain situations when insurance companies must offer certain Medigap policies. There are ONLY 7 situations where Guaranteed Issue Rights apply. Two of the most common are: Beneficiary is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or the beneficiary moves out of the Medicare Advantage plan’s service area. Beneficiary has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. Just like with the Medigap Open Enrollment Period, during a Guaranteed Issue: No eligibility… Read More

What plans are part of the Part D Senior Savings Model?

September 2, 2022August 10, 2022Ed MacConnell

The Centers for Medicare & Medicaid Services (also known as CMS, the federal agency that approves Medicare plans) announced Medicare Advantage plans with prescription drug coverage (MA-PD) and Part D prescription drug plans (PDPs) that are participating in the Model for Calendar Year (CY) 2022 in September 2021. You can call 1-800-MEDICARE to ask questions about enrollment, eligibility, and the Model, or visit Medicare Plan Finder at https://www.medicare.gov/plan-compare/ to search for coverage in your area and compare Part D plan options with the lowest prices for your prescriptions. You can also find a list of participating plans on the Model website at https://innovation.cms.gov/media/document/pdss-2022-model-landscape-file. If you have any questions, please contact… Read More

What is a health insurance deductible?

September 1, 2022August 4, 2022Ed MacConnell

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest. Many plans pay for certain services, like a checkup or disease management programs, before you’ve met your deductible. Check your plan details. All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible. Some plans have separate deductibles for certain services, like prescription drugs. Family plans often have both an… Read More

Defined Contribution Plans

August 31, 2022August 9, 2022Ed MacConnell

The Issue As one of our long-time group insurance customers grew over the years, their workforce became more diverse and the management team found it difficult to accommodate each employee’s unique insurance needs. As much as the team wanted to provide the necessary coverage for the employees, they also required some control over the employee benefits budget. They came to us for advice. The Solution We proposed that this employer consider a defined contribution strategy. Defined contribution plans build benefit portfolios around a specific dollar amount, rather than around a specific plan or plans. In this way, the management team could select an amount that the company would contribute toward… Read More

Medicare Advantage (MA) Quick Facts

August 30, 2022August 3, 2022Ed MacConnell

What is it? A Medicare Advantage Plan is a type of Medicare health plan offered by a private company, such as Independence Blue Cross, that contracts with Medicare to provide all Part A and Part B benefits. If enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Plan types offered: Medicare Advantage Plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), for example. Independence offers Keystone 65 HMO as well as Personal Choice 65 PPO. Medical Coverage: If enrolled in a HMO, members must choose a PCP (which also will coordinate referrals) and must stay In-Network. PPO… Read More

What is a Health Savings Account (HSA)?

August 29, 2022August 9, 2022Ed MacConnell

A type of savings account that lets your set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums. While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan (including a Marketplace plan) that only covers preventive services… Read More

IRS Announces 2023 ACA Affordability Indexed Amount

August 25, 2022August 8, 2022Ed MacConnell

The IRS recently announced in Revenue Procedure 2022-34 that the Affordable Care Act (“ACA”) affordability indexed amount under the Employer Shared Responsibility Payment (“ESRP”) requirements will be 9.12% for plan years that begin in 2023. This is a notable decrease from the 2022 percentage amount (9.61%) and below the original 9.5% threshold. Rev. Proc. 2022-34 establishes the indexed “required contribution percentage” used to determine whether an individual is eligible for “affordable” employer-sponsored health coverage under Section 36B (related to qualification for premium tax credits when buying ACA Marketplace coverage). However, the IRS explained in IRS Notice 2015-87 that a percentage change under Section 36B will correspond to a similar change… Read More

What is copayment?

August 24, 2022August 4, 2022Ed MacConnell

A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20. If you’ve paid your deductible: You pay $20, usually at the time of the visit. If you haven’t met your deductible: You pay $100, the full allowable amount for the visit Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests. and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have… Read More

Medigap Quick Facts

August 23, 2022August 3, 2022Ed MacConnell

What is it? A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Play types offered: Insurance companies can sell only a “standardized” policy identified in most states by letters. Independence Blue Cross offers Plans A, B, F, F-HD, G, G-HD, and N. Medical Coverage: No selection of a PCP is required; members are able to choose any doctor or hospital as long as they accept Original Medicare. This also allows for no referrals and no network. Prescription Drug Coverage:… Read More

What is the Part D Senior Savings Model?

August 19, 2022August 19, 2022Ed MacConnell

The Part D Senior Savings Model allows participating Part D prescription drug plans to offer a broad set of formulary insulins at a maximum $35.00 copayment per month’s supply, throughout the deductible, initial coverage, and coverage gap phases of their Part D drug coverage. This means that participating Part D plans offer enrollees predictable, stable copayments for insulin to help enrollees save money on their drug costs. If you have any questions, please contact your Total Benefit Solutions Inc Medicare specialists at (215)355-2121.

New Prescription Drug Reporting Requirement

August 18, 2022August 2, 2022Ed MacConnell

As previously reported in December 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Employers with fully insured or self-funded (includes level funded) group health plans, including grandfathered plans, church plans subject to the Internal Revenue Code, and governmental plans. The term “group… Read More

Independence Blue Cross and Amerihealth: Behind on your health insurance payments?

August 15, 2022August 15, 2022Ed MacConnell

Please do not assume that your payment is on the way or has been made and that the insurance company will handle it. Our health insurance specialists can assist you with a conference call. Getting reinstated after a cancellation is a long and difficult process and is not always available! If your payments are behind we need to ask for termination suppression BEFORE you are cancelled. First, Please always contact the Billing Department at 215-567-3357 or 1-800-444-6301. When calling, please have your group name, billing account number and address for verification purposes. The Billing Department will not approve an account for termination suppression due to checks mailed, promise to pay… Read More

What is a Self-Insured Plan?

August 10, 2022July 27, 2022Ed MacConnell

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. Please contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

What are HDHPs & HSAs?

August 9, 2022July 22, 2022Ed MacConnell

One way to manage your health care expenses is by enrolling in a High Deductible Health Plan (HDHP) in combination with opening a Health Savings Account (HSA). How High Deductible Health Plans and Health Savings Accounts can reduce your costs: If you enroll in an HDHP, you may pay a lower monthly premium but have a higher deductible (meaning you pay for more of your health care items and services before the insurance plan pays). If you combine your HDHP with an HSA, you can pay that deductible, plus other qualified medical expenses, using money you set aside in your tax-free HSA. So if you have an HDHP and don’t… Read More

Alternative Funding Yields Big Savings

August 4, 2022July 22, 2022Ed MacConnell

The Issue A firm we had worked with for several years had expressed a concern that the cost of their employee benefits package was threatening the financial stability of their firm. With a little over 150 employees, their annual benefits cost was exceeding $1.3 million and increasing at a rate of 8-15% each year. Even more concerning was that the benefits cost represented 32% of the company’s operating revenue. They had contemplated making plan changes including an increase in deductibles, copays and co-insurance limits, but they cared about the well-being of their employees and felt compelled to keep a competitive level of benefits. Our Solution We took the approach that… Read More

Updated FAQ’s on the ACA and Health Insurance

July 17, 2022Ed MacConnell

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

HHS Extends Public Health Emergency until July 15

April 25, 2022April 25, 2022Ed MacConnell

On April 12, 2022, the Secretary of Health and Human Services renewed the COVID-19 pandemic Public Health Emergency, effective April 16, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Please download the bulletin below and contact your health insurance experts at Total Benefit Solutions, Inc at (215)355-2121 Download Bulletin

Additional Guidance Addresses ACA Preventive Care Mandate

February 1, 2022February 1, 2022Ed MacConnell

As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying severalAffordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans. As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing. Click the link below to download the bulletin. As always contact your health insurance specialists at Total Benefit Solutions, Inc if you have any additional questions or concerns (215)355-2121 http://www.totalbenefits.net

If Pennie Customers Missed the Deadline to Enroll Because of COVID-19 Impacts – They Now Have Until January 31st to Enroll!

January 25, 2022January 25, 2022Ed MacConnell

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