#healthinsuranceinPA – Page 11 – Total Benefit Solutions Inc

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

Important Notice Regarding United Healthcare and US Digestive Health

August 17, 2022August 1, 2022Ed MacConnell

USDH has over 150 providers and 25 locations across Central Southeastern, and Southwestern Pennsylvania that remain at the forefront of treatment protocols, attracting the most accomplished specialists and brightest medical minds in the field, and utilizing cutting edge technologies so that our patients receive high-quality care and the best possible health outcomes. USDH is currently negotiating with United Healthcare for a new contract that covers the care we provide patients with United Healthcare employer-sponsored, Exchange, and Medicare Advantage health plans. If we do not reach a new agreement, our doctors and facilities will be forced out of United Healthcare’s network effective September 1, 2022. The contract that has governed our… Read More

MACRA: Medicare Access and CHIP Reauthorization Act of 2015

August 16, 2022July 29, 2022Ed MacConnell

Since January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are no longer available to people who were “new to Medicare” on or after January 1, 2020. For this situation, people “new to Medicare” are people who turned 65 on or after January 1, 2020, and people who got Medicare Part A (Hospital Insurance) on or after January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or you were covered by one of these plans before January 1, 2020, you will be… 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

Best Time to Buy a Medigap Policy

August 8, 2022July 27, 2022Ed MacConnell

The best time to buy a Medigap policy is during the Medigap Open Enrollment Period. The Medigap Open Enrollment Period lasts for 6 months and begins on the first day of the month a beneficiary turns 65 or enrolls in Part B, whichever is later. Under 65 Medicare beneficiaries get a second Medigap Open Enrollment Period when they turn 65. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare health insurance choices. Call us today at (215)355-2121.

Premium Formulary Adoption Swells Among Large Group Clients

August 5, 2022July 22, 2022Ed MacConnell

The Premium formulary is an option for large group clients wanting access to a formulary that manages traditional, non-specialty drug costs without compromising clinical outcomes. In many cases it saved early adopters nearly 10% per member per month on their plan’s traditional drug spend. Overall, members saved on drug costs without rigorous additional step therapies, prior authorizations, or other invasive utilization management strategies. Members transitioning to the Premium formulary will receive communications about the change, potential disruptions to their drug therapies, and clinically appropriate and cost-effective alternatives. Blue KC will continue to make quarterly updates to the Premium formulary and will send subsequent member communications about those changes and appropriate… 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

What is coinsurance?

August 3, 2022July 19, 2022Ed MacConnell

Coinsurance is usually a percentage of the cost for a service that you would pay. For example, if your coinsurance is 20% for covered services, your plan would pay 80% of the covered charges, and you would pay the coinsurance of 20%. Call your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

Independence Blue Cross: Care Cost Estimator

August 2, 2022July 19, 2022Ed MacConnell

Did you know that you can estimate your out-of-pocket costs before you schedule a doctor’s appointment or medical procedure? You can, with the new Care Cost Estimator tool. It also lets you compare providers by price, based on your specific health plan. The Care Cost Estimator tool will display: Provider details Quality information, such as reviews Your estimated out-of-pocket costs for a wide range of common procedures and office visits Click here to learn how to get started with the Care Cost Estimator. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions or concerns at (215)355-2121.

What is the Employer Shared Responsibility Provision?

July 28, 2022July 15, 2022Ed MacConnell

Under the Affordable Care Act, governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. The estimator is specifically designed to help you determine if the employer shared responsibility provision (IRC Section 4980H) applies to you and, if it does, will help you determine the maximum amount of the employer shared responsibility payment that could apply to you under either section 4980H(a) or 4980H(b) based on the number of full-time employees that you report. The provision applies to employers called applicable large employers that employ on average at least 50 full-time employees (including FTEs)… Read More

What is a High Deductible Health Plan (HDHP)?

July 26, 2022July 26, 2022Ed MacConnell

A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes. For 2022, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $7,050 for an… Read More

How To Reconcile Your Premium Tax Credit

July 22, 2022July 14, 2022Ed MacConnell

If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you will have to “reconcile” when you file your federal taxes. This means you will compare these two figures: the amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower) and the premium tax credit you actually qualify for based on your final income for the year. Here is a step-by-step guide to reconciling you premium tax credit. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions… Read More

Consolidated Appropriations Act Updates

July 21, 2022July 7, 2022Ed MacConnell

In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, contains new requirements for cost transparency and provides protections for consumers against surprise medical billing. CareFirst BlueCross BlueShield (CareFirst) has implemented several changes in response to the No Surprises Act. For more information, click here. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

HHS to Extend Public Health Emergency Once Again

July 20, 2022July 20, 2022Ed MacConnell

The Department of Health and Human Services (HHS) has repeatedly renewed the public health emergency since it was originally declared in January 2020. The most recent extension was set to expire July 15. However, it will now be extended again, commencing on Friday, July 15. The administration will give states 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to certain programs and regulatory authorities. HHS last extended the public health emergency in May of 2022. The designation of a public health emergency allows regulators to clear the way for vaccines, therapeutics, and diagnostics for use against the coronavirus. Should the designation expire, people… Read More

New Mental Health Hotline

July 19, 2022July 18, 2022Ed MacConnell

Starting July 16, 2022, the first nationwide three-digit mental health crisis hotline goes live. This hotline is designed to be easy to remember and by dialing 988, an individual in crisis will be connected to trained mental health counselors. This is a free service. The program will be funded by the federal government which has provided over $280 million, not only for the hotline but to help states create systems that will do much more, including mobile mental health crisis teams that can be sent to people’s homes and emergency mental health centers. The hotline is designed not only for individuals in crisis with thoughts of suicide but for all… Read More

Aetna: Understanding the Evolution of Primary Care and What it Means for your Workforce

July 19, 2022July 6, 2022Ed MacConnell

The evolutions of primary care has a great impact on employers and their workforce. As primary care looks to meet current consumer trends, employers and payers must think creatively to support their employees. Virtual, advanced, and multi-disciplinary sites are just the start. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

COVID-19 Vaccines Now Available for Young Children

July 15, 2022July 1, 2022Ed MacConnell

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

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

July 14, 2022July 1, 2022Ed MacConnell

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

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

July 12, 2022June 30, 2022Ed MacConnell

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

Affordability of Health Coverage

July 11, 2022June 30, 2022Ed MacConnell

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

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

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

Beam Dental Expands Benefits Portfolio, Rebrands to Beam Benefits

July 6, 2022June 28, 2022Ed MacConnell

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.

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

July 1, 2022June 24, 2022Ed MacConnell

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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