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.
Continue ReadingHealth 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
Continue ReadingACA Employer Penalties Increased for 2022
The IRS penalty amounts for non-compliance of the ACA’s Employer Mandate are again increasing in 2022. 4980H(a) Penalty For the 2022 tax year, the 4980H(a) penalty amount is $229.17 a month or $2,750 annualized, per employee. The IRS issues the 4980H(a) penalty when: An employer doesn’t offer Minimum Essential Coverage (MEC) to at least 95% of its full-time employees (and their dependents) for any month during the tax year, and At least one full-time employee receives a Premium Tax Credit (PTC) for purchasing coverage through the Marketplace. Here’s an example of how the IRS calculates the penalty: If an organization in 2022has 300 full-time employees, and one of these employees receives a PTC for 12 months, the cost of this penalty would be $742,500.The per-employee penalty applies… Read More
Continue ReadingBeam 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.
Continue ReadingPhiladelphia 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
Continue ReadingPennie: 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
Continue ReadingBeam 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
Continue ReadingIRS 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
Continue ReadingMental 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.
Continue ReadingWhat 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!
Continue ReadingHorizon 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.
Continue ReadingTotal Benefit Solutions, Inc partners with GRAVIE
What Employers Have to Say: Gravie is Revolutionizing the Industry Gravie is rebuilding health benefits from the bottom up by keeping the focus on who matters most: the consumer. That customer-centered attention might seem obvious, but it’s long overdue in the health benefits industry. The savings and improved outcomes numbers speak for themselves, but if you still need convincing, don’t just take our word for it. Employers from organizations large and small, across industries, and throughout the country have shared how Gravie’s modern and innovative approach to health benefits are impacting their businesses and their employees for the better. Across all our solutions, we are hearing from employers that we’re making their… Read More
Continue ReadingAetna: 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.
Continue Reading2022 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.
Continue ReadingTurning 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
Continue ReadingAetna 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
Continue ReadingFixed Funding: Innovative plan solutions now available for New Jersey employers
AmeriHealth New Jersey is excited and proud to announce that it is offering Fixed Funding benefit design options to New Jersey employers, powered by AmeriHealth Administrators. These plans are available now to quote for July 1, 2022 effective dates. Fixed Funding offers innovative benefit designs that are flexible, predictable, and cash‑flow friendly — while providing members access to high‑quality care from an extensive network of doctors and hospitals. These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment. How a Fixed Funding health plan works: Employers have a consistent monthly payment that covers the cost of administrative fees, stop‑loss insurance premiums1, and an estimated cost… Read More
Continue ReadingOxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations
COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More
Continue ReadingNotice Requirements for Group Health Plans
ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.
Continue ReadingFully Insured vs Level Funding: What’s the Difference?
With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More
Continue ReadingSupport for your emotional health
Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.
Continue Reading2023 Inflation Adjusted Amounts for HSAs
The IRS released the inflation adjustments for health savings accounts (“HSAs”) and their accompanying high deductiblehealth plans (“HDHPs”) effective for calendar year 2023, and the maximum amount that may be made newly available forexcepted benefit health reimbursement arrangements (“HRAs”). All limits have increased from the 2022 amounts, somesignificantly.
Continue ReadingProposed Regulations to Fix ACA’s Affordability “Family Glitch”
individuals are not eligible for premium tax credits in the Marketplace
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