#healthinsuranceNJ – Page 10 – Total Benefit Solutions Inc

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.

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

Horizon NJ: Covid-19 Resource Guide Update

June 23, 2022June 23, 2022Ed MacConnell

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.

Fixed Funding: Innovative plan solutions now available for New Jersey employers

June 10, 2022Ed MacConnell

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

Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

June 10, 2022June 10, 2022Ed MacConnell

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

Temporary Telehealth Relief for HSA Plans

March 31, 2022Ed MacConnell

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth services from April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”) to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make Health Savings Account (“HSA”) contributions….

New Option for NJ Groups with Out-of-State Employees

March 15, 2022March 14, 2022Ed MacConnell

New Jersey small groups with employees residing out-of-state have few options and brokers struggle to provide viable alternatives for these employers. Horizon has introduced a solution with two new plans that include Blue Card Access on their popular OMNIA platform. Gold & Silver Plans became available in the market July 1 Provides access to 95% of the doctors and 96% of the hospitals nationwide, that includes New York, Pennsylvania, and Delaware. These plans reduce the benefit gap between Tier One and Tier Two benefits. Horizon also leveraged OMNIA relationships to provide a very attractive price point for national access. Questions or concerns about this bulletin? Please contact your Total Benefit… Read More

Member Cost Sharing for Most Telemedicine and Telehealth Visits Will Resume Effective February 3, 2022

February 2, 2022February 2, 2022Ed MacConnell

Aetna: Over-the-counter COVID-19 tests for small group plan sponsors

February 1, 2022February 1, 2022Ed MacConnell

HHS Extends Public Health Emergency until April 16, 2022

January 24, 2022January 25, 2022Ed MacConnell

Pennsylvania Individual Open Enrollment Deadline

December 10, 2021December 10, 2021Ed MacConnell

2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

September 22, 2021September 21, 2021Ed MacConnell

COBRA Subsidy Termination Notice Reminder

August 16, 2021August 16, 2021Ed MacConnell

AEIs must be provided with a notice of expiration of the COBRA subsidy between August 16 and September 15, 2021. The notice must explain the date that the premium assistance will expire and that the individual may be eligible for coverage without any premium assistance through COBRA, a group health plan, the Marketplace, or Medicare/Medicaid.

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