#healthinsuranceNJ – Page 6 – Total Benefit Solutions Inc

Independence: Additional MLR rebates for 2020 to be issued to some policyholders

February 7, 2023February 6, 2023Ed MacConnell

Starting this week, Independence Blue Cross (Independence) will be issuing an additional medical loss ratio (MLR) rebate to affected customers and subscribers for a portion of their 2020 health insurance premiums. The check mailing will continue until the end of February. The additional rebate is being issued following a clarification on MLR calculation provided by the Centers for Medicare & Medicaid Services (CMS). As a result of the clarification, we looked at prior year calculations and determined an additional amount was due for 2020. Any applicable interest has been included in the amount of each check. Click here for the full story As always please contact your Total Benefit Solutions,… Read More

Does a Health Savings Account (HSA) have Reimbursable Expenses?

February 6, 2023February 1, 2023Ed MacConnell

Employees can use the HSA to pay for Code §213(d) medical expenses, expenses such as expenditures for medical care, to the extent that such amounts are not reimbursed by insurance or any other source. Medicines and drugs (other than insulin) can be qualified medical expenses only if they are prescribed. Under the CARES Act, employers can also allow for reimbursement of OTC drugs. With certain exceptions, qualified medical expenses do not include payments for health insurance premiums or coverage contributions toward self-funded health coverage. However, the expense for coverage under any of the following will be an HSA-qualified medical expenses: HSA funds may not be used to pay insurance premiums… Read More

What is Small Business Health Options Program (SHOP)?

February 3, 2023January 26, 2023Ed MacConnell

The Small Business Health Options Program (SHOP) helps small business owners provide medical and/or dental insurance to their employees. Some smaller employers qualify for tax credits if they enroll in SHOP insurance. A small business can offer SHOP health and/or dental insurance to their employees if they: Small business owners can use an agent or broker to enroll in SHOP insurance, or work with their insurance company. There’s no limited enrollment period for SHOP, so they can apply, pick plans, and enroll employees any time of year. Interested in SHOP for your small business? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

DOL Penalties Increase for 2023

February 2, 2023January 26, 2023Ed MacConnell

The Department of Labor (“DOL”) has published the annual adjustments for 2023 that increase certain penalties applicable to employee benefit plans. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

Between jobs? Aging out of a family policy? Waiting for Open Enrollment?

February 1, 2023January 24, 2023Ed MacConnell

A Short Term Medical plan might be right for you. Short Term Medical plans let you decide how much coverage you want and for how long, with individual and family options available. And you can enjoy quality of life benefits like telemedicine and discounts on a variety of everyday items and services through an Association membership (varies by state). Short Term Medical plans offer plenty of flexibility: Questions about a short term medical plan? Contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Important information about these plans THESE PLANS PROVIDE LIMITED BENEFITS For complete limitations & exclusions by state for Short Term Medical insurance, click here. Plan… Read More

What is the Medicare Advantage Open Enrollment Period (OEP) and why is it important?

January 29, 2023January 29, 2023Ed MacConnell

The Medicare Advantage Open Enrollment Period (OEP) is different than the annual election period in the fall. The MA OEP happens annually from January 1st to March 31st. The OEP allows beneficiaries who are enrolled in a Medicare Advantage Plan to make a one-time change. Beneficiaries can use the Medicare OEP to: The Medicare OEP does not allow a beneficiary to change from one Part D plan to another Part D plan. The reason for the OEP is that Medicare beneficiaries are often confused about Medicare Advantage plans. They don’t understand how these plans work or they may not realize the plan has a network. Some Medicare beneficiaries try to make their… Read More

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

How does Original Medicare work?

January 27, 2023January 24, 2023Ed MacConnell

Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage). Services covered by Medicare must be medically necessary. Medicare also covers many preventive services, like shots and screenings. If you go to a doctor or other health care provider that accepts the Medicare-approved amount, your share of costs may be less. If you get a service that Medicare doesn’t cover,… Read More

What is Stop Loss Coverage?

January 26, 2023January 23, 2023Ed MacConnell

Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read More

Independence: New drugs added to precertification list for 2023

January 25, 2023January 25, 2023Ed MacConnell

Effective January 1, 2023, from Independence Blue Cross: (Independence) IBC will add 12 drugs to the list of specialty drugs that require precertification under the medical benefit. With these additions, Independence now requires precertification for a total of 271 drugs before members can receive coverage for them. The drugs being added include several gene replacement therapies and cancer/antineoplastic agents in the U.S. Food and Drug Administration (FDA) pipeline, as well as several biosimilars that recently received FDA approval. The newly added drugs are: beremagene geperpavec* – gene replacement/gene editing therapiesCimerliTM (ranibizumab‑eqrn) – ophthalmic agentsElahereTM (mirvetuximab soravtansine) – antineoplastic agentsFylnetra® (pegfilgrastim‑pbbk)† – neutropeniaHemgenix® (etranacogene dezaparvovec) – gene replacement/gene editing therapies mosunetuzumab* – antineoplastic agents Skysona® (elivaldogene autotemcel) – gene replacement/gene editing therapiesStimufend® (pegfilgrastim‑fpgk)† – neutropeniatofersen* – amyotrophic lateral sclerosis agents tremelimumab* – antineoplastic agentsVegzelma® (bevacizumab‑adcd)† – antineoplastic agentsZynteglo® (betibeglogene autotemcel) – gene replacement/gene editing therapies We often add drugs… Read More

Explore Blue KC Small Group Dental Plans and Rates for New Business

January 25, 2023January 13, 2023Ed MacConnell

Oral health is a key component of overall health and dental coverage, starting with regular checkups, can help prevent health issues and medical costs down the road. Blue KC small employer group dental coverage offers a selection of plans – with no waiting period – an extensive local and national provider network, competitive rates, plus a rewards program. Don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

Pennie: 1095-A Tax Form Available for Customers

January 24, 2023January 20, 2023Ed MacConnell

The 1095-A tax form has been delivered to Pennie customers for their 2022 tax returns. The 2022 1095-A Form: Health Insurance Marketplace Statement has been delivered to customers’ Pennie Secure inboxes. Important: The 1095-A reflects a Pennie customer’s 2022 enrollment information. Click here to learn more about 1095-A forms. Have any questions regarding your Pennie account or the 1095-A tax form? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is vision coverage?

January 23, 2023January 13, 2023Ed MacConnell

A health benefit that at least partially covers vision care, like eye exams and glasses. All the plans in the Health Insurance Marketplace include vision coverage for children. Only some plans include vision coverage for adults. If adult vision coverage is important to you, check the details of any plan you’re considering. If your plan doesn’t include adult vision coverage, you can buy a “stand-alone” vision plan to reduce your vision care expenses. The Marketplace doesn’t offer stand-alone vision plans. To shop for stand-alone vision plans, contact an insurance agent or broker, or search for plans online. You can also contact your state’s Department of Insurance. As always, don’t hesitate… Read More

Dental coverage in the Marketplace

January 19, 2023January 11, 2023Ed MacConnell

In the Marketplace, you can pick a health plan with or without dental benefits. If you pick a health plan without dental benefits, you can still get a separate dental plan. Important: You can’t buy a Marketplace dental plan unless you’re buying a health plan at the same time. Dental coverage is available in 2 ways: 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

January 17, 2023January 16, 2023Ed MacConnell

Managed care plays a major role in the delivery of health care to Medicaid enrollees. With 69% of Medicaid beneficiaries enrolled in comprehensive managed care plans nationally, plans have played a key role in responding to the COVID-19 pandemic and in the fiscal implications for states. This brief describes 10 themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights significant data and trends. Understanding these trends provides important context for the role managed care organizations (MCOs) play in the Medicaid program overall as well as during the ongoing COVID-19 public health emergency (PHE) and in its expected unwinding. CMS released guidance for state… Read More

What is a stand-alone dental plan?

January 16, 2023January 10, 2023Ed MacConnell

A type of dental plan offered through the Marketplace that’s not included as part of a health plan. You may want this if the health coverage you choose doesn’t include dental, or if you want different dental coverage. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

Four Key Changes in the Biden Administration’s Final Rule on Medicare Enrollment and Eligibility

January 13, 2023January 9, 2023Ed MacConnell

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on October 28, 2022, to implement several changes in Medicare enrollment and eligibility that were included in the Consolidated Appropriations Act of 2021 (CAA). These changes are designed to minimize gaps in coverage for people who sign up for Medicare and improve access to care by shortening the gap between Medicare enrollment and coverage; creating new Special Enrollment Periods for individuals whose coverage would otherwise be delayed due to challenging circumstances, such as a natural disaster; and extending coverage of immunosuppressive drugs for certain beneficiaries with end-stage renal disease (ESRD) who would otherwise lose coverage for these drugs… Read More

Blue KC: 2023 member guides and handbooks now available

January 11, 2023January 9, 2023Ed MacConnell

The 2023 commercial and ACA member guides and Medicare Advantage member handbook are now available. Clients will receive these documents through a variety of touchpoints. Please keep them handy as a quick reference to Blue KC plan benefits and features and to share them with clients as needed. Employer/Group Medicare Advantage ACA Individual and Family Plans Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Final Rule on ACA Reporting and 2022 Forms and Instructions

January 10, 2023January 3, 2023Ed MacConnell

On December 12, 2022, the Internal Revenue Service (“IRS”) released final regulations with respect the ACA reporting requirements. These rules are substantially similar to the proposed rule issues in November last year. The final rule: Applicable large employers (“ALEs”) have until March 2, 2023 (rather than January 31, 2023) to furnish Forms 1095-C for calendar year 2022 to full-time employees and other individuals. The final rule does not extend the deadline to file completed Forms 1094-C and 1095-C (and Forms 1094-B and 1095-B) with the IRS. The due date remains March 31, 2023 (or February 28, 2023 for paper filing if filing fewer than 250 forms). On December 15, 2022,… Read More

woman walking on pathway while strolling luggage

Did you know that Total Benefit Solutions, Inc does Travel Health Insurance?

January 8, 2023January 8, 2023Ed MacConnell

A record number of Americans traveled abroad in 2016 for leisure, business, study abroad and missionary work- to the tune of 67 million. Given recent epidemics, natural disasters and security threats around the world- coupled with your run-of-the-mill medical issues- travelers have more reason than ever to ensure their health and safety are fully insured prior to embarking on their trips. Americans are dedicating more and more time to preparing for their trips and researching the coverage options available to them, and with good reason. What Will a Good Travel Medical Policy Do for You? Travel medical insurance policies are designed to pick up where your primary domestic health plan… Read More

How ACA Marketplace Premiums are Changing by County in 2023

January 5, 2023January 3, 2023Ed MacConnell

Premiums for ACA Marketplace benchmark silver plans are increasing on average across the U.S. in 2023 after four years of slight declines. However, premiums changes vary by location and by metal level, with premiums decreasing in some cases. As most enrollees receive significant premium subsidies on the ACA Marketplaces, the net premium amount an exchange enrollee pays depends on their income and the difference in the cost between the benchmark plan (second-lowest-cost silver plan) and the premium for the plan they choose. The American Rescue Plan Act (ARPA) increased and expanded subsidies temporarily in 2021 and 2022 and the Inflation Reduction Act (IRA) extends those enhanced and expanded subsidies through… Read More

Annual Out-of-Pocket Maximum Adjustments Announced for 2024

January 3, 2023December 30, 2022Ed MacConnell

On December 13, 2022, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2024 (“the Notice”). For purposes of employer-sponsored health plans, the guidance includes the caps on out-of-pocket dollar limits for non-grandfathered group health plans with plan years that begin in 2024. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a Preferred Provider Organization (PPO)?

December 29, 2022December 27, 2022Ed MacConnell

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

Prescription drug list updates effective January 1, 2023

December 28, 2022December 27, 2022Ed MacConnell

The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost. As a result, ACA small employer groups, non-ACA small employer groups (including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023. Click here to read for more information. As always, please contact your Total Benefit Solutions health insurance specialists today with any questions at (215)355-2121.

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement

December 27, 2022December 27, 2022Ed MacConnell

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the PHE ends, millions of people could lose coverage that could reverse recent gains in coverage. The current PHE is in effect until January 11, 2023, and the Biden administration has said it will give states a 60-day… Read More

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