UCR vs MAC Dental plans. What’s the difference?

  When members use an OON (out-of-network) provider, the cost of their procedures may vary from that which they’d see INN (in-network). UCR (Usual, Customary and Reasonable) and MAC (Maximum Allowable Cost) determine how their dental insurance will pay for the procedures. UCR (Usual, Customary and Reasonable)If a member has a UCR-based plan, providers charge a fee that has been set as the most commonly charged amount for that procedurein that location. This reimbursed amount is determined by analyzing claims data in a specific geographic location. MAC: Maximum Allowable ChargeIf a member has a MAC-based plan, providers charge any fee that they have set for a procedure. The reimbursed amount… Read More

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HHS Extends Public Health Emergency until July 20, 2021

The COVID-19 pandemic Public Health Emergency, scheduled to expire on April 21, 2021, was renewed. This will once again extend the period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Click to Download _HHS_Extends_Public_Health_Emergency_until_July_20_2021

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IBC: MLR Additional Rebates

Notice from Independence Blue Cross: Health insurance premium rebates for 2017 Small Group policyholders and 2018 Consumer policyholders As a result of a United States Supreme Court decision last year, Independence received additional payment from the Federal Government that impacted our Medical Loss Ratio (MLR) for 2017 and 2018. Beginning the week of May 17, Small Group policyholders from 2017 and Consumer policyholders from 2018 will receive checks that are a rebate for a portion of their health insurance premiums for that year. What is MLR? The Affordable Care Act requires that all health insurers spend a percentage of each premium dollar received towards paying claims, clinical services, and activities that improve health care quality for… Read More

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5 reasons you may want to switch Medigap policies

Switching Medigap policies 5 reasons you may want to switch Medigap policies You’re paying for benefits you don’t need. You need more benefits. You want to change your insurance company. You want a policy that costs less. Can I switch policies? In most cases, you will not have a right under federal law to switch Medigap policies, unless one of these applies: You’re eligible under a specific circumstance or guaranteed issue rights You’re within your 6-month Medigap open enrollment period You don’t have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy. Note As of January 1, 2020,… Read More

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BCBS Antitrust Litigation and Tentative Settlement –Impact on Group Health Plans

    BCBS Antitrust Litigation and Tentative Settlement – Impact on Group Health Plans   This material was updated on March 22, 2021, to include new information posted on the settlement website. Please refer to the BCBS settlement page and/or materials from the specific BCBS carrier for more information. Antitrust litigation that commenced against the Blue Cross Blue Shield Association and member companies1 in 2012 appears to be coming to a settlement. In short, plaintiffs alleged that Blue Cross Blue Shield companies across the country entered into agreements not to compete with each other for customers of health insurance. On November 30, 2020, the court preliminarily approved a proposed settlement… Read More

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What is a Medicare Medical Savings Account Plan?

A Medicare Medical Savings Account plan (MSA) is a special type of Medicare Advantage plan (Part C). This type of plan may offer the freedom of choice for people who want more control over their health care dollars and decisions. And along with the autonomy come some responsibilities. There are two important parts to a Medicare MSA plan. A special bank savings accountA high-deductible health plan The Medicare Savings Account Plan Special Bank Savings Account The savings account part of a Medicare MSA plan is self-managed like any other bank savings account. One main difference is that the account is funded with money from Medicare versus by you. Medicare beneficiaries… Read More

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Update on COVID-19 Vaccine and Vaccine Administration Cost

Update on COVID-19 Vaccine and Vaccine Administration Cost Medicare has increased and simplified its payment rate for administration of the COVID-19 vaccine to $40 per dose. This change may impact group health plans with respect to their payment rate to providers. Non-grandfathered group health plans are required to cover, without cost sharing, the COVID-19 vaccine. This obligation extended to coverage associated with administering the vaccine. The federal government continues to pay for the vaccine itself through funding authorized by the CARES Act.For vaccines administered in-network, plans will pay the rate negotiated with in-network providers, and that continues to be true. For vaccines administered out-of-network, however, group health plans must reimburse… Read More

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Indy Medicare Part D Health Plan Terminated

Indy Health Insurance Company, a stand-alone Part D plan in Arkansas, Pennsylvania, West Virginia, Illinois, and Georgia has been terminated.

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Tax Advantaged Benefit Documents

The IRS Code has numerous provisions designed to help employers provide essential benefits to their employees tax-free. This saves the employee approximately 30% in income taxes on expenses they’re already paying for, and because the employees have reduced their taxable income, the employer realizes a reduced matching payroll tax liability of approximately 8%. Everybody saves money.    To take advantage of these tax deductions the IRS requires that the employer have a written plan document and the Department of Labor and ERISA law require that every employee receive a summary plan description (SPD) explaining the new benefit in easy to understand language.   This site is dedicated to providing employers… Read More

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Total Benefit Solutions is your Marketplace Navigator

What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective  Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure  

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Total Benefit Solutions to partner with ThinkHR

        In another effort to enhance our client experience and bring value to our small business clients, Total Benefit Solutions is proud to announce that we have entered into an agreement to provide Think       HR. Soon our clients will get an introductory e-mail with instructions on how to access their complimentary ThinkHR account. We expect to have this resource available to our clients in September 2014, just in time for this year’s open enrollment period!   Think HR will help our clients: Stay up to date with the latest news and resources Remain compliant with best practices from HR professionals Build tools like job… Read More

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Will you get financial help when you purchase health insurance?

Will you get financial help when you purchase health insurance?   This handy new brochure from Humana is simple to understand. Download it today for a better understanding of your situation. You may qualify for help buying your health insurance. As always, contact us at Total Benefit Solutions Inc if you have any questions or concerns. We can be reached at (215)355-2121. Click here to download

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What is HR360?

What is HR360? HR360 is the premier online human resources library that features the most current federal and state laws for health care reform, COBRA, FMLA, and hiring and terminating employees. Clients of Total Benefit Solutions have HR360 as a complimentary resource. Watch this short video below and ask us today for your free trial membership, or how your organization can benefit from using Total Benefit Solutions Inc., and HR360. Call us for more information at 1(800)924-6718.

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What is Critical Illness Insurance?

Why Critical Illness as a “wrap” plan Because: They’re more affordable than you might think. They’re available for employer  groups, individuals and seniors. They make selecting a health plan easier. They provide peace of mind against a catastrophic event and large out of pocket expenses. They’re person and portable, it doesn’t matter where you get your health insurance from, having your own critical illness plan makes it better. Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”, meaning they are not regulated by the affordable… Read More

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Healthcare.gov Users Prompted To Change Passwords Because Of Heartbleed Risk.

The CBS Evening News (4/20, story 8, 1:55, Glor) reported Sunday night that “visitors to the to Affordable Care website are being advised to take steps to protect themselves” from Heartbleed, the online security flaw. Mark Albert reported over the weekend, healthcare.gov made the move to “reset everyone’s account password.” Saturday evening, the NBC Nightly News (4/19, story 7, 0:25, Holt) reported that people “with accounts on healthcare.gov are being told to change their passwords after review found that the website was vulnerable to the security breach bug.” The Hill (4/19, Wilson) “Hillicon Valley” blog reported that the call to change log in information for the site were “out of… Read More

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Healtcare Reform Law

Health Reform: New Guidance Clarifies Rules on Health FSA Carryovers

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. Click here to download the bulletin  

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Ed MacConnell earns Voluntary Benefits Certification

We are pleased to announce that Edward T MacConnell, President of Total Benefit Solutions has earned the certification of Certified Voluntary Worksite Professional from the National Association of Health Underwriters. Voluntary/Worksite products are not new to the employee benefit industry. However, the surge of interest in these products has accelerated as employers seek ways to help attract and retain talent. The industry has responded swiftly with new products, new features, new enrollment technologies and many changes to the underwriting rules of these products. This has created new responsibilities for agents, brokers and consultants as advising clients in this area will differentiate their value to the consumers they serve. Certified Voluntary Worksite… Read More

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Client Testimonial: Kristine Kreisher

We received this email from one of our clients this week, Kristine Kreisher, and wanted to share:   Dear Ed: I spent a month and a half calling Blue Cross, getting the run around, and given incorrect information. I make a phone call/send an email to you both and within a couple hours everything is taken care of and corrected!!! You guys are awesome!!! Thank you soooooo much for getting this all taken care of!!!! Kris Kreisher February 2014   We love happy clients!

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Humana-When to Enroll: Important Deadlines under the Affordable Care Act

Have you enrolled? Open enrollment is ending soon! Do you know when? Watch this video from Humana and learn more, then call your Total Benefit Solutions Advisor at (215)355-2121 and get enrolled without any further delay!  

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Health Reform: Final Rule Issued Regarding Health Insurance Provider Fee

Beginning in 2014, a health insurance provider fee applies to covered entities engaged in the business of providing health insurance for United States health risks. United States health risks include the health risk of a U.S. citizen or a resident alien including those living abroad. Thus, insurers issuing expatriate policies covering a U.S. citizen or resident alien living abroad are subject to the fee. Medical, dental and vision carriers in the insured marketplace are subject to this fee. This fee does not apply to self-insured employer-sponsored plans. Click the link below to download the bulletin. Final Rule Issued Regarding Health Insurance Provider Fee  

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Relief for Vision, Dental and EAP Benefits and New Wraparound Coverage

The Departments of Labor, Treasury and HHS issued a proposed rule that provides helpful guidance regarding certain excepted benefits, including vision benefits, dental benefits, employee assistance programs (EAPs) and certain wraparound programs. Click the link below to download the bulletin. Relief for Excepted Benefits-012414R

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Video: Who can help me enroll?

Who can help you enroll on a new affordable care act plan? Remember an independent broker like Total Benefit Solutions Inc can still help you enroll on a plan on the Federal Healtcare Exchange or off at no additional cost to you. Your independent broker is still truly your healthcare advocate! Another simple yet educational video from Humana:  

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Husband & Wife 2 Person Groups No Longer Eligible for Group Coverage

Effective January 1, 2014 for new business and as existing groups renew thereafter, Husband and Wife only and Partner only businesses are no longer eligible for Small Group coverage. There are differences on how each state* will handle immediate family members who are also employees. Sole Proprietors Sole proprietors, owners and their immediate family members forming a business are not considered employees and may only buy insurance through the Individual Marketplace. Sole proprietors reporting on Schedule C cannot form a group health plan without having at least one non-spouse common-law employee.** * The FFM states (e.g., NJ, PA, DE) will abide by the above within the SHOP (Small Group Exchange Marketplace). In… Read More

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