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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Important News From Independence Blue Cross: Trinity Health termination

February 11th 2019: For the past several months, we have been negotiating the terms of our agreements with Trinity Health (Trinity), which includes the following entities, as well as their professional providers, subsidiaries, affiliates, and divisions: Mercy Health System of Southeastern Pennsylvania, including Mercy Fitzgerald, Mercy Philadelphia, and Nazareth hospitals St. Mary Medical Center, including St. Mary Rehabilitation Hospital, Saint Francis Healthcare, including Saint Francis Hospital, Wilmington, Delaware. We continue to engage in good‑faith negotiations, but we want to explain how customers and members could be affected if we are unable to reach a new agreement by March 31, 2019. How members would be affected If we are unable to reach a new agreement, Trinity will no longer be… Read More

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IBC 2019 Member Renewal Notices

October 25th: Independence Blue Cross Member Renewal Letter details Due to the subsidy disruption in some counties, Independence will be sending renewal notices in 2 waves. On October 25th 2018: • Members who do not receive a subsidy will receive their renewal notices for 2019. The notice will include benefit and premium updates for 2019 and provide a personalized URL for a website that enables them to renew plans as-is (EZ Button), or make a change to their current plan. • Members who have a subsidy will receive a letter advising that Independence is waiting for more information from the federal government regarding their subsidy dollars. Upon receipt of this information, the renewal notices will be sent.… Read More

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IBC: Effective January 1, 2015, HIPAA Certificates of Creditable Coverage are no longer required

On February 24, 2014, the United States Departments of Health and Human Services issued a final rule that addressed the requirement to provide HIPAA Certificates of Creditable Coverage (HIPAA Certificates) under the Affordable Care Act (ACA). As the ACA prohibits pre-existing condition exclusions, the new rule eliminates the requirement to provide HIPAA Certificates beginning December 31, 2014. What does this mean for members?  Previously, when coverage was terminated for a member or his/her dependents, Independence Blue Cross (Independence) issued a HIPAA Certificate. Because the ACA prohibits the application of pre-existing condition exclusions, which applies to both grandfathered and non-grandfathered health plans, these certificates are no longer required. Effective January, 1,… 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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Independence Blue Cross launches new private exchange for mid- and large-sized employers

Independence Blue Cross launches new private exchange for mid- and large-sized employers Multiple plan options offer flexibility, comprehensive coverage, and a personalized experience Philadelphia, PA – September 15, 2014 – Today, Independence Blue Cross (Independence) announces the introduction of a new private exchange marketplace that will offer medical, pharmacy, dental, and vision to employers with more than 100 employees. Employers can begin to use the Independence private exchange on October 1, 2014 with coverage effective on or after January 1, 2015.   Click here to read the release

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Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace

‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More

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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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IBC: Individual Dental and Vision PPO’s Now Available!

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More

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IRS: HSA Contributions and limits for 2015 Released

The IRS has released the 2015 cost-of-living adjustments affecting HSAs and HDHPs. The 2015 IRS HSA limits are increasing for 2015. Click to download the bulletin

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IBC: Special Care program ending

As you may already know, the Independence Blue Cross Special Care SM* health care plan will terminate on June 30, 2014. Because the Special Care plan is ending, the individuals who are currently enrolled in this plan will be eligible for a special enrollment period to sign up for a plan that is compliant with the Affordable Care Act (ACA). Special Care members qualify for a special enrollment period All Special Care members will be eligible for a special enrollment period , which will allow them to enroll in an individual or family health plan. Members will have from May 1 to August 29, 2014 to enroll in a health plan… Read More

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