#insurancebrokers – Page 2 – Total Benefit Solutions Inc

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.

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

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

What is a Family Premium?

December 16, 2022December 9, 2022Ed MacConnell

Under the Affordability for Employer Coverage for Family Members of Employees IRS rule, “family members” are individuals who will be on the same federal income tax return — so, an individual, plus their spouse if married and filing jointly, plus any dependents that they (and their spouse, if applicable) claim. The “family premium” is the premium for the lowest-cost employer plan that would cover all members of the tax household who are offered coverage by the employer. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is COBRA?

December 14, 2022December 7, 2022Ed MacConnell

A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Medicare Savings Programs

December 13, 2022December 9, 2022Ed MacConnell

Get help from your state paying your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums through a Medicare Savings Program. If you qualify, Medicare Savings Programs might also pay your Part A and Part B deductibles, coinsurance, and copayments. You’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply. For more information about the Medicare Savings Programs, click here. Have any questions regarding this notice? Please contact your Total Benefit Solutions Medicare health insurance specialists today at (215)355-2121.

What is Modified Adjusted Gross Income (MAGI)?

December 12, 2022November 29, 2022Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

What is Medicaid?

December 7, 2022November 29, 2022Ed MacConnell

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. Medicaid benefits, and program names, vary somewhat between states. You can apply anytime. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

Using your health insurance coverage & getting emergency care

December 6, 2022December 6, 2022Ed MacConnell

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital. I’m having an emergency. Should I go straight to the hospital or do I need to call my insurer first? In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network. What does it mean that insurance companies can’t charge me more? Insurance plans can’t make you pay… Read More

What Marketplace health insurance plans cover

December 5, 2022November 30, 2022Ed MacConnell

All plans offered in the Marketplace cover these 10 essential health benefits: Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Blue KC: Three hospitals added to BlueSelect Plus, BlueSelect networks

November 28, 2022Ed MacConnell

The BlueSelect Plus and BlueSelect networks have expanded their footprints. On November 15, three hospitals – Providence Medical Center, St. Joseph Medical Center, and St. Mary’s Medical Center – joined the networks, increasing the number of hospitals to 16 in BlueSelect Plus and 14 in BlueSelect. The addition of these hospitals applies to: Hospitals in BlueSelect Plus network The BlueSelect Plus network includes: AdventHealth College Boulevard; AdventHealth Shawnee Mission; AdventHealth South Overland Park; Cameron Regional Medical Center; Children’s Mercy Hospital; Children’s Mercy Hospital – South; Liberty Hospital; North Kansas City Hospital; Olathe Medical Center; Providence Medical Center; St. Joseph Medical Center; St. Mary’s Medical Center; University Health Truman Medical Center;… Read More

What is a Medicare Medical Savings Account (MSA) Plan?

November 18, 2022October 14, 2022Ed MacConnell

Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Accounts Plans available outside of Medicare. You can choose your health care services and providers (MSA plans usually don’t have a network of doctors, other health care providers, or hospitals). Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C).… Read More

10 Steps to Use a Medicare MSA Plan

November 11, 2022October 19, 2022Ed MacConnell

Choose and join a high-deductible Medicare MSA Plan. You set up an MSA with a bank the plan selects. Medicare gives the plan an amount of money each year for your health care. The plan deposits some money into your account. You can use the money in your account to pay your health care costs, including health care costs that aren’t covered by Medicare. When you use account money for Medicare-covered Part A and Part B services, it counts towards your plan’s deductible. If you use all of the money in your account and you have additional health care costs, you’ll have to pay for your Medicare-covered services out0of-pocket until… Read More

Beam Teams with Angle Health to Deliver Dynamic Employee Benefits

November 7, 2022October 14, 2022Ed MacConnell

Beam Dental is partnered with Angle Health, a digital-first healthcare benefits providers for the modern employee. Through the partnership with Beam, Angle can now attach best-in-class dental benefits to their innovative healthcare products, creating a more comprehensive and robust benefits package for employers. “There is tremendous activity and innovation in the small group health space right now. Angle is an exciting addition to this space,” said Andy Hutter, Beam’s Director of Digital Distribution. “Angle’s vision for modernizing healthcare aligns well with Beam’s own vision, and we are very excited to deliver a powerful combination of innovative coverage to the market.” Beam is changing and modernizing the dental insurance industry by… Read More

How does the Marketplace verify immigration status?

November 4, 2022September 26, 2022Ed MacConnell

The Marketplace verifies the citizenship and immigration statuses of consumers applying for Marketplace coverage using several electronic systems. Citizenship and immigration information submitted in the Marketplace eligibility application will be checked against the Marketplace’s trusted data sources, including the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service. If a consumer’s citizenship or immigration status cannot be verified, the Marketplace will notify the consumer of an inconsistency or data matching issue on their initial eligibility notice and ask them to submit additional information to resolve the inconsistency. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

What is medical underwriting?

November 3, 2022September 22, 2022Ed MacConnell

A process used by insurance companies to try to figure out your health status when you’re applying for health insurance coverage to determine whether to offer you coverage, at what price, and with what exclusions or limits. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Open Enrollment Tips from Total Benefit Solutions!

November 1, 2022October 26, 2022Ed MacConnell

As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a Health Maintenance Organization (HMO)?

October 27, 2022September 21, 2022Ed MacConnell

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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