#InsuranceTalk – Page 2 – Total Benefit Solutions Inc

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.

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.

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 the Children’s Health Insurance Program (CHIP)?

November 23, 2022November 23, 2022Ed MacConnell

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. You can apply any time. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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

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.

Blue KC: Employer/Group Open Enrollment Dates – Mark Your Calendar

October 21, 2022September 28, 2022Ed MacConnell

Blue KC is pleased to offer two open enrollment deadlines – one for physical ID cards and one for digital ID cards – to provide flexibility to new and renewing groups. Benefit information and open enrollment files/eligibility updates must be submitted to Blue KC based on the following schedule to ensure new ID cards are available to members by January 1, 2023: November 1, 2022 – Paperwork Deadline November 21, 2022 – Eligibility File – Physical ID Card December 16, 2022 – Eligibility File – Digital ID Card Please note: Small groups that make plan changes after this timeframe will receive updated ID cards once their plan changes have been… Read More

Inflation Reduction Act: Limits Monthly Copayments for Insulin in Medicare

October 20, 2022September 8, 2022Ed MacConnell

Beginning in 2023, limits copayments to $35 per month per prescription for covered insulin products in Medicare Part D plans and for insulin furnished through durable medical equipment under Medicare Part B, with no deductible. For 2026 and beyond, limits monthly Part D copayments for insulin to the lesser of: $35 25% of the maximum fair price (in cases where the insulin product has been selected for negotiation) 25% of the negotiated price in Part D plans Please call your Total Benefit Solutions Medicare health insurance specialists with any questions or concerns at (215)355-2121.

What is the Marketplace?

October 19, 2022September 21, 2022Ed MacConnell

Shorthand for the “Health Insurance Marketplace®,” a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. In most states, the federal government runs the Marketplace (sometimes know as the “exchange”) for individuals and families. On the web, it’s found at HealthCare.gov. Some states run their own Marketplace at different websites. Fill out a Marketplace application and you’ll find out if you qualify for lower monthly premiums or savings on out-of-pocket costs based on your income. You may find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can shop for and enroll in affordable medical insurance online, by phone,… Read More

Additional Guidance on New Prescription Drug Reporting Requirement

October 18, 2022September 20, 2022Ed MacConnell

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirements that proves some helpful clarification. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a premium?

October 14, 2022September 21, 2022Ed MacConnell

The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. When shopping for a plan, keep in mind that the plan with the lowest monthly premium may not be the best match for you. If you need much health care, a plan with slightly higher premium but a lower deductible may save you a lot of money. After you enroll in a plan, you must pay your first… Read More

Reminder: New Cost-Sharing Disclosure in 2023

October 13, 2022September 19, 2022Ed MacConnell

Another compliance deadline is quickly approaching. For plan years that begin on or after January 1, 2023, group health plans must provide for advance disclosure of cost-sharing information to enrollees seeking health services, upon request and to the extent practicable. The format of the disclosure is through an internet-based self-service tool, telephone, or paper format (upon request). The tool allows the enrollee to compare the amount of cost-sharing that he or she would be responsible for with respect to a discrete covered item or service by billing code or descriptive term. The required information relates to geographic region and in-network and out-of-network providers and initially addresses 500 items and services.… Read More

New Jersey New Poster Requirements

October 7, 2022October 7, 2022Ed MacConnell

On August 1, 2022, the New Jersey Division on Civil Rights (DCR) finalized regulations to increase the visibility and effectiveness of posters required by the State of New Jersey. Among other things, these regulations require employers to display posters informing people of their rights under New Jersey’s Law Against Discrimination (“NJLAD”) and Family Leave Act (“NJFLA”). The regulations went into effect immediately. The NJLAD protects New Jersey employees from discrimination in the workplace. It prohibits all employers in the State of New Jersey from discriminating against and harassing employees (and prospective employees) based on their protected status (including, but not limited to, race, national origin, age, sex, gender identification, sexual… Read More

Medicare Won’t Cover This Key Expense…

March 29, 2019March 29, 2019Ed MacConnell

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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