CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell of Total Benefit Solutions Inc has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More
Continue ReadingEmployer 2024 Penalties Associated with the ACA (Affordable Care Act)
Add New Post Employers with a large number of part time employees have unique challenges when it comes to ACA compliance. Those with 50 or more full-time or full-time equivalent employees must meet two important requirements of the Affordable Care Act (ACA), or be subject to penalties A and B, A PENALTY: Employers who fail to offer a Minimum Essential Coverage (MEC) plan that provides certain wellness and preventive care to full-time employees may face a penalty of $2,970 per fulltime employee (minus the first 30). B PENALTY: A penalty of $4,460 per full-time employee who enrolls in a subsidized plan throughout a government exchange if the employer fails to… Read More
Continue Reading2023 RxDC Reporting Instructions Released
The Centers for Medicare and Medicaid Services (“CMS”) recently updated its Prescription Drugs Data Collection (“RxDC”) reporting instructions for 2023 data. There are some noticeable differences. As previously reported, group health plan sponsors (typically employers) are required to submit information to CMS on prescription drugs and health care spending on an annual basis (“RxDC reporting”). The first reporting deadline for calendar years 2020 and 2021 was December 27, 2022 (extended to January 31, 2023). The next deadline for reporting on calendar year 2023 is June 1, 2024, which, despite being a Saturday, is a firm date. It should be noted that carriers, pharmacy benefit managers (“PBMs”), and third-party administrators (“TPAs”)… Read More
Continue ReadingCheapest Health Insurance in Pennsylvania (2024 Plans)
Premium costs on Pennsylvania’s health insurance marketplace, Pennie vary by Catastrophic, Bronze, Silver or Gold tier. In Pennsylvania, Highmark Blue Cross Blue Shield offers the most affordable Bronze and Catastrophic plans, while UPMC Health Plan and Jefferson Health Plans provide the lowest-priced Gold and Silver plans in 2024, respectively. Of course, just because one plan costs less to buy does not make it the best plan to meet your needs. The health insurance experts at Total Benefit Solutions, Inc can shop the entire market for you, taking into account the healthcare needs of your family and guide you to the best plan for you. Contact us today at (215)355-2121.
Continue ReadingNavigating the Basics of Medicare: Understanding the Four Parts
Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact… Read More
Continue ReadingHealthcare Update: Cigna’s Negotiations with Orlando Health
Cigna Healthcare Medicare is currently in negotiations with Orlando Health in Florida. The outcome of these talks will determine if Orlando Health remains in the Cigna network. If an agreement isn’t reached, Orlando Health will exit the network on March 1, 2024. Customers will receive letters soon, detailing the change and their new assigned Primary Care Provider (PCP). For inquiries or to choose a different in-network PCP, affected customers can call Cigna Healthcare Medicare at 1-800-668-3813. The company reassures customers that their team is ready to assist, and any updates will be communicated promptly. As a reminder, you can search the online provider directory to find the most recent provider… Read More
Continue ReadingSpecial Election Period may be available to members affected by severe weather
The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP). For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit. Who is eligible? Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and What does this mean for beneficiaries? Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More
Continue ReadingHorizon Members Get 15% Off YMCA Memberships!
Exciting news for Horizon members in New Jersey! We’re thrilled to share that you can now enjoy a 15 percent discount on monthly memberships at select New Jersey YMCAs. Plus, for new YMCA members, the initiation fee is completely waived when you present your Horizon member ID card. This fantastic offer is valid until December 31, 2024, providing you ample time to take advantage of the savings and embrace a healthier lifestyle. Whether you’re a fitness enthusiast or looking to kickstart your wellness journey, this exclusive discount is designed to make your YMCA experience even more accessible. Remember, this exclusive discount is a limited-time offer, so make the most of… Read More
Continue ReadingAetna: Small Business Updates
As the year wraps up, businesses with 2 – 50 employees enrolled in Aetna Funding AdvantageSM groups need to act quickly. We’re filing 1095-B tax forms on your behalf, but it’s crucial to ensure your information is accurate. Deadline: End of December The federal deadline for 1095-B tax forms is approaching. Both businesses and customers must verify and update their details by the end of December to avoid potential IRS rejections. Why It Matters Accurate information on these forms is vital for complying with tax regulations. 1095-B forms provide essential health coverage details, impacting Affordable Care Act compliance. Any discrepancies could lead to filing complications. Review and update your information… Read More
Continue ReadingCase Study: A Voluntary Benefits Strategy
The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More
Continue ReadingIBC’s Latest Updates: Weight Loss Drug Policy
The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More
Continue ReadingCigna Healthcare and Tower Health Contract Updates
In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More
Continue ReadingAlert: Chicago Employers, Brace for Paid Leave Shifts in 2024
In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More
Continue ReadingKey Reminders for Individual Health Plan Payments
In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More
Continue ReadingACA Compliance: Key Calendars for 2024 Revealed!
Stay ahead of the compliance curve with crucial information on Affordable Care Act (ACA) deadlines for 2024. In our latest update, we’ve compiled comprehensive compliance calendars tailored for both small groups (less than 50 employees) and larger groups (50 or more employees). It’s your go-to resource for understanding and meeting important deadlines to ensure a seamless compliance journey. 2024 Small Group Compliance Deadlines: For fully and self-insured groups operating on a calendar year plan, we’ve outlined essential deadline dates for 2024. Please note that some reporting deadlines may vary for plans with a start date other than January 1st. Whether you have a small group or a larger organization, staying… Read More
Continue ReadingOpen Enrollment 2023: Key Reminders and Deadline
Are you ready for Open Enrollment? If not, don’t worry – we’ve got you covered with all the key information you need to make the most of this opportunity to secure health coverage for you and your loved ones. Open Enrollment for 2023 is just around the corner, beginning on November 1. However, it’s crucial to mark your calendars with the DEADLINE REMINDER: December 15th is the last day to enroll for coverage that kicks in on January 1st. For current Pennie customers, here are some important reminders: For those who are potential Pennie customers, here’s what you need to know: Why choose Pennie for your health coverage? Pennie offers… Read More
Continue ReadingTotal Benefits: Your Trusted Guide to Cost-Efficient Coverage
In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More
Continue ReadingAffordable Dental Insurance: A Key Player in Oral Health
Dental health is a crucial aspect of overall well-being, and a recent survey has shed light on the satisfaction levels of Americans with their dental insurance plans. The results, published in a press release by AHIP (America’s Health Insurance Plans) on September 26, 2023, provide an insightful perspective on the state of dental insurance in the United States. The survey, conducted by Global Strategy Group (GSG) on behalf of AHIP, focused on individuals who have dental insurance and have visited dental specialists, including dentists, oral surgeons, and orthodontists, in the past year. The findings from the survey paint a positive picture of Americans’ experiences with their dental insurance plans. Key… Read More
Continue Reading2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?
In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More
Continue ReadingMedicaid Redetermination Updates: Your Next Steps
The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More
Continue ReadingHow should employers distribute Medical Loss Ratio (MLR) Rebate Checks?
Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More
Continue ReadingMLR Rebate Checks Unveiled: A Must-Read for Employers
Every year, insurance carriers are required to meet specific Medical Loss Ratio (MLR) thresholds, ensuring that a significant portion of collected premiums goes toward medical care and improving healthcare quality. For the large group market, this threshold stands at 85 cents for every premium dollar collected, while in the small group market, it’s 80 cents. If these thresholds are not met, employers are in for a timely financial boost, in the form of premium credits or checks. MLR Rebate Deadline: September 30, 2023 The clock is ticking. If your insurance carrier falls short of the MLR threshold, they are obligated to distribute MLR checks to employers by September 30, 2023.… Read More
Continue ReadingUnderstanding the Updates to the Davis Bacon and Related Acts
On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More
Continue ReadingBenefits Notices: What Employers Need to Know
As an employer, it is important to be aware of the various benefits notices that you are required to provide to your employees. These notices are designed to inform employees of their rights and benefits under various laws and regulations. Failure to provide these notices can result in penalties and legal action. One of the notices that employers with 1-19 employees are required to provide is the Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice. This notice is provided to Medicare-eligible individuals who are offered prescription drug coverage under the employer’s group health plan. It must be provided annually prior to October 15th, upon request, and at… Read More
Continue ReadingVoluntary Benefits: Customized Coverage for Your Team
Unlocking the Power of Voluntary Benefits In today’s competitive job market, employers aim to attract and retain top talent by offering comprehensive benefits beyond the basics. Enter voluntary benefits – a customizable solution that benefits both employers and employees. What Are Voluntary Benefits? Voluntary benefits are offerings that employers provide for purchase by employees. They empower employees to tailor their benefits to their needs, offering flexibility and convenience. Here are their key characteristics: A Variety of Benefits Voluntary benefits offer a wide array of options, including: Advantages for Employers and Employees Employers benefit from: Employees enjoy: While voluntary benefits may not suit everyone, employers should assess their package and consult… Read More
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