marketplace health plans obamacare | Total Benefit Solutions Inc

How is COBRA health insurance affected if I am disabled?

September 21, 2021September 21, 2021Ed MacConnell

In certain circumstances, if a disabled individual and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months. The criteria for this 11-month disability extension is a complex area of COBRA law. We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at phig@cms.hhs.gov. In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee’s employment hours. Second, the covered employee must be determined under title II or title XVI of the… Read More

CMS Extends Open Enrollment Period

September 18, 2021September 18, 2021Ed MacConnell

On September 17, 2021, the Centers for Medicare & Medicaid Services (CMS) finalized a series of provisions that follow through on President Biden’s commitment to build on the Affordable Care Act, expand health coverage access for Americans and advance health equity. The provisions are the third installment of the payment notice for 2022. There are several important policy updates that Marketplace agents and brokers should be aware of prior to the beginning of the plan year 2022 Open Enrollment Period (OEP). These provisions include: An extension of the OEP from November 1, 2021, to January 15, 2022, annually for Marketplaces on the federal platform. Clarification for Special Enrollment Period… Read More

Dental & Vision Plans for Families

September 6, 2021September 6, 2021Ed MacConnell

Getting a quality dental plan when you are self employed or don’t have employer coverage can be a real challenge. But don’t worry! The professionals at Total Benefit Solutions, Inc work for your benefit! We have provided this easy to use online portal to help you shop, compare and enroll on a great plan of your choice! We can walk through the options with you or you can enroll on the portal on your own, whatever you choose! Questions about these dental benefits? Just give us a call (215)355-2121. Click here to find and compare dental and vision plans!

What Are Medicare Guaranteed Issue Rights?

August 24, 2021August 23, 2021Ed MacConnell

Guaranteed Issue Rights (Also Called “Medigap Protections”) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change… Read More

Anthem Blue Cross: New agreement with Trinity Health System extends access through 2025

August 22, 2021August 20, 2021Ed MacConnell

August 20, 2021 We notified you last month that the previous agreement with Trinity Health System ended August 1. They have reached a new agreement that will assure continued access to affordable healthcare at Trinity Health hospitals, physicians, and affiliated care providers through 2025. We will continue our collaborative work to serve the community and look for innovative ways to help solve challenges together. Questions? reach out to your Total Benefit Solutions group account manager at (215)355-2121 https://www.totalbenefits.net

UHC: Watch – Understanding The No Surprises Act and 2021 Consolidated Appropriations Act

August 18, 2021August 18, 2021Ed MacConnell

Experts from UnitedHealthcare recently updated self-funded health plan sponsors and consultants on The No Surprises Act, and related compliance requirements, including: Consumer price transparency Mental health parity Implications and obligations for plans sponsors, including qualified payments, health plan ID cards, advanced EOBs and potential impact of out-of-network utilization and independent dispute resolution UHC: Understanding The No Surprises Act and 2021 Consolidated Appropriations Act – Presentation & Materials

COBRA Subsidy Termination Notice Reminder

August 16, 2021August 16, 2021Ed MacConnell

AEIs must be provided with a notice of expiration of the COBRA subsidy between August 16 and September 15, 2021. The notice must explain the date that the premium assistance will expire and that the individual may be eligible for coverage without any premium assistance through COBRA, a group health plan, the Marketplace, or Medicare/Medicaid.

“I’m paying for Health Insurance I don’t even use!”

November 9, 2018November 8, 2018Kimberly Leonardi

You hear it all the time: “I’m paying for Health Insurance I don’t even use!” But, Health insurance isn’t only for when you’re sick! You can use it to maintain your healthy status, you can use it for Preventative Care and you can also use this time to learn how your coverage works before you get sick. Also, many Health Insurance Plans offer things such as discounted gym memberships and rewards for healthy lifestyle choices (such as quitting smoking). Some plans even offer vision or dental benefits, so you can take advantage of an eye screening or 6 month dental check-up. Take advantage of free insurance benefits anytime Get preventive services,… Read More

Important Info! HSA Limits for 2019

November 1, 2018Kimberly Leonardi

End of Summer Social Media Drive 2018

August 16, 2018Kimberly Leonardi

Please help us get the word out on social media in August & September You Could Win a $25-$100 Amazon Gift Card!!! While everyone is getting ready for the End of Season BBQs, gearing up for Back-to-School, and trying to fit in as much adventure as possible the next few weeks, we here at Total Benefit Solutions are getting ready for our busiest time of year: Open Enrollments! Your friends and family members may not be concerned with the open enrollment period.. YET, but it is quickly approaching and we’d like to help them! As always, We appreciate all the referrals and recommendations that we get online from everyone, but we… Read More

New Jersey Out-of-Network Bill

July 31, 2018July 31, 2018Kimberly Leonardi

On June 1, 2018, New Jersey Gov. Murphy passed the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “OON Act”). In general, the OON Act applies to emergency services and other care provided by out-of-network physicians in in-network settings (i.e. hospital-based physicians). It takes effect on September 1, 2018. Click the link below to download the full story: Click to Download For more information or if you have any questions, please feel free to contact your Total Benefit Solutions Account Manager at 215-355-2121

The IRS Code has numerous provisions designed to help employers

November 2, 2017November 2, 2017Ed MacConnell

Employer Strategies and Solutions to Substantially Reduce: the high cost of Health Insurance; the cost for Out-of-Pocket Medical Expenses; the cost for Dependent Day Care Expenses; the cost for Parking and Transit Expenses; cost of Self-Employed Healthcare Expenses; Employer Matching Payroll Taxes by 8%; Employee Income Taxes by 30%. 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… Read More

2018 Individual Health Insurance Open Enrollment: PA Independence Individual Consumer Plans and Rates

October 21, 2017December 31, 2017Ed MacConnell

Individual Health Insurance Open Enrollment 2018! Don’t do it yourself! Our dedicated professionals are here to help you take the fits out of the benefit planning process! One mistake and you could be stuck with a bad plan all year! We work with all available plans both on the healthcare.gov marketplace and off! Have your own expert help you! Our experts are trained to help you Choose between on and off exchange options Maximize any subsidy eligibility. Help you understand the cost sharing subsidies Help you choose the plan that is the best fit for you Explain the differences between the plan design and your out of pocket expectations Fill… Read More

2018 Inflation Adjusted Amounts for HSAs

June 2, 2017June 2, 2017Robert MacConnell

The IRS released the inflation adjustments for health savings accounts (HSAs) and their accompanying high deductible health plans (HDHPs) effective for calendar year 2018. All limits increased from 2017 amounts. Click to download the bulletin below and as always contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns regarding this notice. Click Here to Download 2018 Inflation Adjusted Amounts for HSAs

House Passes Bill to Repeal ACA

May 5, 2017May 5, 2017Robert MacConnell

Just six weeks after the House leaders failed to muster the votes to pass an earlier version of the American Health Care Act (AHCA), the House Republicans narrowly passed their health care bill to repeal and replace Obamacare with a 217 to 213 vote on Thursday… Click the link below to download the bulletin with important points: Download House Passes Bill to Repeal Obamacare

Breaking News: CMS Announces Open Enrollment Dates and More

April 14, 2017Robert MacConnell

CMS issued final rule to increase choices and encourage stability in health insurance markets for 2018 The Centers for Medicare & Medicaid Services (CMS) issued the final Market Stabilization rule to help lower premiums and stabilize individual and small group markets, and to increase choices for Americans. Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits.* The CMS rule is designed to provide some relief for patients and issuers now. “CMS is committed to ensuring access to high quality affordable healthcare for all Americans and… Read More

Stand-Alone HRAs for Small Employers are Back!

March 1, 2017March 1, 2017Robert MacConnell

Stand-Alone HRAs for Small Employers are Back! The 21st Century Cures Act, signed by President Obama on December 13, 2016, gave small employers a means of providing employees help with their individual insurance premiums and other out-of-pocket qualified medical expenses without violating the provisions of the Affordable Care Act (ACA). Small employers can now provide a specific kind of Health Reimbursement Arrangement (HRA) to help employees with the costs of individual health coverage. According to the statutory language under “Title XVIII – Other Provisions” of the Act, qualified small employer health reimbursement arrangements (QSEHRAs) are not considered “group health plans” and do not have to adhere to ACA market reforms,… Read More

Trump’s First Executive Order Addresses the ACA

January 25, 2017January 25, 2017Ed MacConnell

Trump’s First Executive Order Addresses the ACA On January 20, 2017, President Trump issued an Executive Order to minimize the economic burden of the Affordable Care Act (“ACA”). This Order identifies the new administration’s policy for addressing and enforcing the ACA while Congressional Republicans craft legislation to repeal and replace it. The Order directs the agencies responsible for administration and enforcement of the ACA to exercise the authority and discretion available to them: Download Trump’s First Executive Order Addresses the ACA As always please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any additional questions or concerns.

Trump Issues Executive Order To Curb Some Parts Of ACA.

January 23, 2017January 23, 2017Ed MacConnell

Trump Issues Executive Order To Curb Some Parts Of ACA. The New York Times (1/20, Davis, Pear, Subscription Publication) reported that on Friday, President Donald Trump issued an executive order to government agencies directing them “to scale back as many aspects of the Affordable Care Act as possible, moving within hours of being sworn in to fulfill his pledge to eviscerate Barack Obama’s signature health care law.” According to the Times, the one-page order “has symbolic as well as substantive significance, allowing Mr. Trump to claim he acted immediately to do away with a health care law he has repeatedly called disastrous, even while it remains in place and he… Read More

Relief for Small Employers with HRAs

January 9, 2017Ed MacConnell

On December 13, 2016, President Obama signed into law the “21st Century Cures Act” which allows small employers without group medical plans to reimburse individual premiums and other medical expenses of employees under health reimbursement arrangements (“HRAs”), effective with the 2017 plan year, and provides relief from penalties to all small employers reimbursing individual premiums of employees for earlier plan years. In addition, the Cures Act provides a medical innovation package that funds medical research, accelerates cutting-edge treatments for rare diseases, and makes significant reforms to the mental health system. The Issue An employer cannot offer employees cash to reimburse the purchase of an individual policy, without regard to whether… Read More

Health Reform: 4th Quarter 2016 Compliance Compilation

December 29, 2016December 29, 2016Ed MacConnell

Download a digest of our fourth quarter compliance bulletins. This digest includes the following bulletins: Transitional Reinsurance Fee Form Now Available 10/14/2016 Final 2016 Forms 1094-C and 1095-C Available 10/25/2016 November 2017 Cost of Living Adjustments 11/01/2016 Relief Extended for Premium Reimbursement Programs for Student Employees 11/02/2016 Updates Regarding the NJ Small Employer Health Benefits Program 11/07/2016 Election Results and the ACA: Preliminary Thoughts 11/10/2016 16 Extension of Deadline for 2016 Forms 1095-C 11/21/2016 Adjusted PCOR Fee for Fifth Filing Year Released 11/22/2016 December Beware of Phishing Email Disguised as HIPAA Privacy Audit Letter 12/13/2016 Click here to download the 4th quarter compliance compilation

New Law Exempts Certain Small Employer HRAs From ACA Market Reforms

December 15, 2016December 14, 2016Ed MacConnell

New Law Exempts Certain Small Employer HRAs From ACA Market Reforms Gaddiel Gonzalez-Brown & Brown Consulting President Obama has signed into law the 21st Century Cures Act, which, among other things, allows small employers to offer new “qualified small employer health reimbursement arrangements” to reimburse employees for qualified medical expenses, including individual health insurance premiums, for years after December 31, 2016. Small employers are defined as those with fewer than 50 full-time equivalent employees who do not offer a group health plan. Background Under prior agency guidance, stand-alone HRAs (except for retiree-only HRAs and HRAs consisting solely of excepted benefits) and HRAs used to purchase coverage on the individual… Read More

IRS has provided a limited extension of time for employers to provide Forms 1095-C

December 14, 2016Ed MacConnell

The IRS has provided a limited extension of time for employers to provide Forms 1095-C (and carriers to provide Forms 1095-B) to individuals (but NOT to the IRS). Rather than January 31, 2017, the new deadline will be March 2, 2017. Download Extension of Deadline for 2016 Forms 1095-C

Health Reform: Cost of Living Adjustments, Individual Penalty, HSA limits & more for 2017

November 21, 2016Ed MacConnell

On October 25 and 27, 2016, the IRS released cost of living adjustments for 2017 under various provisions of the Internal Revenue Code (the Code). Some of these adjustments may affect your employee benefit plans. These adjustments include but are not limited to the following: Cafeteria Plans Qualified Transportation Fringe Benefits Requirement To Maintain Minimum Essential Coverage (Individual Penalty) Highly Compensated Non-Grandfathered Plan Cost-Sharing Limits H.S.A. Annual contribution limitation, catch up contribution and minimum deductibles Key Employee Click here to download the bulletin As always if you have any additional questions or concerns, please contact your dedicated Total Benefit Solutions, Inc. account manager at (215)355-2121.

Election Results and the ACA

November 10, 2016November 10, 2016Ed MacConnell

With the outcome of the 2016 elections now official, the Republicans will hold the majority in both chambers of Congress and control of the White House beginning in 2017. Since President-elect Trump ran on a platform of “Replace and Repeal” of the Affordable Care Act (ACA), we anticipate that acting on this campaign promise will be one of the top priorities of the new Trump administration. We anticipate there will be significant disruption for individuals, employers, brokers and carriers across the country. Click here to read the latest bulletin