Commuter or Transit Benefits (Section 132) Parking & mass transit expenses may be paid for with pre-tax dollars through a commuter plan. This plan is a straightforward way for participants to reduce their commuting costs and for employers to gain additional payroll tax reductions. Some states, like NY and NJ have mandated the inclusion of commuter benefit plans over the last few years. A commuter benefit plan is typically offered as one component of a Flexible Spending Account (Section 125) What expenses qualify as commuter/transit benefits? Commuter highway vehicle: A commuter vehicle is any highway vehicle that seats at least 6 adults (not including the driver). In addition, you must reasonably… Read More
Continue ReadingHow Safe Is it to Return to Work Once You Are Vaccinated?
There are a lot of things we don’t know yet. Answer by Kara Govro, Senior HR Law Analyst With vaccines rolling out among select populations, can employers start to bring back vaccinated employees into the office? originally appeared on Quora, the place to gain and share knowledge, empowering people to learn from others and better understand the world. As long as employers are complying with state and local law, they can bring employees back whenever they think is prudent… Click here for the full storyhttps://apple.news/A3Zt-q6uTReW37kaI3Z4O8A
Continue ReadingHow Does Level Self Funded Health Insurance Work?
We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding your group’s health insurance might be a good for for your health plan! Contact your Total Benefit Solutions Account manager at (215)355-2121.
Continue ReadingCan Employers Legally Mandate The COVID Vaccine To Return To Work?
Can employers mandate their employees get the COVID vaccine before coming back to the office? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world. Answer by Kara Govro, Senior HR Law Analyst, on Quora: With COVID-19 vaccinations underway and widespread availability in sight, many employers want to know whether they can require their employees to get the vaccine. Click here for the full story
Continue ReadingPPE and Health FSA/HRA
The IRS announced that amounts paid for personal protective equipment such as masks, hand sanitizer and sanitizing wipes for the primary purpose of preventing the spread of COVID-19 are considered amounts paid for medical care under section 213 of the Internal Revenue Code. These items are now allowed to be reimbursed from a health FSA. The IRS notice recognizes all forms of PPE as expenses medical care and does not limit the PPE to just disposable or non-disposable items. Reimbursements are permitted for expenses incurred on or after 1/1/2020 and they must be properly documented for reimbursement. If plan terms do not allow the reimbursement of PPE but the plan… Read More
Continue ReadingDoes Medicare Cover Oral Surgery?
From our partners at HealthLine: If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs. While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage. Let’s explore which types of oral surgery Medicare covers and why. Click here for the full story. Questions about this story or Medicare coverages? Please contact your health insurance specialists at Total Benefit Benefit Solutions, Inc (215)355-2121
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Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums
there are millions of uninsured people who could be getting subsidized coverage on the ACA Marketplaces, but have not taken advantage of this financial help. In many cases, it may be that the financial help available to them is not sufficient to make the premium or the deductible affordable
Continue ReadingARPA Extends Open Enrollment for Individual Coverage in PA
Pennie (PA Individual Exchange) has communicated that they will be extending the open enrollment period from May 15 until August 15, 2021. This extension is to help consumers be able to take advantage of the benefits of the American Rescue Plan. Some of the key benefits of this plan are below: There is no longer a cap on who is eligible for Pennie’s income-based tax credits, which help reduce monthly premium costs. Previously only people whose household income was under 400% of federal poverty level (about $51,000 for an individual), could qualify for a tax credit. Now, anyone may be eligible for a tax credit. The size of the tax… Read More
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Enrollment Period at Get Covered New Jersey Extended
More information on the American Rescue Plan Act changes may be found on the Get Covered New Jersey website. Contact your Total Benefit Solutions, Inc health insurance specialist to get enrolled or if you have any questions or concerns at (215)355-2121
Continue ReadingWhat is Minimum Essential Coverage or MEC health insurance?
The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More
Continue ReadingIndependence Blue Cross COVID-19 claim forms
Independence Blue Cross COVID-19 claim forms
Click on the proper link below to download the COVID-19 Claim form
you need !
As always please reach out to your Total Benefit Solutions, Inc
health insurance specialist at (215)355-2121 for any questions or concerns.
How the COVID-19 Relief Bill Helps Older Adults and People with Disabilities
The recent COVID-19 relief bill, the American Rescue Plan (ARP), makes important changes to help older adults, people with disabilities, and families amid the pandemic and its economic fallout. The $1.9 trillion package signed into law by President Biden includes several of the Medicare Rights Center’s priorities and related reforms that will ease health care access and affordability, strengthen economic security, and advance equity. Key provisions include..Click here for the full story from Medicare Watch
Continue ReadingCopays vs Coinsurance: What is the employer impact?
In a recent study, the Employee Benefits Research Institute examined the differential effect of copayments and coinsurance on health care services. They found that coinsurance reduces inpatient care and specialist physician office visits, but copayments do not. Specifically: For inpatient health care, each 1 percent increase in coinsurance led to a 0.18 percent decrease in utilization. For specialty physician office visits, each 1 percent increase in coinsurance led to a 0.19 percent decrease in utilization. Those who were more likely to want a telehealth visit but did not receive one were more likely to have an unmet need for care because of the pandemic. There was no evidence that demand… Read More
Continue ReadingHealth Insurance: What Do You Pay for?
What Is a Monthly Premium? Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan for the next year. For individual ACA compliant plans, premiums are based on a pre-approved age based grid. When you enter a age on the grid, your premium will increase on your bill. What Are Out-of-Pocket Costs? Out-of-pocket costs are what you must pay when you get care. These costs depend on how much care you actually get and if you have a… Read More
Continue Reading3 Fundamental Life Planning Strategies for the Novice
3 Fundamental Life Planning Strategies for the Novice You may have heard before that it’s never too early to begin life planning. In many ways, this is true. The sooner you start preparing a plan for your life, the more likely it is that you’ll achieve your goals and position yourself and your family to thrive in the future. If this whole idea is new to you, don’t fret. Total Benefit Solutions is here to help you with these simple life planning tips. Get Insurance Insurance can provide much-needed security for you and your loved ones. Health insurance is essential for getting the care you need and… Read More
Continue ReadingAmerican Rescue Plan Act Signed Into Law
The American Rescue Plan Act (ARPA), which is the latest bill to address the ongoing economic impacts of COVID-19, has been signed into law. Most aspects of the law do not directly affect the HR function, but those that do—optional extension of sick and family leave and establishment of COBRA subsidies—are outlined below.
Continue ReadingDepartments Issue Guidance Re: FFCRA and CARES Act
On February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued FAQ 44 addressing health coverage issues related to COVID-19. Briefly, the new FAQs focus on diagnostic testing and coverage for testing and clarify previous guidance in FAQs.Background Section 6001 of the FFCRA requires group health plans (including grandfathered health plans) and health insurance issuers to provide coverage for certain items and services related to testing or the diagnosis of COVID-19 without any cost-sharing requirements, prior authorization or othermedical requirements. Section 3201 of the CARES Act amended Section 6001 of the FFCRA to include a broader range of diagnostic items and services… Read More
Continue ReadingNew COBRA Subsidy Begins April 1st under COVID Relief
Congress passed the American Rescue Plan Act of 2021 (“the Act”) on March 10, 2021 and it was signed into law on March 11, 2021. The Act includes a 100% COBRA subsidy available to certain COBRA qualified beneficiaries who lose group health plan coverage as the result of an involuntary termination or reduction in hours. This is different from the original House legislation, which included an 85% subsidy (with the COBRA beneficiary responsible for 15% of the COBRA premiums). Employers will be able to claim a credit against payroll taxes to reimburse the cost of the subsidy. The COBRA subsidy begins April 1, 2021 (the first day of the month… Read More
Continue ReadingWhat is a benefit Third Party Administrator (TPA)?
A Third-Party Administrator (TPA) is an organization that processes insurance claims or specific aspects of employee benefit plans for other organizations. Using a TPA is a generally a way to outsource claims processing. Employers that self-insure their health insurance benefits often outsource to a TPA. Using a TPA can be a smart business decision whether you want expertise in particular areas or avoid the costs and liabilities of doing it in house. But not always self insured employers need a TPA. Third party administrators also handle many aspects of other employee benefit plans such as the processing of retirement plans. Most employers who provide health insurance plans use a TPA… Read More
Continue ReadingCOBRA Subsidy in the works
Photo by AllGo – An App For Plus Size People on Unsplash A COBRA subsidy is included in early drafts of the proposed fiscal year 2021 budget reconciliation package. If finalized, the COBRA subsidy would apply to workers who have lost group coverage during the COVID-19 pandemic due to involuntary termination or reduction in hours of employment. Download this bulletin below for more information and as always contact your Total Benefit Solutions, Inc health insurance specialist with any questions at (215)355-2121. Download COBRA Subsidy in the Works
Continue ReadingHow to read your Explanation of Benefits EOB
Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find outhow much a provider charged for services, what your health plan paid, and how much you owe. While the attached sample below is from a specific health insurance company they all follow the same format. Reading your EOB is especially important if you are submitting your claims for reimbursement through an HRA or health reimbursement arrangement. Need more information or help with your EOB or claims? Reach out to your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121. Download How to read your EOB
Continue ReadingLosing your employer provided health insurance?
Losing your health insurance through work? No worries the Total Benefit Solutions, Inc team of professionals can help you get affordable coverage to fill in the gap between employers! https://www.totalbenefits.net (215)355-2121
Continue ReadingAre you an applicable large employer, or not? That’s the question!
Calculating Your FTE Count Are you an applicable large employer, or not? That’s the question! To answer this question you’ll need to add up your full-time employees plus the full-time equivalent of part-time employees. For some businesses, this may have been simple, but not for all. This is how you determine your FTE count. Full-Time Employees: Any employee who works an average of at least 30 hours per week in a given month. Or at least 130 hours of service in a given month. Full-Time Equivalent: The full-time equivalent of part-time employees is the number of hours worked by all your part-time employees in a given month divided by 120. For example: two employees… Read More
Continue ReadingWhat is a Direct Primary Care plan?
Photo by CDC on Unsplash What is Direct Primary Care (DPC)? DPC is a non-insurance healthcare model where a flat monthly fee is paid for a defined set of primary care services. Direct Primary Care membership typically includes timely and unlimited access to your physician via in-office visit or over the phone. The model is structured to emphasize the patient-physician relationship to lower care costs, promote better employee health, and better patient experience. Benefits include: Increased Access to Healthcare. Breaks down the barriers to healthcare like confusing narrow networks, high deductibles and limited enrollment period. Detect Diseases and Treat Sooner. Encourages the early detection of illnesses, which reduces expenses for both… Read More
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