#MedicalInsurance – Total Benefit Solutions Inc

Updated No Surprises Act and IDR Guidance

November 3, 2023November 6, 2023Ed MacConnell

Recent developments in healthcare legislation have brought changes to the No Surprises Act’s independent dispute resolution (IDR) process. Issued by the Departments of Labor, the Treasury, and Health and Human Services (HHS), FAQ Part 62 provides essential updates regarding the qualifying payment amount (QPA) calculation methodology and the disclosure requirements for out-of-network (OON) air ambulance services. Moreover, the federal IDR portal has reopened, streamlining the resolution of billing disputes. The No Surprises Act Overview The No Surprises Act, a part of the Consolidated Appropriations Act, 2021, aims to protect patients from surprise medical bills. It places limits on out-of-network cost-sharing and bans balance billing in various situations, such as emergency… Read More

2024 Healthcare Premiums Revealed: The Impact Factors

October 4, 2023October 4, 2023Ed MacConnell

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

Choosing the Right Health Insurance: HMO vs. PPO

September 15, 2023September 15, 2023Ed MacConnell

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

How Is the Medicare Part D Benefit Changing in 2025?

June 30, 2023June 28, 2023Ed MacConnell

Changes in 2025 include a new $2,000 out-of-pocket spending cap, elimination of the coverage gap phase, a higher share of drug costs paid by Part D plans in the catastrophic phase, along with a new manufacturer price discount and reduced liability for Medicare in this phase, and changes to plan costs and the manufacturer price discount in the initial coverage phase. Out-of-pocket drug spending will be capped at $2,000 Beginning in 2025, Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs. (This cap does not apply… Read More

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

Does a Health Savings Account (HSA) have Reimbursable Expenses?

February 6, 2023February 1, 2023Ed MacConnell

Employees can use the HSA to pay for Code §213(d) medical expenses, expenses such as expenditures for medical care, to the extent that such amounts are not reimbursed by insurance or any other source. Medicines and drugs (other than insulin) can be qualified medical expenses only if they are prescribed. Under the CARES Act, employers can also allow for reimbursement of OTC drugs. With certain exceptions, qualified medical expenses do not include payments for health insurance premiums or coverage contributions toward self-funded health coverage. However, the expense for coverage under any of the following will be an HSA-qualified medical expenses: HSA funds may not be used to pay insurance premiums… Read More

What is Small Business Health Options Program (SHOP)?

February 3, 2023January 26, 2023Ed MacConnell

The Small Business Health Options Program (SHOP) helps small business owners provide medical and/or dental insurance to their employees. Some smaller employers qualify for tax credits if they enroll in SHOP insurance. A small business can offer SHOP health and/or dental insurance to their employees if they: Small business owners can use an agent or broker to enroll in SHOP insurance, or work with their insurance company. There’s no limited enrollment period for SHOP, so they can apply, pick plans, and enroll employees any time of year. Interested in SHOP for your small business? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Explore Blue KC Small Group Dental Plans and Rates for New Business

January 25, 2023January 13, 2023Ed MacConnell

Oral health is a key component of overall health and dental coverage, starting with regular checkups, can help prevent health issues and medical costs down the road. Blue KC small employer group dental coverage offers a selection of plans – with no waiting period – an extensive local and national provider network, competitive rates, plus a rewards program. Don’t hesitate to contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

What are Qualified Medical Expenses?

November 16, 2022October 20, 2022Ed MacConnell

Qualified Medical Expenses are generally the same types of services and products that otherwise could be deducted as medical expenses on your yearly income tax return. Some Qualified Medical Expenses, like doctors’ visits, lab tests, and hospital stays, are also Medicare-covered services. Services like dental and vision care are Qualified Medical Expenses, but aren’t covered by Medicare. Qualified Medical Expenses could count toward your Medicare MSA Plan deductible only if the expenses are for Medicare-covered Part A and Part B services. Each year, you should get a 1099-SA form from your bank that includes all of the withdrawals from your account. You’ll need to show that you’ve had Qualified Medical… 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.

What Are Medicare Guaranteed Issue Rights?

October 26, 2022July 25, 2022Ed MacConnell

Please contact your Total Benefit Solutions Inc Medicare health insurance specialists today at (215)355-2121 with any questions.

When can I buy a Medigap plan?

October 24, 2022July 25, 2022Ed MacConnell

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

Did you know? Aetna Medicare Supplement Members can pay their premiums now at CVS stores?

July 23, 2022July 19, 2022Ed MacConnell

Members with Aetna Medicare Supplement policies can now pay their monthly premiums at their local CVS store. Their billing statements (for premiums less than $999) will have a unique barcode, which they can take to their local CVS store. The cashier will scan it just like they do any other CVS merchandise. Members can then pay their premiums by cash, debit card, or credit card. NOTE: The pay in store option is not available at CVS in Target stores at this time. If you have any questions, please contact your Total Benefit Solutions, Inc Medicare supplement specialists at (215)355-2121

What Are Medicare Guaranteed Issue Rights?

August 24, 2021August 23, 2021Ed MacConnell

SCOTUS Upholds Affordable Care Act Ruling

June 22, 2021June 22, 2021Ed MacConnell

New Mandatory Preventive Items and Services

June 21, 2021June 21, 2021Ed MacConnell

Tax Advantaged Benefit Documents

June 18, 2021June 18, 2021Ed MacConnell

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

Alternatives to Health Insurance Benefits

June 13, 2021June 18, 2021Ed MacConnell

What is Blue Card PPO?

June 11, 2021June 18, 2021Ed MacConnell

IRS Guidance Clarifies DCAP Relief

June 9, 2021June 10, 2021Ed MacConnell

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

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