#Medicare – Page 6 – Total Benefit Solutions Inc

Total Benefit Solutions participating in CVS Retail Locations During Medicare Open Enrollment

October 9, 2016October 8, 2016Ed MacConnell

Total Benefit Solutions is pleased to announce that we are participating in the Independence Blue Cross Medicare/ CVS Pharmacy retail program for the upcoming open enrollment period. What this means to our clients is that we will be on site at our local CVS Pharmacy during the AEP. Starting on Saturday October 15th and continuing through open enrollment we will be on site nearly each Monday, Wednesday and Friday at the CVS Pharmacy in Feasterville from Noon to 2 PM each day. Please feel free to stop in without an appointment to get your questions answered and pick up your 2017 plan information from Independence Blue Cross. We will… Read More

Original Medicare: Did You Know?

August 20, 2016Ed MacConnell

Many Medicare beneficiaries are unaware that original Medicare coverage has significant deductibles and co-pays. Part A helps cover medically necessary inpatient care in hospitals. In 2016, for each benefit period (typically 60 days as defined by Medicare) in a year, beneficiaries pay: $1,288 deductible and no coinsurance for a stay of up to 60 days $322 coinsurance per day for days 61-90 of a hospital stay $644 coinsurance per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime) All costs for each inpatient day beyond 150 days At Total Benefit Solutions, Inc we specialize in Medigap programs that are affordable and cover most or… Read More

Total Benefit Solutions Joins Medicareful

February 5, 2016March 1, 2016Ed MacConnell

How do I know which Medicare plans are right for me? Medicare Supplement, Medicare Advantage, Part D drug coverage — the options seem endless! Don’t worry, Medicareful is here to help. By entering your zip code, you’ll unlock all of the Medicare plans available in your area. You can navigate them on your own or leave it to our professionals who can guide you to a plan based on your needs. From experience, we know how complex Medicare is and that people who work with trusted independent licensed sales agents are far more confident in their choices. It’s our job to help you find your plan, and we’re happy to do… Read More

Medicare Premiums and Deductibles Updated for 2016!

November 27, 2015November 27, 2015Ed MacConnell

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90. Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first… Read More

Medicare Part D Creditable Coverage Notice Due Soon

September 18, 2015September 18, 2015Ed MacConnell

Medicare Part D Creditable Coverage Notice The Medicare Modernization Act (MMA) requires employers whose policies include prescription drug coverage to provide a written disclosure notice to all Medicare eligible policyholders of whether such coverage is creditable. Creditable coverage means that the coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage. This disclosure must be provided prior to October 15th, 2015 (and at various times as stated in the regulations) to: Medicare eligible active working individuals and their dependents (including a Medicare eligible individual when he or she joins the plan); Medicare eligible COBRA individuals and their dependents; Medicare eligible disabled individuals covered under… Read More

Take Advantage of Medicare’s Free Preventive Services

July 22, 2015July 22, 2015Ed MacConnell

Many seniors are unaware that preventive tests, screenings and counseling sessions are now available for free, with no copays or deductibles, thanks to the Affordable Care Act. More than 60 million people took advantage of these services, at no cost to themselves, during the first three years after the services became free in 2011, according to government reports. Click the link below to download a list from Medicare for Dummies of Medicare preventative services. Medicares-preventive-services-chart13 Questions about Medicare eligibility, open enrollment, supplements, health plans or PDP drug cards? Total Benefit Solutions, Inc. has a dedicated team of Medicare health plan professionals who are trained, annually re-certified, licensed and… Read More

What about Medicare Supplements or Medigap Policies?

July 12, 2015July 12, 2015Ed MacConnell

Medicare Supplements or Medigap Plans A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy… Read More

CMS has uploaded a new video Medicare & You: Cervical cancer

June 9, 2015June 9, 2015Ed MacConnell

Get information about how Medicare can help you detect cervical and vaginal cancer.

SHOP Rules Finalized, Enrollment Forms Simplified

July 25, 2013February 6, 2022Ed MacConnell

The Small Business Health Options Program’s (SHOP) place along the Affordable Care Act’s (ACA) timeline. It’s now being packaged for mass consumption and soon will be stocked on store shelves across all 50 states. Click here to read more…

New York Health Exchanges Offer 50% Drop in Premiums

July 24, 2013February 6, 2022Ed MacConnell

Empire State approves plans to be sold by 17 insurers and lower expected premiums may ease fears that next year’s implementation of the biggest parts of the Affordable Care Act would send prices soaring… Click here to read the story

IBC: Important change to claims processing for PPO plans

July 22, 2013February 6, 2022Ed MacConnell

Independence Blue Cross (IBC) will begin notifying customers later this week regarding a change in how claims for certain out-of-network providers will be processed under their IBC Personal Choice® PPO health plan. This change impacts fully insured, self-funded, and Individual commercial Personal Choice® PPO plans only. There is no impact to Medicare plans. Effective November 1, 2013, members who have claims submitted by providers who participate in the Highmark Blue Shield (Highmark) professional provider network inside IBC’s five-county service area will be subject to higher out-of-pocket costs and may also be subject to balance billing. Currently, claims submitted by a participating Highmark professional provider are processed as out of network and applied… Read More

Health Reform: Research Filing Fees Due July 31

July 20, 2013February 6, 2022Ed MacConnell

The Research Fee filing deadline is July 31, 2013 for self-funded medical plans and HRAs Insurance carriers will report and pay the Fee for fully insured plans. If an employer has several self-insured arrangements with the same plan year, they are subject to a single fee. An HRA integrated with a self-funded plan providing major medical coverage will not incur a separate fee specific to the HRA if the HRA and plan are established or maintained by the same plan sponsor. Click below to download the bulletin Research Fees Due Interested in our free Health Care Reform Checklist? send an email

Health Reform: Aetna to distribute MLR rebates

July 19, 2013February 6, 2022Ed MacConnell

By August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. For group plans, rebate checks will be sent to the policyholder, with few exceptions. Please click the link below to download the bulletin. Click to download

NJDOBI Issues Amendments to Rating Rules under PPACA

July 19, 2013February 6, 2022Ed MacConnell

NJDOBI Issues Amendments to IHC and SEH Rating Rules under PPACA For rates applicable to all rating periods beginning on or after January 1, 2014, carriers are directed to: Formulate rates in the IHC market to achieve a required 300 percent maximum ratio between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the State. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over; Formulate rates in the SEH market without regard to gender. Age factor categories should be in… Read More

Health Insurance Marketplaces (Exchanges): Informational Video

July 17, 2013February 6, 2022Ed MacConnell

Beginning in 2014, individuals and small businesses with up to 50 employees can purchase insurance through online exchanges, also called “health insurance marketplaces.” Each exchange will offer a choice of health plans that meet certain benefit and cost standards. In 2016, businesses with up to 100 employees will be able to participate. Coventry Health/Aetna recently released this easy to understand video that may help you understand the new exchange or” marketplace” system of buying health insurance. Click here to watch the six minute long video.

Medicare: What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)?

July 17, 2013February 6, 2022Ed MacConnell

Q:What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)? A: Business income has increased for doctors because many people on Medicare are now using free screenings and an annual “wellness visit” provided through the Affordable Care Act (ACA). Through Oct. 6, 2011, the government said, 20.5 million people enrolled in Medicare had received the free screenings or the annual visit, which is also free. Medicare is now offering a 10 percent bonus payment on the fees charged for primary care services, and a 10 percent bonus payment to surgeons who work in areas where there are shortages of doctors. For 2013 and 2014, Medicaid payments… Read More

Total Benefit Solutions Newest Brochure

July 11, 2013February 6, 2022Ed MacConnell

Download our latest brochure to read all about the valuable services we provide for our clients! Download our latest employee benefits brochure

PPACA employer mandate delayed until 2015

July 2, 2013February 6, 2022Ed MacConnell

PPACA employer mandate delayed until 2015 The Obama administration unexpectedly announced Tuesday it is delaying the employer mandate under the Patient Protection and Affordable Care Act until 2015. The mandate — which requires mid-sized and large employers to offer health insurance coverage to their workers — was one of the main requirements of the health care overhaul that was set to go into effect Jan. 1, 2014. But the Treasury Department announced Tuesday that it would delay its enforcement an entire year after hearing numerous concerns from employers about the challenges of its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement… Read More

Prodigy Learning Center’s Executive Director is a Happy Client

June 15, 2013February 6, 2022Ed MacConnell

Hi Ed, I just wanted to let you know how great (our account manager) has been with our insurance issues. She has been so helpful to me. I don’t know if people take the time to tell you when your staff is doing a great job, but I wanted to let you know. She is great!! Thanks. Christine Viteo, R.N. Executive Director Prodigy Learning Center Philadelphia, Pa.19132

EMA Group to become Total Benefit Solutions Inc!

June 15, 2013February 6, 2022Ed MacConnell

The health insurance industry is on its way to a major overhaul by the end of this year. With the implementation of the Patient Protection and Affordable Care Act (PPACA), nearly every American will be affected by the new law and many already have. With this in mind, we have decided to refocus our efforts to better serve our clients in alignment with the new world of health benefits. We are proud to announce that beginning August 1, 2013; EMA Group Inc. will be known as Total Benefit Solutions Inc. Although our name is changing; our commitment to provide top notch guidance and support to our clients will never change.… Read More

IBC Requesting tobacco data

June 15, 2013February 6, 2022Ed MacConnell

Under the Affordable Care Act (ACA) and effective January 1, 2014, insurers are permitted to use the following four categories to determine premiums: Age Family Size Geography Tobacco To comply with this provision, IBC will be implementing a new process to collect tobacco usage as part of their rating methodology for groups with 2-50 employees and sole proprietors. Over the next several days, IBC will send letters to employers with January 1, 2014 renewal dates to gather this information. In the mailing, there will be a letter and a Tobacco Use Form, that must be completed for each of their employees and dependents age 21 and over… Read More

First PCORI Fees Due by July 31, 2013

June 10, 2013February 6, 2022Ed MacConnell

Revised IRS Form 720 Now Available for Employers Sponsoring HRAs and Other Self-Insured Plans to Report and Pay PCORI Fees First PCORI Fees Due by July 31, 2013 The IRS has revised Form 720, Quarterly Federal Excise Tax Return, for employers sponsoring certain self-insured health plans to report and pay new fees imposed under Health Care Reform to fund the Patient-Centered Outcomes Research Institute (PCORI). The fees, which must be reported annually on the second quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under a plan. Affected Self-Insured Plans PCORI fees are imposed on plan sponsors of… Read More

Heathcare Reform: Important New Guidance on Affordability

June 6, 2013February 6, 2022Ed MacConnell

In order to receive a subsidy in the Health Insurance Marketplace (formerly referred to as the Exchange), generally an individual must not be eligible for affordable coverage under an eligible employer sponsored plan that provides minimum value. Additionally, large employers looking to avoid penalty exposure must offer all full-time employees (and their dependents) affordable coverage that meets minimum value. Although final regulations were published back in February, further clarification was needed on the health benefits considered in determining the share of benefit costs paid by a plan. Click the link below to read the rest of the article. Minimum Value and Affordability-060513R

Health Reform: Cost Sharing Limits

June 6, 2013February 6, 2022Ed MacConnell

Effective the first plan year that begins on or after January 1, 2014, all non-grandfathered group health plans (both insured and self-insured) , regardless of size, must comply with annual cost-sharing limitations on out-of-pocket maximums. Click the link below to download and review the entire notice. Health Reform-cost sharing limits

89 charged in Medicare fraud busts in 8 cities

May 20, 2013February 6, 2022Ed MacConnell

WASHINGTON (AP) — Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. Click here for the story.

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