UCR vs MAC Dental plans. What’s the difference?

  When members use an OON (out-of-network) provider, the cost of their procedures may vary from that which they’d see INN (in-network). UCR (Usual, Customary and Reasonable) and MAC (Maximum Allowable Cost) determine how their dental insurance will pay for the procedures. UCR (Usual, Customary and Reasonable)If a member has a UCR-based plan, providers charge a fee that has been set as the most commonly charged amount for that procedurein that location. This reimbursed amount is determined by analyzing claims data in a specific geographic location. MAC: Maximum Allowable ChargeIf a member has a MAC-based plan, providers charge any fee that they have set for a procedure. The reimbursed amount… Read More

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HHS Extends Public Health Emergency until July 20, 2021

The COVID-19 pandemic Public Health Emergency, scheduled to expire on April 21, 2021, was renewed. This will once again extend the period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Click to Download _HHS_Extends_Public_Health_Emergency_until_July_20_2021

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IBC: MLR Additional Rebates

Notice from Independence Blue Cross: Health insurance premium rebates for 2017 Small Group policyholders and 2018 Consumer policyholders As a result of a United States Supreme Court decision last year, Independence received additional payment from the Federal Government that impacted our Medical Loss Ratio (MLR) for 2017 and 2018. Beginning the week of May 17, Small Group policyholders from 2017 and Consumer policyholders from 2018 will receive checks that are a rebate for a portion of their health insurance premiums for that year. What is MLR? The Affordable Care Act requires that all health insurers spend a percentage of each premium dollar received towards paying claims, clinical services, and activities that improve health care quality for… Read More

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5 reasons you may want to switch Medigap policies

Switching Medigap policies 5 reasons you may want to switch Medigap policies You’re paying for benefits you don’t need. You need more benefits. You want to change your insurance company. You want a policy that costs less. Can I switch policies? In most cases, you will not have a right under federal law to switch Medigap policies, unless one of these applies: You’re eligible under a specific circumstance or guaranteed issue rights You’re within your 6-month Medigap open enrollment period You don’t have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy. Note As of January 1, 2020,… Read More

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BCBS Antitrust Litigation and Tentative Settlement –Impact on Group Health Plans

    BCBS Antitrust Litigation and Tentative Settlement – Impact on Group Health Plans   This material was updated on March 22, 2021, to include new information posted on the settlement website. Please refer to the BCBS settlement page and/or materials from the specific BCBS carrier for more information. Antitrust litigation that commenced against the Blue Cross Blue Shield Association and member companies1 in 2012 appears to be coming to a settlement. In short, plaintiffs alleged that Blue Cross Blue Shield companies across the country entered into agreements not to compete with each other for customers of health insurance. On November 30, 2020, the court preliminarily approved a proposed settlement… Read More

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What is a Medicare Medical Savings Account Plan?

A Medicare Medical Savings Account plan (MSA) is a special type of Medicare Advantage plan (Part C). This type of plan may offer the freedom of choice for people who want more control over their health care dollars and decisions. And along with the autonomy come some responsibilities. There are two important parts to a Medicare MSA plan. A special bank savings accountA high-deductible health plan The Medicare Savings Account Plan Special Bank Savings Account The savings account part of a Medicare MSA plan is self-managed like any other bank savings account. One main difference is that the account is funded with money from Medicare versus by you. Medicare beneficiaries… Read More

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Update on COVID-19 Vaccine and Vaccine Administration Cost

Update on COVID-19 Vaccine and Vaccine Administration Cost Medicare has increased and simplified its payment rate for administration of the COVID-19 vaccine to $40 per dose. This change may impact group health plans with respect to their payment rate to providers. Non-grandfathered group health plans are required to cover, without cost sharing, the COVID-19 vaccine. This obligation extended to coverage associated with administering the vaccine. The federal government continues to pay for the vaccine itself through funding authorized by the CARES Act.For vaccines administered in-network, plans will pay the rate negotiated with in-network providers, and that continues to be true. For vaccines administered out-of-network, however, group health plans must reimburse… Read More

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Indy Medicare Part D Health Plan Terminated

Indy Health Insurance Company, a stand-alone Part D plan in Arkansas, Pennsylvania, West Virginia, Illinois, and Georgia has been terminated.

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Tax Advantaged Benefit Documents

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 these tax deductions the IRS requires that the employer have a written plan document and the Department of Labor and ERISA law require that every employee receive a summary plan description (SPD) explaining the new benefit in easy to understand language.   This site is dedicated to providing employers… Read More

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COVID-19 PPE Now a Qualified Medical Expense

On March 26, 2021, the IRS issued IRS Announcement 2021-7, which clarifies that amounts paid for certain personal protective equipment (“COVID-19 PPE”) used to prevent the spread of COVID-19, including masks, hand sanitizer and sanitizing wipes can be treated as amounts paid for medical care under § 213(d) of the Internal Revenue Code. Accordingly, because these amounts are expenses for medical care under § 213(d) of the Internal Revenue Code, these amounts can also be eligible expenses under a health flexible spending account (health FSA), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and Archer medical savings accounts (Archer MSAs). Note, that if the amount is paid or reimbursed under… Read More

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Heard of Reference Based Pricing Health Insurance?

Reference-based pricing is a payment system that replaces or enhances a health plan’s traditional “usual and customary” pricing for contracted claims. Rather than calculating the average charge of providers in a geographic area or a pre-contracted cost, a health plan utilizing reference-based pricing instead arbitrates its allowable amount for medical claims based on its chosen method (most commonly Medicare rates, or a certain percentage above those rates), which is a price that the payor deems reasonable. In other words the employer, the payor brings their rates with them into the health care agreement, not the other way around. This represents a much more independent framework for determining sensible health care… Read More

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What are Commuter or Transit Benefits (Section 132)?

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

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How 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

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How 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.

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Can 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

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Think You’re Covered With Original Medicare?

Medicare in 2020   Everyone has heard of Medicare and over the years, here at Total Benefit Solutions have posted numerous articles explaining how Medicare works. We even wrote out a post about the history of Medicare a little over a year ago (That post can be found here ). However, nothing in the Insurance World stays still and every so often we like to revisit this sector of the Insurance Market and explain how Medicare works with some updates. This way, whether you’re new to Medicare, or you’ve been on it for a while, you are up-to-date on how your Insurance Plan works! Original Medicare (Part A and Part… Read More

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Full Self-Service Compliance Center At No Additional Charge to You!

  We are very pleased to announce an exciting new offering from our partner Infinisource Benefit Services – myHRcounsel’s™ Compliance Center™.  This new offering provides you with a full self-service compliance center at no additional charge to you! You can now access myHRcounsel’s ™ Compliance Center™, which includes key employment, ERISA and corporate law documents, legal overviews, checklists and legal information on all Federal and 50 state employment laws, through the link provided below.  By using myHRcounsel’s™ Compliance Center™, you will now have important current documentation required to comply with federal and state laws.  Through our partner Infinisource, you also have the unique option to consult with the attorneys at… Read More

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Medicare Won’t Cover This Key Expense…

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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Why Offer an HRA to Your Employees?

Healthcare Reimbursement Arrangement, typically referred to as an HRA, can be utilized by employers to reduce their overall healthcare costs without placing additional financial burden on their employees. An HRA allows the employer to pay for eligible expenses with pre-tax dollars. The employer decides what expenses are eligible, within the IRS guidelines, leaving a lot of flexibility in plan design. Typically an HRA is coupled with a High Deductible Health Plan and the HRA pays for either the entire deductible or a portion of the deductible. With this type of a plan the premium savings often outweigh the potential claims that the employer would have to pay if every employee… Read More

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Change of Income? When and How to Notify the Marketplace.

One of the benefits of getting your Health Insurance through the Marketplace is the tax credit applied to your premium, which makes your costs much more affordable. However, when determining how much your tax credit will be, you use an estimate on your income for the following year. Life is always changing, so if your income changes, if your Family size changes or even being offered Healthcare in some other way it is IMPORTANT to alert the Marketplace of these changes or you may end up owing money back to the Government when you file your taxes at the end of the year. Here we will talk about which types… Read More

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Important Info! HSA Limits for 2019

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Update on the Status of the ACA

Update on the Status of the ACA With the impending inauguration, recent actions by the Senate and some confusing media reports, we wanted to provide a short Q&A to help you understand current events and what to expect as we head down the health care reform road in 2017… What’s the latest news? Download the bulletin for an update: Download Update on the Status of the ACA   As always please contact your Total Benefit Solutions, Inc. account manager at (215)355-2121 if you have any questions or concerns.

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New tax form for individuals with coverage from the Health Insurance Marketplace

Beginning in January 2015, the Health Insurance Marketplace Health and Human Services will be issuing a new 1095-A tax form to individuals who purchased coverage through the Health Insurance Marketplace. If you or anyone in your household enrolled in a health plan through http://www.healthcare.gov you should receive the new tax form in the mail. You should use this form when filing your 2014 federal income tax return. For more information visit www.IRS.gov/ACA or www.healthcare.gov/taxes or contact your tax advisor. The following publications are also available: Health Care Law: What’s New for Individuals & Families  This is a large publication with many details. 3 Tips: The Marketplace and taxes Regarding your tax forms and… Read More

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Updated Healthcare Reform Calculators

Total Benefit Solutions Inc. has updated our healthcare reform calculators on our website, https://www.totalbenefits.net Calculators include: How much tax credit is my small group eligible for? What are the conditions required to get the tax credit? Pay or Play Mandate penalty-What is my risk as a group? Individual Subsidy Calculator Click here to get to our healthcare reform calculators.

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