If Pennie Customers Missed the Deadline to Enroll Because of COVID-19 Impacts – They Now Have Until January 31st to Enroll!

Pennie understands that many Pennsylvanians have been impacted recently due to the increase of COVID-19 cases. Because of this, we would like to offer Pennie customers a Special Enrollment Period (SEP) if they experienced any of the following: The customer, or a member of their household, tested positive for COVID-19 within the fifteen (15) days prior to, and including, the January 15, 2022 open enrollment deadline. The location where the customer accesses services necessary to enroll, such as a public library or a community center with internet access, was closed due to COVID-19 within the fifteen (15) days prior to, and including, the January 15, 2022 open enrollment deadline. The customer could not… Read More

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United Healthcare Members can now get up to eight COVID-19 at home tests at no cost

Members can now get up to eight COVID-19 at home tests at no cost to them On Jan. 10, 2022, the Departments of Labor, Treasury and Health and Human Services released guidance to support the Administration’s directive that health insurers and group health plans cover, subject to certain criteria, the cost of FDA-authorized or approved over-the-counter (OTC) COVID-19 at home tests beginning on Jan. 15, 2022.  On Jan. 15, 2022, UnitedHealthcare began covering most commercial individual and group health plan members’ FDA-authorized or approved OTC COVID-19 at home tests without a doctor’s prescription or clinical assessment. This COVID-19 at home test benefit includes up to 8 tests per member per… Read More

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Supreme Court Ends Vaccination Emergency

In a 6-3 decision issued on January 13, 2022, the Supreme Court reimposed a legal stay that prevents OSHA from enforcing its vaccination Emergency Temporary Standard(ETS). And while the matter is being sent back to the 6th Circuit Court of Appeals for further review, the conclusions drawn by the Court almost certainly means the end of the ETS. What does this mean for employers?Employers will no longer have to comply with the ETS, which means that they will now have greater latitude to decide what COVID-related practices are best for their workplaces.   Download Supreme Court Effectively Ends OSHA Vaccination Emergency   As always feel free to contact your Total… Read More

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New PCOR Fee Announced

On December 21, 2021, the IRS released Notice 2022-04, announcing that the adjusted applicable dollar amount used to determine the PCOR fee for plan years ending on or after October 1, 2021 and before October 1, 2022 is $2.79. The PCOR filing deadline is August 1, 2022 for all self-funded medical plans and some HRAs for plan years (including short plan years) ending in 2021. Carriers are responsible for paying the fee for insured policies. Click to Download New PCOR Fees    

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Additional Medicare Tax for High Earners

Employers are required to withhold an Additional Medicare Tax at a rate of 0.9% on wages or compensation paid to anemployee above the following threshold amounts for the employee’s filing status:   Filing Status Threshold Amount Married Filing Jointly $250,000 Married Filing Separately  $125,000 Head of Household (with qualifying person)Single  $200,000 Qualifying Widow(er) with dependent child $200,000              Click below to read the rest of the details including Employer notices. As always if you have any questions please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 Download Additional Medicare Tax for High Earners

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Final 2021 Instructions for Forms 1094-C and 1095-C Issued

  The IRS released final Instructions for Forms 1094-C and 1095-C for calendar year 2021 reporting. Background Applicable large employers (“ALEs”) must furnish Form 1095-C to full-time employees and file Form 1094-C and all 1095-Cs with the IRS. ALEs offering a self-insured group health plan must also furnish Forms 1095-C to covered employees or other primary insured individuals in the self-funded health plan (e.g., covered part-time employees, COBRA qualified beneficiaries). ALEs, in coordination with their payroll or other reporting vendors, should have records to determine each employee’s status as an ACA FTE or not an ACA FTE for each month during 2021 in preparation to complete, furnish and file these… Read More

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Build Back Better Legislation Includes Benefit Provisions

During the last week of October 2021, the Biden administration announced a new framework for the budget reconciliation package, known as the Build Back Better Act (H.R. 5376). Subsequently, the U.S. House of Representatives released the legislative text and a section-by-section summary of the new framework. The legislation is still being negotiated, and the timing for when a vote is expected is uncertain. If the proposed legislation is enacted into law in its current form, the following provisions would have notable impacts on employer-sponsored health and welfare benefit programs. Increased employer contributions to avoid penalties under the ACA employer mandate The 9.61% affordability percentage for 2022 would be reduced to 8.5% (with… Read More

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Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia

We scored Philadelphia Health Insurance Agencies on more than 25 variables across five categories, and analyzed the results to give you a hand-picked list of the best. Total Benefit Solutions Inc chosen as top health insurance agency in Philadelphia by expertise.com

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Medicare Part D Notification Requirements

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drugcoverage provided under the plan is “creditable” or “noncreditable.”This notification must be provided prior to October 15th each year. Also, following the plan’s annualrenewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. Employers should send these notices no later than October15, 2021 if they haven’t done so already. Have questions about this notice? Contact your Total Benefit Solutions Inc health insurance specialists at (215)355-2121. Click here to download Medicare Part D Notification Requirements  

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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carriercollects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activitiesto improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.If a rebate is available, carriers are required to distribute MLR checks to employers by September 30, 2021. Click here to download this bulletin: 2021 MLR Rebate Checks Recently Issued to Fully… Read More

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How is COBRA health insurance affected if I am disabled?

  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

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CMS Extends Open Enrollment Period

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

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

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

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AmeriHealth New Jersey prepares to comply with new Transparency requirements

From Amerihealth NJ: Health care and health insurance are among the most regulated industries in the U.S., making compliance a crucial requirement for success. AmeriHealth New Jersey has a strong track record of compliance to local, state, and federal guidelines, and we are working to comply with the new Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) requirements. We have been focused on transparency for our members for years, and we are now further sharpening our efforts related to transparency and accountability pertaining to the recent legislation for which we have developed an enterprise-wide implementation program to ensure requirements are met. We have a cross-functional team that is… Read More

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HHS Extends Public Health Emergency until October 18, 2021

  On July 19, 2021, the Secretary of Health and Human Services (“HHS”), announced that the administration will renew the COVID-19 pandemic Public Health Emergency, scheduled to expire on July 20, 2021. 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. As previously noted, in a letter sent to state governors, HHS indicated that the agency expects that the Public Health Emergency will likely remain in place for all of 2021. While not formal agency action, it appears that HHS intends to continue to renew the Public Health Emergency through, at least, the end… Read More

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Ways to Save Money on Your Prescription Drugs

Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More

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Aetna Funding Advantage (AFA) is a new self-funded option for small groups

Aetna Funding Advantage (AFA) is a self-funded option that provides all of the financial and plan design flexibility of a traditional arrangement with special features designed to help companies with as few as 2 employees achieve even greater savings on their health insurance. Ask us today if self funding could be a good fit for your organization! Call your Total Benefit Solutions Inc. account manager at (215)355-2121 for more information! Learn more here: AFA-Customer-Flyer New! Minute Clinic Benefit! $0 Copay Minute Clinic Visits Flyer More Documents for downloading: Springboard Marketplace Your Online Administration and Enrollment Portal AFA AppleWatch Wellness Flyer AFA Sample Usage Reports Aetna & Teledoc for AFA AETNA… Read More

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Aetna Funding Advantage for Small Businesses

Aetna Funding Advantage (AFA) is a new self-funded option that provides all of the financial and plan design flexibility of a traditional arrangement with special features designed to help companies with as few as 2 employees achieve even greater savings on their health insurance. The benefits of self-funding have traditionally been considered by larger companies. But Aetna Funding Advantage has changed that. It is specifically designed to be attractive and affordable for small businesses like yours. Watch this short video and download the documents below for some information. As always please contact your Total Benefit Solutions dedicated account manager at (215)355-2121 if you have any questions, concerns or would like to learn… Read More

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Guidance Issued on QSEHRAs

  Under the Affordable Care Act, a health reimbursement arrangement (HRA) must be integrated with a group health plan (as it could not meet the market reform provisions on its own) and was not able to reimburse employees for individual premiums. However, on December 13, 2016, President Obama signed into law the “21st Century Cures Act” which established QSEHRAs (a special standalone HRA). Click to Download Guidance Issued on QSEHRAs This guidance is big news for small groups who would prefer to provide a reimbursement as opposed to a group health plan. Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.  

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

  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

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BREAKING: Aetna to withdraw from New Jersey Small Employer ACA market in 2018

Aetna to withdraw from New Jersey Small Employer ACA market in 2018  Due to mounting financial losses and an uncertain marketplace outlook, Aetna has made the decision to leave the Individual market in New Jersey. Regrettably, this decision also impacts our New Jersey small employer ACA insured medical products. New Jersey law requires a carrier to withdraw from the insured small employer market if it is withdrawing from the individual market.  As such, Aetna will withdraw all of its commercial (fully insured) medical plans offered in the small employer health insurance market. What this means Health insurance coverage for New Jersey small employer clients will end at midnight on the… Read More

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House Passes Bill to Repeal ACA

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

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Video: Our New Online Enrollment System

Watch this short video to get a quick overview of our new employee enrollment system with Ease Central!   As always please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions about our new enrollment system with Ease Central!

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Breaking News: CMS Announces Open Enrollment Dates and More

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

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GOP Pulls AHCA Before Vote

On Friday, March 24, 2017, the U.S. House of Representatives pulled the American Health Care Act (“AHCA”) from consideration after not receiving enough Republican support to pass the bill. The AHCA was President Trump’s first attempt to repeal and replace the Affordable Care Act (the “ACA”). The AHCA, among other things, would have eradicated the penalties associated with the individual and employer mandates, and replaced the ACA subsidies with refundable tax credits. Download GOP Pulls AHCA Before Vote

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