PPO | Total Benefit Solutions Inc

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

May 11, 2021May 12, 2021Ed MacConnell

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

HHS Extends Public Health Emergency until July 20, 2021

May 10, 2021May 12, 2021Ed MacConnell

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

IBC: MLR Additional Rebates

May 7, 2021May 10, 2021Ed MacConnell

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

5 reasons you may want to switch Medigap policies

May 7, 2021May 7, 2021Ed MacConnell

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

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

May 3, 2021May 4, 2021Ed MacConnell

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

What is a Medicare Medical Savings Account Plan?

April 26, 2021May 3, 2021Ed MacConnell

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

Update on COVID-19 Vaccine and Vaccine Administration Cost

April 23, 2021April 23, 2021Ed MacConnell

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

The Future of Employee Benefit Offerings: Student Debt Repayment Assistance

March 27, 2019March 27, 2019Kimberly Leonardi

When looking for a job, the benefits offered to an Employee are definitely a big factor in consideration of accepting an offer of employment. Most people are willing to choose a company with a slight pay decrease if the benefit package compensates for the lost wages. With unemployment the lowest it has been since 2000 in the United States, attracting new talent isn’t as easy as it used to be and Employers are looking for ways to snatch up qualified applicants. When you think of benefit packages, you usually think of the basics: Health Insurance (with possibly an HSA, HRA, or FSA included), Dental and Vision coverage. “Good” benefit packages… Read More

Why Offer an HRA to Your Employees?

March 27, 2019March 27, 2019Kimberly Leonardi

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

IBC: Individual Dental and Vision PPO’s Now Available!

April 29, 2014April 29, 2014Ed MacConnell

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More