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
Continue Reading2018 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 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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Talking with your doctor about Keystone HMO Proactive
A Keystone HMO Proactive plan with a tiered network gives you the opportunity to look for the best value when you receive care. Tell your primary care physician (PCP) you have a tiered network plan so you can discuss your health care decisions and work together to make the best choices for you. Download this document for more information. As always please contact your Total Benefit Solutions, Inc, account manager at (215)355-2121 if you have any questions or concerns.
Continue ReadingIBC Breaking News: Changes to SEP On-Exchange Verification Process
Changes to SEP On-Exchange Verification Process Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including: Loss of minimum essential coverage Change in primary place of living Birth Marriage Adoption, placement for adoption, placement for foster care, or child support or other court order Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within… Read More
Continue ReadingVideo: Are you eligible for a special enrollment period?
You might think that you have to wait for the annual open enrollment period to get enrolled. Think again! You may be eligible for a special enrollment period. Watch this short video to learn more, and then call us at (215)355-2121!
Continue ReadingIBC Updated List of Proactive Hospitals
Download the document to get the latest list of Keystone Proactive hospitals and their tier assignment. The document also has a link to the most up to date IBC list online. Download the 2015 Keystone Proactive Hospital List
Continue ReadingHow do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?
Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross have a unique ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More
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2014 Compliance Bulletin Compilation
Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year! Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.
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Health Reform: Healthcare.Gov Sneak Preview
Healthcare.Gov Sneak Preview Announced Yesterday, Affordable Care Act customers can peek at 2015 prices for the program’s health plans today after the government released a “window-shopping” feature overnight Here is a direct link to the 2015 “sneak preview”: https://www.healthcare.gov/see-plans/ If you have any questions or concerns about your 2015 enrollment, please contact Total Benefit Solutions at (215)355-2121
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2015 Health Reform: Prepare for Health Insurance Open Enrollment
Preparing for 2015 Open Enrollment Getting prepared for open enrollment 2015 has been a major challenge. Total Benefit Solutions is dedicated to serving all of our clients throughout this second annual open enrollment period. With that in mind our offices will be open on the weekend of November 15th 2014 to help you get enrolled. Open enrollment for individual plans begins November 15th, 2014 and ends February 15th 2015. Anyone who enrolls prior to the 15th of the month will be effective the 1st of the next month. This is important because you must enroll by December 15th in order for your plan to be effective on January 1st, 2015… Read More
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Health Reform: Eligibility for the SHOP Marketplace
Eligibility Requirements for the SHOP Marketplaces In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP. To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible employee on payroll Have 25 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year). While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP… Read More
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Heath Reform: 5 States Will Have Early Access to Online Functions of the Federally-Facilitated SHOP Marketplace
‘SHOP Early Access’ Available in Delaware, Illinois, New Jersey, Ohio, and Missouri Starting in late October, small employers, agents, and brokers in Delaware, Illinois, New Jersey, Ohio, and Missouri will be able to experience some of the key new online functions of the federally-facilitated Small Business Health Options Program (FF-SHOP), according to the U.S. Department of Health and Human Services. The online SHOP Marketplace is expected to be available nationwide on November 15, 2014. SHOP Early Access During the “SHOP Early Access,” small employers in the five selected states will be able to use HealthCare.gov to take several initial steps in the enrollment process, including: Establishing a Marketplace SHOP account; Assigning an agent or… Read More
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Health Reform: Network Adequacy Standards
Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More
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Health Reform: 2015 Annual Open Enrollment Period
Annual Open Enrollment & Effective Dates The annual open enrollment period (AEP) for 2015 begins on November 15th 2014 and ends on February 14th 2015. The open enrollment period is the time when you can change, or purchase a new qualified health plan (QHP) on a guaranteed enrollment basis. You do not need a special election period, or a life change event to enroll during the annual open enrollment period. The chart below illustrates the effective dates for enrollments taken during the annual open enrollment period. Effective Dates for 2015 Annual Open Enrollment Period
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Will you get financial help when you purchase health insurance?
Will you get financial help when you purchase health insurance? This handy new brochure from Humana is simple to understand. Download it today for a better understanding of your situation. You may qualify for help buying your health insurance. As always, contact us at Total Benefit Solutions Inc if you have any questions or concerns. We can be reached at (215)355-2121. Click here to download
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IBC: Important notice about pharmacy changes
A number of clients have asked us about network pharmacy changes from IBC because they have been having issues filling prescriptions. We asked for clarification and we were able to find out that the changes only affect members who are on the following: On the Proactive Suite of plans On the Silver Suite of plans On the Bronze Suite of plans. We were directed to this link which was provided to providers. You may also find this link helpful. Simply if you are on one of the plans, or enroll on one, Rite Aid and Walgreens pharmacies are not in the network of participating pharmacies. As always please feel free… Read More
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IBC has selected Laboratory Corporation of America® Holdings (LabCorp) as sole national provider of outpatient laboratory services…
Independence Blue Cross (IBC) has selected Laboratory Corporation of America® Holdings (LabCorp) as sole national provider of outpatient laboratory services. As the July 1, 2014 effective date approaches, we’d like to give you an update on how the change is being implemented. LabCorp continues to open new locations in the area IBC is pleased to share that 29 new LabCorp Patient Service Centers have opened as of June 16. An additional 18 sites are planned to open by June 30, and several more this summer, to provide even more access for IBC membership. You can find a complete list of LabCorp Patient Service Centers by visiting www.LabCorp.com and selecting Find… Read More
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Clarification on IBC Pharmacy Changes
A number of clients have asked about changes to the IBC pharmacy network. Based on these questions we have found out that indeed there are a few. The changes are related specifically to Walgreens and Rite Aid. The changes only affect the following customers: Clients who have chosen one of the Bronze plans Clients who have enrolled on one of the proactive suite of plans. Rite Aid and Walgreens are not in network for these customers. We asked IBC for further clarification and we received this from a previous press release: Starting in 2014, IBC will introduce a new pharmacy network called the FutureScripts Preferred Pharmacy Network. This network is… Read More
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SHOP for Small Group Customers Buying a plan through SHOP versus direct
SHOP for Small Group Customers Buying a plan through SHOP versus direct Buying plans through the Small Business Health Options Program, or SHOP, provides an advantage only for employers with fewer than 25 employees that are eligible for a tax credit provided by the Affordable Care Act (ACA). If customers are not eligible for this tax credit, there is no advantage to purchasing a plan through SHOP. This is because… Click here to download the SHOP bulletin
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IBC: Tobacco Status Important Questions and Answers
Why does IBC collect member-level information about tobacco use? Under the Affordable Care Act (ACA), premium rates for health insurance coverage in the individual and small group markets may be based on family size, geography, age and tobacco use. In order to follow with this guideline and accurately rate each group, Independence Blue Cross (IBC) collects member-level tobacco use information to create group premiums for new and renewing group customers. Click the link below to download the IBC document that covers the most common questions about rating tobacco users in small group in PA. Tobacco Status For Small Group Customers Flyer
Continue ReadingIBC: Small Group Metallic Plans Mapping
Upon renewal in 2014 small groups will be automatically “mapped” to a new ACA compliant metallic plan. Find your new recommended 2014 Blue Solutions plan using the chart below. To make your renewal even easier we’ve identified the plan that most closely matches your current plan. Or you can choose from among 36 other options to suit your needs. More comprehensive coverage Blue Solutions health plans now cover Essential Health Benefits like pediatric dental and vision. Your health plan also continues to cover doctor visits, hospital admissions, emergency room treatments, maternity care, lab tests, X-rays, prescriptions, and vision benefits for both children and adults. Click the link below to download the… Read More
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Total Benefit Solutions Makes Enrolling Easier
In an effort to meet the enrollment challenges that many are facing under healthcare reform, Total Benefit Solutions Inc has designed a custom form for our clients to use. Using this form and submitting it to Total Benefit Solutions Inc will enable our Marketplace trained and certified licensed independent brokers to assist you in the enrollment process from the registration right through the enrollment! Remember as your independent broker we always work in your best interests, not an insurance company. We represent you, our client and not an insurer or government agency. Click the link below to open the form and get started! When completed, just click the link to… Read More
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