#SELFINSURANCE – Total Benefit Solutions Inc

What is a level funded health insurance plan?

September 1, 2024September 1, 2024Ed MacConnell

A level-funded plan is a type of self-funded plan in which the employer contributes a steady monthly payment to cover costs for administration, claims payments, and stop-loss insurance. Level funding has its advantages when compared to fully insured plans and programs. Level-funded plans often cost less, making it easier for small- and mid-sized employers to offer their employees high-quality health care benefits at a more affordable price. Total Benefit Solutions, Inc offers small- to mid-sized employers an opportunity to have a level-funded plan for their business through a Self-Funded Program. We work with many different carriers who offer level funded programs. These carriers change by State. How does the plan… Read More

What is Stop Loss Coverage?

January 26, 2023January 23, 2023Ed MacConnell

Stop-loss insurance, in combination with a self-funded group health plan, is a type of coverage that protects companies from catastrophic or unexpected medical claims. Why choose a plan with stop-loss coverage? Protecting a company financially is critical and stop-loss is an employer’s safety net. With the Self-Funded Program, , stop-loss insurance is always included in employers’ monthly payments. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount, agreed upon up front, that they are responsible for funding the claims account each year. By choosing a self-funded plan with stop-loss coverage, employers limit their risk, protect themselves against high claims, and have… Read More

Additional Guidance Issued on Surprise Billing Protections

September 12, 2022September 9, 2022Ed MacConnell

The Consolidated Appropriations Act of 2021 introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, & providers. The Consolidated Appropriations Act of 2021 (CAA) introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, and providers. The federal Departments of Health and Human Services, Labor, and Treasury recently released a document discussing frequently asked questions (FAQs) about these surprise billing protections that provides clarity on a number of topics within the regulations. The key points from this guidance are outlined below. Application to Reference Based Pricing PlansIt has been unclear how the surprise billing rules apply to… Read More

What is a Self-Insured Plan?

August 10, 2022July 27, 2022Ed MacConnell

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. Please contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

Fixed Funding: Innovative plan solutions now available for New Jersey employers

June 10, 2022Ed MacConnell

AmeriHealth New Jersey is excited and proud to announce that it is offering Fixed Funding benefit design options to New Jersey employers, powered by AmeriHealth Administrators. These plans are available now to quote for July 1, 2022 effective dates. Fixed Funding offers innovative benefit designs that are flexible, predictable, and cash‑flow friendly — while providing members access to high‑quality care from an extensive network of doctors and hospitals. These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment. How a Fixed Funding health plan works: Employers have a consistent monthly payment that covers the cost of administrative fees, stop‑loss insurance premiums1, and an estimated cost… Read More

SCOTUS Upholds Affordable Care Act Ruling

June 22, 2021June 22, 2021Ed MacConnell

New Mandatory Preventive Items and Services

June 21, 2021June 21, 2021Ed MacConnell

Tax Advantaged Benefit Documents

June 18, 2021June 18, 2021Ed MacConnell

This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.

Alternatives to Health Insurance Benefits

June 13, 2021June 18, 2021Ed MacConnell

What is Blue Card PPO?

June 11, 2021June 18, 2021Ed MacConnell

IRS Guidance Clarifies DCAP Relief

June 9, 2021June 10, 2021Ed MacConnell

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

CMS Announces Medicare Plan Finder Improvements

June 8, 2021April 23, 2024Ed MacConnell

Can Employers Ask for Proof of Vaccination?

June 8, 2021June 10, 2021Ed MacConnell

Family Dental & Vision Plans

June 3, 2021June 3, 2021Ed MacConnell

What is Modified Adjusted Gross Income (MAGI)?

June 3, 2021June 3, 2021Ed MacConnell

What is Balance Billing?

June 2, 2021June 3, 2021Ed MacConnell

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Ask your health insurance experts at Total Benefit Solutions today how to avoid balance billing charges!