SCOTUS Upholds Affordable Care Act Ruling

  The Supreme Court has dismissed a challenge to ObamaCare, leaving the industry as is for employers and individuals. By a 7-2 vote on Thursday, the justices left the entire law intact in ruling that Texas and two individuals had no right to bring their lawsuit in federal court. The Supreme Court of the United States heard oral arguments on November 10, 2020, as to the question of whether the Affordable Care Act’s Individual Mandate provision is constitutional. This case, California vs. Texas is the latest challenge against the Affordable Care Act (ACA) and the second time the Justices addressed the constitutionality of the Individual Mandate portion of that law.… Read More

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New Mandatory Preventive Items and Services

  Most plans will be required to cover new preventive items and services beginning later this year, or in 2022 or 2023 (depending on the plan year), including ones related to Hepatitis B virus infection screenings and colon cancer screenings. Non-grandfathered group health plans must provide coverage for in-network preventive items and services and may not impose any cost-sharing requirements (such as a copayment, coinsurance, or deductible) with respect to those items or services. Click to Download New Mandatory Preventive Items and Services – 2021 Update

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Tax Advantaged Benefit Documents

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.

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Alternatives to Health Insurance Benefits

 Sometimes clients offer other alternative benefits to their employees. The reasons for doing this are many but depending on the earnings of their workforce, offering a group medical plan will eliminate any health insurance subsidy. In those cases offering a group health insurance benefit can come off as a penalty for the employees. By offering alternative benefits our experts can help the employees enrolled on a subsidized health insurance plan and still get good if not great benefits from their employer!  ICHRA: with an ICHRA the employer can give the employees money towards their health insurance purchase.  The ICHRA allows the employer to do so with untaxed dollars and the… Read More

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What is Blue Card PPO?

Many clients ask us about Blue Card PPO and how it works. Blue Card PPO is typically attached to our clients policies who are enrolled on an IBC Personal Choice PPO or National Network PPO or a Horizon Blue Cross plan with National Access. You can tell if you have this on your plan if your card has the PPO Traveling Briefcase ppo logo.   It’s important to note that members who have a Keystone HMO, Amerihealth or Horizon HMO or local EPO do NOT have Blue Card PPO.  How Does the BlueCard Program Work? BlueCard® PPO Medical Plan The BlueCard Preferred Provider Organization (PPO) medical plan gives you the freedom to… Read More

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Top 10 Questions to Ask Your Benefits Broker

Analyzing these ten critical questions in relation to your organization’s needs will help you make a more informed decision about your benefits broker

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IRS Guidance Clarifies DCAP Relief

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”).

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CMS Announces Medicare Plan Finder Improvements

Source: medicare.gov   This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to improve and update the Medicare Plan Finder (MPF) and the Health Plan Management System (HPMS). HPMS is the system that Medicare Advantage and Part D plans use to provide data about their plan offerings to Medicare, and the MPF is the online tool that allows beneficiaries to evaluate, compare, and enroll in those plans. The changes will be in place for the start of the Medicare Open Enrollment Period starting on October 15 for 2022 plans. Many of the forthcoming MPF changes reflect suggestions that Medicare Rights and other advocates have made over the years to increase the tool’s… Read More

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Can Employers Ask for Proof of Vaccination?

From our partners at TOTAL HIPAA: As states reopen and companies invite employees back into the workplace, an employee’s vaccination status will become an important factor in minimizing workplace health risks and returning business to normal operations.  Can employers implement a mandatory vaccination program? What do laws like the Americans with Disabilities Act (ADA) and federal agencies like the Equal Employment Opportunity Commission (EEOC) have to say about this? Click the link below to read the rest at Total HIPAA… Can Employers Ask for Proof of Vaccination?

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Family Dental & Vision Plans

We have a number of stand-alone dental and vision plans from Davis Vision, VSP and Delta Dental. You can review, compare and enroll on plans in minutes! https://brokers.dentalforeveryone.com/?id=B3F52EA5-F0E3-40B4-B1DB-0F060AE09478

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What is Modified Adjusted Gross Income (MAGI)?

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Contact you Total Benefit Solutions health insurance specialist for assistance with calculating your MAGI. For many people, MAGI is identical or very close to adjusted gross income. MAGI doesn’t include Supplemental Security Income (SSI). MAGI does not appear as a line on your tax return. 

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What is Balance Billing?

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!

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PEOPLE RISK MANAGEMENT

Employees are usually a business’s biggest asset. Conversely, those same employees are also the biggest risk. If you have employees,you have employee-centric exposures, also known as people risks. These risks are rapidly increasing and evolving, and what were onceconsidered minor problems are now potentially disastrous for businesses.  Download HR Solutions

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What is a Qualified High Deductible Health Plan?

Qualified HDHPs Enrollment in a qualified HDHP is a requirement for establishing and maintaining a health savings account. The chassis for a qualified HDHP is the same as described in Chapter 1, but it must also conform to certain federal guidelines: A qualified HDHP must specify both a minimum annual deductible and a maximum annual out-of-pocket (OOP) expense limit, as set every year by the IRS. The minimum annual deductible is just that—the minimum amount that the insured must pay before the plan pays any benefit. The maximum annual OOP expense limit is the cap on the sum of the annual deductible and all out-of-pocket expenses the insured must pay for covered expenses under the… Read More

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What Is a Health Savings Account?

A health savings account is a special purpose financial account that allows a consumer to save and pay for medical expenses on a tax-favored basis. Funds deposited into an HSA are not taxed; the funds in the account grow tax free; and the money accumulated in the account can be withdrawn tax free to pay for qualifying medical expenses. In effect, an HSA owner uses the account in a manner similar to a checking account to cover his or her (or his or her family’s) medical expenses. There are no income restrictions or requirements on who may or may not open and contribute to an HSA. The HSA—the account and its funds—belongs… Read More

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ARPA Update from United Healthcare COBRA Services

The American Rescue Plan Act (ARPA) of 2021 was signed into law on March 11, 2021. ARPA provides temporary premium assistance for COBRA continuation coverage. The premium assistance is available for the period beginning April 1, 2021 (or prospectively from the date of the qualifying event if the qualifying event is after April 1, 2021) through September 30, 2021 or the end of the qualified beneficiary’s 18-month COBRA eligibility period, whichever is earlier. The premium assistance may end earlier if the assistance eligible individual becomes eligible for another group health plan or Medicare. The premium assistance is available to certain assistance eligible individuals who are eligible for COBRA continuation coverage… Read More

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Aetna Small Group (2-100) Insured & Small Group Aetna Funding Advantage FAQ
Health Plan options for business owners during COVID-19 pandemic

Aetna is mindful of the many challenges our small business customers and their employees are facing as a result of the COVID-19 pandemic. Many are experiencing slower sales, reductions in hours, layoffs and more. The attached Frequently Asked Questions (FAQ) includes our current responses to questions we know are top of mind for many of Small Group Insured and Small Group Aetna Funding Advantage Self-Insured customers. These responses will remain in effect until June 30, 2021 unless otherwise specified. We will continue to evaluate and update our responses as the situation evolves. Downlaod FAQ: Commercial Small Group COVID-19 FAQ

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Get Dental and Vision Quotes Now!

Enjoy next-day coverage on most dental insurance plans. There are no enrollment fees with any plans. Preventive visits, such as exams and cleanings, are covered at 100% with network providers.

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Return to Work Checklist

Thankfully it seems things are coming to and end of the pandemic and your employees will be returning to the workplace!  Download our handy return to work checklist to make certain you have all your bases covered!  Compliments of our partners at Think HR! As always contact your Total Benefit Solutions, Inc health insurance specialist at (215)355-2121 for more information or to get your complimentary subscription to Think HR! Click here to download the return to work checklist  

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IRS Announces New Inflation Adjusted HSA and HRA numbers for 2022

These new rates will take effect for the calendar year 2022. Please reach out to your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 if you have any questions or concerns about this notice.

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What Is Medicare Supplement Insurance?

Medicare coverage can be complex. Some of the rules of Medicare coverage can change without the beneficiary even knowing. Who even knows when their employer crosses an enrollment threshold? Best advice is to always speak to a health insurance specialist who is certified and experienced in the many facets of health insurance including the intersections between Medicare and Employer coverage. Contacting Total Benefit Solutions, Inc is the first step!

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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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