2024 Medicare Parts A & B Premiums and Deductibles

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The Medicare Savings Programs (MSPs) help more than 10 million people with coverage of Medicare premiums and, in most cases, other cost sharing. In their continued efforts to improve access to health care and lower costs for millions of Americans, the Department of Health and Human Services (HHS), through CMS, recently finalized a rule to streamline enrollment in MSPs, making coverage more affordable for an estimated 860,000 people. In addition, the… Read More

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CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell  of  Total Benefit Solutions Inc  has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

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Cheapest Health Insurance in Pennsylvania (2024 Plans)

Premium costs on Pennsylvania’s health insurance marketplace, Pennie vary by Catastrophic, Bronze, Silver or Gold tier. In Pennsylvania, Highmark Blue Cross Blue Shield offers the most affordable Bronze and Catastrophic plans, while UPMC Health Plan and Jefferson Health Plans provide the lowest-priced Gold and Silver plans in 2024, respectively. Of course, just because one plan costs less to buy does not make it the best plan to meet your needs. The health insurance experts at Total Benefit Solutions, Inc can shop the entire market for you, taking into account the healthcare needs of your family and guide you to the best plan for you. Contact us today at (215)355-2121.

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Navigating the Basics of Medicare: Understanding the Four Parts

Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact… Read More

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Special Election Period may be available to members affected by severe weather

The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP).  For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit.  Who is eligible?  Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and  What does this mean for beneficiaries?  Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More

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Case Study: A Voluntary Benefits Strategy

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More

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Empire BCBS Now Anthem BCBS!

In a momentous move, Empire BlueCross BlueShield has officially transformed into Anthem Blue Cross and Blue Shield, marking a significant milestone for the renowned health insurance provider. The company is thrilled to announce the launch of Anthem Blue Cross and Blue Shield in both their downstate and upstate markets, reinforcing their commitment to enhancing the overall customer experience. The transition to the Anthem brand is not merely a change in name; it represents a strategic effort to simplify operations and reduce complexities in the market. Anthem is a nationally recognized name, offering a host of advantages for members residing out of state who are affiliated with New York-based companies. By… Read More

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IBC’s Latest Updates: Weight Loss Drug Policy

The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More

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Cigna Healthcare and Tower Health Contract Updates

In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More

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Alert: Chicago Employers, Brace for Paid Leave Shifts in 2024

In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More

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Key Reminders for Individual Health Plan Payments

In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More

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Ambetter Health Members: Ensure Coverage for January 2024!

As we approach the end of the year, we want to remind you of a crucial deadline to ensure uninterrupted coverage for the upcoming year. Payment Deadline: December 31, 2023: Ambetter Health members must make their January premium payment by December 31, 2023, to guarantee seamless coverage for the start of 2024. To make this process quick and convenient, we recommend using Quick Pay option for a fast, one-time payment. For Assistance: If you have any questions or require assistance, don’t hesitate to reach out to your dedicated Ambetter Health Account Executive. You can contact them at 1-855-700-7985, selecting option 3. Alternatively, you can email ambettersales@centene.com. Ensuring your premium payment is processed… Read More

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Total Benefits: Your Trusted Guide to Cost-Efficient Coverage

In the fast-paced world of insurance, the decision-making process can be a labyrinth of options and potential pitfalls. When it comes to securing the right coverage, you don’t want to gamble with costly mistakes. That’s where Total Benefit Solutions comes to the rescue! Navigating the Insurance Maze with Experts At Total Benefit Solutions, we pride ourselves on being your local experts in the field of insurance. Whether you’re looking for health, life, auto, or any other form of coverage, our team is here to guide you through the entire process. What sets Total Benefit Solutions apart is our team of professionals. We’re not just knowledgeable; we’re also licensed, highly trained,… Read More

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2023 Rule Alert: How Will It Affect Fixed Indemnity Plans?

In today’s world, the rising costs of healthcare have left many Americans grappling with the financial burden of medical expenses. While comprehensive health insurance is essential, fixed indemnity health insurance has emerged as a valuable supplemental resource, offering financial protection to individuals when they need it the most. This blog explores the concept of fixed indemnity health insurance and its importance in providing financial peace of mind to Americans. Fixed Indemnity Insurance: This supplemental insurance differs from major medical plans. It pays a fixed sum directly to you when specific medical events, like doctor visits or hospital stays, occur. While it doesn’t cover all the essential health benefits mandated by… Read More

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Medicaid Redetermination Updates: Your Next Steps

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

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How should employers distribute Medical Loss Ratio (MLR) Rebate Checks?

Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More

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MLR Rebate Checks Unveiled: A Must-Read for Employers

Every year, insurance carriers are required to meet specific Medical Loss Ratio (MLR) thresholds, ensuring that a significant portion of collected premiums goes toward medical care and improving healthcare quality. For the large group market, this threshold stands at 85 cents for every premium dollar collected, while in the small group market, it’s 80 cents. If these thresholds are not met, employers are in for a timely financial boost, in the form of premium credits or checks. MLR Rebate Deadline: September 30, 2023 The clock is ticking. If your insurance carrier falls short of the MLR threshold, they are obligated to distribute MLR checks to employers by September 30, 2023.… Read More

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Understanding the Updates to the Davis Bacon and Related Acts

On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More

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Benefits Notices: What Employers Need to Know

As an employer, it is important to be aware of the various benefits notices that you are required to provide to your employees. These notices are designed to inform employees of their rights and benefits under various laws and regulations. Failure to provide these notices can result in penalties and legal action. One of the notices that employers with 1-19 employees are required to provide is the Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice. This notice is provided to Medicare-eligible individuals who are offered prescription drug coverage under the employer’s group health plan. It must be provided annually prior to October 15th, upon request, and at… Read More

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Voluntary Benefits: Customized Coverage for Your Team

Unlocking the Power of Voluntary Benefits In today’s competitive job market, employers aim to attract and retain top talent by offering comprehensive benefits beyond the basics. Enter voluntary benefits – a customizable solution that benefits both employers and employees. What Are Voluntary Benefits? Voluntary benefits are offerings that employers provide for purchase by employees. They empower employees to tailor their benefits to their needs, offering flexibility and convenience. Here are their key characteristics: A Variety of Benefits Voluntary benefits offer a wide array of options, including: Advantages for Employers and Employees Employers benefit from: Employees enjoy: While voluntary benefits may not suit everyone, employers should assess their package and consult… Read More

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Benefits of a PEO: How to Simplify your Business Operations

If you’re a small- or mid-sized business owner, you’ve probably come across the term “PEO” in your quest to optimize your company’s operations. PEO stands for Professional Employer Organization, and it’s a dynamic solution designed to assist businesses in various crucial areas, such as payroll administration, human resources, risk management, and employee benefits. In this blog post, we’ll explore the advantages of partnering with a PEO and introduce you to a valuable resource to help you navigate this complex landscape. The Advantages of a PEO As beneficial as PEOs can be, the surge in their numbers can be overwhelming for business owners. The plethora of options often leads to confusion… Read More

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Unlocking Change: Pennie’s First Health Equity Report

Are you interested in delving into the intricate landscape of health coverage equity in the Keystone State? Look no further! Pennie is proud to present its inaugural Health Equity report, and it’s available for you to download right now. This comprehensive report goes beyond the surface, delving deep into the heart of healthcare disparities across Pennsylvania. Here’s what you can expect to find within its pages: Addressing Health Coverage Inequities Together: The report lays out a roadmap for collective action to combat the existing health coverage inequities. Discover how Pennie is dedicated to working with communities to bridge these gaps. Setting the Baseline for Change: To measure progress effectively, it’s… Read More

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Elevate Your Productivity with Better BenAdmin

In a fast-paced world, time is of the essence. We’re all too familiar with the feeling of being buried under a mountain of administrative tasks, wishing for an extra set of hands or a few more hours in the day. Well, wish no more! Enter Better BenAdmin, the game-changer powered by EBM (Efficiency-Boosting Machine). Seamless Schedule Management Scheduling headaches? Not anymore. Better BenAdmin effortlessly handles your calendar, ensuring that appointments are well-organized and conflicts are a thing of the past. No more double-bookings or time wasted on manual scheduling. Effortless Email Handling Say goodbye to the endless email backlog. Better BenAdmin sorts, filters, and responds to emails with precision and… Read More

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Choosing the Right Health Insurance: HMO vs. PPO

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

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Annual Health Insurance Check-Up: Don’t Miss Out!

Health insurance is vital for your well-being, providing financial protection and access to essential healthcare. But it’s not a one-time decision. Did you know that reviewing your health insurance plan annually is crucial to ensure it still fits your needs and budget? In this blog, we’ll explore why this check-up is essential and provide key enrollment dates. Plus, we’re here to assist you every step of the way! Why an Annual Review Matters: Enrollment Dates: Let’s talk about the enrollment dates you need to remember: How We Can Help: Navigating health insurance can be complex, but you’re not alone. Our expert team is ready to assist you in reviewing your… Read More

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