The Marketplace – Page 2 – Total Benefit Solutions Inc

Medicaid Redetermination Updates: Your Next Steps

October 10, 2023October 10, 2023Wendy Lopez

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

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

October 5, 2023October 6, 2023Ed MacConnell

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

MLR Rebate Checks Unveiled: A Must-Read for Employers

September 29, 2023September 29, 2023Wendy Lopez

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

Understanding the Updates to the Davis Bacon and Related Acts

September 28, 2023September 28, 2023Wendy Lopez

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

Benefits Notices: What Employers Need to Know

September 27, 2023September 27, 2023Wendy Lopez

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

Voluntary Benefits: Customized Coverage for Your Team

September 26, 2023September 26, 2023Wendy Lopez

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

Benefits of a PEO: How to Simplify your Business Operations

September 21, 2023September 20, 2023Wendy Lopez

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

Unlocking Change: Pennie’s First Health Equity Report

September 20, 2023September 18, 2023Wendy Lopez

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

Elevate Your Productivity with Better BenAdmin

September 18, 2023September 18, 2023Wendy Lopez

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

Choosing the Right Health Insurance: HMO vs. PPO

September 15, 2023September 15, 2023Wendy Lopez

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

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

September 5, 2023September 5, 2023Wendy Lopez

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

Reasons Why You Need a Health Insurance Broker

September 2, 2023September 1, 2023Wendy Lopez

Navigating the world of health insurance can feel like a daunting journey through an intricate maze. That’s where a trusted health insurance broker comes in, acting as your guiding light and advocate. Here’s why you need one in your corner: 1. Expert Guidance: Your Healthcare GPS: Think of a health insurance broker as your personal healthcare GPS. They simplify the bewildering maze of insurance options, helping you choose the path that suits your needs best. With their expertise, you won’t feel lost in the insurance wilderness. 2. Advocacy: Your Fighter: Insurance claims, disputes, and paperwork can be a real hassle. But with a broker, you have a dedicated champion in… Read More

A Voluntary Benefits Strategy

August 29, 2023August 13, 2023Ed MacConnell

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…click here to continue

Medicare Covers Diabetes Supplies & Services for Your Health

August 26, 2023July 24, 2023Wendy Lopez

Discover the power of Medicare, a federal health insurance program in the US designed for individuals aged 65 and older, as well as certain younger people with disabilities, providing access to essential medical services and supplies. Don’t miss the invaluable “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” booklet available on Medicare.gov/publications. This comprehensive guide highlights coverage options for individuals with diabetes, including supplies and services, preventive programs, and access methods. Plus, it features a must-have checklist for your next doctor’s visit, empowering you to ask the right questions about treatments, preventive services, covered supplies, and lifestyle recommendations. Take control of your diabetes management and overall well-being with this… Read More

Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs: Booklet

August 24, 2023July 12, 2023Wendy Lopez

This booklet explains Medicare coverage of diabetes supplies and services in Original Medicare and with Medicare drug coverage (Part D). Original Medicare is fee-for-service coverage. The government usually pays your health care providers directly for your Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) benefits. If you have other insurance that supplements Original Medicare, like a Medicare Supplement Insurance (Medigap) policy, it may pay some of the costs for some.services described in this booklet. For a comprehensive understanding of Medicare coverage for diabetes supplies and services, download this informative booklet today! As always if you have any questions or concerns about this bulleting please contact your Medicare health… Read More

Medicare Coverage of Home Health Care: Booklet

August 23, 2023July 12, 2023Wendy Lopez

This booklet describes the home health care services that Medicare covers, and how to get those benefits through Medicare. If you get your Medicare benefits through a Medicare health plan (not Original Medicare) check your plan’s membership materials and contact the plan for details about your Medicare-covered home health benefits. Download the Medicare Coverage of Home Health Care: Booklet to help you understand the home health services that Medicare covers and much more. As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)-355-2121

Are You Up To Date on Your Preventive Services?

August 22, 2023August 22, 2023Wendy Lopez

Medicare covers a full range of preventive services to help keep you healthy and find problems early when treatment works best. Ask your doctor what services are right for you and use the document below to track appointment dates, times, and other important information. Download our Medicare check list sheet below to help you keep track of your Preventive Services! If you have any questions or concerns, please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)-355-2121.

What’s New in the 2023 ACA Open Enrollment?

August 21, 2023August 21, 2023Wendy Lopez

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

Exploring PEOs: Efficiency and Compliance Solutions

August 8, 2023August 14, 2023Wendy Lopez

In today’s business landscape, optimizing operations and compliance is an ongoing challenge. Enter PEOs – Professional Employer Organizations. PEOs offer outsourcing solutions that reshape how companies handle HR and administrative tasks. Let’s dive into the world of PEOs and unveil their potential advantages and drawbacks. A “PEO,” or Professional Employer Organization, forms a strategic partnership where businesses team up with experts to manage HR and admin functions. This collaboration lets companies offload tasks like payroll, benefits, and compliance, ideal for small to mid-sized businesses aiming to streamline while focusing on core activities. Pros of PEOs: Cons of PEOs: In conclusion, PEOs provide a promising avenue for businesses aiming to bolster… Read More

Unlock Your Best Health: 5 Must-Know Tips & Tools!

August 2, 2023August 2, 2023Wendy Lopez

Five major tips and resources for maintaining overall health and wellness: Remember, it’s important to personalize these tips to your individual needs and consult with healthcare professionals before making significant changes to your lifestyle. We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121. We’re here to answer any questions or address any concerns you may have.

Orlando Health Patients Face Coverage Loss Amid Contract Dispute

August 1, 2023August 1, 2023Wendy Lopez

UnitedHealthcare’s contract with Orlando Health is set to expire on July 31. If an agreement is not reached before the deadline, most services will no longer be covered for individuals on various plans, starting from August 1. The affected plans include employer-sponsored and individual plans, Medicare Advantage (including the Group Retiree PPO plan), and Medicaid (including the Dual Special Needs Plan). Both parties have been engaged in months of negotiations to establish new terms. With less than two weeks remaining, tensions have escalated, and accusations of delaying negotiations, disseminating misleading information, and proposing unreasonable terms have been exchanged by both sides. United Healthcare has taken proactive measures to notify approximately… Read More

Top 10 Ways to Make Your Health Benefits Work for You

July 31, 2023July 31, 2023Wendy Lopez

Unleash the Full Potential of Your Health Coverage! Are you making the most of your health benefits? The Employee Benefits Security Administration (EBSA) administers crucial health benefit laws that cover employer-based health plans. These laws safeguard your rights to essential information about your health plan, guide you on qualifying for benefits and making claims, ensure continued health benefits during job transitions, and offer protections for special medical conditions. Start by exploring your health coverage options, delving into different plans, and matching them with your needs. Not sure if your plan covers mental health or substance use disorder services? We’ve got you covered with essential information on these benefits too! Your… Read More

Why Short Term Heath Insurance is not “ JUNK” insurance.

July 29, 2023July 29, 2023Ed MacConnell

Short-term health insurance, also known as temporary health insurance, is a type of health coverage designed to provide temporary medical insurance for a limited duration, typically ranging from a few months to a year. While short-term health insurance may not be suitable for everyone, it does offer certain benefits for specific situations. When people label Short Term health as “ JUNK” it is clear they do not understand that many people still need short term health insurance coverage. The ACA solved many problems when it comes to access to coverage, but first problem is the COBRA prohibition which specifically disallows ACA tax credits for people who can get on COBRA.… Read More

Making HSAs Work Smarter

July 25, 2023July 24, 2023Wendy Lopez

In the dynamic world of employee benefits, leaders have come to grasp the immense potential benefits hold in achieving their key goals. One approach that has gained significant traction is the combination of High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs), a powerful duo that not only reduces benefits costs but also empowers employees with greater control over their healthcare expenses. However, despite the evident advantages, the journey to unlocking the full potential of HDHPs + HSAs is far from over. There lies an untapped opportunity to optimize plan design and elevate employee education, enabling companies to enhance their workforce’s well-being while achieving cost-effectiveness. If you are eager… Read More

Will health insurance cover a swimming pool?

July 18, 2023July 18, 2023Wendy Lopez

Health insurance typically does not cover the cost of a swimming pool for personal use. Health insurance is designed to provide coverage for medical services, treatments, and supplies that are necessary for the diagnosis and treatment of illnesses or injuries. Swimming pools are a comfort item and are generally not considered medically necessary. However, there may be some exceptions in certain cases where a swimming pool is prescribed as part of a medical treatment plan for specific conditions such as physical therapy or rehabilitation. In such cases, coverage for a swimming pool may be possible, but it would require a thorough evaluation and approval process by the insurance company. It’s… Read More

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: