The Marketplace – Page 3 – Total Benefit Solutions Inc

Cracking the Code: Navigating Health Cost Surge in 2023

July 10, 2023July 10, 2023Wendy Lopez

Managing Health Costs in 2023 Multiple industry and benefits sources are predicting health insurance premium increases in the range of five to eight percent for 2023. An analysis by Aon is forecasting a 6.5% increase. The Society for Human Resource Management (SHRM) is expecting a bump of 5.6%, based on a prediction by Mercer. The International Foundation of Employee Benefit Plans says employers are anticipating a 7.5% increase. The country’s oldest actuarial consulting firm, Buck, has forecast an increase in the range 5.8% to 6.9%. If you have any questions or concerns about this news please contact your Total Benefit Solutions, Inc health insurance specialists at (215)-355-2121

Request to lower an Income-Related Monthly Adjustment Amount (IRMAA)

July 7, 2023July 7, 2023Wendy Lopez

If you’ve had a life-changing event that reduced your household income, you can ask to lower the additional amount you’ll pay for Medicare Part B and Part D. Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment. Amended income tax returns Call +1 800-772-1213 and tell the representative you want to lower your Medicare Income-Related Monthly Adjustment Amount (IRMAA) if you had an amended income tax return. Fax or mail your request Fill out the Medicare Income-Related Monthly Adjustment Amount-Life-changing Event (SSA-44) (PDF) form. Fax or mail your completed form and evidence to a Social Security office. For support completing this task call +1 800-772-1213… Read More

What are the preferred plans for insured employees?

July 6, 2023June 28, 2023Wendy Lopez

Preferred Provider Organization plans remain the most common plan type. Nearly half (49%) of insured employees enrolled in a PPO in 2022. That compares to 29% enrolled in an HDHP, 12% enrolled in an HMO, nine percent in a Point-of-Service (POS) plan, and one percent in a conventional (indemnity) plan. If you have any questions or concerns about this bulletin, please contact your Total Benefit Solutions Inc health insurance account manager at (215) 355-2121

How much do employees contribute towards their insurance expenses?

July 5, 2023June 30, 2023Wendy Lopez

Average Contributions Most employees do make a contribution toward their insurance costs. Covered workers, on average, contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its EHBS in 2021. The average contribution for workers at small firms is $7,556, which is more than a third higher than the average for those at large firms ($5,580). Workers at private, for-profit firms contribute a higher percentage of the premium versus those at public firms, regardless of coverage type. A fortunate one-third of employees (33%) at small firms are enrolled in coverage where the employer pays… Read More

Increases in Premium Found in Health Benefits Survey

July 4, 2023June 28, 2023Wendy Lopez

The latest survey by the Kaiser Family Foundation (KFF) concerning employer-sponsored health benefits found modest increases in employers’ and employees’ costs in 2022. In its 24th Employer Health Benefits Survey (EHBS), KFF found the average annual premiums for employer-sponsored health insurance in 2022 were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years. Small vs. Large Employers In 2022, workers insured through their employers at both… Read More

What Additional Changes Are Being Made to Part D?

July 3, 2023June 30, 2023Wendy Lopez

As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing. Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty. Also starting in 2024, the calculation of the… Read More

How Is the Medicare Part D Benefit Changing in 2024?

June 29, 2023Wendy Lopez

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

What Does the Medicare Part D Benefit Look Like in 2023?

June 28, 2023June 29, 2023Wendy Lopez

The standard design of the Medicare Part D benefit currently has four distinct phases, where the share of drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies (Figure 1). (The Part D enrollee shares reflect costs paid by enrollees who are not receiving low-income subsidies.) If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

Aetna members can soon use their OTC benefit at CVS

June 27, 2023June 27, 2023Wendy Lopez

Starting July 1, members who have an over-the-counter (OTC) benefit administered by OTC Health Solutions, can purchase eligible OTC items in person at all CVS stores (except for CVS pharmacies inside Target or Schnuck stores), in addition to ordering them by phone and online. This will make it even easier for members to take advantage of this popular benefit. Members can use the store locator link, or call 1-833-331-1573 (TTY: 711) to find a store. Contact your Total Benefit Solutions, Inc health insurance specialist at (215)-355-2121 if you have any questions or concerns.

Delta Dental Plans Association: Survey shows patients rate their experiences with dentists a 9.5

June 26, 2023Wendy Lopez

OAK BROOK, Ill., June 22, 2023 /PRNewswire/ — Delta Dental announced key findings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Dental Plan Survey, which provides feedback from Delta Dental patients about their oral health care experiences. Delta Dental is the only carrier utilizing the survey nationwide to continuously enhance patient experiences with its outstanding network of dentists. This trusted anonymous survey tool is used in the health care industry to evaluate a patient’s experience throughout their dental care journey and includes questions related to care from dentists and staff, access to dental care, and dental plan information and services. Recent CAHPS Dental Plan Survey findingsMore than 20,000 Delta Dental adult… Read More

Independence Blue Cross Announcing Value and Select formulary changes effective July 1

June 23, 2023June 23, 2023Wendy Lopez

We want to remind you that we are making changes to the Value and Select Drug Program (Select) formularies for July 1. Updates are made to these formularies on a quarterly basis. A flyer summarizing the changes to each formulary is available by clicking on Value formulary or Select Drug Program. The complete, updated lists for July 1 are available on our website. To view, choose the link to either the Value or Select formulary. The updated list is available under “Formulary drug documents.” Members, as well as their providers, who are impacted by the changes were sent letters in April (60 days in advance). Members are encouraged to talk with their provider about switching… Read More

Independence Blue Cross Announcing Teladoc virtual care services available January 1

June 22, 2023Wendy Lopez

We are pleased to announce that Independence Blue Cross has chosen Teladoc Health (Teladoc) as our vendor of choice for telemedicine, telebehavioral health, and teledermatology virtual care services! Teladoc will replace MDLIVE as the provider of these services effective January 1, 2024. Teladoc advantages Teladoc will triple the size of the virtual care provider network, which will help members receive the specific care that meets their needs. Offering services through Teladoc will allow us to expand our existing relationships with Livongo condition management programs, and offer the myStrength behavioral health tool, both of which are owned by Teladoc. MyStrength will replace On To Better Health in our portfolio of products.… Read More

Revised Form 720

June 21, 2023June 23, 2023Ed MacConnell

The IRS has released a revised Form 720, Quarterly Federal Excise Tax Return, the proper method to file and report PCORI fees. If you owe a PCORI fee, it must be paid using IRS Form 720 by July 31, following the last day of the policy year or plan year. Form 720 and the fee must be submitted on the same date. If your business does not owe a PCORI fee, IRS Form 720 does not need to be completed. Issuers and plan sponsors will only be required to file Form 720 once a year. Per the IRS, “Issuers and plan sponsors who are required to pay the PCORI fee… Read More

Independence: Annual Medicare Secondary Payer Group Size Collection Process

May 5, 2023May 1, 2023Ed MacConnell

Independence Blue Cross (Independence) is required to collect information from group customers with 300 or fewer employees regarding their employer size to ensure proper coordination of benefits and reporting under the Medicare Secondary Payer (MSP) laws. This information is used by The Centers for Medicare & Medicaid Services (CMS) to determine whether Independence or Medicare is the primary payer of claims for Medicare-eligible employees. We are mailing MSP notification letters this week to customers directing them to our MSP group size webpage, where they will find additional information on MSP and can complete a required survey. The survey must be completed by December 31. Customers will need their CID number (provided on the… Read More

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

woman with face mask holding an alcohol bottle

Independence Blue Cross: Changes to the Select and Value formularies for July 1

May 1, 2023May 1, 2023Ed MacConnell

Independence Blue Cross (Independence) is making changes to the Select Drug Program (Select) and Value formularies for July 1. Independence routinely updates its prescription drug formularies and reviews the list of drugs requiring prior authorization as part of our procedures for safe prescribing. These changes are approved by our Pharmacy and Therapeutics Committee. Updates are made to the Select and Value formularies quarterly. The updated lists for July 1 will be available on the website on May 1. Select the link to either the Select or Value formulary. The updated list is available under “Formulary drug documents.” Standard changes can include: Members, as well as their providers, who are impacted by the… Read More

Horizon BCBSNJ Small Group to Add a Surcharge for Premium Payments Made With Credit Cards

May 1, 2023May 1, 2023Ed MacConnell

Effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. During the COVID-19 Public Health Emergency (PHE), Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) changed how they accepted premium payments from their Small Group customers to allow the use of credit cards. With the PHE ending, effective with the June bill Horizon BCBSNJ will add a surcharge when a credit card is used to make a premium payment. The surcharge amount will be displayed on the payment screen. Small Group Customers Still Have No-Cost Payment OptionsHorizon BCBSNJ offers… Read More

Guidance Issued on Emergency Period Expiration

April 24, 2023April 24, 2023Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below. It is possible that FAQ 58 will be updated to reflect new dates. The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.** On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

Horizon BCBSNJ Updated COVID-19 Resource Guide

April 11, 2023April 11, 2023Ed MacConnell

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

12 Tips for Maximizing Your High Deductible

April 6, 2023April 6, 2023Ed MacConnell

Nearly 40% of people have a health care plan with a high deductible. An even higher percentage of people wish they had a lower deductible (who wouldn’t?!). And with medical bills being the leading cause of bankruptcies, it is important to understand how to maximize your high deductible so that you can stay afloat in case something unexpected were to happen. 1. Find Out What’s Free Many routine services are free. Instead of staying home to save money, you could get a free screening for preventative care. Common services covered are colonoscopies, mammograms, and vaccinations. About 90% of people with high deductible plans don’t know that such services are free.… Read More

IBC: How to read your new EOB

March 31, 2023March 24, 2023Ed MacConnell

Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find out how much a provider charged for services, what your Independence Blue Cross (IBC) health plan paid, and how much you owe. As always please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any additional questions or concerns!

Independence: Wellness Guidelines for all ages

March 29, 2023March 24, 2023Ed MacConnell

Your health and wellness are important. That’s why we provide you with these wellness guidelines to help you and your family stay healthy. The wellness guidelines are a summary of recommendations from the U.S. Preventive Services Task Force and other nationally recognized sources. We encourage you to take the time to review these guidelines. Use them as a starting point for conversations with your and your family’s health care providers. Your health care provider may recommend alternatives to the information outlined in these wellness guidelines based on your specific needs and the history of health or illness in your family

Did You Know? Cigna + Oscar plans in Pennsylvania offering you a simple, non-tiered network?

March 21, 2023March 21, 2023Ed MacConnell

That’s right! ? Cigna + Oscar plans in Pennsylvania utilize Cigna‘s Open Access Plus Network. Offering you a simple, non-tiered network. This includes facilities you know and use, such as: View the full Pennsylvania network here. Please contact your health insurance specialists at Total Benefit Solutions, Inc iat (215)355-2121 f you have any further questions or concerns about Oscar heath!

How to activate your OSCAR account

March 11, 2023March 9, 2023Ed MacConnell

We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your ﬁngertips .

Individual Coverage HRA: Choice and affordability in employee health benefits

March 6, 2023March 3, 2023Ed MacConnell

How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More

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