The type of health plan you choose determines the network of providers you can visit. In-network providers are the doctors and hospitals in your plan’s network. You’ll save the most money by visiting network providers. Out-of-network providers are those not in your plan’s network. You may pay more for out-of-network services, and some services may not be covered at all. Know your options — before you need them When you need care and your primary care doctor isn’t available, remember you have other options that don’t involve a trip to the emergency room. Using virtual care, retail clinics, or urgent care centers can save you time and money. https://www.ibx.com/get-care/find-doctors-and-healthcare-providers/where-to-go-for-care Click here for links to your network and more… Read More
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How does a Flex Spending Account Work?
A Flexible Spending Account Plan (“FSA”) offers an easy and convenient way for you to save money on taxes and make your benefit dollars go further. If you participate in a Health Care and/or Dependent (Day) Care FSA, your employer puts money aside from your paycheck (before taxes are taken out) and you use that money to pay for eligible health care and/or dependent (day) care expenses. Questions about an F.S.A. account? please contact your Total Benefit Solutions group health insurance specialists at (215)355-2121 www.totalbenefits.net
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Understanding the Coding of Health Plans from MEC to Metallic
Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More
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Aetna AFA now allows PEO Employers!
From Aetna: We’re now treating small businesses who use the services of a PEO ( Professional Employer Organization) the same as any other group. This excludes any group headquartered in California or New York, or any group currently on an Aetna PEO master health plan. Here are some important details: 1. We no longer require small businesses to terminate their PEO relationship or fill out extra forms for us during the new business process.2.The entire group must move to Aetna –small businesses can’t move some employees to Aetna and leave the rest on the PEO master health plan. What does this mean to groups? If your company is already part… Read More
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What is a Qualifying Life Event or QLE?
There are 4 basic types of health insurance qualifying life events. (The following are examples, not a full list.) Loss of health coverage Losing existing health coverage, including job-based, individual, and student plans Losing eligibility for Medicare, Medicaid, or CHIP Turning 26 and losing coverage through a parent’s plan Changes in household Getting married or divorced Having a baby or adopting a child Death in the family Changes in residence Moving to a different ZIP code or county A student moving to or from the place they attend school A seasonal worker moving to or from the place they both live and work Moving to or from a shelter or… Read More
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Case Study Library
We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!
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Section 125 Tax-Saving POP plan document
In this video, we feature our most popular product, the $99 Section 125 Tax-Saving POP plan document package (Core 125). It explains how employees save up to 40% in taxes while employers eliminate on average 8% of matching payroll tax when the company has a Section 125 POP (Cafeteria) plan document in place, as required by the IRS to pre-tax benefits. As always contact your Total Benefit Solutions, Inc group health insurance specialists at (215)355-2121 to find out more! Click here for more information or to order a document online.
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Horizon BSBSNJ to Withdraw HMO Plans From Individual and Small Employer Markets
Horizon has announced a change to their product portfolio and have elected to withdraw their HMO plans from the Individual and Small Employer Health Benefits Plan (SEH) markets. The New Jersey Department of Banking and Insurance (DOBI) has given its approval for Horizon to withdraw its HMO plans from the markets under the authority of N.J.S.A 17B:27A-6 and N.J.A.C. 11:20-18.5 (for Individual plans) and N.J.S.A. 17B:27A–23e and N.J.A.C. 11:21-16 (for small employer plans). This withdrawal will affect Individual members enrolled in the Horizon HMO Gold plan, and group clients and their employees who are enrolled in the Horizon HMO Platinum plan. Brokers with affected small group clients, and those affected… Read More
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Turning 26: Your Guide to Health Insurance
Thanks to the Affordable Care Act (ACA), many young people choose to stay on their parent’s health insurance for as long as possible, and with good reason. The historic healthcare law, also known as Obamacare, allows young adults to stay on their parent’s health plan until they turn 26, no matter what. Download our free easy to read guide to getting your own health insurance here. Contact your health insurance experts at Total Benefit Solutions Inc with any additional questions (215)355-2121
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Annual Out-Of-Pocket Maximum Adjustments Announced for 2023
On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For more information contact your friends at Total Benefits Solutions! Reach out to us at (215)355-2121
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New Option for NJ Groups with Out-of-State Employees
New Jersey small groups with employees residing out-of-state have few options and brokers struggle to provide viable alternatives for these employers. Horizon has introduced a solution with two new plans that include Blue Card Access on their popular OMNIA platform. Gold & Silver Plans became available in the market July 1 Provides access to 95% of the doctors and 96% of the hospitals nationwide, that includes New York, Pennsylvania, and Delaware. These plans reduce the benefit gap between Tier One and Tier Two benefits. Horizon also leveraged OMNIA relationships to provide a very attractive price point for national access. Questions or concerns about this bulletin? Please contact your Total Benefit… Read More
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Additional Guidance Addresses ACA Preventive Care Mandate
As part of FAQ 51, the Departments of Labor, Health and Human Services, and the Treasury (together, the “Departments”) issued guidance clarifying severalAffordable Care Act (“ACA”) preventive care coverage issues applicable to non-grandfathered group health plans. As background, non-grandfathered group health plans must cover certain in-network preventive care items and services without cost-sharing. Click the link below to download the bulletin. As always contact your health insurance specialists at Total Benefit Solutions, Inc if you have any additional questions or concerns (215)355-2121 http://www.totalbenefits.net
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