You can request an appeal of any Marketplace decision, including decisions about Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions Your eligibility for an exemption from the penalty for not having health insurance Untimely (late) notice from the Marketplace about a decision To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons… Read More
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Now Available: Empower Me Benefits Private Exchange
Total Benefit Solutions has partnered with Empower Me Benefits to provide our clients with best in industry benefits technology that‘s customizable for even the smallest employer. The EmpowerMe Benefits Exchange allows you to remain complaint with the Affordable Care Act (ACA), easily manage benefits, and control health care costs with a single solution. The EmpowerMeBenefits Exchange is an online benefit marketplace and benefits administration platform designed specifically to meet the needs of small and mid-sized companies. The Exchange provides employers with an enrollment and administration platform that aids employers in ACA compliance. This web-based solution allows you to offer any medical coverage next to pre-selected ancillary, voluntary, and TPA products.… Read More
Continue ReadingIBC: Distribution of 1095 Tax Forms
Information about distribution of 1095 tax forms Beginning February 8, Independence Blue Cross will begin mailing IRS 1095-B tax forms on a rolling basis to subscribers who purchased plans individually off-exchange and to subscribers of fully insured group employers. The purpose of these forms is for individuals to verify that they had minimum essential health care coverage during the previous calendar year, as required by the Affordable Care Act. We are issuing 1095-B forms to subscribers only, unless we receive a request from a subscriber to issue a duplicate form to an enrolled spouse and/or dependent. What you need to know about 1095 forms It’s important to know that who… Read More
Continue Reading2015 Compliance Compilation
The attached resource file is a compilation of all of our compliance bulletins for 2015 provided by our business partners at Emerson Reid and your benefits support team. Click the link below to download the entire 2015 compilation: 2015 Compliance Compilation
Continue Reading2016 Health Insurance Open Enrollment Begins
2016 Individual and Family Plans Open Enrollment for 2016 Open enrollment opens on November 1st 2015 and ends on January 21st 2016. As the 2016 Open Enrollment Period gets ready to explode, we will be updating this page regularly with plan benefits, rates and information as they become available. Remember Total Benefit Solutions dedicated, licensed, certified and insured representatives can help anyone enroll on the healthcare Marketplace, or off! Full Service Client Intake Form: Click here to get started. This is not an application for insurance. This form will provide the information that is needed to determine Marketplace eligibility and must be entered on Healthcare.gov We understand that Health Care… Read More
Continue ReadingHealth Reform Video: What Counts as Income in the Marketplace?
What Counts as Income when applying for a Marketplace subsidy? This short video may help: As always contact your Total Benefit Solutions account manager at (215)355-2121 for help applying for a subsidy and health plan on or off the Marketplace.
Continue ReadingSmall Group Definition Changes Per the PACE Act
On Wednesday, October 7, 2015, President Obama signed into law H.R. 1624, the Protecting Affordable Coverage for Employees (PACE) Act, legislation that will give states the ability to define the size of a small group for health insurance purposes. The law repeals the mandated small group expansion of groups of up to 50 employees to groups of up to 100 employees that was to go into effect on January 1, 2016. This law gives states the flexibility to determine the size of their small group market instead of being forced into the national standard. No action is needed if states want to retain their respective definition. There is no announcement… Read More
Continue ReadingHealth Reform: Adjusted Amount for the PCORI fee for HRA Clients and Self Insured Groups
The Internal Revenue Service (IRS) recently released new guidance adjusting the Patient-Centered Outcomes Research Institute (PCORI) fee. Under the notice, the adjusted applicable dollar amount is $2.17 for plan years ending on or before October 1, 2015 and before October 1, 2016. For additional information, please see Notice 2016-60
Continue ReadingTotal Benefit Solutions Introduces the All Check Compliance Tool!
Total Benefit Solutions, Inc. in partnership with Benefit Mall introduces All Check! Want to know how to easily calculate your FTE’s ( Full Time Equivilents)? Not sure if you need to provide the Notice of Exchange? Unsure about your Health Care Tax Credit Eligibilty? Want to get an idea what your overall ACA compliance obligations might be? Let Total Benefit Solutions and All Check do the work. How? It;s simple. Download the input sheet, complete and return to your Total Benefit Solutions, Inc account manager and we will crunch the numbers and send you a customized report just like the sample! Click Here to Download The Input Sheet Sample_ComplianceReport.2147.21136.20150903 … Read More
Continue ReadingHealth Reform: ACA Compliance Partnership
Total Benefit Solutions has partnered with industry leaders such as PrimePay to provide ACA Compliance tools to our valued clients. To learn more about this new ACA Compliance tool, please download the bulletin below and contact your Total Benefit Solutions dedicated account manager at (215)355-2121 today! Click to Download
Continue ReadingKey Facts You Need to Know About: Cost-Sharing Reductions
A recent analysis shows that more than 2 million marketplace enrollees who are eligible for cost-sharing reductions (CSRs) are foregoing this extra level of financial assistance by enrolling in plans that do not qualify. Consumers can receive CSRs only if they enroll in a silver level plan through their marketplace. Many of those who chose not to receive CSRs are likely enrolling in bronze plans with lower premiums but higher out-of-pocket costs. It’s important to communicate the benefits and trade-offs of receiving CSRs to the consumers you are assisting, especially those with significant health care needs. To learn more about cost-sharing reductions, check out this helpful resource from the Center on Budget… Read More
Continue ReadingVideo: Are you eligible for a special enrollment period?
You might think that you have to wait for the annual open enrollment period to get enrolled. Think again! You may be eligible for a special enrollment period. Watch this short video to learn more, and then call us at (215)355-2121!
Continue ReadingEBN: Small Employers look to Alternative Funding Solutions
In the wake of the health care reform, alternative funding solutions for health benefits continue to gain traction among small to mid-size groups. Pending changes to small group rules in January 2016 are driving demand for the funding solutions. Most prominently, groups with 50-100 employees will be subject to community rating legislation that governs how rates are developed and the type of coverage offered. Most states are also changing the definition of employee to the federal full-time employee definition, broadening the scope to include union employees that may have been excluded under previous small employer definitions. Here’s how the new rules will affect small to midsize groups, including potential financial impact, solutions available to mitigate… Read More
Continue ReadingIRS Webinar Series Offered on ACA Provisions
The IRS is hosting a series of educational webinars to help you understand the Affordable Care Act’s employer provisions and related requirements. The IRS designed these webinars for business owners, tax managers, employee benefits managers, and health coverage providers. Employer Shared Responsibility and Information Reporting Learn about the ACA’s employer shared responsibility provisions and information reporting requirements for employers and providers of minimum essential coverage. August 20, 1:00 – 2:30 p.m. September 16, 1:30 – 3:00 p.m. Employer-Sponsored Health Coverage Information Reporting Requirements for Applicable Large Employers Learn about employer-sponsored health coverage information reporting requirements for applicable large employers, including who is required to report, what information the… Read More
Continue ReadingHealth Reform: Reduction in Hours First Lawsuit is Filed by Employees
The first complaint was filed challenging the permissibility of reducing hours below 30 per week in order to avoid the Employer Penalty. The complaint was filed in a New York district federal court on behalf of 10,000 workers at Dave and Buster’s. The plaintiffs allege that their hours were cut so that Dave and Buster’s could avoid health care costs associated with expanding eligibility in order to avoid the Employer Penalty. Click the link below to download this bulletin. Reduction in Hours Subject to Lawsuit in New York – 73115R
Continue ReadingVideo: Independence Blue Cross Medicare Plans
Enjoy the latest TV Commercial from Independence Blue Cross about their Medicare supplement plans. Remember, Independence Blue Cross is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if IBC has a plan that’s a good fit for you.
Continue ReadingHealth Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax
Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More
Continue ReadingAetna: TV Commercial “Aetna works for my life”
Enjoy the latest TV Commercial from Aetna. Remember, Aetna is just one of the many insurers that Total Benefit Solutions works with, on the healthcare.gov marketplace, on the private market, in the senior market and also small groups. Call us at (215)355-2121 to see if Aetna has a plan that’s a good fit for you.
Continue ReadingWho can use the SHOP Marketplace?
What is the SHOP? The Small Business Health Options Program (SHOP) Marketplace helps small businesses provide health coverage to their employees. The SHOP Marketplace is open to employers with 50 or fewer full-time equivalent employees (FTEs), including non-profit organizations. You can enroll in SHOP at any point throughout the year. Click the link below to download a handy “who can” to see if your business or organization can use or benefit from the SHOP. As always please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions about the SHOP or any Affordable Care Act concerns. Click here to download “WHO CAN USE THE SHOP”
Continue ReadingHealth reform: CMS releases SHOP HOW-TO video for employees
CMS releases SHOP video for employees The SHOP enrollment for employees video has been posted by CMS. Please keep in mind that the employer group needs to be set up on the SHOP first. Please contact your Total Benefit Solutions, Inc account manager if you have any questions about setting your organization up as a SHOP employer. Total Benefit Solutions, Inc is a certified SHOP independent broker. Click the video below to watch the video.
Continue ReadingDownload our Mid-Year Compliance Bulletin Compilation
Our Mid-year Compliance Bulletin Compilation is now available, featuring all of our released compliance bulletins for January through June. This document acts a resource for you to have all of the latest health reform information and updates in one place. You can click on a bulletin title in the table of contents and it will bring directly to the corresponding page. Click the link below to download the document. 2015_Compliance_Compilation_mid_year
Continue ReadingIRS Releases Draft 2015 Forms 1094-C and 1095-C
Last week, the IRS issued draft 2015 Forms 1094-C and 1095-C. The forms are substantially the same as the 2014 forms,except for a couple of changes. Please click the link below to read the bulletin. IRS Releases Draft 2015 Forms 1094-C and 1095-C – 062615R Not sure what forms you need? Fee free to contact your Total Benefit Solutions account manager at (215)355-2121 or check our health care reform compliance center.
Continue ReadingForm 5500 Filing Reminder
For calendar year-end plans, the 2014 Form 5500 is due to be filed electronically no later than July 31, 2015. ERISA requires that Form 5500 be filed with the Department of Labor for most health and welfare plans (for example, medical, dental, and life insurance plans) by the last day of the seventh month following the end of plan year unless an extension (Form5558) is completed and mailed to the IRS. Click here to read the Form 5500 Filing Reminder Click here to watch the Brainshark Video
Continue ReadingLost your health coverage?
Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More
Continue ReadingGov. Wolf wants Pa. to operate Obamacare exchange
Gov. Wolf this week formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month. Read more at philly.com Remember that your Total Benefit Solutions professionals are trained, licensed, insured and available to help compare, shop and enroll all affordable care act plans on the healthcare Marketplace and off. As always contact us today if you have any questions or concerns at (215)355-2121.
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