Health Reform: Network Adequacy Standards

Ed MacConnell

Health Reform: Network Adequacy Standards For QHP certification, a plan must have an adequate provider network available to its enrollees. A QHP must: Offer a network with a sufficient number of providers, including mental health and substance abuse providers, to ensure access to all services without unreasonable delay Include a sufficient number and geographic distribution of essential community providers to ensure reasonable and timely access to care for low-income and medically under-served populations in the QHP’s service area   The Marketplaces offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and meet certain transparency requirements. To become certified, a QHP… Read More

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Third Annual National Medicare Education Week Offers Help Before Open Enrollment Period

Ed MacConnell

Educational events and online resources to help baby boomers, Medicare beneficiaries and caregivers learn more about Medicare MINNETONKA, Minn. (Sep. 08, 2014) —  The third annual National Medicare Education Week begins Monday, Sept. 15, exactly one month before the start of Medicare’s annual Open Enrollment Period (Oct. 15-Dec. 7). The observance was created to help people learn more about Medicare. Since National Medicare Education Week began in 2012, thousands of people have participated in educational events during the week in more than 60 cities across the country. This year, National Medicare Education Week events will be held for the first time in Boston, Salt Lake City and Richmond, Virginia; a… Read More

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What is Small Group Defined Contribution-Private Exchange Solution?

Ed MacConnell

What is Small Group Defined Contribution-Private Exchange Solution? With health care reform now being implemented, many employers large and small will consider this arrangement to offer their employees a quality, flexible, easy to use  and competitive benefit package. Simply, the employer decides what dollar amount they will provide to each employee. The employee then uses that dollar amount as a “voucher” of sorts. With the voucher or credit in hand, each employee can choose a plan that best suits their needs from a menu of health plans.  In the past, small group employers had to juggle the challenge of affordability and providing a quality benefit that worked for their entire… Read More

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Health Reform: SHOP Marketplace Changes for 2015

Ed MacConnell

Health Reform: SHOP Marketplace Changes for 2015 In 2014, small businesses that offer coverage through an FF-SHOP Marketplace are able to offer their employees a single qualified health plan (QHP). In 2015, small businesses that offer coverage through an FF-SHOP Marketplace may be able to offer their employees a choice of QHPs and qualified dental plans (QDPs). To qualify for an FF-SHOP, a business must: Be located in an FF-SHOP’s service area (generally a state) Have at least one eligible common-law employee on payroll Have 50 or fewer full-time equivalent (FTE) employees on payroll This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per… Read More

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Health Reform: What is a Special Enrollment Period?

Ed MacConnell

Special Enrollment Periods Under certain circumstances, individuals may enroll in a QHP or change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events or special circumstances. Events that permit an SEP include: Gaining or becoming a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care Gaining status as a citizen, national, or lawfully present individual Loss of coverage (e.g., loss of Medicaid eligibility, QHP no longer available), except if enrollment is terminated based on failure to pay premiums, fraud, or enrollee initiated termination Determination that an individual is newly eligible or ineligible for advance payments of the premium tax… Read More

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Health Reform: ACA Checklist for 2015/2106

Ed MacConnell

Health Reform: Affordable Care Act Business/Plan Sponsor Checklist for 2015/2106   This bulletin features a checklist, including descriptions of key topics, to guide you through Affordable Care Act compliance in 2015-2016. Click the link to download the ACA Checklist: ACA Checklist for 2015-2016-082214R Should you have any questions, please contact your Total Benefit Solutions Inc., account manager directly at (215)355-2121.

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Health Reform: 2015 Annual Open Enrollment Period

Ed MacConnell

Annual Open Enrollment & Effective Dates The annual open enrollment period (AEP) for 2015 begins on November 15th 2014 and ends on February 14th 2015. The open enrollment period is the time when you can change, or purchase a new qualified health plan (QHP) on a guaranteed enrollment basis. You do not need a special election period, or a life change event to enroll during the annual open enrollment period. The chart below illustrates the effective dates for enrollments taken during the annual open enrollment period.             Effective Dates for 2015 Annual Open Enrollment Period

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What is Critical Illness Insurance?

Ed MacConnell

Why Critical Illness as a “wrap” plan Because: They’re more affordable than you might think. They’re available for employer  groups, individuals and seniors. They make selecting a health plan easier. They provide peace of mind against a catastrophic event and large out of pocket expenses. They’re person and portable, it doesn’t matter where you get your health insurance from, having your own critical illness plan makes it better. Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”, meaning they are not regulated by the affordable… Read More

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Health Care Reform Updates: Updated Model COBRA Election Notice

Ed MacConnell

    Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice  is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces).   COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

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IRS: HSA Contributions and limits for 2015 Released

Ed MacConnell

The IRS has released the 2015 cost-of-living adjustments affecting HSAs and HDHPs. The 2015 IRS HSA limits are increasing for 2015. Click to download the bulletin

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