Discussion of new national health insurance law grandfathered plans
This presentation is the property of its rightful owner.
Sponsored Links
1 / 7

Discussion of New National Health Insurance Law – Grandfathered Plans PowerPoint PPT Presentation


  • 61 Views
  • Uploaded on
  • Presentation posted in: General

Discussion of New National Health Insurance Law – Grandfathered Plans. Richard C. Dwyer Operations Manager New Hampshire Local Government Center [email protected] September 17, 2010. Grandfathered Plans. All plans that were in effect on March 23, 2010 are considered grandfathered plans

Download Presentation

Discussion of New National Health Insurance Law – Grandfathered Plans

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Discussion of new national health insurance law grandfathered plans

Discussion of New National Health Insurance Law – GrandfatheredPlans

Richard C. Dwyer

Operations Manager

New Hampshire Local Government Center

[email protected]

September 17, 2010


Grandfathered plans

Grandfathered Plans

  • All plans that were in effect on March 23, 2010 are considered grandfathered plans

  • Grandfathered plans are exempt from some but not all of the reforms

  • However, grandfathered status may be lost due to certain changes in cost or coverage

  • Must include a statement that you believe you are a grandfathered plan


To be grandfathered you cannot

To Be Grandfathered You Cannot

  • Significantly lower employer contributions

  • Significantly raise copayment charges

  • Raise co-insurance charges

  • Significantly raise deductibles

  • Significantly cut or reduce benefits

  • Add or reduce an annual limit on what the plan pays

  • Change insurance companies


Upon loss of grandfathered status

Upon Loss of Grandfathered Status

  • Cover pre-26’ers even if they can get own coverage

  • Preventive care services must be covered at 100%

  • No prior authorization or increased cost-sharing for OON emergency services

  • Have an “effective appeals process”

  • Cover routine patient costs in clinical trials


Discussion of new national health insurance law grandfathered plans

Upon Loss of Grandfathered Status

  • Employers can increase office copayments higher than the $5 cap

  • Employers can increase deductibles and coinsurance amounts

  • Employers can increase employees’ contribution for the cost of the premiums

  • There will be additional reporting duties


Collectively bargained agreements

Collectively Bargained Agreements

  • CBA’s ratified before 3/23/2010 are considered to be grandfathered

  • Amendment to conform to new law is not treated as a termination of CBA

  • Changing carrier during CBA will not cause an insured union-negotiated plan to lose grandfathered status

  • Even after end of CBA, the plan remains grandfathered until it loses that status under one of the triggering situations


Other grandfather information

Other Grandfather Information

  • http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html

  • http://healthreform.gov/about/grandfathering.html

  • http://www.dol.gov/ebsa/pdf/grandfatherregtable.pdf

  • http://www.dol.gov/ebsa/grandfatherregmodelnotice.doc

  • http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/UnionPlans.aspx

  • Google “Health Reform Grandfather”


  • Login