1 / 7

Discussion of New National Health Insurance Law – Grandfathered Plans

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

tehya
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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Discussion of New National Health Insurance Law – GrandfatheredPlans Richard C. Dwyer Operations Manager New Hampshire Local Government Center rdwyer@nhlgc.org September 17, 2010

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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”

More Related