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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

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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
slide5
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”
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