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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

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Discussion of New National Health Insurance Law – Grandfathered Plans

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  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”

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