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tazzygirl -> RE: Unions say Obamacare will destroy the health and wellbeing of workers (7/18/2013 8:02:29 PM)
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Grandfathered Status for Plans Sold in the Individual Market Individual market health plans that covered individuals and families on the day that the Affordable Care Act was enacted, March 23, 2010, may be considered grandfathered plans. People who are enrolled in grandfathered individual market plans can add family members to their policies without the plans’ grandfathered status changing. However, if an insurer in the individual market sells a plan to someone after March 23, 2010, the plan cannot be considered grandfathered for the new purchaser. This is the case even if the plan is considered to be a grandfathered plan for others who were enrolled in it on the day that the law was enacted. In addition, a health plan that is sold in the individual market will lose its grandfathered status for people it covered on or before March 23, 2010, if it makes significant changes to its benefits package or its costs to enrollees. These changes are described on page 3. Grandfathered Status for Job-Based (Group) Coverage Job-based health plans that covered workers and their families on March 23, 2010, may be considered grandfathered plans. If qualifying new enrollees join a plan that their employer already provided on that date, the plan can maintain its grandfathered status. Employers with grandfathered plans can add newly hired employees, existing employees who were not previously enrolled, and employees’ family members to their health plans and still maintain the plans’ grandfathered status. Under the amendment to the interim final rules for grandfathered plans that was released in November 2010, job-based health plans may also be considered grandfathered plans if they change the insurance companies they use for coverage and those changes go into effect on or after November 15, 2010.1 However, such plans must still cover the same benefits at the same costs to enrollees as they did with the previous insurers. If a job-based health plan makes significant changes to its benefits package or its costs to enrollees, whether it is providing coverage through its current insurer or starting a contract with a new health insurer, it will lose its grandfathered status. These changes are described on page 3. ------------------------------------------------------------------------- Plan Element -------------------- Disqualifying Change* Copayment - ]The greater of an increase of more than $5 (adjusted for medical inflation since March 23, 2010) or an increase above medical inflation plus 15 percentage points. Deductible - An increase above medical inflation (since March 23, 2010) plus 15 percentage points Out-of-Pocket Limit - An increase above medical inflation (since March 23, 2010) plus 15 percentage points Co-Insurance - Any increase in the co-insurance rate after March 23, 2010 Annual Limit - Any decrease of an annual limit that was in place on March 23, 2010, disqualifies a plan. Adoption of a new annual limit for plans that did not have one on March 23, 2010, also disqualifies a plan.** Employer Premium Contribution Rate (in group plans)- A decrease of more than 5 percentage points below the existing employer contribution rate as of March 23, 2010 Benefits Package - The elimination of all or substantially all covered benefits to diagnose or treat a particular condition after March 23, 2010 * See the interim final rule on grandfathered plans listed under “Additional Resources” for information regarding exceptions to the March 23, 2010, date. Exceptions may apply to plans that had already filed pending changes at the time that health reform was enacted. ** If a plan had a lifetime limit but no annual limit on March 23, 2010, it may replace its lifetime limit with an annual limit while maintaining its grandfathered status, as long as the annual limit has a dollar value that is equal to or greater than the previous lifetime limit. Having posted all that, you might be interested in page 4. http://www.familiesusa.org/assets/pdfs/health-reform/Grandfathered-Plans.pdf quote:
Same question - since the insurer now cannot have lifetime coverage limits? That was also addressed above.
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