Is It Worth Keeping "Grandfathered" Status?

Full Throttle

Guru
1000 Post Club
1,459
Midwest
I'm trying to get my head around this issue so I can properly advise my clients. What are the main advantages to my clients to maintaining grandfathered status when it is going to cost them real dollars over the next 3 1/2 years.

A quick google search turned this (here's the link):

What are the benefits to an employer of having a grandfathered health plan?
  1. Grandfathered plans are exempt from some, but not all, of PPACA's requirements. For example, grandfathered plans are exempt from: the Act's mandate for plans to offer certain free preventive health services;
  2. The extension of rules prohibiting discrimination in favor of highly compensated employees to insured plans;
  3. The establishment of an external review process for benefit claim appeals;
  4. The prohibition against pre-authorization requirements for OB/GYN and emergency services;
  5. New Department of Health and Human Services ("HHS") reporting requirements regarding plan efforts to improve participant health, safety and wellness;
  6. New HHS reporting requirements regarding claim payment policies, enrollment/disenrollment, claim denials and cost sharing; and
  7. Certain cost-sharing restrictions. In addition, grandfathered plans have delayed compliance deadlines for several of the Act's requirements (e.g., restrictions on annual benefit limits).

Dissecting a few of these:

a. No mandatory preventive care: this doesn't seem to me like it will add a huge burden on the plan pricing, most plans I sell already offer it (unlimited preventive care on the group side, a capped preventive benefit on the IFP side).

b. The rest seems to be on the administrative side, which to me doesn't look like it would have a large impact on premiums.

I'm sure there is a lot I'm still missing, any insight into why it may be prudent to maintain "grandfathered" status instead of saving real dollars today would be appreciated.
- - - - - - - - - - - - - - - - - -
Somarco? Dave? John? Paul? (what was I thinking?) ;) Any insight on this, I've hit a brick wall. Could it be that no one really knows yet?
 
Last edited:
From an individual market standpoint, it seems as if "Grandfathering" is not a positive thing. Newer plans will have more wellness benefits and additional safety-net features. Why be "grandfathered" into an old Ford when
you can get a new BMW, with Uncle Sam helping you make the payments? -AC
 
Back
Top