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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):
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.
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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?
A quick google search turned this (here's the link):
What are the benefits to an employer of having a grandfathered health plan?
- 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;
- The extension of rules prohibiting discrimination in favor of highly compensated employees to insured plans;
- The establishment of an external review process for benefit claim appeals;
- The prohibition against pre-authorization requirements for OB/GYN and emergency services;
- New Department of Health and Human Services ("HHS") reporting requirements regarding plan efforts to improve participant health, safety and wellness;
- New HHS reporting requirements regarding claim payment policies, enrollment/disenrollment, claim denials and cost sharing; and
- 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?
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