Plans Allowed to Retain "Grandfathered" Status After Changing Insurance Coverage
On November 17, 2010, the U.S. Departments of the Treasury, Labor, and Health and Human Services released an amendment to the interim final regulations related to establishing and retaining a plan’s grandfathered status under the Patient Protection and Affordable Care Act (PPACA). The amendment provides guidance on when fully insured group health plans may change policies, certificates, or contracts of insurance without losing grandfathered status.
The amendment applies to changes to group health insurance coverage that are effective on or after November 15, 2010. The important date for this purpose is the effective date of the new coverage, not the date the plan enters into a new agreement for coverage. For example, if a plan enters into an agreement with an issuer on November 1, 2010 for a new policy to be effective January 1, 2011, the new policy will be covered under the amendment because it will not become effective until after November 15, 2010.
Retaining Grandfathered Status
Before the amendment, a fully insured group health plan would lose its status as a grandfathered health plan if the plan changed insurance coverage after March 23, 2010. This rule prevented plans from switching issuers or entering into new insurance policies if the plan wanted to retain its status as grandfathered plan under PPACA.
Under the amended regulation, a fully insured group health plan will be allowed to switch issuers and/or change insurance coverage without losing its grandfathered status as long as the new coverage does not result in significant cost increases, reduction in benefits, or other changes prohibited by the original rule. In order to retain grandfathered status under the amended regulation, a group health plan changing insurance carriers or policies must provide to the new insurance issuer documentation of the plan terms under the prior health coverage sufficient to determine whether a prohibited change is being made. This documentation may include a summary plan description or a copy of the prior policy.
Retaining grandfathered status is important for many group health plans because grandfathered plans are exempt from certain provisions of PPACA. For more detail on the underlying regulations related to grandfathered health plans, please see our Legal News Alert entitled, “Defining Grandfathered Plans and Maintaining Grandfathered Status Under Health Care Reform” at http://tinyurl.com/327dtol.
법률 뉴스 알림은 고객과 동료들에게 영향을 미치는 시급한 문제나 업계 이슈에 관한 최신 정보를 제공하기 위한 당사의 지속적인 노력의 일환입니다.
본 알림에 관한 문의사항이 있거나 해당 주제에 대해 추가로 논의하고자 하시는 경우, 담당 폴리 변호사 또는 다음 담당자에게 연락주시기 바랍니다:
Casey K. Fleming
Milwaukee, Wisconsin
414.319.7314
[email protected]
Leigh C. Riley
Milwaukee, Wisconsin
414.297.5846
[email protected]
미국 국세청 규정상 일반적으로 미국 연방 세금 벌금을 회피하기 위한 목적으로 납세자는 해당 규정에 명시된 특정 요건을 충족하는 공식 서면 의견서에만 의존할 수 있습니다. 본 뉴스레터는 해당 요건을 충족하지 않습니다. 본 뉴스레터에 미국 연방 세금 문제와 관련된 서면 정보가 포함된 경우, 해당 서면 정보는 미국 연방 세금 벌금을 피하기 위한 목적으로 사용되거나 작성된 것이 아니며, 납세자는 이를 그러한 목적으로 사용할 수 없습니다. 또한 본 뉴스레터는 뉴스레터에서 논의된 어떠한 거래나 사안의 홍보 또는 마케팅을 지원하기 위해 작성된 것이 아닙니다.
