Anthem Blue Cross's Guide to Health Care Reform and Grandfathering Plans

One of the changes allowed within the newly enacted Patient Protection and Affordable Care Act (PPACA) is the ability of employers to introduce limited changes to the medical insurance plan they offer their employees. This is known as “grandfathering” the plan.

Only certain changes are allowed under “grandfathering”:

• Holders of a grandfathered plan can add family members
• An employer holding a grandfathered plan can add new employees
• Coverage of persons enrolled on March 23, 2010 can be removed
• Adjustments can be made as needed in order to conform to the new laws
• Employer contributions can be decreased (within certain limits based on the cost of coverage or formula)

A “grandfathered” plan is essentially the same health care insurance package offered by the employer as of March 30, 2010, but with a few changes as specified in the PPACA or as allowed by state or federal law.

Some enhancements are required per the PPACA, and do not need a plan to be “grandfathered” to implement them. The changes should be in place on or before September 23, 2010:

• Members can add dependents aged 26 years and below, regardless of student status
• Pre-existing exclusions for members aged 19 years and below are now removed
• Annual limits on policies can now be adjusted (within the specifications of the PPACA)
• In-network preventive care coverage is now offered 100%
• Non-grandfathered plans will now also include some additional benefits:
• In-network preventive services will be offered at totally no cost to the plan holder (100%, no cost-sharing)
• Clinical trials for life-threatening diseases will be covered (subject to the plan’s benefit and out-of-network provider limits)
• Emergency services without prior authorization will be covered with same cost share as in network
• A pediatrician can now be named as a child’s primary health care provider and women no longer need authorization to visit an OB-GYN
• Health care plan benefits should not depend on salary or company position.

With regards to group policies, certain annual limits can be adjusted under the new laws.

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