[Bryan]

Originally Posted by nolidad

But on eof the guidelines for a plan to be grandfathered is that cannot enroll new individuals after the first day of Y1. There is no "if" exclusion in the parafraph and the bill only providesa for excl;usions on the paragraph.

a Plan that meets the minimum standards set forth by Regulation won't have to be Grandfathered. So if the government sets a maximum copay of $35 and your plan has a copay of $40, it is not compliant with regulation. The grandfathering provision will allow that plan to stay for up to five years as long as certain criteria are met. One criterion is no new members to the plan.

Now if a plan does meet all the regulatory requirements then it doesn't need to be grandfathered and won't be restricted from adding new members.

[Hopeful]

Originally Posted by Bryan

The grandfathering provision will allow that plan to stay for up to five years as long as certain criteria are met. One criterion is no new members to the plan.

Now if a plan does meet all the regulatory requirements then it doesn't need to be grandfathered and won't be restricted from adding new members.

Here's where the devil is in the details. Unless you know what those minimum criteria are and how your current plan compares, you may be forced into the government plan, even if you have a good plan otherwise. If the regulators are setting the requirements, they've got their hooks in the industry.

[nolidad]

Originally Posted by Bryan

a Plan that meets the minimum standards set forth by Regulation won't have to be Grandfathered. So if the government sets a maximum copay of $35 and your plan has a copay of $40, it is not compliant with regulation. The grandfathering provision will allow that plan to stay for up to five years as long as certain criteria are met. One criterion is no new members to the plan.

Now if a plan does meet all the regulatory requirements then it doesn't need to be grandfathered and won't be restricted from adding new members.

you are mixing two sperate provisions. The five year provision is for employment based coverage.

the no new members is for private health plans and group (not employer based) coverage.

This is for private plans:

1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef15
fective date of coverage is on or after the first
16 day of Y1.

This is for employer based coverage:

) GRACE PERIOD FOR CURRENT EMPLOYMENT9
BASED HEALTH PLANS.—
10 (1) GRACE PERIOD.—
11 (A) IN GENERAL.—The Commissioner
12 shall establish a grace period whereby, for plan
13 years beginning after the end of the 5-year pe14
riod beginning with Y1, an employment-based
15 health plan in operation as of the day before
16 the first day of Y1 must meet the same require17
ments as apply to a qualified health benefits
18 plan under section 101, including the essential
19 benefit package requirement under section 121.

See. There is no grace period for private plans and non employer group plans.
These have 3 conditions to meet and one of those conditions is that the insurerer can no longer insure new individuals or add anyone to a non employer based group.

[Ridley's Own]

Originally Posted by nolidad

y
See. There is no grace period for private plans and non employer group plans.
These have 3 conditions to meet and one of those conditions is that the insurerer can no longer insure new individuals or add anyone to a non employer based group.

But that's only provided that they don't initially meet the regulations. That's what Bryan's saying. Once again, you're simply making things up, then refusing correction. having any sort of discussion with you is like talking to a dining room table.

[nolidad]

Originally Posted by Ridley's Own

But that's only provided that they don't initially meet the regulations. That's what Bryan's saying. Once again, you're simply making things up, then refusing correction. having any sort of discussion with you is like talking to a dining room table.

Qouting Barney Frank earns you no points with me!

That is not what the law says- the provision for not enrolling new members to individual plans is not dependent on meeting new requirements at least in section 102- if their are other sections circimvventing section 102 I would like to see them. I have read much but not all ofo the bill.


The key is that it speaks only to succeeding portions of section 102:

(a) GRANDFATHERED HEALTH INSURANCE COV4
ERAGE DEFINED.—Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov6
erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:

And the first condition is no new persons are written except dependents.
2nd condition: it changes no terms or conditions
3rd condition: it cannot raise an individuals rates for risk- it has to raise everyone with the same conditions rates the same.

2) LIMITATION ON CHANGES IN TERMS OR
22 CONDITIONS.—Subject to paragraph (3) and except
23 as required by law, the issuer does not change any
24 of its terms or conditions, including benefits and
25 cost-sharing, from those in effect as of the day be26
fore the first day of Y1.

(3) RESTRICTIONS ON PREMIUM INCREASES.—
2 The issuer cannot vary the percentage increase in
3 the premium for a risk group of enrollees in specific
4 grandfathered health insurance coverage without
5 changing the premium for all enrollees in the same
6 risk group at the same rate, as specified by the
7 Commissioner.

If it meets condition 2&3 but writes new policies- it fails to meet condition 1 and thus not a grandfathered plan and can only be in the exchange program.

The 3 conditions are independent of each other and all three are required.

[Ridley's Own]

Originally Posted by nolidad

Qouting Barney Frank earns you no points with me!

If I was quoting Rep. Frank, it'd be like this: "Tawking with you is wike tawking to a dining woom table..."

That is not what the law says- the provision for not enrolling new members to individual plans is not dependent on meeting new requirements at least in section 102- if their are other sections circimvventing section 102 I would like to see them. I have read much but not all ofo the bill.

But it's not considered 'grandfathered' if it meets the new regulations... That's the point. You can't call something a new 'regulation' and then proceed to not regulate. Its like having a car that doesn't have seatbelts, then buying a new car after the new regulation requiring seatbelts, and being surprised that you can't buy a NEW car without seatbelts. What's the point?

[Hopeful]

Originally Posted by Ridley's Own

But it's not considered 'grandfathered' if it meets the new regulations... That's the point. You can't call something a new 'regulation' and then proceed to not regulate. Its like having a car that doesn't have seatbelts, then buying a new car after the new regulation requiring seatbelts, and being surprised that you can't buy a NEW car without seatbelts. What's the point?

I work for the Federal government; they change the rules all the time. I have seen how they will interpret the law to their benefit because they have the power. They can still make life miserable for you even if they are wrong. Ever been audited by the IRS? I have - twice and it's because we give a lot to charity. When they use this term "grandfathered" it is only lip service to make you feel good so that they can gather public support for the legislation. Just remember, what the government gets a hold of is very rarely given back.

[nolidad]

Originally Posted by Ridley's Own

If I was quoting Rep. Frank, it'd be like this: "Tawking with you is wike tawking to a dining woom table..."



But it's not considered 'grandfathered' if it meets the new regulations... That's the point. You can't call something a new 'regulation' and then proceed to not regulate. Its like having a car that doesn't have seatbelts, then buying a new car after the new regulation requiring seatbelts, and being surprised that you can't buy a NEW car without seatbelts. What's the point?

With Barney you need to add little spitdoodles!

As for your second part-- the section, nor the division says that at all. It doesn't sya if it does or doesn't meet the new regs. It just simply says that all policies on an individual and non-employer group basis will be grandfathered in as long as they meet three conditions--

16
•HR 3200 IH
1 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.
3 (a) GRANDFATHERED HEALTH INSURANCE COV4
ERAGE DEFINED.—Subject to the succeeding provisions of
5 this section, for purposes of establishing acceptable cov6
erage under this division, the term ‘‘grandfathered health
7 insurance coverage’’ means individual health insurance
8 coverage that is offered and in force and effect before the
9 first day of Y1 if the following conditions are met:
10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef15
fective date of coverage is on or after the first
16 day of Y1.
17 (B) DEPENDENT COVERAGE PER18
MITTED.—Subparagraph (A) shall not affect
19 the subsequent enrollment of a dependent of an
20 individual who is covered as of such first day.
21 (2) LIMITATION ON CHANGES IN TERMS OR
22 CONDITIONS.—Subject to paragraph (3) and except
23 as required by law, the issuer does not change any
24 of its terms or conditions, including benefits and
25 cost-sharing, from those in effect as of the day be26
fore the first day of Y1.
VerDate Nov 24 2008 23:22 Jul 14, 2009 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
17
•HR 3200 IH
1 (3) RESTRICTIONS ON PREMIUM INCREASES.—
2 The issuer cannot vary the percentage increase in
3 the premium for a risk group of enrollees in specific
4 grandfathered health insurance coverage without
5 changing the premium for all enrollees in the same
6 risk group at the same rate, as specified by the
7 Commissioner.

These are the only three conditions- no meeting regulations or not. Th einsurers cannot write new policies if they violate these three and only three conditions. If they do- the insurer loses the grandfathered provision, if he does not meet the new regs he is not a qualified plan and becomes part of the exchange based plans which require taxing employer and employee to purchase additioanl coverage under the public opyion to bring hteir coverage to fulol code.

[Bryan]

you're missing the whole point. If the bill becomes law, any new plans created must be a qualified health benefits plan. The requirements for being considered a QHBP is give in section 101. What section 102 allows is the ability to keep your current plan for up to 5 years. This allows Health Insurance Company A to keep the people currently on a plan for up to 5 years. There are conditions to this.

1. You cannot add new members to the plan. (exception would be dependents of a individual enrolled in the plan prior to Y1)
2. You cannot change the terms of the plan.
3. Limits the changes in premiums.

If Health Insurance Company A wants to write a new plan then it must meet the qualifications under section 101.

So I fail to see the problem here. The bottom line is you can keep your current plan for up to 5 years, after which, you must switch to a QHBP (which will include hundreds of private insurance plans and the public option). So where exactly is the problem?

[Hopeful]

Originally Posted by Bryan

you're missing the whole point. If the bill becomes law, any new plans created must be a qualified health benefits plan. The requirements for being considered a QHBP is give in section 101. What section 102 allows is the ability to keep your current plan for up to 5 years. This allows Health Insurance Company A to keep the people currently on a plan for up to 5 years. There are conditions to this.

1. You cannot add new members to the plan. (exception would be dependents of a individual enrolled in the plan prior to Y1)
2. You cannot change the terms of the plan.
3. Limits the changes in premiums.

If Health Insurance Company A wants to write a new plan then it must meet the qualifications under section 101.

So I fail to see the problem here. The bottom line is you can keep your current plan for up to 5 years, after which, you must switch to a QHBP (which will include hundreds of private insurance plans and the public option). So where exactly is the problem?

The problem is the government changes the rules all the time. I see it in my daily work as I pointed out above. Even the local bureaucrats will be able to put their slant to the rules.

[nolidad]

Originally Posted by Bryan

you're missing the whole point. If the bill becomes law, any new plans created must be a qualified health benefits plan. The requirements for being considered a QHBP is give in section 101. What section 102 allows is the ability to keep your current plan for up to 5 years. This allows Health Insurance Company A to keep the people currently on a plan for up to 5 years. There are conditions to this.

1. You cannot add new members to the plan. (exception would be dependents of a individual enrolled in the plan prior to Y1)
2. You cannot change the terms of the plan.
3. Limits the changes in premiums.

If Health Insurance Company A wants to write a new plan then it must meet the qualifications under section 101.

So I fail to see the problem here. The bottom line is you can keep your current plan for up to 5 years, after which, you must switch to a QHBP (which will include hundreds of private insurance plans and the public option). So where exactly is the problem?

The five year time frame only applies to employee based group coverage. Not individual or non-employer group plans. They will not be allowed to add new members, raise rates, or change any part of their plan. If htey do, the lose grandfathered privilge and if there plan does not meet the new regs, does not qualify as a QHBP but goes in to the exhange benefits plan which will force taxation on the inidividual or group subscribimg to teh plan.

[Bryan]

Originally Posted by nolidad

The five year time frame only applies to employee based group coverage. Not individual or non-employer group plans. They will not be allowed to add new members, raise rates, or change any part of their plan. If htey do, the lose grandfathered privilge and if there plan does not meet the new regs, does not qualify as a QHBP but goes in to the exhange benefits plan which will force taxation on the inidividual or group subscribimg to teh plan.

how will it force taxation, exactly?

[nolidad]

Originally Posted by Bryan

how will it force taxation, exactly?

Well as best as has been discerned- Here is ho wit appearsd the bill will force new taxation vis-a-vis what we are talking about.

Existing policies are rolled into "Obama Care" as is. Employer plans have 5 years to make sure that their plans meet the new regs, if they don't already.

Individual and non-employer group insurers are allowed to roll their current policy holders as long as tthe three conditions listed are follows. If the plan is not in compliance- then either the group or the individuals are taxed to cover the additional cost to bring the plan into compliance (through public reinsurance to bring the plan to code)

If the changfes prohibited are made 1. adding new subscribers, 2. changing coverage, 3. increasing premiums wrongly- then these plans l ose grandfathered privilege- are noot QHBP plans, and can only be obtained through the exchange program. And all coverages not available in the plan will have to be bought, through taxing the individual or group to bring plan up through the public option.