Interim Final Regs Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act

[Official Guidance]
Text of Interim Final Regs Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act

121 pages. Filed this morning with the Office of the Federal Register; scheduled for publication on June 17. The regs generally are effective as of today (June 14). Excerpt:

[T]hese interim final regulations provide that a group health plan or health insurance coverage no longer will be considered a grandfathered health plan if a plan sponsor or an issuer:

Eliminates all or substantially all benefits to diagnose or treat a particular condition. The elimination of benefits for any necessary element to diagnose or treat a condition is considered the elimination of all or substantially all benefits to diagnose or treat a particular condition;
Increases a percentage cost-sharing requirement (such as coinsurance) above the level at which it was on March 23, 2010;
Increases fixed-amount cost-sharing requirements other than copayments, such as a $500 deductible or a $2,500 out- of-pocket limit, by a total percentage measured from March 23, 2010 that is more than the sum of medical inflation and 15 percentage points.
Increases copayments by an amount that exceeds the greater of: a total percentage measured from March 23, 2010 that is more than the sum of medical inflation plus 15 percentage points, or $5 increased by medical inflation measured from March 23, 2010;
For a group health plan or group health insurance coverage, an employer or employee organization decreases its contribution rate by more than five percentage points below the contribution rate on March 23, 2010; or
With respect to annual limits (1) a group health plan, or group or individual health insurance coverage, that, on March 23, 2010, did not impose an overall annual or lifetime limit on the dollar value of all benefits imposes an overall annual limit on the dollar value of benefits; (2) a group health plan, or group or individual health insurance coverage, that, on March 23, 2010, imposed an overall lifetime limit on the dollar value of all benefits but no overall annual limit on the dollar value of all benefits adopts an overall annual limit at a dollar value that is lower than the dollar value of the lifetime limit on March 23, 2010; or (3) a group health plan, or group or individual health insurance coverage, that, on March 23, 2010, imposed an overall annual limit on the dollar value of all benefits decreases the dollar value of the annual limit (regardless of whether the plan or health insurance coverage also imposes an overall lifetime limit on the dollar value of all benefits).

(Employee Benefits Security Administration; U.S. Department of Health and Human Services; Internal Revenue Service)

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