Interim Rules for Health Care Reform Effective September 23, 2010

White House Issues Interim Final Rules on Provisions Effective Sept. 23


Interim final rules were issued Tuesday by the Departments of Health and Human Services (HHS), Labor, and Treasury concerning implementation of the pre-existing condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) .

Grandfathered Plans

Last week Interim Final Regulations were issued from the Departments of HHS, Labor, and Treasury around “grandfathered plans” under the Patient Protection and Affordable Care Act of 2010 (PPACA). Health benefit plans in effect on March 23, 2010, are considered grandfathered health plans, which will not be subject to certain PPACA provisions.

The new regulations allow insurers and their customers to make only certain types of changes to their existing health plans while maintaining their grandfathered status. However, if an employer, member or insurer wants to make any changes to their plan beyond those defined in the regulations, they would lose their grandfathered status and have to follow the new rules identified by PPACA.

HHS included in its rules clarification that grandfathered plans:

Cannot significantly cut or reduce benefits

Cannot raise coinsurance charges

Cannot significantly raise copayment charges

Cannot significantly raise deductibles

Cannot significantly lower employer contributions

Cannot add or tighten an annual limit on what the insurer pays

Cannot change insurance companies