Page 1 of 2

pega ta DN ONS fi rG- [84/8 AC

tpt ICATION SCH AUG 4 2019

As of: August 04, 2010

PUBLIC Status: Posted

Posted: August 04, 2010
SUBMISSION Comments Due: September 15, 2019

Submission Type: Web

Docket: IRS-2010-0010
Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered
Health Plan Under the Patient Protection and Afforable Care Act

Comment On: IRS-2010-0010-0002
Group Health Plans and Health Insurance Coverage: Status as Grandfathered Health Plan under
the Patient Protection and Affordable Care Act; Cross-Reference

Document: IRS-2010-0010-0013
Comment on FR Doc # 2010-14487

TT

Submitter Information

Name: Marie Russo
Address:
700 Moravia Street
New Castle, 16101
Email: mrusso@elwd.com
Phone: 724-658-6289
Fax: 724-658-6358
Organization: Ellwood Group, Inc.

General Comment

On behalf of Ellwood Group, Inc., I appreciate the opportunity to submit the following comments
on the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to
Status as a Grandfathered Health Plan under the Patient Protection and Affordable Care Act
published in the Federal Register on June 17, 2010.

Our manufacturing economy, and our ability to create jobs, is significantly impacted by changes
to the health care infrastructure. Ellwood provides health insurance for our employees and we are
very concerned about what impact the Grandfather Rule will have on our ability to continue
provide that coverage.

As currently drafted, we believe the Grandfather Rule is too restrictive and will result in a higher
number of employer-based plans losing or forgoing their grandfather exemption. Such a drarnatic
decline in coverage will create unnecessary disruptions for both employees and employers.

Requested Comments

Changes to a Prescription Drug Formulary: Changes and innovations in treatment standards and
technology require formularies to be updated continually to align with appropriate disease
management. A static formulary would not allow employees to access the safest and most

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 8/4/2010


Page 2 of 2

effective therapies available to them. In addition an insurer changing a formulary for a fully
insured employer should not result in the loss of an employer's grandfather status. Formularies
should be managed to provide the best quality of care and flexibility for employer options.

Changes in Plan Structure: As a company grows it often makes different health care choices for
its employees. For example, a fully-insured company may decide they can manage the risk and
the paperwork burden to become self-insured, or a self-insured company may decide it is mere
economical to be fully-insured. An employer should not be penalized for offering different and
many times better options for their employees.

Changes in a network plan‘s provider network: The final rule needs to allow changes to provider
networks on a regular basis, without impacting the grandfathered status of plans. There are
many reasons plans need to alter their provider networks, such as expanding the network to
provide greater access to services, contract arrangements between insurer and provider or to
address other provider changes. Further, employers currently offering fully-insured plans shculd
not be penalized for changes made by the insurer to their plan. It would be fundamentally unfair
to take away a business’ access to a plan due to some action beyond the employer's control.
Basic modifications to a plan to adjust for technology or doctors who may not longer be affiliated
with a network should not disqualify a plan from being grandfathered.

Other substantial changes to benefit design: It is difficult to determine what technologies of
benefit vehicles will be available in the future. Employers should be allowed to provide as many
options as is possible for their employees, so they may chose the best plan for their family.
Limiting changes to benefit design create a stagnant market devoid of competition and
innovation. Increased competition will lower healthcare costs, and a flat market is not
competitive.

Conclusion

Ellwood Group, Inc. appreciates the opportunity to submit these comments and hopes our
concerns with the substance of these proposed changes are considered. Flexibility will increase
competition in the marketplace. Freezing the market will create a stagnant, uncompetitive and
more expensive insurance market for those who choose to continue proving coverage for their
employees.

It is important to enact these insurance reform changes with consideration of more balanced
approaches that includes a strong employer role.

https://fdms.erulemaking .net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 8/4/2010