-----------------------------------------------------------------

----------------------------------------------------------------

Page 1 of 1 

~AL PROCESSING DIVISION 

As of: August 25, 2010 ... LlCATION &: REGULATIONS 

Received: August 10, 2010 PUStR; Status: Posted

Posted: August 25, 2010 

Tracking No. 80b2d510 SUBMISSION Comments Due: August 16, 2010 

Submission Type: Web 

Docket: IRS-201O-001O 

Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathel-ed 

Health Plan Under the Patient Protection and Afforable Care Act 

Comment On: IRS-201O-001O-0001 

Group Health Plans and Health Insurance Coverage: Interim Final Rules for Relating to Status as 

a Grandfathered Health Plan under the Patient Protection and Affordable Care Act 

Document: IRS-2010-001O-0370 

Comment on FR Doc # 2010-14488 

Submitter Information 

Name: Marc Abla 

Address: 

PO Box 9448 

Springfield, IL, 62791 

Email: marc@ilchiro.org 

Phone: 217-525-1200 

Fax: 2175251205 

Organization: Illinois Chiropractic Society 

General Comment 

See attached file(s) 

-------------------------------------------------------------1---­

Attachments 

IRS-2010-0010-0370.1: Comment on FR Doc # 2010-14488 

https:llfdms.erulemaking.netlfdms-web-agency Icomponentlsubmitter InfoCover Page ?Call=... 8/2512010 
ILChiro 


Ullnol. Chl......racfl. Sacl.ty 

August 8, 2010 

Office of Consumer Information and Insurance Oversight 

Department of Health and Human Services 

Attention: OCII0-9991-IFC 

P.O. Box 8016 

Baltimore, MD 21244-1850 

Re: Interim Final Rule for Group Health Plans and Health Insurance Coverage Relating to Status as 

a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act 

Below are our comments regarding the Interim Final Rule for Group Health Plans and Health 

Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection 

and Affordable Care Act (PPACA). 

We believe that every effort should be made to increase the number of individuals covered by 

PPACA, especially as ofJanuary 1,2014 when most ofthe reform components (Insurance 

Exchanges, Subsidies, Tax Credits, etc.) come into play. 

The Rule provides the seven triggers that would revoke the grandfathered status ofa group health 

plan: 

• Mergers or acquisitions with the sole intention of maintaining grandfather status 

• Elimination ofsubstantially all benefits to treat a particular condition 

• Elimination of benefits for any element necessary to eliminate or diagnose a condition 

• Any change to coinsurance level 

• Fixed-amount cost-sharing (Deductibles/OOP) Inflation +15% 

• Co-payments (Medical Inflation +15% or $5 adjusted for medical inflation) 

• Employer contribution (> 5% reduction in Employer Contribution) 

While relatively straightforward, these guidelines may still result in some confusion to the 

marketplace in their application. For example, if an employer raised the copayment level b(:yond the 

maximum in one area (Le. outpatient services) but retained the copayment level for primary care 

doctor visits, does that mean a loss of grandfather status? Clarity will be critical both for the 

employer and the employee. 

The average consumer has a broad definition of "benefits." Consumers view their health plan 

beyond the covered benefits, cost sharing, and the contribution levels associated with the plan. Other 

components of health care services can have a significant impact on the individual employe:e, which 

can result in a change to their plan including: 

• A "substantial change" to the provider network 

P.O. Box 9448 - Springfield, Illinois 62791 - Phone: (217) S2S·1200 - Fox: (217) S2S·120S - (800) 424·0121 - www.ilchiro.org-- ics@ilchiro.org 
Consumers believe their provider and the provider network associated with any plal1 is an 

integral part ofthe health care benefits provided by the employer. A termination of a hospital 

system or specific provider group sometimes has significant impact on the employee 

population and should be viewed as a substantial change to the plan itself. As a guideline, we 

would suggest any change in the provider network impacting over 50% of the employee 

population (nationally or locally) should result in a loss ofthe grandfather status. 

• 	 Change in issuer or third~party administrator (I'P A) (including moving from fully~insured to 

self-funded) 

Even ifthe benefit structure of a group health plan remains largely the same, a change in 

administration ofthe plan requires new communication, new processes, and new 

requirements on the part of an employee and the employer. Moving from a fully-insured to a 

self-funded status or changing administrators requires new processes and legal agreements 

for the group health plan. These transitions are not daily or regular events and should be 

considered a change in the group health plan. 

• 	 Significant change in care management/authorization requirements 

The processes consumers need to follow to receive care are a significant component oftheir 

perceptions of their health benefits plan. Changing notification requirements, requiring 

referrals, or other care management strategies involved in the delivery of care should also be 

considered as a change to the plan. This may prevent group health plans from maintaining 

their grandfather status by not necessarily eliminating a benefit, but making it difficult to 

receive by changing the care management process around it. 

Even by the most optimistic estimates, a substantial portion of the employee population will remain 

outside the PPACA as ofJanuary 2014 based on the current rules. While we understand the 

difficulty involved in making change, creating another large sub-population of excluded individuals 

wi11 only add to costs, increase confusion, and mitigate the potential impact ofthe legislation. This 

only adds to the uncertainty surrounding the $143 billion in deficit reduction projected by the 

Congressional Budget Office (CBO) when the process began. 

We believe that any changes related to the areas listed above should also result in a loss of 

grandfather status as these are changes that heavily impact a patient's healthcare benefits. The Rule 

needs to be clear, reasonable, and with no ambiguities involved in determining whether a group 

health plan is "in or out." The decisions we make today will determine the outcomes for tomorrow. 

We may need to make some difficult decisions to create a sustainable health care system that will 

support a growing economy in the future. That means getting as many citizens across the country 

participating at the beginning to make it work and delivering on its promises to retain their :mpport. 

Thank you for the opportunity to comment on this regulation. 

jU1I--.. Marc Abla 

Illinois Chiropractic Society 

P.O. Box 9448 - Springfield, Illinois 62791 - Phone: (217) 525·1200 - Fox: (217) 525·1205 - (800) 424-0121 - www.ilchiro.org -, ics@ilchiro.org