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PUBLIC 

SUBMISSION 

As of: September 09, 2010 

Received: August 16, 2010 

Status: Posted 

Posted: September 09, 2010 

Tracking No. 80b323eb 

Comments Due: August 16, 2010 

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-201O-0010-0001 

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

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

Document: IRS-201O-001O-0945 

Comment on FR Doc # 2010-14488 

Submitter Information 


Address: 

Grand Rapids, MI, 

Organization: Priority Health 

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General Comment 

Attached 

--------------------------------------------------------------.,---­

Attachments 

IRS-2010-0010-0945.1: Comment on FR Doc # 2010-14488 

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August 16, 2010 

TO: 	 The Honorable Kathleen Sebelius 


Secretary of Health and Human Services 


FROM: 	Marti Lolli, Director of Health Care Reform 


Priority Health/Grand Rapids, MI 


RE: 	 OCIIO-991-IFC; Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health 

Plan Under the Patient Protection and Affordable Care Act 

Thank you for the opportunity to comment on Section 1251 of the Patient Protection and Affordable Care Act (PPACA). 

We respectfully submit two suggestions for your consideration: 

SUGGESTION 1: 

A change in insurance carriers should not trigger the loss of grandfathered status as long as the benefits remain the 

~. 

RATIONALE: 


Competition plays an important role in managing costs. The provision in the interim regulation will stifle competition by 


preventing employers from switching to a less costly plan with equal benefits. The current regulation limits flexibility, 


locks employers into the current plan, and gives insurance carriers too much power. 


Employers should be free to switch carriers and remain grandfathered especially if the new carrier provides the same 


benefits at a lower cost. Implementing this suggestion promotes competition and gives employers the freedom to 


choose the insurer that best meets their needs. 


SUGGESTION 2: 


The issuance of a new policy, certificate, or contract should not trigger the loss of grandfathered status. 


RATIONALE: 

Policies, certificates, and contracts are typically re-issued annually even if there are no changes to benefit dl~sign. This is 

done as part of the ordinary course of business. The provision as written will cause employers to lose grand fathered 

status simply for making standard changes. The grandfather regulation is intended to protect employees with respect 

to unfavorable changes to their health plans. This goal is accomplished by the other provisions of the regulation. For 

example, if an employer changes insurers or funding arrangements, but does not make changes that exceed the limits in 

the interim regulation, then the employer's plan should remain grandfathered. It is not necessary to also include a 

prohibition on a technical change to an employer's plan certificate, and in fact, this provision could prevent employers 

from being able to make plan design changes that are favorable to employees. This is another reason that this entire 

provision should be eliminated from the regulations. 

Priority Health is a health benefits company nationally recognized for creating innovative solutions that impact health 

care costs while maximizing the customer experience. It offers a broad portfolio of products for employer@Joups, 

individuals and Medicare and Medicaid enrollees. The company serves more than 600,000 people and continues to be 

rated as one of America's Best Health Plans by U.S. News & World Report and the National Committee for G:uality 

Assurance. For more information visit www.prioritvhealth.com.