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Meyer Chiropractic Healthcare 


Dr. Howard R. Meyer 


7102 Pendleton Pike 


Indianapolis, IN 46226 


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August 10, 2010 

Office ofConsumer Information and Insurance Oversight 

Department of Health and Human Services 

l-----....A.Jtention: OC!!0-:-~9jtL-!tC '. . ....... _ ""'"~_ ____"C"'*"-'. _ ___ __....... 


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 

Protecfion'and·AJfordable Care Act (PPACA). . . .. , ,. ," J ~ • \' ~ • -<-_ '.:' '* ., 


t)¥"', 'rr:'~j~-,'1j':.: # .~'" 

Webelleve that everyeffort should be made to increase the number'ofindividjal~ bdvered.b; 

PPACA,espeCially as of January 1, 2014when most ofthe reform compone~ts«Insurance ' 

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

The Rule provides the seven triggers that would revoke the grandfathered status of a group 

health plan: 

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


.• Elimination of substantially a11 benefits to treat a particular condition 
 .......-_.--- -- - """ .. -- ... -- .-- "­

• Elimination of benefits for any element ~ec;ssary to eli~i~e-or-diagnos~ condition' - . -, 

• Any change to coinsurance level 

• Fixed-amount cost-sharing (Deductible slOOP) Inflation +15% 

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

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

While relatively straightforward, these guid,elines may.still result in some cql!fus~on, to th~ 

marketplace:In their 'appljcation, For example, .ifanemployer rais~d the. copaymentJevel beyond 

the maximum in one area (i.e. outpatient services) but retained the copay~en(iever for pri~ary 

.care doctbr visits; does.that ,mean a loss ofgrandfather status? Clarity will be critical both for the • 

employer and the'employee. . I' '.. 
.!l r 

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 

employee, which can result in a change to their plan including: 

• 	 A "substantial change" to the provider network 

Consumers believe their provider and the provider network associated with any plan is ah 

integral part ofthe health care benefits provided by the employer. A termination ofa 

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 of the grandfather 

status. "-~----

• 	

Even 

insured 

Change 

if the 

to 

in 

self-funded) 

issuer 

benefit 

or 

structure 

third-party 

of a 

administrator 

group health plan 

(TP A) 

remains 

(including 

largely 

moving 

the same, 

from fullya 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. 

• 	 Sign(ficant change in care management/authorization requirements 

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

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

requiring referrals, or other care management strategies involved in the delivery ofcare 

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 ofthe employee population will 
 --I

remain outside the PP ACA as of January 2014 based on the current rules. While we understand 


the difficulty involved in making changes, creating another large sub-population of excluded 


individuals will only add to costs, increase confusion, and mitigate the potential impact of the 


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 detennine 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 support. 

Thank you for the opportunity to comment on this regulation. 

Dr.J~1..~ 

Dr. Howard R. Meyer 

Meyer Chiropractic Healthcare 

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