The Connecticut Coafitio~l of Taft-Hartley Healrh Funds, Ina. 

- - - 

Malur~g ud~ry fleilth Care Affordable 

August 6. 20.10 

Via United Status Mail 

Offke of Hea I th Plan Standa rcis and Corn plimce Assistance 

Emplnyet. Renefits Security Admini str~tion 

Kclurn N-5653 

U.S. Department of Labor 

21 111 Constitution Avenue, N.W. 

Washingtan, D.C. 2i)211) 

ATTN: KIN 1210-AM2 

KIN 1210-AD43 

Re: Comments regarding Interim Filial Rulus for: (1) 

Group Health Plans and Health insurance 

Coverage Relatuq to Status as a Grandfathercd 

Il~alth PIan Under fie Patient Protectiun and 

htforciable Carc Ark; and (2) Pati~nt Protection and 

Atfordablc Care Act; Requirements for Group 

I lcaIth Plans and Health Insurance Issuers . . . Reh tin^ to . . . Lifetirnc atid Annual Lim its . . . . 

Dear Sir aiirj/ OT Madam: 

I am the Execukvc Director of T~P C'cmnesticut Coalition of 'I aft-Hartlcy 

Health FuniIs, Inc. ("Coalition"), and with assistance from the Coalition's legal 

cclu nsel, I havc prepared ths I~lter to provid~ you with the Coalition's rnmmrnts 

ta tkc abnvtl-ncbted regulations. Before T do so in Section IT, T want to briefly 

share some background lnformatiun regarding the Coalilion, its mcmhrrs, and 

myself in Section I 50 hi yrlu can understand the basis fur thesc comments. 

Tfie Cualition is a non-stock membershp corporation ut~der Connixticut 

law, and it is operated on a "not-for-profit" bacis. The Coalition u7as 

incorporatecl in 1992, atld the Internal Revenue Service has confirmed that the 

Cudlition is a hx-exempt organization u1'1J~r Section 50l(c)j6) of the Internal 

Revenuc Code of 1986 (the "Code"). In general, th~ C:oalitionls members arc taxexcmpl, multicmployer healdl anti welfare funds whch are governed by variuus 

ledera1 laws, including the Cde, the Ernplvyee Rekernent Income Scwrity Act 

of 2974, as anended ('ERISA") and the Takt-Hartlcy Act of 1947, as amended 

(Taft-Hartley"). Each of these Coalition member funds has an dffiliatlon wilh n 

Robert F. Tcssier, Exccurive Director 

(960) 2.19-610U a (fa*) 249-.600 

www.ctcna1 itiun.org 

1~~jfi~P~ali~ion. @rg 

Mailing Addrcss 

P.0 Box 231443 Hartford, CT 06123 

Strect Address 

!142 Maill Srreer Hartfnrd, CT Vb103 

- 

Member Health Fuids 

Pl~~mhcrs & Steamtirrirs 

Local 131 
specific labor union, and each is nnrnlaIIv tax-exempt under Code 5501(c)(9) as a "voluntary 

employees' beneficiary associa lion' or VERA. 

The CoaIition currentIy has fiftcen member health funds covering Cnrmecticu t r~sidents. 

1 wvuld cstimte that the Coalition membcr fundm and other similar funds in Cunnechcut, 

provide health b~nefit caverage to approximatel>* 200,000 total covered livvs in thr state, 

consisting of ~Tigible active empIoyceu, retired uldividuals and th~ ir eligible dependents 

(hereinafter "covcreil individuals "). Coah tion member funds provide comprehemivc health 

and weIfarc hnefits (c.g., lib msurmce, weekly disability and scholarship bencfj is) to thcir 

cuvercd inrlividuals, and they spend nearly $200 miLIinn mually on mcdirdl, prescripLian 

drr~g, and other benefit payments. 

CoaLition mcmbcr funds are csri;lbIished, maintained and funded pursuant to the terms 

of collective bargaining aprecments ("CDAs") negotia Led by the sponsoring unions and 

raspectivc cmploy ers and,/ or err~ploye~, groups. 'l'h~ individua 1 heaIth funds are mdep~ndently 

managed and the plan of benefits for each fund is established hy a Board of Trustrrts. 

Currcmtly, a11 CoaIition member fun& providc benefits on a "self-insured" basis (i.r., directly 

from trust fund assets), although some mcmber funds do maintain stop-loss insurance p01ir.it.s 

andlor may pruvicle a lik-insurance benefit funded via an insurance policy. These not-forprofit health funds are unique in the health care marketplace in thal they arc hth payfir and 

c~nsumtir. Ah, as these funds are governed by ERISA, they exist for the 'sole and exclusive 

benefit" of the ~overcd individuals, and my ~xperience is that whetn the funds are able iu 

acluevt! savings, those savings are returned to the covered individuaIs in the form of ulrreased 

or improved benefits. 

On a persona1 IeveI, I have extensive experience tvilh labor unions and their associatcrl 

employee benehls plans. Prior to becoming the Cnalition's Executive Dir~ctur in January of 

2008, I was thc! plan administrator of two distinct Cannerticut-based mulhemployer pel-tsion 

and wellare benefit funds for a total of thirteen ycars. I was also the Coaliticln's President from 

2000 through 2007. 

11. Cornmentr 

One of the Coalition's primaq lax-rxen~pt pur~oscs is: "itlo prornvte tic lir~ancially 

sound continued tong term surviva I of Taft-Har t1t.y health funds.' Based on our review of the 

Interim Final Regulations ("IFRs") with resp~ct to status as a grandfathered healh plan issued 

on June 17, 2010, the Cnatiticm believes that the rules contained in the IFRs could possibly Icad 

to the lermination, or sigruficant r~struchiring, of one or marc CoaIiti~n mrrr~bclr funds. The 

primary issues, deahg with the rules governing "grandfathered hcalth plans," are ckcribed 

below in subsections B, 1 and R, 2, after n brief outline of the reIevant statutory rules in 

subsection A. The Coalition also comtnents on the rvcently issued FRs (issued on June 28,201fl) 

regarding lifetime and annuaI Limits in subsection B, 3, below. 

A. - Discussion of statutow rules 

4 critical point in thr hralth care debate was Presidei~t aarna's pronusr that pcop1e 

who liked thcir current hcalh care covcragt. would be pmnittcd in keep it. Indrd, the White 
Housc's web si tr stated: "If You Like the Insurance You Havc, Keep It: Nothing in the 

prvposai lorces anyone to change the insu race they have. Per ind."l 

This broad principle was reflected in Section 1251(a) (entitled "preservatiurl uf right tcr 

maintain existing coverage") uf thc Patient Prot~ctiun and AffordabIe Care Act ("PPACA"). h 

general, group health plans, including those maintained pursuarll to CBAs, which werp in effect 

on th~ date of PPACA1s enactment (March 23, 20111) are exempt from %me, ht not aU of the 

health care rrforms under PPACA.2 Such plans arc known as "grandfatl~~red health pIans" 

under ITACA ST251 (e j . With rcspcct to the effect uf the above rulcs nn grandfathered h~alth plans whch 

involve cuUective bargaining ageemcn ts, wc tion 1 25 1 (d) of PT" ACA provides: 

I The specilic web address is: h:fP:,' /r\: ww .ru hitehqimny/ h~a11l~-r~ar~-i~e~r0posn1~1i11~~ f bra. 

PPACA $1 251(;1), as amended by the Healill Cdw and Education ICeconciliation Act 2CIIO, provides: 

'(I) If4 GENLP-q~.. Uothing in this .kt (or an amendment made by kh14 Act) shall bp construed tn require that an 

rndividusl termimtc cowrage udc~ a pup health plan or health iruurancr! coverage in wkich such 

mdividual ws enrolled on the date cli enectmpnt of chis Art. 

(2) UNT~NUATI~ +h C)F C3VEKAC.C. Except as provided in paragraph (31, with respwt to a group heallh plan or 

health insurance covcrclge tn which rm indkidual WRF enroIlcJ, on the dilk of ena~imunt uf this Act, lhls 

subtitle and subtitle A (and thp amet~dments nude by such subbtles) ha11 nut applv tc such plan or 

coveraw, regardlws nt wheher th~ indi+-idml renpws such cawmge dkr ntrrh dak of Pnahacnt. 

(3) APPLICAT~ON ilFC-ERTAIN PRilVISIDNS. The provisions of sections 2T15 and 2718 of the Public Health Srrvices 

Act (as addd by subtitIc 4) shall ~pply to pncltalhered health plans for ph~ years kghdng nn or al~er 

Ult! date of enactment nf this Act. 

(4) AWLICATION CF CERTAIN PR;'VISIi IKS. 

(A) IN (.E~TEKP,L. me following provisiuns of the Publir Heal'& Scrvic~s Act addd h tide) sl~dll 

apply to grandfathered health plans lor plan years beginning with the first plan yrar to FV ttich such 

prvvlslnns wouW otbewisc upply: 

(1) !kc tiun 271W (il~ubc relating to CAC~SSIVP wailing penoris). 

(ii) Thm~ prn~;isiuns nf 2711 rclutin~ to lifcti111r limits. 

(iii) Section 271 2 {reIaling to r~srissions). 

(1 PR~VEIONS C6X-l<lbkD. Those provisions of section 2711 relating tu annual limit^ and the pruvisrnns 

uf s~t'ti011 2704 (rrlating pre-rhisthe, rundihon eexslusions) of ihe ltluh\ic Health 9nrices Act (as 

added by this subtitle) shall apply to griu-rdfather~d health pIans that are group health plans for 

plan years hgtnning n) ~th th~ first ylm year to wluch such prurbions ntherwat: apply 

(i?) AI )LILT CI IILD )vEBAGE. For plan yeclrs bglim* bpfnr~ Jailllary I, 311 4, thc provtsio~~s uf 3ection 

1714 ot the Public Health Sccvrces .Art (as added by this subtitle) shall ~FFI~ in the case of an add 

child with rpspect 10 a grandfatkrud health plan that is a group health pIan only rf qurh adult child 

ss eligible LO rslrull in an vligble ~mp!qc.r-sponsored health plan (as JefinPd in sccbun 5(XDA(1)(2i 

d the Internal Rcvenue C-ode ol' 1986) 0th th such grandfathered heaIlh plan." 
[i]n the case uf heaIth insurance coveragc ~naintained pursuant tu onc or more 

coIlcctivr bargaining agre~rnents ... that was ratified before the date nf 

mat-tment of this Act [March 23, 20101, hc pmvisbns of this subtitle [subtitle C] 

dnd subtitle A (and the amendments made by such subtitles) shall not applv 

until the dale un which the last d Lhe coIlcctive bargaining agre~ments relating 

tu the coverage terminates.. . . 

B. Inlerpretatinns ig the 1Flis; Analysis 

Section IT, E of the IFlb dating to status as a grmdfath~red health plan seizes a 

pa hcu1ar passage of the statutory hguage noted directly above, specifira l ly the tcrm "hcalth 

insura~~ce uoverage," to conclude that brca~ise the statutory language fails to refer to a "pup 

I-lealth plan," the exccptinn in PPAC:A $1251 (d) appli~s: ". . . only to insured pbns lmir~tained 

pursuant tu a coll~tive barpining agreement and not to self-insured plans." This saw 

analysis is reflected in the ~i~a.partment of Labors proposed regulatim, specifically, 29 C.F.R. 

52590. TI %I251 (f) (1). 

While u7c agree that the definition of heaIth insurance coverage (through PPACA 

S1302(%)(2) and section 2791Ib) of the Public Health Service Act, 42 U.5.C. §300gg-91(b)), 

governs coveragp offered by a health insurance issuer (which IS generally an inswaiwr 

cnmpany and not a group health plan), the Department uf Lah>rfs interpretation of PPACA 

91251(6) essmkia!ly ignores the conrrpts: in PPAC-4 $7 251(a)(1) a r ILI (21, which permit 

individuals in group health plans and cover~d by health insurance covcraEe to maintain thc 

covcl-ap,e they have. As noted carlicr, all of Ute Coalition's member funds, whch are govcrned 

by CBhs, prcl~~ide health benefits on a self-insurd, and probably nmre prudent, basis. WP aIsct 

b&wc that the \.ask nmjority of Taft-Hartley plans throughout the United Stater which are 

governed by CBAs provide health benefits on a sclf-insured basis. As a result. nf the 

irlterprcta lion above: 

a. kl~outl few Bods of Trustees of Taft-Hartley plans which chosc to 

provide heaIth brnefits prior tu March 23, 201I1 solely thmugh a 

"heaIth insurance issuer" (i. e., an insurance company) are 

rewar Jt.d with grandfatherd hcalth plan status =ranteed 

thruugh the md of their current CB4 tern ancl 

b. the remaining maiority of Bnarris of Trustees of Taft-Hartley plans 

which chose to provide hralth benefits prior to March 23, 2010 011 

a self-funded basis initially have grandfathercd status, but are 

st~tjt.r-to all of the othcr rules of IF&, which could Taust! such 

a ~lan to hjse grandlathered status in the event a sywiiic evcnl 

occurs (c.~., those ev elits noted in 29 C.k.li. 52590.715-1.25 1 (g)). 

Such hspi~1.atc trealment, based solely on wh~ther health bencfits are provided directly thruu~h 

an insurance cornpaw or via self-insurancg, simplv defies logic and comrntm sense. Moreover, 

such an interpretation, whde admittedly viable, essentially means that the entire statutory 
exception in PPACA §125.L(d) will apply to a slrlall handful of fully-insured collectively 

bargained plans. 

AnothPr extremely serious issue is that the Department of L.aburrs interpretation runs 

cuuntcr to all prcvinus federal IrgisIation with resp~ct tu plans gvverned by CBAs. As we are 

sure y uu know, federal IlegisIation which has imposed new benefit r~quiremcnls un col1~rtiveIy 

bargained retiremen t pIans and/ or collec tidy bargained group health pIans has aIways 

included a dclayecl effective date (c.g.. ERISA, H1 MA, the Mental Health Parity and Addirlicsn 

Equiiy Act, etc.). Congress has consistently respected the fact hat finali7~d CBAs address a 

multitude of topics, including wagcs and bencfits, at a set point in time, atd that when new 

teb$slation imposes additional mandates the cullective bargaining parties need time to amIyzc 

thc changes and then negotiate with respect to th13~ mandates. '1t is m~realistic and ex~ernely 

burdensome tu change the ruIcs which apply to coLlectively bargained group healtfl pIans 

without giving them sufficient time to mnsider: (i) how, md whether iL is evcn possible, to 

comply with Ihe additional mandates bascd on currcnt employment, wage and bencfi t levels, 

and (ti) other ways to pay for the additional mandates. IVe sitlcereIy and stronp,ly doubt that 

Congress would have intendcd the exception in PFACA §1251(d) to be so limited without 

cxtentlrd dsbate and discussiun on tho t point. 

Moreover, ignoring this "black letter" ruIe means that self-insured group health plans 

maintained under CBAs are Ieft to scramblc to cumpIy with the provisions of the PPACA with 

Iittlc or nu timc tn spare (as sume of th~ PP.4CA's provisiuns apply tn grandfath~red health 

plans beping with plan years cnmencin~ on ad afier Septcrnber 23, 2010). For sl~ch a 

group health pIm that is maintained under a single mllectivc bargaining agreemat, it may be 

possible for the bargaining partics to negotrate over thc costs and requirements of the PPACA, 

but for those group health plans which have multiple bargaining agreements jsoine into the 

hundreds!) each agrccn~mt would have to b~ bargained and coordinated separately. As nr~ 

example, the Coalilion is aware of a particular Cm-lecticut don which mmpleted its collective 

lsargaining agreement i~~gotiations with its larepst contributing cnlpluyer in early Marrh uf 

2010. prior to thc adop tion of the PPACA. Under tl~a l coIlectiv~ bargaining ngreemenl, a group 

health plan is maintained which provides health benefits on a sell-iusured basis. While this 

group health pian providcs coverage fnr full-hme mmployces, it also provides coverage for 

eligible part-lim ernplclyet.~, subject to specific slnnud linl its. With the passage nf the PPACA 

and the impact of these IFRs, the collective bargaining parties are forced to either renegotiate an 

agreement wh irh they just cornplctcd five monll~s agu, or siwicantly cut back or eLiminatc the 

coverage Inr part-time rmployces so as to comply with other intcrim hal mIes whch apply to 

grandfathered health ph with respect tc~ lifetime and annual limits. In short, such a plan is 

essentially [eft in a no-win situation, rtnd ~e entire XegaI structure of the plan of benefits is now 

in j~opardy. The Coalition will comment further on this plan in paragraph 3, below. 

Without providjng much substantive analysis, Sectiun IT, E of the lFRs r~lating to sta~us 

as a panclfathered health plan also conclucies hat, ". .. coUertively barp;ained plans (kwh 

insured and self-insurcd) [hat are grandfathercd plans arc subject to the same requu~ments as 

other grandfathered health plans, and are not prcrvided with a d~tayed effeuhvc datc for PIlS 

Act provisions with which other ganrifatheretl health plans must mmply ." l'l~r Departn~ptlt 
reachrq this conclusivn dcspite the lartguage of PPACA $IZ5l(d) which provides, "... the 

provisions of this subtitle [subtitle C] and subtitle A (and the amendments made by such 

subtitles) +&all not n pIv unliI the datc on which the last of the collective- bargaiqin~ aneemen - ts 

relaha - to coyeraEe terminates.. ." (err~phasis added). 

WhiIc this is a very complicated issup, we bcli~ve the Departrrlcnt of Labor has 

comlud~rl Lhdt the exception m I'PACA §I251 (d) is very limited, in that it only provides an 

insured colIectivel): bargained plan with "grandfa thrred hcahh plan" stabs through the cnll vi 

its CBA. such a rub is reflected in the propused regulation, 29 C.F.R. 52590.715-125Z(f)(I). 

However, the sp~-ific language of PPACA g1251(d) appears tn ~rovidc insured plans which are 

maintained pursuant to cuuectiv~ bargaining agreemellts with a rom~letc exemption from the 

rules of PPACr' suhtit'Ies C and A until the datc the applicable CBA expires. Tlie De~arbl~nt 

shouId clarify how it reached this conclusion in Iight uf the PPACAis express statutory 

language, 

In cortncctinn with our curnmcnts in paragrdplw Z and this paragraph 2, tl~e Coalition 

respec-tCully requests thal the Department modify the IFlis in light of the issues discussed to 

provid~ a c:umplcte exemption from tl~c rules uf PPACA sub tles C and A fur ~oll~ctively 

bar~ained group health pIans (both insured and self-insured) until the date on which the last of 

the CBAs relating to roverage urlcler the appl icable grnup health plan terminates. Such a result 

would be fair and equitable, md wouId be in he with the long-establ ished policy to provide 

collectively bargained plans with a delayed el iective date. 

1 

,7 . In firaction befz~wn thr IFIi s governing grrandfntltrrurrd sintits rtnd tlmw 

gownring nrtrr~firl lami Ziptimr limits. 

T11e Coalition aIso wishes lo cummcnt on the IF% which were issucd nn June 28, 2010, 

particularly those prr~visions governing lifrtrmc and annual limits. 'I'hew IFRs general9 

prohibit group health plans from imposing Zifelhe or annual limits on the dollar value of 

certain "essential health benefits." Essential 11 ealth bcrwfits are defir~rcl in PPACA 513U2(b), .and 

they include emergency services, hospitalization and prescription drugs, to name just a few. 

These rules r~strictinp, lifetimc and annual limits apply tu gr;roup health plans (whether or not 

such plan qualifies as a grandfatheteed health plan) fcr plan years Lwginninp; on or after 

September 2.1, 2010, although wc du acknrmldge that the proposed rcplation, 29 C.F.R. 

$25c)0.715-27lI, has a "trancii tiun period" for annual limits in plan years prior to January 1, 2011. 

Here is a simplc chart wluch ci-or~tains permitted annuill but "flcrors" during the tra~wition 

pcriod: 

- --- \-~-able Plan Y rar T>r-=nnual limit " fl nnr" old 

essential health . benrfits 

bcginnG on nr after $750,000 

September 2.7, 2010, hut before I 

on -- nr -t after $1,250,000 i 

Sptember 23; 2~17, but bcforp 

tember =, 2022 
mm - 

I S~pkmbcr 

Yrdr beginning 

23, 2012, 

on 

but 

or 

befcae I 

$2,000,000 1 

I [ January 1,2011 1 -- I 

Sp~cifir-ally, the Coalition behcves that the operation of [he IFRs guverning 

grandtathered hhlth plan% and those govcnring lifchnr md annual lrnl~h, whcn taken 

Logether, wilI operate to cripple wlf-insured group health phs maintained pursuant trr CBAs 

whcl~: (i) provide different tiers of coverage to part-timc employees and full-time employees. 

and/ ur (ii) cover employees in low-wage industries. We note that these IFRs are silent un th~ 

issue of coveragc for art-hlr ~mploy~rs, and while the trar~sition period for annual llmits is 

certainly helpful, the IFRs do not ser~vuslv consider the impact these new rl11t.3 wlll have on 

group hpdllh plans maintained pursuant ~~CBAS. Even though most employers do not provide 

hcahh to part-time Ur low-wage employees, a significant number of sclf-insured gruup 

health plam maintained pursuant to CBAs do. As you would expcct, the level of bencflts 

provided under such group health plans to eligiblc pad-timc or low-w~ge employees is 

commensurate with the contribution lcvd required under the reIevanl CBA, and are oftm 

subjec? to rcduced annual and lifetime Limits. 

While the Coalition absolutely dgrees with the goal ot providing quaIi@ md afford~ble 

health carp fur all Americans, the Department must acknowledge tho t it is unrealistic and 

highly impractical for sell-in~ured group health phs n~aintaincd pursuant to CBAs which 

provide coverage to part-time ~JJLIT low-tsragt. employees to put in plac-P a minimum Duor of 

$750,0011 fur esserl tial health benefits for the plan year commencing on ur aftcr Seytembcr 23, 

2010 (or for subsequcnl plan ycars as well). ~he'cmli ti4 m sincerely doubh that any r urrrnt 

level nl cvntributions under a CBA for a part-time or low-wage en~ployee cotrId support a 

minimum floor of $750,(100 for essential health benefits or the rising flwrs In lctter years. 

As a concrete ~xample, co~~siiler thc same plan as u~entioned in subsection 0, 1, abuve 

(which is a self-insured group health plan mait~iained pursuant to CBAs which provides 

diff~rmt tiers uf covcragc for full-time cmpluyees and part-time amplnyees). It is our 

undcrstianding that the plan of benefits provided to the part-time employees has an annual limit 

on "csscntial health h~~efits" which will not comply with the $750,000 floor lor the plan year 

commencing on or after Feptemher 23, 201 0, but before September 23, 2111 1 . Accordingly, Uic 

plan is inuncdia ttlly faced with a choice uf either vic~latmg T'PACA 5271 1, and through it, EIIISA 

(by Ieaving the plan as it is and not providing the minimum annual limit el $750,00Q) taking 

action su as to lnse its status as a grandfathered h~aIth plan (i.e., as to part-time employecs, by 

~liminatinp, coveragp or specific b~nefits to mi tigate c~sts).~ For a CoaLitivn r I ember fund such 

as ths which has a calendar year plan yrar, such dvcisions need to hr made nn later than 

Tanuar~~ 1, 21)12, irresywtivt. of thc terms of that plan's. CHAs. With little or no time to bargain 

over the plan of benefits offered to thc part-time employecs, and the clear cost of eliminating 

any annual lirrut on part-time employ yes prohibitive, the Cualition expects the ultimate result 

will be this plal-L eliminating c70veragc for ~wt-tim~ ernploye.~~. Sucl~ a result will also 

sipificmtly undermine tl~e plan's abilily to provide quality f~ealth care htlnefits to its full-time 

- 

j Sinc~ this plan is self-insurcd and does not utiIiz~ "health insurance coverage' (i.e., the Department of Lahnr 

has r unclud~d that PPAC: 4 51251!J) wrwld t~ot apply) it can only mi~tilin its grandfathered healh plan 

status if ~t conlpli~s with the general grandfathering rules ot 29 C.F.R. §25%1.715-1251(g). 
members. The Coalition does acknowledgr here that there is "waiver" authority with respect to 

~CSP mual limits for pIan years bepning bcfore January 1, 2014 under 29 C.F.R. 52590.715- 

271 1 (d)(9), Eu t regulations irnplemenkg this waiver pocess have no 1 been lssurd and time is 

running dangerousIy short. 

Another important point to nlention is that tile state "exchanges" required by the 

PPACA will not be coming un-line until 2014 (per PPACA $1321(b)). 7'herefore, the Coalition 

expects these and other similar part-tim~ and low-wagc ~trnployces ku Iosc the hdth c-overage 

they have, & such employees will have nn other health coverage optiuns. Faced with the 

option of such employees having some level of health coverage, as opposed to nu hcallh 

coverage, the Department should respect the previous decisions of such group health plans, 

their Boards of Trustees, and their professionals, and pcrn~t them to retain anv annual andb 

lifetime limits thev had in effect as of the dat~ nf issuance of hs IFR (Junr 28,2010) throu~h the 

date the state exchanges are up and runnin9; in 2014. Such a decision wdl, at the wry least 

alluw such prt-time and low-wagc ernplayces tu maintain some health care covcragt. until tiley 

hvr other PPACA-mandated health coverage choicrs avdahlc te thp~n. It will also be keeping 

with President Obatna's ~ron~se to let employees keep the covcrage they have. 

FiuaUp. the CoaIition respectfully requests that the Dcpar bent t~~udify these lFRs lor 

self-insured group health plans maintained pursuant to collective bargaining ap~rments 

which: (i) providc differcnl tiers of coverage to part-time employees and full-time employees, 

and/or (iij cover employees in low-wage industries, and pcrmit such plaw tu retain any mud 

andlor lif~he limits they hati in cffwtc't as of lune 28,2010 through the date the stale rxrhanges 

mandated by thu PPAACA ire up and nuuring in 2014.4 

III. Conclusion 

We hope these comments and the abov~ ~warnple pruvidc some insight to the issues and 

ditliculties faced by Coalition member funds (and other self-insured group health plan5 which 

Are maintained pu rsusmt to CBAs) in connection wlth th~ IFRs governing grandfathered health 

plans, as well as those governing lifetime and annrral limits. If you have any yuestions, vou 

may con tact me at 860-249-6200. 

THE CCJNNECl'ICUT COALITTON 

7 

RoJZFFessie r, Executive Director 

-- 

4 While tIlc Departmciil could cerhu~ly utilize its disrMon tu grant expedit~d and liberal waivcrs to such 

self-lnsur~d group health pbns under 29 C.I:.R. ~2590,?1527Il(d)(3), th~ Coatitinn lwlievm an cx~ress 

modifirotiu~~ tn du IFRs wilf be uiure efticiink.