Program Office 

One Kaiser Plaza, 27th Floor 

Oakland, CA 94612 

 Kaiser Foundation Health Plan, Inc

August 10th, 2010 

Submitted Electronically: http://ww.regulations.gov 

Office of Consumer Information and Insurance Oversight 

Department of Health and Human Services 

Attention: OCIIO-4150-IFC 

Baltimore Maryland 21244-1850 

Re: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to 

Dependent Coverage of Children to Age 26 Under the Patient Protection and Affordable Care 

Act 

Dear Sir or Madam: 

Kaiser Permanente offers the following comments in response to the above-captioned Interim 

Final Rules (“IFR”), issued in the Federal Register on May 13, 2010. Kaiser Permanente is the 

largest private integrated healthcare delivery system in the U.S., delivering health care to 

approximately 8.7 million members in nine states and the District of Columbia. Kaiser 

Permanente comprises Kaiser Foundation Health Plan, Inc., the nation’s largest not-for-profit 

health plan, and its health plan subsidiaries outside California and Hawaii; the not-for-profit 

Kaiser Foundation Hospitals which operates 36 hospitals and over 400 other clinical facilities; 

and the Permanente Medical Groups, independent physician group practices that contract with 

Kaiser Foundation Health Plan to meet the health needs of Kaiser Permanente’s members. Most 

pharmacy, diagnostic, and laboratory services delivered to Kaiser Permanente members are 

performed within Kaiser Permanente. 

Kaiser Permanente believes that the Patient Protection and Affordable Care Act (PPACA) can 

serve as an important step towards achieving universal coverage in the United States and towards 

establishing reasonable market rules that will allow plans to compete on quality and cost rather 

than on risk avoidance. The extension of dependent coverage to children under 26 years of age 

is an important component of this. Kaiser Permanente implemented that coverage earlier this 

year, well in advance of the mandate taking effect. 

Kaiser Permanente requests clarification on the rules relating to the premium that may be 

charged for dependents covered under the new rules in the individual market. In the individual 

market, as permitted in most states today, premiums for family coverage take into consideration 

the ages of the covered family members. We do not believe that the group examples in the IFR 

are intended to be construed as prohibiting consideration of age in establishing premiums in the 
Office of Consumer Information and Insurance Oversight 

August 10th, 2010 

Page 2 

individual market, so long as no “surcharge” is imposed on dependents older than 18, and so 

long as a young adult enrolling during the special enrollment period provided for under the IFR 

is not required to pay more than a similarly situated individual who did not have coverage 

because of the cessation or prior unavailability of dependent status. We urge the Secretary to 

clarify that carriers be permitted to rate dependents enrolled through the individual market in a 

manner consistent with existing state law and the protections identified in this paragraph. 

We appreciate the opportunity to comment on this IFR. If you have questions or concerns, please 

contact me at 510.271.6835 (email: anthony.barrueta@kp.org). 

 

Sincerely, 

Anthony Barrueta 

Senior Vice President, Government Relations