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AUG 2 6~/", 

LEGAL PROCESSING DIVISION 


PUBLICATION &.REGULATIONS 


BRANCH 
 As of: August 26, 2010 

Received: August 10,2010 

Status: Posted 

Posted: August 26, 2010 

Tracking No. 80b2d316 

PUBLIC 

SUBMISSION Comments Due: August 16, .2010 

Submission Type: Web 

Docket: IRS-2010-00l0 

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-2010-0010-0001 

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-0442 


Comment on FR Doc # 2010-14488 


Submitter Information 

-------------------------------------------------------------,---­

General Comment 

See attached Word document. 

Attachments 

IRS-2010-0010-0442.1: Comment on FR Doc # 2010-14488 

https:1Ifdms.erulemaking.netlfdms-web-agency Icomponentlsubmitter InfoCoverPage?Call =... 8/2612010 
Additional Comments Regarding Section 1251 of the Public Health Service Act Prior to Rule-making 


Submitted to the Department of Health and Human Services, Department of Treasury, and 


Department of Labor 


Submitted by a FL-based Health Plan 


Through the Federal eRulemaking Portal 


Brief Background on Submitting Health Plan 

The health plan making this submission is a FL-based Health Maintenance Organization with over 40,000 

covered lives. Its large group and individual products are impacted by the health reform act changes. 

The preponderance of its covered lives is individual policyholders. Many of the benefit designs of the 

insurer are individual products with very low monthly premiums to attract individuals with very limited 

means who would otherwise be uninsured as they exceed Federal Poverty Income Thresholds for 

government programs. For example our comprehensive HMO coverage for children product is SE!t as 

$75 per month per child. Our other individual comprehensive HMO coverage begins at $90 per month 

per individual. 

Transition individuals 

Previously in a comment submission we stated: "We are seeking clarification surrounding individuals 

who enrolled in individual policies post 3/23/10 but before 9/23/10. As we understand the rules 

surrounding these individuals (tltransition individuals"), they are not grandfathered but also do not get 

the benefits of the changes in PPACA until their anniversary date in 2011. We assume they can rE'main 

in a grandfathered policy until their anniversary date in 2011 because no mandates apply until them and 

the essential benefits do not kick in until 2014. We would then move them to a fully compliant nongrandfathered plan. As long as we track these individuals, does this comply with the intent of PPt'CA 

and the regulations?" 

We wanted to add additional comments regarding this group of individuals: 

Beginning on their anniversary date in 2011, these transition individuals will have to move to non.. 

grandfathered plans and face much greater premiums in many cases. For example, the premium for a 

child may be below $100 on average for a grandfathered plan. But because of the new mandates 

regarding guaranteed issue and pre-existing conditions that apply as of 9/23/10, child rates in non.­

grandfathered plans could be between $200 and $300. This could mean many people who decided to 

get coverage recently might not be able to afford coverage in 2011 and drop it because of the transition 

from grandfathered to non-grandfathered contracts. 

We think the departments should allow individuals covered after 3/23/10 but before 9/23/10 to choose 

whether to stay on a grandfathered plan permanently or move to non-grandfathered status. If that is 

not possible, we believe the departments should allow these transition individuals to at least stay in the 

grandfathered plan until subsidies are introduced in 2014. 
Additional Comments Regarding Section 1251 of the Public Health Service Act Prior to Rule-n1aking 

Submitted to the Department of Health and Human Services, Department of Treasury, and 


Department of Labor 


Submitted by a FL-based Health Plan 


Through the Federal eRulemaking Portal 


Brief Background on Submitting Health Plan 

The health plan making this submission is a FL-based Health Maintenance Organization with over 40,000 

covered lives. Its large group and individual products are impacted by the health reform act changes. 

The preponderance of its covered lives is individual policyholders. Many of the benefit designs of the 

insurer are individual products with very low monthly premiums to attract individuals with very limited 

means who would otherwise be uninsured as they exceed Federal Poverty Income Thresholds for 

government programs. For example our comprehensive HMO coverage for children product is SE!t as 

$75 per month per child. Our other individual comprehensive HMO coverage begins at $90 per month 

per individual. 

Transition individuals 

Previously in a comment submission we stated: "We are seeking clarification surrounding individuals 

who enrolled in individual policies post 3/23/10 but before 9/23/10. As we understand the rules 

surrounding these individuals ("transition individuals"), they are not grandfathered but also do not get 

the benefits of the changes in PPACA until their anniversary date in 2011. We assume they can mmain 

in a grandfathered policy until their anniversary date in 2011 because no mandates apply until then and 

the essential benefits do not kick in until 2014. We would then move them to a fully compliant m>ngrandfathered plan. As long as we track these individuals, does this comply with the intent of PPj~CA 

and the regulations?" 

We wanted to add additional comments regarding this group of individuals: 

Beginning on their anniversary date in 2011, these transition individuals will have to move to nongrandfathered plans and face much greater premiums in many cases. For example, the premium for a 

child may be below $100 on average for a grandfathered plan. But because of the new mandates 

regarding guaranteed issue and pre-existing conditions that apply as of 9/23/10, child rates in nOI1­

grandfathered plans could be between $200 and $300. This could mean many people who decidE!d to 

get coverage recently might not be able to afford coverage in 2011 and drop it because of the tralsition 

from grandfathered to non-grandfathered contracts. 

We think the departments should allow individuals covered after 3/23/10 but before 9/23/10 to choose 

whether to stay on a grandfathered plan permanently or move to non-grandfathered status. If that is 

not possible, we believe the departments should allow these transition individuals to at least stay in the 

grandfathered plan until subsidies are introduced in 2014.