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As of: August 25, 2010 

Page 1 of 1 

Received: August 10, 2010 PUBLIC Status: Posted

Posted: August 25, 2010 

Tracking No. 80b2d23c SUBMISSION Comments Due: August 16, :2010 

Submission Tvpe: 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-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-2010-0010-0396 

Comment on FR Doc # 2010-14488 

Submitter Information 

Name: Nancy Ruhland 

Address: 

1101 Twin C Lane 


#201 


Newark, DE, 19713 


Email: dscnancy@comcast.net 

Phone: 302-892-9355 

Organization: Diamond State Chiropractic 

General Comment 

See attached file(s) 

Attachments 

IRS-2010-0010-0396.1: Comment on FR Doc # 2010-14488 

https:llfdms.erulemaking.netlfdms-web-agency Icomponentl submitterlnfoCoverPage?Call =... 8/25/2010 
August 10, 2010 

Office ofConsumer Information and Insurance Oversight 

Department of Health and Human Services 

Attention: OCII 0-9991-IFC 

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 my 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 

Protection and Affordable Care Act (PPACA). 

I believe that every effort should be made to increase the number ofindividuals covered by 

PPACA, especially as of January 1,2014 when most of the reform components (Insuranc(: 

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

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. 

It is my opinion that the Rule may still result in some confusion to the marketplace in its 

application. For example, if an employer raised the copayment level beyond the maximum in one 

area (Le. outpatient services) but retained the copayment level for primary care doctor visits, 

does that mean a loss of grandfather status? Clarity will be critical both for the employer ,and the 

employee. 

Even by the most optimistic estimates, a substantial portion of the employee population will 

remain outside the PPACA as ofJanuary 2014 based on the current rules. While I understand the 

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

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

legislation. 

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 the federal government makes today will 

determine 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. 

Nancy Ruhland 

Office Manager, Diamond State Chiropractic, P.A. 

Newark, DE