https://fdms.erulemaking.net/...y/component/submitterInfoCoverPage?Call=Print&PrintId=0900006480b2f7f0&Comment=true[8/13/2010 4:01:15 PM]

PUBLIC SUBMISSION

As of: August 13, 2010

Received: August 13, 2010

Status: Pending_Post

Tracking No. 80b2f7f0

Comments Due: August 16, 2010

Submission Type: Web

Docket: HHS-OS-2010-0015

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

Comment On: HHS-OS-2010-0015-0001

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: HHS-OS-2010-0015-DRAFT-0041

Comment on FR Doc # 2010-14488

Submitter Information

Name: Mary Burns

Organization: NYS Insurance Department

General Comment

On behalf of the NYS Insurance Department, comments on the Grandfathering interim final rules are attached.

Attachments

HHS-OS-2010-0015-DRAFT-0041.1: Comment on FR Doc # 2010-14488
Comments for HHS on its Interim Final Rules relating to status as a 

Grandfathered Health Plan 

File Code 0C110 – 9991 - IFC 

1) It is unclear from the Interim Final Rules as to whether the rules are applicable to 

categories of groups in addition to employer groups such as associations. We favor 

uniformity in the group market and suggest that the rules be extended to all categories of 

recognized groups. 

2) In addition to group and individual insurance, a number of states (including NY), have 

another category of health insurance known as blanket insurance. It is very similar to 

group insurance, however, it constitutes its own separate category. It is unclear from the 

Interim Final Rules as to whether the rules are applicable to blanket insurance. We favor 

uniformity in the health insurance market and suggest that the rules pertaining to group 

insurance be extended to also apply to blanket insurance. 

3) We note that the Interim Final Rules did not address some issues related to enrollment 

in a grandfathered plan. We suggest that the rules clarify the following: 

 Allowance for Family Members- - § 1251(b) of PPACA and 45 CFR 147.140 

(a)(4) use the undefined term “Family Member.” A number of states (including 

NY), have statutes and regulations that include several categories of dependents. 

For example, New York recognizes adopted children and stepchildren dependent 

upon the insured as eligible dependents. New York also recognizes same-sex 

spouses and domestic partners as eligible dependents. Are these categories of 

dependents to be included as part of the allowance for family members? 

 Allowance for New Employees to Join Current Plan- § 1251(c) of PPACA and 

45 CFR 147.140 (b) permit new employees to join a grandfathered plan. A 

number of states (including NY), recognize categories of groups in addition to 

employer groups such as associations. Would the federal law and regulation 

permit a new association member or other non-employer group member to join a 

current grandfathered plan? 

4) In the case where a health insurance issuer discontinues a class of policies in 

accordance with the permissible bases for non-renewal set forth in HIPAA, is the 

replacement policy eligible for grandfathering status?