rnI DAVISBRO\VN 
 LAW FIRM 

REPLY TO DES MoINES OFFICE 

August 11,2010 

VIA OVERNIGHT MAIL 

Office of Consumer Information & insurance Oversight 

Department of Health & Human Services 

Attention: OCIIO-9991-IFC 

Mail Stop C4-26-05 

7500 Security Blvd 

Baltimore, MD 21244-1850 

Re: OCnO-9991-IFC 

Comments to Interim Final Rules for Group Health Plans & 

Health Insurance Coverage Relating to Status as a Grandfathered 

Plan Under the Patient Protection & Affordable Care Act 

We represent the Iowa Bankers Benefit Plan, a self-insured multiple employer 

welfare arrangement ("MEWA") that provides health benefits to employees 

of Iowa banks and related organizations (the "Plan"). On behalf of the Plan, 

we appreciate the opportunity to comment on the Interim Final Rules 

regarding grandfathered plans under the Patient Protection & Affordable Care 

Act. 

Established in 1978, the Plan has provided affordable health insurance to 

Iowans for over thirty years. The Plan currently has 418 participating 

employers and insures approximately 26,000 participants. The Plan's unique 

structure allows it to offer participating employers a choice of seven different 

benefit plans at extremely competitive rates. As a self-insured MEW A and 

tax-exempt VEBA, Plan participants are protected by a number of federal and 

state law protections, including restrictions on administrative fees and state 

benefit mandates. The Plan is subject to the regulatory oversight of the Iowa 

Insurance Commissioner, the United States Department of Labor and the 

Internal Revenue Service. 

As a self-insured MEW A, the Plan is responsible for implementing the 

provisions of the Patient Protection & Affordable Care Act. Since some of 

these provisions do not apply to grandfathered plims, the determination of 

#1873735 

DAVIS BROWN KOEHN SHORS &. ROBERTS PC. 

John D. Shors 

Stephen W. Roherts 

William R. King 

Rohert F. Hoi>, Jr. 

Rohert A. Gamble 

Michael G. Kulik 

Frank 1 Carroll 

Bruce 1. Camphell 

Jonathan C Wilflon 

Steven L. Nelson 

David B. VanSickel 

Gene R, La Suer 

Deborah M. Tharnish 

Kent A. Herink 

Robert J. Douglas. Jr. 

Mark 0 W.I, 

Gary M. Myers 

Stanley J. Thompson 

D.vid M. Erickson 

Lori Torgerson Chesser 

Jo Ellen Whitney 

Becky S. Knu,son 

Julie Johnson Mclean 

Beverly Evans 

Margaret Van UOulen 

Thomas E Stanberry 

Christopher p, Jannes 

Sharon K. Malheim 

Kris Holub Tilley 

Wilham A. Boatwrighl 

Thomas J, Houser 

Kendall R. Walkins 

Scott M. Brennan 

William E. Hanigan 

Debra Rectenbaugh Pe1iit 

Matlhcw E. Laughlin 

Judilh R Lynn B6es 

William P Kelly 

Susan J. Freed 

lason M, Ross 

Jason M. Stone 

Amy M. Landwehr 

John C. Pie'il. 

Emily E. Harri. 

S. J. Miller 

lodie Clark McDougal 

Jeffrey D, Ewold, 

10hn S. Long 

Tara Z. Hall 

Charles N. Willmack 

Courtney 81rull Todd 

Kelly A. Delers 

Nichole Mira!' Mordini 

Kryslle L Campa 

S.rah K Franklin 

Victoria p, Nwasike 

M. Michelle Lickteig 

Christopher E lames 

Rohert W. Dixon 

Mark D. Wickham 

Christopher S. Talcon 

Samuel P Langhol, 

Elizabeth R, Meyer 

Michele L. Warnock 

Intellectual Property 

Kent A. Herink 

Emily E. Harris 

OfCounsel 

Jeffrey A, Baker 

Donald J. BroW11 

Denise R. elaton 

c. Carl.,on Frederiei 

A. 1. Greff.nius 

Dennis D. Jerde 

William J. Koehn 

Siephen M. Morarn 

Joseph M, Pawlosky 

Richard E. Ramsay 

Thomas E Salsbery Neal Smith . 

William D. Thomas 

A, Arthur Davis 


1928.1997 

Office ofConsumer Information & insurance Oversight 

Department of Health & Human Services 

Attention: OCIIO-9991-IFC 

Mail Stop C4-26-05 

7500 Security Blvd 

Baltimore, MD 21244-1850 

August 11,2010 

Page 2 

whether the Plan's benefit packages are "grandfathered" is extremely important to the Plan's 

continued compliance with federal law. We are concerned by the Interim Final Rules' failure to 

address how the grandfathered plan rules apply to MEW As. Specifically, we believe the Rules 

must address the issues outlined below. 

1. Employer Contribution Levels. It is unclear in the Interim Final Rules how one 

employer's decrease of contribution levels would impact the Plan and the other participating 

employers. If one employer decreases its contributions toward employee premiums by more 

than the allowe~ percentage to maintain grandfathered status, how is the Plan affected? Is the 

Plan required to offer that employer a non-grandfathered benefit plan package? Does that 

employer's conduct impact the grandfathered status ora benefit plan package made available to 

other participating employers in the Plan? What ifthe employer fails to disclose to the Plan that 

the employer has significantly decreased its contributions toward employee premiums? Who is 

ultimately liable for the failure to comply with the Affordable Care Act provisions applicable to 

non-grandfathered plans? 

2. Changing or Adding Benefit Packages. The Plan currently offers seven benefit 

packages. It is not uncommon for a participating employer to change the benefit packages it 

offers to employees or add a new benefit package. It is unclear in the Interim Final Rules how an 

employer's addition of a benefit package or changing benefit packages would impact the Plan 

and other participating employers. If an employer wants to add a new benefit package, does that 

jeopardize the Plan's grandfathered status or the grandfathered status of that benefit package? 

Because it's a new benefit package for the employer, is that benefit package considered a "nongrandfathered plan" that must comply with the Affordable Care Act provisions applicable to 

non-grandfathered plans? Ifthe employer completely changes the benefit packages it offers, 

how does that impact the Plan, that employer and the other participating employers? 

3. New Employers. Each year the Plan has new employers enrolling in the Plan. It 

is unclear in the Interim Final Rules how a new employer will impact the Plan or how the Interim 

Final Rules will apply to this new employer. The Interim Final Rules state that a change in 

carriers will result in a loss of grandfathered status. If an employer leaves its carrier to join the 

Plan, must that employer be offered a non-grandfathered benefit package? How does the addition 

of a new employer impact the Plan and the other participating employers? 

4. Plan Year. The effective date of many of the Affordable Care Act's provisions is 

tied to the plan year. To date, neither the Interim Final Rules nor any of the other rules 

promulgated in response to the Affordable Care Act have addressed the determination ofthe plan 

year in the context of a MEW A. We believe the plan year should be the plan year ofthe MEWA 
Office ofConsumer Information & insurance Oversight 

Department ofHealth & Human Services 

Attention: OCIIO-9991-IFC 

Mail Stop C4-26-05 

7500 Security Blvd 

Baltimore, MD 21244-1850 

August 11,2010 

Page 3 

as indicated in its plan document and reported in its annual reports. We believe this needs to be 

clarified, however, as participating employers in a MEWA may file a Form 5500 and report a 

different plan year. 

The failure ofthe Interim Final Rules to address MEWAs is extremely problematic as it 

forces the Plan and other MEWAs to either forfeit their grandfathered status immediately or to 

freeze the Plan completely allowing no employer changes to contribution levels or benefit 

packages and denying enrollment to new employers. We urge Health & Human Services, the 

Department of Labor and the Department ofTreasury to address MEWAs in the Final Rules and 

how the grandfather rules apply to them. 

Thank you for the opportunity to comment on this important issue. 

Very truly yours, 

DAVIS, BROWN, KOEHN, SHORS & ROBERTS, P.C. 

~~-1.~Jl Susan J. Freed