Wednesday, June 30, 2010

Grandpas and Teeth

Well, "grandfathering," anyway. A recent Anthem email included their take on how plans may remain eligible under ObamaCare©:

■ "In general, a group health plan or group or individual health insurance coverage is considered "grandfathered" if it had members enrolled before March 23, 2010 ... [but] new policies sold in the group or individual market after March 23, 2010, are not grandfathered, even if the product was offered before March 23, 2010."

Ooops. Better hope your group plan was in place in March. All you new businesses, though (and there probably were some, despite the dismal Obaconomy), are outta luck:

■ "If a plan made changes before the interim final rules ... those changes would impact the plan's grandfathered status, the plan has a grace period within which it can revoke or modify these changes to maintain its grandfathered status."

Rotsa ruck with that: what carrier will let you go back and retroactively change your plan?

So what will trigger that dreaded "no grandfathering for YOU!" outcome?

■ "Increasing coinsurance by any amount above the level at which it was set on March 23, 2010"

So if your employer raised the group plan's co-insurance limits to offset the last renewal, or you did that with your individual plan, then you're SOL. And this may be a bigger problem than you think: how many employers tweaked their plans this way before they had a clue that this would screw them up going forward? There's also a litany of other plan changes, based on obscure formulae that could only come from Poppa Washington, that could trip you up.

The bottom line is: Most folks won't be able to keep the plan they have.

Of course, medical insurance is only one piece of the benefits pie. A lot of employers also offer dental coverage, which is not subject to the draconian provisions we've been discussing. In Ohio (and other states), new rules have been promulgated for the gorup health market to make sure everyone's on the same Obamapage. That means, for example, that your 26 year old "child" is still eligible to stay on your group health plan, but not necessarily the dental cover.

From Superior Dental Care, we learn that Ohio's "new regulation applies only to medical insurance carriers; dental is not included." [emphasis in original] So unless you're a full-time student or an "IRS dependent," you're off the dental at age 19 (although groups may choose to set that upper limit lower). It's nice to see at least one segment of the industry that refuses to cave.
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