Tuesday, August 03, 2010

ObamaCare© Changes (Pretty Much) Everything

Let's start at the top with the new "Grandfathering" provisions (which if course begs the obvious question: what about Grandma?). These make it pretty much impossible to keep the insurance that you currently have, because any changes you might like to make to it (like increasing deductibles or co-pays) will require a new set of forms:

"Starting with benefit changes being submitted Monday August 2nd [MMO is] requiring Groups and Individuals to complete the attached form and for this form to be included with the benefit change submission. MMO is requiring this form to be completed to ensure that Groups and Individuals are aware that they may lose Grandfathered status with their plan change."

And what does "Grandfathered status" mean? Well, it's the provision that renders your plan immune to the penalties and requirements of ObamaCare© except, of course, it doesn't (since you have to complete a new set of forms). This may not be a big deal for an individual, but it will be a major migraine for small groups:

"Member cost sharing for in-network preventive benefits" is removed, meaning that the plan will now have to include first dollar preventive benefits. While that may, in fact, be a good idea, it comes at a price.

As we've mentioned before, there's a whole new (and complex) "internal claims appeal and external review" process.

And just what kinds of "changes" would trigger these requirements? Here are just a few of the seemingly simple but dangerous items:

■ Increasing co-insurance (thinking about an HSA plan? Fuggedaboutit!)

■ Increasing employees' share of the premium (looking to cut some costs by asking folks to chip in an extra 10% means losing your status - wonder how many actual, you know, jobs will be lost due to this provision alone).

■ Changing carriers, fer Pete's sake! Perhaps the simplest, most cost-effective means to reduce premiums, and it's a no-no.

We've said it before, and will state it - unequivocally - again: this is the final nail in the employer-based health care coffin. Now, I happen to think that severing the tie between employment and health insurance is actually a good thing, but this is most assuredly not the way to do it.
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