Provision
SEC. 1251
(a) NO CHANGES TO EXISTING COVERAGE.-
(1) IN GENERAL.-Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.
(2) CONTINUATION OF COVERAGE.-With respect to a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after such date of enactment.
(b) ALLOWANCE FOR FAMILY MEMBERS TO JOIN CURRENT COVERAGE.-
With respect to a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of such date of enactment.
(c) ALLOWANCE FOR NEW EMPLOYEES TO JOIN CURRENT PLAN.-
A group health plan that provides coverage on the date of enactment of this Act may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families).
(d) EFFECT ON COLLECTIVE BARGAINING AGREEMENTS.-In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before the date of enactment of this Act, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collective bargaining agreement.
(e) DEFINITION.-In this title, the term ”grandfathered health plan” means any group health plan or health insurance coverage to which this section applies.
Summary
This provision and its revision in the Reconciliation Act (see Section 2301) states that with few exceptions, an individual can maintain their existing coverage (individual is not required to terminate coverage under a group health plan or health insurance coverage). According to an NAIC Consumer group report, “grandfathered plans are exempt from many insurance market reforms and benefits, with the exception of a few specific reforms enumerated in PPACA and the Health Care Education Reconciliation Act of 2010 (HCERA)”.  The “grandfathering principles” section of the “Consumer Recommendations for Regulators and Law Makers,” (written by the NAIC Consumer group) outlines which sections of the new law will impact existing “grandfathered” plans.  Grandfathered (existing) plans must comply with many of the provisions, but not all provisions will apply.Â
What does this mean for the bleeding disorders community?
If you have an existing plan, some of the insurance market reforms will not apply to your plan.   As noted in the Consumer Recommendations for Regulators and Law Makers,” chart on page 19, restrictions to annual limits (individual coverage), preventative health benefits with no cost sharing, and prohibition on coverage discrimination, among other things will not apply to existing plans. The lack of compliance for certain provisions, could potentially pose problems for people with existing plans, especially if benefits such as “strengthened internal and external appeals process” do not apply. The chart, however, highlights the provisions that apply to grandfathered plans.
