Health Care Reform Grandfather Regulations – Costs Associated with Loss of Status

An unofficial draft version of the highly-anticipated, much-needed regulations on grandfather status under Health Care Reform has been circulating this week. The White House has said this document should not be relied upon, and we will wait to comment until the regulations are released in their official form.

Since we know the regulations will be released imminently, now is a great time to discuss the costs associated with loss of grandfather status. The provisions of the Affordable Care Act that will apply to non-grandfathered plans (and will not apply to plans that maintain grandfather status) include:

1. Adult child (under age 26) coverage if the child is not covered in another employer-based plan (not counting parents’), until January 2014.
2. Preventive services – first-dollar coverage.
3. Patient protections (designation of PCP, certain emergency service rights, no pre-authorization or referral for OB-GYN services, others).
4. Essential health benefits (yet to be defined) required to be covered.
5. New claims appeal procedures.
6. Non-discrimination requirements (already in effect for self-insured plans, now extended to insured plans).
7. Non-discrimination based on health status, provider.
8. Participation in clinical trials.