Health Care Reform (HCR)
As Applicable to Employer Sponsored Group Health Plans
The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act, collectively referred to as the Affordable Care Act (ACA), were enacted in March 2010. They provide for a number of changes for group health plans. The Departments of Labor, Health and Human Services and the Treasury have been issuing regulations in several phases to implement the new law.
ACA allows employer sponsored group health plans that were in existence on March 23, 2010 to declare their plan as “Grandfathered”. This simply means that some of the mandates of the ACA will not have to be implemented at their due dates, but rather at later dates. The Chart below lists the mandates and implementation dates. Those that are “grayed out” do not apply to grandfathered plans at this time.
Banner Health has determined that the Health Plans offered to its employees are considered to be “grandfathered” under the requirements of the Patient Protection and Affordable Care Act and the Affordable Care Act (ACA). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic and preventive health coverage that were already in effect when that law was enacted. Although the Banner Employee Health Plans are considered grandfathered and exempt from implementing all the requirements of the Acts, many of them were already incorporated into the plans before the laws were passed. The remaining protections of the Affordable Care Act that apply the Banner Health Plans will be incorporated according to the schedule the government has laid out for implementation. However, grandfathered health plans must comply immediately with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from a grandfathered health plan status can be directed to Banner Plan Administration (480) 684-7070 or (800) 827-2464). As a self-insured and self-administered health plan regulated by the Federal Government under ERISA, you may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.