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Informer: Law allows people to keep insurance carriers

Last Modified: Saturday, September 29, 2012 6:15 PM

By Andrew Perzo / American Press

When the Obama health care bill was first mentioned, we were told we would be able to keep our present insurance carrier. Now it seems no one is able to find out what is taking place.

I have contacted my insurance company, which is a very good one, but have not been able to get any direct answers. Hopefully you can shed some light on this very important issue.

The Informer will try.

Nothing in the Affordable Care Act forces people to change their health plans or carriers or to stick with a particular insurer. But certain actions by insurers and employers could lead to changes in health plans.

Section 1251 of the health care law says, “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.”

Under federal regulations, health plans that existed on March 23, 2010 — the date the law was signed — are exempt from certain Affordable Care Act consumer-protection provisions.

Those policies, known as grandfathered plans, will lose their exempt status, exposing them to the full slate of requirements, if they make any of several changes.

But Erin Shields, a spokeswoman for the U.S. Department of Health and Human Services, said consumers can keep their carriers regardless of a plan’s grandfather status.

What grandfathered plans can’t do, according to HealthCare.gov, a portal for information on the law:

They can’t “significantly cut or reduce benefits.”

They can’t raise charges for co-insurance.

They can’t “significantly raise” co-payments or deductibles.

The can’t “significantly lower” employer contributions.

They can’t “add or tighten an annual limit” on what insurers pay.

The rules allow employers with group plans to change plan administrators and insurers as long as they don’t make any of the changes listed above. Additionally, plans must inform consumers of their grandfather status.

Consumer protections that apply to all health plans:

Lifetime dollar limits can’t be applied to certain health benefits.

Coverage can’t be canceled because of an honest mistake on the insurance application.

Dependent coverage must be extended to adult children up to age 26; grandfathered group plans (those from employers) don’t have to comply until 2014.

Provisions that don’t apply to grandfathered plans:

Protection, at no added cost, of recommended preventive services.

Protections on appeals of claims and coverage denials.

Protections on doctor choice and a prohibition against higher charges for out-of-network emergency care.

Additionally, grandfathered health plans that aren’t work-based don’t have to abide by provisions that “phase out annual dollar limits on key benefits” and “eliminate pre-existing condition exclusions for children under 19 years old,” reads HealthCare.gov.

According to a Congressional Research Service report released in January 2011, the U.S. Departments of Health and Human Services, Labor and Treasury estimated that half of all grandfathered group plans could lose their grandfather status by next year.

•••

The Informer answers questions from readers each Sunday, Monday and Wednesday. It is researched and written by Andrew Perzo, an American Press staff writer. To ask a question, call 494-4098, press 5 and leave voice mail, or email informer@americanpress.com

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