DomKen
Posts: 19457
Joined: 7/4/2004
From: Chicago, IL
Status: offline
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ORIGINAL: papassion
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ORIGINAL: DomKen
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ORIGINAL: DesideriScuri
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ORIGINAL: freedomdwarf1
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ORIGINAL: RacerJim
Well, since you seem to know the insurance companies never leave a plan alone surely it's not a stretch to assume Sabelius and Obama knew that also and, therefore, knew that most plans would not meet the grandfather exemption and, therefore, THEY DID INDEED LIE. Given that Obamacare mandates what the insurance companies MUST include in their policies, blaming this on the insurance companies is BULL$HIT.
That fact that the insurance companies make those changes, then the onus is on those insurance companies, not the president.
Ergo, the president didn't lie - the insurance companies moved the goalposts.
Not exactly, freedomdwarf. The insurance companies were forced to move them because of Obamacare. This was not a free choice. They had no choice other than to change the policies.
Again, the policies only lost grandfather status if they failed to come into compliance with the ACA or raised premiums while eliminating coverage. Simply obeying the ACA regs is not sufficient!
You lose your grandfather status if you FAILED TO COME INTO COMPLIANCE with the ACA. Then if you do come into compliance, thats a CHANGE,. so you lose your grandfather status?And obeying ACA regs is not sufficient!? What the hell are U smokin?
Read the regs!
http://webapps.dol.gov/FederalRegister/HtmlDisplay.aspx?DocId=23967&AgencyId=8&DocumentType=2
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these interim final regulations, coordinated
rules are set forth for determining when changes to the terms of a plan
or health insurance coverage cause the plan or coverage to cease to be
a grandfathered health plan. The first of those rules (in paragraph
(g)(1)(i)) constrains the extent to which the scope of benefits can be
reduced. It provides that the elimination of all or substantially all
benefits to diagnose or treat a particular condition causes a plan or
health insurance coverage to cease to be a grandfathered health plan.
If, for example, a plan eliminates all benefits for cystic fibrosis,
the plan ceases to be a grandfathered health plan (even though this
condition may affect relatively few individuals covered under the
plan). Moreover, for purposes of paragraph (g)(1)(i), the elimination
of benefits for any necessary element to diagnose or treat a condition
is considered the elimination of all or substantially all benefits to
diagnose or treat a particular condition. An example in these interim
final regulations illustrates that if a plan provides benefits for a
particular mental health condition, the treatment for which is a
combination of counseling and prescription drugs, and subsequently
eliminates benefits for counseling, the plan is treated as having
eliminated all or substantially all benefits for that mental health
condition.
A second set of rules (in paragraphs (g)(1)(ii) through (g)(1)(iv))
limits the extent to which plans and issuers can increase the fixed-
amount and the percentage cost-sharing requirements that are imposed
with respect to individuals for covered items and services. Plans and
issuers can choose to make larger increases to fixed-amount or
percentage cost-sharing requirements than permissible under these
interim final regulations, but at that point the individual's plan or
health insurance coverage would cease to be grandfathered health plan
coverage. A more detailed description of the basis for the cost-sharing
requirements in these interim final regulations is included in section
IV.B later in this preamble.
These interim final regulations provide different standards with
respect to coinsurance and fixed-amount cost sharing. Coinsurance
automatically rises with medical inflation. Therefore, changes to the
level of coinsurance (such as moving from a requirement that the
patient pay 20 percent to a requirement that the patient pay 30 percent
of inpatient surgery costs) would significantly alter the level of
benefits provided. On the other hand, fixed-amount cost-sharing
requirements (such as copayments and deductibles) do not take into
account medical inflation. Therefore, changes to fixed-amount cost-
sharing requirements (for example, moving from a $35 copayment to a $40
copayment for outpatient doctor visits) may be reasonable to keep up
with the rising cost of medical items and services. Accordingly,
paragraph (g)(1)(ii) provides that any increase in a percentage cost-
sharing requirement (such as coinsurance) causes a plan or health
insurance coverage to cease to be a grandfathered health plan.
With respect to fixed-amount cost-sharing requirements, paragraph
(g)(1)(iii) provides two rules: a rule for cost-sharing requirements
other than copayments and a rule for copayments. Fixed-amount cost-
sharing requirements include, for example, a $500 deductible, a $30
copayment, or a $2,500 out-of-pocket limit. With respect to fixed-
amount cost-sharing requirements other than copayments, a plan or
health insurance coverage ceases to be a grandfathered health plan if
there is an increase, since March 23, 2010, in a fixed-amount cost-
sharing requirement that is greater than the maximum percentage
increase. The maximum percentage increase is defined as medical
inflation (from March 23, 2010) plus 15 percentage points. For this
purpose, medical inflation is defined in these interim final
regulations by reference to the overall medical care component of the
Consumer Price Index for All Urban Consumers, unadjusted (CPI),
published by the Department of Labor. For fixed-amount copayments, a
plan or health insurance coverage ceases to be a grandfathered health
plan if there is an increase since March 23, 2010 in the copayment that
exceeds the greater of (A) the maximum percentage increase or (B) five
dollars increased by medical inflation. A more detailed description of
the basis for these rules relating to cost-sharing requirements is
included in section IV.B later in this preamble.
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RE: OBAMA LIED!!! - 
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