Grandfathered Health Plan Coverage definition

Grandfathered Health Plan Coverage section has been added to the “Miscellaneous Provisions” section of the Group Agreement, indicating that a Group must inform Company if coverage identified as a “grandfathered health plan” in the EOC does not meet (or no longer meets) the requirements for grandfathered status. Additional changes and clarifications that apply to Added Choice® medical plans only Benefit changes  The “Referrals to Select Providers and Select Facilities” section of EOC has been modified. Ophthalmology has been removed from the list of departments that do not require a referral for outpatient Services. A referral will now be required to schedule an appointment for ophthalmology Services. Benefit clarifications  The “Reconstructive Surgery Services” section of the EOC has been modified to align with other sections within the EOC. Language indicating that Services are covered when prescribed by a Select, PPO, or Non-Participating Provider has been moved to the beginning of the section. Additionally, language has been added to specify that Services are subject to Utilization Review. The word significant has been removed in this section for consistency across products. Services are covered based upon Utilization Review.  The Chiropractic Services Received Without a Referral” exclusion in the “Exclusions and Limitations” section of the EOC has been retitled “Chiropractic Services” for alignment with other products and other exclusions within the section.  The “Custodial Care” exclusion in the “Exclusions and Limitations” section of the EOC has been modified to align across lines of business and for Member clarity.  The “Optometric Vision Therapy and Orthoptics (Eye Exercises)” exclusion in the “Exclusions and Limitations” section of the EOC has been modified for clarity and moved so that it appears in alphabetical order. Language has been added explaining that Services related to optometric vision therapy and orthoptics (eye exercises) are excluded.  A “Hospitalization on Your Effective Date” section has been added to the EOC for alignment across products.  A sentence has been added to the second paragraph of the “Benefit Summary” to clarify that all applicable visit limits are combined across all tiers, unless otherwise indicated in the EOC. Language has been removed from the left column of the “Benefit Summary” table indicating “all tiers combined.”  A row for “certain preventive medications” has been added to the “Limited Outpatient Prescription Drugs and Supplies” sectio...

Grandfathered Health Plan Coverage means coverage provided by a health carrier in which an individual was enrolled on March 23, 2010, for as long as it maintains that status in accordance with federal regulations, and includes any extension of coverage to individuals who become dependents of grandfathered enrollees after March 23, 2010.

Grandfathered Health Plan Coverage means coverage provided to a small employer by a health carrier on March 23, 2010 for as long as it maintains that status in accordance with federal regulations.

Examples of Grandfathered Health Plan Coverage in a sentence

• Grandfathered health plan coverage means coverage provided by a group health plan, or a health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).

• Section 2590.715–1251 revised to read as follows:§ 2590.715–1251 Preservation of right to maintain existing coverage.(a) Definition of grandfathered health plan coverage—(1) In general—(i) Grandfathered health plan coverage means coverage provided by a group health plan, or a health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).

• Section 147.140 is added to read as follows:§ 147.140 Preservation of right to maintain existing coverage.(a) Definition of grandfathered health plan coverage—(1) In general—(i) Grandfathered health plan coverage means coverage provided by a group health plan, or a group or individual health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).

• Grandfathered health plan coverage providing individual market health insurance coverage and student health insurance coverage, the 12-month period that is designated as the policy year in the policy documents of the health insurance coverage.

• Section 54.9815–1251 is added to read as follows:§ 54.9815–1251 Preservation of right to maintain existing coverage.(a) Definition of grandfathered health plan coverage—(1) In general—(i) Grandfathered health plan coverage means coverage provided by a group health plan, or a health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).

• Grandfathered health plan coverage is tied to the individual or employer who obtained the coverage, not to the policy or contract form itself.

• Grandfathered health plan coverage as defined in 45 CFR 147.140 and excepted benefits as described in section 2791(c) of the PHS Act are already exempted from rate review under the existing regulation at §154.103(b).

• In doing so, HRSA required every group health plan and health insurance plan to include coverage for these preventative care services to employees working at non- 1 Grandfathered health plan coverage is that which has existed continually prior to March 23, 2010 and has not undergone any of several specified changes since that time.

• Grandfathered health plan coverage means coverage provided by a group health plan, or a group or individual health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).

• Prevention is a well-recognized, effective tool in improving health and2122 well-being and has been shown to be cost-effective in addressing many conditions early.3 2324 2 Grandfathered health plan coverage is that which has existed continually prior to March 23, 2010 and hasnot undergone any of several specified changes since that time.

More Definitions of Grandfathered Health Plan Coverage

Grandfathered Health Plan Coverage means coverage under a Plan Coverage Option described in Medical Plan Coverage Option Schedules A, B, C, D, E, H, HMO, HMO-C, HMO-C2 and CSS provided by a group health plan in which an individual was enrolled on March 23, 2010, and which is considered grandfathered health plan coverage under the Patient Protection and Affordable Care Act.‌

Grandfathered Health Plan Coverage means coverage provided by a group health plan, or a group or individual health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section). A group health plan or group health insurance coverage does not cease to be grandfathered health plan coverage merely because one or more (or even all) individuals enrolled on March 23, 2010 cease to be covered, provided that the plan or group health insurance coverage has continuously covered someone since March 23, 2010 (not necessarily the same person, but at all times at least one person). In addition, subject to the limitation set forth in paragraph (a)(1)(ii) of this section, a group health plan (and any health insurance coverage offered in connection with the group health plan) does not cease to be a grandfathered health plan merely because the plan (or its sponsor) enters into a new policy, certificate, or contract of insurance after March 23, 2010 (for example, a plan enters into a contract with a new issuer or a new policy is issued with an existing issuer). For purposes of this section, a plan or health insurance coverage that provides grandfathered health plan coverage is referred to as a grandfathered health plan. The rules of this section apply separately to each benefit package made available under a group health plan or health insurance coverage. Accordingly, if any benefit package relinquishes grandfather status, it will not affect the grandfather status of the other benefit packages.