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...
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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.
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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.
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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.‌
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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.
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Related to Grandfathered Health Plan Coverage

  • Grandfathered health plan means a group health plan or an

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Grandfathered Service means service which is no longer available for new customers and is limited to the current customer at their current locations with certain provisioning limitations, including but not limited to upgrade denials, feature adds/changes and responsible/billing party.

  • Retiree means any person who has begun accruing a retirement

  • Retirement Plans means the retirement income, supplemental executive retirement, excess benefits and retiree medical, life and similar benefit plans providing retirement perquisites, benefits and service credit for benefits at least as great in the aggregate as are payable thereunder prior to a Change in Control;

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Significant break in coverage means a period of 63 consecutive days during each of which an individual does not have creditable coverage.

  • Retirement program means a program of rights and obligations which a county, city, village, or township establishes, maintains, or participates in and which, by its express terms or as a result of surrounding circumstances, does 1 or more of the following:

  • Social Security Retirement Age means the age used as the retirement age under Section 216(l) of the Social Security Act, applied without regard to the age increase factor and as if the early retirement age under Section 216(l)(2) of such Act were 62.

  • Grandfathered Amounts means, if applicable, the amounts that were deferred under the Plan and were earned and vested within the meaning of Section 409A of the Code and regulations thereunder as of December 31, 2004. Grandfathered Amounts shall be subject to the terms designated in the Adoption Agreement.

  • SERP has the meaning assigned thereto in Section 5(c) hereof.

  • Grandfathered Person means any Person who is the Beneficial Owner of 20% or more of the outstanding Voting Shares as determined at the Record Time; provided, however, that a Person shall cease to be a Grandfathered Person in the event that such Person ceases to Beneficially Own 20% or more of the outstanding Voting Shares at any time after the Record Time.

  • Retirement Plan means a plan which provides retirement benefits to you and which is not funded wholly by your contributions. The term shall not include a profit-sharing plan, informal salary continuation plan, registered retirement savings plan, stock ownership plan, 401(K) or a non-qualified plan of deferred compensation.

  • Designated Retirement Account means any retirement plan or account described or qualified under the Internal Revenue Code of 1986, as amended, or a subaccount thereof.

  • Gap medical benefits means the benefits (if any) payable in respect of medical expenses that are less than, greater than or equal to the schedule fee, provided always that the medical expenses relate to a professional service that:

  • Medical Benefits means the monthly fair market value of benefits provided to the Employee and the Employee’s dependents under the major medical, dental and vision benefit plans sponsored and maintained by the Company, at the level of coverage in effect for such persons immediately prior to the Employee’s termination of employment date. The “monthly fair market value” of such benefits shall be equal to the monthly cost as if such persons elected COBRA continuation coverage at such time at their own expense.

  • retirement annuity contract means a contract or scheme approved under Chapter III of Part XIV of the Income and Corporation Taxes Act 1988;

  • Nonqualified Deferred Compensation Rules means the limitations or requirements of Section 409A of the Code, as amended from time to time, including the guidance and regulations promulgated thereunder and successor provisions, guidance and regulations thereto.

  • Special Hazard Coverage Termination Date The point in time at which the Special Hazard Loss Coverage Amount is reduced to zero.

  • Retirement Eligibility means Employee’s attainment of 60 years of age and ten years of continuous employment with Corporation.

  • Health benefits plan means a benefits plan which pays or

  • Covered benefits or “benefits” means those health care services to which a covered person is entitled under the terms of a health benefit plan.

  • COBRA Continuation Coverage means the health care benefit continuation coverage mandated by the Consolidated Omnibus Budget Reconciliation Act and similar provisions of state law.

  • Grandfathered Percentage means, with respect to any Grandfathered Person, the percentage of the outstanding shares of Common Stock of the Company that such Grandfathered Person, together with all Affiliates and Associates of such Grandfathered Person, Beneficially Owns as of the Grandfathered Time, plus an additional 1/2%; provided, however, that, in the event any Grandfathered Person shall sell, transfer, or otherwise dispose of any outstanding shares of Common Stock of the Company after the Grandfathered Time, the Grandfathered Percentage shall, subsequent to such sale, transfer or disposition, mean, with respect to such Grandfathered Person, the lesser of (i) the Grandfathered Percentage as in effect immediately prior to such sale, transfer or disposition or (ii) the percentage of outstanding shares of Common Stock of the Company that such Grandfathered Person Beneficially Owns immediately following such sale, transfer or disposition, plus an additional 1/2%.

  • Continuation Coverage means the temporary continuation of PEBB benefits available to enrollees under the Consolidated Omnibus Budget Reconciliation Act (COBRA), 42 U.S.C. Secs. 300bb-1 through 300bb-8, the Uniformed Services Employment and Reemployment Rights Act (USERRA), 38 U.S.C. Secs. 4301 through 4335, or the public employees benefits board's policies.

  • Plan Benefit means the benefit payable to a Participant as calculated in Article V.