Health Insurance Policy Changes – America’s Top Insurance Lawyer Weighs In

December 6, 2010

By now, Americans everywhere are receiving premium increases and new policy choices when it comes to healthcare. Subscribers' rates are increasing and companies are making decisions about what they plan to do with the rising costs heading their way, says Frank N. Darras, the nation's top insurance lawyer.

It is time to review what you have in place and determine whether you should keep your coverage or change your benefit plan in relationship to the new health care reform.

As the nation's top insurance lawyer, Frank N. Darras suggests you take these steps before making any changes:

  • Read everything thoroughly, especially the fine print. Anything you don't understand, ask your trusted agent or broker or the company's human resource director for answers.
  • Determine if you are grandfathered into your policy and if any changes will adversely affect your coverage.
  • Is increasing the deductible a smart move, to save money on your premium payment?
  • Will decreasing your deductible affect your grandfathered status?

Some of the changes that could affect your grandfathered status could include:

  • Elimination of all (or substantially all) benefits to diagnose or treat a particular condition.
  • Any increase in cost-sharing requirements that are excessive (e.g., deductibles, out-of-pocket limits, or copayments); more than 15 percent over medical inflation.
  • More than a 5% reduction in employer contributions.
  • Any decrease in the dollar amount of the overall annual limit.

Some insurers say grandfathered status will not change if the following occurs:

  • Adding a dependent to a grandfathered plan.
  • Adding a new employee to a grandfathered employer plan.
  • Removal of dependents or employees from a grandfathered plan, as long as at least one member remains on the grandfathered plan at all times.
  • Changing your premiums.
  • Changes required for state or federal requirement compliance.
  • Changing third-party administrators (as long as the benefits remain the same).

Some business analysts predict that by 2013, strict regulations governing the maintenance of grandfathered status will likely cause many employers to eliminate these plans.

Staying within the guidelines may just become an administrative nightmare. "What that means is that we may only need to be concerned about the whole grandfathering concept for the short term," says Darras. It is also predicted that by 2013, only 55% of large employers and 34% of small employers will maintain these grandfathered plans.

"Healthcare plans and policies are tricky, so make sure you understand your options and how it will affect your care and your pocketbook," says Darras.