During the healthcare reform debate, the Obama administration said, “If you like your current health plan, you can keep it.” Any health plan that was in the market prior to Mar. 23, 2010 is considered a “grandfathered” plan. LifeWise is working to preserve choices for our customers and supports grandfathered plans at this time.
What this means to you…
- If you were a LifeWise individual health plan member prior to Mar. 23, 2010 and you have not made any changes to your plan since then, you have a grandfathered plan. You have the option to remain on this plan as long as it is available through LifeWise. Going forward, if you switch to a different health plan (even with the same carrier), you will lose grandfathered status.
- If you have an employer-sponsored health plan, you may wish to check with your benefits administrator about your health plan choices and whether you have a grandfathered plan.
Will I have a better premium with a grandfathered plan?
- Grandfathered plans will require fewer mandated benefits due to healthcare reform and therefore may not be as impacted by increased costs.
If I choose a new LifeWise plan, will I have a grandfathered plan?
- Our new individual plans effective Sept. 1, 2010 will not have grandfathered status.
Is there value in keeping a grandfathered plan?
- If you have a LifeWise individual health plan, you may find value in keeping your plan if you:
- Are under age 50
- Prefer to have a higher deductible plan (above $1,500), with a lower monthly rate
- Have an annual household income of $88,000 or more. (Households earning over 400 percent of the federal poverty level, or approximately $88,000 per year for a family of four, will not have access to federal subsidies starting in 2014.)
- You may find less value in grandfathering if you:
- Are over age 50
- Prefer to have a lower deductible plan with richer benefits
- Have an annual household income less than $66,000 or more. (Households earning under 300 percent of the federal poverty level, or approximately $66,000 per year for a family of four will have access to federal subsidies starting in 2014.)
If I changed plans, can I go back to my original plan to retain grandfathered status?
- If you were a LifeWise individual plan member prior to Mar. 23, 2010 and you made a plan change between Mar. 23 and Jun. 14, 2010, you have the option of going back to your original plan to maintain grandfathered status. We will contact impacted members with their options in the future when more information is available.
Are there benefit changes due to healthcare reform that grandfathered plans must include?
- If you have a LifeWise individual health plan, the following mandates regardless of grandfathered status are effective Sept. 1, 2011.*
- No lifetime maximum
- Extension of parents’ coverage to dependents to age 26.
- If you have an employer-sponsored health plan, the following mandates regardless of grandfathered status are effective on the policy year on or after Sept. 23, 2010.
- No lifetime maximum
- Extension of parents’ coverage to dependents to age 26
- No pre-existing condition for children under age 19
- Removal of restricted annual limits.
What are the minimum essential benefits that all non-grandfathered plans must include starting in 2014?
- Beginning in 2014, all non-grandfathered plans are subject to essential benefits such as:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse
- Prescription drugs
- Preventive and wellness services
*The Oregon Insurance Division has asked for clarification from the federal Department of Health and Human Services about the application of the “policy year” definition to Oregon’s fixed individual products. Therefore, this date may be subject to change.
