Healthcare Reform: retiree medical plans

[Guest BL333]

p. 9 of the recently issued Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan under the PPACA provides that HHS does not intend to enforce the requirements of HIPAA or the Affordable Care Act with respect to nonfederal governmental retiree-only plans. Also, the regulations provide that HHS is encouraging states not to apply the provisions of title XXVII of the PHS Act to issuers of retiree-only plans.

1. Can anyone confirm that this language applies to retiree-only plans created both before and after the enactment date (ie, it applies to plans that would be grandfathered and those that would not be grandfathered)?

2. Can anyone point me to a useful secondary source outlining any requirements under the healthcare reform act that still apply to retiree-only plans?

Many thanks!

[Guest JKosciusko]

The general consensus (should I comment on how sad it is that we have to look at "general consensus" instead of clear guidelines?) is the PPACA does not apply to retiree plans. The only place I believe I've seen it mentioned is, of course, in the reimbursement (financial aid, so to speak) for those employers who now maintain such plans, for which $5b has been allocated and the GAO expects the program to cost $15b. Get those forms in today!

[KimberlyC]

Helath Reform uses the same defintion of group health plan as HIPAA special enrollment rules. Look to Section 9831(a)(2) of the Code, which exempts plans with fewer than 2 particpants who are current employees. This is the exception for retiree plans for HIPAA special enrollment rules, Michelle's law, benefits for mothers and newborns, mental health parity, and health reform. So none of these laws applies to a retiree health plan provided the plan is separate from the employer's plan for active employees. This of course begets the age-old quesiton of what is a separate plan.