First, there was grandfathering for health benefit plans in place upon enactment of PPACA (March 23, 2010), then there were rules that plans have to follow to keep that grandfathering, who cares?
Employers should care because if the employer loses its grandfathering here is what they will have to comply with:
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Rules on deductible maximums and out-of-pocket maximums
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Required coverage of preventive services with no cost-sharing
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Internal and external appeal process rules
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No prior authorization for ob-gyn visits
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Emergency care must have same payment in and out of network, and
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Nondiscrimination for insured plans under the tax Code
Complying with these rules will increase the costs of the plan, will increase the cost of administration, will increase the premiums employees pay, will reinforce the idea that someone else must pay the health care bill and will further limit the ability for an employer to develop and implement a sound health benefits strategy. Sadly, you can say that about much of PPACA, but grandfathering was a realistic approach. One can only wonder if providing grandfathering was a serious goal in the first place given the new rules restricting the changes an employer can make and remain grandfathered.
Of all the items above, the new external and internal appeal process will be the most troublesome. ERISA already provides extensive rules for handling appeals. For large employer plans, especially self-insured plans, new rules will add no value and can only serve to drive costs up further.
On the other hand, it is not at all clear that all employers will want to keep grandfathering. What you have to do to keep grandfathering may not be worth the long term commitment of being restricted in how you manage your health benefits. For example, to keep grandfathering you can NEVER increase your coinsurance, you cannot change your insurance carrier and you cannot decrease the employer contribution by more than 5%
Also, note that self-insured collectively bargained plans are treated no differently than non-union plans for all the insurance reform provisions of PPACA. Effective dates are not deferred until the end of the current collective bargaining agreement (and neither would the loss of grandfathering should that occur.
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