Are you familiar with the PPACA and the "Grandfathered Plan" provision? - Mothering Forums

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#1 of 3 Old 01-24-2011, 08:18 PM - Thread Starter
 
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I have *zero* idea where to put this thread and am not sure where else I can ask this.  Disclaimer:  I don't care what anyone things about the plan, whether it's good, or bad.  I don't want debate on the merits of the reform or desired repeal.

 

What I really want to know is about the whole "grandfathered plan" business.  Dh has h/i through his employer.  We've been on the plan since he started about 2 1/2 years or so ago.  I don't think it's been changed since they upped our out of pocket maximum, but that was well before the passage of the PPACA.  They just signed a new contract, but I don't believe there were any changes to the health plan.  I'm assuming this means it's a "grandfathered plan," right?

 

The only reason why I care is because our h/i does not cover well-child/preventive care for children older than 4.  It covers preventive visits for my husband and myself as well as our two youngest children, but not my son.  I'd, obviously, really like to have him covered as well.  So...I'm figuring our h/i plan is exempt from the preventive care w/out cost sharing requirements part.  Does anyone know if there's a point in time at which even grandfathered plans will have to cover this?

 

TIA - I've been trying to figure this out.  Yes, I know I can call the third-party admin for the plan (which is self-funded), but they're snotty and not the slightest bit helpful.  I'd like to better understand the issue before I give them a call.

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#2 of 3 Old 01-24-2011, 11:26 PM
 
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I want to ask who your TPA is, because I work for one...LOL. However, I work in IT so I haven't attended the PPACA training. :(


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#3 of 3 Old 01-25-2011, 07:21 AM - Thread Starter
 
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It's a combo of PBA and then some managed care thing.  It's basically an HMO, but without calling itself that.

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