SEC. 1251 ø42 U.S.C. 18011¿. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.
(a) NOCHANGES TOEXISTINGCOVERAGE.—
(1) IN GENERAL.—Nothing in this Act (or an amendment made by this Act) shall be construed to require that an indi-vidual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.
(2) CONTINUATION OF COVERAGE.—øAs revised by section 10103(d)(1)¿ Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regard-less of whether the individual renews such coverage after such date of enactment.
(3) APPLICATION OF CERTAIN PROVISIONS.—øAs added by section 10103(d)(1)¿ The provisions of sections 2715 and 2718 of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after the date of enactment of this Act.
(4) APPLICATION OF CERTAIN PROVISIONS.—øAs added by section 2301(a) of HCERA¿
(A) IN GENERAL.—The following provisions of the Pub-lic Health Service Act (as added by this title) shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply:
(i) Section 2708 (relating to excessive waiting peri-ods).
(ii) Those provisions of section 2711 relating to lifetime limits.
(iii) Section 2712 (relating to rescissions).
(iv) Section 2714 (relating to extension of depend-ent coverage).
(B) PROVISIONS APPLICABLE ONLY TO GROUP HEALTH PLANS.—
(i) PROVISIONS DESCRIBED.—Those provisions of section 2711 relating to annual limits and the provi-sions of section 2704 (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years begin-ning with the first plan year to which such provisions otherwise apply.
(ii) ADULT CHILD COVERAGE.—For plan years be-ginning before January 1, 2014, the provisions of sec-tion 2714 of the Public Health Service Act (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored
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health plan (as defined in section 5000A(f)(2) of the In-ternal Revenue Code of 1986) other than such grand-fathered health plan.
(b) ALLOWANCE FOR FAMILY MEMBERS TO JOIN CURRENT COV
-ERAGE.—With respect to a group health plan or health insurance coverage in which an individual was enrolled on the date of enact-ment of this Act and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of such date of enactment.
(c) ALLOWANCE FOR NEW EMPLOYEES TO JOIN CURRENT
PLAN.—A group health plan that provides coverage on the date of enactment of this Act may provide for the enrolling of new employ-ees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their fami-lies).
(d) EFFECT ON COLLECTIVE BARGAINING AGREEMENTS.—In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee rep-resentatives and one or more employers that was ratified before the date of enactment of this Act, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to con-form to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collec-tive bargaining agreement.
(e) DEFINITION.—In this title, the term ‘‘grandfathered health plan’’ means any group health plan or health insurance coverage to which this section applies.
SEC. 1252 ø42 U.S.C. 18012¿. RATING REFORMS MUST APPLY UNI-FORMLY TO ALL HEALTH INSURANCE ISSUERS AND GROUP HEALTH PLANS.
Any standard or requirement adopted by a State pursuant to this title, or any amendment made by this title, shall be applied uniformly to all health plans in each insurance market to which the standard and requirements apply. The preceding sentence shall also apply to a State standard or requirement relating to the stand-ard or requirement required by this title (or any such amendment) that is not the same as the standard or requirement but that is not preempted under section 1321(d).
SEC. 1253 ø42 U.S.C. 18013¿. ANNUAL REPORT ON SELF-INSURED PLANS.
Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of Labor shall prepare an aggregate annual report, using data collected from the Annual Re-turn/Report of Employee Benefit Plan (Department of Labor Form 5500), that shall include general information on self-insured group health plans (including plan type, number of participants, benefits offered, funding arrangements, and benefit arrangements) as well as data from the financial filings of self-insured employers
(includ-June 9, 2010
ing information on assets, liabilities, contributions, investments, and expenses). The Secretary shall submit such reports to the ap-propriate committees of Congress.
øSection 1253 added by section 10103(f)(2)¿
SEC. 1254. STUDY OF LARGE GROUP MARKET.
øSection 1254 added by section 10103(f)(2)¿
(a) IN GENERAL.—The Secretary of Health and Human Serv-ices shall conduct a study of the fully-insured and self-insured group health plan markets to—
(1) compare the characteristics of employers (including in-dustry, size, and other characteristics as determined appro-priate by the Secretary), health plan benefits, financial sol-vency, capital reserve levels, and the risks of becoming insol-vent; and
(2) determine the extent to which new insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-in-sure.
(b) COLLECTION OF INFORMATION.—In conducting the study under subsection (a), the Secretary, in coordination with the Sec-retary of Labor, shall collect information and analyze—
(1) the extent to which self-insured group health plans can offer less costly coverage and, if so, whether lower costs are due to more efficient plan administration and lower overhead or to the denial of claims and the offering very limited benefit packages;
(2) claim denial rates, plan benefit fluctuations (to evalu-ate the extent that plans scale back health benefits during eco-nomic downturns), and the impact of the limited recourse op-tions on consumers; and
(3) any potential conflict of interest as it relates to the health care needs of self-insured enrollees and self-insured em-ployer’s financial contribution or profit margin, and the impact of such conflict on administration of the health plan.
(c) REPORT.—Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to the appropriate commit-tees of Congress a report concerning the results of the study con-ducted under subsection (a).
SEC. 1255. EFFECTIVE DATES.
øAs revised by section 10103(e) and redesignated by section 10103(f)(1)¿ This subtitle (and the amendments made by this sub-title) shall become effective for plan years beginning on or after January 1, 2014, except that—
(1) section 1251 shall take effect on the date of enactment of this Act; and
(2) the provisions of section 2704 of the Public Health Service Act (as amended by section 1201), as they apply to en-rollees who are under 19 years of age, shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act.
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