Idaho extends “grandmothered” health insurance plans

The Idaho Department of Insurance has announced that health insurance plans that are not compliant with provisions of the Public Health Service Act (PHSA), known as “grandmothered” health plans, will be extended through December 31, 2017. Health insurance plans that were purchased between March 23, 2010—when the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) was signed into law—and October 1, 2013, are considered “grandmothered” policies.

State insurance authorities are permitted to allow issuers to continue certain coverage that would otherwise not be compliant with section 1312 of the ACA. This transitional relief began for policy years starting between January 1 and October 1, 2014, and the CMS has extended this relief two separate times. In February 2016, the CMS extended this relief through December 31, 2017.

CMS still intends to bring all non-grandfathered coverage into compliance with the PHSA no later than 2018, so the transitional relief only applies to policies that end by December 31, 2017. Issuers may offer options that include policy years that last less than 12 months in order to obtain transitional relief.

Idaho Bulletin 16-03 extends the CMS policy to Idaho health plans. The bulletin provides the following information:

• For all renewals of grandmothered plans on or after August 1, 2016, the carrier shall renew each policy for a period through December 31, 2017, with no increase of premium after that renewal.
• Deductibles and out-of-pocket maximums must be allowed to accumulate on plans with plan-year deductibles in a manner that protects consumers from incurring additional deductibles or out-of-pocket maximums.
• Grandmothered policies must continue to comply with certain ACA provisions with respect to essential health benefits, preexisting condition exclusions, waiting periods, and mental health parity rules.


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