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Small Group Grandmothered Plans to Disappear


As I write this, I’m reminded of the holiday tune, “Grandma Got Run Over By a Reindeer”. Obviously the songwriter had no idea how fitting it would be this particular December as Grandmothered Medical Plans expire in California, but it does seem like an appropriate theme song.

To be sure, this will be a renewal season for the ages. As we prepare for the flurry of activity, where upwards of 70% of all small groups across the state will be renewing at the very same time, we thought we’d share some general information for small groups with Grandmothered plans:

• All non-grandfathered small group medical plans that are not already on the carriers’ ACA portfolio will be retired from the market effective 11/30/15.
• Some key differences between pre-ACA and ACA plans:
– Member Level Rating. Each family member is assigned an individual monthly rate and those are totaled to determine a family’s total premium. This will be good news for smaller families and not so good for larger ones.
– Pediatric Dental & Vision. The ACA requires all small group plans to include certain dental and vision benefits for minor dependents into the medical plan. The cost for this coverage has been embedded into the medical premium rates for all carriers except Blue Shield, which has structured the pediatric dental ala carte.
– Benefits uniformity. The ACA dictates specific requirements and limitations on certain benefits such as out of pocket maximums, and applicability of deductibles. You will notice some changes to the ACA plans, based on these new rules.

We’ve seen a wide range of rate changes, including actual decreases all the way into high double digit increases. How any one employer’s rates are affected will depend on their current plans and enrollment mix.

As always, CoreMark’s Benefits Team will apply our expertise to analyzing all our clients’ options, and present solid recommendations. We do this for potential clients as well, at no extra charge.