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  • Health Reform – What are Grandfathered Plan and Why Are They Beneficial?

    Under the recently enacted Health Reform Legislation, Individual and Group plans that are in existence from March 23, 2010 to January 10, 2014 may be “Grandfathered”, and will not have to meet the premium and benefit requirements that will be implemented in 2014 by the Federal Government. To retain the grandfather status the benefits of the existing plan must not be substantially changed.  The following changes are allowed without impacting the grandfather status:

    • Premiums
    • Benefits to comply with changes in state or federal law or PPACA
    • Changes to provider network or prescription formulary
    • Changes to third party plan administrator
    • Changes to plan structure, i.e. switching from insured to self funded

     Increases in co-insurance percentage, changing insurers, employee contributions by more than 5% or elimination of benefits to treat a particular condition are among the changes that would cancel a plans grandfather status. 

     For a full list please refer to: www.healthcare.gov/news/factsheets/keeping_the_health_plan_you_have_grandfathered.html – 47k – 2010-03-23

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