Grandfathered plans

The interim final rule for group health plans and health insurance coverage relating to status as a grandfathered plan under the Patient Protection and Affordable Care Act Rule addresses what changes an insurer or plan sponsor may make to health insurance coverage or a group health plan without loss of its "grandfather" status under the Patient Protection and Affordable Care Act ("PPACA") and what administrative steps a plan must take to maintain grandfather status.

Key points

Why might a group want to be grandfathered?

A group may want to maintain grandfather status so as not to have to comply with certain provisions of the PPACA.

What you need to know

Employers

To be a grandfathered plan, the policy or group health plan must have had at least one individual enrolled in coverage on March 23, 2010, and the policy or plan must have continuously covered someone since March 23, 2010 (even if it's not the same individual or set of individuals).

Any new policy, certificate or contract of insurance (versus renewal) issued after March 23, 2010 is not grandfathered.

Brokers

Any insurance policy sold to new entities or individuals after March 23, 2010, will not be grandfathered, even if the product was offered in the group or individual market before March 23, 2010.

Grandfathered plans (pdf, 86 KB)