Grandfathered Health Plans Under the Affordable Care Act source:

The Affordable Care Act exempts most plans that existed on March 23, 2010 — the day the law was enacted — from some of the law’s consumer protections. This preserves consumers’ rights to keep the coverage they already had before health reform.

If you have health coverage from a plan that existed on March 23, 2010 — and that has covered at least one person continuously from that day forward — your plan may be considered a “grandfathered” plan.

A grandfathered health plan isn’t required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered.

Grandfathered plans are not required to:

Provide certain recommended preventive services at no additional charge to you.

Offer new protections when you are appealing claims and coverage denials.

Protect your choice of health care providers and your access to emergency care.

Compared to their polices in effect on March 23, 2010, grandfathered plans:

* Previously, one way an employer group health plan could lose its grandfather status was to change issuers--switch from one insurance company to another. The original regulation allowed only self-funded plans to change third-party administrators without necessarily losing their grandfathered plan status. On November 15, the regulation was amended to allow all group health plans to switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status, as long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status.

By William F. Schaake, CIC, CRM  © 2012