Grandfathering allows you to maintain group coverage that was in place when the law was enacted March 23, 2010, without being required to implement certain aspects of the ACA.
Grandfathered plans are exempt from:
- A required package of essential health benefits
- The restriction on rate variation by age and health status
- Mandated coverage of specified preventive services with no cost sharing
- Limited out-of-pocket costs for participants
Other provisions of ACA apply to grandfathered and non-grandfathered plans alike:
- No lifetime limits on coverage amounts
- A maximum waiting period of 90 days for new employee coverage
- Coverage of dependent children up to the age of 26
Your organization can lose its grandfathered status if you:
- Significantly lower employer premium contributions
- Raise coinsurance charges or significantly raise copayments and deductibles
- Materially modify existing benefits when purchasing coverage from a different insurer
- Reduce or eliminate benefits for a specific condition (e.g., diabetes or cystic fibrosis)
For some employers, grandfathering may create a cost savings. For others, these restrictions might be too limiting. Contact your BCBSND account executive for more detailed information about the impact of maintaining grandfathered status.