Plan Features for “Grandfathered” Health Plans Under PPACA

Tuesday, July 13, 2010

The Patient Protection and Affordable Care Act (Act) exempted or “grandfathered” those employer sponsored health care plans in effect on or before March 23, 2010 from some but not all provisions of the Act. Both these exemptions as well as mandated provisions were documented in the Federal Register on June 17, 2010.  Additional information is provided by DOL.  This grandfathering created certain advantages to employers with such plan by allowing them to maintain their current plan design features and avoid having to add possibly expensive features mandated under the Act. At the same time, the Act added certain notification requirement for grandfathered plans, notification requirements in addition to those already on the books.

The mandated and exempted plan feature
provisions include for grandfathered plans:

.................................................................................................................... Applies to ---

............................................................................................................... Grandfathered
Section ---------------------------------------------------- Title ----------------------------------------------------- Plans

§ 2701 ....... Fair Health Insurance Premiums ............................................................  No

§ 2702 ....... Guaranteed Availability of Coverage .....................................................  No

§ 2703 ....... Guaranteed Renewability of Coverage ..................................................  No

§ 2704 ....... Prohibition of Preexisting Condition Exclusions or ................................ Yes

                   Other Discrimination Based on Health Status

§ 2705 ....... Prohibiting Discrimination Against Individual ......................................... No

                   Participants/Beneficiaries Based on Health Status

§ 2706 ....... [Providers] Non-Discrimination in Health Care ........................................ No

§ 2707 ....... Comprehensive Health Insurance Coverage ........................................... No

§ 2708 ....... Prohibition on Excessive Waiting Periods .............................................. Yes

§ 2709 ....... Coverage For Individuals Participating in ............................................... No

                   Approved Clinical Trials

§ 2711(a) ... No Lifetime or Annual Limits ................................................................ Yes

§ 2711(b) ... [Restricted] Annual Limits Prior to 2014 ................................................ Yes

§ 2712 ....... Prohibition on Rescissions .................................................................... Yes

§ 2713 ....... Coverage of Preventive Health Services ................................................. No

§ 2714 ....... Extension of Dependent Coverage ........................................................ Yes

§ 2715 ...... Uniform Explanation of Coverage Documents/ ....................................... Yes

                  Standardized Definitions

§ 2715A .... Provision of Additional Information ......................................................... No

§ 2716 ...... Prohibition on Discrimination in Favor of ................................................. No

                  Highly Compensated Individuals

§ 2717 ...... Ensuring The Quality of Care .................................................................. No

§ 2718 ...... Bringing Down The Cost of Health Care Coverage ..................................Yes

§ 2719 ...... Appeals [Claims] Process ......................................................................... No

§ 2719A ... Choice of Health Care Professional .......................................................... No