Keeping your Grandfathered Plan

For employers who decided to "Grandfather" their health benefit plan, some of the health reform changes are not required.  Grandfathering a plan means that you decided to keep the plan that you had in effect on March 23, 2010, and made no or only minimal changes as permitted by the grandfather rules.  However, there are a number of changes that apply to all plans whether or not they are a grandfathered plan.

As we approach 2014, grandfathered plans will not be required to implement a number of health reform law provisions, including:

• Rating restrictions such as adjusted community rating (for small group plans only)
• Capping deductibles and/or implementation of the ACA's out-of-pocket limits
• Providing essential health benefits (for small groups only)
• Providing coverage for clinical trials

In general, plan changes that can cause loss of grandfathered status include eliminating certain benefits, increasing coinsurance, increasing fixed-dollar cost sharing (co payments, deductibles and out-of-pocket limits) beyond allowed amounts, and the plan sponsor's decrease in its contributions toward the cost of coverage by more that 5 percent below the contribution rate on March 23, 2010.

SOOOOOO, if you have chosen to maintain grandfathered status, you will need to satisfy the notice and record keeping obligations that are required to maintain that grandfathered status.