Grandfathered health plans

Summary

Under the grandfathered plans provision, individual and group coverage in effect on March 23, 2010, is exempt from some reform provisions. Grandfathered plans include self-funded, employer-sponsored plans, and insured group and individual health plans in effect on this date. Grandfathered plans are exempt from some provisions in the Act, but not all.

Exemptions include appeals, preventive care at no cost share, certain patient protections, Essential Health Benefit requirements, rate restrictions/adjusted community rating, guaranteed issue and renewability, and out-of-pocket requirements.

Grandfathered plans are not exempt from revenue raisers, covering dependents (adult children) to age 26,  exclusion of pre-existing conditions, nondiscrimination regulations and reporting requirements among other requirements.

Some provisions of the health reform law may not apply to grandfathered plans.