Slideshow 5 ways a plan could lose grandfathered status

Published
  • May 12 2015, 9:57am EDT
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Overview:

Health plans purchased before March 23, 2010 are considered to have grandfathered status and don’t have to follow the ACA's rules and regulations or offer the same benefits, rights and protections as new plans. But certain plan changes or adjustments can trigger the loss of grandfathered status. According to the health care reform law, they are:

1. An increase in a percentage cost-sharing requirement (i.e. co-insurance), regardless of the amount.

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2. An increase in the deductible or out-of-pocket maximum by an amount that exceeds medical inflation plus 15 percentage points.


3. An increase in copayments if the increase exceeds the greater of $5 (adjusted for medical inflation) or medical inflation plus 15 percentage points.

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4. A decrease in the employer’s contribution rate by more than 5 percentage points (measured for each tier of coverage).


5. Eliminating all or substantially all benefits to diagnose or treat a particular condition.