Being grandfathered brings certain advantages

The Patient Protection and Afford­able Care Act, Pub. L. 111-148, as amended by the Health Care and Education Affordability Reconciliation Act of 2010, Pub. L. 111-152 (collectively, ACA) enact a set of mandates that significantly change coverage for virtually all group health plans and insurance policies. At the same time, the ACA allows grandfathered health plans, generally those that existed on March 23, to avoid the application of many, but not all, of the coverage mandates. For example, grandfathered health plans do not have to adopt the new claims appeals procedures set forth under ACA nor do these plans have to comply with ACA’s mandate requiring that certain preventative care benefits be provided under group health plans without cost-sharing.

On June 14, the U.S. departments of Labor, Health and Human Services and Treasury released interim final rules (IFRs) defining a grandfathered health plan and explaining how grandfathered plans could lose their grandfathered status. This article summarizes the applicable ACA grandfathering rules.