How a health plan loses grandfathered status

November 8, 2013

Any of these six criteria under the health reform law

If any one of the following changes were made to a policy at any time since the Patient Protection and Affordable Care Act became law on March 23, 2010, the plan will lose its grandfathered status:

• coverage for a particular condition or illness is eliminated,

• an annual dollar limit on benefits is imposed or an existing limit is reduced,

• a coinsurance percentage is increased to any extent,

• a dollar co-payment is increased by more than the greater of $5.00 indexed for medical inflation or 15% (one-time allowance) plus medical inflation beyond what was in effect at the time the law was enacted,

• deductibles or out-of-pocket maximums are increased by more than 15% (one-time allowance) plus medical inflation beyond what was in effect at the time the law was enacted, or

• the employer changes eligibility requirements in certain ways or increases its employees’ contributions to premium by more than 5% plus medical inflation.