As employers determine their plan designs for the coming year, those with grandfathered status need to decide if maintaining grandfathered status is their best option.  Following are some frequently asked questions, and answers, about grandfathering a group health plan.

Q1:  May plans maintain grandfathered status after 2014? A1:  Yes, they may.  There is no specific end date for grandfathered status.

Q2:  What are the advantages of grandfathered status? A2:  Grandfathered plans are not required to meet these PPACA requirements:

  • Coverage of preventive care without employee cost-sharing, including contraception for women
  • Limitations on out-of-pocket maximums (starting in 2014)
  • Essential health benefits, metal levels and deductible limits (starting in 2014; these only  apply to insured small group plans)
  • Modified community rating (starting in 2014; this only applies to insured small group plans)
  • Guaranteed issue and renewal (starting in 2014; this only applies to insured plans)
  • Nondiscrimination rules for fully insured plans (requirement has been delayed indefinitely)
  • Expanded claims and appeal requirements
  • Additional patient protections (right to choose a primary care provider designation, OB/GYN access without a referral , and coverage for out-of-network emergency department services)
  • Coverage of routine costs associated with clinical trials (starting in 2014)
  • Reporting to HHS on quality of care (requirement has been delayed indefinitely)

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