If you enrolled in an Individual and Family plan on or before March 23, 2010, when the Affordable Care Act (ACA) became law, your plan may now be considered "grandfathered." All Blue Shield Individual and Family plans in effect as of that date were eligible for grandfathered status, except Essential*, Access+ HMO®, Shield Secure Plus, Shield Secure, Shield Wise, and Shield Saver plans.
Grandfathered plans are exempt from many health reform mandates. Most individuals who are not currently enrolled in a grandfathered plan may not enroll in one now.
Health reform changes effective January 1, 2014
Everyone is required to have health coverage or pay a tax penalty.
Individuals and families are able to purchase health coverage directly from Blue Shield or other carriers or from California’s healthcare insurance marketplace, “Covered California.”
Members in grandfathered plans are able to keep their current health plan as long as it remains available. They are not required to purchase a new ACA-compliant plan as long as their current plan remains available for enrollment.
Learn more about other health reform changes.
Benefits of grandfathered plans
Members in grandfathered plans enjoy stability with their current coverage. Under the ACA, in order for a plan to maintain its grandfathered status, some changes that reduce benefits or increase costs to customers cannot be made to grandfathered plans.
|Maintaining grandfathered status||For example|
|Cannot significantly cut or reduce plan benefits||Coverage for conditions such as asthma or diabetes cannot be lost.|
|Cannot increase a plan's coinsurance charges||The percent charge for a service, such as 20% of a hospital bill, cannot increase.|
|Cannot significantly increase a plan's copayment charges or deductible||The fixed dollar amount paid for a service, such as a doctor visit, can only increase based on the annual medical inflation rate. |
|Cannot reduce annual limits on what Blue Shield pays||Blue Shield cannot decrease the maximum amount we will pay for covered services each year.|
Health reform mandates and grandfathered plans
Some health reform mandates apply to all plans, including grandfathered plans. These mandated plan changes apply to grandfathered plans:
More information and resources
Frequently Asked Questions (PDF, 32KB)
*Essential plans are underwritten by Blue Shield of California Life & Health Insurance Company.