Grandfathered Health Plans

If a group purchased an a plan on or before March 23, 2010, the plan may now be considered “grandfathered”, and may be exempt from many of health reform’s mandates.

However, some mandates apply to all plans, including grandfathered plans. If changes not mandated by law are made to a policy, the plan could lose its grandfathered status and become subject to all health reform mandates.

Blue Shield has made the following business decisions in regard to grandfathering for large employer groups.

  • Standard group medical plans will NOT be grandfathered for groups with 51 or more employees

  • Self-funded or highly-customized plans will have the option to grandfather as long as their plan was in effect on or before March 23, 2010 and meets all grandfathering requirements.

Frequently Asked Questions

Learn which mandates must be applied to grandfathered self-funded and highly-customized group plans, upon renewal* on or after September 23, 2010:

 

Mandate Applies to
grandfathered plans?
Extension of dependent coverage up to age 26 Yes
Removal of annual or lifetime dollar coverage limits on essential benefits Yes
No member cost-sharing for preventive benefits Optional
No pre-existing condition exclusions for enrollees under 19 Yes


* If your group has an ERISA plan, the plan may need to make the health reform changes according to your ERISA plan year. Contact your broker or Blue Shield sales representative for details.

 

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