Compliance Date: Plan Renewal
Group health plans that were in effect on or before the date PPACA was signed into law (March 23, 2010) are generally considered "grandfathered" and not subject to some of the rules and regulations contained in PPACA.
To maintain status as a grandfathered health plan, a plan or health insurance coverage must include a statement, in any plan materials provided to a participant or beneficiary describing the benefits provided under the plan or health insurance coverage, that the plan or coverage believes it is a grandfathered health insurance coverage, that the plan or coverage believes it is a grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act and must provide contact information for questions and complaints. Don't forget your COBRA participants.
The following model language can be used to satisfy this disclosure requirement:
This (your current group health plan or insurance issuer) believes this (plan or coverage) is a "grandfathered health plan" under the "Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan means that your (plan or policy) may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator. For ERISA plans you also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This web-site has a table summarizing which protetions do and do not apply to grandfathered health plans. For individual market policies and nonfederal governmental plans, you may contact the U.S. Department of Health and Human Services at www.healthreform.gov
www.dol.gov/ebsa/grandfatherregmodelnotice.doc