Under the Affordable Care Act, health insurance plans that existed on March 23, 2012 and haven’t been changed in ways that substantially cut benefits or increase costs for consumers may be “grandfathered.” Your insurer should notify you if you have one of these plans.
There are two types of grandfathered plans — job-based plans and individual plans — and they each must follow different regulations.
- Job-based grandfathered plans can enroll new employees and dependents after March 23, 2010 and still maintain their grandfathered status, as long as the plans have not changed in significant ways. Employees must also be notified that they have a grandfathered plan, and the plan must have continuously covered at least one person since March 23, 2010.
- Individual grandfathered plans are no longer available for purchase since March 23, 2010, however existing grandfathered plans may continue for those already enrolled. Insurance companies may cancel grandfathered plans with 90 days notice. Individuals enrolled in grandfathered plans may add or remove dependents and maintain grandfathered status, however making substantial benefit changes will result in loss of grandfathered status.
Unsure of whether your plan is grandfathered? Check any materials you have describing your benefits, or check in with your employer or your health plan’s benefits administrator.
Unlike other health care plans under the Affordable Care Act, grandfathered plans aren’t required to cover preventive care for free, guarantee your right to appeal, protect your choice of doctors and access to emergency care, or be held accountable for excessive premium increases. Furthermore, grandfathered individual health insurance plants don’t have to end yearly limits on coverage or cover you if you have pre-existing conditions.
To learn more about your coverage and protection under grandfathered health insurance plans, contact Independent Benefit Advisors today at (919) 303-9690. We look forward to serving you!
Individuals and businesses in Apex, Raleigh, Durham, Cary, Charlotte, Fuquay-Varina, Greensboro, Rocky Mount, Sanford, Wake Forest and other locations throughout North Carolina choose Independent Benefit Advisors for help understanding benefits with grandfathered health insurance plan.