Affordable Care Act’s Special Rules for Grandfathered And Self-Insured Health Plans

The Affordable Care Act’s (“ACA”) mandates regarding health care plans, including the individual mandate, take effect with no change in schedule, despite the recent U.S. Treasury Department’s decision to postpone employer penalties for one year, to January 1, 2015. By now, any employer that is covered by the Fair Labor Standards Act has either provided the required ACA notice to current employees or is preparing to do so by no later than October 1.

Determining when and which ACA requirements apply to a specific health care plan hinges on a number of things, including the health care plan’s effective date, whether the plan is fully-insured or self-insured, and the expiration date of a collective bargaining agreement if the plan is the subject of collective bargaining. This article covers the special ACA rules and effective dates for grandfathered and self-insured health care plans and offers guidance on how to determine whether your organization’s health care plan is a grandfathered, self-insured, or fully-insured plan and, if so, which ACA requirements do and do not apply to the plan.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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