Health Care Reform: Considering Changes to Your Health Plan

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The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively the “Act”) mandates a host of new requirements for employer-provided health plans. The Act did, however, exempt employer-provided health plans that were in place on March 23, 2010 from certain provisions of the Act so long as the plan meets certain requirements (“grandfathered plans”).

To be a grandfathered plan, an employer-provided health plan must (1) be in place on March 23, 2010, (2) continuously provide coverage to one or more individuals, (3) avoid implementing any of the changes described below, (4) provide a notice in all materials describing plan benefits that, among other things, states that the employer believes the plan is a grandfathered plan, (5) maintain records documenting the plan’s terms on March 23, 2010 (along with any other documents necessary to explain or verify its grandfathered status), and (6) make such records available upon request to participants, beneficiaries, and federal officials. Grandfathered plan status is determined separately for each benefit package (e.g., PPO, HMO); therefore, changes to one benefit package may result in that package losing grandfathered status while grandfathered status for another package is maintained.

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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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