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The Affordable Care Act (ACA) imposes regulations on all employer and individual health plans. However, “grandfathered” plans, those that were in existence on the date of the law’s passage, March 23, 2010, are subject only to certain aspects of the law.

Individuals and Small Employers

Though grandfathered status allows individuals and employers to keep coverage similar to their March 23, 2010, plan design, maintaining this status is very restrictive and will result in less choice for employers and individuals when making changes to their plans.

Consequently, beginning September 23, 2010, SelectHealth will only offer individuals and small employers (2-50 employees) new and renewing plans that meet all current reform mandates and will not maintain grandfathered plans.

Large Employers

Large employers (51+ employees) may choose to maintain grandfathered status by declaring this intention to SelectHealth. Large employers who have already renewed will be contacted directly for grandfathered status declaration.

Changes That Affect Both Grandfathered and Non-Grandfathered Plans

Many changes created by the ACA affect all plans, regardless of grandfathered status, including the following:

• Expanded coverage for young adults—A subscriber may choose to keep a dependent on his or her plan until the dependent turns age 26, regardless of financial or marital status.
• Elimination of lifetime and annual dollar limits—Lifetime limits for “essential health benefits” will be removed and annual limits will be restricted. Essential health benefits have not yet been defined by the Department of Health and Human Services.
• No pre-existing conditions (PEC) for enrollees younger than age 19—Children younger than age 19 will not be subject to PEC exclusions.

Additional Benefits for Non-Grandfathered Plans

Members on non-grandfathered plans will receive additional benefits, including the following:

• No cost-sharing for preventive services—Plans will cover many preventive services without charging a deductible, copay, or coinsurance.
• Emergency services—Benefits will be the same for both participating and nonparticipating emergency services.

For More Information

If you have questions or need help understanding how this will affect your plan, please contact your employer, SelectHealth-appointed insurance broker, or sales representative.