Grandfathered Plans Part II – Health Net

What types of changes can a plan make without losing grandfathered status?
Health Net Clients be advised of these changes in regard to employer Health Plans. Contact Jeremy for information about other carrier plan changes.

Grandfathered health plans (policies in effect prior to March 23, 2010) will be able to make routine changes to their policies and maintain their status. These changes include making cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with state or other federal laws.

Grandfathered plans:

• Cannot significantly cut or reduce benefits.
• Cannot raise coinsurance charges.
• Cannot significantly raise copayment charges.
• Cannot significantly raise deductibles.
• Cannot significantly lower employer contributions.
• Cannot add or tighten an annual limit on what the insurer pays
• Cannot restructure the company
• Cannot move employees to a plan with lesser benefits.

Among the changes that will not result in the loss of grandfathered status are the following:
• Changes in premiums
• Addition of family members of an individual who is enrolled in a grandfathered plan
• Addition of new employees (whether newly hired or newly enrolled) in a grandfathered plan
• Disenrollment of one or more individuals enrolled on March 23, 2010, (provided that the plan or coverage has continuously covered at least one person since March 23, 2010)
• Changes required to conform to federal and state laws and regulations
• Voluntary adoption of consumer protections as articulated in the new reform laws or increases in benefits
• Changes in a third-party administrator (TPA)

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