In 2014, when insurers will be required to maintain a single risk pool for all of their individual market policies in a state and a single risk pool for all of their small group market policies in a state, grandfathered plans will not be required to be included in those single risk pools. Any state law that attempts to require them to be included would be invalid.1 In addition, grandfathered plans will not be included in the risk adjustment mechanism2 or the temporary risk corridor program3. While grandfathered plans will be required to make payments into the transitional reinsurance program for the individual market that the bill establishes, they will not be eligible to collect payments under the program.
The legislation does specifically apply a number of provisions to grandfathered plans from which they would otherwise be exempt. These provisions include:
Other provisions are applied only to group plans that are grandfathered. These provisions are:
Grandfathered plans are exempt from all other provisions of subtitles A (immediate reforms) and C (market reforms). These provisions include the following reforms that go into effect prior to 2014:
Grandfathered plans are also exempt from the main market reforms that go into effect on January 1, 2014. These provisions include:
Open Questions to be Decided in Regulations
Practical Questions Raised by Grandfathering
PPACA SEC. 1251. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.
SEC. 1252. RATING REFORMS MUST APPLY UNIFORMLY TO ALL HEALTH INSURANCE ISSUERS AND GROUP HEALTH PLANS.
1P.L. 111-148 1312(c).
--Information provided by National Association of Insurance Commissioners (April 2010)