Health Care Reform Provisions that Apply to Grandfathered Plans
Posted on Tue, Jul 27, 2010
Here is a list of a few of the provisions that grandfathered medical insurance plans are mandated to comply with. Please note that this is not a complete list.
- Ban on Annual Limits and Lifetime Limits: Beginning with plan years of September 23, 2010 and after, insurers are not allowed to place lifetime limits on essential health benefits. Group medical plans are allowed to place a reasonable yearly limit on essential medical benefits until January 2014. At that point, all group medical plans must get rid of all annual limits.
- Prohibition of Rescissions: Beginning with plan years of September 23, 2010 and after, insurers may not rescind medical insurance coverage after enrolling a member, with the exception of fraud or other limited circumstances.
- Ban on Preexisting Conditions Exclusions: Beginning with plan years of September 23, 2010 and after, insurers cannot decline children under the age of 19 due to preexisting conditions. On January 1, 2014, medical insurers will not be allowed to decline anyone medical coverage due to preexisting conditions.
- Required Coverage for Adult Children: Beginning with plan years of September 23, 2010 and after, insurers that provide dependent coverage are required to cover adult children up to the age of 26 without any conditions of dependency. However, grandfathered health insurance plans may still exclude coverage for adult children with other employment-based coverage available until January 1, 2014.
- Prohibition on Excessive Waiting Periods: Beginning on January 1, 2014, group medical insurance plans cannot impose a waiting period for eligible employees to join an employer plan of no more than 90 days.