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Keep the Health Plan You Have: Grandfather Status and the Patient Protection and Affordable Care Act

updated April 2013

The Patient Protection and Affordable Care Act (PPACA) allows those health insurance plans that were in effect March 23, 2010 – the day the President signed it into law – to be exempt from some requirements of the law. The plans that were in effect those days are referred to as "grandfathered." All plans that were not in effect March 23, 2010, are considered "non-grandfathered."

Your employer or health insurance company will inform you on an annual basis if your plan is grandfathered or non-grandfathered.

Some patient protections in the law apply to all health plans, no matter if they are grandfathered or non-grandfathered, such as elimination of lifetime maximums, no rescissions of coverage except in cases of fraud or intentional misrepresentation of material fact, and extension of a parent's coverage to most young adults under age 26.

All grandfathered plans are exempt from the portions of the law which require no-cost sharing for preventive services, requirements for choice of health care provider, and applying the same cost-sharing formula for out-of-network emergency care as in-network.

The requirements prohibiting annual dollar limits on essential health benefits and pre-existing conditions for those under age 19 that began in 2010 and all others beginning in 2014, do not apply to grandfathered individual plans.

A health plan will lose its grandfathered status if it:

A health plan will not lose its grandfathered status by making changes: