What Affordable Care Act (ACA) requirements must a grandfathered plan meet?

Author: Jayne Zanglein, Western Carolina University

Grandfathered plans are not required to comply with some of the requirements of the ACA; however, they are required to meet the following:

  • No lifetime limits on essential benefits coverage;
  • Elimination of all annual limits on essential benefits coverage (as of 2014 plan years);
  • No rescission of insurance except for fraud or misrepresentation;
  • No pre-existing condition exclusions for children under age 19, or any enrollee for plan years beginning after January 1, 2014;
  • Automatic enrollment for large employers (effective date to be determined when final regulations are issued);
  • Summary of Benefits and Coverage (SBC) requirements;
  • Medical loss ratio (MLR) requirements for fully insured plans; and
  • No waiting periods longer than 90 days (as of 2014).