How Should A Plan Approach Decisions Regarding Grandfathered Status?

In the wake of this year's Affordable Care Act, many employers are eyeing their upcoming health care plan renewals with dread and caution as they struggle to make decisions that affect their grandfathered status under the new regulations. A practical approach when deciding on plan changes is to ask three basic questions:

  • Will the proposed plan changes impact the grandfathered status of the plan? 
  • What is the impact on the plan of losing grandfathered status? 
  • What are the potential benefits of making the change?


While we would like to be able to say in a few sentences what approach is the best to take, in the end, each plan has to be treated on a case by case basis. First, ask yourself what part of the new requirements would you have to meet regardless of grandfather status? Next, evaluate the changes your health plan has been contemplating to see if they result in a loss of the grandfather exemption. Then you need to determine what would be the costs of losing the exemption. What part of any changes required for non-grandfathered plans would have no impact on your plan? What are the potential savings from the proposed plan changes? Do these savings outweigh any added expenses, including overhead, of meeting the new regulations if you lose grandfather status? Are there any of the new regulations you would have to meet if you lost grandfathered status that would significantly impact your health plan or the resources for the implementation pieces of it you are accountable for? 

The bad news? Your decisions will most likely not be simple or easily decided. The good news? Integra Employer Health is here to help! Navigate the path of plan changes with the help of a knowledgeable consultant such as your Integra Employer Health account executive or sales representative and you'll have no problem in reaching the right decision.