Application Of The New Health Reform Provisions Of Part A Of Title Xxvii Of The Phs Act To Grandfathered Plans printable pdf download

This chart contains an illustrative summary of some of the new health reform provisions and does not cover all the

specifics of the provisions. This chart provides an informal explanation of the new health reform provisions and should

not be considered legal advice or interpretive guidance.

Application of the New Health Reform Provisions of Part A of Title XXVII of the PHS Act to Grandfathered Plans

PHS Act Section

Summary of Provision

Application to Grandfathered plans

§2701 Fair health insurance

Health insurance issuers may not charge

Not applicable; also does not apply

premiums

discriminatory premium rates. The rate may

to large group insurance market

vary only by whether such plan or coverage

coverage in States that do not

covers an individual or family, rating area,

allow such coverage to be offered

actuarial value, age, and tobacco use.

through the State exchanges.

§2702 Guaranteed availability of

Health insurance issuers in both the individual

Not applicable

coverage

and group markets must accept every employer

and individual in the State that applies for

coverage, but are permitted to limit enrollment

to annual open and special enrollment periods

for those with qualifying lifetime events.

§2703 Guaranteed renewability

Requires guaranteed renewability of coverage

Not applicable

of coverage

regardless of health status, utilization of health

services, or any other related factor. Coverage

can only be cancelled under specific,

enumerated circumstances.

§2704 Prohibition of preexisting

Group health plans and health insurance issuers

Applicable to grandfathered group

condition exclusion or other

offering group or individual coverage may not

health plans and group health

discrimination based on health

impose a preexisting condition exclusion or

insurance coverage.

status

discriminate based on health status.

Not applicable to grandfathered

individual health insurance

coverage.

§2705 Prohibiting discrimination

Retains the HIPAA

nondiscrimination

The HIPAA nondiscrimination

against individual participants

provisions for group health plans and group

provisions are applicable to

and beneficiaries based on health

health insurance issuers. Specifically, plans and

grandfathered group health plans

status

group health insurance issuers may not set

and group health insurance issuers.

eligibility rules based on factors such as health

status and evidence of insurability – including

The new Affordable Care Act

acts of domestic violence or disability. Provides

extensions are not applicable to

limits on the ability of plans and issuers to vary

grandfathered group health plans

premiums and contributions based on health

and group health insurance

status.

coverage.

The Affordable Care Act adds new provisions

Not applicable to grandfathered

regarding wellness programs and extends all the

individual health insurance

nondiscrimination protections to the individual

coverage.

market.

§2706 Nondiscrimination in

Prohibits discrimination by group health plans

Not applicable

health care

and health insurance issuers against health care

providers acting within the scope of their

professional license and applicable State laws.

§2707 Comprehensive health

Requires health insurance issuers in the small

Not applicable

insurance coverage

group and individual markets (and large group

markets in State exchanges) to include coverage

which incorporates defined essential benefits,

provides a specified actuarial value, and requires

all group health plans to comply with limitations

on allowable cost sharing.

HIPAA is the Health Insurance Portability and Accountability Act of 1996.

Application Of The New Health Reform Provisions Of Part A Of Title Xxvii Of The Phs Act To Grandfathered Plans

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