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51-250: Grandfathering - How Anthem Will Review Rates

Aug 09, 2010


Grandfathering in the 51-250 Market

As you know the Patient Protection and Affordable Care Act (PPACA) has brought significant changes to the health benefits industry and has impacts to your clients. The newly enacted health care reform legislation allows plans to be grandfathered to ensure groups and individuals that are happy with their current plans can continue to offer them.  

Generally, a plan is considered to be "grandfathered" if your clients continue to offer the same benefit plan which was offered to their employees and had enrollment in on March 23, 2010, with adjustments only for enhanced benefits as required by PPACA or other state or federal law. All plans will be adjusted to include the following enhancements beginning on or after September 23, 2010 regardless of whether the plan is or is not "grandfathered": 

This "grandfathering" provision allows Anthem customers to keep their plan structure as is - as long as they make limited benefit or contribution changes. Grandfathered plans will include many health care reform benefits, but will not be eligible for future plan design changes.   Anthem's rating pool for the 51-250 market will be considered non-grandfathered, to continue providing benefit modification flexibility.

Important note: Plans that are grandfathered will be rated outside of the pool at their next year's renewal, and they would not be permitted to change benefits or contributions as a grandfathered plan.

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