Federal Agencies Want to Hear From You

In an effort to minimize the economic burden of the Patient Protection and Affordable Care Act (PPACA), various federal agencies are soliciting input from the public on the challenges that employers with PPACA “grandfathered” group health plans (or coverages provided by health insurance issuers) face in avoiding a loss of the “grandfathered” status (of these group health plans). Many employers desire to maintain the “grandfathered” status of their group health plans because these plans are subject to only certain provisions of PPACA.

Once “grandfathered’ status is lost, it cannot be regained.

Generally, a “grandfathered group health plan” is a group health plan in which an individual was enrolled on March 23, 2010, and which has maintained its status as a “grandfathered” group health plan by continuously covering at least one person (not necessarily the same person, but at all times at least one person) since March 23, 2010, and not being amended in a way that results in certain changes in benefits, cost-sharing requirements and contribution rates.

Public input must be received no later than 5 p.m. Eastern Time on March 27, 2019.

Examples of the type of input solicited include:

  • What action could be taken by governmental agencies, consistent with the law, to assist group health plan sponsors and issuers in preserving the grandfathered status of their plans?
  • What challenges do group health plan sponsors and issuers face regarding retaining grandfathered status of their plans? Does any particular requirement(s) for maintaining grandfathered status create more challenges than others, and if so, how could the requirement(s) be modified to reduce such challenges?
  • For group health plan sponsors and issuers that have chosen to preserve grandfathered status of their plans, what are the primary reasons for doing so? If grandfathered status is preserved so that particular PPACA requirements will not apply to the plan, specify the particular PPACA requirements not included in the grandfathered plan and explain any related concerns.
  • Why have participants and beneficiaries remained enrolled in grandfathered group health plans if alternatives are available?
  • What are the costs, benefits, and other factors considered by plan sponsors and issuers when considering whether to retain grandfathered status of their plans?
  • Is preserving grandfathered status important to group health plan participants and beneficiaries? If so, which participants and beneficiaries benefit the most and which, if any, are affected detrimentally by the employer offering grandfathered group health coverage?

Public input may be made electronically by visiting:

Or by regular mail to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-9923-NC
P.O. Box 8013
Baltimore, Maryland 21244-1850

Or by express or overnight mail to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-9923-NC
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, Maryland 21244-1850

For more information about anything discussed in this Client Alert, please contact a member of Maynard's Employee Benefits and Executive Compensation Practice Group.

This client alert is for information purposes only and should not be construed as legal advice. This information in this client alert is not intended to create and will not constitute as a lawyer-client relationship.


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