The Department of Health and Human Services (HHS), the DOL, and the Department of the Treasury (the Departments) continue to release additional guidance regarding the implementation of the market reform provisions of PPACA in the form of new questions and answers, most recently on October 8th and 13th. The FAQ clarifies that only six changes will be considered to change a health plan so significantly that they will cause a group health plan or health insurance coverage to relinquish grandfather status:

  • Elimination of all or substantially all benefits to diagnose or treat a particular condition  
  • Increase in a percentage cost-sharing requirement (for example, raising an individualʼs coinsurance requirement from 20% to 25%)  
  • Increase in a deductible or out-of-pocket maximum by an amount that exceeds medical inflation plus 15 percentage points  
  • Increase in a copayment by an amount that exceeds medical inflation plus 15 percentage points (or, if greater, $5.00 plus medical inflation)  
  • Decrease in an employerʼs contribution rate towards the cost of coverage by more than five percentage points  
  • Imposition of annual limits on the dollar value of all benefits below specified amounts  

The FAQ stresses that only these changes would cause a cessation of grandfather status under the Departments' interim final grandfather regulations. The FAQs address additional topics relating to (1) grandfathered health plans, (2) dental and vision benefit plans, (3) rescissions of coverage, (4) preventative health services, and (5) exemptions for group health plans with less than two current employees. The newest FAQs are available online at http://www.dol.gov/ebsa/faqs/faq-aca2.html  and http://www.dol.gov/ebsa/faqs/faq-aca3.html.