Author Topic: Health Insurance Plan Description  (Read 2335 times)


  • Bristles
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  • Posts: 382
Health Insurance Plan Description
« on: January 13, 2015, 05:41:50 PM »
The company I work for is self-insured for health insurance purposes.  I was told that under the current plan (2014 and earlier), lactation consultants and breast pumps are not covered because the plan is grandfathered in for ACA purposes.  I did a bit of research on what blows the grandfathered plan status and found that raising the premiums or deductibles more than (I think it was) 10% or maybe 15% makes a plan no longer grandfathered.  Both our premiums and deductibles increased about 25% so I would think the grandfather status is blown. I also found that the company is required to disclose in the plan description whether or not the plan is grandfathered for ACA and if it is grandfathered why this status is in effect (which I would love to know because according to my research they blew the grandfathered status).  I asked HR for a copy of the 2015 plan description and they said it isn't ready yet.  I talked to the administrator of our plan and asked when I should expect a copy of the 2015 plan description, and they said "oh some companies don't issue them until July but any changes are retroactive to January".  I don't understand how claims that come in in January are paid properly if they don't have the updated plan document.

Anyway, just wondering if anyone has any expertise in this area? Maybe someone is in HR? Does anyone know how long the company has to issue the plan document? It seems like there should be some kind of deadline.


  • Walrus Stache
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  • Posts: 7374
  • Senior Mustachian
Re: Health Insurance Plan Description
« Reply #1 on: January 14, 2015, 08:06:49 AM »
They can lose their grandfather status by raising deductibles "significantly". They also lose their grandfather status by not including the statement that it is a grandfathered plan in their policy documents--and this is true starting in 2011, not just 2014.

Raising premiums is OK.

More info at

Can a plan lose its grandfathered status?
Yes. Plans can lose their grandfathered status if they make certain changes that lower your benefits or increase your costs.

In order to keep their grandfathered status, plans can't:

Significantly cut or lower coverage
Raise coinsurance of the allowed amount for the service.
Significantly raise copayment charges
Significantly raise deductibles
Significantly lower employer contributions
Add or tighten a yearly limit on what the health plan pays

What if my grandfathered plan changes significantly?
If you see major changes to your grandfathered job-based health plan's coverage or costs, contact:

Employee Benefits Security Administration, U.S. Department of Labor



Wow, a phone plan for fifteen bucks!