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Keeping "Grandmothered" Health Plans Extended

Keeping your current non-grandfathered individual or small group medical plan (also referred to as “grandmothered” plans) has been extended for policies with annual renewals on or before October 1, 2016. This provides another two years to the previous transitional extension that was set to end on October 1, 2014. The option to adopt this new extension rests with each state department of insurance in the various states and then with each insurance company within the state. Idaho has allowed this extension while Washington state did not allow any extensions of ACA compliance.

The Idaho Department of Insurance (DOI), issued bulletin 14-1 which announced that Idaho will exercise the extension option and allow insurance companies the option to offer renewals to policies of non-grandfathered transitional plans (that were in existence on or before December 31, 2013) until these policies renew on or before October 1, 2016.

Insurance companies who elect to offer renewals of these existing plans in 2014, 2015 and 2016 are required to provide, at each renewal, notice to any affected individuals and small employers. The notice informs the individual or small employer of the option to renew the existing coverage or to enroll in a new plan on or off Your Health Idaho, Idaho’s exchange, and also includes the information concerning ACA market reforms that are not included in their  extended plans.

Consumers who would rather enroll in a new ACA compliant plan in the individual market rather than renew a grandmothered or a grandfathered plan are entitled to a special enrollment period, both on and off exchange, beginning 60 days prior to the date their current plan ends, and continuing 60 days after the plan’s end date. This special enrollment period will be available at each renewal offered to policyholders of both grandmothered and grandfathered plans.

The Idaho DOI encourages insurance companies and their agents to proactively assist Idaho consumers to understand their different options and to make the decision that best suits their health insurance needs. For free assistance and more information please Contact Us and speak with one of our exchange certified Health Agents at AMERICAN INSURANCE.

As provided in the CMS March 5, 2014, CCIIO letter, the non-grandfathered transitional plans are not required to contain the ten essential health benefits (EHB) or to adopt the rating structure of the fully ACA compliant plans. However, the grandmothered plans must comply with the following ACA provisions upon renewal on or after January 1, 2014:

  • Elimination of annual dollar limits on EHB as defined by the Idaho benchmark plan, to the extent the grandmothered plans cover EHB
  • No pre-existing condition exclusion (small groups)
  • Waiting periods not to exceed 90 days (small groups)
  • Mental health parity rules (individual plans upon renewal July 1, 2014, or later; not applicable to small group plans)

 Source: Idaho Department of Insurance, Bulletin 14-1 - May 1, 2014


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