Grandfathering Tool


IS MY PLAN A GRANDFATHERED PLAN?

INSTRUCTIONS
	* Answer the following questions based on your plan as it was on March 23, 2010 by completing the yellow boxes.
	* If you have a collective bargaining agreement, special grandfathering rules apply and this worksheet will not accurately reflect your grandfathered status.
	* The grandfathering test can be applied to each line of coverage included in a plan (i.e., POS, HMO, PPO, etc.) Making changes to one plan does not result in another plan losing grandfathered status if no changes were made to that plan.
	* See "What it Means to be Grandfathered" in the KTB Health Care Reform Center for additional information about grandfathering. Contact your KTB agent for questions.


	Company Name:


	Name of Plan/Line of Coverage:


	Question		Answer


	1. Did you change insurance carriers? (If self-insured and only changed third-party administrators, answer NO.)		Yes No


	2. Did you force participants to switch to this specific plan because it was more cost effective for the employer (if it has less benefits, costs more for the participant, or was bought or merged with another plan)?		Yes No


	3. Did you add or tighten any annual limit on what the insurer pays?		Yes No


	4. Did your plan significantly cut or reduce benefits? (For example, if a plan decides to no longer cover care for people with diabetes, cystis fibrosis or HIV/AIDS.)		Yes No


	5. Did your plan raise deductibles more than an amount equal to medical inflation plus 15% (for 2010 20%)?

	a. Previous deductible	$
	b. New deductible	$


	6. If your plan has a co-insurance, did the percentage of the coinsurance raise? (For example, if the coinsurance the employee is required to pay raised from 10% to 20% the answer is yes.)		Yes No


	7. Did your plan raise co-payments more than the greater of $5 or medical inflation plus 15% (for 2010, $5 or 20%)?
	a. Previous co-payment	$
	b. New co-payment	$



	8. Are employer contribution percentages different for different levels of coverage (for example, single vs. family coverage)?					Yes No


	9. Did you lower employer premium contributions more than 5%?	Single	EE/Spouse (EE + 1)	EE/ Child(ren) (EE + 2)	Family
	a. Previous percent of employer contribution	%	%	%	%
	b. New percent of employer contribution	%	%	%	%


	10. Did you add or reduce any annual limits? (If the change made was to replace a lifetime dollar limit with an annual dollar limit that is at least as high as the lifetime limit, answer NO.)					Yes No


Clicking the button below will open a new window with the calculated form ready for you to print from your browser. This page will remain open.

	The information contained herein is for informational purposes only and is not intended as legal or tax advice.