What changes will trigger the loss of grandfathered status?
A803. A plan or option will lose its grandfathered status under any of the following conditions: • Changing insurer (insured plans) • Eliminating coverage (or any necessary element) to diagnose or treat a specific condition • Eliminating certain existing benefit options • Reducing annual dollar limits by any amount • Increasing a flat dollar co-pay by more than the greater of $5 (indexed) or medical trend plus 15% • Increasing flat dollar deductible or out-of-pocket maximums by more than medical trend plus 15% • Reducing corporate premium subsidies by more than 5 percentage points • Transferring employees from one plan to another that are not for bona fide business reasons (anti-abuse rule) • Increasing employee coinsurance percentages by any amount (e.g.
