Notice of Grandfathered Status

A short notice telling participants that their health plan is "grandfathered" under the ACA, with contact information for questions or complaints.

See the Step-by-Step ProcessView Model Notice
Heads up: This requirement only applies to grandfathered health plans: plans that existed on March 23, 2010 and have not made certain benefit or cost-sharing changes since then. Very few employer plans have maintained grandfathered status this long. If you are not certain your plan is grandfathered, this page most likely does not apply to you.
What A short notice included in plan materials stating the plan believes it is a grandfathered health plan, with contact information for questions or complaints.
Who Employers of any size that offer a grandfathered plan, whether fully insured or self-funded.
When Every time plan materials that describe benefits are provided, such as the SPD, open enrollment packet, or enrollment guide.
Risk There is no single enumerated penalty for missing this notice. However, failure to provide it can be used as evidence that the plan does not qualify as grandfathered, which would expose the plan to all ACA requirements it had been exempt from: a potentially significant compliance gap.
Every
Benefit-describing material

Include the notice each time you hand out materials that describe plan benefits.

OE
Open enrollment packet

Add it to the annual enrollment guide so participants see it each year.

New
Plan or material changes

Re-include it whenever you revise materials, as long as the plan stays grandfathered.

Trigger Due Date / Window Notes
Open Enrollment materials With the OE packet Include in the main enrollment guide or packet.
SPD/SMM or other benefit descriptions Whenever distributed Attach the notice in each set of materials that describe benefits.
New plan option or material revisions With updated materials Re-include the notice if status remains grandfathered.
Trigger: Open Enrollment materials
Window: With the OE packet
Notes: Include in the main enrollment guide or packet.
Trigger: SPD/SMM or other benefit descriptions
Window: Whenever distributed
Notes: Attach the notice in each set of materials that describe benefits.
Trigger: New plan option or material revisions
Window: With updated materials
Notes: Re-include the notice if status remains grandfathered.
  • Notice text: Model language adapted with your plan name and contact details. See the Model Notice section below and customize the bracketed fields before inserting it into your materials.
  • Contact info: Plan administrator or benefits office email and phone for questions and complaints.
  • Status file: Documentation of the plan's terms as they existed on March 23, 2010, plus a record of all changes made since. This must be maintained for as long as grandfathered status is claimed.
  • Distribution list: All materials that describe benefits (SPD, OE guide, enrollment packet) where the notice will appear.
1
Confirm statusVerify the plan still qualifies as grandfathered by reviewing benefit and cost changes since March 23, 2010.
2
Prepare the noticeUse the Model Notice section below as your starting point and fill in your plan name and plan administrator contact details.
3
Place in materialsAdd the notice to each document that describes plan benefits: SPD/SMM, OE packets, and enrollment guides.
4
Publish and deliverDistribute with plan materials using compliant paper or electronic delivery methods.
5
Archive proofKeep copies of what you sent, when, and to whom.
  • Include with benefits descriptions: Attach the notice every time materials describing benefits are provided.
  • Electronic delivery: Acceptable if ERISA e-delivery rules are met, or provide a paper alternative.
  • Clarity: Use plain language and do not bury the notice. Keep it easy to find in the packet or PDF.
  • Notice languageThe exact notice language used, kept per plan year.
  • MaterialsCopies of each document where the notice appears, such as the SPD/SMM and OE guide.
  • Distribution evidenceMail or email logs, portal timestamps, and acknowledgments showing it went out.
  • Status change logDocumentation of the plan's terms as of March 23, 2010 and all subsequent changes. Per federal regulations, this must be maintained for as long as grandfathered status is claimed, and made available to participants and regulators upon request.

Common traps

Assuming status survives changes: Do not assume the plan is still grandfathered after benefit or cost changes. Verify annually.
Skipping a document: Forgetting to include the notice in every benefit-describing document.
Stale contact details: Using outdated contact information or vague instructions for complaints and questions.

FAQs

What makes a plan "grandfathered"?
It existed on March 23, 2010 and has not made certain changes that reduce benefits or increase costs to consumers.

What does grandfathered status mean?
The plan may be exempt from some ACA requirements, so participant rights and protections can differ from those of non-grandfathered plans.

Can a plan lose grandfathered status?
Yes. Significant changes to benefits or cost-sharing since 2010 can cause loss of status, for example certain increases to deductibles, copays, or coinsurance, or reductions in employer contributions.

What are the consequences of not providing the notice?
There is no single statutory penalty amount. However, failing to provide the notice can be used as evidence that the plan does not qualify as grandfathered, which would expose the employer to all ACA requirements the plan had claimed exemption from, including coverage mandates, cost-sharing limits, and preventive care rules.

  • Multiple plan options: Show the notice only for plan options that are truly grandfathered.
  • Insured vs. self-funded: Carriers may provide sample language for insured plans, but the employer remains responsible for ensuring the notice is included in all benefit-describing materials.
  • Status change: If the plan loses grandfathered status, remove the notice and update materials to reflect the new ACA requirements.
NOTICE OF GRANDFATHERED HEALTH PLAN STATUS

This [insert: name of group health plan or health insurance issuer] believes this plan is a "grandfathered health plan" under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan or policy may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime dollar limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at:

[Plan Administrator Name / HR Department]
[Mailing Address]
[Phone Number]
[Email Address]

You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa.

Source: DOL Model Notice of Grandfathered Health Plan Status. Download the original Word document if you prefer to work from that directly.