As the industry continues to interpret and adjust to a host of new ACA regulations, we wanted to take a moment to remind you about plans who hold grandfathered status under the ACA. If your plan is grandfathered, there can be no more than 5% cost-sharing shift from employer to employee since 2010. This 5% cost-shift cap is cumulative, not annual. Therefore, the plan cannot shift 5% of cost each year to employees, but rather can only shift a total of 5%
from employer to employee since 2010.

Bravo has some suggestions for your wellness plan if your health plan wishes to keep grandfathered status.

If you are grandfathered now and plan to stay grandfathered next year:

  • You can tie a maximum of 5% of total premium to your design.
  • Consider using more stringent (NIH) goals and charging the entire 5% of premium to individuals who do not achieve all goals (or complete the required alternative standard).

If you are grandfathered now and will not be grandfathered next year:

  • Tie 5% of premium to tobacco this year.
  • You can tie up to 30% (or 50% with tobacco) of premium to the contributions next year as you move to a non-grandfathered plan.

If you are NOT grandfathered, you can use our suggested plan design or use an even more aggressive design.

There is no time limit on grandfathered status as of now. So long as your plan continues to abide by all grandfathered plan rules, it may remain grandfathered indefinitely. However, the 5% cost shift is only one of several rules that grandfathered plans must follow.

For more information on these plans, click here to view the page from www.cms.gov.