Your notice likely relates to the renewal of a transitional or grandmothered policy, which can be either an individual or small group health plan. Under current federal policy, these plans, which existed prior to the implementation of the Affordable Care Act’s (ACA) insurance reforms, do not have to meet certain provisions of the ACA. Insurers that offer these plans must provide the following information in their renewal notices:
- Any changes in the plan options that are available to you;
- Which of the ACA consumer protections are not included in any coverage that continues;
- Your potential right to enroll in a qualified health plan offered through a Health Insurance Marketplace, possibly including financial assistance;
- How to access such coverage through a Marketplace; and
- Your right to enroll in health insurance coverage outside of a marketplace that complies with the ACA consumer protections.
The advantage of renewing is that you can continue in your health plan if you like it and you believe it provides coverage of the services and providers you need. The disadvantage is that these plans don’t have to comply with ACA consumer protections like providing coverage of ten categories of health services referred to as essential health benefits, limiting out-of-pocket costs, and not discriminating based on health or gender when setting premium rates. (CMS, Extension of Limited Non-Enforcement Policy through 2023 and Later Benefit Years, March 23, 2022).