A non-grandfathered plan is a plan that has come into force after March 23, 2010.
The Affordable Care Act (ACA) came into being on March 23, 2010. A plan that
existed before the ACA, but lost its grandfathered status at renewal is also a
non-grandfathered plan.
The Affordable Care Act requires non-grandfathered
health plans in the individual and small group markets to cover essential
health benefits (EHB) from January 1,2014. The essential health benefits (EHB)
include items and services in the following ten benefit categories:
1. Ambulatory patient services (Outpatient
care);
2. Emergency Services (Trips to the
emergency room).
3. Hospitalization (Treatment in the
hospital for inpatient care);
4. Maternity and newborn care;
5. Mental health and substance use disorder
services including behavioral health treatment;
6. Prescription
drugs;
7. Rehabilitative and habilitative services and
devices;
8. Laboratory
services;
9. Preventive
and wellness services and chronic disease management;
10. Pediatric services, including oral and
vision care.
While all qualified plans must offer these
ten essential benefits, the scope and quantity of services offered under each
category may vary.
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